尺桡骨双骨折.ppt

* AP and lateral views of the both bones fracture of the forearm, demonstrating significant shortening and relatively simple oblique fracture patterns. The patient is positioned supine with the arm prepped and draped to just above the elbow and a tourniquet in place. This figure demonstrates the arm held in supination. Note the position of the biceps insertion as well as the palpable tendon of the FCR and radial artery. BICEPS TENDON RADIAL ARTERY FLEXOR CARPI RADIALIS (FCR) A useful technique to make the skin incision is to take a bovi cord and pull it taught from the radial side of the biceps tendon to the FCR at the level of the wrist. This can then be used as a template for the incision line. The incision is taken down through the skin, identifying the fascial layer with care taken not to damage any superficial veins that may be intact. The FCR tendon is clearly visible throughout the wound, as is the radial artery in the distal extent of the wound. FCR RADIAL ARTERY A closeup of the distal aspect of the wound demonstrating The radial artery and its venous commtantes. RADIAL ARTERY AND VENOUS COMMTANTES FCR RADIAL ARTERY The fascia on the radial side of the flexor carpi radialis is released, exposing the deep tissue. The radial artery can be followed now throughout the entire incision. The radial artery may be taken in either direction, however, typically it is easier to take the artery to the radial side. FCR RADIAL ARTERY The deep dissection is now performed between the flexor-pronator mass on the ulnar side and the artery and the mobile wad on the radial side. PRONATOR For the proximal dissection, the forearm is brought into supination and the pronator, FDS and FDP are released from the volar aspect of the radius FDS The pronator is being released from the radial aspect of the radius in a subperiosteal manner. This subperiosteal dissection continues distally to release the origin of the common flexor. After exposure of the volar aspect of the