上肢骨折与关节损伤吕海ppt2概要课件.ppt

Take Home Message 肱骨干骨折、桡骨下端骨折的移位特点、诊断和治疗; Volkmann缺血性挛缩 前臂骨折的移位特点和治疗原则; 舟状骨骨折的病因、特点； 桡骨下端骨折的病因、分类、移位特点。 Fracture Distal of the Humerus Radial Nerve Injury Results in Wrist drop Associated with fracture humerus in up to 12% of fractures 2/3 ( 8%) of Radial injury are Neuropraxia(神经失用) Management of Radial Nerve Injury When present in open fractures ; immediate exploration and ± repair In closed injuries treated conservatively ; initial management is doing Nerve Conduction Studies ( NCS ) and Electromyography ( EMG ) and awaiting for spontaneous recovery Management of Radial Nerve injury Recovery usually starts after few days but may take up to 9 months for full recovery If No spontaneous recovery occurs in 12 weeks confirmed by NCS and EMG ;then exploration of the nerve should be carried out Management of Humerus Shaft Fracture Most of the time is Conservative Closed Reduction in upright position followed by application of U shaped Slab or Cylinder cast Few weeks later or initially in stable fractures Functional Brace may be used U Shaped Slab of POP Functional Brace 功能支具 Indications for ORIF 切开复位内固定 Failure to reduce fracture conservatively 保守失败 Bilateral humeral fractures 双侧骨折 Open fracture with radial nerve Injury 开放骨折并神经伤 Unconscious patient 昏迷病人 Delayed-Union 延迟愈合 Non-Union 不愈合 Mal-Union 畸形愈合 ORIF：open reduction internal fixation Supra-condylar Fracture of Humerus 肱骨髁上骨折 Pediatric Supra-Condylar Humeral Fracture Pediatric Supra-condylar fracture Reduction of supra-condylar Fracture Absolute Emergency Should be done by experienced doctor as soon as possible In the past the arm was held in flexed elbow position in back-slab POP after reduction At present time Percutaneous K wire fixation is ALWAYS carried out after reduction Complications Supra-Condylar Fractures Early= Compartment syndrome （Volkmann‘s Ischemia） Late= Stiffness Volkmanns Ischemic Heterotopic Calcification Mal-Union (Valgu