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IN THE NAME OF GOD

This article discusses the common fracture of the distal radius and ulna, including treatment options and factors that influence functional outcome. It also explores the importance of accurate measurement and alignment of the articular surface for optimal results.

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IN THE NAME OF GOD

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  1. IN THE NAME OF GOD

  2. FRACTURE OF THE DISTAL RADIUS AND ULNA

  3. Common fracture encountered BY orthopedic trauma surgeons Low energy Trauma %80 high energy trauma %20 Men are significantly younger than woman

  4. 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

  5. Who framwork of measurment (internationnal classification of ICIDH - Impairment (abnormal physical activity) - Disability (unable to perform daily activity) - Handicaps

  6. 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

  7. Gartlant score:Excellent : 0-2 pointsGood : 3-8 Fair : 9-20Poor: 21 <Prwe overall is a valid – reliable & responsive outcome measure

  8. Treatment option 1- Splint2- CR & plaster fixation3- Fixator – extern4- Pin & plaster5- CR & CP6- ORIF Depend to prediction of functional outcome and instability

  9. A: prediction of stability several factors are associated with re – displacement following CR: 1- Age over 80 under 30 2- Initial displacement : radius shortening 3- Metaphyseal communition 4- Displacement following CR repeated manipulation is unlikely to good x-ray result outcome

  10. B:Prediction of function related to patient1- Age 2- Work3- Poor socioeconomic status4- Lower education levels5- Low bone density

  11. 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

  12. In ulnar variance shorthening has more effect alternation in (DRUJ) function than radial inclinationpalmar tilt Radial inclination + shortening (Axial compression) A: DECREAS GRIP POWER B: R-C JOINT DJD C: DRUJ DJD

  13. Dorsal – palmar tilt:Incongruence of distal r-u joint Increase A: tightness of interosseosB: L-O-MC: mid carpal instabilityD: decreas grip powerE: worse dash score

  14. Articular alingment :Relation ship between cartilage damage and residual incongruity & development of DJD is not obvious Outcome is related to 1- Age 2- Severity of trauma 3- Residual articular displacement 4- Difficulty in Obtaining accurate measurement of the articular surface 5- Inter & intraobserver reliability

  15. In one study 38 years After this fracture : All treated non operativly now average age are 64y 2/3 of fracture mal-united but patients are sign free and no need treatment In 64 cases with this fracture & 20 osteoprotic 44 osteo penia Result in protic group was unaccepted

  16. Indication of treatment related to:1- patient 2- Type of fracture Age Condition demand The purpose of treatment is maintain: Normal power Mobility Function in wrist & hand.

  17. 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

  18. For displace type 5-6 weeks casting • Some beleav that after 3 w remove of cast and start mobilization has better result.

  19. Some follow-up for non – operative treatment 9 - 13 y Age: 9-78 y Dorsal angulation : 13 in > 60 y 18 in< 60y But 52 of 66 cases had excellent clinical outcome Mackenney %10 of minimmaly displace %43 of displace fracture Are unstable after 2 week. (re-manipulate)

  20. Results in RTC study of non-operative treatment with B: with bridging EXT-fix x-ray position good function : no difference A: pc pining has no or minimal x-ray advantage But no functional advantage in patient < 60 years x-ray & clinical result are better

  21. C: with volar- locking plate:94 case 65> ageX- ray : goodClinical : acceptedHigh rate tendon complication has need re-surgery D: FIX-EXTRE + ORIF X-ray & clinical result are better than Non-operative treatment

  22. THE END

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