Distal radius fracture
Introduction
Introduction to distal radius fracture Collesfracture refers to a cancellous fracture of the lower end of the humerus. The fracture occurs in the cancellous region within 2 to 3 cm of the lower end of the humerus. It is one of the most common fractures in the human body, accounting for 10% of all fractures, with the majority of the elderly and adults. Most of the fractures are crushed and the joint surface can be destroyed. The same violence in young people can cause the separation of the lower jaw bones. basic knowledge Sickness ratio: 0.05% Susceptible people: Most of them occur in middle-aged and older women. Mode of infection: non-infectious Complications: dislocation of the lower ankle joint Osteoporosis in the elderly
Cause
Causes of distal radius fracture
Physical factors (35%)
Mostly caused by indirect violence, mostly flat fall, palm support, wrist joints in the extension and forearm internal rotation, so that the violence is concentrated in the distal cancellous bone of the humerus and cause fracture, in this state, fracture The distal end must have a displacement to the dorsal and temporal sides. At this time, the ulnar styloid process may be accompanied by a fracture, and the triangular fibrocartilage disc may also tear.
Body factor (24%)
Due to the aging of the body, the gastrointestinal absorption function is poor or the malnutrition caused by improper feeding, the bone calcium content is low, leading to osteoporosis, causing the body to suffer from fracture under the influence of external forces.
Prevention
Prevention of distal radius fracture
The disease is caused by traumatic factors, no special preventive measures, the prevention and treatment of this disease, the focus is on the prevention of complications, the grams are elderly, mainly have the following points:
(1) Timely review of outpatients: The time of review is generally reviewed once every 2 days in the first week, and once a week after 1 week. First, the bandage is tight and swollen. When the fracture is fixed, adjust according to the swelling of the wrist and forearm. The tightness of the splint bandage and the plaster clip, the X-ray film showed fracture healing at 4 weeks, the fixation could be released, and the functional exercise was actively performed.
(2) Prevention of tendon and nerve damage: When the Cray's fracture is fixed, the palmar ulnar deviation is used to fix the pressure in the carpal tunnel. Some of them may compress the median nerve, and some may be healed due to deformity of the fracture end. Coupled with prolonged fixation, it can cause fracture of the long extensor tendon of the thumb, which should be paid attention to during the review process. Once found, it should be promptly surgically explored and treated.
(3) Early rotation control should be controlled: when the fixation is performed, the affected limb should be kept at the 15° or neutral position of the supination. Pre-rotation fixation often restricts the function of the forearm to be rotated, and should be corrected in time to return to the supination position. Otherwise, it will affect the rotation function of the forearm.
(4) Early correct functional exercise: patients should overcome the fear of swelling due to functional exercise, worry about fracture dislocation, under the accurate reduction and local firm external fixation, early functional exercise of the affected limb, first Passive activities, then active activities, functional exercise should be gradual, fixed on the same day can be active finger joints, fist fists and fists activities, the number of activities gradually increased, while doing flexion and extension exercises of the shoulder and elbow joint, after fracture healing, should be removed early, With reasonable treatment, all aspects of shoulder, elbow, wrist joint activities, especially strengthen the exercise of fist fists and punches, restore muscle strength and muscle coordination function, prevent dysfunction caused by muscle atrophy.
Complication
Distal humeral fracture complications Complications of the elderly under the dislocation of the ankle and ankle
The disease can have the following complications:
1. Malformation healing:
Unaccurate reduction and unreliable fixation are the main causes of fracture malformation. The extra-articular criteria for the treatment of distal radius fractures include restoration of the dip angle, tibial slope and height. The generally accepted standard is that the ankle joint is less than 2 mm apart. The lateral tilt angle is less than 10 degrees, the humerus is shortened to 5 mm, the dorsal or volar comminuted fracture, and the severe dorsal angulation or incomplete reduction is a sign that the fracture may be displaced again after the fixation and subsequent malformation. The dorsal deformity is mainly due to the palmar flexion at the time of reduction, the ulnar deviation is not in place and the deformity is healed, and the volar deformity of the wrist is uncorrected due to the excessive flexion of the reduction to the distal side of the volar, especially in the elderly, osteoporosis, excessive force during reset The incidence of repositioning of the distal radius fracture after reduction is high, especially for comminuted fracture. It is more prone to re-displacement and deformed healing during the fixation process. The obvious deformity will seriously affect the wrist joint function.
2. Lower ankle joint dislocation :
Dislocation of the lower ankle joint is most likely to occur in the distal radius fracture, and it is easy to be neglected. The lower ankle joint mainly relies on the articular disc and the ulnar ulnar, and the dorsal ligament remains stable. When the wrist is stretched, the ligament can be broken. Dislocation of the lower radius and humerus joints, early identification and treatment of the lower radius and ankle joint injury with distal radius fractures, is essential to reduce the incidence of pain sequelae and loss of function, X-ray examination found that the lower ankle joint is greater than 3mm, That is, the lower ankle joint dislocation, the accurate reduction and reliable fixation of the distal radius fracture can restore and heal the dislocated lower ankle joint.
3, the median nerve compression:
The position of the distal radius fracture is fixed and fixed, which makes the carpal tunnel flexion. The displacement of the fracture and hematoma can increase the pressure inside the carpal tunnel. In severe cases, it can lead to median nerve compression and carpal tunnel syndrome. After fracture reduction, the alignment is good, and the percutaneous wear is performed. Needle fixation can reduce the incidence of median nerve compression, early detection, early removal of median nerve compression can reduce hand dysfunction.
4. Severe traumatic wrist arthritis:
Maintaining articular surface flattening is an important condition for the recovery of joint function in the distal radius fracture. For comminuted fracture, the most important criterion for treatment success is intra-articular reconstruction, that is, the accuracy of articular surface restoration. The unevenness of the joint surface is more than 2 mm. Proof, we use the needle reduction to fix the needle and the wrist or smash, the extremely unstable distal radius fracture, the effect is good.
5, forearm compartment syndrome:
The palm flexor is fixed by pressure, which can increase the pressure of the forearm fascia, excessive flexion of the wrist, reduce the venous return, and further increase the pressure of the fascial compartment. In severe cases, the compartment syndrome may occur, so plaster or Observing the blood supply and pain properties of the hand after the splint is fixed can reveal a precursor to the compartment syndrome, so that it can be treated in time to avoid more serious complications.
Symptom
Symptoms of distal radius fracture Common symptoms Wrist swelling and tenderness Wrist pain, wrist swelling and palmar flexion... Wrist contusion and wrist joint to the ulnar side...
Patients with distal radius fractures have the following clinical manifestations:
Wrist pain swelling, especially with limited palmar flexion, severe fracture displacement, there may be a fork-shaped deformity, that is, the dorsal bulge of the wrist, the volar protrusion, the outline of the ulnar styloid disappears, the wrist widens, the hand squats Lateral displacement, the lower end of the ulna protrudes, and the styloid process of the humerus moves up to or beyond the level of the ulnar styloid process. The distal end of the humerus has tenderness, which can reach the fracture end displaced to the ankle. The comminuted fracture can touch the bone squeak.
Examine
Examination of distal radius fractures
The auxiliary examination method of this disease is mainly X-ray examination, X-ray film shows typical displacement, there are several points:
1. The distal radius fracture block is displaced to the dorsal side.
2. The distal radius fracture block is displaced to the temporal side.
3. The humerus is shortened, and the dorsal cortical bone is embedded or fractured.
4. The fracture is angled to the volar side.
5. The distal radius of the humerus is supinated.
In addition, it also showed subluxation or total dislocation of the ulnar head. The distal radius fracture of the humerus was displaced to the temporal side to indicate the edge tear of the triangular cartilage. The avulsion fracture of the ulnar stump was often combined, and the dip angle and the ulnar angle were reduced or negative.
Diagnosis
Diagnosis and diagnosis of distal radius fracture
diagnosis
Diagnosis can be performed based on clinical manifestations and examinations.
Differential diagnosis
In the differential diagnosis, it is more important to identify different types of distal radius fractures in order to give a correct diagnosis:
1. Distal radial fracture
include:
1 distal humeral fracture;
2 osteophyte spondylolisthesis in adolescents and children;
3 The distal end is displaced to the dorsal side, the temporal side is displaced, and the volar side is angled;
4 combined with the lower ankle joint separation, and even combined with the distal ulna or ulnar styloid fracture.
2, distal radius flexion fracture: refers to the fracture line from the dorsal distal end obliquely proximal, the distal end of the fracture together with the carpal bone to the volar side of the volar side, the angle to the dorsal side.
3, dorsal lateral cleft palate: external force through the carpal bone impact the dorsal lateral edge of the lower end of the humerus, the fracture line from the distal volar oblique to the proximal side of the dorsal wedge.
4, palmar marginal cleft palate: external force through the carpal bone impact the lower side of the humerus articular surface of the volar side, the fracture line from the distal dorsal oblique to the proximal volar avulsion.
