锁骨骨折的固定盘治疗经验分享课件

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1、FixationofProximalHumerusFractureswithLockingPlatesNeerClassificationBasedonPartsShaftHeadGreaterandlessertuberosityPart=1cmdisplacementOR45degreesangulationAO/ASIFClassificationBasedonlikelihoodofvascularinjuryTypeA:Unifocal,intactvascularsupplyTypeB:Bifocal,possibleinjurytobloodsup

2、plyTypeC:Articularfxinvolvinganatomicneck,OsteonecrosismostlikelyinthisgroupMostProximalHumeralFracturesCanBeTreatedWithoutSurgeryStablefractureNondisplacedorminimallydisplacedtwo-partandthree-partfracturesSlingShoulderimmobilizerEarlyROMIndicationsforLockingPlatesforProximalHumerusF

3、racturesThreeandfourpartsalvageablefracturesValgusimpactedforfourpartThreepartfracturesinvarusElderly,osteoporoticVeryproximal(Mighell:twopartanatomicneckfracturesinthepatientyoungerthan40years)Twopartsurgicalneckfxwith>30°ofvarusisrelativeindicationforfixedangletoavoidtuberosityimpi

4、ngementSurgicalapproachDPapproachALacromialapproachVascularSupplyAscendingbranchofanteriorhumeralcircumflexVascularImplicationsofMinimallyInvasivePlatingofProximalHumerusFracturesGardneretal.JOTOctober,2006InDPapproachAHCAisdirectlyinthesurgicalfieldVascularImplicationsofMinimallyIn

5、vasivePlatingofProximalHumerusFracturesGardneretal.JOTOctober,2006NoteonlysmallterminalmotorbranchesoftheaxillarynervearedirectlylateralVascularImplicationsofMinimallyInvasivePlatingofProximalHumerusFracturesGardneretal.JOTOctober,2006AVNratesupto16%for3-4partfracturesvs9%forminimal

6、lyinvasiveLockingplatestudiesshowAVNrates4-13%DPapproachlargedissectionandmuscleretractionDPisanindirectapproachtoplatingzone6cadavericspecimensALacromialapproach10cmincisionfromALacromionRapheb/wanteriorandmiddleheadssplit6cmtypicallyfoundaxillarynervefound3holeSyntheslockingproxima

7、lhumerusplateLatexpolymerinjectedintoaxillaryarteryFindings:NovesselsexposedthatpenetrateheadAvoidAHCAinthegroove“barespot”hypovacularzonefoundonGTAnteriorrapheincisioniscolinearwiththe“barespot’inallspecimensPlatetoanteriorvessel4mmPlatetoposteriorvessel7mmAveragewidth30mmVascularIm

8、plicationsof