dislocation肘关节脱位课件

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1、WARRAICHROLL#17-CElbowDislocationBasicsHistoryoftrauma.Posteriordislocationismostcommon.Agegroup:<20yearsofage.Rarely,elbowdislocationcanoccurinelderlypatientsafterafall.Commonsite:ulnohumeraljoint.Classification(stimson)Proximalradioulnarjointintact:Posterior(90%):Poste

2、rolateralPosteromedialAnteriorMediallateralProximalradioulnarjointdisrupted:AnteroposteriorRadiusisanteriorUlnaisposteriorMediallateral:RadiusislateralulnaismedialTreeibletraidoftheelbow:PosteriordislocationofelbowRadialheadfractureFractureofcoronoidprocessofulnaPathophy

3、siologyThecollateralligamentsusuallyareruptured,withinjurytothebrachialismuscleandcoronoid.AssociatedConditionsFractureoftheradiusFractureoftheulnaFractureofthehumerusUlnarandmediannerveinjuryBrachialarteryinjuryCont..fig:complexdislocationoftheelbow.Inadditiontodislocat

4、ion,therearemultiplefractureoftheelbow.Cont…NerveinjuryCont..Arteryinjuries:DiagnosisSignsandSymptomsThepatientpresentswith:pain,swelling,elbowdeformity,andinabilitytomovetheelbow.PhysicalExamAssessthepatient'sneurovascularstatus.Examinethefunctionsoftheradial,median,and

5、ulnarnervesbeforereduction.Themediannervecanbeinjuredatthetimeofreductionbybecomingentrappedinthejoint.checknervefunctionbeforeandafterreduction.Evaluatethepatientforbrachialarteryinjurybeforereduction.Thebrachialarterymaybetrappedinthejointalongwiththemediannerve.Vascul

6、arinjuryisanindicationforimmediatesurgery.Cont..Fig:Cont..Arteryinjuries:Exam..Theupperextremityshouldbeinspectedforotherinjuries,suchasMonteggiafracture-dislocation[fractureoftheulnawithradialheaddislocation].Palpatetheforearmforincreasedswellingorsignsofcompartmentsynd

7、romeTestsImagingRadiography:AP:greatersuperimpositionofdistalhumeruswithproximalulnaandolecranonisseen.lateralviews:coronoidprocessliesposteriortothecondylesofthehumerusCT(fracturepattern).MRI(ligamentousinjury).TreatmentGeneralMeasures-armshouldbeimmobilizedandelevated,

8、Cryotherapyneurovascularstatusmustbeevaluatedbeforeandafterreduction.rulesoutassociatedfractures.closed