01general-principles-of-fracture-骨折

GeneralPrinciplesoftheDiagnosisAndManagementofFRACTURETheFirstAffiliatedHospital,ChongqingUniversityofMedicalSciencesDepartmentofOrthopedicsHuangweiEpidemiologytheUnitedStatesTraumacausesmorethan140,000deathsperyearleadingcauseofdeathforthoseaged1-34yearsmorethancoronaryarterydisease,cancer,andstrokecombinedbeforeage65yearsIn2000,morethan50millionAmericansunderwentmedicaltreatmentforaninjury.Theestimatedlifetimecostoftheseinjuriesisbelievedtobe$406billion.DEFINITIONofFRACTUREThecontinuityandcompletenessofbonehavebrokenAfractureisacompleteorincompletebreakinthecontinuityofaboneTerminologyAnatomy:Thefractureisdescribedwithrelationtothebonesinvolvedandthelocationwithinthebone(diaphysis,metaphysis,physis,epiphysis).Articularsurfaceinvolvement:Doesthefracturehaveintra-articularinvolvement?Isthereintra-articulardisplacementorgapping?Displacement:Isthedistalfracturefragmentdisplacedcomparedwiththeproximalfragment?Towhatdegreeorpercentageisthefracturedisplaced?Angulation:Theangulardeformityisdefinedindegreesintermsofthedistalfragmentinrelationtotheproximalfragmentorwithrespecttotheproximalapexofthedistalfragment.Rotation:Rotationaldeformityisdescribedbothclinicallyandradiographically.Shortening:Hasthefracturecausedshorteningoftheinvolvedbone?Towhatextenthasshorteningoccurred?TerminologyFragmentation:TheMullerAO(ArbeitsgemeinschaftfürOsteosynthesefragen[AssociationforOsteosynthesis])ComprehensiveClassificationofFracturesprovidesastandardizeddescriptionoffracturepatterns,makingcommunicationregardingsuchinjuriesmorepreciseandunderstandable.Amultifragmentaryfractureisonethathasseveralbreaksinthebone,creatingmorethan2fragments.Wedgefracturesareeitherspiral(lowenergy)orbending(highenergy)andallowtheproximalanddistalfracturefragmentstocontacteachother.Thecomplexmultifragmentaryfractureisasegmentalfractureoroneinwhichthereisnocontactbetweentheproximalanddistalfragmentswithouttheboneshortening.Simplefracturesarespiral,oblique,ortransverse.FactorsResponsibleforFracturesDirectviolenceappliedtothebonealsodamagessurroundingsofttissueAtappingforceappliedtotheboneproducesanobliquefractureAcrushinginjuryresultsinafragmentedfractureoftheboneApenetratingdirectinjuryfromahigh-velocitygunshotblastdestroysboneandsofttissueFactorsResponsibleforFracturesIndirectviolenceappliedtotheboneproducessignificantlylessdamagetosoftandhardtissuesAnabductionorverticalormusclepullforcecausesacompressionoravulseorobliqueorspinalfractureFactorsResponsibleforFracturesManydiseasesofbonemaycausedestructionofboneormayweakentheboneproducesapathologicfractureinflammationtumorortumor-likediseasesosteogenesisimperfectametabolicdiseasesetalFactorsResponsibleforFracturesInrepeatedstresses,whichcausefatiguefracturesthesestressfracturearemostfrequentlyencounteredinboneofthelowerextremity:theneckofthesecondorthirdmetatarsalbonetheshaftofthetibiaorfibulartheneckofthefemurCLASSIFICATIONSFracturesmaybecausedbyViolencedirectindirectInjuryfractureMusclepullAvulsionfractureFatigueStressfractureDiseasePathologicalfractureclassificationsFromWhetherHaveDirectorindirectCommunicationBetweentheFractureandWoundoftheSkinandMucosaFromWithinOpenFractureFromWithoutClosedFractureDirectViolenceIndirectViolenceMusclepullAvulsionfractureOpenFractureOpenComminutedFracture车祸致左小腿开放性毁损OpenandComminutedfractureclassificationsFromStabilityStableTransversefractureGreenstickfractureImpactedfractureEpiphysealinjuryTransversefractureofthelefthumerusImpactedfractureoftheneckoftherightfemurFromStabilityUnstableSpiralfractureObliquefractureSlopeofmorethan200o0ComminutedfractureAvulsionclassificationsThecomminutedfractureoftherighthumerusThelongspinalfractureoftheleftfemurdistalGreenstickTransverseAngulationObliqueSpiralDoubleComminutedImpactedCrushAvulsionInvolvingajointCompressionFracture-DislocationEpiphysealinjuryclassificationsPatternofDisplacementAngulationRotationLateralSideOverlaporShorteningImpactingMechanismofthedisplacementofthefragmentsDirectionoftheviolenceEffectsofgravityMusclepullImproperFirstAidCLINICAL&RADIOLOGICALFEATURESOFTHEFRACTURESystemicManifestationsPrimaryShock(NeurogenicShock)SecondaryShock----Haemorrhagia(-ge)Notice:excludetocerebralinjuryandrespiratoryembarrassmentCLINICAL&RADIOLOGICALFEATURESOFTHEFRACTURESystemicManifestationsLowFeverorSlightFevertemperature380CtraumareactionhaematomaabsorptionWBC(whitebloodcell)SR(erythrocytesedimentationrate)CLINICAL&RADIOLOGICALFEATURESLocalManifestationTraumaticInflammation:PainLocalSwellingLossorImpairmentofFunctionEcchymosisLocalizedbonetendernessSpecificSignsThefollowingfeaturesarepathognomonicoffractureDeformityAbnormalMobilityCrepitusorGratingCLINICAL&RADIOLOGICALFEATURESAbsenceofdysfunctiondoesnotprecludefracturethisisparticularlytrueof:greenstickfacturesimpactedfracturesfatiguefracturesCLINICAL&RADIOLOGICALFEATURESRadiologicalExaminationFractureyesorno?Patternoffracture?Anatomicpartofthefracture?SelectingofTreatmentMethods!COMPLICATIONSOFFRACTUREEarlyPeriodS