curs 2 fracturile mb. sup. i
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ortopedieTRANSCRIPT
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Spitalul Universitar de Urgenta
ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE MEMBRULUI
SUPERIOR
Partea I
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Spitalul Universitar de Urgenta
ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE SCAPULEI
Generalitati:
1% din totalul fracturilor
ete rara datorita !anonului
!ucular "o#at
![Page 3: CURS 2 Fracturile Mb. Sup. I](https://reader030.vdocuments.pub/reader030/viewer/2022021111/5695cf2c1a28ab9b028ceace/html5/thumbnails/3.jpg)
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ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE SCAPULEI
Mecani! de $roducere:
indirect $rin cadere $e u!ar
indirect $rin contractii iolente !uculare
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ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE SCAPULEI
Claificare anato!o&clinica:
1' fracturile cor$ului ca$ulei
(' fracturile un#)iurilor ca$ulei
*' fracturi ale $roceelor ca$ulei
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ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE SCAPULEI
Fracturile cor$ului ca$ulei:• afectea+a foa u$ra i infra$inoaa
• durere in re#' ca$ulei $ontana, la $al$are
i la !icarile re$iratorii• ec)i!o+a tardia
• d#' radiolo#ic $e incidentele antero&
$oterioara i in $lanul ca$ulei
• trata!ent: "anda- .eault $tr' (&*
a$ta!ani
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Spitalul Universitar de Urgenta
ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE SCAPULEI
Fracturile un#)iurilor ca$ulei:Fracturile colului anatomic al glenei:
• fracturi intraarticulare cu traiect ce porneste
dintre tuberculul supraglenoidian si coracoida siajunge inf. de tuberculul infraglenoidian
• !" deplasare
• durere in punct fi# spontana si la mobili$areamb. sup.
• dg. clinic si radiologic
• tratament% bandaj &essault ' saptamani
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Spitalul Universitar de Urgenta
ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE SCAPULEI
Fracturile un#)iurilor ca$ulei:Fracturile colului anatomic al glenei:
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ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE SCAPULEI
Fracturile un#)iurilor ca$ulei:Fracturile colului chirurgical al glenei:• fracturi e#traarticulare cu traiect ce porneste de la inci$urascapulei pana inferior de tuberculul infraglenoidian• !" deplasare
• durere in punct fi# spontana si la mobili$area mb. sup.(tumefactie( ec)imo$a a#ilara(• dg. clinic si radiologic *incidenta antero"posterioara si a#ilara+•complicatii% le$iunea n. a#ilar( ple#ului bra)ial( vaselor a#ilare
• tratament%" bandaj &essault ' saptamani( in fr. ara deplasare
" reducere si imobili$are in aparat gipsat toraco"bra)ial ,"- saptamani
" tratament c)irurgical paca in T/ cu suruburi
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Spitalul Universitar de Urgenta
ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE SCAPULEI
Fracturile un#)iurilor ca$ulei:Fracturile colului chirurgical al glenei:
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ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE SCAPULEI
Fracturile un#)iurilor ca$ulei:Fracturile glenei:
• in 012 dintre lu#atiile
scapulo")umerale• recomandat e#.
computer tomografic
• tratament%
" fara deplasare 3 bandaj &essault 04 $ile
" cu deplasare 3 tratament c)irurgical cu
fi#area fragmentului detasat cu un surub
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ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE SCAPULEI
Fracturile $roceelor ca$ulei:Fracturile acromionului:• prin mecanism direct sau in lu#atiile sup. scapulo")umerale
• tratament% bandaj &essault( OS tip )oban( cu brosesau surub
Fracturile coracoidei:• prin mecanism direct sau prin avulsia tendonului
conjuct si a m. pectoral mic• durere spontana( la adductia fortata a bratului( lafle#ia si supinatia antebratului• tratament% reducere si fi#are cu surub
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Spitalul Universitar de Urgenta
ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE CLAVICULEI
Generalitati:
442 din totalul fracturilor
adultului
legatura intre torace
si membrul superior
os superficial(
paucivasculari$at
in forma de S italic
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Spitalul Universitar de Urgenta
ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE CLAVICULEI
Generalitati:
442 din totalul fracturilor
adultului
legatura intre torace
si membrul superior
os superficial(
paucivasculari$at
in forma de S italic
![Page 14: CURS 2 Fracturile Mb. Sup. I](https://reader030.vdocuments.pub/reader030/viewer/2022021111/5695cf2c1a28ab9b028ceace/html5/thumbnails/14.jpg)
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Spitalul Universitar de Urgenta
ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE CLAVICULEI
Mecani! de $roducere:
direct
actiune directa a unuicorp contondent
indirect cadere pe umar
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ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE CLAVICULEI
Mecani! de $roducere:
direct
actiune directa a unuicorp contondent
indirect cadere pe umar(
accentuarea curburilor
S i l l U i i d U
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ELIAS
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Traumatologie
FRACTURILE CLAVICULEI
Claificare:
4. fracturile 4!' e#terne
0. fracturile 4!' medii
'. fracturile 4!' interne
S it l l U i it d U t
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ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE CLAVICULEI
Fractura 1/* e0terna:
4-2 din fr. de clavicula
cand este situata e#t. de lig.
coraco"claviculare( este faradeplasare *A+
cand lig. coraco"claviculare sunt
le$ate( fragmentele se deplasea$a%
cel e#t. coboara sub actiunea
greutatii umarului(
re$ultand treapta de scara/ *5+
A B
S it l l U i it d U t
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ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE CLAVICULEI
Fractura 1/* !edie:
cea mai frecventa( 6-2
pre$inta cel mai des un traiect
oblic sau cominutiv fragmentul e#tern se deplasea$a
in jos si anterior sub
actiune m. pectoral
fragmentul intern se deplasea$a
in sus si posterior sub actiunea
mm. sternocleidomastoidieni
S it l l U i it d U t
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ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE CLAVICULEI
Fractura 1/* interna:
-2
frecvent traiectul este la nivelul insertie mm. sternocleidomastoidieni(traiect fara deplasare
cand traiectul este situat
intern de insertie( atunci
fragmentul e#t. se
deplasea$a superior
S it l l U i it d U t
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ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE CLAVICULEI
Si!$to!atolo#ie:
Inspectie:
• po$itie antalgica 3 atitudine umila/• umar coborat• stergerea foselor supra si
subclaviculara
• ulterior " umar globulos( tumefiat• La 0, " ,7 ) 3 ec)imo$a in
fosa supraclaviculara• distanta acromio"stenala diminuata
fata de cea contralaterala
Spitalul Universitar de Urgenta
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ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE CLAVICULEI
Si!$to!atolo#ie:
Palpare:
• durere in punct fi#
• crepitatii osoase
• mobilitate anormala• intreruperea continuitatii osoase
• impotenta functionala a mb. Sup in special inabductie si rotatiee#terna
Spitalul Universitar de Urgenta
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ELIAS
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Traumatologie
FRACTURILE CLAVICULEI
E0a!enul radiolo#ic:
• incidenta 8anca
*incidenta antero"posterioaracu o inclinatie de 4-1 a ra$ei
dispre caudal spre cranial
• evidentia$a sediul si• tipul de fractura
Spitalul Universitar de Urgenta
![Page 23: CURS 2 Fracturile Mb. Sup. I](https://reader030.vdocuments.pub/reader030/viewer/2022021111/5695cf2c1a28ab9b028ceace/html5/thumbnails/23.jpg)
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ELIAS
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Traumatologie
FRACTURILE CLAVICULEI
Co!$licatii
Imediate:
• le+iuni te#u!entarefracturi dec)ie2
• aculare, in $ecial a
enei u"claii i !ai
rar a arterei
• neroae $rin inte$area$le0ului "ra)ial• e!fi+e! u"cutanat• )e!o au $neu!otora0
Spitalul Universitar de Urgenta
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Traumatologie
FRACTURILE CLAVICULEI
Co!$licatii
Tardive:
• $eudartro+e, neceita inetrentie c)irur#icala
• calu icio, deo"icei "ine tolerat
• oteita, du$a fracturi dec)ie
• redoare de u!ar, du$a i!o"ili+are• cicatrici c)eloide au retractile du$a interentie
c)irur#icala
Spitalul Universitar de Urgenta
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Clinica de Ortopedie si
Traumatologie
FRACTURILE CLAVICULEI
Trata!entrtopedic:
Reducere i i!o"ili+are in
"anda- !oale ti$:" .eault 3 * a$ta!ani
$tr' fr' 1/* e0terna i interna
" 4aton&5one in 6782 3
9 a$ta!ani $tr' fractura1/* !edie
" Po+itia Ric)et&Couteau
in $olitrau!ati!e2
Spitalul Universitar de Urgenta
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ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE CLAVICULEI
Trata!entChirurgical:
Indicatii:
" $olifracturati
" fractura "ilaterala
" afectiuni neurolo#ice ca Prinon
" fracturi dec)ie
" fracturi de claicula cu co!$licatii
Spitalul Universitar de Urgenta
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ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE CLAVICULEI
Trata!entChirurgical:
Te)nici:
" Fi0ator e0tern in
fracturile dec)ie
" ;o"ana- in fracturile
1/* e0terne
" Placa cu uru"uri in
fracturile 1/* !edii
Spitalul Universitar de Urgenta
![Page 28: CURS 2 Fracturile Mb. Sup. I](https://reader030.vdocuments.pub/reader030/viewer/2022021111/5695cf2c1a28ab9b028ceace/html5/thumbnails/28.jpg)
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ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE !U"ERUSULUI PR#I"AL
Generalitati:
, 3 -2 din totalul fracturilor
,-2 din fr. )umerusului 9 :1 ani
9-1 ani mai frecventa la femei
Spitalul Universitar de Urgenta
![Page 29: CURS 2 Fracturile Mb. Sup. I](https://reader030.vdocuments.pub/reader030/viewer/2022021111/5695cf2c1a28ab9b028ceace/html5/thumbnails/29.jpg)
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Spitalul Universitar de Urgenta
ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE !U"ERUSULUI PR#I"AL
Mecani! de $roducere:
direct cadere direct pe umar
actiune directa a unuicorp contondent
indirect
cadere pe cot cu mb. sup.
in adductie cadere cu mb. sup. in
abductie si rot. e#t.
Spitalul Universitar de Urgenta
![Page 30: CURS 2 Fracturile Mb. Sup. I](https://reader030.vdocuments.pub/reader030/viewer/2022021111/5695cf2c1a28ab9b028ceace/html5/thumbnails/30.jpg)
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Spitalul Universitar de Urgenta
ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE !U"ERUSULUI PR#I"AL
Mecani! de $roducere:
direct cadere direct pe umar
actiune directa a unuicorp contondent
indirect
cadere pe cot cu mb. sup.
in adductie cadere cu mb. sup. in
abductie si rot. e#t.
Spitalul Universitar de Urgenta
![Page 31: CURS 2 Fracturile Mb. Sup. I](https://reader030.vdocuments.pub/reader030/viewer/2022021111/5695cf2c1a28ab9b028ceace/html5/thumbnails/31.jpg)
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Spitalul Universitar de Urgenta
ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE !U"ERUSULUI PR#I"AL
Mecani! de $roducere:
direct cadere direct pe umar
actiune directa a unuicorp contondent
indirect
cadere pe cot cu mb. sup.
in adductie cadere cu mb. sup. in
abductie si rot. e#t.
Spitalul Universitar de Urgenta
![Page 32: CURS 2 Fracturile Mb. Sup. I](https://reader030.vdocuments.pub/reader030/viewer/2022021111/5695cf2c1a28ab9b028ceace/html5/thumbnails/32.jpg)
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ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE !U"ERUSULUI PR#I"AL
Claificari:
4. ;ara deplasare
*< 0 mm.+
0. Cu deplasare
clasificarea AO clasificarea 5o)ler
clasificarea =oc)er
clasificarea >eer
Spitalul Universitar de Urgenta
![Page 33: CURS 2 Fracturile Mb. Sup. I](https://reader030.vdocuments.pub/reader030/viewer/2022021111/5695cf2c1a28ab9b028ceace/html5/thumbnails/33.jpg)
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ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE !U"ERUSULUI PR#I"AL
Claificari:
4. ;ara deplasare
*< 0 mm.+ 0. Cu deplasare clasificarea AO
clasificarea 5o)ler prin abductie *A+
prin adductie *5+
clasificarea =oc)er
clasificarea >eer
A
B
Spitalul Universitar de Urgenta
![Page 34: CURS 2 Fracturile Mb. Sup. I](https://reader030.vdocuments.pub/reader030/viewer/2022021111/5695cf2c1a28ab9b028ceace/html5/thumbnails/34.jpg)
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Spitalul Universitar de Urgenta
ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE !U"ERUSULUI PR#I"AL
Claificari:
4. ;ara deplasare
*< 0 mm.+
0. Cu deplasare
clasificarea AO clasificarea 5o)ler
clasificarea =oc)er
clasificarea >eer
Spitalul Universitar de Urgenta
![Page 35: CURS 2 Fracturile Mb. Sup. I](https://reader030.vdocuments.pub/reader030/viewer/2022021111/5695cf2c1a28ab9b028ceace/html5/thumbnails/35.jpg)
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p g
ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE !U"ERUSULUI PR#I"AL
Claificari:
4. ;ara deplasare
*< 0 mm.+
0. Cu deplasare
clasificarea AO clasificarea 5o)ler
clasificarea =oc)er
clasificarea >eer
Spitalul Universitar de Urgenta
![Page 36: CURS 2 Fracturile Mb. Sup. I](https://reader030.vdocuments.pub/reader030/viewer/2022021111/5695cf2c1a28ab9b028ceace/html5/thumbnails/36.jpg)
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p g
ELIAS
Clinica de Ortopedie si
Traumatologie
Spitalul Universitar de Urgenta
![Page 37: CURS 2 Fracturile Mb. Sup. I](https://reader030.vdocuments.pub/reader030/viewer/2022021111/5695cf2c1a28ab9b028ceace/html5/thumbnails/37.jpg)
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p g
ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE !U"ERUSULUI PR#I"AL
Si!$to!atolo#ie:
Inspectie:
• po$itie antalgica 3 atitudine umila/• imediat 3 depresiune subdeltoidiana ? semnul loviturii de
topor/ *diag. dif. cu lu#atia de umar unde semnul abductieelastice 5erger este po$itiv+
• ulterior " umar globulos( tumefiat• La 0, " ,7 ) 3 ec)imo$a bra)io"toracica @enneuin
*cvasipatognomonica+• distanta acromio"epicondiliana diminuata fata de cea
contralaterala
Spitalul Universitar de Urgenta
![Page 38: CURS 2 Fracturile Mb. Sup. I](https://reader030.vdocuments.pub/reader030/viewer/2022021111/5695cf2c1a28ab9b028ceace/html5/thumbnails/38.jpg)
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p g
ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE !U"ERUSULUI PR#I"AL
Si!$to!atolo#ie:
Palpare:
• durere in punct fi# la -": cm subacromial( spontan si la
mobili$area mb. sup.
• crepitatii osoase
• mobilitate anormala
• evaluare eventualelor complicatii vasculo"nervoase
Li$ec in fracturile an#renate i de
aceea !anerele e efectuea+a cu#ri-a
Spitalul Universitar de Urgenta
![Page 39: CURS 2 Fracturile Mb. Sup. I](https://reader030.vdocuments.pub/reader030/viewer/2022021111/5695cf2c1a28ab9b028ceace/html5/thumbnails/39.jpg)
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p g
ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE !U"ERUSULUI PR#I"AL
E0a!enul i!a#itic:
Radiogra$ia clasica:•
Incidenta antero"posterioara reala *A+
• Incidenta laterala in planul
scapulei *5+
• Incidenta Belpeau *5+
Computer tomogra$ia
!" reconstructie tridimensionala
Spitalul Universitar de Urgenta
![Page 40: CURS 2 Fracturile Mb. Sup. I](https://reader030.vdocuments.pub/reader030/viewer/2022021111/5695cf2c1a28ab9b028ceace/html5/thumbnails/40.jpg)
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g
ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE !U"ERUSULUI PR#I"AL
E0a!enul i!a#itic:
Radiogra$ia clasica:•
Incidenta antero"posterioara reala *A+
• Incidenta laterala in planul
scapulei *5+
• Incidenta Belpeau *5+
Computer tomogra$ia
!" reconstructie tridimensionala
Spitalul Universitar de Urgenta
![Page 41: CURS 2 Fracturile Mb. Sup. I](https://reader030.vdocuments.pub/reader030/viewer/2022021111/5695cf2c1a28ab9b028ceace/html5/thumbnails/41.jpg)
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ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE !U"ERUSULUI PR#I"AL
Co!$licatii
Imediate:
• le+iuni te#u!entare 3 fracturi dec)ie
• Ireducti"ilitatea fracturii $rin inter$o+itie de $arti !oi
• le+iuni aculare ale $ac)etului a0ilar
• le+iuni neroae, cel !ai frecenta n' a0ilar cu)i$oete+ie in re#' deltoidiana i deficit !otor al!uc)iului deltoid
• le+iuni ale !!' coafei rotatorilor
Spitalul Universitar de Urgenta
![Page 42: CURS 2 Fracturile Mb. Sup. I](https://reader030.vdocuments.pub/reader030/viewer/2022021111/5695cf2c1a28ab9b028ceace/html5/thumbnails/42.jpg)
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ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE !U"ERUSULUI PR#I"AL
Co!$licatii
Tardive:
• $eudartro+e, < (=%
• calu icio, la an#ulari de > 9=o
• necro+a aaculara a ca$ului )u!eral, datorita le+arii
arterei circu!fle0e anterioare• !io+ita oifianta
• inta"ilitati #leno&)u!erale
• u!ar in#)etat, datorita i!o"ili+arii
Spitalul Universitar de Urgenta
![Page 43: CURS 2 Fracturile Mb. Sup. I](https://reader030.vdocuments.pub/reader030/viewer/2022021111/5695cf2c1a28ab9b028ceace/html5/thumbnails/43.jpg)
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ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE !U"ERUSULUI PR#I"AL
Trata!entul
rtopedic:1' Indicat in:
& fracturi fara de$laare
& fracturi cu de$laare du$a reducere
& contarindicatii c)irur#icale
(' Manere de reducere:
& !anera Bo)ler in fr' $rin a"ductie2
& tractiune continua
& tranooaa
& #i$ de atarnare Cald?ell
*' I!o"ili+are *&9 a$ata!ani:& "anda- !oale .eault
& "anda- !oale @el$eau
9' Recu$erare
Spitalul Universitar de Urgenta
![Page 44: CURS 2 Fracturile Mb. Sup. I](https://reader030.vdocuments.pub/reader030/viewer/2022021111/5695cf2c1a28ab9b028ceace/html5/thumbnails/44.jpg)
7/21/2019 CURS 2 Fracturile Mb. Sup. I
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ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE !U"ERUSULUI PR#I"AL
Trata!entul
rtopedic:1' Indicat in:
& fracturi fara de$laare
& fracturi cu de$laare du$a reducere
& contarindicatii c)irur#icale
(' Manere de reducere:
& !anera Bo)ler in fr' $rin a"ductie2
& tractiune continua, lenta
& tranooaa
& #i$ de atarnare Cald?ell
*' I!o"ili+are *&9 a$ata!ani:& "anda- !oale .eault
& "anda- !oale @el$eau
9' Recu$erare
Spitalul Universitar de Urgenta
![Page 45: CURS 2 Fracturile Mb. Sup. I](https://reader030.vdocuments.pub/reader030/viewer/2022021111/5695cf2c1a28ab9b028ceace/html5/thumbnails/45.jpg)
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ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE !U"ERUSULUI PR#I"AL
Trata!entul
rtopedic:1' Indicat in:
& fracturi fara de$laare
& fracturi cu de$laare du$a reducere
& contarindicatii c)irur#icale
(' Manere de reducere:
& !anera Bo)ler in fr' $rin a"ductie2
& tractiune continua, lenta
& tranooaa
& #i$ de atarnare Cald?ell
*' I!o"ili+are *&9 a$ta!ani:& "anda- !oale .eault
& "anda- !oale @el$eau
9' Recu$erare
Spitalul Universitar de Urgenta
![Page 46: CURS 2 Fracturile Mb. Sup. I](https://reader030.vdocuments.pub/reader030/viewer/2022021111/5695cf2c1a28ab9b028ceace/html5/thumbnails/46.jpg)
7/21/2019 CURS 2 Fracturile Mb. Sup. I
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ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE !U"ERUSULUI PR#I"AL
Trata!entul
rtopedic:1' Indicat in:
& fracturi fara de$laare
& fracturi cu de$laare du$a reducere
& contarindicatii c)irur#icale
(' Manere de reducere:
& !anera Bo)ler in fr' $rin a"ductie2
& tractiune continua, lenta
& tranooaa
& #i$ de atarnare Cald?ell
*' I!o"ili+are *&9 a$ta!ani:
& "anda- !oale .eault
& "anda- !oale @el$eau
9' Recu$erare
Spitalul Universitar de Urgenta
![Page 47: CURS 2 Fracturile Mb. Sup. I](https://reader030.vdocuments.pub/reader030/viewer/2022021111/5695cf2c1a28ab9b028ceace/html5/thumbnails/47.jpg)
7/21/2019 CURS 2 Fracturile Mb. Sup. I
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ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE !U"ERUSULUI PR#I"AL
Trata!entul
rtopedic:1' Indicat in:
& fracturi fara de$laare
& fracturi cu de$laare du$a reducere
& contarindicatii c)irur#icale
(' Manere de reducere:
& !anera Bo)ler in fr' $rin a"ductie2
& tractiune continua, lenta
& tranooaa
& #i$ de atarnare Cald?ell
*' I!o"ili+are *&9 a$ta!ani:
& "anda- !oale .eault
& "anda- !oale @el$eau
9' Recu$erare
Spitalul Universitar de Urgenta
ELIAS
![Page 48: CURS 2 Fracturile Mb. Sup. I](https://reader030.vdocuments.pub/reader030/viewer/2022021111/5695cf2c1a28ab9b028ceace/html5/thumbnails/48.jpg)
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ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE !U"ERUSULUI PR#I"AL
Trata!entul
Chirurgical:1' Indicat in:
& fracturi cu de$laare la tineri
& fracturi cu de$laare ireducti"ile
& la $olifracturati i $olitrau!ati+ati
(' Te)nici c)irur#icale:& $innin#
& $laca cu uru"uri
& oteointe+a centro!edulara:
& elatica:
& ti-e elatice
& "roe 3 te)nica ;acetal
& ri#ida 3 ti-a tele#raf
& $rote+a $artial ti$ eer au totala
Spitalul Universitar de Urgenta
ELIAS
![Page 49: CURS 2 Fracturile Mb. Sup. I](https://reader030.vdocuments.pub/reader030/viewer/2022021111/5695cf2c1a28ab9b028ceace/html5/thumbnails/49.jpg)
7/21/2019 CURS 2 Fracturile Mb. Sup. I
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ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE !U"ERUSULUI PR#I"AL
Trata!entul
Chirurgical:1' Indicat in:
& fracturi cu de$laare la tineri
& fracturi cu de$laare ireducti"ile
& la $olifracturati i $olitrau!ati+ati
(' Te)nici c)irur#icale:& $innin#
& $laca cu uru"uri
& oteointe+a centro!edulara:
& elatica:
& ti-e elatice
& "roe 3 te)nica ;acetal
& ri#ida 3 ti-a tele#raf
& $rote+a $artial ti$ eer au totala
Spitalul Universitar de Urgenta
ELIAS
![Page 50: CURS 2 Fracturile Mb. Sup. I](https://reader030.vdocuments.pub/reader030/viewer/2022021111/5695cf2c1a28ab9b028ceace/html5/thumbnails/50.jpg)
7/21/2019 CURS 2 Fracturile Mb. Sup. I
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ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE !U"ERUSULUI PR#I"AL
Trata!entul
Chirurgical:1' Indicat in:
& fracturi cu de$laare la tineri
& fracturi cu de$laare ireducti"ile
& la $olifracturati i $olitrau!ati+ati
(' Te)nici c)irur#icale:& $innin#
& $laca cu uru"uri
& oteointe+a centro!edulara:
& elatica:
& ti-e elatice
& "roe 3 te)nica ;acetal
& ri#ida 3 ti-a tele#raf
& $rote+a $artial ti$ eer au totala
Spitalul Universitar de Urgenta
ELIAS
![Page 51: CURS 2 Fracturile Mb. Sup. I](https://reader030.vdocuments.pub/reader030/viewer/2022021111/5695cf2c1a28ab9b028ceace/html5/thumbnails/51.jpg)
7/21/2019 CURS 2 Fracturile Mb. Sup. I
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ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE !U"ERUSULUI PR#I"AL
Trata!entul
Chirurgical:1' Indicat in:
& fracturi cu de$laare la tineri
& fracturi cu de$laare ireducti"ile
& la $olifracturati i $olitrau!ati+ati
(' Te)nici c)irur#icale:& $innin#
& $laca cu uru"uri
& oteointe+a centro!edulara:
& elatica:
& ti-e elatice
& "roe 3 te)nica ;acetal
& ri#ida 3 ti-a tele#raf
& $rote+a $artial ti$ eer au totala
Spitalul Universitar de Urgenta
ELIAS
![Page 52: CURS 2 Fracturile Mb. Sup. I](https://reader030.vdocuments.pub/reader030/viewer/2022021111/5695cf2c1a28ab9b028ceace/html5/thumbnails/52.jpg)
7/21/2019 CURS 2 Fracturile Mb. Sup. I
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ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE !U"ERUSULUI PR#I"AL
Trata!entul
Chirurgical:1' Indicat in:
& fracturi cu de$laare la tineri
& fracturi cu de$laare ireducti"ile
& la $olifracturati i $olitrau!ati+ati
(' Te)nici c)irur#icale:& $innin#
& $laca cu uru"uri
& oteointe+a centro!edulara:
& elatica:
& ti-e elatice
& "roe 3 te)nica ;acetal
& ri#ida 3 ti-a tele#raf
& $rote+a $artial ti$ eer au totala
Spitalul Universitar de Urgenta
ELIAS
![Page 53: CURS 2 Fracturile Mb. Sup. I](https://reader030.vdocuments.pub/reader030/viewer/2022021111/5695cf2c1a28ab9b028ceace/html5/thumbnails/53.jpg)
7/21/2019 CURS 2 Fracturile Mb. Sup. I
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ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE !U"ERUSULUI PR#I"AL
Trata!entul
Chirurgical:1' Indicat in:
& fracturi cu de$laare la tineri
& fracturi cu de$laare ireducti"ile
& la $olifracturati i $olitrau!ati+ati
(' Te)nici c)irur#icale:& $innin#
& $laca cu uru"uri
& oteointe+a centro!edulara:
& elatica:
& ti-e elatice
& "roe 3 te)nica ;acetal
& ri#ida 3 ti-a tele#raf
& $rote+a $artial ti$ eer au totala
Spitalul Universitar de Urgenta
ELIAS
![Page 54: CURS 2 Fracturile Mb. Sup. I](https://reader030.vdocuments.pub/reader030/viewer/2022021111/5695cf2c1a28ab9b028ceace/html5/thumbnails/54.jpg)
7/21/2019 CURS 2 Fracturile Mb. Sup. I
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ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE !U"ERUSULUI PR#I"AL
Trata!entul
Chirurgical:
1' Indicat in:
& fracturi cu de$laare la tineri
& fracturi cu de$laare ireducti"ile
& la $olifracturati i $olitrau!ati+ati(' Te)nici c)irur#icale:
& $innin#
& $laca cu uru"uri
& oteointe+a centro!edulara:
& elatica: & ti-e elatice
& "roe 3 te)nica ;acetal
& ri#ida 3 ti-a tele#raf
& $rote+a $artial ti$ eer au totala
Spitalul Universitar de Urgenta
ELIAS
![Page 55: CURS 2 Fracturile Mb. Sup. I](https://reader030.vdocuments.pub/reader030/viewer/2022021111/5695cf2c1a28ab9b028ceace/html5/thumbnails/55.jpg)
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ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE %IAFI&EI !U"ERALE
Generalitati:
limite% superior 3 marginea inferioara a insertiei mpectoral mare
inferior 3 la ,cm superior de interliniularticulatiei cotului
'2 din totalul fracturilor
mai frecventa la tineri
Spitalul Universitar de Urgenta
ELIAS
![Page 56: CURS 2 Fracturile Mb. Sup. I](https://reader030.vdocuments.pub/reader030/viewer/2022021111/5695cf2c1a28ab9b028ceace/html5/thumbnails/56.jpg)
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ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE %IAFI&EI !U"ERALE
Mecani! de $roducere:
direct( mai rar actiune directa a unui
corp contondent
indirect
cadere pe cot sau pe mana( prin mecanism de parg)iein fle#ie
torsiune
Spitalul Universitar de Urgenta
ELIAS
![Page 57: CURS 2 Fracturile Mb. Sup. I](https://reader030.vdocuments.pub/reader030/viewer/2022021111/5695cf2c1a28ab9b028ceace/html5/thumbnails/57.jpg)
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ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE %IAFI&EI !U"ERALE
.e$laarea fra#!entelor:In functie de nivelul fracturii:
" intre insertiile m. pectoral mare si m. deltoid % fragmentul superior este inadductie iar cel superior in abductie
" sub insertia m. deltoid% fragmentul superior este tras in abductie si rotatiee#ternaiar cel inferior in adductie si roratie interna
Spitalul Universitar de Urgenta
ELIAS
![Page 58: CURS 2 Fracturile Mb. Sup. I](https://reader030.vdocuments.pub/reader030/viewer/2022021111/5695cf2c1a28ab9b028ceace/html5/thumbnails/58.jpg)
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ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE %IAFI&EI !U"ERALE
Claificare:4. &upa nivelul fracturii%
" 4!' superioara
" 4!' medie
" 4!' inferioara
" lalimita dintre acestea
0. &upa tipul fracturii%
" simpla
" bifocala
" cominutiva
" desc)isa *ustilo Andersen+
" pe os patologic'. &upa traiectul fracturii
" transversa
" oblica scurta sau lunga
" spiroida
,. Clasificarea AO
Spitalul Universitar de Urgenta
ELIAS
![Page 59: CURS 2 Fracturile Mb. Sup. I](https://reader030.vdocuments.pub/reader030/viewer/2022021111/5695cf2c1a28ab9b028ceace/html5/thumbnails/59.jpg)
7/21/2019 CURS 2 Fracturile Mb. Sup. I
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ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE %IAFI&EI !U"ERALE
Si!$to!atolo#ie:
Inspectie:
• tumefactie
• deformarea bratului
• distanta acromio"epicondiliana diminuata fata decea contralaterala
Spitalul Universitar de UrgentaELIAS
![Page 60: CURS 2 Fracturile Mb. Sup. I](https://reader030.vdocuments.pub/reader030/viewer/2022021111/5695cf2c1a28ab9b028ceace/html5/thumbnails/60.jpg)
7/21/2019 CURS 2 Fracturile Mb. Sup. I
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ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE %IAFI&EI !U"ERALE
Si!$to!atolo#ie:
Palpare:
• durere in punct fi#
• crepitatii osoase
• mobilitate anormala
• intreruperea continuitatii osoase• evaluare eventualelor complicatii vasculo"nervoase si in
special al nervului radial prin testare dorsofle#iei miinii siabductiei policelui( testarea sensibilitatii in teritoriul radial
Spitalul Universitar de UrgentaELIAS
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ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE %IAFI&EI !U"ERALE
E0a!enul i!a#itic:
Radiogra$ia clasica:
• Incidenta antero&$oterioara
• Incidenta laterala
Spitalul Universitar de UrgentaELIAS
![Page 62: CURS 2 Fracturile Mb. Sup. I](https://reader030.vdocuments.pub/reader030/viewer/2022021111/5695cf2c1a28ab9b028ceace/html5/thumbnails/62.jpg)
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ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE %IAFI&EI !U"ERALE
Co!$licatii
Imediate:
• le+iuni te#u!entare• ireducti"ilitatea fracturii
$rin inter$o+itie de $arti !oi
• le+iuni aculare 3 indro!ulde artera "ra)iala
• le+iuni neroae, cel !ai
frecent a nerului radial
Spitalul Universitar de UrgentaELIAS
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ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE %IAFI&EI !U"ERALE
Co!$licatii
Tardive:
• $eudartro+a, in ca+ul trata!entului c)irur#ical
• intar+ieri deconolidare in $ecial in 1/* !edie datorita +onei$auciaculare au in ca+ul celor tranerale datorita u$rafeteide contact !ici
• caluul icio, dia#noticat in $re+enta unei an#ulatii !ai !ari de*= in $lan a#ital au (= in $lan frontal au un decala- in rotatie$rot tolerat2 au o curtare > ( c!
• oteita cronica, ducand la $eudartro+e e$tice, calu oteitic,tul"urari trofice locale, redori articulare • afectarea tardia a nerului radial, $rodua de o"icei $rin
in#lo"area a in calu au $rin elon#area a $e un calu a"undent
Spitalul Universitar de UrgentaELIAS
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ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE %IAFI&EI !U"ERALE
Trata!ent:rtopedic • Cel mai frecvent indicat in fr.
stabile cu rata mica de
pseudartro$e
*)umerusul nu iubeste bisturiul+• Decomandat in fracturile stabile
*oblice( spiroide( etc+• Deducere si atela cu epolet pentru
:"7 saptamani
• ptr. fracturile instabile cu deplasarelongitudinala 3 aparatul gipsat de
atarnare tip Calell timp de ' saptamani
si apoi atela cu epolet
Spitalul Universitar de UrgentaELIAS
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7/21/2019 CURS 2 Fracturile Mb. Sup. I
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ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE %IAFI&EI !U"ERALE
Trata!ent:rtopedic • Cel mai frecvent indicat in fr.
stabile cu rata mica de
pseudartro$e
*)umerusul nu iubeste bisturiul+• Decomandat in fracturile stabile
*oblice( spiroide( etc+• Deducere si atela cu epolet pentru
:"7 saptamani
• ptr. fracturile instabile cu deplasarelongitudinala 3 aparatul gipsat de
atarnare tip Caldell timp de ' saptamani
si apoi atela cu epolet
Spitalul Universitar de UrgentaELIAS
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ELIAS
Clinica de Ortopedie si
Traumatologie
FRACTURILE %IAFI&EI !U"ERALE
Trata!ent:Chirurgical:
Indicatii:• fracturi inta"ile•
fracturi dec)ie• fracturi "ilaterale• fracturi "ifocale• $olifracturati• fracturi ce $re+inta co!$licatii
• fracturi $e o $atolo#ic• intar+ieri de conolidare• $eudartro+e
Spitalul Universitar de UrgentaELIAS
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Clinica de Ortopedie si
Traumatologie
FRACTURILE %IAFI&EI !U"ERALE
Trata!ent:Chirurgical:
• Fi0ator e0tern
• OS $laca cu uru"uri• OS centro!edulara
& elatica 3 ti-e Ru)
& ri#ida 3 ti-a& Seidel
& Ruell& Talor
Spitalul Universitar de UrgentaELIAS
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Clinica de Ortopedie si
Traumatologie
FRACTURILE %IAFI&EI !U"ERALE
Trata!ent:Chirurgical:• Fi0ator e0tern
• OS $laca cu uru"uri
DD ric de $eudartro+a DD
• OS centro!edulara
& elatica 3 ti-e Ru)
& ri#ida 3 ti-a& Seidel
& Ruell& Talor
Spitalul Universitar de UrgentaELIAS
![Page 69: CURS 2 Fracturile Mb. Sup. I](https://reader030.vdocuments.pub/reader030/viewer/2022021111/5695cf2c1a28ab9b028ceace/html5/thumbnails/69.jpg)
7/21/2019 CURS 2 Fracturile Mb. Sup. I
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Clinica de Ortopedie si
Traumatologie
FRACTURILE %IAFI&EI !U"ERALE
Trata!ent:Chirurgical:
• Fi0ator e0tern
• OS $laca cu uru"uri• OS centro!edulara
& elatica 3 ti-e Ru)
& ri#ida 3 ti-a& Seidel
& Ruell& Talor
Spitalul Universitar de UrgentaELIAS
![Page 70: CURS 2 Fracturile Mb. Sup. I](https://reader030.vdocuments.pub/reader030/viewer/2022021111/5695cf2c1a28ab9b028ceace/html5/thumbnails/70.jpg)
7/21/2019 CURS 2 Fracturile Mb. Sup. I
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Clinica de Ortopedie si
TraumatologieFRACTURILE %IAFI&EI !U"ERALE
Trata!ent:Chirurgical:
• Fi0ator e0tern
• OS $laca cu uru"uri• OS centro!edulara
& elatica 3 ti-e Ru)
& ri#ida 3 ti-a& Seidel
& Ruell& Talor