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1、尺桡骨双骨折,1,尺桡骨双骨折1,AP and lateral views of the both bones fracture of the forearm,demonstrating significant shortening and relatively simpleoblique fracture patterns.,2,AP and lateral views of the bo,The patient is positioned supine with the arm prepped anddraped to just above the elbow and a tourniqu
2、et in place. This figure demonstrates the arm held in supination. Note theposition of the biceps insertion as well as the palpable tendonof the FCR and radial artery.,BICEPSTENDON,RADIALARTERY,FLEXOR CARPIRADIALIS (FCR),3,The patient is positioned supi,A useful technique to make the skin incision is
3、 to take a bovicord and pull it taught from the radial side of the biceps tendonto the FCR at the level of the wrist. This can then be used as a template for the incision line.,4,A useful technique to make the,5,5,The incision is taken down through the skin, identifying the fascial layer with care t
4、aken 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,RADIALARTERY,6,The incision is taken down thr,A closeup of the distal aspect of the wound demonstratingThe radial artery
5、 and its venous commtantes.,RADIAL ARTERY ANDVENOUS COMMTANTES,7,A closeup of the distal aspect,FCR,RADIALARTERY,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.,8,FCRRADIALThe fasc
6、ia on the rad,The radial artery may be taken in either direction, however, typically it is easier to take the artery to the radial side.,FCR,RADIALARTERY,9,The radial artery may be taken,The deep dissection is now performed between the flexor-pronator mass on the ulnar side and the artery and the mo
7、bile wad on the radial side.,10,The deep dissection is now per,PRONATOR,For the proximal dissection, the forearm is brought intosupination and the pronator, FDS and FDP are releasedfrom the volar aspect of the radius,11,PRONATORFor the proximal disse,FDS,The pronator is being released from the radia
8、l aspect of the radius in a subperiosteal manner. This subperiostealdissection continues distally to release the origin of thecommon flexor.,12,FDSThe pronator is being relea,After exposure of the volar aspect of the radius proximallyand distally, two clamps can be placed on the ends of thebone in o
9、rder to deliver them for cleaning.,13,After exposure of the volar as,FCR,RADIAL ARTERY,Each side of the fracture is be delivered in order to expose and clean the cortical edges.,14,FCRRADIAL ARTERYEach side of t,These figures demonstrate delivery of the distal fragment and acurved curette being used
10、 to clean the cortical edge. Nocleaning should be performed within the intramedullary canal,as this is healthy tissue and can be useful for the healing process.,15,These figures demonstrate deli,Once the fractures are completely cleaned along their cortical edges such that the fracture reduction can
11、 be visualized, the two clamps are used to reduce the fracture. If a butterfly fragment exists, it is necessary to fix this with a lag screw back to one of the fracture ends in order to realign the fracture.,16,Once the fractures are complet,In the current case, the fracture is a simple pattern and
12、is reduced by delivering the bones jointly, accentuating the deformity and then rotating and fitting the bones together with progressive compression while pushing the bones back into the wound, obtaining alignment by steric interference of one side against the other.,17,In the current case, the frac
13、t,Once the bones are held reduced, as seen in the following sequence, an appropriate dynamic compression plate is placed and held in place with a clamp. It is important that this plate must have the appropriate bend for the volar aspect of the forearm so as not to gap open the dorsal side as the pla
14、te is fixed to the bone. Thus, it should be slightly underbent with respect to the standard volar concavity.,18,Once the bones are held reduce,19,19,20,20,21,21,These figures demonstrate reduction of the fracture with a plateheld in place on the flat, volar aspect of the bone.Once the reduction is c
15、onfirmed fixation of the plate is performedusing a compressive technique through the plate.,22,These figures demonstrate redu,The following sequence demonstrates using the offset drillguide to place an eccentrically drilled hole away from thefracture. The screw is placed to the point where it abutsb
16、ut is not inserted completely within the plate until it isaffixed on the other side.,23,The following sequence demonst,24,24,HOLEECCENTRICALLYILLUSTRATED,25,HOLE25,26,26,In a similar fashion to the first screw, the second screw is placed on the opposite side of the fracture, also eccentrically away
17、from the fracture. By compressing these two screws against the plate the fracture is translated and compressed together as shown inthe following sequence.,27,In a similar fashion to the fi,28,28,29,29,This image demonstrates the reduced fracture, viewedfrom the volarly.,30,This image demonstrates th
18、e re,This image shows that the fracture is also compressed on the oppositeside due to proper contouring of the plate. Once the radius is fixed, the ulna is approached using a standard subcutaneous longitudinal incision with the arm flexed, as seen in the next image.,31,This image shows that the frac
19、,32,32,These images demonstrate the superficial dissection downto the fascia directly over the ulna, which is the commonfascia between the flexor carpi ulnaris and the extensor carpi ulnaris. This is divided in line with the muscles directly over the subcutaneous border of the ulna.,33,These images
20、demonstrate the s,34,34,ECUEXTENSORCARPI ULNARIS,FCUFLEXOR CARPI ULNARIS,35,ECUFCU35,A periosteal elevator is used to cleanthe external surface of the ulna.,36,A periosteal elevator is used,This is cleaned, reduced and fixed in exactly the same fashion as the radius was, using a 6-hole DCP plate and
21、 in compressive mode. These images show the plate in place with screw holes, allowing for compression in the final compressed fracture.,37,This is cleaned, reduced and f,38,38,39,39,Intraoperative fluoroscopic views demonstrate accuratereduction and appropriate length of screws.,40,Intraoperative fluoroscopic vi,Postoperative AP and lateral views demonstratinganatomic reduction and alignment of the radius and ulna.,41,Postoperative AP and lateral v,42,42,43,43,44,44,45,45,46,46,47,47,48,48,49,49,50,50,
