外科精品教学课件（重庆医科大学）10Upper extremities fracture-01.pptVIP

Fracture of surgical neck of humerus Company Logo Comminuted fracture Strong violence and osteoporosis, most cases are old patients. Clinical manifestation Pain, swell, ecchymosis, dysfunction of the shoulder. X ray show the number, the size and the location of the fragments. Diagnosis The history of trauma, clinical manifestation and X ray. Treatment Conservative treatment：sling with triangular bandage or bone traction and splint fixation. Operation treatment：open reduction and fixation with screw and plate Pay attention to injury of nerves and blood vessels Section II-Part II Part II: Fractures of Humeral Shaft Fractures of Humeral Shaft Company Logo Preface Accounting for 1%-3% of all fractures Associated neurologic injuries occur with these fractures Fractures of Humeral Shaft Company Logo Anatomy On the back of the middle third, there is a shallow spiral groove for radial nerve on the bone 2cm proximal to surgical neck 2cm distal to supracondyle Fractures of Humeral Shaft Company Logo Pathogenesis Direct force：blow, sharp trauma Indirect force: pitching, wrestling ,a fall on the outstretched extremity Clinical features Adequate history Associated with swelling, ecchymosis, pain, deformity of the upper arm A careful soft-tissue and neurological examination should be performed Sensory : dorsal first web space Motor:extension of the wrist and metacarpophalageal joint the wrist and metacarpophalageal joint can not be actively extended Fractures of Humeral Shaft Fractures of Humeral Shaft Company Logo Radiographic evaluation Including two orthogonal radiographic views(anteroposterior and lateral) of humeral shaft and adjacent joint (shoulder or elbow) Fractures of Humeral Shaft Company Logo Displacement of fragments A fracture between the insertion of the pectoralis major and the deltoid 1.The proximal fragment is adducted by the pectoralis major , teres major and latissimus dorsi. 2.The distal fragment is shortened and displaced laterally by deltoid Fr