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Fracture extreminte inferieure_radius

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Fracture extreminte inferieure_radius

  1. 1. Fracture de l’extrémitéFracture de l’extrémité inférieure du radiusinférieure du radius S.REZZIKS.REZZIK E.H.S BEN-AKNOUNE.H.S BEN-AKNOUN
  2. 2. DéfinitionDéfinition  Les fractures de l’extrémité inférieure du radiusLes fractures de l’extrémité inférieure du radius sont les fractures les plus fréquentes.sont les fractures les plus fréquentes.  Elles touchent préférentiellement la femmeElles touchent préférentiellement la femme après 60 ans (ce qui justifie une prise en chargeaprès 60 ans (ce qui justifie une prise en charge de l’ostéoporose),de l’ostéoporose),  mais aussi le sujet jeune (accidents de sport, demais aussi le sujet jeune (accidents de sport, de travail, de la voie publique).travail, de la voie publique).  Elles sont souvent considérées, à tort, commeElles sont souvent considérées, à tort, comme bénignes mais justifient, comme toutes lesbénignes mais justifient, comme toutes les fractures, une restitution correcte de l’anatomiefractures, une restitution correcte de l’anatomie pour assurer un bon résultat fonctionnelpour assurer un bon résultat fonctionnel
  3. 3. Rappel anatomique  L’articulation radio-carpienneL’articulation radio-carpienne  L’articulation radio-ulnaire inférieureL’articulation radio-ulnaire inférieure
  4. 4. ANATOMIEANATOMIE
  5. 5. Repères radiographiques  De face la surface articulaire du radius estDe face la surface articulaire du radius est inclinée de 25° par rapport à l’horizontale etinclinée de 25° par rapport à l’horizontale et l’index radio-ulnaire est d’environ 2 mm (radiusl’index radio-ulnaire est d’environ 2 mm (radius plus long que l’ulna) ; la ligne bi-styloïdienneplus long que l’ulna) ; la ligne bi-styloïdienne présente une inclinaison de face de 20° enprésente une inclinaison de face de 20° en dedans.dedans.  De profil la surface articulaire du radius estDe profil la surface articulaire du radius est orientée vers le bas et vers l’avant d’environ 10°.orientée vers le bas et vers l’avant d’environ 10°.
  6. 6. Mécanisme  par compression - extension .par compression - extension .  compression – flexion .compression – flexion .
  7. 7. classification (Castaing)  fracture par compression - extension avecfracture par compression - extension avec déplacement postérieur par chute sur ladéplacement postérieur par chute sur la paume de la main.paume de la main.  fracture par compression – flexion àfracture par compression – flexion à déplacement antérieurdéplacement antérieur
  8. 8. CLASSIFICATIONCLASSIFICATION CASTAINGCASTAING
  9. 9. ClassificationClassification
  10. 10. ClassificationClassification
  11. 11. ClassificationClassification
  12. 12. ClassificationClassification
  13. 13. CliniqueClinique Type de description : la fracture deType de description : la fracture de Pouteau CollesPouteau Colles  à l’interrogatoire .à l’interrogatoire .  inspection .inspection .  recherche des complicationsrecherche des complications
  14. 14. Inspection
  15. 15. Examen radiographique  clichés du poignet : face et profil.clichés du poignet : face et profil. • diagnostic.diagnostic. • traitement.traitement.  Incidence de ¾.Incidence de ¾.  Autres radio.Autres radio.
  16. 16. Fracture E.I RFracture E.I R
  17. 17. Fr.de Gérard MarchandFr.de Gérard Marchand
  18. 18. Traitement  Méthodes :Méthodes : – traitement orthopédique .traitement orthopédique . • Réduction .Réduction . • BABP .BABP .  critères de reduction :critères de reduction : - ligne bistyloidienne sur le plan frontale.- ligne bistyloidienne sur le plan frontale. - index radio-ulnaire sur le plan frontale.- index radio-ulnaire sur le plan frontale. - orientation de la glène sur le plan sagittal.- orientation de la glène sur le plan sagittal.  Critère : franchissement des corticalesCritère : franchissement des corticales
  19. 19. Critères de reductionCritères de reduction
  20. 20. TRAITEMENT CHIRURGICALTRAITEMENT CHIRURGICAL  embrochage classique.embrochage classique.  Embrochage intrafocale «  Kapandji »Embrochage intrafocale «  Kapandji »  Embrochage de PYEmbrochage de PY  Fixateur externe.Fixateur externe.  Plaque vissée.Plaque vissée.
  21. 21. Embrochage classique.Embrochage classique.
  22. 22. Embrochage intrafocal.Embrochage intrafocal.  KAPANDJIKAPANDJI
  23. 23. Embrochage de PYEmbrochage de PY
  24. 24. Plaque vissée type consolePlaque vissée type console
  25. 25. Fixateur externeFixateur externe
  26. 26. COMPLICATIONSCOMPLICATIONS  IMMEDIATESIMMEDIATES – lésions cutanéeslésions cutanées – Lésions associéesLésions associées – Lésions vasculo-Lésions vasculo- nerveusesnerveuses  SECONDAIRESSECONDAIRES – DéplacementDéplacement – ANDAND – SepsisSepsis – PseudarthrosePseudarthrose  A DISTANCEA DISTANCE – Cal vicieuxCal vicieux – arthrosearthrose – Syndrome canalaireSyndrome canalaire

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