Distal Radius Fracture：桡骨远端骨折.pptVIP

DISTAL RADIUS FRACTURE DISTAL RADIUS FRACTURE Also known as Colles’ fracture Classically 1.5” from proximal end of radius Often from fall on outstretched hand Fracture has volar apex of fragments PATIENT HISTORY 48 y/o female involved in MVA on 9/23/10 Sustained multiple injuries including right distal radius fracture Imaging taken same day of accident at doctor office where patient works ORIF on 9/28/10 Was in splint for 4 weeks Referred for post-op rehab EXAMINATION CC: 9/10 pain on outside of right wrist, stiffness and weakness Initial evaluation found: Decreased ROM and strength of wrist flexion, extension, radial deviation, ulnar deviation, pronation and supination TTP of right extensor digitorum tendon Difficulty grasping objects INITIAL X-RAYS 9/23/10 Views: Left: AP Right: Oblique INITIAL X-RAY FINDINGS Imaging can show: Amount of fx fragment angulation Radial shortening Associated ulnar styloid fx Findings: severely comminuted fracture of distal radius Extensive fx through articular cortex Largest fragment displaced somewhat anteriorly TREATMENT OPTIONS If stable and minimally displaced: Reduction and immobilization for 6-8 weeks Long arm cast for 3 weeks, then short arm cast If unstable or displaced: Fixation after reduction External fixation with pins Open reduction internal fixation with plate and screws Study comparing external fixation and internal fixation found: Better grip strength and ROM and fewer malunions at 1 year with internal fixation1 POSSIBLE COMPLICATIONS 30% of distal radius fractures have complications from malunion Radial shortening Radial angle less than 15 degrees Ulnocarpal impingement, pain, decreased ROM Posttraumatic arthritis Median nerve dysfunction Midcarpal instability PATIENT TREATMENT Closed reduction was attempted and failed Patient underwent ORIF on 9/28/10 Volar approach Surgeon used locking volar plate mechanism Elevated forearm to avoid radiocarpal joint FOLLOW-UP X-RAYS 11/17/10 Views: Left: AP Right: Lat