4. A: airway patent, no c-spine tenderness, neck
full ROM
B: clear&equal breath sound both lung, CCT-,
no wound
C: BP140/89 mmHg, PR 106 bpm
D: E4V5M6, pupil 3 mm RTLBE, motor gr.V all
E: left wrist - swelling, deformities, tender, no
wound
6. GA: aThai elder man, good consciousness
HEENT: no pale conjunctivae, anicteric
sclerae, no wound
Lungs: clear&equal Breath sound
Heart: normal s1s2, no murmur
Abdomen: soft, not tender, no wound
7. Ext: Left wrist – swelling, deformities, Mark
tender at left wrist, stepping, capillary refill <
2sec, limit ROM due to pain, sensation-intact,
8.
9.
10.
11. Comminute fracture at distal end radius,
dorsal angulation, radial shortening, no
articular involvement,no ulnar fracture
12. Closed reduction on short arm AP slab
Repeat Film
Pain control
F/U 1 wk + film + เปลี่ยน slab
Advise compartment syndrome
22. View Measurement Normal Acceptable
criteria
AP Radial height 13 mm
<5 mm
shortening
Radial
inclination
23 degrees change <5°
Articular
stepoff
congruous <2 mm stepoff
LAT Volar tilt 11 degrees
dorsal
angulation <5°
or within 20° of
contralateral
distal radius
23.
24. Unstable
Fernandez type II,IV,V
Lafontaine criteria > 3/5 ( 20 ul dor เข้าข้อ 60)
▪ Dorsal angulation > 20 degree
▪ Ulnar fx
▪ Dorsal comminution (fernandez type IV)
▪ Intraarticular Fx
▪ Age > 60
Secondary displacement after casting
26. Closed reduction with immobilization
Analgesic drug
Traction -> increase deformities -> decrease
deformities -> on short arm AP slab&3 point
fixation + arm sling