IN THE NAME OF GOD

FRACTURE OF THE DISTAL

RADIUS AND ULNA

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

THE END