Fracture of Upper Extremities上肢骨折-01

Local Manifestation
•
Specific Signs
• Deformity (畸形) • Abnormal Mobility（反常活动） • Crepitus or Grating（骨擦音or骨擦感）
Review of last Class
•The principles of treatment（治疗原则）
1 humerus (arm) 1 ulna (forearm) 1 radius (forearm) 8 carpals (wrist) 19 metacarpal and phalanges (hand)
Section I
FRACTURE OF CLAVICLE
锁骨骨折
Anatomy
The clavicle is the bone that connects the trunk of the body to the arm
CT
Complications
– Lung injury
Complications
– Subclavian vessels injury锁骨下血管损伤 asymmetric pulse or pulsatile hematoma
Complications
– Brachial plexus injury（臂丛神经损 伤）
Treatment
Conservative treatment:
Displaced Middle 1/3 fractures Closed manipulative reduction,Figure-of-8 strap
Surgical treatment
Indication（手术指征）
➢Closed reduction fail（闭合复位失败） ➢Neurovascular injurie（神经血管损伤） ➢Open fracture（开放性骨折） ➢Lateral fracture with Coracoclavicular ligament rupture or scapular neck fractures（合并喙锁韧带断裂或肩胛颈骨折的锁骨外端骨折） ➢Non-union f and Internal Fixation 切开复位内固定
The Hook Plate（锁骨钩钢板）
specifically designed for the lateral fracture of clavicle
Type II
Section II
FRACTURE OF HUMERUS
Neer, JBJS ‘70
Mechanism
Elderly
– fall onto outstretched hand – direct blow- fall – bone fragility-osteoporosis
（骨质疏松）
Young
– high energy trauma （高能量创伤）
Clinical manifestation
Case 3
➢87岁，老年女性 ➢诊断：肱骨近端骨折（大小 结节、外科颈、解剖颈） ➢Neer分型：四部分骨折 ➢治疗：半肩关节置换术
Hemiarthroplasty
Section II-Part II Part II: Fractures of Humeral Shaft
CT scan and 3D reconsrruction
Diagnosis
• History of trauma; • Clinical manifestation • Radiographic evaluation
受伤史 临床表现 影像学表现
Classification
Understanding Fracture Patterns – 4 bony fragments – Lesser Tub – Greater Tub – Head – Shaft
Reduction、Immobilization、Rehabilitation 复位、固定、功能锻炼
Anatomy
• Bone that compose upper limb:
The girdle of upper limb clavicle and scapular
The free bone of upper limb
– Three-part fractures
▪ Due to disruption of opposing muscle forces, these are unstable so closed treatment is difficult. Displacement requires ORIF.
– Four-part fractures
Case 1
➢77岁，老年女性 ➢诊断：肱骨外科颈骨折 ➢Neer分型：一部分骨折 ➢治疗：保守治疗
Case 2
➢81岁，老年女性 ➢诊断：肱骨近端骨折（大结节、小结节、 外科颈） ➢Neer分型：三部分骨折 ➢治疗：切开复位锁定钢板螺钉内固定术
Open Reduction and Internal Fixation
History of trauma;受伤史
Pain;
疼痛
Swelling;
肿胀
Ecchymosis; 瘀斑
Dysfunction of the shoulder
肩关节功能障碍
X ray
Radiographic evaluation
AP
Scapular “Y”
Radiographic evaluation
Part I: Proximal humeral fracture Part II: Fractures of humeral shaft Part III: Supracondylar Fractures
Section II-Part I
Part I: Proximal humeral fracture
Acromioclavicular 肩锁关节
Sternoclavicular 胸锁关节
The clavicle is weakest at the junction of the two curves Therefore, most breaks occur approximately in the middle of the clavicle
肱骨近端骨折
Proximal Humeral Anatomy
– 4 bony fragments • Lesser Tubercle 小结节 • Greater Tubercle 大结节 • Head 肱骨头 • Shaft 肱骨干
Anatomical neck of humerus 肱骨解剖颈 Surgical neck of humerus 肱骨外科颈
Anatomy “S”
Lateral
从上面看
从前面看
横截面
Medial
Anatomy
臂丛神经
Mechanism
– Fall onto shoulder (87%) – Direct blow onto clavicle (7%) – Fall onto outstretched hand (6%)
Classification
Fracture of lateral clavicle 锁骨外端骨折的分型
Coracoclavicular ligament（喙锁韧带）
Treatment
Conservative treatment:保守治疗
Nondisplaced or greenstick fractures （非移位或青枝骨折） Sling for 3-6 weeks （悬吊3-6周）
Birth injury from passing through the birth canal.
Mechanism
– Birth injury from passing through the birth canal.
Clinical features
– History of a trauma – pain, swelling and crepitus – Inability to raise a shoulder – Deformity along the line of the clavicle
Neer Classification – 1 cm displaced – 45 degree angulated – Excessive rotation
Classification
Neer Classification
– Four parts
▪ Greater and lesser tuberosities,
Fracture of Upper Extremities
• Sports medicine&Arthroscopy • Adult Joints Reconstruction
Review of last Class
• What ‘s fracture? A fracture is a break in the continuity of a bone
Anteroposterior View 前后位片
30-degree Cephalic Tilt View 30度头侧斜位片
Radiographic Evaluation
Greendstick fracture 青枝骨折
(children usually)
Radiographic Evaluation
▪ Anatomic neck fractures likely require ORIF. High incidence of osteonecrosis
▪ Surgical neck fractures that are minimally displaced can be treated conservatively. Displacement usually requires ORIF
CLINICAL FEATURES 临床特征
• Local Manifestation •
Traumatic Inflammation
Swelling（肿胀） Pain（疼痛） Impairment of function （功能障碍）
Deformity (畸形)
CLINICAL FEATURES
▪ Humeral shaft ▪ Humeral head
– A part is displaced if >1 cm displacement or >45 degrees of angulation is seen
Treatment
– Minimally displaced fractures- Sling immobilization, early motion – Two-part fractures-
▪ In general for displacement or unstable injuries ORIF in the young and hemiarthroplasty in the elderly and those with severe comminution. High rate of AVN（avascular necrosis 缺血坏死） (13-34%)
Diagnosis
受伤史
症状、体征
X线、CT
合并伤的判断
Classification 分型
According to fracture site（根据骨折部位） 80% occur in the medial 1/3 15% distal third occure in the lateral or distal 1/3 5% occur in the medial or proximal 1/3
Clinical features
– 患者姿势（头偏向患侧）
Radiographic Evaluation
X-Ray ：In order to determine the fracture type and extent of injury. Take both clavicle bones for comparison