Kum upa lam distal radius fracture enkawl dan

Distal radius-a ruh tliakte hi tarte zingah chuan ruh tliak tam ber zinga mi a ni. Tunah hian kum 50 leh 75 inkarte chu kum upa lam anga sawi an ni. Puitling kum upa zawkte zingah range of motion a pun zel avangin distal radius fractures vei an pung zel a. Distal radius fracture chungchanga inhnialnaah hian hot issue a awm reng a: Surgery hi a ngai em?

Epidemiological zirchianna 1.1.

Distal radius-a fracture-te hian puitling kum upa zawkte taksa hliam zawng zawng zinga 18% vel an nei a ni. Caucasian population, hmeichhe damlo, leh ruh natna (osteoporosis) te hi distal radius fractures awm theitu lian ber an ni. Chu bakah, seasonal factors te pawh a huam tel a, chu chu thlasik laiin distal radius-a fractures nei tar slip-to-fall te hi a ni. Zirna thenkhatah chuan kum upa lam damlo, intact cognitive ability leh neuromuscular system nei te chu distal radius fractures an neih theihna tur a sang hle tih an sawi (a chhan chu damlote chuan reflexes chak tak an nei a, an tlak hunah lei an thlawp theih nan reflexive takin an kut an phar ang a, chu chuan fracture a thlen ang). .

Statistics-a a lan dan chuan, United States-ah chuan kum 2007-a distal radius fracture-te medical cost chu US dollar maktaduai 170 vel a ni (1983 US dollar / mi vel). Distal radius fracture nei tar tam zawk chu conservative-a enkawl ni mah se, surgical internal fixation thlangtu chu kum tin an pung zel a ni. Intraoperative fixation-a medical cost chu conservative treatment aiin a let thum zetin a tam zawk a, chubakah damdawi ina awm man leh a kaihhnawih senso dangte pawh a tipung bawk.

Distal radius fractures atana internal fixation hman danah pawh regional leh ethnic hrang hrang a awm bawk. Medicare chungchanga zirchianna pakhat chuan hmeichhia leh Caucasian-te chu operation an neih tam zawk thu a tarlang a, internal fixation atana range of internal fixation chu 4.6% atanga 42.1% a ni. leh kut operation-a training nei doctor-te chuan operation an thlang tam zawk tih an hmuchhuak bawk.

Clinical evaluation neih a ni a.

Damlo hliam dan leh complaint lian ber berte chu clinical history-ah hriat tur a ni a, chutah chuan natna awmna hmun, hnathawh dan leh degree of deformity te pawh a tel a ni. Chutih rual chuan, damlo kut thunun thei, a hobby pangngai, leh damlo hnathawh dan hriatthiam a ngai bawk. Chu bakah, damloin hliam a tuar hmaa a ke ruh a tihnat theihna tur osteoarthritis emaw sequelae emaw a neih leh neih loh hriat a pawimawh zawk bawk. Chumi zingah chuan damlo tarte chu kea kal laiin crutch an hman a ngai em tih leh nitin nunah an in enkawl theih leh theih loh zawh hi damlo mamawh hriatthiamna leh diagnosis leh enkawlna tur ruahmanna siam nan a pawimawh hle.

Clinical physical examination neih chhung hian damlo kut chu hla tak atanga hnai thlenga systematic leh comprehensive examination neih a ngai a ni. A kutphah thisen supply hi capillary refill test leh radial leh ulnar pulse hmanga hriat a ni. Median nerve, ulnar nerve leh radial nerve te sensory conditions chu two-point discrimination test leh light touch test hmangin an hmu a. Distal radius fracture-a acute carpal tunnel syndrome vei zat hi 5.4% atanga 8.6% a ni a, chuvangin median nerve distribution area-a paresthesia leh numbness chungchangah ngaihven bik tur a ni. Damlo motor hnathawh dan chu anterior leh posterior interosseous, radial, median, leh ulnar nerve te enfiahin an enfiah a. Chu bakah, examiner chuan damlo vun hliam (ecchymosis, edema, fork ang chi ang chi ang chi) dinhmun chu a ngaihven a ngai bawk a, chu chuan open fracture a nih leh nih loh a hriat a ngai bawk. Soft tissue dinhmun tha lo leh tarte vun hring vangin distal radius fractures hi vun lacerations nen a inzawm fo thin. Closed traction reduction hman a nih chuan soft tissue tihchhiat belh loh nan uluk taka hnathawh a ngai a ni.

Imaging tehna 1.1.

Distal radius fracture-te radiographic evaluation-ah hian anteroposterior, lateral, leh oblique radiograph-te a tel tlangpui. Fracture angulation leh rotation hi imaging examination hmangin hriatthiam theih a ni a, shortening a awm leh awm loh, fracture fragment chu comminuted a nih leh nih loh leh joint line a zawh leh zawh loh hriat theih a ni. Specific imaging parameter dangte chu: ulnar tlahniam (mean 22°, range: 19°-29°), distal radius san zawng (11-12 mm), leh distal radius (mean 11°, range: 11 °-14.5°) palmar inclination te pawh a tel. Forearm leh elbow te X-ray te pawh forearm damage emaw elbow instability emaw a awm leh awm loh enfiah nan an la bawk. Closed reduction leh splint immobilization hnuah distal radius-a parameters a ṭhat leh ṭhat loh tehna atan X-ray film dang a ngai leh a ni. Clinically chuan CT examination hi fractures diagnosis leh classification-a puih nan an hmang fo thin (eg, intra-articular fracture a awm leh awm loh, compression emaw shear fracture emaw a awm leh awm loh), chutiang chuan surgical treatment plan an hriat belh theih nan. Chutih rual chuan, malunion osteotomy leh orthopedic treatment tih hunah CT examination pawh a ngai bawk.

Enkawl

AAOS enkawlna kaihhruaina ang chuan distal radius fractures conservative emaw surgical management hman chungchangah hian inremna a awm lo. Surgical treatment-a volar locking plate fixation emaw percutaneous Kirschner wire fixation emaw hman tur leh hman loh chungchangah inremna a awm lo. Kodama et al chuan damlo pakhatin operation a mamawh leh mamawh loh hriat nan fracture scoring system hman an rawt a. Tin, kum upa lam kum ≥50 te tan chuan ruh tliak chi hrang hrang, wrist joint, kum, kut zungtang dominant leh damlo luah dan radiographic parameters inthlak danglamna te chu enkawlna plan hriat belh zel nan hman tur a ni. Multiple regression analysis-ah chuan volar emaw dorsal distal radius fragment-a comminution degree chu tihtlem a nih hnuah, fracture-ah hian ulnar neck, palmar inclination, leh distal ulna-a variability te chu clinical outcome nen a inzawm tlat a ni.

Conservative taka enkawlna .

Kan center-ah chuan minimally displaced distal radius fractures chu elbow chungah sugar tong plaster splint hmangin immobilized an ni tlangpui a, chu chuan elbow pronation leh supination a tihtlem phah a ni (Figure 1 en la). Fracture atanga displacement a lian chuan closed reduction hnuah sugar tong splint tih tur a ni. Hriat tur chu plaster splint immobilization tih hian immobilization scope chu kut zungtang proximal end-ah a ding tur a ni a, chutiang chuan kut zungtang kal awlsam zawk nan leh stiffness a veng thei ang. Compression fixation tlemte atana elastic bandage hman hian splinting a pui thei a ni. Fracture chi hian closed reduction hman dan tur a hril a ni. A tul chuan distal radius-a local hematoma anesthesia thlan theih a ni a, chutah chuan traction reduction chu kut zungtang (index leh middle fingers) te chu deformity siamthat leh radiocarpal joint alignment siam that leh turin tih a ni. Traction tihtlem hi inverse fracture mechanism hmanga tih a ni tlangpui. Ligament restoration tihfel nan leh fracture fragments, capitulum leh lunate te alignment siam that nan plane hrang hrangah traction tihtlem a ngai a ni. Coronal plane-ah chuan ulna leh radius-a anatomical alignment, distal bone fragment leh radial shaft te chu siam leh rawh. Colles fracture pangngai tihtlem a nih chuan assistant chuan damlo kutpui chu kut pakhatah a chelh a, a kut dangah chuan damlo kut zungtang 4 a vawn a ngai a, countertraction hmangin radius metaphysis atanga fracture fragment chu a then a, longitudinal traction a chhunzawm a, chutah chuan palmar a ni. Flexion leh ulnar deviation te hian fracture fragment tihtlem nan an pui a ni. A chhehvela soft tissue tihchhiatna nei tar damlo tan chuan vun natna venna atan hian uluk taka manipulation a ngai a, chu chuan vun a tear loh nan a veng thei a ni (reduction lai hian cotton pad hman theih a ni). Repositioning hnuah neurovascular examination an nei leh a.

Figure 1. (a) distal radius fracture nei damlo chu redisplacement awm lohna turin sugar tong plaster splint hmangin neutral palmar position tlem berah immobilized a ni a (b) leh (C) anteroposterior leh lateral radiographs hmanga damlo kutkawr fixation tha tak a awm. Plaster splint chu metacarpal head atanga chhuakin a inzar pharh lo va, chutiang chuan kut zungtangte chu a kal tha thei ang.

Operation hmanga enkawlna .

Distal radius fracture nei tarte tan surgical treatment options te chu: closed reduction leh external fixation, percutaneous Kirschner wire fixation, open reduction, volar/dorsal locking plate fixation, leh dorsal bridging plate fixation te an ni (Figure 2-a kan hmuh ang hian en la). 

Open reduction leh dorsal plate fixation chi dang chu intra-articular fracture enkawlna atan hman a ni ber. A hnu lama radiocarpal joint instability awm theihna a tihtlem avangin wrist joint volar side-a ligament tissue chu strip lovin direct vision hnuaiah articular surface a tihtlem thei a ni. Volar lunate fracture a awm chuan a chet theih loh tur a ni. Radial shaft fracture emaw hliam tam tak nei damlote tan chuan built-in traction plate hmang hian ligament restoration hmangin tihtlem a ni thei. Chutih rual chuan traction plate pawh hi comminuted leh osteoporotic distal radius fractures tihtlem leh fixation atan a tha hle. Plate hi operation an neih atanga kar 12 hnuah an la chhuak a, clinical therapeutic effect tha tak an nei thei bawk.

Volar locking plate hian radial shortening leh volar tilt a ti tha thei a, complication a awm tlem hle bawk. Dorsal plate nen khaikhin chuan a ke ruh natna (grip strength) chu operation hnu thla 6 chhungin nasa takin a ti tha thei a, a hnathawh leh a natna pawh a tha thei bawk. Dorsal plate fixation redisplacement leh extensor digitorum tendon irritation te ang chi harsatna a awm a, 30% thlengin a awm thei. Tin, volar plate-a fixation effect pawh Kirschner wire emaw external fixator emaw aiin a tha zawk bawk.

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