骨折概论(英文)

Clinical Situation & X-ray Examination
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Clinical Situation 1. systemic symptoms: ⑴Shock: Because of bleeding due to pelvic(骨盆 ) fracture, femoral(股骨) fracture, multiple femoral( ) fracture, and open fracture, injury to the important organs. Because of severe pain that can irritate sympathetic nerve(交感神经).
(3) Crepitus or Grating (骨擦音或骨擦感)：
F F F
பைடு நூலகம்
Clicking or the feeling of friction between the fractured bone ends may be heard or felt. Diagnosis of fracture can be made if one of the 3 special signs is found. But you are not allowed to exam the signs deliberately for the reason of increasing the pain and damage. Some incomplete or other stable fractures may not have any of the signs, so without the special signs, you can not diagnose the patient as: No Fracture.
• 2. Indirect Violence: The fracturing force is transmitted through the axis of the limb and the fracture occurs at a distance from the site of the impact.
• 4. Bone Disease: The normal structure and intensity of bone is destroyed by the disease and pathologic fracture happens under a hit with minor force. e.g. osteomyelitis-bone infection bone tumors or tumor-like diseases, either benign(良性) or malignant(
Factors Causing Displacement
• 1. The nature, amount and direction of the force that causes the fracture. F 2. Pulling strength of the muscle. F 3. Pulling by the weight of the distal part of the limb. F 4. Inappropriate transfer and treatment.
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⑵ Open Fracture: The skin or mucous membrane is ruptured and the fracture communicates with outside air. including pubis(耻骨) fracture with bladder or urethral track rupture, coccyx(尾骨) fracture with rectum(直肠) rupture.
恶性).
Classifications 1. Dependent upon the intactness of the skin and mucous membrane ⑴ Closed Fracture: The skin or mucous membrane is intact and the fracture does not communicate with outside air.
• ② Greenstick Fracture: Frequently seen in young children. Just like the broken greenstick of willow
• ⑵ Complete Fracture: F The continuity of bone is completely broken. F ① Transverse Fracture: The fracture line is perpendicular to the longitudinal axis of the bone. F ②Oblique Fracture: There is a certain angle between the fracture line and the longitudinal axis of the bone.
• ⑵ Fever: F For most fractured patients, their body temperatures are normal. F In the situation of large amount of bleeding, lower fever <38℃ or 38.5℃ because of absorption of the haematoma(血肿). F High fever for open fracture indicates an infection.
• 3. Repeated Fatigue(疲劳 Force: 疲劳) 疲劳
Long-term repeated minor force, either direct or indirect, can result in fracture in some certain bones, e.g. the distal 1/3 0f fibula(腓骨), the 2nd and 3rd metatarsals(跖骨).
• 2. Special Signs for Fracture:
• (1). Deformity(畸形): The contour of the limb is changed because of the displacement of fracture. (2). Abnormal movement: The site that normally can’t move can move or be moved.
• ⑦Depressed Fracture(凹陷骨折)：seen in skull fracture. • ⑧Epiphyseal Separation(骨骺分离): The fracture line goes wholly or partially within the epiphyseal line.
normal physis or growth-plate
• 3. Dependent upon the stability of the fractured ends. F ⑴ Stable Fracture: The fracture ends are not F easy to displace(移位) before or/and after F reduction(复位). F e.g. fissured fracture, greenstick, F transverse, impacted fracture etc.
Displacement of Fracture
• 1. Angulation Displacement.
F F
2. Lateral Displacement. 3. Shortening Displacement.
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4. Separation Displacement.
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5. Rotation Displacement.
bladder rectum
urethral track
2. Dependent upon degree and shape of fracture. • ⑴ Incomplete Fracture: The continuity of bone is partially broken. • ① Fissured Fracture: Occurs on flat bones like scapula(肩胛骨) and skull(颅骨).
Normal Bone Consists of :
Cortical Bone（皮 质骨） Cancellous Bone（ 松质骨） Bone Marrow（骨 髓） Periosteum（骨膜 ） Blood Vessels
Definition of Fracture
The definition of fracture is a break in the continuity or intactness (完整 性) of bone.
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• ③ Spiral Fracture: The fracture line is spiral. F ④ Comminuted Fracture(粉碎骨折): The bone is broken into 3 or more fragments.
• ⑤ Impacted Fracture(嵌插骨折): The hard F cortical bone impacts into the soft F cancellous bone. F ⑥ Compression Fracture(压缩骨折): F A fracture with crushed bone tissue, seen F in cancellous bone.
• ⑵ Unstable Fracture: The fracture ends are easy to displace(移位) before or after reduction(复位). e.g. oblique fracture, spiral fracture, comminuted fracture, transverse fracture of femur(股骨).
X-ray Examination:
F
For the suspicious cases-avoid misdiagnosis. For the clinically diagnosed patients, to make sure the type and displacement of fracture for the purpose of treatment.
• 2. Local Symptom and Signs: F (1). Common symptom: F Pain: Nerve endings in the periosteum and soft tissue are irritated by the haematoma and swelling. F Swelling: reaction of soft tissue to the damage. F Loss of function: Framework to support the limb is damaged; Pain. F Black and blue colour on the skin because of decomposition of hemoglobin.
Etiology of Fracture
• 1. Direct Violence: F The bone is broken immediately beneath the site of impact accompanied by the overlying soft tissue injury.