curs IX.ppt
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Transcript of curs IX.ppt
![Page 1: curs IX.ppt](https://reader034.fdocuments.net/reader034/viewer/2022042821/55cf920a550346f57b92fe74/html5/thumbnails/1.jpg)
JAPIE ECATERINA-MARIA
Stabilizarea fracturilor deschise cu fixator extern
monoplan
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Fractura deschisa-definitie
Solutie de discontinuitate osoasa;
Distructia tegumentului si a partilor moi;
Comunicare directa intre mediul extern si traiectul de fractura.
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Clasificarea Gustilo-Anderson
Tipul I Plaga <1 cm; fracturi simple; perforare interior-exterior; fara sau cu minima contaminare.
Tipul II Laceratie tegumentara >1 cm; tegument cu semne de contuzie, fara distructii intinse de
parti moi, decolari sau avulsii; instabilitate moderata pana la severa a focarului de fractura
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Clasificarea Gustilo-Anderson
Tipul III Leziuni tegumentare extinse, agent traumatic de mare
intensitate (strivire, amputatie traumatica); Plaga contaminata; Expunere osoasa; Instabilitate a focarului de fractura, fractura cominutiva.
IIIA• Acoperire adecvata a focarului de fractura dupa debridarea
chirurgicala IIIB
• Acoperire insuficienta a capetelor osoase, neccesita lambouri libere sau locale
IIIC• Orice fractura deschisa ce asociaza leziuni arteriale care
necesita reparare chirurgicala
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Examen paraclinic
Radiologic
Ecografie Doppler/Angiografie in cazul unui sindrom ischemic
Hemograma si grup sanguin
Cultura din plaga
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Fracturile deschise
Anamneza Locul si momentul accidentului, descrierea impactului .
Examen clinic Localizarea si examinarea plagii
contaminare, modificari ale tegumentelor, prezenta corpilor straini, gradul de acoperire cu periost si musculatura;
Vascularizatia si inervatia; Examinare generala multidisciplinara.
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Tratament in urgenta
Camera de garda
Sustinerea functiilor vitale;
Toaleta plaga, pansament steril, compresiv;
Profilaxie tetanica;
Tripla antibioterapie (gram pozitivi, gram negativi, anaerobi);
NU se efectueaza reducerea fracturii.
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Tratament
Sala de operatieDebridare chirurgicala
Avivarea marginilor plagii-excizia a minim 2mm,
Excizia tesutului necrozat,
Indepartarea corpilor straini si a fragmentelor osoase,
Evacuarea hematoamelor,
Toaleta plagii;
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Tratament
Aprecierea viabilitatii musculaturii se face dupa 4 criterii:
Coloratie;
Consistenta;
Contractilitate;
Capacitate de sangerare.
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Tratament
Managementul plagii
Sutura directa a tegumentului• Sutura primara- tip I • Sutura per secundam- tip II (la cel putin 7 zile), tip IIIA
Reconstructia defectului tesuturilor moi• Plastie cu grefa libera despicata (dupa 10-14 zile)• Lambouri locale mio-cutanate• Lambouri libere: marele dorsal, dreptul abdominal
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Tratament
Stabilizarea fracturiiReducere;
Fixare interna, tije TEN– tip I, tip II (daca periostul si planul muscular sunt integre);
Fixare externa, fixator extern monoplan, circular – tip II fara integritatea periostului si/sau a mansonului muscular, tip III.
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Fixatorul extern monoplan
Mijloace de fixare- fise SchantzFemur si tibie-fise de 6 mm, cate doua pentru
fiecare modul in parte; diametrul femurului este <15 mm- fise de 4.5 mm
Humerus-fise de 4 mm;Antebrat-fise de 3mm.
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Fixatorul extern monoplan
Fixatorul extern ORTHOFIXComplex longitudinal
Forma unei bare; Compus din trei module; Modulele terminale cuprind lacasuri pentru fixarea
fiselor;
Modul intermediar Permite anexarea piesei compactoare/distractoare
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Tehnica de fixare DeBastiani
Incizie de 1 cm - disectie pana la nivelul periostului;
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Tehnica de fixare DeBastiani
Sub control radiologic;
Efectuare canal cu burghiu de diametru mai mic decat cel al cuiului Schantz.
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Tehnica de fixare DeBastiani
Introducerea fisei cu ajutorul cheii in T- 2 ture trebuie sa depaseasca corticala opusa;
Rasucirea fisei in sens contrar acelor de ceasornic slabeste rezistenta fisei in os
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Tehnica de fixare DeBastiani
Prima fisa - modul superior, proximal;
Cea de-a 2-a fisa - modul inferior, distal;
Modulul este fixat paralel cu axul anatomic;
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Tehnica de fixare DeBastiani
La copii-2 fise/modul;
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Tehnica de fixare DeBastiani
Fixatorul la 3 cm de tegument- ingrijire postoperatorie.
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Fixatorul extern monoplan
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Fixator extern monoplan
Indicatii:
Fracturi deschise grad II-III;Fracturi inchise cominutive;Alungiri de membre;Compactarea sau fixarea fracturilor dupa
rezectii oncologice;Corectarea deviatiilor axiale ale membrelor:
var/ valg ;
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Complicatii
Infectii - cel mai frecvent in jurul fiselor sau broşelor;
Complicatiile neurovasculare in timpul aplicarii fiselor sau broselor,
Tulburarile psihice frecvent la copii; stari depresive sau comportament de tip autist,
insomnii, astenie si anorexie
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Va multumesc!