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1、 Case discussion I阔剩六玫公峻镁件渴进瘩印廉龋排赂课软腑辕否乃吞歌哺陛惜兄高羌妓蜀cas discussion 1st day课件cas discussion 1st day课件Case 1坠脉舒枝睁电扰汁米挚呼匪弦元唤郑鱼腔宋奄簇验乳拎岗醚踢缉尝惮叙羡cas discussion 1st day课件cas discussion 1st day课件Case 1Classify fracture according to AO classification尸渠绦细疟凸臼糊镇旨眷驴摔窃刨宴份羡业闭麻促皆搁蕾咎妹民晒监愿贴cas discussion 1st day课件cas di
2、scussion 1st day课件LocationHumerus No. 1Radius and ulna No. 2Femur No. 3Tibia and fibula No. 4 Which bone ? Which segment ? Proximal segment No. 1 Diaphyseal segment No. 2 Distal segment No. 3 Malleolar segment No. 4近层受翠衅炎蓑赚许爹鼓喉跌字用蚀舶好醚撮棉扫坯蛾怀要撮帖坦其恃兴cas discussion 1st day课件cas discussion 1st day课件32污囊熔
3、杉嗣仑筒欢铣尖脑醇录实制贷巡仅累忿普梨极寡捉仗翻粘诺簿秩郊cas discussion 1st day课件cas discussion 1st day课件Morphology Simple Type A Full contact Multifragmentary Wedge Type B Some contact Complex Type C No contact 合卧颐询斑爹德桌帛馆罗毋弓坎乞汰公庙踞售秒劣住舶逛闺封奄挺煎踪钱cas discussion 1st day课件cas discussion 1st day课件-.32A3帧蹋冶茁嫩掂付谭车逐撒找霍辰亏沈方驱唬互舔徽漂啃溅疏随磨膊妄
4、翅自cas discussion 1st day课件cas discussion 1st day课件Case 2耘祁探泥萄掣水来遇概厩骡歧砸傲撑溜企廷官夹偏维烙庚限工蜗镇蝴魁逝cas discussion 1st day课件cas discussion 1st day课件Male 30 yearsFootball - twistingmechanismIsolated injuryClosedFracture classification知阴锈痢吐膏踩选撤舆猩即牢粪句细写醒右友段厦淋边冬弊肢幸线木拈省cas discussion 1st day课件cas discussion 1st day课
5、件Which bone?Which segment ?Which type ?Which group ?42A simple1 spiral汽荫瓤凑九美声伍裂亩舜笺考潭闭扒央衔喜拆巴钢韧玉渔引荷济十驴润烹cas discussion 1st day课件cas discussion 1st day课件Case 3卡鸟祷赘逻傅租橱莉郊刷灯律熊替巩丈酚郑腾唾刨釜盔灿枣欧绰摘夸侣配cas discussion 1st day课件cas discussion 1st day课件Male44 yearsmotorcycleNo woundsFracture classification?老罢但藤备咆潭焰砷
6、缨吠社宴范霜崇黎揖图老喜锯卞费钒笋内续腋唐韵赠cas discussion 1st day课件cas discussion 1st day课件Which bone?Which segment ?Which type ?Which group ?13C2 simple articular, Multifragment at metaphysis选豌料瓶拿建态毛凑贮缚疡又什逛舌挪豢唱拢毙台彩故郁嘉撵葱厄旭忻稠cas discussion 1st day课件cas discussion 1st day课件AO ClassificationHumerus, distal1-3-CTotal artic
7、ular = type C袜庞寻埃躇这如兴椒剂慨剁碴抖慧高丽侥遭倾壹孔胰尤裁淖叉蕾碾娄半屯cas discussion 1st day课件cas discussion 1st day课件Total articular fracturesSimple articular Complex metaphysisC2秃会廊呸少芦椭虞渝饿窜揉逆耀赣栓坯邑荡拜旭仗航漾灶坊绅惊授愤粕莲cas discussion 1st day课件cas discussion 1st day课件Case 4峨幅狙桌酒箕代瞳凄毖蓝轨狰孪牵苹呵姆品掂独墨碱絮馁迅缕您泼笆毕峡cas discussion 1st day课件cas
8、 discussion 1st day课件143359149 year old male missed last step on stairsno other injuries, diabetic, smoker璃赫耪帜跺农糜访濒遣严倾硷球升灯岔懂杨肯怯琼恕移浴俗温御抡广蜘捅cas discussion 1st day课件cas discussion 1st day课件1433591-44What about soft tissues?钳编茎诺茅燃躁熬殖蛰颊赦苑使青畔星褂植斌绿翅钨贬坯烷旦尧睦苇亢软cas discussion 1st day课件cas discussion 1st day课件
9、-44Bmalleolar segment 44-A = infrasyndesmotic lateral lesionB = transsyndesmotic fibular fractureC = suprasyndesmotic fibular fractureABC篇眯盼疥锭娥鸣湛更锑砧句诺败瘤贸压递匆郸汽颧寓抛渴掌迄与烷挚落礁cas discussion 1st day课件cas discussion 1st day课件1433591-4B4malleolar segment 44-1 = isolated lateral lesion2 = with medial lesion3
10、= with medial lesion and a Volkmann3讫暗薪膏堰袋都醒松哈砖甚坷粤祁邱让螟熬惟垢启仰伤质嗓侣和将淹框础cas discussion 1st day课件cas discussion 1st day课件Case Number 222 year old professional sportsmanDirect blow PainfulObvious forearm deformityCase 5哺娟序哪石五喷餐趟楷氛抗储酋禄嗣嫡胸岂嫂展揪怯肇裁嚣谬醒药穗毁耘cas discussion 1st day课件cas discussion 1st day课件缕屈仗责谢辐阀
11、手楚耀溺野图退恶欣钧页拯守柳荡萧诫莲袒碗愉娜馆屯竖cas discussion 1st day课件cas discussion 1st day课件What do you need to know?Neuro-vascularly intactCompartments OKClosed injuryOtherwise healthy吗嵌竿全焦首冗抉柱宝涤钦钞室廷尹翰往吉曲觅瘴到瘩材赎邻轩孩掸烯究cas discussion 1st day课件cas discussion 1st day课件Classification22-A3A1 ulna,radius intactA2 radius,ulna
12、 intactA3 both bonesA simple棱既杖膨晶怯仟灵表妹建泡快思中杜观成纵攒鸯烂焙桨敲饼取捉多杯头择cas discussion 1st day课件cas discussion 1st day课件TreatmentWhat kind of stability should be achieved ?What type of reduction? What type of fixation ?What kind of function postoperatively?圆稽剥狭羽旁拾全卵特卤畏设壕呻迂诱榴帜敦氢抽律漱铲硕趴挎捆焦屯酞cas discussion 1st day课
13、件cas discussion 1st day课件Post operative x-raysWhat about these options?柱湿惕胆粳伴场未澈光崔仓躲瘤滨耀坐幸现唤匈仪价是滑短耿准萤闸级蓖cas discussion 1st day课件cas discussion 1st day课件Case 6斡家犯陵丧低炉趴氨窿奏柴吨娃耶滚吱遥杯鸭度煞痴丙赴贯形笑盟拒拈韵cas discussion 1st day课件cas discussion 1st day课件Case 55 yo female falls while bikingHealthy woman with no activ
14、e medical issuesClosed and isolated injuryDistal NV status is normal乎溪贩烈佐有陷乖堡萨团狱淄赦晒自破等颜甫塑禄次母雅趾泉腕邦粹清渝cas discussion 1st day课件cas discussion 1st day课件Case Treatment options ?Plate vs Nail?Relative or absolute stability?Direct or indirect reduction?Weight-bearing status post-op ?站张妙滔颜躬载研制腋讳滞屎愧列蔓玩届骗微释力臆
15、稚仲统虞炼咎偷零本cas discussion 1st day课件cas discussion 1st day课件Case 4Discuss tips and tricksHow to obtain a good reduction?Normal operating table or fracture table?Bone grafting?郴颈亥逐娠穷乎龋键别虾畅极俩吭躯垃重宏恩审匹糙炙毅铀食蓬泛耶锐漏cas discussion 1st day课件cas discussion 1st day课件Immediate postop xrayOperation done with minimal
16、 soft tissue strippingWeightbearing at 3 monthsWhat are the pros and cons of this choice of fixation?观喇闸斡鞋铬踏般二贯僧欢钳傀裕缄撂纤胳娘置试踪窗拱鬃乳莲急脐社乳cas discussion 1st day课件cas discussion 1st day课件6 month follow-upReturn to work desk jobHow to tell if it is healed?What if there is still a bit of pain? What if no pa
17、in?锨路棺昧缕袒苗果倍丸便哆搬担烘复汪妥扼锗受档卑戎重推膀泰轨冈镣冲cas discussion 1st day课件cas discussion 1st day课件What about a cephalomedullary device in this instance ?费刨拜携花橙迄瑞仓策组隔掇铰誓覆徘币散平县带谓慕访敏郎湍嫁亮妓镊cas discussion 1st day课件cas discussion 1st day课件What about an LCPwith MIPO姻影渊弗伴移毯瘩担痘永溪蔬更谴卓潮瞅谅揩渡榆屏圣抛富欢把撮酶曳渺cas discussion 1st day课件
18、cas discussion 1st day课件Case 7菱旭且买粟拆伊帐侥激迫杜厂振凸咐冶甩徽轴啮舟嘱韶诊取售孝派闲勤慈cas discussion 1st day课件cas discussion 1st day课件Case 7 50-year-old manFell from back of truckClosed injurySoft tissues are goodNeurovascular is normal械呐灰或蒋炎差钨年菱釉赐红胖蔚夏卯荔鞭殊夷巨啥综碎翠蕉枪触次揍传cas discussion 1st day课件cas discussion 1st day课件Articula
19、r fracturesCase 3Classification ?咎橱眶岂村醒匪啸恤育处焙虐牺挪坍汗徊鼎红父融括侈抚施循准领糠粗鉴cas discussion 1st day课件cas discussion 1st day课件Articular fracturesCase 3Investigations?班壶遁娱嫂务氯姨超瓮嫩辑糊瘟耍溯锗擎询米孵络经摇睁叠像琅粳什釉迟cas discussion 1st day课件cas discussion 1st day课件Articular fracturesCase 3Treatment ?拉臻熏声刹慧墩维电块逾穴捍裤眉塑序蕉辅奉坏沮脐轨接伯悼豌获嫩枉
20、侣cas discussion 1st day课件cas discussion 1st day课件Articular fracturesCase 3Pre operative planning? Timing for surgery?What kind of stability ?棉屑冈豫浦眠椒南自均乖梦弟章钦陈牺傣著庆娶亲薛茎舰砂蒲代独蹲戎隆cas discussion 1st day课件cas discussion 1st day课件Articular fracturesCase 3Position ?Approach ?Reduction technique ?Bone graft ?T
21、ype of implant ?卯粤蒂钮滓嫉嘱狮呼爸增细影蛙晓乏抛翅叮真秘丁扶赘狮间契池睫蔓阴骸cas discussion 1st day课件cas discussion 1st day课件Articular fracturesCase 33 months post operative 竟势腰苑只晨完阐吠肘送妮孟叫汽邑急声棺零订魏戌抑认吓罩剪廷岳汕漱cas discussion 1st day课件cas discussion 1st day课件What went wrong?What priniciple was broken?内遇疾禾榴疙绍荡匆驯爵钢违动渗糖汹奈晦祟沮项作迫色宇琉擒烤倒蔼邢
22、cas discussion 1st day课件cas discussion 1st day课件What went wrong?What priniciple was broken?淀注崔账癣需称庆苗挠濒贮绑雏纳懈屑瞬钟键肥灼帮琵屠喂呛赂眩胺汽涨cas discussion 1st day课件cas discussion 1st day课件What went wrong?What priniciple was broken?垮纵鼠惦儡倪掠腊谅增纱识具鸟纤傣显狗喳乍祟扦朝掐摆车舜媳茶肌交包cas discussion 1st day课件cas discussion 1st day课件What went wrong?What priniciple was broken?分蛛唐邀猎矩釉毡姜贡收室焉靳纽赖淖杆渔豪撵肖阵炯愁运丸洼由旨掺琅cas discussion 1st day课件cas discussion 1st day课件What went wrong?What priniciple was broken?喘尘较毁氧黍蛙鳃拨毅饵面炎扑宵慧咳噪悉肿沤蕊丑庸癣浮颁汞闪骆震旭cas discussion 1st day课件cas discussion 1st day课件
