Distal Radius Fractures: Numeɖeɖe Blibo Tso Ŋutilã ƒe Nɔnɔme Ŋuti Nusrɔ̃ƒe Vaseɖe Amekoko Dzi

Distal radius fractures nye abɔta ƒe gbagbã ƒe 75% eye wòbɔ ŋutɔ le atikewɔƒea. Le nyati sia me la, míeƒo ŋutilã ƒe wɔwɔme, hatsotsowo me toto, atikewɔwɔmɔnu, kple amekokomɔnu siwo wozãna le distal radius fractures gbɔ ƒe xexlẽdzesiwo nu ƒu be nàte ŋu akpɔe.

Gblɔe kpuie

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

Le nyateƒe me la, ŋutasẽnuwɔwɔ si gbɔ eme gbɔe wòtsona be distal radius fractures katã, negbe avulsion fractures of the dorsal margin of the radius koe mele eme o. Asi la ƒe nɔnɔme to vovo ne gotagomeŋusẽwo wɔ dɔ ɖe edzi, eye gotagomeŋusẽwo ƒe ŋusẽkpɔɖeamedzi to vovo.

1.Flexion ŋutasẽnuwɔwɔ ate ŋu ana dorsally displaced intra- alo extra-articular fractures le ŋusẽ sue abi abe anyidzedze ene.

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

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4.Mɔnu vevitɔ si dzi ƒu ƒe gbagbã le enye avulsion injury afisi avulsed bone mass nye zi geɖe la ƒu ƒe attachment point of a ligament.

Radiologic anatomy si le didiƒe ƒe didime

1.Anteroposterior films (radial kɔkɔme, ulnar ƒe tete ɖa, ulnar varus) .

2. Film siwo woɖena le axadzi (asibidɛ ƒe ŋgɔgbedede) .

Fernandez ƒe hatsotsowo me toto

Ƒomevi I Metaphyseal flexion ƒe gbagbã

Ƒomevi II Articular kple Shear Fracture

Ƒomevi III Compression Fracture of Articular Surface

Type IV avulsion fracture of the radial wrist, eƒe ʋuʋu

Ƒomevi V Mixed Fractures (Ŋusẽ Kɔkɔ ƒe Avulsion Fractures) .

Dzesiwo Na Amekoko

Wotsɔa brek daa dɔ na distal radius fractures akpa gãtɔ le closed reduction megbe, nublanuitɔe la, fractures siawo dometɔ geɖe aʋuʋu alo reduction madze o kple emetsonu gbegblẽ.

LaFontaine et al de dzesi nu atɔ̃ siwo nana ame ƒe lãme me mekɔna o:

1 Akɔta ƒe dzogoe gbãtɔ > 20° (asibidɛ ƒe ʋuʋu);

2 Akɔta ƒe lãkusi ƒe gbagbã vivivi;

3 ƒunukpeƒea ƒe gbagbã;

4 Ulnar ƒe gbagbã si do ƒome kplii;

5 Dɔnɔa ƒe ƒexɔxɔ > ƒe 60.

Dzidzenu alo mɔfiame aɖeke meli si ŋu kakaɖedzi le si afia mɔ atikewɔwɔ o, eye wowɔa atikewɔwɔ ƒe ɖoɖowo le nu gbogbo aɖewo ŋu bubu me, siwo dometɔ aɖewoe nye abi ƒe nɔnɔme gbãtɔwo, alesi woawɔ adzidzee le teƒe bubu ɖoɖo vɔ megbe, ƒe si dɔnɔa xɔ, ƒu ƒe nyonyome, nusiwo dɔnɔa hiã, kple nusiwo wodi be yewoado tso eme.

Le gbagbãƒe siwo wosusu be woli ke dzi ɖeɖe kpɔtɔ nutsitsi gome la, ekema wokafui be woakplɔe ɖo kplikplikpli. Ele vevie be míade dzesii be ne x-ray siwo kplɔ wo nɔewo ɖo le edziɖeɖe vɔ megbe ɖee fia be womeli ke o alo woʋu le teƒe bubu la, ekema ate ŋu ahiã be woatrɔ atikewɔwɔ. Ne ate ŋu anye be gbagbãƒea mate ŋu ali ke o la, ekema ele be woaɖe fotoɖeɖe le radio dzi ahadae kpɔ vaseɖe esime gbagbãƒea haya eye wòli ke.

Atikewɔwɔ si Me Womekpɔa Nu Le O

Woate ŋu atu gbagbã siwo li ke la dzidzedzetɔe-aɖe wo ɖa eye woatsɔ brek awɔ atike na wo, le gɔmedzedzea me la, woatsɔ aŋe abla wo eye emegbe woatsɔ aŋe si wotsɔna ƒoa ʋuƒoe, kple kwasiɖa sia kwasiɖa ƒe fotoɖeɖe vaseɖe kwasiɖa 3.

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

Le dɔnɔ siwo gbɔdzɔ eye womebiaa wo boo o gome la, zi geɖe la, atikewɔwɔ si wotu ɖe wo nɔewo dzi sɔ, ne wobia be woawɔ dɔ na wo gɔ̃ hã.

Closed reset percutaneous aŋe fixation

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

Afɔɖeɖe gbãtɔe nye ŋutilã ƒe wɔwɔme gbugbɔgaɖoanyi, emegbe wotsɔa gram pins naa eƒe liƒolili. Zi geɖe la, wotsɔa pin gbãtɔ tso radial styloid gbɔ yia radial metaphysis medial gbɔ va ɖoa diaphysis gbɔ.

Wozãa pin 2 ya teti tsɔ naa gbugbɔgaɖoanyi si li ke nyuie le orthogonal kple lateral nɔnɔmewo me, eye woate ŋu atsɔ pin abla lunate facet ne wodi.

Intrafracture pinning (Kapanji mɔnu) naa akɔta ƒe kpeɖeŋutɔ. Wozãa dɔwɔwɔ vɔ megbe ƒe ʋuʋu le aŋekotoku me kwasiɖa 2 be woatsɔ akpɔ eƒe tɔtrɔ dzi eye woaɖe pin ƒe dzikudodo dzi akpɔtɔ, eye le ema megbe la, woate ŋu atsɔ abɔta falɛfalɛ aɖɔlii.

Wotu-ɖɔli gotagome fixation bracket fixation

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

External fixator la ɖea axial stresses siwo wɔa dɔ ɖe distal radius dzi le ŋgɔgbe abɔta ƒe lãmeka ƒe ƒuƒoƒoawo ƒe tete me la ɖa. Woate ŋu atsɔ nusi woatsɔ alée ɖe asibidɛa ƒe go kemɛ dzi alo manɔ eŋu o, alo woate ŋu atsɔ nusi woatsɔ ablae bubu akpe ɖe eŋu.

Parallel traction menaa asibidɛ ƒe ŋgɔgbedede gaɖoa anyi bliboe o, gake nɔnɔme si medea akpa aɖeke dzi o sɔ. Le dɔwɔwɔ vɔ megbe la, woblaa asibidɛa le mɔ̃ si wotsɔa ʋuƒo wɔe me le megbe ƒe nɔnɔme si wogbugbɔ trɔna me hena ŋkeke 10 vaseɖe esime vevesesea kple ʋuʋudedia nu fa.

Plate fixation kple incision kple repositioning

1、Dorsal plate ememe fixation ƒe didiƒe radius gbagbã

Woɖea nu dzɔdzɔe le Lister ƒe node la ŋu, eye eƒe nuwuwu si le didiƒe la tso radial carpal joint line eye wòwua enu sentimeta 1 le metacarpal wrist joint evelia ƒe gɔme gbɔ. Nuwuƒe si te ɖe eŋu la kekena ɖe ati si le dzogoe ene me la dzi hena sentimeta 3 va ɖo 4, eye wòɖea titina sɔti la ɖe go to kekeɖenudɔa ƒe dometsotso etɔ̃lia ƒe gɔme.

2、Palm plate ememe fixation ƒe didiƒe radius gbagbã

Wowɔa lãɖeɖe didi aɖe le radial carpal flexor tendon la ŋu, eye bunion flexor tendon la le radial carpal flexor tendon ƒe gogloƒe, si wogbugbɔna ɖe megbe be wòaɖe anterior rotator ani lãmekaa ɖe go, eye wotsoa anterior rotator ani lãmeka la le radial side ƒe gɔmedzedze eye wogbugbɔe ɖe megbe ulnarly be wòaɖe distal end of the radius ƒe didime.

Nya 1 lia

Nya 2 lia

Nya 3 lia

3. Traction plate fixation ƒe didiƒe didime gbagbã

- Wowɔa lãɖeɖe si didi sentimeta 4 le megbe na abɔta ƒe ke etɔ̃lia, eye woƒoa titinasibidɛ ƒe kekeɖenudɔa nu be wòaɖe akɔta ƒe akpa etɔ̃lia ɖe go;

- Wowɔa evelia si ƒe didime nye sentimeta 4 ƒe lãɖeɖe si ƒe didime nye sentimeta 4 ya teti le megbe va ɖo didime si wotso la gbɔ;

- Wowɔa megbelã etɔ̃lia si ƒe didime nye sentimeta 2 le Lister ƒe node la gbɔ be woaɖe extensor hallucis longus tendon la afia.

Tso didiƒe ʋĩ ƒe ʋuʋudedi la, wotsɔa hehe ƒe agbalẽvi la dea yameʋu si le kekeɖenudɔa (akɔta ƒe akpa enelia), ƒunukpeƒe ƒe lãkusi kple ƒunukpeƒe dome la nu. Woate ŋu aʋuʋu extensor tendon la ne ehiã.

4. Ame ɖekaɖekawo ƒe fixation na comminuted fractures of the distal radius si wotu ɖe TriMed ɖoɖoa dzi