TRAUMATOLOGIE
Inhoud
Hf 1 inleiding.........................................................................................................................................................................................6
Definities en basisbegrippen traumatologie....................................................................................................................................6
3 soorten fracturen...........................................................................................................................................................................6
Hf 2 wondheling....................................................................................................................................................................................6
2.1 inleiding.......................................................................................................................................................................................7
2.2 fases van wondheling.................................................................................................................................................................7
2.3 Vertraagde wondheling..............................................................................................................................................................7
HF 3 Fractuurheling...............................................................................................................................................................................7
3.1 inleiding.......................................................................................................................................................................................8
3.2 biologie.......................................................................................................................................................................................8
3.3 belang van bloedvoorziening......................................................................................................................................................8
3.4 biomechanica en fractuurheling.................................................................................................................................................9
3.4.1 niet-operatieve behandeling van fracturen........................................................................................................................9
3.4.2 operatieve behandeling van fracturen................................................................................................................................9
3.5 methoden van fractuurfixatie...................................................................................................................................................10
3.5.1 interne fixatie....................................................................................................................................................................10
3.5.2 externe fixator...................................................................................................................................................................10
3.6 basisprincipes van operatieve fractuurheling..........................................................................................................................10
3.6.1 gewrichtsfracturen............................................................................................................................................................10
3.6.2 schaftfracturen..................................................................................................................................................................11
3.6.3 metafysaire fracturen........................................................................................................................................................11
3.6.4 intracapsulaire kop-halsfracturen.....................................................................................................................................11
3.6.5 alvulsiefracturen................................................................................................................................................................11
HF 4 opvang en behandeling vd polytraumapatient..........................................................................................................................12
HF 5 letsels vh bewegingstelsel: open fracturen................................................................................................................................12
5.1 inleiding.....................................................................................................................................................................................12
5.2 classificatie................................................................................................................................................................................12
5.3 behandeling..............................................................................................................................................................................12
5.3.1 systematische antibioticaprofylaxe...................................................................................................................................12
5.3.2 fractuurstabilisatie............................................................................................................................................................13
5.3.3 lokale antibiotica...............................................................................................................................................................13
5.3.4 wekedelenbedekking........................................................................................................................................................13
HF 6 letsels van bewegingsstelsel: bovenste lidmaat.........................................................................................................................13
6.1 claviculafracturen.....................................................................................................................................................................13
6.1.1 inleiding.............................................................................................................................................................................13
1
, 6.1.2 diagnose............................................................................................................................................................................13
6.1.3 classificatie........................................................................................................................................................................13
6.1.4 behandeling.......................................................................................................................................................................14
6.1.5 Nabehandeling..................................................................................................................................................................14
6.2 scapulafracturen.......................................................................................................................................................................15
6.2.1 inleiding.............................................................................................................................................................................15
6.2.2 Diagnose............................................................................................................................................................................15
6.2.3 Classificatie........................................................................................................................................................................15
6.2.4 behandeling.......................................................................................................................................................................15
6.2.5 nabehandeling...................................................................................................................................................................15
6.3 proximale humurusfracturen....................................................................................................................................................16
6.3.1 inleiding.............................................................................................................................................................................16
6.3.2 diagnose............................................................................................................................................................................16
6.3.3 classificatie (geen articulaire breuk wel metafysair).........................................................................................................16
6.3.4 behandeling.......................................................................................................................................................................16
6.3.5 nabehandeling...................................................................................................................................................................17
6.4 humurusschaftfracturen...........................................................................................................................................................17
6.4.1 inleiding.............................................................................................................................................................................17
6.4.2 diagnose............................................................................................................................................................................17
6.4.3 behandeling.......................................................................................................................................................................17
6.4.5 nabehandeling...................................................................................................................................................................18
6.5 distale humurusfracturen.........................................................................................................................................................18
6.5.1 inleiding.............................................................................................................................................................................18
6.5.2 diagnose............................................................................................................................................................................18
6.5.3 behandeling.......................................................................................................................................................................18
6.5.4 nabehandeling...................................................................................................................................................................18
6.6 olecranonfracturen...................................................................................................................................................................19
6.6.1 inleiding.............................................................................................................................................................................19
6.6.2 diagnose............................................................................................................................................................................19
6.6.3 behandeling.......................................................................................................................................................................19
6.6.4 nabehandeling...................................................................................................................................................................19
6.7 radiuskopfracturen...................................................................................................................................................................19
6.7.1 inleiding.............................................................................................................................................................................19
6.7.2 diagnose............................................................................................................................................................................20
6.7.3 behandeling.......................................................................................................................................................................20
6.7.4 nabehandeling...................................................................................................................................................................20
6.8 distale biceppeesruptuur..........................................................................................................................................................20
6.8.1 inleiding.............................................................................................................................................................................20
6.8.2 diagnose............................................................................................................................................................................20
2
, 6.8.3 behandeling.......................................................................................................................................................................21
6.8.4 nabehandeling...................................................................................................................................................................21
6.9 fracturen van radius en/of ulnaschaft......................................................................................................................................21
6.9.1 inleiding.............................................................................................................................................................................21
6.9.2 Diagnose............................................................................................................................................................................21
6.9.3 behandeling.......................................................................................................................................................................21
6.9.4 nabehandeling...................................................................................................................................................................21
6.10 distale radius fracturen...........................................................................................................................................................21
6.10.1 inleiding...........................................................................................................................................................................21
6.10.2 Diagnose..........................................................................................................................................................................21
6.10.3 behandeling.....................................................................................................................................................................22
6.10.4 nabehandeling.................................................................................................................................................................22
HF 7 letsels van het bewegingsstelsel: bekkenfracturen....................................................................................................................22
7.1 fracturen van de bekkenring.....................................................................................................................................................22
7.1.1 inleiding.............................................................................................................................................................................23
7.1.2 diagnose............................................................................................................................................................................23
7.1.3 behandeling.......................................................................................................................................................................23
7.1.4 Nabehandeling..................................................................................................................................................................24
7.2 fracturen vh acetabulum..........................................................................................................................................................24
7.2.1 inleiding.............................................................................................................................................................................24
7.2.2 diagnose............................................................................................................................................................................24
7.2.3 behandeling.......................................................................................................................................................................24
7.2.4 nabehandeling...................................................................................................................................................................25
7.3 osteoperotische bekkenringfracturen......................................................................................................................................25
HF 8 letsels vh bewegingsstelsel: onderste lidmaat...........................................................................................................................25
8.1 heupfracturen...........................................................................................................................................................................25
8.1.1 inleiding.............................................................................................................................................................................25
8.1.2 diagnose............................................................................................................................................................................26
8.1.3 classificatie........................................................................................................................................................................26
8.1.4 behandeling.......................................................................................................................................................................27
8.1.5 nabehandeling...................................................................................................................................................................28
8.2 femurschaftfracturen................................................................................................................................................................28
8.2.1 inleiding.............................................................................................................................................................................28
8.2.2 diagnose............................................................................................................................................................................28
8.2.3 behandeling.......................................................................................................................................................................28
8.2.4 nabehandeling...................................................................................................................................................................29
8.3 distale femurfracturen..............................................................................................................................................................29
8.3.1 inleiding.............................................................................................................................................................................29
8.3.2 diagnose............................................................................................................................................................................29
3
, 8.3.3 behandeling.......................................................................................................................................................................29
8.3.4 nabehadeling.....................................................................................................................................................................29
8.4 quadricepsruptuur....................................................................................................................................................................29
8.4.1 inleiding.............................................................................................................................................................................29
8.4.2 diagnose............................................................................................................................................................................30
8.4.3 behandeling.......................................................................................................................................................................30
8.4.4 Nabehandeling..................................................................................................................................................................30
8.5 patellafracturen........................................................................................................................................................................30
8.5.1 inleiding.............................................................................................................................................................................30
8.5.2 diagnose............................................................................................................................................................................30
8.5.3 behandeling.......................................................................................................................................................................30
8.5.4 nabehandeling...................................................................................................................................................................31
8.6 patellapeesruptuur...................................................................................................................................................................31
8.6.1 inleiding.............................................................................................................................................................................31
8.6.2 diagnose............................................................................................................................................................................31
8.6.3 behandeling.......................................................................................................................................................................31
8.6.4 Nabehandeling..................................................................................................................................................................31
8.7 proximale tibiafracturen...........................................................................................................................................................32
8.7.1 inleiding.............................................................................................................................................................................32
8.7.2 diagnose............................................................................................................................................................................32
8.7.3 behandeling.......................................................................................................................................................................32
8.7.4 Nabehandeling..................................................................................................................................................................32
8.8 Tibiashaftfracturen...................................................................................................................................................................32
8.8.1 inleiding.............................................................................................................................................................................32
8.8.2 diagnose............................................................................................................................................................................32
8.8.3 behandeling.......................................................................................................................................................................33
8.8.4 Nabehandeling..................................................................................................................................................................33
8.9 distale tibiafracturen................................................................................................................................................................33
8.9.1 inleiding.............................................................................................................................................................................33
8.9.2 diagnose............................................................................................................................................................................33
8.9.3 behandeling.......................................................................................................................................................................33
8.9.4 Nabehandeling..................................................................................................................................................................34
8.10 enkelfracturen........................................................................................................................................................................34
8.10.1 inleiding...........................................................................................................................................................................34
8.10.2 anatomie en classificatie.................................................................................................................................................34
8.10.3 diagnose..........................................................................................................................................................................34
8.10.4 Behandeling.....................................................................................................................................................................35
8.10.5 Nabehandeling................................................................................................................................................................35
8.11 ruptuur syndesmosis tibiofibularis.........................................................................................................................................35
4
Inhoud
Hf 1 inleiding.........................................................................................................................................................................................6
Definities en basisbegrippen traumatologie....................................................................................................................................6
3 soorten fracturen...........................................................................................................................................................................6
Hf 2 wondheling....................................................................................................................................................................................6
2.1 inleiding.......................................................................................................................................................................................7
2.2 fases van wondheling.................................................................................................................................................................7
2.3 Vertraagde wondheling..............................................................................................................................................................7
HF 3 Fractuurheling...............................................................................................................................................................................7
3.1 inleiding.......................................................................................................................................................................................8
3.2 biologie.......................................................................................................................................................................................8
3.3 belang van bloedvoorziening......................................................................................................................................................8
3.4 biomechanica en fractuurheling.................................................................................................................................................9
3.4.1 niet-operatieve behandeling van fracturen........................................................................................................................9
3.4.2 operatieve behandeling van fracturen................................................................................................................................9
3.5 methoden van fractuurfixatie...................................................................................................................................................10
3.5.1 interne fixatie....................................................................................................................................................................10
3.5.2 externe fixator...................................................................................................................................................................10
3.6 basisprincipes van operatieve fractuurheling..........................................................................................................................10
3.6.1 gewrichtsfracturen............................................................................................................................................................10
3.6.2 schaftfracturen..................................................................................................................................................................11
3.6.3 metafysaire fracturen........................................................................................................................................................11
3.6.4 intracapsulaire kop-halsfracturen.....................................................................................................................................11
3.6.5 alvulsiefracturen................................................................................................................................................................11
HF 4 opvang en behandeling vd polytraumapatient..........................................................................................................................12
HF 5 letsels vh bewegingstelsel: open fracturen................................................................................................................................12
5.1 inleiding.....................................................................................................................................................................................12
5.2 classificatie................................................................................................................................................................................12
5.3 behandeling..............................................................................................................................................................................12
5.3.1 systematische antibioticaprofylaxe...................................................................................................................................12
5.3.2 fractuurstabilisatie............................................................................................................................................................13
5.3.3 lokale antibiotica...............................................................................................................................................................13
5.3.4 wekedelenbedekking........................................................................................................................................................13
HF 6 letsels van bewegingsstelsel: bovenste lidmaat.........................................................................................................................13
6.1 claviculafracturen.....................................................................................................................................................................13
6.1.1 inleiding.............................................................................................................................................................................13
1
, 6.1.2 diagnose............................................................................................................................................................................13
6.1.3 classificatie........................................................................................................................................................................13
6.1.4 behandeling.......................................................................................................................................................................14
6.1.5 Nabehandeling..................................................................................................................................................................14
6.2 scapulafracturen.......................................................................................................................................................................15
6.2.1 inleiding.............................................................................................................................................................................15
6.2.2 Diagnose............................................................................................................................................................................15
6.2.3 Classificatie........................................................................................................................................................................15
6.2.4 behandeling.......................................................................................................................................................................15
6.2.5 nabehandeling...................................................................................................................................................................15
6.3 proximale humurusfracturen....................................................................................................................................................16
6.3.1 inleiding.............................................................................................................................................................................16
6.3.2 diagnose............................................................................................................................................................................16
6.3.3 classificatie (geen articulaire breuk wel metafysair).........................................................................................................16
6.3.4 behandeling.......................................................................................................................................................................16
6.3.5 nabehandeling...................................................................................................................................................................17
6.4 humurusschaftfracturen...........................................................................................................................................................17
6.4.1 inleiding.............................................................................................................................................................................17
6.4.2 diagnose............................................................................................................................................................................17
6.4.3 behandeling.......................................................................................................................................................................17
6.4.5 nabehandeling...................................................................................................................................................................18
6.5 distale humurusfracturen.........................................................................................................................................................18
6.5.1 inleiding.............................................................................................................................................................................18
6.5.2 diagnose............................................................................................................................................................................18
6.5.3 behandeling.......................................................................................................................................................................18
6.5.4 nabehandeling...................................................................................................................................................................18
6.6 olecranonfracturen...................................................................................................................................................................19
6.6.1 inleiding.............................................................................................................................................................................19
6.6.2 diagnose............................................................................................................................................................................19
6.6.3 behandeling.......................................................................................................................................................................19
6.6.4 nabehandeling...................................................................................................................................................................19
6.7 radiuskopfracturen...................................................................................................................................................................19
6.7.1 inleiding.............................................................................................................................................................................19
6.7.2 diagnose............................................................................................................................................................................20
6.7.3 behandeling.......................................................................................................................................................................20
6.7.4 nabehandeling...................................................................................................................................................................20
6.8 distale biceppeesruptuur..........................................................................................................................................................20
6.8.1 inleiding.............................................................................................................................................................................20
6.8.2 diagnose............................................................................................................................................................................20
2
, 6.8.3 behandeling.......................................................................................................................................................................21
6.8.4 nabehandeling...................................................................................................................................................................21
6.9 fracturen van radius en/of ulnaschaft......................................................................................................................................21
6.9.1 inleiding.............................................................................................................................................................................21
6.9.2 Diagnose............................................................................................................................................................................21
6.9.3 behandeling.......................................................................................................................................................................21
6.9.4 nabehandeling...................................................................................................................................................................21
6.10 distale radius fracturen...........................................................................................................................................................21
6.10.1 inleiding...........................................................................................................................................................................21
6.10.2 Diagnose..........................................................................................................................................................................21
6.10.3 behandeling.....................................................................................................................................................................22
6.10.4 nabehandeling.................................................................................................................................................................22
HF 7 letsels van het bewegingsstelsel: bekkenfracturen....................................................................................................................22
7.1 fracturen van de bekkenring.....................................................................................................................................................22
7.1.1 inleiding.............................................................................................................................................................................23
7.1.2 diagnose............................................................................................................................................................................23
7.1.3 behandeling.......................................................................................................................................................................23
7.1.4 Nabehandeling..................................................................................................................................................................24
7.2 fracturen vh acetabulum..........................................................................................................................................................24
7.2.1 inleiding.............................................................................................................................................................................24
7.2.2 diagnose............................................................................................................................................................................24
7.2.3 behandeling.......................................................................................................................................................................24
7.2.4 nabehandeling...................................................................................................................................................................25
7.3 osteoperotische bekkenringfracturen......................................................................................................................................25
HF 8 letsels vh bewegingsstelsel: onderste lidmaat...........................................................................................................................25
8.1 heupfracturen...........................................................................................................................................................................25
8.1.1 inleiding.............................................................................................................................................................................25
8.1.2 diagnose............................................................................................................................................................................26
8.1.3 classificatie........................................................................................................................................................................26
8.1.4 behandeling.......................................................................................................................................................................27
8.1.5 nabehandeling...................................................................................................................................................................28
8.2 femurschaftfracturen................................................................................................................................................................28
8.2.1 inleiding.............................................................................................................................................................................28
8.2.2 diagnose............................................................................................................................................................................28
8.2.3 behandeling.......................................................................................................................................................................28
8.2.4 nabehandeling...................................................................................................................................................................29
8.3 distale femurfracturen..............................................................................................................................................................29
8.3.1 inleiding.............................................................................................................................................................................29
8.3.2 diagnose............................................................................................................................................................................29
3
, 8.3.3 behandeling.......................................................................................................................................................................29
8.3.4 nabehadeling.....................................................................................................................................................................29
8.4 quadricepsruptuur....................................................................................................................................................................29
8.4.1 inleiding.............................................................................................................................................................................29
8.4.2 diagnose............................................................................................................................................................................30
8.4.3 behandeling.......................................................................................................................................................................30
8.4.4 Nabehandeling..................................................................................................................................................................30
8.5 patellafracturen........................................................................................................................................................................30
8.5.1 inleiding.............................................................................................................................................................................30
8.5.2 diagnose............................................................................................................................................................................30
8.5.3 behandeling.......................................................................................................................................................................30
8.5.4 nabehandeling...................................................................................................................................................................31
8.6 patellapeesruptuur...................................................................................................................................................................31
8.6.1 inleiding.............................................................................................................................................................................31
8.6.2 diagnose............................................................................................................................................................................31
8.6.3 behandeling.......................................................................................................................................................................31
8.6.4 Nabehandeling..................................................................................................................................................................31
8.7 proximale tibiafracturen...........................................................................................................................................................32
8.7.1 inleiding.............................................................................................................................................................................32
8.7.2 diagnose............................................................................................................................................................................32
8.7.3 behandeling.......................................................................................................................................................................32
8.7.4 Nabehandeling..................................................................................................................................................................32
8.8 Tibiashaftfracturen...................................................................................................................................................................32
8.8.1 inleiding.............................................................................................................................................................................32
8.8.2 diagnose............................................................................................................................................................................32
8.8.3 behandeling.......................................................................................................................................................................33
8.8.4 Nabehandeling..................................................................................................................................................................33
8.9 distale tibiafracturen................................................................................................................................................................33
8.9.1 inleiding.............................................................................................................................................................................33
8.9.2 diagnose............................................................................................................................................................................33
8.9.3 behandeling.......................................................................................................................................................................33
8.9.4 Nabehandeling..................................................................................................................................................................34
8.10 enkelfracturen........................................................................................................................................................................34
8.10.1 inleiding...........................................................................................................................................................................34
8.10.2 anatomie en classificatie.................................................................................................................................................34
8.10.3 diagnose..........................................................................................................................................................................34
8.10.4 Behandeling.....................................................................................................................................................................35
8.10.5 Nabehandeling................................................................................................................................................................35
8.11 ruptuur syndesmosis tibiofibularis.........................................................................................................................................35
4
