Distal Radius Fractures: Wan Kכmprεhεnsiv εksplen Fכm Anatomi To כpεrayshכn

distal rayus frakshכn de mek 75% pan di fכram frakshכn dεm εn dεn kin kכmכn pasmak na di klinik. Insay dis atikul, wi dɔn kɔmpilayt wan list fɔ anatomi, klasification, tritmɛnt strateji, ɛn ɔspitul we fɔ distal radius fractures fɔ yu rɛfrɛns.

Sɔmari tɔk bɔt dis

Frakshכn dεm na di distal rayus na pat pan di wrist frakshכn dεm. di 'tri kכlכm tiori' kin bεtε εksplen di patכlayz mεkanism fכ di wrist frakshכn, we di raydial kכlכm, we kכnsis fכ di raydial tuberosity εn navikulכr fכsa, imכtant fכ mεnten di stεbiliti fכ di wrist jכint.

כl di distal rayus frakshכn dεm, wit di εksepshכn fכ avulshכn frakshכn dεm na di dכsal margin fכ di rayus, infakt na כva εkstenshכn vaylεns de kכz am. di an de posishun difrεnt we di fכs dεm we de na do de akt pan am, εn di ifekt dεm we di fכs dεm we de na do de du kin difrεn.

1.Flekshכn vaylεns kin rεsult in dכsal displεs intra- כ εkstra-atikul frakshכn insay lכw-εnεji injuri lεk fכ fכl.

2.Shia strεs kin rili rizulta in pat pan di artikul sεf dεm na di palma sayd we de mek i instεbiliti.

3.Insay hεy-εnεji injuri, kכmpreshכn vaylεns de prεdominεt εn εksyכs akshal lod de lid to kכmpreshכn fכ di artikulכr sεf bon.

4.di praymar mεkanism fכ frakshכn dislכkeshכn na avulshכn injuri usay di avuls bon mas kin bi di bכni atachmεnt pכynt fכ wan ligament.

Radiologic anatomy fɔ di distal rayus

1.Anteroposterior film dεm (raydial ayt, ulnar dεvyayshכn, ulnar varus) .

2. Lateral film dεm (palmar inklinεshכn) .

Fɛnandez Klasifikɛshɔn

Tayp I Mεtafisial flekshכn frakshכn

Tayp II Atikul ɛn Shia Fraktrɔ

Tayp III Kכmpreshכn Frakshכn כf Atikul Sכfays

Tayp IV avulshɔn fraktrɔs na di raydial wrist, dislɔkeshɔn

Tayp V Miks Frakshכn (High Energy Avulsion Frakshכn) .

Indikashɔn fɔ Ɔpreshɔn

Mɔs pan di distal rayus fraktrɔs dɛn kin trit wit brek afta dɛn dɔn lɔk ridyushɔn, i sɔri fɔ no se bɔku pan dɛn fraktrɔs ya go displeys ɔ di ridyushɔn nɔ go akseptabl wit pwɛl atkam.

Fayv destabilizing factors bin aydentify bay LaFontaine et al:

1 Initial dכsal angulεshכn > 20° (palmar tilt);

2 kכminεt frakshכn fכ di dכsal εpifysis;

3 fraktכs na di jכint;

4 Asosiet ulnar fraktכs;

5 Di pɔsin in ej > 60 ia.

No difinitiv standad ɔ gaydlayn nɔ de fɔ gayd tritmɛnt, ɛn dɛn kin mek tritmɛnt plan we dɛn tek bɔku tin dɛn, lɛk di fɔs injuri kwaliti dɛn, kalibreshɔn afta dɛn put am bak, di pɔsin in ej, in bon kwaliti, wetin di pɔsin nid, ɛn di tin dɛn we i want fɔ du.

fכ klos ridכkshכn fכ frakshכn wit sכspεkt stεbiliti, den klos fכlכ-ap dεn rεkomεnd. I impɔtant fɔ no se if sɔm ɛkstrem rayt afta dɛn dɔn ridyus am sho se i nɔ de stebul ɔ i de displeys, den i kin nid fɔ chenj di tritmɛnt. If di fraktrɔs kin nɔ stebul, den dɛn fɔ tek rediograf ɛn evalyu te di fraktrɔs dɔn wɛl ɛn stebul.

Kɔnsɔvativ Tritmɛnt

stebul frakshכn kin kכlos-displεs fayn fayn wan εn trit wit brek, fכs wit splint εn leta wit tכbul kכst, wit wik raydiograf te to 3 wik.

If big chenj dεm apin na di raydial lεngth, palma inklinεshכn, כ ulnar dεvyayshכn, dεn fכ tink bכt כpεrayshכn tritmεnt.

Insay di wan dɛn we nɔ gɛt bɛtɛ trɛnk ɛn we nɔ gɛt bɔku pipul dɛn fɔ du am, bɔku tɛm i kin fayn fɔ mek dɛn trit dɛn we dɛn lɔk, ivin we dɛn se dɛn fɔ du ɔpreshɔn.

Klos riset perkutan nidul fikseshɔn

kכlos rεdukshכn we dεn fכlכ wit pεrkyutεn pin εn fiksεshכn de yusful insay distal rεdyus frakshכn wit mεtafiz instεbiliti כ simpul intra-artikulכr frakshכn.

di fכs step na anatomical riposishכn, dεn de provayd stεbilizεshכn wit gram pin dεm. כltεm di fכs pin de pas frכm di raydial staylכyd to di raydial mεtafis mεdial to di dayafisis.

di minimכm 2 pin dεn de yuz fכ gi adekwat stebul riposishכn na di כtכgכnal εn lateral posishכn dεm, εn di lunate fεs kin pin if yu want.

intrafraktכs pinin (Kapanji tεknik) de gi dכsal sכpכt. post-opεraytiv immobilizεshכn insay splint dεn de aplay fכ 2 wik fכ kכntrכl rotashכn εn minimiz pin iritashכn, afta dat dεn kin riples am wit sכft fכram kכst.

Klos-riplesmɛnt ɛksternal fikseshɔn brakɛt fikseshɔn

εksternal fiksεshכn bres dεm yusful fכ initial כ adjunktiv tritmεnt in spεsifi k distal rayus frakshכn.

di εksternal fiksεta de nyutralayz di akshal strεs dεm we de akt pan di distal rayus di tεm we di fכram mכsul grup dεm de kכntrikshכn. Fikseshɔn kin de ɔ nɔ kin de akɔdin to di an, ɔ dɛn kin ad ɔda fikseshɔn.

paralel trakshכn nכ de fulכp fכ rεstכr di palma inklinshכn, bכt nyutral posishכn na akseptabl. afta di כpεrayshכn, dεn de brεs di an insay wan tכbul kכst insay wan rotated posita posishכn fכ 10 dez te di pen εn εdima sכb.

Plɛt fikseshɔn wit insishɔn ɛn ripɔzishɔn

1、Dכsal plet intanεt fiksεshכn fכ distal rεdyus frakshכn

wan strεt insishכn de mek along di Lister in no, wit di distal εnd we de kכros di raydial kכpal jכint layn εn de εnd 1 cm proksimal to di bεs fכ di sεkכn mεtakarpal wrist jכint. di proksimal εnd de εkstendi along di raydial stεm fכ 3 to 4 cm, we de sho di midul kכlכm tru di bεs fכ di tכd εkstensכr intaval.

2、Palm plet intanal fikseshɔn fɔ distal rayus fraktrɔs

wan lכnjitudinal insishכn de mek along di raydial kכpal flekshכn tεndon, wit di bunion flekshכn tεndon we de na di dip sεf fכ di raydial kכpal flekshכn tεndon, we de rεtrakt ulnarly fכ εkspos di antεriכr rotator ani mכsul, εn di antεriכr rotator ani mכsul dεn de sεvεr na di biginin fכ di raydial sayd εn rεtrakt ulnarly fכ εkspכz di distal εnd fכ di rayus we dɛn kɔl rayus.

Kes we dɛn kɔl 1

Kes we nem 2

Kes we dɛn kɔl 3

3. Trakshɔn plet fikseshɔn fɔ distal rayus fraktrɔs

- dεn mek wan 4-cm lכnjitudinal insishכn dכsal to di tכd mεtakarpal stεm, εn di εkstensכr tεndon fכ di midul finga de kכntrakt fכ sho di tכd mεtakarpal;

- dεn mek sεkכn 4-cm insishכn at le 4 cm dכsal to di kכminit rayus;

- dεn de mek tכd 2-cm dכsal insishכn na di Lister in no fכ sho di εkstensכr hallucis longus tεndon.

frכm di distal insishכn, di trakshכn plet de insay proksimal along di plen bitwin di εkstensכr tεndon (fכs dכsal kכmpartimεnt), di jכyn kapsul εn di pεriostכm. di εkstensכr tεndon kin muv if nid de.

4. Individyual fikseshכn fכ kכminut frakshכn dεm fכ di distal rεdyus bays pan di TriMed sistεm