The document discusses fractures of the upper limb, specifically focusing on fractures of the elbow joint, radial head, and distal radius. It provides details on the anatomy, mechanisms of injury, classification systems, clinical presentation, treatment approaches, and potential complications for each type of fracture. For elbow fractures, closed and open reduction techniques are described for treating dislocations. Radial head fractures are classified using the Mason system and can be managed non-operatively or surgically with fixation or excision. Distal radius fractures commonly result from falls and involve the articular surfaces, with treatment depending on the degree of displacement.
Hoffa's Fracture: Diagnosis, management & New Classification System by BAGARI...Vaibhav Bagaria
Hoffa's Fracture - coronal split fracture of distal femur, its diagnosis, management strategy, a new classification and tips and tricks of management. First described Hoffa, a new classification system by Bagaria et al helps plan the surgery for these tricky fracture. The most crucial step is not to miss these fractures in ER.
Hoffa's Fracture: Diagnosis, management & New Classification System by BAGARI...Vaibhav Bagaria
Hoffa's Fracture - coronal split fracture of distal femur, its diagnosis, management strategy, a new classification and tips and tricks of management. First described Hoffa, a new classification system by Bagaria et al helps plan the surgery for these tricky fracture. The most crucial step is not to miss these fractures in ER.
A fractured neck of femur (NOF) is a serious injury, especially in older people. It is likely to be life changing and for some people life threatening.
Neck of femur fractures (NOF) are common injuries sustained by older patients who are both more likely to have unsteadiness of gait and reduced bone mineral density, predisposing to fracture. Elderly osteoporotic women are at greatest risk.
arthroscopy of the knee joint is a relatively common orthopedic procedure to treat a host of sports injuries and other knee diseases. Commonly a 4 mm size scope is used via two standard arthroscopy portals. Arthroscopic examination of the knee confirms MRI findings. Synovial fluid and biopsy can be taken to confirm diagnosis.
paediatric injuries around the elbow
supracondylar elbow injuries
pulled elbow in paediatric age r
radiological signs around elbow in supracondylar fracture humerus
A fractured neck of femur (NOF) is a serious injury, especially in older people. It is likely to be life changing and for some people life threatening.
Neck of femur fractures (NOF) are common injuries sustained by older patients who are both more likely to have unsteadiness of gait and reduced bone mineral density, predisposing to fracture. Elderly osteoporotic women are at greatest risk.
arthroscopy of the knee joint is a relatively common orthopedic procedure to treat a host of sports injuries and other knee diseases. Commonly a 4 mm size scope is used via two standard arthroscopy portals. Arthroscopic examination of the knee confirms MRI findings. Synovial fluid and biopsy can be taken to confirm diagnosis.
paediatric injuries around the elbow
supracondylar elbow injuries
pulled elbow in paediatric age r
radiological signs around elbow in supracondylar fracture humerus
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
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Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
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1. Upper Limb
Fractures Part 2
Dr. Apoorv Jain
D’Ortho, DNB Ortho
drapoorvjain23@gmail.com
+91-9845669975
2. • The elbow joint is a modified hinge joint formed by
3 separate articulations,
– Ulnotrochlear(hinge)
– Radocapitellar(rotation)
– Proximal radioulnar(rotation)
5. Ulnar ligament is also known as the
medial collateral ligament. It
prevent abduction of elbow joint. It
cosists of 3 bands: Anterior,
posterior, Transverse.
Radial ligament is also called as
the lateral collateral ligament.it
prevent adduction of elbow
6. • The soft tissue restriants can be divided into
Static stabilizers
Dynamic stabilizers
• Static stabilizers include:
oJoint capsule
oLCL & MCL
• Dynamic stabilizers include Biceps,
Brachialis & Triceps
8. Two set of movements occur at the
elbow:
A)Flexion and extension at the
Ulnotrochlear joint
B)Pronation and supination at
Superior radio-ulnar joint
9. Normal range of motion:
0 to 150°flexion
85° supination & 80° pronation
Functional range of motion:
a 100° arc (30 to 130 degrees flexion)
50° supination & 50° pronation
11. Dislocation of the elbow
Dislocation of UlnoHumeral joint
Mechanism of injury:
Most commonly injury is caused by fall onto an
outstretched hand or elbow
• Posterior dislocation: a combination of elbow
hyperextention, valgus stress, arm abduction
and forearm supination
• Anterior dislocation: a direct force strikes the
posterior forearm with elbow in flexed position
12. • Most elow dislocations & fracture
dislocations result in injury to all
capsulo-ligamentous stabilizers of
elbow joint
• The capsuloligamentous injury
progresses from lateral to medial (HORI
CIRCLE)
13.
14. Signs and Symptoms
Pain, Swelling and Ecchymosis
Instability, Crepitus and Deformity
(With the elbow flexed at 90 degrees,the medial &
lateral epicondyles & olecranon process should from
isosceles triangle)
A complete peripheral neurological examination
for both motor & sensory functions should be
done
Radial & ulnar pulses should be compared on
both sides
15. Classificaton
According to direction of
displacement of ulna
relative to the humerus
• Posterior
• Posterolateral
• Posteromedial
• Lateral
• Medial
• Anterior
16. Treatment principles
Restoration of the inherent bony
stability is goal
Ulnotrochlear and Radiocapitellar contact.
The LCL is more important than MCL in
setting of most cases of traumatic elbow
instability
MCL will usually heal properly without any
repair
17. • Parvin’s method Of Closed reduction
Patient lies prone
Physician applies gentle downward traction of
the wrist for few min, as the olecranon begin to
slip distally, the physician lift up gently on the
arm
18. • Meyn and Quigley’s
method of reduction:
Only the forearm hangs
from the side of the
stretcher as gentle
downward traction is
applied on the wrist, the
physican gudies the
reduction of olecranon
with the opposite hand
19. Surgical repair (if elbow clinically is
unstable post reduction)
Direct repair of the ligaments,capsule and
muscles
Static or Hinged external fixator application
Cross pining of the joint
Temporary bridge plating of the elbow
20. • If the elbow remains unstable
inspite of repair to lateral structures
the medial side of the elbow is
approached with care taken to
protect the ulnar nerve
• If the elbow is still unstable then an
External fixator should be placed
21. Complications
Vascular injury of brachial artery may occur
Nerve injury the medial ulnar nerve may be affected
Myositis ossificans which is more common if passive
exercise is inflicted on the patient.
Late complications
Stiffness
Heterotopic ossification
Unreduced dislocation
Recurrent dislocation
Osteoarthritis after severe fracture dislocation.
23. EPIDEMIOLOGY
4% of all fractures and 30% of all elbow
fractures
1/3 patients associated injury to shoulder,
humerus, forearm,wrist or hand.
Rare in children due to cartilagenous nature of
radial head
Radial neck fracture more common in children
24. Anatomy of proximal radius
RadioCapitellar joint transmit 50-60% load
across elbow
25. Radius Head Surgical Anatomy
Important for:
Valgus Stability
Posterolateral Rotatory
Stability
Longitudinal Forearm
Stability
(Along With Interossi
Membrane & Druj)
27. Mechanism Of Injury
(1) Fall On Outstreched Hand (most Common)
Distal Radius
Interossi Membrane(forearm)
Radial Head Impaction Against Capitellum
(2) Valgus Injury To Elbow/Direct Injury
Mcl Rupture/Olecranon Fracture Unstable Elbow
28. Signs and Symptoms
Swelling
Ecchmosis
Anconeus Triangle Fullness
Range Of Motion Restriction
Stability
Active Finger Extension
Forearm/Interossi Membrane Tenderness
Wrist Tenderness
ESSEX LOPRESTI Lesion
29. Essex Lopresti Lesion
This is defined as
longitudinal disruption of forearm
interosseous ligament,
usually combined with radial head
fracture and/or dislocation
plus distal radioulnar joint injury
30. Muscle Attachment Around Proximal
Radius:
SUPINATOR ATTACHMENT AT PROXIMAL RADIUS.
BICEPS TENDON ATTACH TO RADIAL TUBEROSITY.
31. Posterior Interossei Nerve At Risk:
Posterior Interosseous Nerve Traverses From Anterior To
Posterior Through Supinator Muscle.
Always Check Pre Operative Active Finger Extension
34. Classification Of Radial Head Fractures
Mason classification
Type I
Minimally displaced, no
mechanical block to rotation,
intraarticular displacement <2mm
Type II
Displaced fx >2mm or angulated,
possible mechanical block to
forearm rotation
Type III Comminuted and displaced fx,
mechanical block to motion
Type IV Radial head fracture with elbow
dislocation
MORREY MODIFIED MASON CLASSIFICATION BY QUANTIFYING DISPLACEMENT
AREA >30% AND DISPLACEMENT OF >2 MM
35. Treatment Goal
Correction Of Any Block To Forearm Rotation
Early Mobilisation Of Elbow And Forearm
Stability Of Elbow And Forearm
Prevention Of Secondary Osteoarthrosis Of
Elbow
36. Non Operative Treatment
Indication:
Isolated Radial Head Fracture With Mason Type 1
(Undisplaced <2mm)
Plaster Slab For 3 Weeks
Early Active Mobilization Of Elbow
Persistant Pain.Inflammation,contracture
Suspect Capitellar Fracture
37. Operative Management
(Open Reduction & Internal Fixation)
INDICATION FOR ORIF:
Mason type II with mechanical block(displaced)
Large fragment >2 mm
Mason type III where ORIF feasible(>3 FRAGMENT POOR
OUTCOME)
Mechanical block to motion (lignocaine inj in elbow joint)
Presence of other complex ipsilateral elbow injuries(without
metaphyseal bone loss)
FRAGMENT EXCISION LEADS TO INSTABILITY
TRY TO PRESERVE SMALLEST FRAGMENT
39. Which implant to use?
Mini fragment screw(2.4 or 2.7
mm)(counter sink must)
Headless compression compression
screw/Herbert screw
Low profile plate/mini t plate(in safe
zone/postero lateral)
K WIRE
40. COMPLICATION OF ORIF
PIN INJURY
HARDWARE FAILURE
HARDWARE IMPINGEMENT
STIFFNESS OF ELBOW
RESTRICTION OF SUPINATIONPRONATION
41. Radial Head Replacement
To prevent proximal migration of the radius
Silicon implant poor outcome : SILICON SYNOVITIS
Titanium/vitallium metallic implant of choice
42. RADIAL HEAD EXCISION
INDICATION:
Low demand, sedentary patients
In a delayed setting for continued pain of an isolated radial
head fracture
CONTRAINDICATION:
In children
Presence of destabilizing injuries (Essex-lopresti
lesion,fracture dislocation elbow(mason type 4),monteggia)
Terrible triad of elbow(coronoid fracture,MCL deficiency)
43. Common injury
Potential for functional
impairment and frequent
complications
44. First surgeon to recognize these injuries was
Pouteau 1783. His work was not widely
publicized.
Later Abraham Colles 1814 gave the classic
description of “Colles fracture”
Advent of X rays at the end of nineteenth
century contributed much to the understanding
of different patterns of injury.
45. One sixth of all fractures treated in the
Emergency Room (16%)
Bimodal distribution
less than 30 years (70% men)
over 50 years (85% women)
Males age 35 or older - 90 per 100,000 population
46. Occurs through the distal metaphysis of the
radius
May involve articular surface.
Mechanism of injury
forced extension of the carpus,
impact loading of the distal radius.
47. History
Wrist is typically swolen with ecchymosis and
tender
Visible deformity of the wrist, with the hand
most commonly displaced in the dorsal
direction less comonly in volar direction
Movement of the hand and wrist are painful.
Adequate and accurate assessment of the
neurovascular status of the hand is performed,
before any treatment is carried out.
48. General physical exam of the patient, including
an evaluation of the injured joint, and a joint
above and below
Radiographs of the injured wrist-pa and lat
view , oblique view
CT scan of the distal radius to know extent of
intrarticular involvement
50. Scaphoid and lunate
fossa
Ridge normally exists
between these two
Sigmoid notch: second
important articular
surface
Triangular
fibrocartilage
complex(TFCC): distal
edge of radius to base
of ulnar styloid
60. Type I Extraarticular, undisplaced
Type 2 Extraarticular, displaced
Type 3 Intraarticular, undisplaced
Type 4 Intraarticular, displaced
61. Type A Extraarticular
Type B Partial articular
B1–radial styloid fracture
B2–dorsal rim fracture
B3–volar rim fracture
B4–die-punch fracture
Type C Complete articular
63. Radial Column
Lateral side of
radius
Intermediate
Column
Ulnar side of
radius
Ulnar Column
distal ulna
Radial column
Intermediate column
Ulnar column
64. I. Bending-metaphysis
bending with loss of
palmar tilt and radial
shortening ,DRUJ
injury(Colles, Smith)
II. Shearing-fractures
of joint surface
(Barton, radial styloid)
65. III. Compression-
intraarticular fracture
with impaction of
subchondral and
metaphyseal bone (die-
punch)
IV. Avulsion-fractures of
ligament attachments
(ulna, radial styloid)
V. Combined/complex -
high velocity injuries
66. Assess involvement of dorsal or volar rim
Is comminution mainly volar or dorsal?
is one of four cortices intact?
Look for “die-punch” lesions of the
scaphoid or lunate fossa.
Assess amount of shortening
Look for DRUJ involvement
67. COLLES #
-extra articular or intra articular distal radius -
clinicaly described as dinner fork deformity
-mechanism---fall on to an hyper extended ,radialy
deviated wrist with the forearm in pronation
68. # distal radius with volar angulation or
volar displacement of the hand and
distal radius
mechanism—fall on to a flexed wrist
with the forearm fixed in supination
unstable pattern often requires ORIF
because of difficulty in maintaining
closed reduction
69. # disdlocation or subluxation of
wrist in which the dorsal or volar
rim of distal radius is displaced
mechanism-fall on to a dorsiflexed
wrist with the forearm fixed in
pronation
unstable # requires ORIF
70. Avulsion # with extrinsic ligaments
remaining attached to styloid fragment
Mechanism-compression of scaphoid
against styloid with the wrist in
dorsiflexion and ulnar deviation
Often associated with intercarpal
ligament injury
Requires ORIF
71. five factors indicative of instability
(1)initial dorsal angulation of more than 20
degrees (volar tilt),
(2) dorsal metaphyseal comminution,
(3) intraarticular involvement,
(4) an associated ulnar fracture, and
(5) patient age older than 60 years
72. Preserve hand and wrist function
Realign normal osseous anatomy
Promote bone healing
Avoid complications
Allow early finger and elbow ROM
73. Casting
Long arm vs short arm
Sugar-tong splint
External Fixation
Joint-spanning
Non bridging
Percutaneous pinning
Internal Fixation
Dorsal plating
Volar plating
Combined dorsal/volar plating
focal (fracture specific) plating
75. Obtaining and then maintaining an
acceptable reduction.
Immobilization:
long arm
short arm adequate for elderly patients
Frequent follow-up necessary in order to
diagnose redisplacement.
76. Anesthesia
Hematoma block
Intravenous sedation
Bier block
Traction: finger traps and weights
Reduction Maneuver (dorsally angulated fracture):
hyperextension of the distal fragment,
Maintain weighted traction and reduce the distal
to the proximal fragment with pressure applied
to the distal radius.
Apply well-molded “sugar-tong” splint or cast,
with wrist in neutral to slight flexion.
Avoid Extreme Positions!
77. Radial length: within 2-3 mm of the
contralateral wrist
Palmar tilt: neutral tilt
Intrarticular step-off or gap< 2mm
Radial inclination <5° loss
Carpal malalignment: absent
Ulnar variance: no more than 2 mm of
shortening compare to ulnar head
78. High-energy injury
Open injury
Secondary loss of reduction
Articular comminution, step-off, or gap
Metaphyseal comminution or bone loss
Loss of volar buttress with displacement
DRUJ incongruity
82. A spanning fixator is
one which fixes
distal radius
fractures by
spanning the carpus;
I.e., fixation into
radius and
metacarpals
Use for comminuted
fracture
83.
84. Mal-union
Pin track infection
Finger stiffness
Loss of reduction; early vs late
Tendon rupture
87. Bulky
Poor screw hold in porosis and comminution
Screws do not buttress
Cutaneous radial nerve injury
Pin tract infection
Reflex sympathetic dystrophy
88.
89. intrafocal pinning
through fracture site
buttress against
displacement
Drawback-tendency to
translate distal fragment
in opposite direction
90. Useful for elevation of depressed articular
fragments and bone grafting of metaphyseal
defects
required if articular fragments can not be
adequately reduced with percutaneous
methods
91. Based on location of comminution.
Dorsal approach for dorsally angulated
fractures.
Volar approach for volar rim fractures
Radial styloid approach for buttressing of
styloid
Combined approaches needed for high-energy
fractures with significant axial impaction.
99. Generally not prefere because of high rate of
complication like
- tendon dysfunction and rupture
- tenosynovitis of extensor tendons
indicated for-
dorsal die-punch fractures or fractures
with displaced dorsal lunate facet fragments
113. External fixators still have a role in the
treatment of distal radius fractures
Spanning ex fix does not completely correct
fracture deformity by itself
Should usually combined with percutaneous
pins (augmented fixation)
114. new plating techniques allow for accurate
and rigid fixation of fragments
Plating allows early wrist ROM
Volar, smaller and more anatomic plates are
better tolerated
combination treatment is often needed