principles of orthopaedics and fx dr.h.saremi orthopedic surgeon

Principles of orthopaedics and fx

DR.H.SAREMIOrthopedic surgeon

Hand and shoulder surgery felloiwship

ارتوپدی تاریخچه

Sprain Arthrodesis•Grade1 •Grade2•Grade3 Arthroplasty

Strain (treatment)

Subluxation Arthroscopy

Dislocation(NV,FX)Fracture dislocation Mal union

Rteductuon NonunionClosedOpen

Fixation castingExternal tractionInternal external fixatorpercutaneous

بندی طبقهشکستگیها

بندی طبقهشکستگیها

Closed

Open(gustilo anderson classification)

Etiology of FX

• Compression

• Torsion

• Angulation

• tension

انواع شکستگی

انواع شکستگی

Traumatic fx

Pathologic fx

Avulsion fx

Stress fx

Insufficiency fx

نیروها نیروها انواع انواع

Compression-----------------compression fx

Angulation---------------------Transverse fx

Torsion--------------------------Spiral fx

Compression+angulation-----butterfly fx

Compression+angulation+torsion---------oblique fx

تشخیص اشکستگیتشخیص شکستگی

1. Mechanism of injury2. Sign and symptoms Pain Tender ness Deformity3.Radiography Conventional Specific view(navicular,tangential,magnifying04.CT5.Nuclear scan6.MRI

تشخیص اشکستگیتشخیص شکستگی

NV examJoint above and below the fx siteSpecific views

AirwayAirway BreathingBreathing Circulation(bleeding,shock,pain)Circulation(bleeding,shock,pain) Diagnosis of neurological statusDiagnosis of neurological status ExposureExposure

شکستگی شکستگی درمان شکستگی درمان شکستگی درمان درمان

Reduction FixationReduction Fixation

-------- -------- castingcasting

Closed---------------------------castingClosed---------------------------casting

Close----------------------tractionClose----------------------traction

Closed---------------------------external fixClosed---------------------------external fix

Closed---------------------------per int fixClosed---------------------------per int fix

Open-----------------------------external fixOpen-----------------------------external fix

Open-----------------------------int fixOpen-----------------------------int fix

شکستگی شکستگی درمان شکستگی درمان شکستگی درمان درمان

شکستگی شکستگی درمان درمانبازباز

شکستگی شکستگی درمان درمانبازباز

1.Examining of wound,Neurologic and vascular function2.Splinting

3.Removal of obvious debris leaves,stones,grass4.Cover with sterile bandage and transport to operating room

5.Antibiotic and tetanus immunity6.culture?

In the operating roomIrrigation and debridement

Nervemtendon repairFixationApproximating sutures or not

Inflamatory phase---------2-3 daysInflamatory phase---------2-3 days

Reparative phaseReparative phase Soft callus------------------3wSoft callus------------------3w Hard callus-----------------3-4mHard callus-----------------3-4m

Remodeling phase-------- ms to ys Remodeling phase-------- ms to ys

جوش جوش مراحل مراحلشکستگی شکستگی خوردن خوردن

جوش جوش مراحل مراحلشکستگی شکستگی خوردن خوردن

AnemiaAnemiaCorticosteroidesCorticosteroidesDiabetesDiabetesRichetesRichetesExcess vit A,DExcess vit A,DDelaied reductionDelaied reductionDenervationDenervationAnti coagulating agntsAnti coagulating agntsRadiotherapyRadiotherapy

در مؤثر در عوامل مؤثر عواملجوشخوردن جوشخوردن شکستگیشکستگی


W.bW.bfixationfixationNutrition??Nutrition??Bone graftBone graftUltrasoundUltrasoundBMP,……BMP,……



Thick periosteomThick periosteomLess displacementLess displacementHigher union rateHigher union rateLess stiffness due to immobilizationLess stiffness due to immobilizationBetter remodeling and correctionBetter remodeling and correction

در در شکستگی شکستگیکودکانکودکان

در در شکستگی شکستگیکودکانکودکان

Bending of bone(plastic deformity)Bending of bone(plastic deformity)

Green stick fxGreen stick fx

Growth plate fx(salter harris Growth plate fx(salter harris classification)classification)

شکستگی شکستگی انواع انواعکودکان کودکان در در


Salter-harrisSalter-harris

Child abuseChild abuse 3y/o3y/o Multiple fx in different stages of healingMultiple fx in different stages of healing Arm,leg thigh,skullArm,leg thigh,skull Family historyFamily history



ShockShock NeurogenicNeurogenic HypovolemicHypovolemic Thromboemboli----prophylaxy in high risk patientsThromboemboli----prophylaxy in high risk patients ObesityObesity History of TE orTPH orHeart diseaseHistory of TE orTPH orHeart disease OldOld Pelvic fxPelvic fx drugdrug

عوارض عوارض شکستگیهاشکستگیها


Fat embolism syndromeFat embolism syndrome Multiple fx long bonesMultiple fx long bones Afew symptomaticAfew symptomatic Young patients lower limb fxYoung patients lower limb fx Usually in first 72 h----------up to 3w Usually in first 72 h----------up to 3w Majors featuresMajors features Minor featuresMinor features



Compartement syndromCompartement syndrom

5p5p Passive motion is very painfulPassive motion is very painful Open circular cast or bandageOpen circular cast or bandage ReductionReduction Elevation?Elevation? Faciotomy if not-----volkman’s Faciotomy if not-----volkman’s

ischemic contractureischemic contracture



VaVascular injuryscular injury Neurological injuryNeurological injury Non union and delaied unionNon union and delaied union MalunionMalunion StiffnessStiffness

Myositis ossificantMyositis ossificant YoungerYounger Elbow>hip>Elbow>hip> Fx dis>dis>fxFx dis>dis>fx Head trauma paraplegicsHead trauma paraplegics prophylaxisprophylaxis



CRPSCRPS Type1--------RSDType1--------RSD Type2-------Type2-------

Pain killer,pt.sympathectomyPain killer,pt.sympathectomy



Distal phalanxDistal phalanx

Metacarpal fxMetacarpal fx

Thumb cmc fx disThumb cmc fx dis

Bennett’s fx disBennett’s fx dis

Rolando’s fx disRolando’s fx dis

wristwrist

Wrist gilula’s lineWrist gilula’s line

scaphoidscaphoid

scaphiodscaphiod

Distal radius fxDistal radius fx

Distal radiusDistal radius

Gleazzi fx disGleazzi fx dis

forearmforearm

Monteggia fx disMonteggia fx dis

Radial headRadial head

olecranonolecranon

coronoidcoronoid

Elbow fx disElbow fx dis

THANK YOU

principles of orthopaedics and fx dr.h.saremi orthopedic surgeon

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