distal rayus fraktכs: wan komprεhεnsiv εksplen frכm di anatomi to di כpεrayshכn .

di distal rayus fraktכs dεm de mek 75% fכ fכm fraktכs dεm εn dεm kin kכmכn pasmak na di klinik. Insay dis atikul, wi dɔn kɔmpilayt wan list fɔ anatomi, klasifikeshɔn, tritmɛnt strateji, ɛn ɔspitul we fɔ du distal rayus fraktrɔs fɔ yu rɛfrɛns.

Sɔmariz .

fraktכs dεm na di distal rayus na pat pan wrist fraktכs. di 'Three-Column Theory' kin bεtε εksplen di patכlayz mεkanism fכ di wrist fraktכs, we di raydial kכlכm, we kכnsis fכ di raydial tubכs εn di navikul fכs, na imכtant fכ mεnten di stεbiliti fכ di wrist jכint.

כl distal rayus fraktכs, wit di εksepshכn fכ avulshכn fraktכs dεm na di dכsal margin fכ di rayus, na infakt kכz fכ ova εkstenshכn vaylεns. di an de posishun difrεnt wan 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 difrεn.

1.Flekshɔn vaylɛns kin rilizɔt in dɔsal displeys intra- ɔ ɛkstra-atikul fraktrɔs insay low-ɛnaji injuri lɛk fɔl.

2.Sheya strεs kin rεsכlt in pat pan displεsmεnt fכ di artikulכr sεf dεm na di palmar sayd so dat de mek i instability.

3.Insay ay-ɛnaji injuri, kɔmpreshɔn vaylɛns de prɛdomin ɛn pasmak akshal lod de lid to kɔmpreshɔn fɔ di artikul sɔfa bon.

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

Radiologic Anatomy of di Distal Radius .

1.Anteroposterior Films (Redial Ayt, Ulnar Devyashon, Ulnar Varus)

2. Lateral film (Palmar inklin) .

Fernandez klasifikeshɔn .

Tayp I mɛtafisɛl flekshɔn fraktrɔs .

Tayp II artikul ɛn shia fraktrɔs .

Tayp III kɔmpreshɔn fraktrɔs fɔ artikul sɔfays .

Tayp IV avulshɔn fraktrɔs na di raydial an, dislɔkeshɔn .

Tayp V miks fraktrɔs (ay ɛnaji avulshɔn fraktrɔs)

Indikɛshɔn fɔ di ɔpreshɔn .

Mɔs distal rayus fraktrɔs dɛn de trit wit brek afta dɛn dɔn lɔk di ridɔkshɔn, i sɔri fɔ no se bɔku pan dɛn fraktrɔs ya go kɔmɔt na dɛn os ɔ di ridɔkshɔn nɔ go akseptabl wit bad autkam.

Fayv destabilizing factors bin aydentify bay Lafontaine et al:

1 di initial dorsal angulεshכn > 20° (Palmar tilt);

2 Kɔmminit fraktrɔs na di dorsal epifis;

3 Frakshɔn na di jɔyn;

5 Ulnar fraktrɔs we gɛt fɔ du wit am;

5 Di pɔsin in ej > 60 ia.

Nɔr definitiv standad ɔr gaydlain nɔr de fɔ gayd tritmɛnt, ɛn tritmɛnt plan dɛn de mek tek tɛm tink bɔt bɔku bɔku tin dɛm, lɛk di fɔs injury kwaliti dɛm, kalibreshɔn afta dɛn dɔn ripɔzishɔn, di pasɛnt in ej, di bon kwaliti, di pasɛnt we dɛn nid, ɛn di autkam dɛm we dɛn want.

Fɔ klos ridɔkshɔn fɔ fraktrɔs wit sɔspɛkt stebiliti, den klos fɔlɔp na rikɔmɛnd. I impɔtant fɔ no se if wan siriɔs ɛkstrem rayt afta dɛn dɔn ridyus am, dat min se instabiliti ɔ displeysmɛnt, den wan chenj na tritmɛnt kin nid fɔ apin. If di fraktrɔs nɔ stebul, den dɛn fɔ tek rediograf ɛn evaluate am te di fraktrɔs dɔn wɛl ɛn stebul.

Kɔnsɔvativ tritmɛnt .

Stebul fraktכs kin bi saksesful klos-displεs εn trit wit brek, fכs wit splintin εn leta wit tכbulכs kכst, wit wik rεdyugraf dεm we go rich 3 wik.

If big chenj na di raydial lɔng, palmar inklin, ɔ ulnar devyashon apin, dɛn fɔ tink bɔt ɔspitul tritmɛnt.

Insay di wan dɛn we nɔ gɛt trɛnk ɛn we nɔ gɛt bɔku mɔni, dɛn kin gi dɛn tritmɛnt we dɛn kin lɔk bɔku tɛm, ivin we dɛn sho se dɛn du di ɔpreshɔn.

klos riset perkutan nidul fikseshɔn .

Klosed ridyushɔn we dɛn fala wit pɔrkyutan pinin ɛn fikseshɔn na yusful insay distal rayus fraktrɔs wit mɛtafyus instabiliti ɔ simpul inta-atikul fraktrɔs.

di fכs step na di anatomical riposishun, dεn de provayd stεbyulεshכn wit gram pin. כlsay na di fכs pin dεn kin pas frכm di raydial styloid to di raydial mεtafis mεdial to di dayafis.

a minimum 2 pin dεm dεn yuz fכ gi adekwayt stebul riposishכn insay di כtogonal εn lateral posishכn dεm, εn di lunate facet kin pin if dεn want.

intrafraktכn pinin (Kapanji tεknik) de gi dכsal sכpכt. Pכstכpεraytiv imכbilizεshכn in wan splint de aplay fכ 2 wiks fכ kכntrכl rotashכn εn minimiz pin iritashכn, afta dat i kin riples wit sכft fכram kכst.

Klos-riplesmɛnt ɛksternal fikseshɔn brakɛt fikseshɔn

Ekstanshal fikseshכn bres dεm na yusful fכ initial כ adjunktiv tritmεnt in spεsifi k distal rayus fraktכs.

di ekstenal fiksata nyutralayz di akshal strεs dεm we de akt pan di distal rayus di tεm we di fכs an mכsul grup dεm de kכntrikt. Fikseshɔn kin ɔ nɔ kin de akɔdin to di an, ɔ dɛn kin ad ɔda fikseshɔn.

Paralel trakshɔn nɔ de fulɔp fɔ briŋ bak palmar inklin, bɔt wan nyutral pozishɔn na akseptabl. afta dεn dכn du di wrist, dεn kin brays di wrist insay wan tכbul we dεn kכl dεm we dεn de rotate posita posishכn fכ 10 dez te di pen εn di εdima sכbsayd.

Plɛt fikseshɔn wit insishɔn ɛn ripɔzishɔn .

1、Dorsal plet intanal fikseshɔn fɔ distal rayus fraktrɔs

wan strεt insεshכn dεn mek am along di lista in node, wit di distal εnd we de kכros di raydial kכpal jכint layn εn we de εnd 1 cm proksimal to di bays fכ di sεkכn mεtakapal wrist jכint. di proksimal εnd de εkstendi along di raydial stem fכ 3 to 4 cm, we de sho di midul kכlכm tru di bays fכ di tכd εkstensכr intaval.

2、Palm plet intanɛnt fikseshɔn fɔ distal rayus fraktrɔs

wan lכnjitudinal insεshכn dεn mek am along di raydial kכpal fleksכr tεndon, wit di bunion fleksכr tεndon we de na di dip surface fכ di raydial kכpal fleksכr tεndon, we de rεtrakt ulnarly fכ εkspכz di antεriכr rotatori ani mכsul, εn di antεriכr rotatory ani mכsul de kכmכt na di biginin fכ di rεdyush Di rayus.

Kes 1 .

Kes 2.

Kes 3 .

3. Trakshɔn plet fikseshɔn fɔ distal rayus fraktrɔs .

- wan 4-cm longitudinal insεshכn de mek dכsal to di tכd mεtakapal stem, εn di εkstensכr tεndon fכ di mid fכn de kכntrakt fכ εkspכz di tכd mεtakapal;

- dεn mek wan sεkכn 4-cm insishכn at le 4 cm dכsal to di comminited radius;

- dεn mek wan tכd 2-cm dכsal insishכn na di Lister in node fכ εkspכz di extensor hallucis longus tεndon.

frכm di distal insishכn, di trakshכn plet de insay proksimal along di plan bitwin di εkstensכr tεndon (fכs dכsal kכmpartimεnt), di joyn kכpsul εn di pεriostכm. di extensor tεndon kin muv if nid de.

4. Individyualiz fikseshɔn fɔ kɔminit fraktrɔs dɛn na di distal rayus bays pan di trimed sistɛm .