membru superior 1
DESCRIPTION
bTRANSCRIPT
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Mecanism de producere
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Clasificarea AllmanClasificarea Allman
1. Fractura treimii medii
2. Fractura treimii externe
3. Fractura treimii interne
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• Fracturi ale treimii mediiFracturi ale treimii medii• Fracturi ale treimii distaleFracturi ale treimii distale
– Tip I – cu deplasare minimă/interligamentară– Tip II – cu deplasare datorită poziţiei fracturii medial de
ligamentele coracoclaviculare• IIA conoidul şi trapezoidul ramân ataşate de fragmentul distal• II B fie conoidul, fie ambele sunt rupte
– Tip III – fracturi cu implicare articulară– Tip IV – ligamentele ataşate la periost, cu deplasarea
fragmentului proximal– Tip V – cominutive
• Fracturi ale treimii proximale– Tip I – cu deplasare minimă– Tip II – cu deplasare– Tip III – intraarticulare– Tip IV – separare a epifizei (sub vârsta de 25 de ani)– Tip V – cominutive
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Fracturile treimii medii
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Fractură fără deplasareFractură fără deplasare
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Fractură cu deplasareFractură cu deplasare
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Fracturile extremităţii Fracturile extremităţii distaledistale
Tip I
(fără deplasare)
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Tipul IIA
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Tipul IIB
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Tip IIITip III
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Aspect clinic
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ComplicaComplicaţiiţii
Leziuni vasculo-nervoase
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PseudartrozaPseudartroza
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Bandaj încrucişat în 8 Bandaj încrucişat în 8 (Billington)(Billington)
TRATAMENTUL FRACTURILOR CLAVICULEI
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A. Perham
B. Böhler brace
C. Taylor
D. -
E. Velpeau
F. Velpeau modificat
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IndicaIndicaţiile tratamenului chirurgicalţiile tratamenului chirurgical
•Pseudartroza
•Fractura deschisă sau cu iminenţa de deschidere
•Fractura cu fragmente intermediare
•Leziuni vasculo-nervoase
•Fracturile capătului distal cu ruptura ligamentului coracoclavicular la adult
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Fixarea centromedulară cu broşe KirschnerFixarea centromedulară cu broşe Kirschner(Tehnica Mc Keever)(Tehnica Mc Keever)
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Osteosinteza cu placă şi şuruburi (DCP)Osteosinteza cu placă şi şuruburi (DCP)
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Anatomia scapulei
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ClasificareA. Fractura unghiurilor omoplatului• Fractura unghiului extern - fractura gâtului anatomic - fractura gâtului chirurgical• Fractura unghiului inferior• Fractura unghiului intern
B. Fractura corpului omoplatuluiC. Fracturile apofizei coracoide şi ale
acromionului
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Fractură glenoidală antero-inferioară
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Fractura cominutivă a cavităţii glenoideFractura cominutivă a cavităţii glenoide
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Fractura bazei Fractura bazei acromionuluiacromionului
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Fractura bazei apofizei Fractura bazei apofizei coracoidecoracoide
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Fractură stabilă/instabilă a colului scapulei
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Tratament• Majoritatea conservator• Uneori chirurgical
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Tratament•
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Tratament•
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Tratament•
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TratamentTratament
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Disociere scapulo-toracicăDisociere scapulo-toracică
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Luxaţii acromoiclaviculare
Clasificarea Rockwood
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Rockwood tip III
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Disjuncţie acromioclaviculară Tratament chirurgical
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Mecanism de producereMecanism de producere
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Luxaţie subcoracoidiană
Luxaţie infraglenoidiană (erectă)
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Luxaţie anterioară intratoracicăLuxaţie anterioară subclaviculară
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Coafa rotatorilor• Subscapularis• Supraspinatus• Infraspinatus• Teres minor
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Mecanism de producere
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Clasificarea Neer
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Fractură extremitate proximală humerus
Aspect clinic
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Incidenţă axilară a Rtg în fracturile extremităţii proximale humerus
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Neer ?
Neer ?
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Reducere şi OS cu tijă zăvorâtăReducere şi OS cu tijă zăvorâtă
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Targon interlocking nailTargon interlocking nail
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Helix wireHelix wire
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Reducere şi OS cu placă şi Reducere şi OS cu placă şi şuruburişuruburi
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Procedeul Neer de reducere a fracturilor Procedeul Neer de reducere a fracturilor trohiterului în 3 părţitrohiterului în 3 părţi
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Procedeul Neer de reducere a Procedeul Neer de reducere a fracturilor trohinului în 3 părţifracturilor trohinului în 3 părţi
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Osteosinteză cu fixator externOsteosinteză cu fixator extern
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Endoprotetizarea extremităţii Endoprotetizarea extremităţii proximale humeraleproximale humerale
Indicaţii
• Fracturile în 4 părţi cu deplasare• Fracturi-dislocaţie în 4 părţi• Fracturile cominutive complexe ale capului
femural• Fracturi pe os patologic• Redori secundare foarte strânse
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Endoproteze tip Neer IEndoproteze tip Neer I
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Endoproteze tip Neer IIEndoproteze tip Neer II
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Fractură cominutivă în 4 Fractură cominutivă în 4 părţipărţi endoproteti endoprotetizatăzată
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Endoprotetizare cu reinserEndoprotetizare cu reinserţţia ia trohiteruluitrohiterului
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Mecanism de producere• Direct
• Indirect
→ tipurile de fractură
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Examen clinic• Probabilitate• Certitudine• + ?
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Examen clinic• Probabilitate• Certitudine• + → ax vasculo-nervos
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Examen clinic• Probabilitate• Certitudine• + → ax vasculo-nervos• ?
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Examen clinic• Probabilitate• Certitudine• + → ax vasculo-nervos• radiografie → 2 incidenţe
perpendiculare
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Fractură pe os patologic
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Clasificarea AO a fracturilor diafizei humerale
Ia în considerare următorii factori:
1. Localizare
•Proximale
•Medii
•Distale
2. Traiect
•Transverse
•Oblice
•Spiroide
•Cominutive
3. Leziuni asociate ale ţesuturilor moi
4. Leziuni asociate vasculo-nervoase
5. Starea osului (normal sau patologic)
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Tratamentul ortopedicfuncţie de vârstă, forma anatomoclinică şi de funcţie de vârstă, forma anatomoclinică şi de complicaţiicomplicaţii
Adulţi, cu fracturi fără deplasare sau cu deplasare moderată:
• Imobilizare în aparat gipsat toracobrahial
(atelă gipsată brahială în ’’U’’ – Böhler, manşon gipsat brahial
cu antebraţul liber – W. Jones, Crawford Adams)Fracturi cu deplasare ale diafizei:
• Reducere şi imobilizare în aparat gipsat toracobrahial (abducţie 45º, anteducţie 30º, rotaţie externă)Fracturi cominutive
• Aparat de atârnare Caldwell 14 zile, apoi ap. gipsat obişnuit
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Indicaţiile tratamentului chirurgical
• Fracturile deschise• Leziuni vasculare asociate• Fracturi pe os patologic• Fracturi bilaterale de humerus• Fracturi humerale la un pacient
politraumatizat• Disfuncţii ale nervului radial după
manipularea fracturilor humerale• Eşecul tratamentului ortopedic• Fracturi cu extensie intraarticulară
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Aparat de atârnare Caldwell
Atelă brahială în ‘’U’’ Manşon gipsat brahial funcţional
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Aparat gipsat de atârnare Caldwell
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Tratamentul chirurgical
Osteosinteză cu placă şi şuruburi Fixator extern
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Osteosinteză cu tije Ender Osteosinteză centromedulară cu tije zăvorâte (Küntscher)
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Complicaţii
Leziunea nervului radial
(Fractura Holstein-Lewis – oblică, treimea distală)
![Page 100: Membru Superior 1](https://reader035.vdocuments.site/reader035/viewer/2022081506/55cf9292550346f57b978de3/html5/thumbnails/100.jpg)
Complicaţii
Leziunea nervului radial
(Fractura Holstein-Lewis – oblică, treimea distală)
![Page 101: Membru Superior 1](https://reader035.vdocuments.site/reader035/viewer/2022081506/55cf9292550346f57b978de3/html5/thumbnails/101.jpg)
Complicaţii
![Page 102: Membru Superior 1](https://reader035.vdocuments.site/reader035/viewer/2022081506/55cf9292550346f57b978de3/html5/thumbnails/102.jpg)
Complicaţii
![Page 103: Membru Superior 1](https://reader035.vdocuments.site/reader035/viewer/2022081506/55cf9292550346f57b978de3/html5/thumbnails/103.jpg)
Complicaţii
![Page 104: Membru Superior 1](https://reader035.vdocuments.site/reader035/viewer/2022081506/55cf9292550346f57b978de3/html5/thumbnails/104.jpg)
Pseudartroza
![Page 105: Membru Superior 1](https://reader035.vdocuments.site/reader035/viewer/2022081506/55cf9292550346f57b978de3/html5/thumbnails/105.jpg)
![Page 106: Membru Superior 1](https://reader035.vdocuments.site/reader035/viewer/2022081506/55cf9292550346f57b978de3/html5/thumbnails/106.jpg)
![Page 107: Membru Superior 1](https://reader035.vdocuments.site/reader035/viewer/2022081506/55cf9292550346f57b978de3/html5/thumbnails/107.jpg)
![Page 108: Membru Superior 1](https://reader035.vdocuments.site/reader035/viewer/2022081506/55cf9292550346f57b978de3/html5/thumbnails/108.jpg)
Clasificare
1. Supracondiliană
2. Supra-intercondiliană
3. Diacondiliană
4. A epitrohleei
5. A epicondilului humeral
6. A trohleei
7. A capitelului
![Page 109: Membru Superior 1](https://reader035.vdocuments.site/reader035/viewer/2022081506/55cf9292550346f57b978de3/html5/thumbnails/109.jpg)
Fracturile supracondiliene
![Page 110: Membru Superior 1](https://reader035.vdocuments.site/reader035/viewer/2022081506/55cf9292550346f57b978de3/html5/thumbnails/110.jpg)
Clasificarea fracturilor supra-
intercondiliene (Riseborough & Radin)
Tip I: Fără dislocare
Tip II: Cu deplasare, dar fără rotaţie
Tip III: Cu deplasare şi rotaţie
Tip IV: cu deplasare, rotaţie, cominutivă
![Page 111: Membru Superior 1](https://reader035.vdocuments.site/reader035/viewer/2022081506/55cf9292550346f57b978de3/html5/thumbnails/111.jpg)
Tratament
• Reducere ortopedică, imobilizare în aparat gipsat brahiopalmar (doar în fracturile fără deplasare!)
• Extensie continuă transscheletică cu broşe sau şurub transolecranian, cu cotul la zenit
(în fracturile cu cominuţie importantă şi la pacienţii tineri) • Tratament chirurgical (cu o singură contraindicaţie: fracturile cominutive cu fragmente
mici)
![Page 112: Membru Superior 1](https://reader035.vdocuments.site/reader035/viewer/2022081506/55cf9292550346f57b978de3/html5/thumbnails/112.jpg)
![Page 113: Membru Superior 1](https://reader035.vdocuments.site/reader035/viewer/2022081506/55cf9292550346f57b978de3/html5/thumbnails/113.jpg)
![Page 114: Membru Superior 1](https://reader035.vdocuments.site/reader035/viewer/2022081506/55cf9292550346f57b978de3/html5/thumbnails/114.jpg)
![Page 115: Membru Superior 1](https://reader035.vdocuments.site/reader035/viewer/2022081506/55cf9292550346f57b978de3/html5/thumbnails/115.jpg)
Reducere, osteosinteză cu plăci semitubulare, respectiv grefon osos corticospongios
![Page 116: Membru Superior 1](https://reader035.vdocuments.site/reader035/viewer/2022081506/55cf9292550346f57b978de3/html5/thumbnails/116.jpg)
Fracturile izolate ale condililor humerali(Clasificarea Milch)
Tip I: nu intersează creasta laterală a trohleei humerale
Tip II: interesează creasta laterală a trohleei humerale
![Page 117: Membru Superior 1](https://reader035.vdocuments.site/reader035/viewer/2022081506/55cf9292550346f57b978de3/html5/thumbnails/117.jpg)
a. Fractura condilului lateral tip I b. Fractura condilului lateral tip II
![Page 118: Membru Superior 1](https://reader035.vdocuments.site/reader035/viewer/2022081506/55cf9292550346f57b978de3/html5/thumbnails/118.jpg)
Fractura condilului medial - Osteosinteză cu şuruburi -
![Page 119: Membru Superior 1](https://reader035.vdocuments.site/reader035/viewer/2022081506/55cf9292550346f57b978de3/html5/thumbnails/119.jpg)
Fractura capitelului humeral
![Page 120: Membru Superior 1](https://reader035.vdocuments.site/reader035/viewer/2022081506/55cf9292550346f57b978de3/html5/thumbnails/120.jpg)
Fractura epicondilului medial
![Page 121: Membru Superior 1](https://reader035.vdocuments.site/reader035/viewer/2022081506/55cf9292550346f57b978de3/html5/thumbnails/121.jpg)
Fractura epicondilului lateral şi medial
![Page 122: Membru Superior 1](https://reader035.vdocuments.site/reader035/viewer/2022081506/55cf9292550346f57b978de3/html5/thumbnails/122.jpg)
Fractura epicondilului medial cu inclavare intraarticulară
![Page 123: Membru Superior 1](https://reader035.vdocuments.site/reader035/viewer/2022081506/55cf9292550346f57b978de3/html5/thumbnails/123.jpg)
Luxaţiile cotului
Subluxaţie laterală a cotului Luxaţie laterală a cotului
![Page 124: Membru Superior 1](https://reader035.vdocuments.site/reader035/viewer/2022081506/55cf9292550346f57b978de3/html5/thumbnails/124.jpg)
Luxaţie divergentă a cotului
![Page 125: Membru Superior 1](https://reader035.vdocuments.site/reader035/viewer/2022081506/55cf9292550346f57b978de3/html5/thumbnails/125.jpg)
Luxaţie anterioară a capului radial
![Page 126: Membru Superior 1](https://reader035.vdocuments.site/reader035/viewer/2022081506/55cf9292550346f57b978de3/html5/thumbnails/126.jpg)
![Page 127: Membru Superior 1](https://reader035.vdocuments.site/reader035/viewer/2022081506/55cf9292550346f57b978de3/html5/thumbnails/127.jpg)
![Page 128: Membru Superior 1](https://reader035.vdocuments.site/reader035/viewer/2022081506/55cf9292550346f57b978de3/html5/thumbnails/128.jpg)
Tratament
![Page 129: Membru Superior 1](https://reader035.vdocuments.site/reader035/viewer/2022081506/55cf9292550346f57b978de3/html5/thumbnails/129.jpg)
Osteosinteză cu şurub
![Page 130: Membru Superior 1](https://reader035.vdocuments.site/reader035/viewer/2022081506/55cf9292550346f57b978de3/html5/thumbnails/130.jpg)
Osteosinteză cu placă şi şuruburi
![Page 131: Membru Superior 1](https://reader035.vdocuments.site/reader035/viewer/2022081506/55cf9292550346f57b978de3/html5/thumbnails/131.jpg)
Metoda hobanului
![Page 132: Membru Superior 1](https://reader035.vdocuments.site/reader035/viewer/2022081506/55cf9292550346f57b978de3/html5/thumbnails/132.jpg)
![Page 133: Membru Superior 1](https://reader035.vdocuments.site/reader035/viewer/2022081506/55cf9292550346f57b978de3/html5/thumbnails/133.jpg)
Mecanism de producere
![Page 134: Membru Superior 1](https://reader035.vdocuments.site/reader035/viewer/2022081506/55cf9292550346f57b978de3/html5/thumbnails/134.jpg)
Clasificare (Mason)
• Tip I: Fractură parcelară sau completă, fără deplasare
• Tip II: Fractura cu deplasare• Tip III: Fractura cominutivă
![Page 135: Membru Superior 1](https://reader035.vdocuments.site/reader035/viewer/2022081506/55cf9292550346f57b978de3/html5/thumbnails/135.jpg)
Fractură cap radial tip I
![Page 136: Membru Superior 1](https://reader035.vdocuments.site/reader035/viewer/2022081506/55cf9292550346f57b978de3/html5/thumbnails/136.jpg)
Fractură cominutivă cap radial
![Page 137: Membru Superior 1](https://reader035.vdocuments.site/reader035/viewer/2022081506/55cf9292550346f57b978de3/html5/thumbnails/137.jpg)
Tratament
![Page 138: Membru Superior 1](https://reader035.vdocuments.site/reader035/viewer/2022081506/55cf9292550346f57b978de3/html5/thumbnails/138.jpg)
Tratament
![Page 139: Membru Superior 1](https://reader035.vdocuments.site/reader035/viewer/2022081506/55cf9292550346f57b978de3/html5/thumbnails/139.jpg)
Tratament
![Page 140: Membru Superior 1](https://reader035.vdocuments.site/reader035/viewer/2022081506/55cf9292550346f57b978de3/html5/thumbnails/140.jpg)
Tratament
![Page 141: Membru Superior 1](https://reader035.vdocuments.site/reader035/viewer/2022081506/55cf9292550346f57b978de3/html5/thumbnails/141.jpg)
Tratament