Distal Radius Fractures: Anatomy atanga Surgery thlenga sawifiahna kimchang

Distal radius fracture hi forearm fracture zinga 75% a ni a, clinic-ah hian a tam hle. He article-ah hian i reference atan distal radius fractures-a anatomy, classification, treatment strategies, leh surgical approaches list kan rawn siam a ni.

A tawi zawngin sawi rawh

Distal radius-a fracture hi wrist fracture-a tel a ni. hian 'three-column theory' kut ruh tliak pathological mechanism a sawifiah tha zawk thei a, chutah chuan radial column, radial tuberosity leh navicular fossa atanga siam chu kut ruh inzawmna nghet tak vawng reng turin a pawimawh hle.

Distal radius fracture zawng zawng, radius dorsal margin-a avulsion fracture tih loh chu a takah chuan overextension violence avanga lo awm a ni. Pawn lam thiltihtheihnain a tih chuan kut chu a dinhmun a inang lo va, pawn lam thiltihtheihnain nghawng a neih dan pawh a inang lo.

1.Flexion violence hian dorsally displaced intra- emaw extra-articular fracture a thlen thei a, chu chu chakna hniam tak tak hliam, tlu ang chi a ni.

2.Shear stress hian palmar lam a articular surface te chu a then a displace thei a chu chuan instability a thlen thei a ni.

3.Energy sang tak nei hliam ah chuan compression violence a tam zawk a, axial loading tam lutuk hian articular surface bone compression a thlen thin.

4.Fracture dislocation awm chhan ber chu avulsion injury a ni a, chutah chuan avulsed bone mass chu ligament ruh inzawmna hmun a ni tlangpui.

Distal radius atanga radiologic anatomy a awm

1.Anteroposterior films (radial san zawng, ulnar deviation, ulnar varus) te a awm a.

2. Lateral film (kutphah lam hawi) .

Fernandez Classification a ni

Type I Metaphyseal flexion tihchhiat a ni

Type II Articular leh Shear Fracture te a awm thei

Type III Compression hmanga Articular Surface-a tihchhiat a ni

Type IV avulsion avanga radial wrist a tliak, a hring chhuak

Type V Mixed Fractures (High Energy Avulsion hmanga tihchhiatna) te hi a awm a.

Surgery neih theihna tur hriattirna

Distal radius fracture tam zawk hi closed reduction hnuah braking hmanga enkawl a ni a, vanduaithlak takin heng fracture tam tak hi a displace ang a, a nih loh leh reduction hi pawm theih a ni lo ang a, outcome tha lo tak a awm ang.

LaFontaine et al-te chuan destabilizing factor panga an hmuchhuak a:

1 A tir lamah chuan hnungzang angulation > 20° (palmar tilt);

2 Dorsal epiphysis-a hliam (comminuted fracture) a awm a;

3 ruh (joint)-a ruh tliak (fracture);

4 Ulnar fracture nena inzawm;

5 Damlo kum > kum 60 a ni.

Enkawlna kaihruaitu tur standard leh kaihhruaina mumal tak a awm lo va, enkawl dan tur ruahmanna chu thil tam tak ngaihtuah chungin siam a ni a, chung zingah chuan a tir lama hliam tuar ziarang, repositioning hnua calibration, damlo kum, ruh quality, damlo mamawh, leh outcome duh zawng te pawh a tel.

Stability rinhlelh nei fracture closed reduction atan chuan close follow-up neih a tha. Hriat tur pawimawh tak chu, tihhniam hnua x-ray hrang hrang neih a nih chuan instability emaw displacement emaw a awm tih a hriat chuan enkawlna thlak danglam a ngai mai thei. Fracture chu a nghet lo thei a nih chuan radiograph lak a, a ruh chu a dam leh a nghet hma loh chuan endik tur a ni.

Conservative hmanga enkawl dan

Stable fracture chu hlawhtling takin closed-displaced leh braking hmanga enkawl theih a ni a, a tir lamah splinting hmangin enkawl theih a ni a, a hnuah tubular cast hmangin kar tin radiograph kar 3 thleng enkawl theih a ni.

Radial length, palmar inclination, ulnar deviation-a danglamna nasa tak a awm chuan surgical treatment ngaihtuah tur a ni.

Damlo chak lo leh mamawh tlem zawkah chuan, operation tih tur a nih pawhin closed treatment hi a tha fo thin.

Closed reset percutaneous needle hmanga tihchak a ni

Closed reduction hnua percutaneous pinning leh fixation hi metaphyseal instability nei distal radius fracture emaw simple intra-articular fracture emaw ah a tangkai hle.

Step hmasa ber chu anatomical repositioning a ni a, chutah chuan gram pin hmangin stabilization pek a ni. A tlangpuiin pin hmasa ber chu radial styloid atanga radial metaphysis medial atanga diaphysis thlenga kal a ni.

Orthogonal leh lateral position-ah stable repositioning tling tak siam turin pin 2 aia tlem lo hman a ni a, duh chuan lunate facet pawh pin theih a ni.

Intrafracture pinning (Kapanji technique) hian dorsal support a pe a. Splint-a postoperative immobilization chu kar 2 chhung hman a ni a, chu chuan rotation control a, pin irritation a tihtlem theih nan, chumi hnuah soft forearm cast hmangin thlak theih a ni.

Closed-replacement pawn lam fixation bracket fixation a ni

External fixation braces hi specific distal radius fracture-a initial emaw adjunctive emaw enkawlna atan a tangkai hle.

External fixator hian forearm muscle groups te contraction laiin distal radius-a thawk axial stress te chu a neutralize thin. Fixation hi kutphah sir zawng zawngah a awm thei a, a awm lo thei bawk a, fixation dang pawh a awm thei bawk.

Parallel traction hian palmar inclination a siam tha kim lo a, mahse neutral position erawh chu pawm theih a ni. Postoperative-ah chuan wrist chu tubular cast-ah rotated posterior position-ah ni 10 chhung braced a ni a, a natna leh edema a reh hma loh chuan.

Plate fixation hmangin incision leh repositioning a awm bawk

1、Dorsal plate chhunga distal radius fracture awm dan fixation

Lister’s node zawhin straight incision siam a ni a, distal end chu radial carpal joint line a pel a, second metacarpal wrist joint base atanga 1 cm proximal-a tawp a ni. Proximal end chu radial stem zawhin cm 3 atanga 4 vel a inzar pharh a, third extensor interval base kaltlangin middle column chu a pholang a ni.

2、Palm plate chhunga distal radius fracture awm dan fixation

Radial carpal flexor tendon-ah longitudinal incision siam a ni a, bunion flexor tendon chu radial carpal flexor tendon thuk takah a awm a, chu chu ulnarly-ah retracted a ni a, anterior rotator ani muscle chu a lang chhuak a, anterior rotator ani muscle chu radial side bul tannaah tihtawp a ni a, ulnarly-in retracted a ni a, distal end of the radius a ni.

Case 1 a ni

Case 2-na a ni

Case 3-na a ni

3. Distal radius fracture atanga traction plate fixation hmanga siam

- 4-cm longitudinal incision chu metacarpal stem pathumna thlengin dorsal-ah siam a ni a, middle finger-a extensor tendon chu contract-in metacarpal pathumna chu a lang chhuak a

- Comminuted radius atanga cm 4 tal dorsal-a 4-cm incision vawi hnihna siam a ni a;

- Lister’s node-ah 2-cm dorsal incision pathumna siam a ni a, chu chuan extensor hallucis longus tendon chu a pholang a ni.

Distal incision atang chuan traction plate chu extensor tendon (fourth dorsal compartment), joint capsule leh periosteum inkar plane-ah proximally-in dah a ni. Extensor tendon hi a tul chuan sawn theih a ni.

4. TriMed system hmanga distal radius-a comminuted fracture-te chu mimal taka fixation