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![Page 1: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/1.jpg)
FRACTURILE MEMBRULUI SUPERIOR
CLINICA ORTOPEDIE SPITAL COLENTINA
CONF.RODICA MARINESCU
![Page 2: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/2.jpg)
FRACTURILE DE CLAVICULA
![Page 3: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/3.jpg)
FRACTURILE CLAVICULEI
• Frecventa:11%fracturi adult (loc II)• 69-82% in 1/3 medie• Copii:30%din fracturi• mecanism-frecvent indirect
![Page 4: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/4.jpg)
SEDIUL FRACTURII
• 1/3 medie Mecanism indirect-cadere umar-Cu deplasare
![Page 5: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/5.jpg)
CLINICA
• Pozitia antalgica • Deformarea regiunii • Umar mai coborat si mai scurt • Echimoza tardiva • Mobilitate in focar
![Page 6: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/6.jpg)
Complicatii
• Tegumentare –deschidere focar• Vasculare • Nervoase • Viscerale
![Page 7: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/7.jpg)
COMPLICATII TARDIVE
Calus vicios hipertrofic Pseudartroza Osteita postfracturara Redoarea de umar
![Page 8: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/8.jpg)
TRATAMENT ORTOPEDIC
BANDAJ DESSAULT BANDAJ WATSON-JONES
![Page 9: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/9.jpg)
TRATAMENT CHIRURGICAL
• Fracturi complicate • Fracturi cu mare deplasare • Scurtare importanta umar
![Page 10: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/10.jpg)
TRATAMENT CHIRURGICAL
• Avantaje :reducere anatomica ,mobilizare precoce .
• Dezavantaje :deperiostare ,devascularizare ,intarziere in consolidare ,risc infectie risc deteriorare montaj.
![Page 11: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/11.jpg)
FRACTURILE OMOPLATULUI
• 1% total fracturi • Varietati :ale glenei si colului • Ale corpului omoplatului
![Page 12: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/12.jpg)
FRACTURILE OMOPLATULUI
• FRACTURILE GLENEI SI COLULUI
![Page 13: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/13.jpg)
FRACTURILE COLULUI OMOPLATULUI
• Chirurgical• Anatomic
![Page 14: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/14.jpg)
TRATAMENT
• Functional • Ortopedic • chirugical
![Page 15: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/15.jpg)
FRACTURILE HUMERUSULUI
• Extremitatea proximala • Diafizare • Extremitatea distala
![Page 16: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/16.jpg)
FRACTURILE EXTREMITATII PROXIMALE
• Parcelara cap • Col anatomic • Trohiter –smulgere rotatori externi • Trohin –smulgere subscapular • Col chirurgical –cea mai frecventa
![Page 17: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/17.jpg)
FRACTURI COL CHIRURGICAL
• Prin adductie • Prin abductie
![Page 18: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/18.jpg)
CLASIFICARE FRACTURI ARTICULARE
• ANGRENATE• CU DEPLASARE• CU MARE DEPLASARE• FRACTURI/LUXATII
![Page 19: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/19.jpg)
CLINICA
Durere ,impotenta functionala totala ,umar globulos ,cu zona de depresiune- “lovitura de topor “,echimoza brahiotoracica Hennequin .
Atentie complicatii :vasculare ,nervoase ,cutanate ,musculare !
![Page 20: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/20.jpg)
TRATAMENT
• ORTOPEDIC • CHIRURGICAL
![Page 21: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/21.jpg)
TRATAMENT CHIRURGICAL
• osteosinteza brose K ,suruburi ,placa cu suruburi
![Page 22: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/22.jpg)
FRACTURILE DIAFIZEI HUMERALE
• Relativ frecvente :4%• Mecanism indirect :flexie, torsiune .
![Page 23: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/23.jpg)
MECANISME SI TRAIECTE DE FRACTURA
![Page 24: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/24.jpg)
CLINICA
• Durere ,impotenta functionala ,durere in punct fix .
• Netransmisibilitatea miscarii, crepitatii osoase ,mobilitate anormala,scurtare
• Atitudine umila
![Page 25: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/25.jpg)
DEPLASARE=FUNCTIE DE SEDIU
![Page 26: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/26.jpg)
RISC COMPLICATII PRECOCE
• Cutanate-deschidere focar fractura • Nervoase-n.radial• Vasculare-a.brahiala
![Page 27: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/27.jpg)
TRATAMENT ORTOPEDIC
• Reducere –imobilizare • Reducere lenta +imobilizare
![Page 28: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/28.jpg)
TRATAMENT CHIRURGICAL
• Indicat :fracturi cu deplasare instabile ,fracture pe os patologic ,politraumatizati,fracture complicate.
![Page 29: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/29.jpg)
VARIETATI TRATAMENT CHIRURGICAL
• Osteosinteza centromedulara elastica/ rigida .• Osteosinteza cu placa si suruburi .• Fixator extern
![Page 30: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/30.jpg)
COMPLICATII TARDIVE
Intarziere consolidare Pseudartroza Osteita postfracturara Calusul vicios-afectare tardiva n. radial
![Page 31: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/31.jpg)
FRACTURILE EXTREMITATII DISTALE A HUMERUSULUI
• Mecanism frecvent indirect :hiperextensie ,hiperflexie ,deviatie laterala cot .
• Prognosticul functional depinde de reducerea anatomica .
![Page 32: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/32.jpg)
CLASIFICARE ANATOMOPATOLOGICA
SUPRACONDILIENE SUPRA SI INTERCONDILIENE
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CLASIFICARE ANATOMOPATOLOGICA
CONDIL EXTERN CONDIL INTERN
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FRACTURI SUPRACONDILIENE –MECANISME
• Hiperextensie • Hiperflexie
![Page 35: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/35.jpg)
REPERE CLINICE
EXTENSIE FLEXIE
![Page 36: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/36.jpg)
CLINICA
• Plica cotului plina ,echimoza liniara Kirmisson ,distanta acromioepicondiliana scurtata,diametru>anteroposterior.
![Page 37: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/37.jpg)
TRATAMENT ORTOPEDIC
![Page 38: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/38.jpg)
TRATAMENT CHIRURGICAL
• Brose K,placi in Y cu suruburi .
![Page 39: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/39.jpg)
COMPLICATII IMEDIATE
CUTANATE,NERVOASE.
VASCULARE
![Page 40: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/40.jpg)
COMPLICATII TARDIVE
CALUS VICIOS REDOARE DE COT
![Page 41: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/41.jpg)
FRACTURILE SUPRAINTERCONDILIENE
• Frecventa la adult • Traiect intraarticular
![Page 42: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/42.jpg)
CLINICA
• Brat scurtat ,paleta humerala largita ,grava instabilitate a cotului ,crepitatii osoase .
• Risc complicatii 30%:vasculare ,nervoase ,cutanate .
• Rx –certitudine
![Page 43: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/43.jpg)
COMPLICATII
• Imediate :cutanate,vasculare ,nervoase .• Tardive :pseudartroza ,calusul vicios ,redoarea
de cot ,calcificarile periarticulare ,infectia .
![Page 44: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/44.jpg)
TRATAMENT
• Ortopedic • Chirurgical-frecvent
![Page 45: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/45.jpg)
FRACTURI PARCELARE
CONDILULUI EXTERN CAPITELULUI
![Page 46: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/46.jpg)
FRACTURA DE EPITROHLEE
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FRACTURILE OASELOR ANTEBRATULUI
• Extremitatii proximale a cubitusului =olecran
![Page 48: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/48.jpg)
TRATAMENT CHIRURGICAL
• Osteosinteza suruburi ,placa cu suruburi ,hobanaj.
![Page 49: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/49.jpg)
FRACTURILE EXTREMITATII PROXIMALE RADIALE
• Ale capului radial • Ale colului radial
![Page 50: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/50.jpg)
TRATAMENT
• Ortopedic • chirurgical
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FRACTURILE ANTEBRATULUI
• Izolate :rareori;cubitus sau radius .• Asociate :frecvent .• Mecanism producere :direct sau indirect .• Risc-pierderea pronosupinatiei
![Page 52: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/52.jpg)
IMPERATIVELE PRONOSUPINATIEI
• Refacere lungime oase• Refacere curbura radius• Spatiu interosos liber• Articulatii radiocubitale
mobile• Fara decalaj intre cele
doua oase
![Page 53: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/53.jpg)
TRATAMENT
• Ortopedic –fara deplasare
![Page 54: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/54.jpg)
TRATAMENT CHIRURGICAL
• Osteosinteza cu placa si suruburi
![Page 55: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/55.jpg)
COMPLICATII REDUTABILE
• Imediate –sindromul de compartiment • Tardive –sindromul Volkman
![Page 56: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/56.jpg)
COMPLICATII TARDIVE
• Pseudartroza • Calusurile vicioase • Fracturi iterative • Sinostoza radiocarpiana
![Page 57: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/57.jpg)
FRACTURI-LUXATII ANTEBRAT
ESSEX-LOPRESTI RX
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FRACTURA LUXATIE MONTEGGIA-STANCIULESCU
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FRACTURA GALLEAZZI
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FRACURA GALEAZZI-TRATAMENT
![Page 61: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/61.jpg)
FRACTURILE EXTREMITATII DISTALE A RADIUSULUI
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FRACTURA POUTEAU-COLLES
• Cea mai frecventa fractura in traumatologie • Mecanism indirect-cadere podul palmei• Deplasare “in dos de furculita “,inclinare
radiala ,proximala .
![Page 63: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/63.jpg)
FRACTURI DE EPIFIZA DISTALA RADIALA
FARA DEPLASARE CU DEPLASARE
![Page 64: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/64.jpg)
FRACTURILE ARTICULARE
![Page 65: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/65.jpg)
TRATAMENT
• Reducere si imobilizare
![Page 66: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/66.jpg)
CHIRURGICAL
• Placa cu suruburi • Fixator extern
![Page 67: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/67.jpg)
COMPLICATII
• Calusul vicios • Sindromul de tunel carpian• Redoarea articulara
![Page 68: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/68.jpg)
COMPLICATII
• Mana stramba radiala
![Page 69: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/69.jpg)
FRACTURILE DE SCAFOID CARPIAN
![Page 70: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/70.jpg)
CLINICA
• Durere in tabachera anatomica • Incidenta speciale Rx
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TRATAMENT
ORTOPEDIC
CHIRURGICAL
![Page 72: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/72.jpg)
COMPLICATII
• Necroza avasculara • Pseudartroza
![Page 73: curs 2](https://reader035.fdocumente.com/reader035/viewer/2022062408/563db822550346aa9a90d53c/html5/thumbnails/73.jpg)
FRACTURILE METACARPIENELOR
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FRACTURILE FALANGELOR
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LOCALIZARE FRACTURI MTC
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TRATAMENT
• Ortopedic • Chirurgical
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FRACTURA BENNETT
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TRATAMENT FRACTURI FALANGE
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ASPECTE RX FRACTURI FALANGE
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TRATAMENT ORTOPEDIC FRACTURI FALANGE