Distal radius fractures: numeɖeɖe blibo tso ŋutilã ƒe wɔwɔme dzi va ɖo amekoko dzi .

Distal radius fractures nyea 75% le abɔta ƒe gbagbã me eye wobɔ ɖe atikewɔƒea koŋ. Le nyati sia me la, míeƒo ŋutilã ƒe wɔwɔme, hatsotsowo me toto, atikewɔwɔmɔnu, kple amekokomɔnu siwo wozãna tsɔ kpɔa nu le didiƒe ʋĩ ƒe xexlẽdzesiwo nu ƒu hena wò nufiame la ƒe xexlẽdzesiwo.

Gblɔe kpuie .

Distal radius ƒe gbagbã nye asibidɛwo ƒe gbagbã ƒe akpa aɖe. ate 'kɔsɔkɔsɔ ƒe nufiafia ' ŋu aɖe asibidɛ ƒe gbagbã ƒe dɔléle ƒe mɔnu me nyuie wu, si me radial sɔti, si me radial tuberosity kple navicular fossa le la le vevie na asibidɛ ƒe ƒunukpeƒe ƒe liƒo me léle ɖe asi.

Le nyateƒe me la, distal radius ƒe gbagbãwo katã, negbe avulsion fractures of the dorsal margin of the radius la, le nyateƒe me la, ŋutasẽnuwɔwɔ si gbɔ eme gbɔe wòtso. Wotsɔa asi la ɖoa teƒe bubu ne gotagomeŋusẽwo wɔa dɔ ɖe edzi, eye gotagomeŋusẽwo ƒe ŋusẽkpɔɖeamedziwo to vovo.

1.Flexion ŋutasẽnuwɔwɔ ate ŋu ahe akɔta ƒe ʋuʋu le intra- alo extra-articular fractures le abi siwo me ŋusẽ mele o abe falls ene me.

2.Shear stress ate ŋu ana be akpa aɖe naʋuʋu le articular surfaces le palmar ƒe akpa dzi ale be wòahe malikenyenye vɛ.

3.Le abi siwo me ŋusẽ geɖe le me la, nutete ƒe ŋutasẽnuwɔwɔ xɔ aƒe ɖe eme eye axial loading si gbɔ eme hea articular surface bone ƒe nutete vɛ.

4.Nu vevitɔ si wɔa dɔ le ƒu gbagbã ƒe ʋuʋu nye avulsion abi si me avulsed ƒu ƒe lolome zi geɖe nye ƒu ƒe kpeɖeŋutɔ teƒe le lãkusi.

Radiologic Anatomy of the Distal Radius .

1.Ateroposterior filmwo (kɔkɔe ƒe kɔkɔme, ulnar deviation, ulnar varus)

2. lateral filmwo (Palmar inclination) .

Fernandez ƒe hatsotsowo me toto .

Type I Metaphyseal Flexion Fracture .

Akɔta kple lãkusi ƒe gbagbã ƒomevi II .

Type III ƒe nutete ƒe gbagbã le articular surface .

Ƒomevi IV ƒe avulsion gbagbã le radial asibidɛ, dislocation .

Ƒomevi V mixed fractures (high energy avulsion fractures) .

Nusiwo fia be woawɔ dɔ na ame .

Wotsɔa brek daa dɔ na distal radius fractures akpa gãtɔ le closed reduction megbe, nublanuitɔe la, fractures siawo dometɔ geɖe aʋuʋu alo woaɖe edzi akpɔtɔ ne emetsonu gbegblẽ aɖeke mele eme o.

Wode dzesi nusiwo ana mali ke la to Lafontaine kple exɔlɔ̃wo dzi:

1 Dorsal ƒe ʋuʋu gbãtɔ > 20° (palmar tilt);

2 comminuted fracture of the dorsal epiphysis;

1 Akpa si wogbã le ƒunukpeƒea;

1 Ulnar ƒe gbagbã si do ƒome kplii;

6 Dɔnɔa ƒe ƒe > ƒe 60.

Dzidzenu alo mɔfiame siwo ŋu kakaɖedzi le aɖeke meli si fiaa mɔ atikewɔwɔ o, eye wowɔa atikewɔwɔ ƒe ɖoɖowo le nu geɖe ŋu, siwo dometɔ aɖewoe nye abixɔxɔ ƒe nɔnɔme gbãtɔwo, dzidzedze le woƒe nɔƒewo ɖoɖo vɔ megbe, dɔnɔa ƒe ƒexɔxɔ, ƒu ƒe nyonyome, dɔnɔa ƒe nudidiwo, kple emetsonu siwo wodi.

Le gbagbãƒe siwo wosusu be woli la dzi ɖeɖe kpɔtɔ si wotu nu la, wokafui be woakplɔe ɖo nyuie. Ele vevie be míade dzesii be ne X-ray siwo kplɔ wo nɔewo ɖo le wo dzi ɖeɖe kpɔtɔ megbe ɖee fia be malikenyenye alo woƒe ʋuʋu le wo ɖokui si la, ekema ahiã be woatrɔ atikewɔwɔ. Ne gbagbãƒea mate ŋu anɔ anyi ɖaa o la, ekema ele be woawɔ radiographs eye woada wo kpɔ vaseɖe esime gbagbãƒea nahaya eye wòali ke.

Atikewɔwɔ si me woɖea mɔ ɖe nu ŋu le .

Woate ŋu axe mɔ ɖe gbagbãƒe siwo li ke nu dzidzedzetɔe eye woatsɔ brek awɔ dɔ na wo, le gɔmedzedzea me la, woatsɔ aŋe abla wo eye emegbe woatsɔ ʋuƒo si wotsɔna ƒoa ʋuƒoe, eye woaɖe foto kwasiɖa sia kwasiɖa vaseɖe kwasiɖa 3.

Ne tɔtrɔ ɖedzesiwo va le radial ƒe didime, asibidɛ ƒe ŋgɔgbedede, alo ulnar ƒe vovototo ŋu la, ele be woabu amekoko ƒe atikewɔwɔ ŋu.

Le dɔnɔ siwo ƒe lãme gbɔdzɔ eye womebiaa wo boo o gome la, zi geɖe la, atikewɔwɔ si wotu la sɔ, ne wogblɔ be wowɔ dɔ na wo gɔ̃ hã.

Wotu reset percutaneous needle fixation .

Closed reduction si kplɔe ɖo kple percutaneous pinning kple fixation ɖea vi le distal radius fractures siwo me metaphyseal instability alo intra-articular fractures bɔbɔewo le me.

Afɔɖeɖe gbãtɔe nye anatomical repositioning, emegbe wotsɔa gram pins naa liƒolili. Zi geɖe la, wotsɔa pin gbãtɔa tsoa radial styloid gbɔ yia radial metaphysis medial gbɔ yia diaphysis la gbɔ.

Wozãa pin 2 ya teti tsɔ naa nɔnɔme si sɔ si li ke le orthogonal kple lateral positions me, eye woate ŋu atsɔ lunate facet la aƒoe ne wodi.

Intrafracture pinning (Kapanji mɔnu) naa akɔta ƒe kpekpeɖeŋu. Wozãa dɔwɔwɔ vɔ megbe ƒe ʋuʋu le aŋekotoku me kwasiɖa 2 tsɔ kpɔa tɔtrɔ dzi eye woɖea pin ƒe dzikudodo dzi kpɔtɔna, eye le ema megbe la, woate ŋu atsɔ ŋgɔgbeti falɛfalɛ aɖɔlii.

Wotu gotagome fixation bracket fixation .

External fixation braces ɖea vi na gbãtɔ alo kpeɖeŋutɔ atikewɔwɔ le distal radius fractures tɔxɛwo me.

External fixator la ɖea axial stress siwo wɔa dɔ ɖe distal radius dzi le abɔta ƒe lãmekawo ƒe ƒuƒoƒoawo ƒe tete me la ɖa. Woate ŋu atsɔ fixation akpe ɖe asibidɛa ŋu alo mate ŋu anɔ eme o, alo woate ŋu atsɔ fixation bubuwo akpe ɖe eŋu.

Parallel traction megbugbɔa asibide ƒe ŋgɔgbedede ɖoa anyi bliboe o, gake woda asi ɖe akpaɖekedzimademade ƒe nɔnɔme dzi. Le dɔwɔwɔ vɔ megbe la, wotsɔa asiƒome la blaa asibidɛa ɖe megbe ƒe nɔnɔme si trɔna me hena ŋkeke 10 vaseɖe esime vevesesea kple edema la nu fana.

Plate fixation kple incision kple repositioning .

1、Dorsal plate ememe fixation ƒe distal radius fracture .

Wowɔa lãɖeɖe dzɔdzɔe to lister ƒe node dzi, eye eƒe nugbɔ si le didiƒe la tsoa radial carpal joint line eye wòwua enu 1 cm proximal ɖe metacarpal wrist joint evelia ƒe gɔme. Nugbɔ si te ɖe eŋu la keke ɖe enu le radial stem la dzi hena sentimeta 3 va ɖo 4, si naa titina sɔti la toa extensor dometsotso etɔ̃lia ƒe gɔme.

2、Palm plate ememe fixation ƒe didiƒe radius gbagbã .

A longitudinal incision is made along the radial carpal flexor tendon, with the bunion flexor tendon located on the deep surface of the radial carpal flexor tendon, which is retracted ulnarly to expose the anterior rotator ani muscle, and the anterior rotator ani muscle is severed at the beginning of the radial side and retracted ulnarly to expose the distal end of the Radius.

Nya 1 .

Nudzɔdzɔ 3 .

Nudzɔdzɔ 3 .

3. traction plate fixation of distal radius fracture .

- wowɔa 4-cm ƒe didime ƒe ʋuʋu ɖe megbe na metacarpal stem etɔ̃lia, eye woblaa titina asibidɛ ƒe lãkusi ƒe lãkusi be wòaɖe metacarpal etɔ̃lia ɖe go;

- Wowɔa evelia 4-cm ƒe ʋuʋudedi ya teti cm 4 cm dorsal na comnumed radius;

- Wowɔa 2-cm ƒe akɔta ƒe akpa etɔ̃lia le Lister ƒe node be woatsɔ aɖe Extensor Hallucis Longus ƒe lãkusia ɖe go.

Tso distal incision me la, wotsɔa traction plate la dea eme le mɔ si te ɖe yameʋua ŋu le extensor tendon (akɔta ƒe akpa enelia), ƒunukpeƒe ƒe lãkusi kple ƒunukpeƒea dome. Woate ŋu aʋuʋu extensor tendon ne ehiã.

4. Ame ɖekaɖekawo ƒe fixation of comminud fractures of the distal radius si wotu ɖe trimed system dzi .