Kum upa lam zingah chuan distal radius-a ruh tliak hi a tam ber pawl a ni. Tunah hian kum 50 leh 75 inkar te hi kum upa lam tia sawi an ni. Puitling kum upa zawkte range of motion a san chhoh zel avangin distal radius fracture hi kum tin a pung zel a ni. Distal radius fracture chungchanga inhnialnaah hian thupui lar tak chu a la awm reng a ni: Surgery neih a ngai em?
Epidemiological Studies hmanga thil tih dan (Epidemiological Studies) te
Puitling kum upa zawkte taksa ruh tliak zawng zawng zinga 18% vel chu distal radius-a fracture a ni. Caucasian population, hmeichhe damlo leh osteoporosis te hi distal radius fracture thlentu lian ber an ni. Chu bakah, seasonal factors te pawh a huam tel a, chu chu thlasik laiin distal radius fracture nei tar slip-to-fall te pawh a huam tel bawk. Zirna thenkhatah chuan damlo tar, intact cognitive ability leh neuromuscular system nei te chu distal radius fracture vei an hlauhawm hle tih an sawi (damlote hian reflexes chak tak an neih avangin an tlu hunah leiah thlawp turin reflexive takin an kut an han phar ang a, chu chuan fracture a thlen ang). .
Statistics atanga a lan dan chuan United States-ah chuan kum 2007 khan distal radius fractures avanga damdawi man chu US dollar maktaduai 170 vel (1983 US dollar / mi vel) vel a ni. Distal radius fracture nei kum upa lam tam zawk chu conservative takin enkawl ni mah se, kum tin surgical internal fixation thlangtu hi an pung zel a ni. Intraoperative fixation-a medical cost hi conservative treatment aiin a let thum zetin a tam a, damdawi ina awm man leh a kaihhnawih senso dangte pawh a tipung bawk.
Distal radius fracture-a internal fixation hman danah pawh regional leh ethnic hrang hrang a awm bawk. Medicare chungchanga zirchianna pakhatah chuan hmeichhia leh Caucasian-te chu operation an nei tam zawk tih a tarlang a, internal fixation atana duhthlan tur range chu 4.6% atanga 42.1% a ni. Tin, kut zai thiam doctor-te chuan operation an thlang zawk tih an hmuchhuak bawk.
Clinical Evaluation neih a ni
Damlo hliam dan leh a complaint berte chu clinical history-ah chhinchhiah tur a ni a, chutah chuan natna awmna hmun, hnathawh dan leh a piansualna degree te pawh a tel tur a ni. Chutih rual chuan damlo kut thunun ber, a hobby pangngai, leh damlo hnathawh dan hriatthiam a ngai bawk. Tin, damlo hian osteoarthritis emaw sequelae emaw a nei em tih hriat a pawimawh zawk a, chu chuan a hliam hmaa a kut leh ke hnathawhna a tichhe thei a ni. Chumi zingah chuan damlo tarte chu kea kal laiin kekawrte hman a ngai em tih leh nitin nunah anmahni in enkawl theih em tih zawh hi damlote mamawh hriatthiamna leh diagnosis leh treatment plan siamna atan a pawimawh hle.
Clinical physical examination neih chhung hian damlo kutphah chu hla tak atanga hnai thlenga systematic leh comprehensive examination neih a ngai a ni. Kutphaha thisen pek dan hi capillary refill test leh radial leh ulnar pulse hmanga hriat theih a ni. Median nerve, ulnar nerve leh radial nerve te sensory condition te chu two-point discrimination test leh light touch test hmangin an hmu chhuak a ni. Distal radius fracture-a acute carpal tunnel syndrome vei zat hi 5.4% atanga 8.6% a nih avangin median nerve distribution area-a paresthesia leh numbness hi a bik takin ngaihven tur a ni. Damlo motor function 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-like angulation, etc.) dinhmun pawh a ngaihven a ngai a, open fracture a nih leh nih loh a hriat a ngai bawk. Tarte soft tissue dinhmun tha lo leh vun te tak te avang hian distal radius fracture hi vun lacerations a awm fo thin. Closed traction reduction hman a nih chuan soft tissue tihchhiat belh loh nan uluk taka hnathawh a ngai hle.
Imaging hmanga tehna (Imaging Assessment) neih a ni
Distal radius fracture radiographic evaluation-ah hian a tlangpuiin anteroposterior, lateral, leh oblique radiograph te hi a tel a ni. Fracture angulation leh rotation hi imaging examination hmangin shortening a awm em tih te, fracture fragment chu comminuted a nih leh nih loh te, joint line a kim em tih te hriat theih a ni. Imaging parameter bik dangte chu: ulnar declination (mean 22°, range: 19°-29°), distal radius san zawng (11-12 mm), leh distal radius-a palmar inclination (mean 11°, range: 11 °-14.5°) te a ni. Forearm leh elbow X-ray pawh lak a ni a, forearm chhiatna emaw elbow instability emaw enfiah a ni bawk. Closed reduction leh splint immobilization hnuah distal radius parameters a lo tha tawh em tih enfiah nan X-ray film dang a ngai leh a ni. Clinically chuan CT examination hi fracture (eg, intra-articular fracture a awm leh awm loh, compression emaw shear fracture emaw a awm leh awm loh) hriatchhuah leh classification-a pui turin an hmang fo thin a, chutiang chuan surgical treatment plan hriat belh theih a ni. Chutih rual chuan osteotomy leh malunion orthopaedic treatment tih hunah evaluation dang neih belh zel nan CT examination neih a ngai bawk.
Enkawl
AAOS enkawlna kaihhruaina ang chuan distal radius fracture-a conservative emaw surgical management emaw hman chungchangah hian inremna a awm lo. Surgical treatment-ah hian volar locking plate fixation emaw percutaneous Kirschner wire fixation emaw hman tur tih chungchangah hian inremna a awm lo. Kodama et al te chuan damlo pakhatin operation a mamawh leh mamawh loh hriat nan fracture scoring system hman an rawt a ni. Tin. Multiple regression analysis-ah chuan reduction hnua volar emaw dorsal distal radius fragment-a comminution degree, fracture-ah hian ulnar neck a tel em tih te, palmar inclination leh distal ulna-a variability te chu clinical outcome nen a inzawm tlat a ni.
Conservative hmanga enkawl dan
Kan lai takah chuan minimally displaced distal radius fractures te chu elbow chungah Sugar tong plaster splint hmangin immobilized a ni tlangpui a, chu chuan elbow pronation leh supination a tihtlem phah a ni (Figure 1 en la). Fracture displacement a lian chuan closed reduction hnuah Sugar tong splint tih tur a ni. Plaster splint immobilization tih hian immobilization scope chu kut zungtang proximal end-ah a tawp tur a ni tih hre reng la, chutiang chuan kut zungtang chu a kal awlsam ang a, a nghet lo ang. Compression fixation tlemte atan elastic bandage hman hian splinting-ah a pui thei a ni. Fracture chi hian closed reduction tih dan tur a hril a ni. A tul chuan distal radius-a local hematoma anesthesia thlan theih a ni a, chutah chuan kut zungtang (index leh middle finger) te chu hrual chungin traction reduction tih a ni a, chu chuan deformity chu siamthat a ni a, radiocarpal joint alignment chu a siam tha leh a ni. Traction tihtlem hi inverse fracture mechanism hmanga tih a ni tlangpui. Plane hrang hranga traction tihtlem a ngai a, chu chu ligament siam that zawh nan leh fracture fragment, capitulum leh lunate te alignment siam that nan a ni. Coronal plane-ah chuan ulna leh radius, distal bone fragment leh radial shaft te anatomical alignment chu siam tha leh rawh. Colles fracture pangngai tihziaawmna atan chuan assistant chuan damlo kutpui chu a kut pakhatin a chelh a, damlo kut zungtang 4 chu a kut lehlamah a chelh a ngai a, countertraction hmangin fracture fragment chu radius metaphysis atanga thliar hran a ngai a, longitudinal traction chhunzawm a ngai a, chutah chuan palmar a hmang bawk. Flexion leh ulnar deviation hmangin fracture fragment tihziaawmna tur a ni. Damlo tar, a chhehvel soft tissue chhiatna nei tan chuan vun a tikehsawm loh nan reduction process chhung hian uluk taka manipulation a ngai a (reduction laiin cotton pad hman theih a ni). Repositioning hnuah neurovascular examination an nei leh a.
![Distal radius a awm a ni]()
Figure 1. (A) Distal radius fracture nei damlo pakhat chu a redisplace loh nan Sugar tong plaster splint hmangin neutral palmar position tlemteah immobilized a ni a (B) leh (C) anteroposterior leh lateral radiograph-ah damlo kutphah fixation tha tak a awm tih a lang. Plaster splint hi metacarpal lu pawn lamah a inzar pharh lo va, chutiang chuan kut zungtangte chu a pangngaiin a kal thei a ni.
Operation hmanga enkawl dan tur
Distal radius fracture nei tar damlote tan surgical treatment option hrang hrang chu: closed reduction leh external fixation, percutaneous Kirschner wire fixation, open reduction, volar/dorsal locking plate fixation, leh dorsal bridging plate fixation te hi a ni (Figure 2-a kan hmuh ang hian).
![Palm locking plate a ni]()
Open reduction chi dang leh dorsal plate fixation hi intra-articular fracture enkawlna atan hman a ni ber. Direct vision hnuaiah articular surface chu a tihtlem thei a, wrist joint volar lam a ligament tissue chu a strip lo thei a, a hnu lama radiocarpal joint instability awm theihna a ti tlem thei bawk. Volar lunate fracture a awm chuan immobilized a ngai a ni. Radial shaft fracture emaw hliam tam tak nei damlo tan chuan built-in traction plate hmangin ligament restoration hmangin reduction neih theih a ni. Chutih rual chuan traction plate hi comminuted leh osteoporotic distal radius fracture tihtlem leh fixation atan pawh a tha hle. Operation atanga kar 12 hnuah plate chu lakchhuah a ni a, clinical therapeutic effect tha tak a awm thei bawk.
Volar locking plate hian radial shortening leh volar tilt a ti tha thei a, harsatna awm zat pawh a tlem hle. Dorsal plate nena khaikhin chuan operation hnu thla 6 chhungin a ke ruh natna chu a grip strength nasa takin a ti tha thei a, a hnathawh leh a natna pawh a ti tha thei bawk. Dorsal plate fixation redisplacement leh extensor digitorum tendon irritation ang chi complication hi 30% thlengin a awm thin. Tin, volar plate fixation effect pawh Kirschner wire emaw external fixator emaw aiin a tha zawk bawk.
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