骨科总论教案 外科课件

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Crepitus
The definite diagnosis of fracture can be made if one of the three characteristics is found,and there may be a fracture even none of them is found.
肱骨近端 11-
A = 关节外，1部分 B = 关节外，2部分 C = 关节内
A
B
11
31
股骨近端 31-
C
A = 粗隆
B = 颈骨折
C = 头骨折
踝关节 44-
A = 下胫腓联合远端 B = 经下胫腓联合 C = 下胫腓联合近端
A
B
C
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.
骨 节段 型 组
亚组
随严重程度数字增大
12- 32- 42- Diaphyseal groups
How to learn orthopedics？
• Pay attention to the characteristic of the local anatomic structures Bone,muscle,tendon,fascia,nerve,blood vessel
• Pay attention to the systemic effects • Associate the clinical findings with radiographic examination
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>30° <<3300°°
A1 A2 A3
B1 B2 B3
C1 C2 C3
Key Points
Displacement of Fragments – Angulation lateral shortened segregated rotation
Classification of fractures according to the degree and shape of fractures
AO/ASIF
AO Arbeitsgemeinschaft fur Osteosynthesefragen ASIF The Association for the Study of Internal Fixation
November 6, 1958, Hotel Elite, Biel (Bienne), Switzerland
Shock hemorrhagic shock（5210804） multifractures, pelvic,femoral and open fractures
traumatic shock soft tissue,pain,visceral injuries
Fever absorption of hematoma＜ 38℃ Open fractures with infection ＞38℃
Orthopaedics General aspects part 1
What is orthopedics about ?
• ORTHOPAEDIA Nicolas Andry 1741
• orthopaedics Ortho- straight Paedion- child
What is orthopedics about ?
5210804
Local signs
•
•
General findings ：
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ቤተ መጻሕፍቲ ባይዱ
Pain,tenderness,swelling,ecchymosis,Loss of function
•
•
Characteristic signs of fracture： ※
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Deformity
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Abnormal movement
The Classification of Fractures
• The integrity of the skin and muscles • The degree and shape of fractures • The stability of the broken parts
The Classification of Fractures
骨 节段 型 组 亚组
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骨 节段
型组
亚组
1 1 11
2 222 3
3 33 4
类型
—
骨 节段
型
·
组 亚组
骨干(2) 关节周围(1,3)
骨干
A = 简单
A
B = 楔形 C = 粉碎
12
22
B
32
—
.
42
骨 节段 型 组 亚组
C
关节周围
A = 关节外 B = 部分关节 C = 完全关节
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骨 节段 型 组 亚组
1 pubic fracture with rear urethra breakage 2 rectum breakage caused by coccygeus fracture
Closed Fracture
bruise
The High risk Open Fracture Sites forearm and crus
General Aspects of Fractures
1.The definition,cause,classification and displacement of fractures
2.The clinical findings and radiographic examination of the fractures
muscles、fascia、skin 4. the whole body：shock、other visceral injuries
(二）The Causes of Fractures
• Traumatic – Direct force－local soft tissue injuries – Indirect force －there is a conduction
Orthopedics is a specialty of diagnosing and management to the musculoskeletal disease, abnormalities and trauma. Musculoskeletal system：supporting and movement Trauma,Abnormalities ,Inflammation,Tumor and Degenerative disease
Incomplete Fracture
green stick fracture
The stability of fractures
Stable fracture – Crack – green stick – Transverse – Compression – impacted
Unstable fracture – oblique fracture – spiral fracture – comminuted fracture
The bad prognosis of the open fracture
The Classification of Fractures
※ The Degree and Shape of Fractures • Incomplete Fracture
– crack fracture – green stick fracture • Complete Fracture – Transverse fracture – Oblique fracture – spiral fracture – comminuted fracture – impacted fracture – compression fracture – epiphyseal separation / epiphysiolysis
– Incomplete – Complete – Stable unstalbe
※ Clinical findings of fractures
• Local signs • The systemic response • Radiographic signs
The systemic response
Traumatic Fractures: Special Indirect Force
※（三）Displacement of Fragments
Angulation lateral shortened segregated rotation
The Displacement Factors
• The character of the force • The traction of the muscles • The weight of the extremities • Improper transportation and treatment
The Classification of Fractures (AO)
Maurice E. Müller 1988
The Classification of Fractures (AO)
123 123 骨 节段
部位
ABC 型
123 组
123 亚组
形态
部位由近及远编号 1234 部位 形态
-.
(一)The Definition of Fractures
• Definition：the continuity or integrity of a living bone
•
has been broken
1. fracture＝broken 2. skeleton：the loss of mechanical supporting function 3. local：soft tissue injuries－－blood vessel 、 nerves 、
Deformity
The Radiological signs
To confirm the diagnosis the fracture type and the displacement of the fragments Anterior-posterior position should cover at least one joint CT in pelvis, hip, spine fractures MRI in spine and knee injuries
The integrity of the skin and muscles Whether the bone is exposed through a soft tissue wound?
Closed fracture: the skin and muscles at the fracture site is intact
Open fracture :directly or indirectly open to a severe damage to soft tissue lack of coverage easily infected insufficient blood slow to heal －a worse prognosis
3.The fracture healing process 4.Factors influencing bone healing 5.First aid of fractures
General Aspects of Fractures
6.Principles in treatment of fractures 7.Treatment of open fractures 8.Principles in treatment of open joints injuries 9.Complications of fractures 10.Treatment of delayed union ,nonunion and mal-union
• Accumulated physical force – slight , repeated, long time
• Pathologic – a primary disease＋a slight force
• Pathologic
Traumatic Fractures: Direct Force Traumatic Fractures: Indirect Force