Distal radius fractures: Ennyinyonnyola enzijuvu okuva mu nsengeka y’omubiri okutuuka ku kulongoosa .

Distal radius fractures zikola ebitundu 75% ku kumenya kw’omukono ogw’omu maaso era nga zitera okubeera mu ddwaaliro. Mu kiwandiiko kino, tukuŋŋaanyizza olukalala lw’ensengekera y’omubiri, okugabanya, enkola z’okujjanjaba, n’enkola z’okulongoosa okumenya kwa radius olw’okujuliza kwo.

Mu bufunze .

Okumenyeka kwa radius ey’ewala kitundu kya kumenyeka kw’engalo. ' Endowooza ya mpagi ssatu' esobola bulungi okunnyonnyola enkola y'obulwadde bw'okumenya engalo, nga mu yo empagi ey'ekika kya radial, erimu ekikuta kya radial tuberosity ne navicular fossa, kikulu okukuuma obutebenkevu bw'ekiwanga ky'omukono.

Okumenyeka kwonna okw’ewala okwa radius, okuggyako okumenya kwa avulsion okw’omumwa gw’omugongo ogwa radius, mu butuufu kuleetebwa effujjo ery’okugaziya ennyo. Omukono guteekebwa mu ngeri ya njawulo nga gukolebwako amaanyi ag’ebweru, era ebikolwa by’amaanyi ag’ebweru bya njawulo.

1.Obutabanguko mu kukyukakyuka buyinza okuvaamu okumenya oba okusengulwa kw’omugongo ogw’omugongo mu bisago eby’amaanyi amatono ng’okugwa.

2.Shear stress eyinza okuvaamu okusengulwa ekitundu ku bitundu by’omubiri ku ludda lw’omukono bwe kityo ne kivaamu obutabeera mu ntebenkevu.

3.Mu buvune obw’amaanyi amangi, obutabanguko bw’okunyigirizibwa businga era okutikka okw’ekyekulungirivu okuyitiridde kivaako okunyigirizibwa kw’eggumba ly’okungulu kw’ekitundu ky’omubiri.

4.Enkola enkulu ey’okuseeseetula kw’emmeeme (fracture dislocation) bwe buvune obw’okuvunda (avulsion injury) nga avulsed bone mass etera okuba ekifo eky’okunyweza amagumba mu ligamenti.

radiologic anatomy ya radius ey’ewala .

1.AnteroPosterior Films (obuwanvu bwa radial, okukyama kw’amagulu, ulnar varus) .

2. Firimu ez’ebbali (Palmar inclination) .

Fernandez Okugabanya .

Ekika kya I metaphyseal flexion fracture .

Ekika kya II articular ne shear fracture .

Ekika kya III okunyigirizibwa okumenya ku ngulu kw’ekitundu ky’omubiri .

Ekika kya IV okumenya okumenya engalo ya radial, okuseeseetula .

ekika kya V okumenya okutabuddwa (okukutuka kw’amasoboza amangi) .

Ebiraga okulongoosebwa .

Okumenya kwa radius okusinga ewala kujjanjabwa ne buleeki oluvannyuma lw’okukendeeza okuggaddwa, ebyembi bingi ku bimenya bino bijja kusengulwa oba okukendeeza tekujja kukkirizibwa n’ebivaamu ebibi.

Ebintu bitaano ebitabangula emirembe byazuulibwa Lafontaine et al:

1 Okusooka okugonjoola ensonga z’omugongo > 20° (palmar tilt);

2 comminute fracture ya dorsal epiphysis;

3 okumenya mu kiwanga;

4 okumenya kw’ekisambi okukwatagana;

5 Emyaka gy'omulwadde > Emyaka 60.

Tewali mutindo oba ebiragiro ebikakafu okulungamya obujjanjabi, era enteekateeka z’obujjanjabi zikolebwa nga zitunuulidde ensonga nnyingi, omuli engeri z’obuvune ezisookerwako, okupima oluvannyuma lw’okuddamu okuteekebwa mu kifo, emyaka gy’omulwadde, omutindo gw’amagumba, ebyetaago by’omulwadde, n’ebivaamu bye baagala.

Ku kukendeeza okuggalawo okumenya nga kiteeberezebwa okuba nga kinywevu, olwo okugobererwa okuggalawo kirungi. Kikulu okumanya nti singa omuddirirwa gwa X-rays oluvannyuma lw’okukendeeza gulaga obutali butebenkevu oba okusengulwa, olwo enkyukakyuka mu bujjanjabi eyinza okwetaagisa. Singa okumenya kuyinza okuba nga tekunywevu, olwo ebifaananyi bya leediyo birina okutwalibwa n’okwekenneenya okutuusa ng’okumenya kuwonye ne kutebenkera.

Enzijanjaba y’abakuumaddembe .

Okumenyeka okutebenkedde kuyinza okuggalwa obulungi ne kujjanjabibwa ne buleeki, mu kusooka nga kusiba n’oluvannyuma nga kulimu ekikuta kya tubular, nga buli wiiki leediyo zituuka ku wiiki 3.

Singa enkyukakyuka ez’amaanyi mu buwanvu bwa radial, palmar inclination, oba ulnar deviation zibaawo, obujjanjabi bw’okulongoosa bulina okulowoozebwako.

Mu balwadde abanafu n’abatali banyiikivu, obujjanjabi obuggaddwa butera okusaanidde, ne bwe kiba nti okulongoosebwa kulagibwa.

Closed reset percutaneous empiso okunyweza .

Okukendeeza okuggaddwa nga kugobererwa okusibira mu lususu n’okunyweza kwa mugaso mu kumenyeka kwa radius okw’ewala n’obutabeera mu ntebenkevu bwa metaphyseal oba okumenya okw’omunda okwangu.

Omutendera ogusooka kwe kuzzaawo ensengekera y’omubiri (anatomical repositioning), olwo okutebenkera ne kuweebwa ne ppini za gram. Ebiseera ebisinga ppini esooka eyisibwa okuva mu radial styloid okutuuka ku radial metaphysis medial ku diaphysis.

Ekitono ennyo ekya ppini 2 kye kikozesebwa okuwa okuddamu okutebenkeza okunywevu mu bifo eby’obutuufu n’eby’ebbali, era ekitundu kya lunate kisobola okusimbibwa ppini bwe kiba kyetaagisa.

Intrafracture pinning (kapanji technique) egaba obuyambi obw’omugongo. Postoperative immobilization mu splint esiigibwa okumala weeks 2 okufuga rotation n'okukendeeza ku pin irritation, oluvannyuma esobola okukyusibwamu soft forearm cast.

Closed-Replacement ebweru okunyweza ekikwaso okunyweza .

External fixation braces za mugaso mu kujjanjaba okusooka oba okusikiriza mu bitundu ebimu eby’ewala eby’ewala.

Ekiziyiza eky’ebweru kifuula okunyigirizibwa okw’ekyekulungirivu okukola ku radius ey’ewala mu kiseera ky’okukonziba kw’ebibinja by’ebinywa by’omu maaso. Okunyweza kuyinza okuba oba nga tekuyinza kuba ku mukono, oba okunyweza okw’enjawulo kuyinza okugattibwako.

Parallel traction tezzaawo mu bujjuvu palmar inclination, naye ekifo ekitaliimu kikkirizibwa. Oluvannyuma lw’okulongoosebwa, engalo zinywezebwa mu kisenge ekisuuliddwa mu kifo eky’emabega ekikyusiddwa okumala ennaku 10 okutuusa ng’obulumi n’okuzimba bikendedde.

Okunyweza pulati n’okusala n’okuzzaawo ekifo .

1、Dorsal plate Okunyweza munda mu radius fracture .

Okusala okugolokofu kukolebwa ku node ya lister, nga enkomerero ey’ewala esala layini y’ekiyungo ky’ekiwanga eky’ekika kya radial n’ekoma sentimita emu okumpi n’omusingi gw’ekiyungo eky’omukono ogw’okubiri ekya metacarpal. Enkomerero ey’okumpi ebuna ku kikolo kya radial okumala sentimita 3 ku 4, n’efulumya empagi eya wakati okuyita mu musingi gw’ekiseera eky’okusatu eky’okugaziwa.

2、Palm Plate Okunyweza okw’omunda okw’okumenya kwa radius okw’ewala .

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 radius ya radius.

Omusango 1 .

Omusango 2 .

Omusango 3 .

3. Okunyweza pulati y’okusika (traction plate fixation of distal radius fracture) .

- Okusalako obuwanvu bwa sentimita 4 kufuulibwa dorsal ku kikolo kya metacarpal eky’okusatu, era omusuwa gwa extensor ogw’engalo eya wakati gukonziba okulaga metacarpal ey’okusatu;

- Okusalako okw’okubiri okwa sentimita 4 kukolebwa waakiri sentimita 4 ez’omugongo okutuuka ku radius ey’omugatte;

- Okusala omugongo okw’okusatu okw’e 2-cm kukolebwa ku node ya Lister okulaga omusuwa gwa extensor hallucis longus.

Okuva mu kusala okw’ewala, ekipande ky’okusika kiyingizibwa mu kifo ekimu okumpi n’ennyonyi wakati w’omusinde gwa extensor (ekitundu eky’okuna eky’omugongo), ekiyungo ky’ekiwanga n’ekisenge ekiyitibwa periosteum. Omusuwa gwa extensor gusobola okutambuzibwa bwe kiba kyetaagisa.

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