Distal radius fractures: Nkyerɛkyerɛmu a edi mũ a efi nipadua mu yare so kosi oprehyɛn so .

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

Bɔ no mua .

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

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

1.Flexion basabasayɛ betumi ama dorally tu fi intra- anaa extra-articular fractures wɔ ahoɔden a ɛba fam apirakuru te sɛ asehwe mu.

2.Shear stress betumi ama articular surfaces no akɔ anim fã bi wɔ palmar fã no ma enti ɛde instability ba.

3.Wɔ ahoɔden kɛse apirakuru mu no, nhyɛso basabasayɛ na ɛwɔ hɔ na axial loading a ɛboro so no ma ntini no ani dompe no mia.

4.Afiri titiriw a ɛma fracture dislocation yɛ avulsion opira a avulsed bone mass taa yɛ bony attachment point of a ligament.

Radiologic Anatomy a ɛwɔ akyirikyiri radius no mu .

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

2. Sini a ɛwɔ akyi (Palmar inclination) .

Fernandez nkyekyɛmu .

Type I metaphyseal flexion a ɛpaapae .

Type II articular ne shear fracture .

Type III Ntini a ɛwɔ ntini no ani a ɛyɛ mmerɛw .

Type IV avulsion fracture a ɛwɔ radial wrist no mu, dislocation .

Type V a wɔadi afra mu abubu (ahoɔden a ɛkorɔn a ɛma ɛyɛ mmerɛw) .

Nneɛma a ɛkyerɛ sɛ obi bɛyɛ oprehyɛn .

Wɔde breki sa distal radius radius fractures dodow no ara bere a wɔatew so awie no, awerɛhosɛm ne sɛ saa fractures yi mu pii betu afi hɔ anyɛ saa a wɔrenpene so a ɛnyɛ nea ebefi mu aba.

Nneɛma anum a ɛma nneɛma yɛ basaa a Lafontaine ne ne mfɛfo hui:

1 Mfitiaseɛ akyi angulation > 20° (Palmar tilt);

2 comminited fracture of the dorsal epiphysis;

3 abubu wɔ nkwaa no mu;

4 ulnar a ɛpaapae a ɛbata ho;

5 Ɔyarefo no mfe a wadi > mfe 60.

Gyinapɛn anaa akwankyerɛ a edi mũ biara nni hɔ a wɔde bɛkyerɛ ayaresa kwan, na wɔma ayaresa nhyehyɛe ahorow no susuw nneɛma pii ho, a nea ɛka ho ne opira su a edi kan, nea wɔde hyɛ mu bere a wɔasan de asi baabi foforo, ayarefo mfe a wɔadi, nnompe no su, ayarefo a wɔhwehwɛ, ne nea wɔpɛ sɛ efi mu ba.

Sɛnea ɛbɛyɛ a wɔbɛtew mpaapaemu a ɛwɔ mu a wosusuw sɛ ɛyɛ nea ɛyɛ den no so no, afei wɔkamfo kyerɛ sɛ wonni akyi koraa. Ɛho hia sɛ yɛhyɛ no nsow sɛ, sɛ X-ray ahorow a ɛtoatoa so wɔ reduction akyi kyerɛ sɛ tebea a entumi nnyina anaasɛ ɛkɔ baabi foforo a, ɛnde ebia nsakrae a ɛba ayaresa mu no ho behia. Sɛ akisikuru no ntumi nnyina a, ɛnde ɛsɛ sɛ wɔyɛ radiographs na wɔsɔ hwɛ kosi sɛ akisikuru no bɛsa na ayɛ den.

Ayaresa a wɔde di dwuma wɔ ɔkwan a ɛyɛ katee so .

Wobetumi atoto akisikuru a ɛyɛ den no mu yiye na wɔde breki ayɛ no yiye, mfiase no wɔde splinting ayɛ no na akyiri yi wɔde afiri a wɔde yɛ nneɛma a ɛyɛ nhama a wɔde ayɛ no ayɛ, na wɔde radiographs dapɛn biara ayɛ adwuma kosi adapɛn 3.

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

Wɔ ayarefo a wɔn ho yɛ mmerɛw ne wɔn a wonni ahoɔden pii mu no, ayaresa a wɔatoto mu taa fata, bere mpo a wɔkyerɛ sɛ wɔyɛ wɔn oprehyɛn no.

Closed reset percutaneous needle fixation .

Closed reduction a edi hɔ a percutaneous pinning ne fixation di akyi no ho wɔ mfaso wɔ distal radius fractures a metaphyseal instability anaasɛ intra-articular fractures a ɛnyɛ den mu.

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

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

Intrafracture pinning (Kapanji Technique) ma akyi mmoa. Wɔde oprehyɛn akyi a wɔmma ɛnyɛ adwuma wɔ aduru a wɔde hyɛ mu no di dwuma adapɛn 2 de hwɛ sɛnea ɛdannan no so na ɛma pin a ɛyɛ hyew no so tew, na ɛno akyi no, wobetumi de nsa a wɔde ayɛ anim a ɛyɛ mmerɛw asi ananmu.

Closed-replacement abɔnten fixation bracket fixation .

External fixation braces ho wɔ mfaso ma ayaresa a edi kan anaa nea wɔde ka ho wɔ distal radius fractures pɔtee bi mu.

Abɔnten fixator no ma axial stress ahorow a ɛyɛ adwuma wɔ distal radius no so bere a nsa anim ntini akuw no twetwe no yɛ nea ɛho nhia. Ebia fixation betumi akɔ nsateaa no so anaasɛ enni hɔ, anaasɛ wobetumi de fixation foforo aka ho.

Parallel traction mma nsateaa no ntumi nsan n’awie koraa, nanso gyinabea a ɛnyɛ nea ɛfa biribiara ho no yɛ nea wogye tom. Wɔ oprehyɛn no akyi no, wɔde nsateaa no ahyɛ ntini a wɔde ahyɛ mu no mu wɔ akyi gyinabea a ɛkyinkyini nnafua 10 kosi sɛ ɛyaw ne ahurututu no bɛbrɛ ase.

Mprɛte a wɔde hyɛ mu a wɔde ntwitwiridii ne nea wɔde si ananmu .

1、dorsal plate no mu a ɛyɛ mmerɛw sɛ ɛbɛpaapae wɔ akyirikyiri radius mu .

Wɔyɛ ntwitwiridii tẽẽ wɔ Lister no node no ho, a ɛwɔ akyirikyiri awiei no twa radial carpal joint line no na ɛde 1 cm bɛn metacarpal wrist joint a ɛto so abien no ase. Awieɛ a ɛbɛn no trɛw fa radial stem no ho ma 3 kɔsi 4 cm, na ɛda mfimfini adum no adi fa extensor interval a ɛtɔ so mmiɛnsa no ase.

2、palm mprɛte mu fixation a ɛwɔ akyirikyiri radius fracture .

Wɔyɛ ntwitwiridii a ɛkɔ akyiri wɔ radial carpal flexor tendon no ho, a bunion flexor tendon no wɔ radial carpal flexor tendon no ani a emu dɔ no so, a ɛtwe ulnarly no fi hɔ ma ɛda anterior rotator ani ntini no adi, na anterior rotat anis no ntini a ɛwɔ anim no yɛ radi no radi no radial of the don radius a ɛwɔ hɔ.

Asɛm 1 .

Asɛm 2 .

Asɛm 3 .

3. Traction mprɛte a ɛwɔ akyirikyiri radius fracture .

- a 4-cm tenten ntwitwiridii no yɛ akyi kɔ metacarpal dua a ɛto so abiɛsa, na extensor tendon a ɛwɔ mfinimfini nsateaa no mu no twetwe ma ɛda metacarpal a ɛto so abiɛsa no adi;

- a eto so mmienu 4-cm ntwitwiridii anyɛ yiye koraa no 4 cm dorsal to comminited radius;

- a eto so 2-cm akyi ntwitwiridii wo Lister node no mu de pae extensor Hallucis longus tendon no ho ntama.

Efi akyirikyiri ntwitwiridii no mu no, wɔde traction plate no hyɛ plane a ɛda extensor tendon (akyi fã a ɛto so anan), nkwaa a ɛwɔ nkwaa no mu ne periosteum no ntam. Sɛ ɛho hia a, wobetumi de extensor tendon no akɔ baabi foforo.

4. Ankorankoro a wɔde wɔn ho ahyɛ comminited fractures of the distal radius a egyina trimed nhyehyɛe so .