Mɔnu xoxowo kple aɖaŋu siwo wotu ɖe aŋe si wotu me na distal radius fractures .

Distal radius fracture nye fracture si bɔ le snodzadza le sno dzi le dzomeŋɔli megbe, eye closed reduction kple Kirschner wire fixation nye atikewɔwɔmɔnu siwo bɔ wu.

Nyati sia ƒo nu tso K-kadodo ƒe gɔmeɖosewo kple aɖaŋuwo ŋu be woatsɔ ato amekokomɔnu siwo nye pinning si wotu la vɛ.

Ka etɔ̃ ƒe fixation technique lae nye ka etɔ̃ ƒe fixation technique si wonya nyuie .

ɖeka to Lister tubercle la me.

ɖeka to radial styloid ƒe dɔwɔwɔ me.

ɖeka to Lunate Fossa ƒe ƒu ƒe ƒuƒoƒo me.

IF: commimed fractures kple osteoporosis sesẽ aɖe dzɔna, woate ŋu azã kirschner ka bubuwo.

1. Amekokomɔnu .

Gbã la, wowɔa gbagbãƒea dzi ɖeɖe kpɔtɔ si wotu, eye woɖɔa megbe kple radial ƒe ʋuʋu ɖo blewuu eye wòyia edzi toa palmar flexion kple ulnar deviation me. Ne woɖe edzi vɔ la, wotsɔa asi la dana ɖe agbalẽ xatsaxatsa si woxatsa dzi, eye wòléa asibidɛwo ƒe ʋuʋu kple ulnar ƒe vovototo me ɖe asi (Nɔnɔmetata 2A, B), eye wotsɔa kirschner ka etɔ̃ ya teti ɖoa wo ŋu.

Wotsɔa K-ka gbãtɔ dea Lister ƒe tubercle, si le dzogoe 45° me, eye woɖonɛ ɖe ƒu kakɛ si te ɖe eŋu ƒe asibidɛ ƒe lãkusi dzi le radius ƒe axa didi la dzi. Ne teƒe si wotsɔ de eme le le Lister ƒe tubercle ƒe ulnar ƒe akpa dzi la, ate ŋu axɔ abi le extensor pollicis ƒe lãkusia me.

Wotsɔa k-ka evelia dea 0.5 cm me le didiƒe tso radial styloid ƒe dɔwɔwɔ gbɔ, K-ka la le 60° ƒe dzogoe dzi na radial axis, eye wògena ɖe ulnar cortex si te ɖe gbagbãƒea ŋu la me.

Wotsɔa K-ka etɔ̃lia blaa lunate fossa ƒu kakɛ si ƒe didime nye 0.5 cm si le didiƒe tso asibidɛ ƒe ƒuƒoƒo ƒe fli gbɔ, si le extensor ƒe akpa enelia kple atɔ̃lia dome. Wotsɔa k-ka la ɖoa radius ƒe palmar ƒe akpa dzi le dzogoe 45° dzi, abe alesi woɖee fia le nɔnɔmetata A kple B si le ete me ene.

Klasik percutaneous kirschner ka fixation ƒe distal radius gbagbãwo dze le nɔnɔmetata ae le ete.

 

Woɖe asibidɛ ƒe ʋuʋu le Kirschner ƒe ka si wotsɔna ƒoa ka ɖe lãme na ame megbe fia le nɔnɔmetata siwo le ete ƒe nɔnɔmetata siwo le ete la me.

2. Amekoko ƒe afɔɖeɖewo kple aɖaŋuwo .

1.Ne k-ka la ƒu du yi ɖe medullary cavity me eye mege ɖe contralateral cortex la me o la, ate ŋu atso eƒe ʋuʋu fũ ne K-ka la ge ɖe eme gbɔ. Le go sia me la, amewo dina be yewoakɔ yewoƒe asiwo ɖe dzi be yewoaɖe alesi woaɖɔe ɖo la dzi akpɔtɔ. Gake le nyateƒe me la, nusi to vovo na emae nye nyateƒe. Woatsɔ k-ka la aɖo dzogoe ene me eye wòabɔbɔ le mɔ si le ʋuʋu ɖi nu, si ana K-ka ƒe dodo nado kpo nu. Ke boŋ ele be wòanɔ dzi yim blewuu ayi dzi le K-ka ƒe nɔnɔme nu, abe alesi woɖee fia le nɔnɔmetata si le ete me ene.

Le K-ka si wofia asi la dzi la, wowɔa teƒe aɖe si gena ɖe eme le lãkusi si le didiƒe si me axial pressure mele o, eye ate ŋu age ɖe distal cortex la me. Alo ele be woatrɔ teƒe si woatsɔ ade eme la eye woadze egɔme tso gɔmedzedzea me (Nɔnɔmetata AE le ete).

2.Le Kapandji mɔnu me la, wotsɔa K-ka eve va ɖo etɔ̃ dea gbagbãƒea me be woaɖe didiƒe ʋĩ ƒe gbagbã kakɛawo dzi akpɔtɔ ahaɖɔ wo ɖo ɖe teƒe si wodi. Ne wonya ɖe K-kawo dzi kpɔtɔ ko la, wodoa wo ɖe ŋgɔ ɖe akpa siwo te ɖe wo nɔewo ŋu la me (Nɔnɔmetata AF le ete).

3.Ne Kirschner ka ƒe gege ɖe eme kple dodoƒewo te ɖe gbagbãƒea ŋu ŋutɔ la, fixation ƒe kpododonu ate ŋu adzɔ. Mele be akɔta ƒe kirschner ka eveawo nato palmar cortex la me le dzisasrã ɖeka dzi o, eye ele be palmar ƒe dodoƒe nanɔ sentimeta 2 tso afisi wogbãe le gbɔ. Kpɔ nɔnɔmetata siwo le ete.

4. Ne akɔta ƒe lãkusia ƒo ƒu vevie la, dze agbagba be màge ɖe ƒu ƒe akpa si le didiƒe ƒe gbagbãƒe o, elabena esia ate ŋu ana be fixation nado kpo nu. Figures AE le ete.

5. Le ƒumeŋuɖui sesẽ gome la, anyo wu be nàzã kirschner ka ene va ɖo atɔ̃ atsɔ aɖɔ ƒunukpeƒea ƒe gbagbã ɖo. Ɣeaɖewoɣi la, be woalé radius ƒe didime ɖe te la, wozãa kirschner ka si le tsia dzi tsɔ ɖɔa ƒu si le didiƒe ʋĩ la ɖo ɖe ulna si le didiƒe la ŋu.

6. Le akpa didiwo ƒe gbagbã le epiphyseal nuwuwu, woate ŋu azã kirschner ka gã aɖe si le ŋgɔgbe la hena fixation. Ke hã, Kirschner ka la ate ŋu adze ɖe medullary cavity la me eye esesẽ be woaɖɔe ɖo (Nɔnɔmetatawo AD le ete).

7. Woʋua ƒu ƒe akpa si le ƒunukpeƒea me la eye wotsɔa kirschner ka si le ƒunukpeƒea ɖe ƒunukpeƒea te gbã, eye emegbe wotsɔa kirschner ka etɔ̃ siwo wotsɔna ƒoa ƒu ɖe wo nɔewo ŋu la ɖoa wo ŋu le mɔ si wozãna ɖaa nu (nɔnɔmetata siwo le ete).

8. Distal fracture sesẽ si nye distal radius si kpe ɖe shortening kple collapse ŋu la bia kirschner wire bubu si le tsia dzi be wòato ulna la me be wòalé radius ƒe kɔkɔme ɖe te. Kirschner ka la nyo wu be woafia asi styloid ƒe akpa si le deti ƒe akpa dzi va ɖo ulna ƒe megbeƒuƒu ƒe akpa dzi, abe alesi woɖee fia le nɔnɔmetata A kple B si le ete me ene.

9. Radial styloid gbagbã kple megbe ƒe ʋuʋu. Ne èɖe edzi vɔ la, tsɔ styloid kirschner ka eve siwo le radial la ɖɔ ɖo: ɖeka le megbe ƒe akpa dzi eye evelia le palmar ƒe akpa dzi vaseɖe styloid la ƒe nugbɔ. (Nɔnɔmetata A kple B le ete)

10. Akpa ene ƒe gbagbã si le didiƒe ƒe didime, si ƒe megbe ʋuʋu kple lunate fossa ƒe mama tso palmar ƒe akpa dzi. Woate ŋu atsɔ Kirschner ka la aɖo akɔta ƒe lãkusi me le mɔ si le tsia dzi nu tso metacarpal ƒu kakɛ si te ɖe eŋu va ɖo didiƒe. (Nɔnɔmetata A kple B le ete).

11. Ne èle akɔta kple palmar kirschner ka siwo wotsɔ ƒoa ƒu ɖe didiƒe ƒe didime si wotsɔ ƒo ƒu wɔe la zãm la, ne womeɖe lunate fossa ƒe palmar kakɛa dzi kpɔtɔ le amekoko me o la, àte ŋu azã palmar mɔnu, azã ʋuka ƒe akpa si wotsɔ ƒo ƒu ɖe ƒu me, eye emegbe nàde Kirschner ƒe ka la me. (Nɔnɔmetata AH le ete)

12. Le distal radius fractures siwo woɖe ɖa si dze ƒã siwo womate ŋu aɖe to reducted dzi ɖeɖe kpɔtɔ me o ta la, woate ŋu azã 3 mm kirschner wire atsɔ akɔ distal fracture fragment tso megbe be woaɖo edzi (Nɔnɔmetata AH le ete).

13. Zã gotagome fixators nàtsɔ akpɔ comminuted fractures of the distal radius. External fixators sɔ na distal radius ƒe gbagbã sesẽ siwo wotsɔ ƒo ƒu ɖe wo nɔewo ŋu siwo kpe ɖe swelling, open fractures, alo local skin condition si meɖea mɔ ɖe ememe fixation ŋu o (abe plate fixation ene) (Nɔnɔmetata siwo le ete) ŋu.

3. Xɔ mɔ ɖe kuxiwo nu .

1.Be nàxe mɔ ɖe fixation si meli ke o nu la, lé ŋku ɖe dɔ siwo gbɔna ŋu .

Lé ŋku ɖe bicortical fixation ŋu.

Ƒo asa na aŋe si le didiƒe ƒe dodoƒe si te ɖe gbagbãƒea ŋu la dada.

Ƒo asa na Kirschner ka siwo katã ƒo ƒu ɖe eƒe nugbɔ si le didiƒe la be woaƒo ŋusẽa nu ƒu.

Kpɔ nyuie be nàƒo asa na tɔtrɔ ɖe nɔnɔme ŋu ne èle Kirschner ka la bɔbɔm.

Le ƒumeŋuɖui gome la, ehiã be woatsɔ Kirschner ka bubuwo aɖo wo teƒe.

2. Afɔɖeɖe siwo woawɔ atsɔ axe mɔ ɖe aŋe si wotsɔ ƒoa aŋee nu .

Gbã la, lã ŋutigbalẽa, tsɔ ʋuka si me ʋukawo le la ma lãkusi falɛfalɛa ɖe ƒu ŋu, eye emegbe nàzã kirschner ka.

Drill blewuu be nàxe mɔ ɖe dzoxɔxɔ ƒe kuku nu.

Ƒo asa na dɔwɔwɔ enuenu zi geɖe akpa.

Ðe Kirschner ka si le ŋutigbalẽa dzi ƒe nyaƒoɖeamenu dzi kpɔtɔ.