CausesofClavicleFractureAccidentssuchasfallsSometimes,ablowfromabluntobjectoracollisionofsomesortFractureClassificationFractureofmiddle1/3(groupI)Fractureofmiddle1/3(groupI)accountfor80%accountfor80% frxofdistal1/3(groupII)frxofdistal1/3(groupII) accountfor10-15%accountfor10-15%typeI:minimaldisplacementtypeI:minimaldisplacementtypeII:frxmedialtotypeII:frxmedialtocoracoclavicularligamentscoracoclavicularligamentstypeIII:articularsurfacefracturestypeIII:articularsurfacefractures frxofmedial1/3(groupIII)frxofmedial1/3(groupIII)accountfor5%accountfor5%SymptomsofClavicleFracturePainSwellingTendernessDeformityInternalbleedingIfaskedtolifttheirarm,patientswithabrokenclaviclecannotdosowithoutextremepain.TreatmentofClavicleFractureThegoaloftreatingbrokenbonesistosetthem,makingthemwholeagainfigure-8splintorstrapimmobilizedfor6-8weeksOpenreductionandinternalfixationHumerusShaftFractures肱骨干骨折CausesofHumeralShaftFractureDirectstress,suchasablowtothearm.Indirectforces,suchasafall,twistingortorsionalforces.mechanismbendingforceproducestransversefrxofbendingforceproducestransversefrxoftheshaft;theshaft;torsionforcewillresultinaspiralfracture;torsionforcewillresultinaspiralfracture;combinationofbendingandtorsioncombinationofbendingandtorsionproduceobliquefrxw/orw/oabutterflyproduceobliquefrxw/orw/oabutterflyfragment;fragment;compressionforceswillfrxeithercompressionforceswillfrxeitherproximalordistalendsofhumerus;proximalordistalendsofhumerus;typesofhumeralshaftfractureTransversehumeralfracturesShortobliquefracturesLongspiralfracturesSymptomsofhumeralshaftfracturePainLossofstrengthinthegripSwellDeformityTendernessIfthebloodsupplyisimpaired,theremaybenumbnessandcoldnessinthearmandhand.NonOperativeTreatmentofHumeralShaftfractureLongarmsplintneedstobeappliedfromshouldertowristtofullyimmobilizetheextremity;OperativeTreatment:internalfixationshouldbereservedforfractureswithinadequatereductionorpatientswithmultipletrauma;IMNailingofHumeralShaftFracturesPlateFixationAnatomySupracondylarFractureoftheHumerus肱骨髁上骨折肱骨髁上骨折CausesBy a fallBy a fallThe child may stretch out his or The child may stretch out his or her hand and the force from the her hand and the force from the impact may be enough to cause a impact may be enough to cause a break in the bone. But any trauma break in the bone. But any trauma to the area, such as an injury from to the area, such as an injury from a car accident, may also be a a car accident, may also be a cause.cause. -typeI:non-displacedfrx-typeI:non-displacedfrx-typeII:displacedwithintactposterior-typeII:displacedwithintactposteriorcortexcortex-typeIII:displacedwithnocorticalcontact-typeIII:displacedwithnocorticalcontactSymptomspainintheelbowswellingintheelbowinabilitytomovethearmduetopainComplicationscompartmentsyndromeVolkmannscontracturemedianorulnarnerveinjurystiffnessangulationmyositisossificansTreatmentTreatmentCase1Case2Bothboneforearmfractures前臂双骨折前臂双骨折ClassificationBothBoneForearmFracturesBothBoneForearmFracturesBothBoneForearmFracturesBothBoneForearmFracturesLocationLocationLocationLocationProximal,middle,distalthird,Proximal,middle,distalthird,Proximal,middle,distalthird,Proximal,middle,distalthird,epiphysealepiphysealepiphysealepiphysealSkinSkinSkinSkinIntegrityIntegrityIntegrityIntegrityOpen,ClosedOpen,ClosedOpen,ClosedOpen,ClosedFractureFractureFractureFracturePatternPatternPatternPatternSamelevel,differentlevel,Samelevel,differentlevel,Samelevel,differentlevel,Samelevel,differentlevel,associatedjointdisruptionassociatedjointdisruptionassociatedjointdisruptionassociatedjointdisruptionMonteggiaFracturesMonteggiaFracturesMonteggiaFracturesMonteggiaFracturesGaleazziFracturesGaleazziFracturesGaleazziFracturesGaleazziFracturesDisplacemenDisplacemenDisplacemenDisplacement t t tRotation,translation,shortening,Rotation,translation,shortening,Rotation,translation,shortening,Rotation,translation,shortening,interosseousspaceinterosseousspaceinterosseousspaceinterosseousspaceSkeletalSkeletalSkeletalSkeletalMaturityMaturityMaturityMaturityMaturevsimmatureMaturevsimmatureMaturevsimmatureMaturevsimmatureCase1:42yearoldmaninjuredCase1:42yearoldmaninjuredinacaraccident.Hisleftarminacaraccident.HisleftarmCase2Case2CollesfractureCollesfractureSmithfractureSmithfractureDistalradiusFracture桡骨远端骨折桡骨远端骨折ClassificationofdistalradiusClassificationofdistalradiusfracturesfracturesIDorsalIDorsaldisplaceddisplacedCollesCollesfracturesfracturesIIPalmarIIPalmardisplaceddisplacedSmithfracturesSmithfracturesIIIIIIComminutedComminutedfracturesfractures(1.)DistractionwithexternalfixationsupplementedwithpercutaneousKirschnerwires.(2.)Distractionusingatemporaryplateandscrews,tunnelledbetweentwosmallaccessincisions.(3.)Openreductionwithabuttressplate.(4.)OpenreductionwiththeMedofffixationsystem.FixationofdistalradiusfracturesComplicationReflexsympatheticdystrophy;fingerstiffness;ulnarstyloidnonunion;Carpaltunnelsyndrome;posttraumaticarthritis;tendonrupturecarpalinstabilityCase1This60yearoldThis60yearoldwoman.woman.ShewastreatedShewastreatedwithwithclosedreductionclosedreductionandandpinning.pinning.TreatmentTreatmentCase2PreopPreopPostopPostopTheInjuredHand手外伤手外伤ArteriesofhandNervesofhandExaminationoftheInjuredHandAtrest,fingertipsnormallyAtrest,fingertipsnormallyfallintoacascadeposturefallintoacascadepostureofincreasingflexionfromofincreasingflexionfromtheindextothesmalltheindextothesmallfinger.finger.Flapsforfingertipreconstruction(1.)PalmarV-Y(1.)PalmarV-Yneurovascularneurovascularislandislandadvancementflap.advancementflap.(2.)Dorsalcross(2.)Dorsalcrossfingerflap.fingerflap.(3.)Thenarflap.(3.)Thenarflap.TendonInjury肌腱损伤肌腱损伤flexortendonsflexortendonzones1:digitalsheath1:digitalsheathcontainingonetendon;containingonetendon;2:digitalsheath2:digitalsheathcontainingtwotendonscontainingtwotendons(nomanslandnomansland) )3:palm;3:palm;4:carpaltunnel;4:carpaltunnel;5:theforearm.5:theforearm.nomanslandnomanslandTendonSutureScaphoidfractures舟骨骨折舟骨骨折XraybeforetwomonthspostoptwomonthspostopXraybeforeIntraarticularMetacarpalbasefractures关节内掌骨基底骨折关节内掌骨基底骨折BennettsandreversedBennettsBennettsandreversedBennettsfractures.fractures.MetacarpalNeckFractures掌骨颈部骨折掌骨颈部骨折Boxers fractureBoxers fractureBoxers fractureBoxers fracture Phalangealfractures指骨骨折指骨骨折middlephalanxbasefractureDorsalfractureDorsalfracturedislocationdislocation palmarfracturedislocationfracturedislocationUnicondylar phalanx head fractures Unicondylar phalanx head fractures 指骨头部骨折指骨头部骨折