骨折治疗原则.ppt

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1、PRINCIPLESOFTREATMENTOFFRACTURESGOALSOFFRACTURETREATMENTRestorethepatienttooptimalfunctionalstatePreventfractureandsoft-tissuecomplicationsGetthefracturetoheal,andinapositionwhichwillproduceoptimalfunctionalrecoveryRehabilitatethepatientasearlyaspossibleHOWFRACTURESHEALInnatureRegeneratio

2、nvsrepairThreephasesofhealingbycallusRapidprocess,rehabilitationslow,lowriskWithoperativeintervention(reduction+compression)PrimarybonehealingSlowprocess,rehabilitationrapid,highriskWithoperativeintervention(nailingorexternalfixation)HealingbycallusRapidprocess,rehabilitationrapid,lesserr

3、iskFACTORSAFFECTINGFRACTUREHEALINGTheenergytransferoftheinjuryThetissueresponseTwoboneendsinoppositionorcompressedMicro-movementornomovementBS(scaphoid,talus,femoralandhumeralhead)NSNoinfectionThepatientThemethodoftreatmentHIGH-ENERGYINJURYLOWENERGYINJURYDESCRIBINGTHEFRACTUREMechanismofin

4、jury(traumatic,pathological,stress)Anatomicalsite(boneandlocationinbone)ConfigurationDisplacementthreeplanesofangulationtranslationshorteningArticularinvolvement/epiphysealinjuriesfractureinvolvingjointdislocationligamentousavulsionSofttissueinjuryMINIMALLYDISPLACEDDISTALRADIUSFRACTURECOM

5、MINUTEDPROXIMAL-THIRDFEMORALFRACTUREWITHSIGNIFICANTDISPLACEMENTMANAGEMENTOFTHEINJUREDPATIENTLifesavingmeasuresDiagnoseandtreatlifethreateninginjuriesEmergencyorthopaedicinvolvementLifesavingComplicationsavingEmergencyorthopaedicmanagement(Day1)Monitoringoffracture(Daystoweeks)Rehabilitati

6、on+treatmentofcomplications(weekstomonths)LIFESAVINGMEASURESAAirwayandcervicalspineimmobilisationBBreathingCCirculation(treatmentanddiagnosisofcause)DDisability(headinjury)EExposure(musculo-skeletalinjury)EMERGENCYORTHOPAEDICMANAGEMENTLifesavingmeasuresReducingapelvicfractureinhaemodynami

7、callyunstablepatientApplyingpressuretoreducehaemorrhagefromopenfractureComplicationsavingEarlyandcompletediagnosisoftheextentofinjuriesDiagnosingandtreatingsoft-tissueinjuriesDIAGNOSINGTHESOFTTISSUEINJURYSkinOpenfractures,deglovinginjuriesandischaemicnecrosisMuscles