fracturesoftheforearmwristandhand小儿骨折的前臂手腕和手课件

Conscious sedation/Bier block/general anesthesia Traction/counter-traction Reproduce/exaggerate deformity to unlock fragments Reduce/lock fragments using periosteal hinge Correct rotational deformity Open fractures Compartment syndrome Inability to maintain acceptable reduction Multi-trauma Floating elbow Neurologic/vascular compromise Re-fracture with displacement Infection Delayed union Non-union Prominent hardware Hardware migration Loss of reduction Compartment syndrome Irrigation and debridement in the OR Plate and screws or percutaneous cross pinning Antibiotics for 24 hours Radial shaft fracture with distal ulnar physeal injury instead of DRUJ injury Distal ulnar physeal injuries have a high incidence of growth arrest “Repeated efforts at reduction do nothing more than grate the plate away.” “These injuries unite quickly, so that attempts to correct malposition after a week are liable to do more damage to the plate than good.” “For Salter-Harris type I and II injuries in children younger than 10 years of age, angulation of up to 30 can be accepted. In children older than 10 years, up to 15 of angulation is generally acceptable.” Radiograph within one week to check reduction Do not re-manipulate physeal fractures after 5-7 days for fear of further injury to physis Metaphyseal fractures may be re-manipulated for 2-3 weeks if alignment lost Expect significant remodeling of any residual deformity Patient gave history of a fall sustained one year ago with a “bad wrist sprain” Did you note the scaphoid nonunion ? Distal fragment rotated and extended Blocks IP joint flexion Limited remodeling potential Closed reduction and percutaneous pinning Malunion may require osteotomy and pinning Most are SH I or SH II injuries Majority treated with closed management Buddy taping and/or