Recommended
More Related Content
What's hot
What's hot (14)
Viewers also liked
Viewers also liked (15)
Similar to Case conference orthokorat
Similar to Case conference orthokorat (20)
Case conference orthokorat
- 2. ผู้ป่วยชายไทย อายุ 16 ปี ภูมิลาเนา จังหวัดนครราชสีมา อาชีพ นักเรียน CC : ปวดแขนขวา 3 ชม. ก่อนมาโรงพยาบาล
- 3. 3 ชั่วโมงก่อนมาโรงพยาบาล ผู้ป่วยขับ MC ล้มเอง แขน ขาขวากระแทก พื้น มีอาการปวดบริเวณแขนขวาไปถึงข้อมือ มีแผลถลอกบริเวณแขน ขาขวา ขยับข้อมือขวาไม่ได้ กามือได้ขยับนิ้วได้ไม่ชา ไม่อ่อนแรง ไม่มีศีรษะกระแทก พื้น ไม่หมดสติ จาเหตุการณ์ได้
- 4. A : Can speak, C-spine not tender, full ROM B : Equal breath sound both lungs, CCT –ve C : BP 122/75 mmHg, PR 112 bpm, no active external hemorrhage D : E4V5M6, Pupils 3 mm RTLBE E : Rt.wrist tenderness and swelling, no deformity,AW 1x2 cm at rt arm, no ecchymosis, radial pulse 2+, cap refill<2s normal sensation
- 5. A : no drugs & food allergy B : No current medication P : Unknown underlying disease L : 15.00 pm E :ขับ MC ล้มเอง แขนขวากระแทกพื้น
- 6. GA : AThai man good consciousness HEENT : not pale conjunctivae, anicteric RS : clear, equal breath sound CVS : full, regular pulse, normal S1S2 Abdomen : soft, not tender, no guarding
- 7. Ext : Rt.wrist tenderness and swelling, no deformity,AW 1x2 cm at rt arm, no ecchymosis, radial pulse 2+, cap refill<2s normal sensation, can’t wrist extension & flexion due to pain, can hand grip
- 9. Closed fracture Rt distal end radius
- 10. A distal end radius fracture occurs about 1 inch from the end of the bone
- 11. Most common orthopaedic injury - younger patients - high energy - older patients - low energy / falls ,osteoporosis Cause - Fall onto outstretch arm
- 12. Pain and swelling around the wrist Deformity Paresthesia or numbness in the fingers to exclude any median or ulnar nerve injury
- 13. Film wrist AP - Radial inclination - Radial height
- 14. Film wrist lateral -Volar tilt
- 16. 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
- 19. 1. Extra-articular distal radius fracture Stable fracture : Incomplete fracture , Impact fracture , non-displaced or minimal displace fracture Displace fracture : Colle’s fracture , Smith fracture 2. Intra-articular fracture
- 21. AP slab Short arm cast with three point fixation 3-4 wk
- 22. Close reduction : traction , increase deformity and reverse mechanism Short arm cast with three point fixation : Colle’s fracture Long arm cast and position elbow flex 90 , full supination , slight dorsiflexion wrist and ulna deviation : Smith’s fracture 4-6 wk
- 24. No displacement ( Stepping articular surface <1mm) -Traction & Long arm cast with three point fixation
- 25. volar or dorsal conminution articular margins fractures dorsal angulation >5° or >20° of contralateral distal radius >5mm radial shortening progressive loss of volar tilt and loss of radial length following closed reduction and casting Osteoporosis
- 26. Early - Compartment syndrome - EPL rupture - Carpal tunnel syndrome prevent by avoiding immobilization in excessive wrist flexion Late - Malunion - Prolong stiffness