中医骨科学外文版 (28).ppt

Fracture of Scaphoid BoneI.OverviewIntra-articular fractureProne in adultsOne of the most difficult bones to heal due to the special blood supply,with a 10%nonunion rateApplied AnatomyAnatomical snuffbox:located on the wrist and radial side of the dorsum of hand,with a triangular depression pointed towards the thumb when the thumb is extendedRadial side:abductor pollicis longus and extensor pollicis brevisRuler side:extensor hallucis longusProximal side:radial styloid processAnatomical snuffbox bottom:scaphoid boneFracture of Scaphoid Bone The scaphoid bone,lunar bone and triquetral bone are joined together and form an oval articular surface at the proximal end.Applied AnatomyApplied AnatomyResponsible for palmar flexion,dorsiflexion,ulnar deviation and radial deviation of the wrist jointFracture of Scaphoid Bone The scaphoid bone is the The scaphoid bone is the largest piece among carpal largest piece among carpal bones,slightly curved and bones,slightly curved and boat-shaped,with the thinner boat-shaped,with the thinner middle section as the waist,middle section as the waist,where most fractures occur.where most fractures occur.Applied AnatomyFracture of Scaphoid Bone It is located in the proximal row on the radial side in the neutral position of the carpal bones and makes up the wrist joint.Applied AnatomyApplied AnatomyFracture of Scaphoid BoneTuberosity FractureApplied Applied Anatomy:Anatomy:Blood supply of scaphoid bone Blood supply of scaphoid bone comescomes from from the tuberosity the tuberosity and waistand waistWaist FractureProximal FractureApplied AnatomyVery sharp palmar tilt of 10-15 and ulnar tilt of 20-25 on the distal articular surface of the radiusApplied AnatomyThe bones of the wrist are closely aligned and there are no muscles or ligaments attached,so there is usually no significant displacementEtiology and PathogenesisCharacteristics of violence:1.Mostly of transmitting violence,from falls with the palms of the hands landing,the body leaning forward and the forearms pronating 2.The stress is either directly on the scaphoid bone or transmitted upwards through the scaphoid bone tuberosity,and the bodys gravity is transmitted downwards through the radius Fracture of Scaphoid BoneTuberosity fracture Displacement is rare,and it does not affect blood supply to the fracture end,with healing in 6 weeks.Etiology and Pathogenesis:Types and Prognosis of FracturesTypes and Prognosis of FracturesFracture of Scaphoid BoneWaist fracture Displacement is rare,blood supply to the proximal end of the fracture is affected and the healing is slow,with most cases healing within 10 weeks of fixation.Individual cases suffer from nonunion and ischemic necrosis.Types and Prognosis of FracturesTypes and Prognosis of FracturesFracture of Scaphoid BoneProximal fracture Blood supply to the proximal end of the fracture is affected and healing is achieved in 8-10 weeks with appropriate fixation.The prognosis is poor in those with displacement.Diagnosis is easily missed.Types and Prognosis of FracturesTypes and Prognosis of FracturesFracture of Scaphoid BoneHistory of trauma Swelling and tenderness of the snuffboxLimited wrist joint mobility Pain on radial deviation and dorsiflexion of the wrist jointDiagnostic Points.Fracture of Scaphoid Bone Pain in the wrist on percussion of the 2nd and 3rd metacarpal bones and the metacarpal head of the thumbDiagnostic Points.X-ray film(mostly negative at early stage,re-imaging in 1 to 2 weeks)Fracture lineDifferential DiagnosisOld fracture and congenital double scaphoid bone deformityTreatmentNo displacement:more,and can be fixed directly with a forearm overarticular splintsWith displacement:manipulative reduction firstFracture of Scaphoid BoneManipulative reduction:Draw the lower carpal ulnar deviation and press the thumb medially to reduce the bone.Fix the wrist joint in a plaster cast at dorsiflexion of 25 30,ulnar deviation of 10,and keep palmar opposition of thumb,and neutral forearm position.Tuberosity fracture heals in 6 weeks and should be fixed for 34 months.The rest heals in 3-6 months and should be fixed for up to 6 months or a year.Fracture of Scaphoid BoneFix the wrist joint in a plaster cast at dorsiflexion of 25-30,ulnar deviation of 10,palmar opposition of thumb,and neutral forearm position.Plaster castOld fracture3 weeks after injuryDelayed healing-nonunion-necrosisBone graft fusionRadial styloidectomyScaphoidectomyWrist fusion