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1、ORTHOPEDICS INTRODUCTION,Wenzhou Central Hospital Traumatology Department Chen Mang-mang,Section onedefinitioncauseclassificationdisplacement,一、Definition：,The integrity and/or continuity of the bone be interruptted,二、cause,1direct violence：meas:violence direct to the bone-than fracture.,2indirect v
2、iolence：translate to the bone-than fracture.Violence indirect to the fracture part.(such as colles fracture)。myotility：muscles attached the bone(patellafracture)。transverseprocess fracture.,3fatigue fracture：Long-term,repeated and minor external force.the stress accumulated.such as:the second and th
3、ird metatarsal fractures because of long-distance march;distal 1/3 part fibula fracture above three types,all occur in healthy bone,called Traumatic fractures 4pathological fracture：occur in Bone disease,Slight force。(tumor、infection),三、classification(plenty of),（一）according to skin、Mucosa of the fr
4、ature.1、close fracture：ends of the fracture and air are interlinked.2、open fracture：arent interlinked,（二）according to severity and shape,1、incomplete fracture：The integrity and/or continuity of the bone be interruptted 1）linear fracture：gap,not displaced.（The skull bone,scapula bone）2）greendstick fr
5、acture：Bone and periosteum partly broken，with or without angulationdeformity。（like Willow branches）,2、complete fracture：The integrity and/or continuity of the bone be interruptted completelyAccording to fracture line and shape：1）Transverse Fracture：fracture and vertical axis=vertical。(right pic.）,三、
6、according to severity and shape,2）oblique fracture：fracture line and vertical axis to form a certain Angle（as right figure）,（according to severity and shape）,3）spiral fracture:(right pic.）,4comminuted fracture：more than 2 fragments。（as right pic.）,三、according to severity and shape,5）impacted fractur
7、e：the fragments compacted into the other one，mainly occurs in fracture of metaphysis。Insert cancellous bone cortical bone inserted into cancellous bone(right pic.),三,6compression fracture：compressed and deformed。Occurs in spongy bone。如spinalfracture，calcanealfracture。(right pic.),三,7）depressed fract
8、ure：Skull bone。8）Epiphyseal separation：fracture line goes through the epiphyseal。,according to stable or not,1、stable fracture：the ends of the fracture is not easy to move/stabe after reduction.such as:Crack fracture,greenstick fracture,transverse fracture,compression fractures,impacted fractures et
9、c.2、un stable fracture：move again easily.。Such as:Oblique fracture,spiral fracture,comminuted fracture etc.,according to time,1、fresh fracture：less than 3 weeks.2、old fracture：More than 3 weeks。*Involving the articular surface:Intra-articular fractures-Anatomical reduction,四、fragment displacement,Re
10、latement:force is big/small;,the direction/character of the force。The weight of the distal body。Pull force of the muscles。Transfer/treatment is not proper.,四、fragment displace,The most common typesangular displacementlateral displacementshorten displacementseparation displacement rotating displaceme
11、nt,Section 2:clinical manifestation and x ray examimation,General menifestation,shockCould be：serious open fracture,pelvis fracturecause：Extensive soft tissue contusion、Severe pain、bleeding、Visceral injury feverHematoma,body temperature less than 38,local menifestation,usual manifestations：pain、swel
12、ling、obstacle。Special signs：deformity;abnormalmovement;bony crepitusOne of above 3=fractureA question?,Xray examination,Have an important value of diagnosis and treatment,so Routinelyto take the x-ray.AP-Xray,LP-Xray(contain adjacent joints)Compared with the contralateral limb if necessary,section3
13、complication,（一）early complication,shockfat embolism syndromeVisceral injury(Lung,liver,spleen,bladder,urethra,rectum)Important surrounding tissue damage（blood vessel、surrounding nerve、spinal nerve cord injury）bonefascial compartment syndrome（Common in the calves and forearm）,（二）later complication,H
14、ypostatic pneumonia bedsoreDeep vein thrombosis of lower limbs infection（pyogenic osteomyelitis）,（二）later complication,Traumatic ossification traumatic arthritis arthroclisisischemic contraction ischemic necrosis ischemic muscle contracture,stardard of Clinical healing,Local tenderness and longitudi
15、nal taps pain;Abnormal activityX-ray show:fracture line is obscure;callus continuous observation for two weeks without deformation;Without fixion,hold the upper limbs at least for 1min,1kg;walk for 3min,at least 30 steps for lower limbs.,Section 5 Factors affectting the healing of fracture,一、Systemi
16、c factors,ageHealth status,二、local factors,types and quantitiesBlood supplyObjective soft tissue injurySoft tissue insert infection,三、The influence of treatment,repeatedly gimmick reset(outer membrane injury of soft tissue and bone)Cut open reduction(soft tissue,stripping bone outer membrane)imprope
17、r debridement of open fracture(bone defect caused by removing the broken bone)continuous tractioninappropriately weak fixion(callus growth)Functional exercise(premature and inappropriate),Section 6 first aid of fracture,objective,Simple and effective save life、Protect limb、e and effective Shift safe
18、ly,Rescue shock:-heat preservation,the respiratory tract unobstructedThe wound:-a relatively clean cloth,tourniquet(if necessary),outside the hard-core end should not be reset.fixed properly:-fracture first aid treatment is the most important one,its role is to avoid further injury,relieve pain,easy
19、 to transport,local materials.rapiddly transferred,Section 7 The principle for the treatment of fractures,Three principles for the treatment of fractures reductionfixionFunctional exercise,Function restoration standard,二、fixion,External fixion splintplaster-bracket、braceTraction systemExternal fixio
20、n,Internal fixtionplatescrewintramedullarynail,三、functional exercise,Section 8 how to deal with open fracture,most dangerous complicationinfection3 types:,debridement time limited6-8h，contaminated,First phase of the suture 8-24h，debridement may could over24h，Dont debridement,Debridement tips clean u
21、p:,a tourniquet best not to use.cleaning resection margin,and the deactivation,keep nerves,blood vessels,cutting fat more,Joint capsule excision of the pollution and harms.bone outer membrane to retain,Chisel in addition to the 0.5 1 cm,fracture end,it is not easily removed bone block,Once again,cle
22、aning,change of dressings,Section 9 principleofmanagementof open fracture,According to severity and prognosis,divided to 3 types:take something into consideration:,Section 10 delayed union、nonunion、malunion,delayed union：The ends of the fracture is not ossifiednonunion：For a period of time,the ends of the fracture is sealed。malunion：Did not meet the requirements of function restoration,operation.,THANK YOU,
