Extern conference สุชาวดี 1มิ.ย. 61

1. Extern Conference
Ext.Suchavadee Toragsaskul
1 June,2018

2. History
• ชายไทย 77 ปี ภูมิลาเนา จ.นครราชสีมา
• CC:ตกจากโต๊ะเอามือยันพื้น 5 hr PTA
• Present illness: 5 hr PTA พลาดล้มจากโต๊ะ เอามือขวากระแทกพื้น ไม่มีศีรษะ
กระแทกพื้น ไม่สลบ จาเหตุการณ์ได้ ไม่ได้รับบาดเจ็บบริเวณอื่น มีปวดบวม และผิดรูปที่
ข้อมือขวา
• No known underlying disease

3. History
• Primary survey
A:patent airway , no c spine tenderness
B:trachea in midline,RR=16/min,clear equal both
lungs,CCT-negative
C:BP=135/85mmHg,PR=76bpm, no external
bleeding,PCT-negative
D:E4V5M6 pupil 3mm RTLBE
E:no external wound, tender and deformity Rt.wrist
Limit ROM due to pain

4. Physical examination
• GA: A Thai elderly man, well cooperate
• HEENT: Not pale conjunctivae, anicteric sclerae
• CVS: normal s1s2, no murmur
• Lungs: clear equal both lungs
• Abdomen: soft, not tender
• Neuro: E4V5M6, pupil 3mm RTLBE
• Extremities: Rt.wrist: deformity,marked
swelling,tender,limit ROM,Radial pulse 2+, intact
nerve,cap refill<2s

5. Rt.wrist AP,lat

6. management
• Hematoma block
• Close reduction
• On AP short arm slab

7. Distal end radius fracture

8. Distal end radius fracture
• Epidemiology – Most common fractures of the
upper extremity – Common in younger and older
patients. Usually a result of direct trauma such as fall
on out stretched hand – Increasing incidence due
to aging population
• Mechanism of Injury – Most commonly a fall on an
outstretched extremity with the wrist in dorsiflexion –
High energy injuries may result in significantly
displaced, highly unstable fracture

9. Distal end radius fracture
• Clinical Evaluation
– Patients typically present with gross deformity of the
wrist with variable displacement of the hand in
relation to the wrist. Typically swollen with painful ROM
– Ipsilateral shoulder and elbow must be examined –
NV exam including specifically median nerve for
acute carpal tunnel compression syndrome

10. • 3 view of the wrist including AP, Lat, and Oblique –
Normal Relationships
Radiographic Evaluation

11. – Colles Fracture
• Combination of intra and extra articular fractures of
the distal radius with volar angulation, dorsal
displacement, radial shift, and radial shortenting
• Most common distal radius fracture caused by fall
on outstretched hand
– Smith Fracture (Reverse Colles)
• Fracture with dorsal angulation from a fall on a
flexed wrist
Type

12. Type
– Barton Fracture
• Fracture with dorsal or volar rim displaced with the
hand and carpus
– Radial Styloid Fracture (Chauffeur Fracture)
• Avulsion fracture with extrinsic ligaments attached
to the fragment
• Mechanism of injury is compression of the scaphoid
against the styloid

13. Fernandez 1987
• Base on mechanism of injury

14. Distal end radius fracture
Treatment
– Displaced fractures require and attempt at reduction.
• Hematoma block -10cc of lidocaine in the fracture site
• Hang the wrist in fingertraps with a traction weight
• Reproduce the fracture mechanism and reduce the
fracture
• Place in sugar tong splint
– Operative Management
• For the treatment of intraarticular, unstable, malreduced
fractures.
Unstable: -Fernandez type II,IV,V and some case in I,III
-Lafontaine criteria≥3 of 5 instability parameters
-Secondary displacement after casting
• As always, open fractures must go to the OR.

15. Parameters for predict
instability

16. Rt.wrist AP,lat

17. Post close reduction

18. Thank you