Distal Radius Fractures: Ennyinyonnyola enzijuvu Okuva ku Anatomy Okutuuka ku Kulongoosa

Distal radius fractures zikola ebitundu 75% ku forearm fractures era nga zitera nnyo mu ddwaaliro. Mu kiwandiiko kino, tukuŋŋaanyizza olukalala lw’ensengekera y’omubiri, okugabanya, enkola z’obujjanjabi, n’enkola z’okulongoosa ku kumenyaamenya okw’ewala (distal radius fractures) okusobola okukujuliza.

Mu bufunze

Okumenya kw’ekitundu eky’ewala (distal radius) kitundu ku kumenya engalo. ' Endowooza y'ennyiriri ssatu' esobola okunnyonnyola obulungi enkola y'obulwadde bw'okumenya engalo, nga mu kino empagi eya radial, erimu ekitundu ky'omubiri ekiyitibwa radial tuberosity ne navicular fossa, kikulu okukuuma obutebenkevu bw'ekiyungo ky'engalo.

Okumenya kwonna okw’ewala (distal radius fractures), okuggyako okumenya kw’okumenya (avulsion fractures) okw’omugongo ogw’omugongo (dorsal margin of the radius), mu butuufu kuva ku butabanguko obw’okugaziwa ennyo. Omukono guteekebwa mu ngeri ya njawulo nga gukolebwako amaanyi ag’ebweru, era ebiva mu maanyi ag’ebweru bya njawulo.

1.Flexion violence eyinza okuvaamu dorsally displaced intra- oba extra-articular fractures mu buvune amaanyi matono nga okugwa.

2.Shear stress eyinza okuvaamu okusengulwa ekitundu ky’ebitundu by’ennyindo ku ludda lw’engalo bwe kityo ne kivaako obutabeera mu ntebenkevu.

3.Mu buvune obw’amaanyi amangi, effujjo ly’okunyigirizibwa lye lisinga era okutikka okuyitiridde okw’ekyekulungirivu kuleeta okunyigirizibwa kw’eggumba ery’okungulu ery’omugongo.

4.Enkola enkulu ey’okumenyaamenya y’obuvune bw’okukutuka ng’amagumba agakulukusiddwa gatera okuba ekifo amagumba we gakwatagana n’omusuwa.

Ensengekera y’omubiri (radiologic anatomy) ey’ekitundu eky’ewala (distal radius).

1.Firimu z’omu maaso n’emabega (obuwanvu bwa radial, okuva mu ulnar, ulnar varus) .

2. Firimu ez’ebbali (okuserengeta kw’engalo) .

Fernandez Okugabanya

Ekika I Okumenya kw’okufukamira kw’omubiri (metaphyseal flexion fracture).

Ekika kya II Okumenya kw’ebitundu by’omubiri (Articular and Shear Fracture).

Okumenya okw’ekika kya III okw’okunyigirizibwa okw’okungulu kw’ebitundu by’omubiri (Articular Surface).

Type IV avulsion fracture y’engalo eya radial, okukutuka

Ekika kya V Mixed Fractures (Emenyeka ez’amaanyi amangi agava mu kumenyamenya) .

Ebiraga Okulongoosa

Okumenya okusinga ku distal radius kujjanjabwa na buleeki oluvannyuma lw’okukendeeza okuggaddwa, ebyembi bangi ku kumenya kuno kujja kusengulwa oba okukendeeza tekujja kukkirizibwa nga kivaamu bubi.

Ensonga ttaano ezitabangula embeera zazuulibwa LaFontaine et al:

1 Enkoona y’omugongo esooka > 20° (okulengejja kw’engalo);

2 Okumenya okukendeera kw’ekitundu ky’omugongo ekiyitibwa dorsal epiphysis;

3 okumenya ekiwanga;

4 Okumenya kw’omumwa gwa nnabaana okukwatagana;

5 Emyaka gy’omulwadde > emyaka 60.

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

Ku kukendeeza okuggaddwa kw’okumenya nga kuteeberezebwa okutebenkera, olwo okugoberera okumpi kirungi. Kikulu okumanya nti singa omuddirirwa gwa x-ray oluvannyuma lw’okukendeeza kulaga obutali butebenkevu oba okusengulwa, olwo okukyusa mu bujjanjabi kiyinza okwetaagisa. Singa okumenya kuyinza obutabeera kunywevu, olwo ebifaananyi bya leediyo birina okukwatibwa ne byekenneenyezebwa okutuusa ng’okumenya kuwonye era ne kutebenkera.

Obujjanjabi obw’okukuuma

Emenyeka ezitebenkedde zisobola bulungi okuggalwa-okusengulwa ne zijjanjabwa n’okusiba buleeki, mu kusooka n’okusiba ebisiba ate oluvannyuma n’okusiba ekyuma ekiyitibwa tubular cast, nga buli wiiki zikwatibwa ku leediyo okutuuka ku wiiki 3.

Singa enkyukakyuka ennene mu buwanvu bwa radial, palmar inclination, oba ulnar deviation zibaawo, obujjanjabi obw’okulongoosa busaana okulowoozebwako.

Mu balwadde abanafu era abatalina bwetaavu bungi, obujjanjabi obw’okuggalawo butera okuba obutuufu, ne bwe kiba nti kiragiddwa okulongoosebwa.

Closed reset okunyweza empiso okuyita mu lususu

Okukendeeza okuggaddwa nga kugobererwa okusiba n’okunyweza okuyita mu lususu kya mugaso mu kumenya kwa distal radius nga kulina obutabeera mu ntebenkevu mu metaphyseal oba simple intra-articular fractures.

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

Ekitono ennyo ppini 2 zikozesebwa okusobola okuwa okuddamu okuteekebwa mu kifo ekinywevu okumala mu bifo eby’enjuyi n’eby’ebbali, era ekitundu ky’omu lunate kisobola okusibirwa ppini bwe kiba kyetaagisa.

Intrafracture pinning (enkola ya Kapanji) kiwa obuwagizi bw’omugongo. Postoperative immobilization mu splint ssiigibwa okumala wiiki 2 okufuga okukyusakyusa n’okukendeeza ku pin irritation, oluvannyuma esobola okukyusibwamu soft forearm cast.

Closed-replacement ebweru fixation bracket okunyweza

Ebisiba eby’ebweru ebinyweza bya mugaso mu bujjanjabi obusookerwako oba obw’okugatta mu kumenya okw’enjawulo okw’ewala (specific distal radius fractures).

Ekinyweza eky’ebweru kifuula ebizibu by’ekyekulungirivu ebikola ku radius ey’ewala mu kiseera ky’okukonziba kw’ebibinja by’ebinywa by’omukono ogw’omu maaso. Okunyweza kuyinza okuba oba nedda okubuna engalo, oba okunyweza okulala kuyinza okugattibwako.

Okusika okukwatagana (parallel traction) tekuzzaawo mu bujjuvu okuserengeta kw’engalo, naye ekifo ekitaliimu kikkirizibwa. Oluvannyuma lw’okulongoosebwa, engalo enywezebwa mu ngeri ey’ekika kya tubular cast mu mbeera ey’emabega ekyusibwa okumala ennaku 10 okutuusa ng’obulumi n’okuzimba bikka.

Okunyweza epulati nga osalako n’okuddamu okugiteeka mu kifo

1、Dorsal plate munda fixation ya distal radius okumenya

Okusala okugolokoka kukolebwa ku kitundu kya Lister’s node, ng’enkomerero ey’ewala esala layini y’ekinywa ky’omukono ogw’ekyekulungirivu era n’ekoma sentimita emu okumpi n’omusingi gw’ekiyungo ky’engalo eky’okubiri eky’omukono. Enkomerero ey’okumpi ewanvuwa okuyita ku kikolo eky’enkulungo okumala sentimita 3 ku 4, ng’ebikkula empagi eya wakati okuyita mu musingi gw’ensengekera ey’okusatu ey’okugaziya.

2、Palm plate munda fixation ya distal radius okumenya

Okusala okuwanvu kukolebwa okumpi n’omusuwa gwa radial carpal flexor tendon, nga bunion flexor tendon esangibwa ku ngulu enzito ey’omusuwa ogw’omukono ogw’ewala, ogudda emabega ulnarly okulaga ekinywa kya anterior rotator ani, ate ekinywa kya anterior rotator ani kisalibwako ku ntandikwa y’oludda oluwanvu ne kidda emabega ulnarly okulaga enkomerero y’ewala eya radius (radius) nga.

Omusango 1

Omusango 2

Omusango 3

3. Okunyweza pulati y’okusika (traction plate fixation) y’okumenya kwa distal radius

- Ekitundu ekiwanvu ekya sentimita 4 kikolebwa mu mugongo okutuuka ku kikolo eky’okusatu eky’omukono, era omusuwa ogugaziya ogw’engalo eya wakati gukonziba okulaga ekitundu eky’okusatu eky’omukono;

- Okusala okw’okubiri okwa sentimita 4 kukolebwa waakiri sentimita 4 emabega okutuuka ku radius esaliddwa;

- Ekitundu eky’okusatu eky’omugongo ekya sentimita 2 kikolebwa ku kitundu kya Lister okulaga omusuwa gwa extensor hallucis longus.

Okuva ku kitundu eky’ewala ekisaliddwa, ekipande ekisika kiyingizibwa mu ngeri ey’okumpi okuyita ku nnyonyi wakati w’omusuwa ogugaziya (ekitundu eky’okuna eky’omugongo), ekikuta ky’ekiwanga n’ekisenge ky’omugongo. Omusuwa ogugaziya gusobola okutambuzibwa bwe kiba kyetaagisa.

4. Okunyweza okw’omuntu ku bubwe okw’okumenyaamenya okusaliddwako okw’ekitundu eky’ewala nga kwesigamiziddwa ku nkola ya TriMed