in the name of god. fracture of the distal radius and ulna
TRANSCRIPT
Common fracture encountered BY
orthopedic trauma surgeons
Low energy Trauma %80 high energy trauma %20
Men are significantly younger than woman
AO BASE CLASSIFICTION
EXTRA – ARTICULAR %60 AO T1PARTIAL – ARTICULAR %12 AO T2COMPLETE – ARTICULAR %28 AO T3
TRIANGULAR FIBROCARTILAGE COMPLEX INJURY (TFCC)IS MORE COMMON THAN INTERESSEOS LIGAMENTS (%40- 80)MAJORITY ARE SUPERFICIAL AVULSION WITH ULNA STYLOID FRACTURE
Who framwork of measurment (internationnal classification of
ICIDH
- Impairment (abnormal physical activity)
- Disability (unable to perform daily
activity)
- Handicaps
Today emphasis on self reported measurment (prwe)
Disablity that patient reported may has a psychologic base that no need treatmentPain L-O-MR-u joint unstableFingers stiffnessCTSOA changes
Gartlant score:
Excellent : 0-2 pointsGood : 3-8 Fair : 9-20Poor: 21 <
Prwe overall is a valid – reliable & responsive outcome measure
Treatment option 1- Splint2- CR & plaster fixation3- Fixator – extern4- Pin & plaster5- CR & CP6- ORIF Depend to prediction of functional outcome and instability
A:
prediction of stabilityseveral factors are associated with re – displacement following CR:1- Age over 80 under 30 2- Initial displacement : radius shortening 3- Metaphyseal communition4- Displacement following CRrepeated manipulation is unlikely to good x-ray result outcome
B:
Prediction of function related to patient1- Age 2- Work3- Poor socioeconomic status4- Lower education levels5- Low bone density
C:
Fracture – factorsSome surgeon emphasis to influence of x-ray position on outcome function 1- Metaphyseal alignment 2- Articular alignment3- Radial Height (over 4mm has permanent pain after 2-3 month)4- Ulnar variance
In ulnar variance shorthening has more effect alternation in (DRUJ) function than radial inclinationpalmar tilt
Radial inclination + shortening (Axial compression)A: DECREAS GRIP POWERB: R-C JOINT DJDC: DRUJ DJD
Dorsal – palmar tilt:
Incongruence of distal r-u joint Increase
A: tightness of interosseos
B: L-O-M
C: mid carpal instability
D: decreas grip power
E: worse dash score
Articular alingment :Relation ship between cartilage damage and residual incongruity & development of DJD is not obvious
Outcome is related to 1- Age2- Severity of trauma3- Residual articular displacement4- Difficulty in Obtaining accurate measurement of the articular surface5- Inter & intraobserver reliability
In 64 cases with this fracture & 20 osteoprotic
44 osteo penia
Result in protic group was unaccepted
In one study 38 years After this fracture :All treated non operativly now average age are 64y2/3 of fracture mal-united but patients are sign free and no need treatment
Indication of treatment related to:
1- patient
2- Type of fracture
The purpose of treatment is maintain:
Normal power
Mobility
Function in wrist & hand.
AgeConditiondemand
No differenc outcome between position of wrist in cast1- Palmar Flexion & Ulnar Deviation2- Neutral position
patient & fracture factors are more effective rather than wrist position in cast.
Functional recovery is faster in limited immobilization removal splint than complete cast
For displace type 5-6 weeks castingSome beleav that after 3 w remove
of cast and start mobilization has better result.
Mackenney
%10 of minimmaly displace
%43 of displace fracture
Are unstable after 2 week. (re-manipulate)
Some follow-up for non – operative treatment 9 - 13 yAge: 9-78 yDorsal angulation : 13 in > 60 y 18 in< 60y
But 52 of 66 cases had excellent clinical outcome
A: pc pining has no or minimal x-ray advantageBut no functional advantage
in patient < 60 years x-ray & clinical result are better
Results in RTC study of non-operative treatment with
B: with bridging EXT-fix x-ray position good function : no difference
D: FIX-EXTRE + ORIFX-ray & clinical result are better thanNon-operative treatment
C: with volar- locking plate:94 case 65> ageX- ray : goodClinical : acceptedHigh rate tendon complication has need re-surgery