เอกสารประกอบการสอน Fracture&dislocation of upper extremity ...

1

?????????????????? Fracture&dislocation of upper

extremity Part I

?.?. ??? ??????????

????

?????????????????????????????? ??????????????????????????????????? ???

????????????????????????????????? ?????????????????? ??????????????????????

????????????????????????????? ????????????????????? ????????????????????????

????????????????????????????????? sternoclavicular joint ?????????

?????? shaft of humerus

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Sternoclavicular dislocation

????????????????? proximal end of clavicle ??? sternum ??????????

???????????????????????? ?????????????????????????? ??????????????????????????

???????? ??????????????????????????????????????????????????? ??????????????????

??????????? 2 ??? ???

1. anterior dislocation ?????????? ???????????????????????????? ???

????????????????????????????? ????????????????????????? closed

reduction ???????????????????????? old dislocation ???????????????????

?????????????????? ??????????????????? bone prominence ????????

2. posterior dislocation ?????????? ???????????????????????????????

???????????????????????????????????????? ???? trachea,

esophagus, thoracic duct ???? large vessel ??????? ??????

reduction ???? ??????????? closed method ???? open method

?????

??????? direction of dislocation

?????????????????

?????????????????? sternoclavicular joint ????????????????

???????????????? ????????????? ??? ????????????? anterior dislocation

????????????????????????????? ?????????? posterior dislocation ???

????????????????????????????????????????

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??? x-ray

??? x-ray ????? AP ????????????????????? ??????????????? x-ray

???????? ????????????????????????? ???? serendipity view(??????) ???????

???????????????? ???? CT, Tomogram ???????

?????????????? x-ray serendipity view

????????

??????????????????????????????????????????????????? ??????????????????????????

????????????? ?????????? immobilization ???? figure-of-eight ???

?????? 4 ??????? ??????????????????????????????? ???????????????????????????????

??????? ???????????? posterior dislocation

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Clavicle fracture

Clavicle ??????????????????????? s-shape ?????????????????????? 3

??? ????????????? medial & lateral ???????????????????????????

??????????????????????????????????????????????????????????????( middle

third )??????????????????????????????

??????? ????????????? clavicle

Clavicle ????????????????????????????? ????????????????????????????????

??????????? closed reduction ?????????? anatomic position ???????

??????????????????????????????????

Important deforming force ????????? fracture ??????

- sternocleidomastoid muscle ??? medial fragment

- deltoid, trapezius muscle ??? lateral fragment

- ?????????????? lateral fragment ??

??????? deforming force ??? fracture clavicle

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?????????????????? clavicle ??? ???? osseous protector ???

brachial plexus & subclavian artery ??????? ??????? fracture ???

?????? neurovascular ????????????????

Classification

???????????????????????? middle third, medial third, lateral

third

?????????????????????????????? ?????????????????????? ?????????????

?????????? ?????????????? vehicle accident

??????????????

??????? deformity ??????????????? subcutaneous bone ?????

??????????????????????? ??????????????????????????????????????????????

????? ??????????????????????????????????????? ???????????????????????

??????????????????????

x-ray

??????? ??? x-ray single AP ???clavicle ????????? ?????????

?????????????????????

??? x-ray ???? fracture of clavicle ??? film AP

????????

?????????????????????????? nonoperative technique ??? ?????????????

???? 2 ??? ???

1. figure-of-eight strap (??????)

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