fraktur colles dan smith
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Transcript of fraktur colles dan smith
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Injuries of the forearmColle`s and smith`s fracture
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Normal wrist jointFig : -
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Normal wrist jointFig : -
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Colles fracture. describe by : - Abraham colle`s - 1814. Definition : - it is not just fracture lower end of radius but a fracture dislocation of the inferior radioulnar joint .Occurs about 2.5 cm above the carpal extremity of the radius . Commonest age group- Elderly.( 60 yrs) Women> Men. MOA fall in outstretched hand.Force required to cause this fracture is 192 kg in women and 282 kg in men.
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Colles fractureFig : -
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Colles fractureFig : -
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AP View Fig : - colle`s fracture
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Clinical features.-Swelling.Pain.Dinner fork defomity, it is not found in all cases but seen only if there is a dorsal tilt or rotation of the distal fragment
Examination-Distal neurovascular status.External injuries.
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Dinner fork defomityFig :
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dorsal displacement of the distal fracture fragments.
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Styloid process test :Normally , the radial styloid proces is lower by 1.3 cm when compaired to the ulnar styloid process.In colle`s both radial and ulnar styloid processes are at the same level and are found in all displacements of colle`s fracture.This is more reliable sign than dinner fork deformity
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Distance between radial and styloid processesFig :
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Colles fractureFig : -
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Frykmann`s classification : Fracture line Distal ulnar fractureAbsentpresent 1 .. Extra - articular122. Intra articular (involving RC joint only ) 3 4 3 . Intra articular (involving distal RU joint only ) 5 64 . Intra articular (both RC + inferior RU joints ) 78RC = radiocarpalRU = radioulnar
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Frykmann`s classification Fig :
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Radiograpy : X ray of the wrist : - AP and lateral views and lower end of the radius Displacement in a colle`s fracture : Dorsal displacementDorsal rotationLateral displacementLateral rotationImpaction supination
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Treatment :Conservative methods Operative methods CONSERVATIVE METHODS : - closed reduction under general anaesthesia (GA),or local anaesthesia (LA) - If the level of the styloid processes are restored back to normal , it indicates that the reduction has been achieved satisfactorily. - limb is immobilised by colle`s cast and a check radiograph is taken - Removed after 6 8 weeks - physiotherapy
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6 immobilisation method : Below elbow cast (10 20 degree palmar flexon , 15 20 degree ulnar deviation ) COLLE`S CAST ABOVE ELBOW CAST IN SUPINATION ABOVE ELBOW CAST IN PRONATION. ABOVE ELBOW CAST IN MID- PRONATION. COTTON LODER`S POSITION( WRIST FULLY FLEXED) . EXTERNAL FIXATORS
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Colle`s cast It is a below elbow cast in supination and ideally it has to meet the following 4 criteria :- Firm fit at the dorsum Firm fit at the volar fracture apexJust snuggly fitting at the forearmMetacarpophalangeal joints should be free to move
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Colle`s cast
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Acceptable limits of colle`s fracture:A dorsal tilt of less than 10 degreesA radial shorteing of less than 5 mm. OPERATIVE METHODS : INDICATION :ImpactionMedian nerve intrapment
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Cont..Fig : -
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Surgical methods : 1 . Closed reduction and percutaneous pinning with k wires 2 . Open reduction and plate fixation.
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Complication Early complication :Unstable reductionMedial or ulnar nerve stretchedPost reduction swellingCompartmental syndromeAnaesthesia problemInjury to proximal segment of the bone during reduction Late complication :Malunion Rupture of extensor pollicis tendonFrozen shoulderCarpel tunnel syndrome Nonunion Sudeck`s osteodystrophy
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COLLE`S FRACTURE - Why is it called fracture of 6?Common at 60 yearsForce required to cause colle`s fracture are multiples of 66 classical displacements6 method of fracture immobilisation 6 important early and late complications60 per cent cases have fracture ulnar styloid
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Smiths Fracture.Reverse of colles fracture.Wrist fracture in which the distal end of the radius is displaced forwards. Mechanism of injury :Fall on the back of the dorsum of the handFall on the forearm in supination Direct blow to the flexed hand
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Colle`s and smith`s fractureFig : -
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Clinical features : -Pain Swelling Deformity Loss of wrist functionDeformity is opposite to that of colle`s fracture and is called the garden shaped deformity. Radiography : -AP view of the wrist
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Complication : Complication of colle`s Treatment : -Closed reduction and immobilisation in a long arm cast with forearm in supination and wrist in extension. Unstable fractures : -Fixation with k wire or open reduction and plate fixation.