Distal Radius Fractures: Kuongororwa, Kuronga uye Kurapa

Clinical overview · Yakagadziridzwa gwara redzidzo

Distal radius fracture ibreak padhuze neruboshwe rweradius. Kurapa kunogona kubva kune splint kana kukandwa kune percutaneous mapini, kunze kwekugadzirisa, kana plate fixation. Urongwa hwakakodzera hunoenderana nekuputsika kurongeka uye kugadzikana, kubatanidzwa kwekubatana, nyoro-tishu mamiriro, mapfupa emhando, zera, zvinoshanda zvinodiwa, uye zvinodiwa nemurwere.

Kuongororwa Kliniki yekuongorora uye wrist radiographs inosimbisa iyo yekutyoka pateni, kutama, uye kubatana.

Kurapa Kutyoka kwakagadzikana kunogona kurapwa pasina kuvhiyiwa; kusagadzikana kana kusanyatso kurongeka fractures zvingada kugadzirisa.

Mugumisiro Zera chete harisarudze kurapwa. Kushanda kudiwa, hunhu hwekutyoka, uye kugovaniswa kuita sarudzo kwakakosha.

Chii chinonzi Distal Radius Fracture?

Iyo distal radius inoumba iyo huru-inotakura nzvimbo padivi pechigunwe cheruoko. Kutyoka kunowanzoitika mukati memasendimita mashoma ejoint reradiocarpal uye inogona kunge iri extra-articular, inotambanudzira mujoinhi, kana kubatanidza distal radioulnar joint. Iyo ulnar styloid uye anotsigira ligaments anogona zvakare kukuvara.

Kuwira paruoko rwakatambanudzwa chinhu chinowanzoitika. Kudonha kwepasi-simba kunowanzoitika kune vakwegura vane simba rakaderedzwa remapfupa, asi kukuvara kwemitambo, zviitiko zvemigwagwa, uye kudonha kubva pakakwirira zvinogona kuunza maitiro epamusoro-simba muvarwere vaduku.

Distal radius fracture overview inoratidza wrist anatomy uye mapatani ekutyoka — Distal radius fractures inosiyana munzira, comminution, kutama, uye kubatanidzwa kweiyo wrist joint.

Nei anatomy yakakosha

Iyo distal radius ine yakafara articular pamusoro uye inotsigira scaphoid uye lunate. Zvimiro zvepedyo zvinosanganisira tsinga yepakati, flexor uye extensor tendons, radial artery, distal radioulnar joint, uye triangular fibrocartilage complex. Kudzoreredza kurongeka kunobatsira paunenge uchidzivirira izvi zvimiro ndicho chinangwa chepakati chekurapa.

Zviratidzo uye Zviratidzo Zvinoda Kukurumidza Kuongororwa

Zviratidzo zvakajairika zvinosanganisira kukurumidza kurwadziwa kweruoko, kuzvimba, mavanga, unyoro, kuderera kwekufamba, uye kunetseka kubata. Kutyoka kwakatamiswa kunogona kuburitsa kuremara kunooneka. Mumwe chiremba anoongororawo mamiriro eganda, kutenderera kwemunwe, kunzwa, tendon basa, uye kukuvara kwakabatana.

Tsvaka rubatsiro rwechimbi-chimbi nokuda kweronda rakavhurika, bhonzo rinoonekwa neganda, ruoko rwakacheneruka kana kutonhora, chiveve chinowedzera, kutadza kufambisa zvigunwe, kukurumidza kuwedzera kuzvimba, kana kurwadziwa kwakanyanya kusingadzorwi. Izvi zvakawanikwa zvinogona kuratidza kutsemuka kwakavhurika, neurovascular compromise, kana kumanikidza kune njodzi mukati mematishu.

Kuongororwa uye Radiographic Assessment

Yakajairwa posteroanterior uye lateral wrist radiographs inoshandiswa kuona kutyoka uye kuongorora kutamiswa. Oblique maonero anogona kubatsira mune dzakasarudzwa kesi. Computed tomography inogona kupa mamwe mashoko kana intra-articular fracture yakaoma kana kuti kuronga kwekushanda kunoda tsanangudzo yakajeka yezvidimbu.

Posteroanterior wrist radiograph zviyero mune distal radius kutyoka — Pamaonero ePA, varapi vanoongorora kureba kweradial, radial inclination, ulnar musiyano, uye articular congruity.

Lateral wrist radiograph inoratidza volar uye dorsal tilt kuyerwa — Pamusoro pekuona kwemashure, volar kana dorsal tilt uye carpal alignment inoongororwa.

Radiographic ficha	Zvainotsanangura	Nei zvichikosha
Radial urefu	Hurefu hweredhiyo yedistal inoenderana nenzvimbo dzekunongedza pajoint surface.	Kurasikirwa kwehurefu kunogona kushandura kutapurirana kwemutoro uye musiyano we ulnar.
Radial inclination	Kutenuka kweiyo distal radial articular pamusoro paPA maonero.	Kudzikira kurerekera kunogona kuratidza kudonha kana kusimuka kwemashure.
Volar/dorsal tilt	Iyo sagittal kutaridzika kweiyo articular pamusoro peiyo lateral maonero.	Yakawandisa dorsal kana volar tilt inogona kukanganisa wrist mechanics.
Articular nhanho-kubva kana gap	Kurasikirwa kwekugadzirisa kwakatsetseka panzvimbo yejoint.	Inobatsira kutsanangura intra-articular displacement uye kurapa zvinangwa.
Ulnar musiyano	Hurefu hwehukama hwe distal ulna uye radius.	Inogona kuchinja kana radius yapfupika uye ichifurira ulnocarpal kurodha.

Maitiro eDistal Radius Fractures Anoparadzaniswa sei

Mazwi anotsanangura akadai saColles , Smith , uye Barton fractures anotaurirana maitiro ekutama, asi haatore kukuvara kwese. Ongororo yemazuva ano inonyorawo kana kuputsika kwakavhurika kana kuvharwa, yakawedzera-articular kana intra-articular, yakadzingwa kana isina nzvimbo, yakagadzikana kana isina kugadzikana, uye iri nyore kana comminuted.

Fernandez classification by mechanism

Iyo Fernandez system mapoka anoputsika zvinoenderana neakanyanya kukuvara maitiro. Inogona kubatsira varapi kuti vafunge nezve inosanganiswa yakapfava-tishu kukuvara uye kugadzirisa nzira, asi kurapwa hakuna kusarudzwa kubva muchikamu chete.

Fernandez type I distal radius inokotama mufananidzo wekutyoka — **Nyora I:** kupeta kuputsika, kazhinji ne metaphyseal cortical kutadza.

Fernandez type II distal radius shearing fracture illustration — **Rudzi rwechipiri:** kukuvara kwekuveura, kusanganisira rim fracture-dislocations.

Fernandez mhando III distal radius compression fracture illustration — **Rudzi rwechitatu:** kukuvara kwekumanikidza ne articular impaction.

Fernandez mhando IV distal radius avulsion kuputsika mufananidzo — **Rudzi IV:** kukuvadzwa kwekukuvara kunosanganisira ligament attachments.

Fernandez mhando V yakasanganiswa distal radius fracture illustration — **Rudzi V:** yakasanganiswa kukuvara kwepamusoro-simba nemaitiro akawanda.

Kurapa Kunosarudzwa

Chinangwa hachisi chekungoita kuti X-ray iite seyakajairika. Kurapa kunotsvaga wrist yakagadzikana, yakagadzikana, inoshanda uku uchienzanisa njodzi dzeanesthesia, kuvhiyiwa, kusafamba, kuoma, uye kurasikirwa kwekuderedza. Sarudzo yakagovaniswa inofanirwa kufunga:

kuputsika kusimuka, comminution, kubatanidzwa kwekubatana, uye kugadzikana mushure mekuderedza;
kukuvara kwakavhurika, zviratidzo zvetsinga, kutenderera, uye mamiriro akapfava-tishu;
zera remurwere semumiriri-kwete chinotsiva-yechimiro chephysiologic uye kudiwa kwebasa;
kunaka kwepfupa, kumwe kukuvadzwa, mamiriro ekurapa, basa, uye kutonga kwemaoko;
kukwanisa kupinda mukutevera uye kutora chikamu mukugadzirisa;
zvinangwa zvemurwere uye kushivirira kune zvinobatsira uye njodzi dzesarudzo imwe neimwe.

Nhungamiro yechirevo: AAOS/ASSH nhungamiro inotsigira kugadziriswa kwekushanda muvarwere vakawanda vasiri geriatric apo, mushure mekuderedza, kupfupika kweradial kunodarika 3 mm, dorsal tilt inodarika 10 °, kana intra-articular displacement / nhanho-off inodarika 2 mm. Kune varwere vane geriatric-inowanzomiririrwa muzvidzidzo nezera 65 kana kupfuura-kuvhiyiwa kazhinji hakugadzirisi mhedzisiro yenguva refu-inoshumwa nemurwere kana ichienzaniswa nekusavhiya. Izvi zvikumbaridzo zvinozivisa, asi hazvitsive, yega yega kutonga kwekiriniki.

Nonsurgical Treatment

Kutyoka kwakadzikama kusingagadzike kana kutambirwa kunogona kudzorwa nesimbi kana kukandwa. Kutyoka kwakabviswa kunogona kutanga kuderedzwa, kuchiteverwa nekusafamba. Ongororo yekutevera uye radiographs inorongwa maererano nehunhu hwekutyoka uye kutonga kwechiremba nekuti kumwe kutsemuka kunogona kurasikirwa nekurongeka sezvo kuzvimba kunoderera.

Kudzivirirwa kwekutanga: splint inobvumira nzvimbo yekuzvimba kwekutanga; kusimudza uye kufamba kwemunwe kunogona kurairwa.
Kuderedza kana zvichidiwa: kuputsika kunogadziriswa uchishandisa analgesia yakakodzera kana anesthesia.
Immobilization uye wongororo: kukanda kwakaringana, kutenderera, kunzwa, uye kurongeka kunoongororwazve.
Rehabilitation: wrist uye forearm kufamba zvinounzwa apo kupora uye kugadzikana kunobvumira.

Nonsurgical immobilization ye distal radius fracture — Immobilization inogona kunge yakakodzera kana kurongeka kunogamuchirwa uye kuputsika kunoramba kwakagadzikana.

Kuvhiya Kunogona Kufungwa Rini?

Kuvhiyiwa kunogona kukurukurwa apo kurongeka kunogamuchirwa hakugone kuwanikwa kana kuchengetedzwa, nzvimbo yakabatana inonyanya kubviswa, kuputsika kwakazaruka, carpus haina kugadzikana, kana maitiro ekukuvadza haakwanisi kuramba akadzikama mukanda. Kuvhiya uye kuisirwa zvinosarudzwa kune chaiyo chidimbu chidimbu uye murwere-kwete kungoita diagnostic label.

Kuvhiya Sarudzo dzeDistal Radius Fractures

Nzira	Basa rakajairika	Mipimo yakakosha kana njodzi
Percutaneous K-waya kugadzirisa	Yakasarudzwa inoderedza kuputsika iyo inogona kudzikamiswa nemapini uye yekuwedzera immobilization.	Pini-turakiti hutachiona, kutama kwewaya, kurasikirwa kwekuderedzwa, uye kudiwa kwekuchengetwa kwepini.
Kugadziriswa kwekunze	Yakasarudzwa isina kugadzikana, yakazaruka, yakanyatsogadziriswa, kana yakapfava-tishu-yakakanganiswa kukuvara; inogona kuva yenguva pfupi kana yechokwadi.	Pin-turakiti matambudziko, kuoma, tsinga / tendon kushatirwa, uye kurasikirwa kwekurongeka.
Volar locking plate	Mazhinji asina kugadzikana ekuwedzera-articular uye intra-articular mapatani anoda kuderedzwa kwakananga uye yakagadziriswa-angle rutsigiro.	Flexor tendon kushatirwa kana kuputika, zviratidzo zvetsinga, kupinza mukati, hutachiona, uye zviratidzo zvehardware.
Dorsal plate	Yakasarudzwa dorsal rim kana dorsal shear zvimedu zvisina kudzorwa zvakakwana kubva kudivi revolar.	Extensor tendon kushatirwa uye mukurumbira wehardware.
Dorsal bridge plate	Kutyoka kwakanyanya uko ndiro inotenderera ruoko uye inoshandisa ligamentotaxis.	Inomisa kufamba kwemaoko uye kazhinji inoda kubviswa kweplate gare gare.
Fragment-chaiyo kugadzirisa	Complex mapatani umo makoramu ega ega kana marimu zvimedu zvinoda rutsigiro rwakanangwa.	Mamwe maimplants uye maitiro anogona kuwedzera nyoro-tishu yakaoma.

Uchapupu hweAAOS/ASSH hunoratidza kuti hapana mutsauko wakakura wenguva refu pakati pematanho ekugadzirisa ekusagadzikana kana kuzere articular mafractures, kunyangwe mabhoti ekuvhara evhavha anogona kupa kupora kwekutanga kushanda mumwedzi mitatu yekutanga. Kusarudzwa kwemaitiro ekupedzisira kunoenderana nekutyoka uye hunyanzvi hwekuvhiya.

Percutaneous pin fixation

Mushure mekuvharwa kana kushoma-yakavhurika kuderedzwa, akatsetseka Kirschner waya anogona kubata zvidimbu zvakasarudzwa. Fluoroscopy inosimbisa kuderedza uye nzvimbo yewaya. Mapini anogona kusiiwa kunze kweganda kana kuvigwa, zvichienderana nehunyanzvi, uye wrist inowanzo chengetedzwa mu splint kana cast.

Percutaneous Kirschner wire fixation ye distal radius fracture — Percutaneous waya dzinogona kuwedzera kudzikamisa kuderedzwa kwemaitiro akasarudzwa kuputsika.

Kugadziriswa kwekunze

Mugadziri wekunze anoshandisa mapini akaiswa kunze kwenzvimbo yekutyoka uye akabatana kune yekunze furemu. Chivakwa chinotenderera-chanza chinogona kuchengetedza kureba uye kurongeka kuburikidza ne ligamentotaxis. Inogona zvakare kusanganiswa newaya, mahwendefa madiki, kana pfupa rekubatanidza mukukuvara kwakaoma. Ona muenzaniso we a wrist yekunze fixator uye mhedziso ye orthopedic ekunze kugadzirisa masisitimu.

Wrist-spaning yekunze kugadzirisa kune distal radius kutyoka — Iyo inotenderera furemu inogona kudzoreredza kureba uye kutsigira kurongeka.

Radiograph yekugadziriswa kwekunze inodzikamisa distal radius fracture — Radiographic yekutarisa inoongorora kutyoka kurongeka uye nzvimbo yepini.

Dorsal plate fixation

Nzira yedorsal inopa mukana kune zvakasarudzwa dorsal articular zvidimbu uye shear mapatani. Mazuva ano akadzika-profile implants anoderedza kuwanda, asi extensor tendons inoramba iri padyo nehardware uye inofanirwa kuchengetedzwa. Iyi mifananidzo inotevera inoratidza dorsal fixation concepts kwete yekuvhiya kwepasirese kutevedzana.

Dorsal approach anatomy ye distal radius plate fixation — Dorsal exposure inoda kungwarira manejimendi e extensor compartments.

Dorsal plate kuiswa pane distal radius fracture — Rutsigiro rwemudhori rwakanangwa runogona kudzora zvidimbu zvemudhori.

Radiograph mushure me dorsal plate fixation ye distal radius fracture — Final imaging inotarisa kudzikiswa, plate position, uye kureba sikururu.

Volar locking plate fixation

Volar plating inoshandiswa zvakanyanya nekuti inogona kutsigira subchondral bone kubva kudivi remichindwe ichidzivirira kuiswa kwakananga pasi peiyo extensor tendons. Iyo flexor carpi radialis interval inzira yakajairika. Plate position, kudzoreredzwa kwenzvimbo yakabatana, distal screw kureba, uye flexor tendon clearance zvinoda kunyatso tariswa.

XC Medico mienzaniso inosanganisira a 7-hole distal radius yekuvhara ndiro , a 6-gomba distal radius yekuvhara ndiro , uye a DVR distal radius yekuvhara ndiro . Izvi zvigadzirwa zvinongedzo ndezveruzivo rwemudziyo; kusarudzwa kwekudyara kunoramba kuri basa revarapi vakadzidziswa.

Volar plate fixation kesi ye distal radius fracture — Case muenzaniso: volar plate fixation yekutsemuka kusina kugadzikana.

Postoperative PA radiograph ye volar distal radius plate fixation — PA imaging inotarisa radial alignment uye distal screw distribution.

Postoperative lateral radiograph ye volar distal radius plate fixation — Lateral imaging inoongorora kurereka, kudzikisira, uye kuisirwa chinzvimbo.

Complex distal radius fracture pamberi pe volar plate fixation — Complex articular fracture isati yanyatsogadzirisa.

Volar yekuvhara ndiro inovaka ye intra-articular distal radius fracture — Fixed-angle tsigiro inogona kudzikamisa akawanda distal zvidimbu.

Radiographic mhedzisiro mushure me volar plate fixation ye distal radius fracture — Maonero epostoperative anonyora mubatanidzwa conngruity uye Hardware chinzvimbo.

Dorsal bridge (distraction) plating

Plate yebhiriji inotenderera kubva paradius kuenda kune metacarpal uye inoshanda sechinhu chinovhiringidza mukati. Inogona kubatsira kune zvakasarudzwa zvakanyanya kukuvadzwa izvo zvisingakwanisi kutsigirwa zvakavimbika nekazhinji distal plate. Nekuti inoyambuka ruoko kwechinguva, nzira yechipiri yakarongwa inowanzodiwa kubvisa ndiro mushure mekupora.

Dorsal bridge plate inotenderera ne comminuted distal radius fracture — Plate yebhiriji inotenderedza chanza kuchengetedza kureba uye kurongeka apo pakatyoka ichipora.

Fragment-chaiyo kugadzirisa

Yakaoma articular fractures inogona kunge iine radial styloid, volar rim, dorsal rim, uye zvakakanganiswa zvepakati zvimedu. Fragment-chaiyo masisitimu anoshandisa maimplants madiki akamisikidzwa kusimbisa zvikamu izvo zvinoda kutonga kwakananga. Inogona kushandiswa yega kana neimwe nzira yekugadzirisa.

Fragment-specific fixation system ye distal radius fractures — Madiki anodyara anogona kunanga ega articular columns kana marimu zvimedu.

Radiograph ye fragment-specific distal radius fracture fixation — Mapoinzi akawanda ekugadzirisa anogona kugadzirisa yakaoma chidimbu pateni.

Kudzoreredza, Rehabilitation, uye Zvinogoneka Matambudziko

Kufamba kwemunwe kunowanzokurudzirwa kare kana kukuvara uye kurapwa kuchibvumira. Wrist uye forearm maekisesaizi anotanga zvichienderana nekugadzikana, mamiriro eronda, uye radiographic kuporesa. Simba, dexterity, uye kutsungirira zvinopora zvishoma nezvishoma pane yekutanga kufamba, uye kumwe kuzvimba kana kuomarara kunogona kuenderera kwemwedzi. Rehabilitation inogona kuitwa kumba kana kutariswa zvichienderana nezvinodiwa nemurwere uye maitiro emunharaunda.

Zvinetso zvinogona kuitika zvinosanganisira kurasikirwa kwekuderedza, malunion, kusava nehanya, kuoma, post-traumatic arthritis, zviratidzo zvetsinga dzepakati, chirwere chekurwadziwa kwenharaunda, kutsamwa kwetendon kana kuputika, utachiona, zvinetso zvepini-tract, uye hardware yezviratidzo. Chiveve chitsva, kurwadziwa kuri kuwedzera, fivha, mvura, kana kurasikirwa kwemunwe kunopa ongororo yekiriniki.

Bone hutano nyaya: kuderera-simba wrist kuputsika mumunhu mukuru angave chiratidzo chekunyevera cheosteoporosis. Varwere vanogona kubvunza chiremba wavo kana kuongororwa kwengozi yekuputsika, kuongororwa kwefupa-density, kudzivirira kudonha, kuongororwa kwevhitamini D, kana mamwe matanho ehutano hwemapfupa akakodzera.

Mibvunzo Inowanzo bvunzwa

Ko yese yakadzingwa distal radius fracture inoda kuvhiyiwa?

Kwete. Mamwe mafracture anogona kuderedzwa uye anoramba akanyatsoenderana mune inokanda. Kugadzikana, kutama pamwe chete, zera, kudiwa kwebasa, hutano, uye zvido zvevarwere zvese zvinopesvedzera sarudzo.

Inguva yakadii distal radius fracture inotora kupora?

Kupora kwemapfupa ekutanga kunowanzoitika kweanenge mavhiki matanhatu, asi nguva yenguva inosiyana. Kufamba, simba, kuzvimba, uye chivimbo zvinogona kuramba zvichivandudza kwemwedzi yakati wandei kana kupfuura.

Ko ndiro yevolar nguva dzose ndiyo yakanakisa yekuvhiya sarudzo?

Hapana implant imwechete yakanakira kuputsika kwese. Mapureti ekukiya evhavha akajairwa uye anogona kutsigira basa rekare-pfupi, asi mapini, gadziriso yekunze, dorsal fixation, bhiriji plating, kana chidimbu-chaiwo maimplants anogona kuenzanisa mamwe mapatani.

Ko distal radius plate inofanira kubviswa gare gare?

Kubvisa nguva dzose hakusi kudiwa nguva dzose. Kubvisa kunogona kutariswa nekuda kwekushatirwa kwetendon, yakakurumbira kana yechiratidzo hardware, hutachiona, kana zvimwe zvikonzero zvekiriniki. Plate yebhiriji kazhinji inoda kubviswa kwakarongwa nekuti inotenderera chanza.

Ruoko runogona kushandiswa nguva dzose riini zvakare?

Kushandiswa kwakachengeteka kunoenderana nekutsiga kwekutsemuka, kurapwa, radiographic kuporesa, kurwadziwa, uye chiitiko chinobatanidzwa. Mabasa akareruka ezuva nezuva anowanzo dzoka pamberi pekubata zvine simba, kusimudza, kuonana nemitambo, kana basa rinorema. Tevedzera zvinorambidzwa nanachiremba.

Inoenderana XC Medico Zviwanikwa

Izvi zvinotevera zviwanikwa zvemukati zvinopa zvirevo zvemaimplants, zviridzwa, uye zvine chekuita nekushungurudza masisitimu akataurwa mugwaro rino.

Distal Radius Instrument Set Instrumentation uye tireyi kumisikidza kune distal radius plate masisitimu. 7-Hole Distal Radius Locking Plate Chigadzirwa zviyero, screw kuenderana, uye kugadzirisa. 6-Hole Distal Radius Locking Plate Alternative distal head configuration ye volar radius. DVR Distal Radius Locking Plate Distal volar radius plate yakatarwa uye system ruzivo. Wrist External Fixator Yekunze furemu zvikamu zvakagadzirirwa kushandiswa kwemaoko. Small Fragment Instrument Set Instrumentation yeakasarudzwa diki-fragment trauma fixation. Trauma System Bhurawuza mahwendefa, screws, zviridzwa, uye zvekunze zvigadzirwa zvekugadzirisa. Hunhu Kudzora Ruzivo nezve kugadzirwa kwekuongorora uye maitiro emhando.

Mareferensi uye Hwaro hwekupepeta

Medical disclaimer: Ichi chinyorwa ndechedzidzo yakajairika uye nehunyanzvi chigadzirwa-referenzi zvinangwa. Iyo haipe kuongororwa, kukurudzira chaiyo kuisirwa, kana kutsiva kuongororwa uye kurapwa nenyanzvi yehutano yehutano. Kuwanikwa kwemudziyo, zviratidzo, uye mamiriro ekutonga zvinogona kusiyana nenyika.