IN THE NAME OF GOD

FRACTURE OF THE DISTAL RADIUS AND ULNA

Common fracture encountered BY orthopedic trauma surgeons Low energy Trauma %80 high energy trauma %20 Men are significantly younger than woman

AO BASE CLASSIFICTION EXTRA – ARTICULAR %60 AO T1 PARTIAL – ARTICULAR %12 AO T2 COMPLETE – ARTICULAR %28 AO T3 TRIANGULAR FIBROCARTILAGE COMPLEX INJURY (TFCC) IS MORE COMMON THAN INTERESSEOS LIGAMENTS (%40- 80) MAJORITY ARE SUPERFICIAL AVULSION WITH ULNA STYLOID FRACTURE

Who framwork of measurment (internationnal classification of ICIDH - Impairment (abnormal physical activity) - Disability (unable to perform daily activity) - Handicaps

Today emphasis on self reported measurment (prwe) Disablity that patient reported may has a psychologic base that no need treatment Pain L-O-M R-u joint unstable Fingers stiffness CTS OA changes

Gartlant score: Excellent : 0-2 points Good : 3-8 Fair : 9-20 Poor: 21 < Prwe overall is a valid – reliable & responsive outcome measure

Treatment option 1- Splint 2- CR & plaster fixation 3- Fixator – extern 4- Pin & plaster 5- CR & CP 6- ORIF Depend to prediction of functional outcome and instability

A: prediction of stability several factors are associated with re – displacement following CR: 1- Age over 80 under Initial displacement : radius shortening 3- Metaphyseal communition 4- Displacement following CR repeated manipulation is unlikely to good x-ray result outcome

B: Prediction of function related to patient 1- Age 2- Work 3- Poor socioeconomic status 4- Lower education levels 5- Low bone density

C: Fracture – factors Some surgeon emphasis to influence of x-ray position on outcome function 1- Metaphyseal alignment 2- Articular alignment 3- Radial Height (over 4mm has permanent pain after 2-3 month) 4- Ulnar variance

In ulnar variance shorthening has more effect alternation in (DRUJ) function than radial inclination palmar tilt Radial inclination + shortening (Axial compression) A: DECREAS GRIP POWER B: R-C JOINT DJD C: DRUJ DJD

Dorsal – palmar tilt: Incongruence of distal r-u joint Increase A: tightness of interosseos B: L-O-M C: mid carpal instability D: decreas grip power E: worse dash score

Articular alingment : Relation ship between cartilage damage and residual incongruity & development of DJD is not obvious Outcome is related to 1- Age 2- Severity of trauma 3- Residual articular displacement 4- Difficulty in Obtaining accurate measurement of the articular surface 5- Inter & intraobserver reliability

In 64 cases with this fracture & 20 osteoprotic 44 osteo penia Result in protic group was unaccepted In one study 38 years After this fracture : All treated non operativly now average age are 64y 2/3 of fracture mal-united but patients are sign free and no need treatment

Indication of treatment related to: 1- patient 2- Type of fracture The purpose of treatment is maintain: Normal power Mobility Function in wrist & hand. Age Condition demand

No differenc outcome between position of wrist in cast 1- Palmar Flexion & Ulnar Deviation 2- Neutral position patient & fracture factors are more effective rather than wrist position in cast. Functional recovery is faster in limited immobilization removal splint than complete cast

 For displace type 5-6 weeks casting  Some beleav that after 3 w remove of cast and start mobilization has better result.

Mackenney %10 of minimmaly displace %43 of displace fracture Are unstable after 2 week. (re-manipulate) Some follow-up for non – operative treatment y Age: 9-78 y Dorsal angulation : 13 in > 60 y 18 in< 60y But 52 of 66 cases had excellent clinical outcome

A: pc pining has no or minimal x-ray advantage But no functional advantage in patient < 60 years x-ray & clinical result are better Results in RTC study of non-operative treatment with B: with bridging EXT-fix x-ray position good function : no difference

D: FIX-EXTRE + ORIF X-ray & clinical result are better than Non-operative treatment C: with volar- locking plate: 94 case 65> age X- ray : good Clinical : accepted High rate tendon complication has need re-surgery

THE END