(医学课件)骨折概论英文版本

ORTHOPEDICSINTRODUCTIONWenzhouCentralHospitalTraumatologyDepartmentChenMang-mang* Sectiononedefinitioncauseclassificationdisplacement*一、Definition：Theintegrityand/orcontinuityofthebonebeinterruptted*二、cause1directviolence：meas:violencedirecttothebone----thanfracture.*2indirectviolence：translatetothebone-thanfracture.Violenceindirecttothefracturepart.(suchascolle’sfracture)。myotility：musclesattachedthebone(patella fracture)。transverse processfracture.*3fatiguefracture：Long-term,repeatedandminorexternalforce.thestressaccumulated.suchas:thesecondandthirdmetatarsalfracturesbecauseoflong-distancemarch;distal1/3partfibulafractureabovethreetypes,alloccurinhealthybone,calledTraumaticfractures4pathologicalfracture：occurinBonedisease,Slightforce。(tumor、infection)*三、classification(plentyof)（一）accordingtoskin、Mucosaofthefrature. 1、closefracture：endsofthefractureandairareinterlinked. 2、openfracture：aren’tinterlinked*（二）accordingtoseverityandshape 1、incompletefracture：Theintegrityand/orcontinuityofthebonebeinterruptted 1）linearfracture：gap,notdisplaced.（Theskullbone,scapulabone）2）greendstickfracture：Boneandperiosteumpartlybroken，withorwithoutangulation deformity。（likeWillowbranches）* 2、completefracture：Theintegrityand/orcontinuityofthebonebeinterrupttedcompletely Accordingtofracturelineandshape：1）TransverseFracture：fractureandverticalaxis=vertical。(rightpic.）*三、 accordingtoseverityandshape2）obliquefracture：fracturelineandverticalaxistoformacertainAngle（asrightfigure）*（accordingtoseverityandshape）3）spiralfracture:(rightpic.）*4comminutedfracture：morethan2fragments。（asrightpic.）*三、accordingtoseverityandshape5）impactedfracture：thefragmentscompactedintotheotherone，mainlyoccursinfractureofmetaphysis。Insertcancellousbonecorticalboneinsertedintocancellousbone(rightpic.)*6compressionfracture：compressedanddeformed。Occursinspongybone。如spinal fracture，calcaneal fracture。(rightpic.)*三7）depressedfracture：Skullbone。8）Epiphysealseparation：fracturelinegoesthroughtheepiphyseal。*accordingto…stableornot 1、stablefracture：theendsofthefractureisnoteasytomove/stabeafterreduction.suchas:Crackfracture,greenstickfracture,transversefracture,compressionfractures,impactedfracturesetc. 2、unstablefracture：moveagaineasily.。Suchas:Obliquefracture,spiralfracture,comminutedfractureetc.*accordingto…time 1、freshfracture：lessthan3weeks. 2、oldfracture：Morethan3weeks。*Involvingthearticularsurface:Intra-articularfractures----Anatomicalreduction*四、fragmentdisplacementRelatement:forceisbig/small;,thedirection/characteroftheforce。Theweightofthedistalbody。Pullforceofthemuscles。Transfer/treatmentisnotproper.*四、fragmentdisplace ThemostcommontypesØangulardisplacementØlateraldisplacementØshortendisplacementØseparationdisplacementØrotatingdisplacement*Section2:clinicalmanifestationandxrayexamimation*Generalmenifestation shock Couldbe：seriousopenfracture,pelvisfracture cause：Extensivesofttissuecontusion、Severepain、bleeding、Visceralinjury fever Hematoma,bodytemperaturelessthan38℃*localmenifestation usualmanifestations： pain、swelling、obstacle。 Specialsigns： deformity; abnormal movement; bonycrepitusOneofabove3=fractureAquestion?*Xrayexamination Haveanimportantvalueofdiagnosisandtreatment,soRoutinely totakethex-ray. AP-Xray,LP-Xray(containadjacentjoints) Comparedwiththecontralaterallimbifnecessary*section3complication*（一）earlycomplication shock fatembolismsyndrome Visceralinjury(Lung,liver,spleen,bladder,urethra,rectum)Importantsurroundingtissuedamage（bloodvessel、surroundingnerve、spinalnervecordinjury） bonefascialcompartmentsyndrome（Commoninthecalvesandforearm）*（二）latercomplication Hypostaticpneumonia bedsore Deepveinthrombosisoflowerlimbs infection（pyogenicosteomyelitis）*（二）latercomplication Traumaticossification traumaticarthritis arthroclisis  ischemiccontraction ischemicnecrosis ischemicmusclecontracture*stardardofClinicalhealing Localtendernessandlongitudinaltapspain; Abnormalactivity X-rayshow:fracturelineisobscure;callus continuousobservationfortwoweekswithoutdeformation; Withoutfixion,holdtheupperlimbsatleastfor1min,1kg;walkfor3min,atleast30stepsforlowerlimbs.*Section5Factorsaffecttingthehealingoffracture*一、Systemicfactors age Healthstatus*二、localfactors typesandquantities Bloodsupply Objective softtissueinjury Softtissueinsert infection*三、Theinfluenceoftreatment  repeatedlygimmickreset(outermembraneinjuryofsofttissueandbone)Cut openreduction(softtissue,strippingboneoutermembrane) improperdebridementofopenfracture(bonedefectcausedbyremovingthebrokenbone) •continuoustractioninappropriately weakfixion(callusgrowth) Functionalexercise(prematureandinappropriate)*Section6firstaidoffracture*objective Simpleandeffective savelife、 Protectlimb、eandeffective Shiftsafely* Rescueshock:-heatpreservation,therespiratorytractunobstructedThewound:-arelativelycleancloth,tourniquet(ifnecessary),outsidethehard-coreendshouldnotbereset.•fixedproperly:-fracturefirstaidtreatmentisthemostimportantone,itsroleistoavoidfurtherinjury,relievepain,easytotransport,localmaterials.•rapiddlytransferred*Section7Theprincipleforthetreatmentoffractures*ThreeprinciplesforthetreatmentoffracturesreductionfixionFunctionalexercise* Functionrestorationstandard*二、fixion Externalfixion splint plaster--bracket、brace Tractionsystem Externalfixion* Internalfixtion plate screwintramedullary nail*三、functionalexercise*Section8howtodealwithopenfracture*mostdangerouscomplication—infection3types:*  debridementtimelimited 6-8h，contaminated,Firstphaseofthesuture 8-24h，debridementmaycould over24h，Don'tdebridement* Debridementtipscleanup:,atourniquetbestnottouse.•cleaning•resectionmargin,andthedeactivation,•keepnerves,bloodvessels,cuttingfatmore,Jointcapsuleexcisionofthepollutionandharms.•boneoutermembranetoretain,Chiselinadditiontothe0.51cm,fractureend,itisnoteasilyremovedboneblock,Onceagain,cleaning,changeofdressings*Section9principle of managementofopenfracture* Accordingtoseverityandprognosis,dividedto3types:takesomethingintoconsideration: *Section10delayedunion、nonunion、malunion** 概念 X线片 治疗与预后 延迟愈合 骨折经治疗，超过平均愈合时间，未愈合 骨折线明显骨折端无硬化 有愈合可能去除原因、延长时日可愈合 不愈合 骨折经治疗，超过平均愈合时间，未愈合 骨折线明显骨折端萎缩光滑，髓腔封闭 没有愈合可能一般需要手术治疗 畸型愈合 已经愈合 骨折线模糊或消失 影响功能需要手术矫正 delayedunion： Theendsofthefractureisnotossified nonunion： Foraperiodoftime,theendsofthefractureissealed。 malunion： Didnotmeettherequirementsoffunctionrestoration,operation.*THANKYOU*