ผศ.นพ.ธรา ธรรมโรจน ภาควชาออรโธปดกส คณะแพทยศาสตร, มหาวทยาล!ยขอนแก#น

Transcription

1 1972 ผศ.นพ.ธรา ธรรมโรจน ภาควชาออรโธปดกส คณะแพทยศาสตร, มหาวทยาล!ยขอนแก#น

2 Common Fracture in lower Extremity Common Fracture in Adult(Traumatic Associated Fracture) Fracture of Tibia and Fibular Fracture of The Shaft of The Femur Common Fracture in Elderly(Nontraumatic Associated Fracture) Femoral neck fracture Intertrochanteric fracture

3 Orthopaedic Conditions 78% incidence of significant orthopaedics injury in the patients with multiple trauma equivalent to head injury twice that of major thoracic injury four times the incidence of abdominal injury

4 Multiple Injured Patient

5 Phase in The Care of The Multiple Injured Patient 1.Resuscitation 2.Emergency Procedures 3.Stabilization 4.Delayed Operative Procedure 5.Rehabilitation

6 Indication for Immediate Surgery Hemorrhage secondary to Laparotomy: liver, spleen, kidney Thoracotomy: Aortic, caval or pulmonary vessel tear Craniotomy: depressive skull fracture, acute subdural hemorrhage Pelvic fracture stabilization Prevention of pulmonary failure femoral shaft fracture pelvic fracture

7 First Orthopaedics Management

8 Fracture around the ankle Anatomy Biomechanic

9 Anatomy

10 Diagnosis History Physical examinations X-ray

11 Diagnosis

12 Diagnosis

13 Diagnosis

14 Diagnosis

15 Diagnosis

16 Fracture Managements Maleolar Fracture Stable Unstable Casting ORIF

17 ORIF

18 Fracture of The Tibia and Fibula The most common long bone fracture Anatomy Two unequal bone Four compartments Between two hinge joints

19 Open Fracture Management What? When? Where? How? Diagnosis&Classification Golden period Operative room Preoperative Intraoperative Postoperative

20 Diagnosis History Physical examinations X-ray

21

22 X-ray

23 Classification of Open Fracture Type Wound Level of Soft tissue Bone Contamination I <1cm. Simple II >1cm. Moderate III A >10cm. Comminuted B C Clean Minimal Moderate Moderate High Severe+crushing Skin defect Vascular injury

24

25

26

27 Preoperative management Splint+Pressure dressing Antibiotic Tetanus prophylaxis Lab.blood request IV

28 Intraoperative procedures Systematic debridement Immobilization Cast Nail Plate External fixator

29

30 Closed Fracture Managements Closed Tibial Fracture Stable Unstable Casting CRIF

31 Casting Technique

32 Internal Fixation for Tibial Fracture

33 Femoral Shaft Fracture Incidence second most common long bone fracture in lower extremity Anatomy Tubular bone Anterolateral bowing

34 Physical Examination Clinical features Shortening external rotation swelling angulation Splint

35 X-ray

36 Classification

37 Treatment Options Plate External fixator Femoral Shaft Fracture Cast Indications for plating 1.Metaphyseal extension 2.Ipsilateral major arterial injury 3.Nonavalability for closed nailing Nail

38 Femoral Neck Fracture Incidence and Epidermiology 280,000cases/yr. 63% of osteoporotic fractures(3-5% in adult) increase 2 times/5 yrs. from 30 yrs. 18/1000 at 85

39 Diagnosis History mechanism of injury underlying disease medications Physical Examinations minimal swelling minimal external rotation minimal shortening pain on motion

40 X-ray

41 Classification

42 Patient and Fracture Evaluation What? Fracture type and Where? When? How? OPD/Operative room Underlying Control medical conditions Conservative/Operative

43 Treatment Options Femoral neck fracture Nonoperative treatment Operative treatment Internal fixation Hemiarthroplasty

44 Indication for Hemiarthroplasty Old fracture dislocation Neglected fracture Fail internal fixation Untolerate to second operation Preexisting lesion

45

46 Intertrochanteric Fracture Incidence Gender and race dependance M:F=63:34/ Anatomy Zone of transition Calcar femorale

47 Diagnosis History mechanism of injury underlying disease medications Physical examinations swelling external rotation shortening pain on motion large subcutaneous hematoma

48 Classification

49 Patient and Fracture Evaluation What? Fracture type and Where? When? How? Operative room Underlying Control medical conditions Conservative/Operative

50 Treatment Options Intertrochanteric fracture Nonoperative treatment Operative treatment Internal fixation Hemiarthroplasty

51 Internal Fixation for Intertrochanteric Fracture

52