1、Fracture of Upper ExtremitiesMao Nie,MD,PhD Attending and LecturerDepartment of OrthopaedicsThe 2nd Affiliated Hospital of CQMUSChongqing,ChinaTel&wechat:13678428205Section IISupracondylar Fractures of HumerusFracture of shaft of radius and ulnaFracture of distal end of radiusSection IISupracondylar
2、 Fractures of Humerus Epidemiology A fracture of the distal humerus just above the epicondyles.More common factures to occur in children.The peak incidence is between the ages of 5-8 years of age Often associated with the development of serious complications.Distal Humerus Anatomyn Medial epicondyle
3、 proximal to trochlea（滑车）n Lateral epicondyle proximal to capitellum（肱骨小头）n Radial fossa accommodates margin of radial head during flexionn Coronoid fossa accepts coronoid process of ulna during flexionAnatomyForward tilt angle:30-50Axis of Humerus shaft and Axis of Humeral condylarAnatomy桡神经桡神经正中神经
4、正中神经尺神经尺神经Classification 伸直型伸直型屈曲型屈曲型Extension typen Fall on outstretched handn 95%Extension typeAnterior interosseous nerve injury(正中神经的分支正中神经的分支)Radial nerve（桡神经）（桡神经）Weekness in wrist and fingers extension Brachial arteryBrachial artery injury（肱动脉损伤）Osteofascial Compartment Syndrome（骨筋膜室综合征骨筋膜室综合
5、征）Extension typeFlexion typen Fall directly on the flexed elbown 5%Flexion typeUlar nerve injury尺神经损伤尺神经损伤 Clinical featuresHistory of trumaSwellingPainDeformityEcchymosis,kmoss 瘀斑Disfunction of elbowPhysical Examination Careful neurovascluar examination of the arm is essential.n Brachial artery may
6、 be lacerated by the proximal fracture fragment,either at the time of injury or during reduction,Osteofascial compartment syndrome may be developed.n Radial and median nerves are the most commonly affected in extension typen Ular nerve is commonly affected in flexion typeRadiographic evaluationX-ray
7、:Roentgenogram may identify the site of the damage,displacement of fragment,type of fractures and degree of comminuting Extension typeFlexion typeTreatmentNonoperative treatmentClosed reduction,immobilization with arm splint,maintaining elbow joint flexing about 80 degree for 46 weeksSelf-study自学自学伸
8、直型伸直型屈曲型屈曲型Operative treatmentChoice of implantsn Crossed screws or crossed pins can be used successfully（mostly）n Reconstructive plates and screwsOpen reduction and internal fixation Indication:closed reduction fail open fracture neurovascular injuriesOpen reduction and internal fixation Section II
9、-Part IPart I:Fractures of shaft of radius and ulnanTwo bonesnThere is a interosseous membrane between the bonesnFive joints:radiohumeral,ulnohumeral,proximal radioulnar,radiocarpal and distal radioulnar joints.These joints make it possible for the radius to rotate by rolling over the ulnarAnatomy o
10、f forearmMechanism With a direct blow you can break either isolated,however more likely indirect blow to damage both.n Pain,crepitus,swelling secondary to fracture hematoma and soft-tissue injury.n Apparent deformity:results from the high energy and the multitude of deforming muscle force.n Skin:sho
11、uld be throughly inspected for any breaks that may communicate with fracture.Clinical featuresnMore severe swelling nTense forearm compartmentsnPain out of proportion to the injurynPain with passive extension of fingersAny signs of compartment syndrome warrants immediate fasciotomyCompilcation-compa
12、rtment syndrome Radiographic evaluationX rayTwo special fractures of forearmn Monteggia fracturen Galeazzi fractureMonteggian Monteggia fracture:proximal 1/3 fracture of ulnar associated with radial head dislocation.Galeazzin Galeazzi fracture:distal 1/3 fracture of radial shaft associated with dist
13、al radioulnar joint dislocation.TreatmentOpen reduction and internal fixation：Compression plate and screws Intramedullary fixationCompression plate and screwsSegmental fractures of diaphysis of forearmnIntramedullary fixationFracture of distal end of radius Most commonly women age 60-70.90%caused by
14、 compression on dorsiflexed wrist.90%of distal radius fractures are Colles Fractures Fracture of distal end of radiusDefinitionFracture is within 3cm of the distal articular surface of radiusAnatomy掌倾角掌倾角尺偏角尺偏角1-1.5cm Classification based on the mechanism of injury Extension type fracture (Colles)Fl
15、exion type fracture (Simith)Fracture-dislocation （Barton）Classification Mechanism of injuryThe fracture occurs from a fall on extended arm and on the palm of hand with forearm pronation Extenion type-Colles fracture骨折远端的移位方向：dorsal and radial（背、桡侧移位）n Pain,crepitus,swelling,dysfunction of wrist.n De
16、formity Lateral view:dinner fork deformity（银叉样畸形）Anteroposterior view:rifle bayonet deformity（枪刺样畸形）Clinical featuresRadiographic evaluationCollesNormal X-rayCollesNormalExternal FixationOpen reduction and internal fixation Mechanism of injuryThe fracture occurs from a blow on the dorsum of wristFle
17、xion type-simith fracture骨折远端的移位方向：掌、桡侧移位ORIF-Volar Bartons FracturesKey pointsIndications of the Open Reduction and Internal fixation for a close FractureComplications of the fractures:humeral shaft,supracondyleDeformity of the Colles Fracture,Baton FractureDefinition of Monteggia fracture and Galeazzi fracture
