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1、ORTHOPEDICS INTRODUCTION,Wenzhou Central Hospital Traumatology Department Chen Mang-mang,Section one definition cause classification displacement,一、Definition：,The integrity and/or continuity of the bone be interruptted,二、cause,1direct violence：meas:violence direct to the bone-than fracture.,2indire
2、ct violence：translate to the bone-than fracture. Violence indirect to the fracture part.(such as colles fracture) 。myotility ：muscles attached the bone(patella fracture) 。transverse process fracture.,3fatigue fracture ：Long-term, repeated and minor external force.the stress accumulated.such as: the
3、second and third metatarsal fractures because of long-distance march ;distal 1/3 part fibula fracture above three types,all occur in healthy bone,called Traumatic fractures 4pathological fracture ：occur in Bone disease , Slight force 。(tumor、infection),三、classification(plenty of),（一）according to ski
4、n、Mucosa of the frature . 1、close fracture：ends of the fracture and air are interlinked. 2、open fracture：arent interlinked,（二） according to severity and shape,1、incomplete fracture ： The integrity and/or continuity of the bone be interruptted 1）linear fracture ：gap,not displaced.（The skull bone,scap
5、ula bone） 2）greendstick fracture ：Bone and periosteum partly broken ，with or without angulation deformity 。（like Willow branches ）,2、complete fracture：The integrity and/or continuity of the bone be interruptted completely According to fracture line and shape： 1）Transverse Fracture：fracture and verti
6、cal axis =vertical。 (right pic.）,三、 according to severity and shape,2）oblique fracture ：fracture line and vertical axis to form a certain Angle （as right figure）,（ according to severity and shape ）,3）spiral fracture: (right pic.）,4comminuted fracture：more than 2 fragments。（as right pic.）,三、 accordin
7、g to severity and shape,5）impacted fracture：the fragments compacted into the other one，mainly occurs in fracture of metaphysis 。Insert cancellous bone cortical bone inserted into cancellous bone(right pic.),三,6compression fracture ：compressed and deformed。 Occurs in spongy bone 。如spinal fracture ，ca
8、lcaneal fracture。(right pic.),三,7）depressed fracture： Skull bone。 8）Epiphyseal separation：fracture line goes through the epiphyseal。,according to stable or not,1、stable fracture：the ends of the fracture is not easy to move/stabe after reduction.such as:Crack fracture, greenstick fracture, transverse
9、 fracture, compression fractures, impacted fractures etc. 2、un stable fracture：move again easily.。Such as:Oblique fracture, spiral fracture, comminuted fracture etc.,according to time,1、fresh fracture：less than 3 weeks. 2、old fracture：More than 3 weeks 。 *Involving the articular surface:Intra-articu
10、lar fractures-Anatomical reduction,四、fragment displacement,Relatement: force is big/small;,the direction /character of the force 。 The weight of the distal body。 Pull force of the muscles。 Transfer/treatment is not proper.,四、 fragment displace,The most common types angular displacement lateral displ
11、acement shorten displacement separation displacement rotating displacement,Section 2:clinical manifestation and x ray examimation,General menifestation,shock Could be：serious open fracture,pelvis fracture cause：Extensive soft tissue contusion 、Severe pain 、bleeding、Visceral injury fever Hematoma,bod
12、y temperature less than 38,local menifestation,usual manifestations： pain、swelling 、obstacle 。 Special signs ： deformity; abnormal movement; bony crepitus One of above 3=fracture A question?,Xray examination,Have an important value of diagnosis and treatment ,so Routinely to take the x-ray. AP-Xray,
13、LP-Xray(contain adjacent joints ) Compared with the contralateral limb if necessary,section3 complication,（一）early complication,shock fat embolism syndrome Visceral injury(Lung, liver, spleen, bladder, urethra, rectum ) Important surrounding tissue damage （blood vessel、surrounding nerve、spinal nerve
14、 cord injury） bonefascial compartment syndrome （Common in the calves and forearm ）,（二）later complication,Hypostatic pneumonia bedsore Deep vein thrombosis of lower limbs infection（pyogenic osteomyelitis ）,（二） later complication,Traumatic ossification traumatic arthritis arthroclisis ischemic contrac
15、tion ischemic necrosis ischemic muscle contracture,stardard of Clinical healing,Local tenderness and longitudinal taps pain; Abnormal activity X-ray show:fracture line is obscure; calluscontinuous observation for two weeks without deformation; Without fixion,hold the upper limbs at least for 1min,1k
16、g;walk for 3min,at least 30 steps for lower limbs.,Section 5 Factors affectting the healing of fracture,一、Systemic factors,age Health status,二、local factors,types and quantities Blood supply Objective soft tissue injury Soft tissue insert infection,三、The influence of treatment,repeatedly gimmick res
17、et (outer membrane injury of soft tissue and bone) Cutopen reduction (soft tissue, stripping bone outer membrane) improper debridement of open fracture(bone defect caused by removing the broken bone) continuous traction inappropriatelyweak fixion(callus growth) Functional exercise (premature and inappropriate),
