Fracture_of_Distal_Radius PPT课件.pptVIP

Ulnocarpal Impaction Syndrome Nerve Injury Is Also A Possibility Pain was persistent and disabling The patient is a 79 years old who had a?distal radius fracture which was treated with an volar plate Intraoperative view with the screw tip impinging on the posterior interosseous nerve Another intraoperative view with a better view of the screw tip. Screws into Radiocarpal Joint PA facet view Tilt to 11° Facet lateral view tilt to 21° True lateral view Non-union Complex Regional Pain Syndrome The incidence of CRPS after distal radius fracture ranges from 2% to 39% stiffness, difficulty sleeping, burning pain, and cold sensitivity are the common symptoms Vitamin C at a dose of 500 mg/d has been shown to decrease the incidence Consensus - 3 X-rays in nonoperative fractures for 3 weeks and start of ROM. Re-evaluate patients with unremitting pain during follow-up. Patients perform active finger ROM. “In the absence of reliable evidence it is the opinion of the work group that . . .” Moderate - 5 ORIF for post-reduction radial shortening 3mm, dorsal tilt 10 degrees, or intra-articular displacement or step-off 2mm Rigid immobilization removable splints for displaced fractures treated non-operatively Patients do not need to begin early wrist motion Vitamin C for the prevention of disproportion-ate pain. Questions and Debates The absence of large, prospective outcome trials of the different methods of treatment is surprising ? Is anatomical restoration of the distal radius necessary to achieve good long-term function ? Does the early mobilization allowed by volar locking plates improve outcome? There does not appear to be a clear correlation between radiological degenerative change and a poor clinical outcome What is the cost of the procedure and does the cost of the surgery and the implant balance any earlier return to normal function? Thanks for Your Attention * * * * Chauffeurs fracture The backfire, or Chauffe