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Principles of orthopaedics and fx DR.H.SAREMI Orthopedic surgeon Hand and shoulder surgery felloiwship. تاریخچه ارتوپدی. Sprain Arthrodesis Grade1 Grade2
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Principles of orthopaedics and fx DR.H.SAREMI Orthopedic surgeon Hand and shoulder surgery felloiwship
Sprain Arthrodesis • Grade1 • Grade2 • Grade3 Arthroplasty • Strain (treatment) • Subluxation Arthroscopy • Dislocation(NV,FX) • Fracture dislocation Mal union • Rteductuon Nonunion • Closed • Open • Fixation casting • External traction • Internal external fixator • percutaneous
طبقه بندی شکستگیها • Closed • Open(gustilo anderson classification)
Etiology of FX • Compression • Torsion • Angulation • tension
انواع شکستگی • Traumatic fx • Pathologic fx • Avulsion fx • Stress fx • Insufficiency fx
انواع شکستگی • Traumatic fx • Pathologic fx • Avulsion fx • Stress fx • Insufficiency fx
انواع نیروها • Compression-----------------compression fx • Angulation---------------------Transverse fx • Torsion--------------------------Spiral fx • Compression+angulation-----butterfly fx • Compression+angulation+torsion---------oblique fx
تشخیص شکستگی ا • Mechanism of injury • Sign and symptoms • Pain • Tender ness • Deformity 3.Radiography • Conventional • Specific view(navicular,tangential,magnifying0 4.CT 5.Nuclear scan 6.MRI
تشخیص شکستگی ا NV exam Joint above and below the fx site Specific views
درمان شکستگی • Airway • Breathing • Circulation(bleeding,shock,pain) • Diagnosis of neurological status • Exposure
درمان شکستگی Reduction Fixation -------- casting Closed---------------------------casting Close----------------------traction Closed---------------------------external fix Closed---------------------------per int fix Open-----------------------------external fix Open-----------------------------int fix
درمان شکستگی باز 1.Examining of wound,Neurologic and vascular function 2.Splinting 3.Removal of obvious debris leaves,stones,grass 4.Cover with sterile bandage and transport to operating room 5.Antibiotic and tetanus immunity 6.culture? In the operating room Irrigation and debridement Nervemtendon repair Fixation Approximating sutures or not
مراحل جوش خوردن شکستگی • Inflamatory phase---------2-3 days • Reparative phase • Soft callus------------------3w • Hard callus-----------------3-4m • Remodeling phase-------- ms to ys
عوامل مؤثر در جوش خوردن شکستگی • Anemia • Corticosteroides • Diabetes • Richetes • Excess vit A,D • Delaied reduction • Denervation • Anti coagulating agnts • Radiotherapy
عوامل مؤثر در جوش خوردن شکستگی • W.b • fixation • Nutrition?? • Bone graft • Ultrasound • BMP,……
شکستگی در کودکان • Thick periosteom • Less displacement • Higher union rate • Less stiffness due to immobilization • Better remodeling and correction
انواع شکستگی در کودکان • Bending of bone(plastic deformity) • Green stick fx • Growth plate fx(salterharris classification)
انواع شکستگی در کودکان Child abuse • 3y/o • Multiple fx in different stages of healing • Arm,legthigh,skull • Family history
عوارض شکستگیها • Shock • Neurogenic • Hypovolemic • Thromboemboli----prophylaxy in high risk patients • Obesity • History of TE orTPHorHeart disease • Old • Pelvic fx • drug
عوارض شکستگیها • Fat embolism syndrome • Multiple fx long bones • Afew symptomatic • Young patients lower limb fx • Usually in first 72 h----------up to 3w • Majors features • Minor features
عوارض شکستگیها • Compartementsyndrom 5p • Passive motion is very painful • Open circular cast or bandage • Reduction • Elevation? • Faciotomy if not-----volkman’s ischemic contracture
عوارض شکستگیها • Vascular injury • Neurological injury • Non union and delaied union • Malunion • Stiffness • Myositisossificant • Younger • Elbow>hip> • Fxdis>dis>fx • Head trauma paraplegics • prophylaxis
عوارض شکستگیها • CRPS • Type1--------RSD • Type2------- Pain killer,pt.sympathectomy
