Fracture of Upper ExtremitiesSectionIISupracondylar Fractures of HumerusFracture of shaft of radius and ulnaFracture of distal end of radiusSectionIISupracondylar Fractures of Humerus Epidemiology Afractureofthedistalhumerusjustabovetheepicondyles.Morecommonfacturestooccurinchildren.Thepeakincidenceisbetweentheagesof5-8yearsofageOftenassociatedwiththedevelopmentofseriouscomplications.Distal Humerus AnatomynMedial epicondyleproximaltotrochlea（滑车）nLateral epicondyleproximaltocapitellum（肱骨小头）nRadial fossaaccommodatesmarginofradialheadduringflexionnCoronoid fossaacceptscoronoidprocessofulnaduringflexionAnatomyForwardtiltangle:30-50AxisofHumerusshaftandAxisofHumeralcondylarAnatomy桡神经桡神经正中神经正中神经尺神经尺神经Classification 伸直型伸直型屈曲型屈曲型Extension typenFallonoutstretchedhandn95%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 arteryBrachialarteryinjury（肱动脉损伤）OsteofascialCompartmentSyndrome（骨筋膜室综合征骨筋膜室综合征）Extension typeFlexion typenFalldirectlyonthe flexed elbown5%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 Carefulneurovascluarexaminationofthearmisessential.nBrachial artery may be lacerated by the proximal fracture fragment , either at the time of injury or during reduction, Osteofascial compartment syndrome may be developed.nRadial and median nerves are the most commonly affected in extension typenUlar nerve is commonly affected in flexion typeRadiographic evaluationX-ray: Roentgenogrammayidentifythesiteofthedamage,displacementoffragment,typeoffracturesanddegreeofcomminutingExtensiontypeFlexiontypeTreatmentNonoperative treatmentClosed reduction,immobilization with arm splint ,maintaining elbow joint flexing about 80 degree for 46 weeksSelf-study自学自学伸直型伸直型屈曲型屈曲型Operative treatmentChoice of implantsnCrossedscrewsorcrossedpinscanbeusedsuccessfully（mostly）nReconstructiveplatesandscrewsOpen reduction and internal fixation Indication: closed reduction fail open fracture neurovascular injuriesOpen reduction and internal fixation SectionII-PartIPart I: Fractures of shaft of radius and ulnanTwobonesnThereisainterosseousmembranebetweenthebonesnFivejoints:radiohumeral,ulnohumeral,proximalradioulnar,radiocarpalanddistalradioulnarjoints.ThesejointsmakeitpossiblefortheradiustorotatebyrollingovertheulnarAnatomy of forearmMechanismWithadirect blowyoucanbreakeitherisolated,howevermorelikelyindirectblowtodamage both.nPain,crepitus,swellingsecondarytofracturehematomaandsoft-tissueinjury.nApparentdeformity:resultsfromthehighenergyandthemultitudeofdeformingmuscleforce.nSkin:shouldbethroughlyinspectedforanybreaksthatmaycommunicatewithfracture.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-compartment syndrome Radiographic evaluationDirect forceXrayTwo special fractures of forearmnMonteggia fracturenGaleazzi fractureMonteggianMonteggia fracture:proximal 1/3 fracture of ulnar associated with radial head dislocation.GaleazzinGaleazzi fracture: distal 1/3 fracture of radial shaft associated with distal radioulnar joint dislocation. TreatmentOpen reduction and internal fixation： CompressionplateandscrewsIntramedullaryfixationCompression plate and screwsSegmental fractures of diaphysis of forearmnIntramedullary fixationFracture of distal end of radiusMostcommonlywomenage60-70.90%causedbycompressionondorsiflexedwrist.90%ofdistalradiusfracturesareCollesFracturesFracture of distal end of radiusDefinitionFractureiswithin3cmofthedistalarticularsurfaceofradiusAnatomy掌倾角掌倾角尺偏角尺偏角1-1.5cmClassificationbasedonthemechanismofinjuryExtensiontypefracture(Colles)Flexiontypefracture(Simith)Fracture-dislocation（Barton）ClassificationMechanism of injuryThefractureoccursfromafallonextendedarmandonthepalmofhandwithforearmpronationExtenion type-Colles fracture骨折远端的移位方向：dorsalandradial（背、桡侧移位）nPain,crepitus,swelling,dysfunctionofwrist.nDeformityLateralview:dinnerforkdeformity（银叉样畸形）Anteroposteriorview:riflebayonetdeformity（枪刺样畸形）Clinical featuresRadiographic evaluationCollesNormalX-rayCollesNormalExternal FixationOpen reduction and internal fixationMechanism of injuryThefractureoccursfromablowonthedorsumofwristFlexion 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