Recommended
More Related Content
What's hot
What's hot (15)
Similar to Conference
Similar to Conference (20)
More from Toey Sutisa
More from Toey Sutisa (20)
Recently uploaded
Recently uploaded (20)
Conference
- 1. Case conference Ext วิธวินท์ ไพศาขมาศ Pramongkutklao hospital
- 3. Chief complaint ✤ แขนซ้ายผิดรูป 3hr PTA
- 4. Present illness ✤ 3hr PTA – ผู้ป่วยขับรถปิคอัพหลบรถจักรยานยนต์ เสียหลักชนต้นไม้ มีแขนซ้ายผิด รูป แผลเปิดฉีกขาดบริเวณหน้าแข้งขวา เข่าขวา มือขวาและขาซ้าย กู้ภัยนาส่งรพ.
- 5. Primary survey ✤ A : can talk ,not tender at posterior midline of neck ✤ B : normal breathing ,equal breath sound ,CCT negative ✤ C : BP 120/80 mmHg ,HR 80 bpm ,no active bleeding ✤ D : E4V5M6 ,pupil 2 mm RTLBE ✤ E : Tender and swelling at left arm ,limit ROM at left arm due to pain ,capillary refill < 2sec ,radial pulse 2+ ,left finger full ROM
- 6. Secondary survey ✤ A : no drug and food allergy ✤ M : no current medication ✤ P : no underlying disease ✤ L : last meal 08:00 ✤ E : ผู้ป่วยขับรถปิคอัพหลบรถจักรยานยนต์ เสียหลักชนต้นไม้ มีแขนซ้ายผิดรูป แผลเปิด ฉีกขาดบริเวณหน้าแข้งขวา เข่าขวา มือขวาและขาซ้าย
- 7. Physical examination ✤ GA : good consciousness ✤ HEENT : no external wound ,not tender along c-spine ,full ROM of neck ,not pale conjunctivae ,anicteric sclerae ✤ Heart : pulse full and regular ,normal S1S2 ,no murmur ✤ Lung : trachea in midline ,equal breath sound ,no adventitious sound ✤ Abdomen: soft ,not tender ,no external wound
- 8. Physical examination ✤ Extermities : Tender and swelling at left arm ,limit ROM at left arm due to pain ,capillary refill < 2sec ,radial pulse 2+ ,left finger full ROM ,pinprick sensation intact ✤ Neurological examination : E4V5M6 ,motor grade V all extremities ,sensory intact
- 10. Investigation ✤ Film left humerus AP ,lateral ✤
- 13. Diagnosis ✤ Close fracture midshaft left humerus
- 14. Mid shaft humerus fracture
- 15. Epidemiology ✤ 3-5% of all fracture ✤ Bimodal distribution ✤ Male, Young (21-30), High-energy trauma ✤ Female, Old (60-80), Simple fall
- 16. Epidemiolgy
- 17. Clinical presentation ✤ Pain ✤ Extremity weakness ✤ Examine overall limb alignment - will often present with shortening and in varus ✤ May occur radial nerve injury
- 18. Anatomy
- 19. Anatomy
- 20. Associated injury ✤ Open wound ✤ Vascular injury ✤ Radial nerve injury ✤ Brachial plexus injury ✤ Ipsilateral forearm fracture ✤ Ipsilateral shoulder or elbow fracture
- 21. Associated condition ✤ Radial nerve palsy ✤ Incidence 3-34% ✤ increases with open fractures, polytrauma, vascular injury, and multiple ipsilateral fractures
- 22. Radial Nerve Palsy ✤ Most frequent with fractures of the middle and middle-distal humeral shaft ✤ More common with transverse and spiral fractures ✤ Most injuries are neurapraxia ✤ >90% return to function in 3-4 months
- 23. Classification ✤ AO/OTA Classification ✤ Diaphysis of humerus : 12 ✤ Fracture pattern, Zone of diaphysis ✤ Reflect increasing fracture severity
- 24. 01
- 26. Non-Operative Treatment ✤ Gold Standard treatment ✤ Hanging arm casts ✤ Coaptation splints ✤ Functional Brace (Gold standard)
- 27. Non-Operative Treatment ✤ Acceptable alignment ✤ AP Angulation < 20 degrees ✤ Varus/Valgus angulation < 30 degrees ✤ Shortening < 3 cm
- 28. Functional Brace ✤ Union rate 90-100% ✤ Principles: Gravity and soft tissue compression to achieve acceptable alignment and function ✤ Position: 1 inch distal to axilla and 1 inch proximal to humeral condyles ✤ Avoid active abduction and elevation of shoulder
- 29. Functional Brace ✤ Contraindication ✤ Polytrauma patient ✤ Open fracture ✤ Bilateral humeral fractures ✤ Fracture with axial distraction between fragment
- 30. Failure of Non-Operative Treatment ✤ Definition:1. Inability to maintain reduction 2. Delayed union, non-union ✤ Transverse fracture with gap ✤ Obese patient ✤ Woman with large breast
- 31. Operative Treatment ✤ Plate Fixation ✤ Intramedullary nail ✤ Multiple Flexible Intramedullary nails ✤ External Fixation
- 32. Operative Treatment ✤ Indication ✤ Fracture indications ✤ Patient indications ✤ Associated injury
- 33. Fracture indications ✤ Failure to obtain and maintain adequate closed reduction ✤ Shortening > 3 cm ✤ Varus/valgus > 30 degrees ✤ AP Angulation > 20 degrees ✤ Segmental fracture ✤ Pathological fracture ✤ Intraarticular extension (shoulder joint, elbow joint)
- 34. Patient indications ✤ Multiple injuries, polytrauma ✤ Head injury (Glasgow Coma Scale score < 8) ✤ Chest trauma ✤ Poor patient tolerance, compliance ✤ Unfavorable body habitus (morbid obesity, large breasts)
- 35. Reference ✤ Rockwood and Green' Fracture in Adults, 7th edition, Humeral shaft fracture ✤ Campbell's Operative Orthopedics, 12th edition, Fractures of the shoulder, arm and forearm ✤ www.orthobullets.com ✤ www.jaaos.org ✤ www2.aofoundation.org
Editor's Notes
- - Musculocutaneous N: เลี้ยง Coracobrachialis, Biceps, Medial part of Brachialis แล้วไปเป็น sensory ให้กับ forearm - Radial N. : เริ่มจาก medial แล้ว วิ่งอ้อม humerus ไปทาง posterolateral ผ่าน spiral groove แล้วอ้อมกลับมาทาง Anterior compartment อีกครั้ง โดยผ่าน Lateral intermuscular septum
- - Incidence 3increases with open fractures, polytrauma, vascular injury, and multiple ipsilateral fractures
- - Coaptation splint : ใส่ไว้ 7-10 วัน แล้วเปลี่ยนเป็น functional brace
- - The “hydraulic” effect of soft tissue compression aligning the fracture fragments - Active muscle contraction correcting rotation and angulation - Beneficial effect of gravity on alignment