外科精品教学课件（重庆医科大学）10Upper extremities fracture-02.pptVIP

* * * * * * * * * * * * * * * * * * * * * * * * * * Key points Indications of the Open Reduction and Internal fixation for a close Fracture Complications of the fractures: humeral shaft, supracondyle Deformity of the Colles Fracture, Baton Fracture * * * * * * * * * * * * * * * * * * * * Direct blow Indirect force Indirect force Direct force fractures of shaft of radius and ulna Clinical features Pain,crepitus,swelling secondary to fracture hematoma and soft-tissue injury. Apparent deformity:results from the high energy and the multitude of deforming muscle force. Skin:should be throughly inspected for any breaks that may communicate with fracture. fractures of shaft of radius and ulna More severe swelling Tense forearm compartments Pain out of proportion to the injury Pain with passive extension of fingers These may point to compartment syndrome Any signs of compartment syndrome warrants immediate fasciotomy Clinical features Neuromotor examination: Radia nerve: extensor digitorum communis with a neutral wrist Media nerve: abductor pollicis brevis Ulnar nerve: abductor small finger Clinical features Sensory examination Radia nerve: the first web space Median nerve: volar pad of index finger Ulnar nerve: volar pad of small finger fractures of shaft of radius and ulna Vascular examination Palpation of the brachial, radial and ulnar pulse, along with examination of distal capillary refill fractures of shaft of radius and ulna Radiographic evaluation Anteroposterior and lateral views of the forearm is necessary for the assessment of a suspected forearm fractures The elbow and wrist must be included on each film to help evaluate the extent of injury fractures of shaft of radius and ulna Two special fractures of forearm Monteggia fracture: proximal ulnar fracture associated with radial head dislocation. Galeazzi fracture: distal radial shaft fracture associated with distal radioulnar joint disruption.