2558 1 Fracture Femur 579 Lower leg include

จำนวนกลมโรคทางออรโธปดกส ทเขารบการผาตด โรงพยาบาลนครพงค พ. ศ. จำนวนผปวย 2558 โรค 1. Fracture - Femur 579 - Lower leg include ankle 199 - Foot 180 - Shoulder and upper arm 198 - Forearm 412 - Wrist and hand 440 2. Sport 47 3. Hand wrist (exclude trauma) 161 4. Hip and knee 247 5. Infection 23 6. Spine 261 รวม 2, 747

Definition of fracture • A fracture is a break in the continuity of bone and is defined according to its type and extent.

Causes of fracture Direct blows Crushing forces Sudden twisting motions Extreme muscle contractions

Types of fracture Complete fracture Incomplete fracture

Classification according to soft tissue injury Closed fracture Open fracture

Classification according to direction of fracture line

Goals of fracture treatment • Solid union • Functional recovery

Clinical manifestations • Pain • Loss of function • Deformity • Shortening • Crepitus • Swelling and discoloration

หลกการ รกษา กระดกหก 1. Recognition 2. Reduction 3. Retention 4. Rehabilitation 5. Reconstruction 6. Refer ( 6 R )

3. Retention • External immobilization Bandages, casts, splints, traction • Internal immobilization Wire, plate and screw, intramedullary nail, external fixation

Spinting จดประสงค 1. 2. Immobilization Correct deformity

Good splint • Fitted early after trauma / injury • Quickly & cleanly construct • Easily adjustable • Efficient adequate support • Simple & easy to be molded to various contour

• Soft Splint materials Towels, blankets, or pillows, tied with bandaging materials or soft cloths. • Rigid A board, metal strip, folded magazine or newspaper, or other rigid item.

Upper extremity injury

Upper extremity injury

Upper extremity injury

Upper extremity injury

Lower extremity injury

Lower extremity injury

Lower extremity injury

Lower extremity injury

Lower extremity injury

Sheet wrapped around

Spinal injury

Spinal injury

Spinal injury

Spinal injury

Open fracture

Open fracture หลกการในการรกษา 1. 2. 3. 4. 5. 6. ผปวย open fracture ������ emergency surgery Initial evaluation, diagnose other life-threatening injuries ให Antibiotics ทเหมาะสมใหเรว ทสด Fluid replacement Tetanus prophylaxis Immediate debride the wound using copious irrigation

Complication of fracture Early complication • Hypovolemic shock • Arterial injury • Nerve injury • Fat embolism syndrome • Compartment syndrome Delayed complication • Delayed union and nonunion • Avascular necrosis of bone • Reaction to internal fixation devices • Infection