Distal end of Radius Fractures
- 2. 犖犖項犖犢犖о権犖犖迦権犢犖犖 犖犖迦権犖 14犖犖 犖犖迦犖朽 犖犖迦検犢犖犖 犖犖項検犖巌献犖迦犖犖 犖.犖犖犖犖犖迦犖犖朽検犖
- 3. Chief complaint 犖犖о犖犢犖犖÷厳犖犖犖о顕 4 hr PTA
- 4. Present illness 4 hr PTA 犖犖犖萎犖ム犖犖犖園犢犖犖劇犖犖 犢犖犖犢犖犖劇犖犖犖犖園犖犖犖園犖ム犖÷顕犢犖犖犢犖 outstretch 犖犖ム険犖犖犖迦犖犖園犖犖犖項犖犖謹犖犖о犖犖朽犖犢犖犖÷厳犖犖犖о顕 犖犖о検 犖犖∇険犖犢犖犢犖ム犖ム 犢犖÷犖÷元犖犖 犢犖÷犖÷元犖犖迦犢犖犖
- 5. Primary Survey A: can speak,c-spine not tender B: equal breath sound,CCT negative C: v/s stable,no active bleed D: E4V5M6,pupil 3 mm RTLBE E: tender at rt wrist,limit ROM due to pain
- 6. Secondary survey Allergy: no food/drug allergy Medication: no current medication Past history: no previous medical/surgical history Last meal: last meal 11 hr PTA Event: as in PI
- 7. Physical Examination GA: A Thai male,good conscious,well co-operative v/s: BT 36C,PR 102/min,BP 117/57mmHg,RR 20/min HEENT: not pale conjunctivae,anicteric sclerae Skin: no wound Heart: normal S1S2,no murmur Lung: clear both lung,equal breath sound Abdomen: soft,not tender,normoactive bowel sound Extremities: no wound,deformities at rt wrist,mild tender,limit ROM due to pain,neurovascular intact
- 9. Film Rt. Wrist AP,Lat
- 10. Diagnosis closed fracture at rt distal end of radius(colles' fracture)
- 11. Distal radius fractures Most common orthopaedic injury with a bimodal distribution younger patients - high energy older patients - low energy / falls 50% intra-articular Osteoporosis high incidence of distal radius fractures in women >50 distal radius fractures are a predictor of subsequent fractures DEXA scan is recommended in woman with a distal radius fracture
- 12. Classification Fernandez: based on mechanism of injury Frykman: based on joint involvement (radiocarpal and/or radioulnar) +/- ulnar styloid fx Melone: divides intra-articular fxs into 4 types based on displacement AO: comprehensive but cumbersome
- 14. Common distal end radius fracture Colles' fracture Very common extra-articular fractures of the distal radius Most frequently seen in elderly women Fall in to wrist dorsiflexion Dinner fork deformity Transverse fracture at distal radial metaphysis Dorsal displacement of the distal fragment
- 15. Common distal end radius fracture Smith's fracture(reverse Colles) Fall in to wrist palmarflexion Volar displacement of the distal fragment
- 16. Common distal end radius fracture Barton's fracture Intra-articular fracture Shearing force Volar type/Dorsal type Usually associated subluxation/dislocation of the carpal bone
- 17. Common distal end radius fracture Die-punch fracture A depression fracture of the lunate fossa of the distal radius High energy compression force
- 18. Imaging
- 20. Treatment Successful outcomes correlate with accuracy of articular reduction restoration of anatomic relationships early efforts to regain motion of wrist and fingers Nonoperative closed reduction and cast immobilization indications extra-articular <5mm radial shortening dorsal angulation <5属 or within 20属 of contralateral distal radius
- 21. Treatment Operative surgical fixation (CRPP, External Fixation, ORIF) indications: radiographic findings indicating instability (pre- reduction radiographs best predictor of stability) displaced intra-articular fx volar or dorsal comminution articular margins fxs severe osteoporosis dorsal angulation >5属 or >20属 of contralateral distal radius >5mm radial shortening comminuted and displaced extra-articular fxs (Smith's fx) progressive loss of volar tilt and loss of radial length following closed reduction and casting associated ulnar styloid fractures do not require fixation
- 22. Close reduction What should concern in close reduction? 1. Dorsal and radial displacement 2. Shortening of radius 3. Loss of normal 10 volar tilt in lateral view
- 23. Close reduction 1. Disimpaction 2. Traction 3. Volar flexion with ulnar deviation
- 24. Complication Early Edema EPL rupture CTS Late Malunion Prolong stiffness
- 25. Follow up 犖犖伍犖÷幻犢犖犖犖÷顕犖∇犖犖犖迦牽犖犖園犖犖犖о犖犢犖迦犖劇賢 1.犖犖犖萎犖÷鹸犖犖犖犖迦犖犖犖犢犖犖劇賢犖 犖犖迦牽犢犖犢犖犖迦犖犖犖犖÷厳犖 犖犖迦牽犖犖о検 犖犖犖劇賢犖犖迦硯犖萎犖犖犖犖犢犖犖犖犖劇犖 犢 2.犖犖犖萎犖÷鹸犖犢犖犖犖犢犖犖∇犖犖ム険犖犖犖迦犖犖園犖犖犖萎犖項 犖犖犖劇賢犢犖÷厳犢犖犢犖犖劇賢犖犢犖犖巌犖÷見犖ム硯犖 3.犢犖犖ム元犢犖∇犢犖犖劇賢犖犢犖÷厳犢犖犢犖犖劇賢犖犖犖ム硯犖 犖犖犖劇賢犢犖犖ム元犢犖∇犖犖迦 slab 犢犖犢犖犢犖犖劇賢犖犖犖ム険犖犖犖迦犖∇幻犖犖犖о検犖犖朽犖ム犖 Non displaced fracture 犖犖朽犢犖÷犖犖о検犖÷顕犖 犖犖迦犖犖萎犖園犖犖項犖犖萎検犖迦 1-2 犖犖園犖犖迦見犢 犖犖迦犖犖園 犖犖犖о犖犢犖迦犖ム犖о犖犖劇賢犖犢犖÷犖犖ム硯犖 犢犖犢犖犖園犖犢犖犖犖犖犖犖 6 犖犖園犖犖迦見犢 犢犖犖劇犖犖犖犖犢犖犖劇賢犖犖犖犖 Displaced fracture 犖犖朽犢犖犢犖犖園犖犖迦牽犖犖 close reduction 犖犖犖園犖犢犖犖犖犖о牽犖犖萎犖園犖犖迦権犢犖 2-3 犖о険犖 犢犖犖劇犖犖犖犖萎犖÷鹸犖犖犖迦牽 犖犖о検 犖犖迦犢犖÷犖犖о検犖犖迦検犖劇賢犢犖犢犖犖 犖犖園犖犢犖犖犖朽 1-2 犖犖園犖犖迦見犢 犢犖犖劇犖犖犖項犖犖劇賢犖犢犖ム鍵犢犖犖犖犢犖犖∇ 犖犖迦犢犖÷犖÷元犖犖園犖犖 犢犖犢犖犖園犖犖朽犖犖犖園犖犢犖÷厳犢犖犖犖犖 6 犖犖園犖犖迦見犢 犢犖犖劇犖犖犖犖犢犖犖劇賢犖 犖犖犖萎犖÷鹸犖犢犖犖犖犢犖犖∇犢犖ム鍵犖犖項犖迦牽犖犖巌犖犖犖犖犖犖萎犖項 (clinical union)
- 26. Plan of treatment Hematoma block then close reduction and short arm AP slab Pain control : paracetamol 1 tab oral prn q 4-6hr D/C + F/U 1 wk with film Wrist AP,Lat
- 27. Film Rt. Wrist AP,Lat Post close reduction