Distal Radius Fractures: Nkyerɛkyerɛmu a Ɛkɔ Akyiri Fi Anatomy So Kosi Oprehyɛn So

Distal radius fractures yɛ 75% wɔ forearm fractures mu na ɛtaa ba titiriw wɔ ayaresabea. Wɔ saa asɛm yi mu no, yɛaboaboa nipadua akwaa, nkyekyɛmu, ayaresa akwan, ne oprehyɛn akwan a wɔfa so yɛ distal radius fractures ano de ahwɛ.

Bobɔ no mua

Distal radius a ɛpaapae no yɛ nsateaa a ɛpaapae no fã. betumi 'adum abiɛsa nsusuwii' akyerɛkyerɛ ɔyare kwan a ɛma nsateaa mu abubu no mu yiye, a ɛno mu no, adum a ɛyɛ radial tuberosity ne navicular fossa no ho hia ma nsateaa nkwaa no a ɛbɛkɔ so agyina pintinn.

Distal radius fractures nyinaa, gye avulsion fractures a ɛwɔ dorsal margin of the radius no nkutoo, nokwarem no, basabasayɛ a ɛtrɛw dodo na ɛde ba. Ɛsono sɛnea nsa no si hɔ bere a abɔnten tumi ahorow di ho dwuma no, na ɛsono nea efi akyi tumi ahorow no mu ba no.

1.Flexion basabasayɛ betumi ama dorsally displaced intra- anaa extra-articular fractures wɔ ahoɔden a ɛba fam opira te sɛ asehwe.

2.Shear stress betumi ama articular surfaces no fã bi atutu wɔ palmar fã ma enti ɛde instability aba.

3.Wɔ ahoɔden kɛse opira mu no, compression basabasayɛ predominates na axial adesoa a ɛboro so de compression of the articular surface bone.

4.Akwan titiriw a ɛma mpaapaemu tu ne avulsion opira a avulsed bone mass taa yɛ nnompe attachment point of a ligament.

Radiologic anatomy a ɛwɔ akyirikyiri no

1.Anteroposterior sini ahorow (radial sorokɔ, ulnar deviation, ulnar varus) .

2. Sini ahorow a ɛwɔ nkyɛnkyɛn (nsateaa a ɛkɔ soro) .

Fernandez Nkyekyɛmu

Type I Metaphyseal flexion a ɛpaapae

Type II Articular ne Shear Fracture a Ɛyɛ Fɛ

Type III Compression Fracture a ɛwɔ ntini no ani

Type IV avulsion a ɛpaapae wɔ radial wrist no mu, a ɛpaapae

Type V Mixed Fractures (Ahoɔden a Ɛkorɔn a Ɛma Apaapae) .

Nsɛnkyerɛnne a Ɛfa Oprehyɛn Ho

Wɔde breki na ɛsa distal radius fractures dodow no ara wɔ closed reduction akyi, awerɛhosɛm ne sɛ saa fractures yi mu pii bɛtu anaasɛ reduction no rennye ntom a nea ebefi mu aba no nyɛ papa.

Nneɛma anum a ɛma nneɛma yɛ basaa na LaFontaine ne ne mfɛfo huu:

1 Mfiase no akyi a ɛkɔ soro > 20° (nsateaa a ɛdannan);

2 Akyi epiphysis no a ɛpaapae kakraa bi;

3 nkwaa no mu a ɛpaapae;

4 Ulnar a ɛpaapae a ɛbata ho;

5 Ɔyarefo no mfe > mfe 60.

Gyinapɛn anaa akwankyerɛ pɔtee biara nni hɔ a ɛbɛkyerɛ ayaresa kwan, na wɔyɛ ayaresa nhyehyɛe ahorow a wosusuw nneɛma pii ho, a nea ɛka ho ne opira no su a edi kan, sɛnea wɔyɛ no sɛnea wɔsan de si baabi foforo akyi, mfe a ɔyarefo adi, nnompe pa, nea ɔyarefo no hwehwɛ, ne nea wɔpɛ sɛ efi mu ba.

Sɛ wopɛ sɛ wɔtew akisikuru a wosusuw sɛ ɛyɛ den no so a, ɛnde wɔkamfo kyerɛ sɛ wonni akyi yiye. Ɛho hia sɛ yɛhyɛ no nsow sɛ sɛ x-ray ahorow a wɔyɛ toatoa so bere a wɔatew so akyi no kyerɛ sɛ entumi nnyina anaasɛ ɛretu akɔ baabi foforo a, ɛnde ebia ɛho behia sɛ wɔsakra ayaresa no. Sɛ abubuw no betumi ayɛ nea entumi nnyina a, ɛnde ɛsɛ sɛ wɔyɛ radiographs na wɔhwehwɛ mu kosi sɛ abubu no bɛsa na ayɛ den.

Ayaresa a Wɔde Di Dwuma a Wɔkora So

Wobetumi atoto akisikuru a ɛyɛ pintinn no mu yiye na wɔde breki ayɛ ho adwuma, mfiase no wɔde ahama a wɔde kyekyere nneɛma ho na akyiri yi wɔde nhama a wɔde hyɛ mu, de radiographs dapɛn biara a ɛkɔ adapɛn 3 ayɛ ho adwuma.

Sɛ nsakrae kɛse ba radial tenten, nsateaa a ɛkɔ fam, anaa ulnar deviation mu a, ɛsɛ sɛ wosusuw oprehyɛn ayaresa ho.

Wɔ ayarefo a wɔn ho yɛ mmerɛw na wɔhwehwɛ pii fam no, mpɛn pii no, ayaresa a wɔatoto mu fata, bere mpo a wɔkyerɛ sɛ wɔnyɛ oprehyɛn no.

Closed reset percutaneous nnade a wɔde si hɔ

Closed reduction a percutaneous pinning ne fixation di akyi no ho wɔ mfaso wɔ distal radius fractures a metaphyseal instability anaasɛ simple intra-articular fractures.

Anamɔn a edi kan ne anatomical repositioning, afei stabilization ne stabilization ne gram pins. Mpɛn pii no, wɔde pin a edi kan no fi radial styloid no mu kɔ radial metaphysis a ɛwɔ mfinimfini kɔ diaphysis no mu.

Anyɛ yiye koraa no, wɔde pin 2 di dwuma de ma repositioning a ɛfata a ɛyɛ den wɔ orthogonal ne lateral gyinabea ahorow no mu, na sɛ wɔpɛ a wobetumi de pin abɔ lunate facet no.

Intrafracture pinning (Kapanji kwan) ma akyi no gyina akyi. Wɔde oprehyɛn akyi a wɔde hyɛ aduru a wɔde kyekyere nipadua no mu no di dwuma adapɛn 2 de hwɛ sɛnea ɛkyinkyini no so na wɔmma pin no mu abufuw so tew, na ɛno akyi no wobetumi de nsateaa a ɛyɛ mmerɛw asi ananmu.

Closed-replacement abɔnten so fixation bracket fixation

Abɔnten so fixation braces ho wɔ mfaso ma mfiase anaa adjunctive ayaresa wɔ distal radius abubu pɔtee bi mu.

Abɔnten so fixator no ma axial stresses a ɛyɛ adwuma wɔ distal radius no so bere a forearm ntini akuw no twetwe no yɛ adwuma. Ebia ade a wɔde si hɔ no bɛfa nsateaa no so anaasɛ ɛnte saa, anaasɛ wɔde biribi foforo a wɔde besi hɔ aka ho.

Parallel traction ntumi nsan mma nsateaa no nkɔ fam koraa, nanso gyinabea a ɛnyɛ afã biara no yɛ nea wogye tom. Wɔ oprehyɛn akyi no, wɔde afiri a ɛte sɛ nhama hyehyɛ nsateaa no mu den wɔ akyi gyinabea a ɛkyinkyini mu nnafua 10 kosi sɛ ɛyaw ne akisikuru no bɛbrɛ ase.

Plate fixation ne incision ne repositioning

1、Dorsal mprɛte mu fixation a ɛwɔ akyirikyiri radius abubu

Wɔtwa tẽẽ wɔ Lister node no so, na akyirikyiri awiei no twa radial carpal joint line no na ɛba awiei cm 1 wɔ metacarpal wrist joint a ɛto so abien no ase. Awiei a ɛbɛn no trɛw fa radial dua no so cm 3 kosi 4, na ɛda mfinimfini adum no adi fa extensor ntamgyinafo a ɛto so abiɛsa no ase.

2、Palm mprɛte mu fixation a ɛwɔ akyirikyiri radius abubu

Wɔyɛ ntwitwiridii tenten wɔ radial carpal flexor tendon no so, a bunion flexor tendon no wɔ radial carpal flexor tendon no ani a emu dɔ, a wɔtwe kɔ akyi ulnarly ma ɛda anterior rotator ani ntini no adi, na wɔtwa anterior rotator ani ntini no wɔ radial fã no mfiase na wɔtwe kɔ akyi ulnarly ma ɛda adistal end of the radius a ɛyɛ den.

Asɛm 1

Asɛm a Ɛto so 2

Asɛm a ɛto so 3

3. Traction mprɛte fixation a ɛwɔ akyirikyiri radius a ɛpaapae

- woye 4-cm longitudinal incision dorsal to the third metacarpal stem, na wotwitwa mfimfini nsateaa no extensor tendon no mu ma ɛda metacarpal a ɛtɔ so mmiɛnsa no adi;

- a woatwa a eto so mmienu a ne tenten ye cm 4 anyɛ yie koraa no 4 cm akyi akosi comminuted radius no so;

- a wotwa akyi 2-cm a eto so abiɛsa wɔ Lister node no so de da extensor hallucis longus tendon no adi.

Efi distal incision no, wɔde traction plate no hyɛ proximally wɔ plane a ɛda extensor tendon (fourth dorsal compartment), joint capsule ne periosteum ntam no so. Wobetumi de extensor tendon no akɔ baabi foforo sɛ ɛho hia a.

4. Ankorankoro fixation a comminuted fractures a ɛwɔ distal radius a egyina TriMed nhyehyɛe no so