Mɔnu xoxowo kple aɖaŋu siwo wozãna tsɔ dea aŋe si wotu me na distal radius fractures

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

Nyati sia ƒo nu tso K-Wiring Gɔmeɖosewo Kple Mɔnuwo ŋu tsɔ to amekokomɔnu siwo nye closed pinning vɛ.

Mɔnu si wozãna tsɔ léa ka etɔ̃e nye ka etɔ̃ ɖɔɖɔɖomɔnu si wozãna tsã

Ðeka to lister tubercle me.

Ðeka to radial styloid ƒe dɔwɔwɔ dzi.

Ðeka to lunate fossa bone block me.

Ne: ƒu ƒe gbagbã sesẽwo kple ƒumeŋuɖui dzɔ la, woate ŋu azã Kirschner ka bubuwo.

1. Amekoko ƒe mɔnu

Gbã la, woɖea gbagbãƒea dzi kpɔtɔna, eye woheae blewu eye woyia edzi, eye woɖɔa akɔta kple akɔta ƒe ʋuʋu ɖo to asibidɛ ƒe ƒoƒo kple ulnar ƒe tete ɖa me. Ne woɖe asi dzi kpɔtɔ vɔ la, wotsɔa asi la dana ɖe agbalẽ si woxatsa dzi, si léa asibidɛ ƒe ƒoƒo kple ulnar ƒe tete ɖe anyi (Nɔnɔmetata 2a, b), eye wotsɔa Kirschner ka etɔ̃ ya teti siwo toa ŋutigbalẽ me la lénɛ ɖe te.

Wotsɔa K-ka gbãtɔ dea Lister ƒe ƒunukpeƒe, eƒe dzogoe le 45°, eye woɖonɛ ɖe ƒu kakɛ si te ɖe eŋu ƒe asibidɛ si le didime ƒe axa didi la dzi. Ne afisi wotsɔe de Lister ƒe tubercle ƒe akpa si nye ulnar la, ate ŋu axɔ abi le extensor pollicis tendon la ŋu.

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

Wotsɔa K-ka etɔ̃lia blaa lunate fossa bone kakɛ si didi sentimeta 0.5 tso asibidɛ ƒe ƒunukpeƒe ƒe fli gbɔ, si le extensor ƒe akpa enelia kple atɔ̃lia dome. Wotsɔa K-ka la blaa asibidɛ ƒe akpa si le didime si le dzogoe 45° me, abe alesi woɖee fia le Nɔnɔmetata a kple b si le ete me ene.

Classic percutaneous Kirschner wire fixation of distal radius fractures dze le Nɔnɔmetata ae le ete.

 

Woɖe asibidɛ ƒe ʋuʋu le Kirschner ka ƒe ƒoƒo ɖe ŋutigbalẽ me megbe fia le Figures ad si le ete me.

2. Afɔɖeɖe kple aɖaŋu siwo woatsɔ awɔ amekokoe

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

Ne K-ka la fia ɖe dzi le mɔ si le gbadzaa nu la, wowɔa gegeɖeƒe aɖe le lãkusi si le didiƒe la me axial pressure manɔmee, eye ate ŋu age ɖe lãkusi si le didiƒe la me. Alo ele be woatrɔ teƒe si wotsɔa nu dea eme eye woadze egɔme tso gɔmedzedzea me (Nɔnɔmetatawo ae le ete).

2.Le Kapandji mɔnu me la, wotsɔa K-ka eve va ɖo etɔ̃ dea afisi wogbãe le be woaɖe gbagbãƒe kakɛ siwo le didiƒe dzi akpɔtɔ ahaɖɔ wo ɖo ɖe teƒe si wodi. Ne woɖee dzi kpɔtɔ ko la, wodoa K-kaawo ɖe ŋgɔ yia proximal fragments (Nɔnɔmetatawo af le ete).

3.Ne Kirschner ka ƒe gege ɖe eme kple dodo le teƒewo te ɖe gbagbãƒea ŋu ŋutɔ la, fixation ƒe kpododonu ate ŋu adzɔ. Mele be Kirschner ka eve siwo le megbe nato asibidɛ ƒe lãkusi me le ɖoɖo ɖeka nu o, eye ele be asibidɛ ƒe dodoƒe nadidi tso afisi wògbã le gbɔ sentimeta 2. Kpɔ Figures ac le ete.

4. Ne akɔtaƒua vuvu akpa la, dze agbagba be màgage ɖe ƒu kakɛ si le didiƒe ƒe gbagbãƒe o, elabena esia ate ŋu ana be ƒu si le didiƒe la nado kpo nu. Nɔnɔmetatawo ae le ete.

5. Le ƒumeŋuɖui sesẽ gome la, anyo wu be nàzã Kirschner ka ene va ɖo atɔ̃ atsɔ aɖɔ ƒu gbagbãƒea ɖo. Ɣeaɖewoɣi la, be woalé radius ƒe didime ɖe te la, wozãa Kirschner ka si le tsia dzi tsɔ ɖɔa distal radius bone block la ɖe distal ulna la ŋu.

6. Le epiphyseal ƒe nuwuwu ƒe akpa didiwo ƒe gbagbã me la, woate ŋu azã Kirschner ka gã aɖe si le ŋgɔgbe hena fixation. Gake Kirschner ka la ate ŋu age ɖe medullary cavity me eye esesẽna be woaɖɔe ɖo (Nɔnɔmetatawo ad le ete).

7. Woʋua ƒu kakɛ si le ƒunukpeƒea me eye wotsɔa Kirschner ka si le ŋgɔgbe la lénɛ ɖe ƒunukpeƒea te gbã, eye emegbe wotsɔa Kirschner ka etɔ̃ siwo toa ŋutigbalẽ me la lénɛ ɖe te le mɔ si bɔ nu (Nɔnɔmetatawo ad le ete).

8. Distal radius ƒe gbagbã sesẽ si kpe ɖe kpuiƒe kple mumu ŋu bia be woatsɔ Kirschner ka bubu si le tsia dzi ato ulna la me be wòalé radius ƒe kɔkɔme me ɖe asi. Kirschner ka la nyo wu tso styloid ƒe dɔwɔwɔ ƒe asibidɛ ƒe akpa dzi yi ulna ƒe megbe gome, abe alesi woɖee fia le Nɔnɔmetata a kple b si le ete me ene.

9. Radial styloid gbagbã kple akɔta ƒe ʋuʋu. Ne èɖee dzi kpɔtɔ vɔ la, tsɔ Kirschner ka eve siwo nye radial styloid ɖɔe ɖo: ɖeka le akɔta eye evelia le asibidɛ dzi va ɖo styloid la ƒe nugbɔ. (Nɔnɔmetata a kple b siwo le ete)

10. Akpa ene ƒe gbagbã le didiƒe ƒe didime, si me akɔta ƒe ʋuʋu kple lunate fossa ƒe mama tso asibidɛ ƒe axadzi. Woate ŋu atɔ Kirschner ka la tso akɔta ƒe ƒunukpeƒea le mɔ si le tsia dzi nu tso akɔtaƒu ƒe kakɛ si te ɖe eŋu va ɖo didiƒe. (Nɔnɔmetata a kple b siwo le ete).

11. Ne èle Kirschner ka siwo le akɔta kple asibidɛ zãm tsɔ le akɔta kple asibidɛ ƒe Kirschner ka siwo gbã la dam la, ne womeɖe asibidɛ ƒe akpa si le lunate fossa me dzi kpɔtɔ le amekoko me o la, àte ŋu azã asibidɛ ƒe mɔnu, azã ʋukawo ƒe nulénu atsɔ ama ƒua dome, eye emegbe nàtsɔ Kirschner ka si tso asibidɛ ƒe nugbɔ ƒe kakɛa me ade akɔta ƒe lãkusi me. (Nɔnɔmetatawo ah le ete)

12. Le distal radius fractures siwo dze ƒã be woɖe wo ɖa si womate ŋu aɖe akpɔtɔ to closed reduction me o gome la, woate ŋu azã 3 mm Kirschner wire atsɔ akɔ distal fracture fragment tso megbe be woakpɔ reduction gbɔ (Nɔnɔmetata ah le ete).

13. Zã gotagome fixators nàtsɔ ada comminuted fractures of the distal radius. External fixators sɔ na comminuted gbagbã sesẽ siwo le distal radius kpe ɖe eŋu kple vuvu gã, gbagbã, alo teƒea ƒe ŋutigbalẽ ƒe nɔnɔme siwo meɖe mɔ ɖe ememe fixation (abe plate fixation) o (Nɔnɔmetatawo ad le ete).

3. Xɔ mɔ ɖe kuxiwo nu

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

Lé ŋku ɖe bicortical fixation ŋu.

Ƒo asa na aŋea ƒe dodoƒe si le didiƒe la dada ɖe afisi te ɖe afisi wògbã ŋu.

Ƒo asa na Kirschner ka siwo katã ƒoa ƒu ɖe nuwuƒe si le didiƒe be ŋusẽa naƒo ƒu.

Kpɔ nyuie be nàƒo asa na tɔtrɔ si mebɔbɔ o ne èle Kirschner ka la bɔbɔm.

Ne ƒumeŋuɖui le ame ŋu la, ehiã be woatsɔ Kirschner ka bubuwo ablae.

2. Afɔɖeɖe siwo woawɔ atsɔ axe mɔ ɖe aŋe ƒe dɔlékuiwo xɔxɔ nu

Gbã la, lã ŋutigbalẽa, tsɔ ʋuka siwo wotsɔna léa ʋukae la mã lãkusi falɛfalɛa vaseɖe ƒua gbɔ, eye emegbe nàzã Kirschner ka.

Do blewuu be nàxe mɔ ɖe dzoxɔxɔ ƒe kuku nu.

Ƒo asa na dɔwɔwɔ nɛ enuenu zi gbɔ zi geɖe.

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