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. Convert to humeral fracture brace 7-10 days after fracture –Improved pain –Less swelling (nerve compression, compartment syndrome). Encourage early active elbow ROM. Monitor for skin lesions. Fracture reduction maintained by hydrostatic column principle. Co-contraction of muscles -Snug brace daily. ORTHOPAEDIC IMMOBILIZATION TECHNIQUES ORTHOPAEDIC IMMOBILIZATION TECHNIQUES N a t i o n a l A s o c i a t i o n o f O r t h o p a e dic c T e h n o l o g i s t s A STEP-BY-STEP GUIDE FOR CASTING AND SPLINTING.
Background Fractures of the distal radius represent the most common fracture in elderly patients, and often indicate the onset of symptomatic osteoporosis. A variety of treatment options is available, including closed reduction and plaster casting, K-wire-stabilization, external fixation and open reduction and internal fixation (ORIF) with volar locked plating.
Download Free Autosport 660I Manual here. The latter is widely promoted by clinicians and hardware manufacturers. Closed reduction and cast stabilization for six weeks is a simple, convenient, and ubiquitously available intervention.
In contrast, ORIF requires hospitalization, but allows for functional rehabilitation. Given the lack of randomized controlled trials, it remains unclear whether ORIF leads to better functional outcomes one year after injury than closed reduction and casting. Methods/Design ORCHID (Open reduction and internal fixation versus casting for highly comminuted intra-articular fractures of the distal radius) is a pragmatic, randomized, multi-center, clinical trial with two parallel treatment arms. It is planned to include 504 patients in 15 participating centers throughout Germany over a three-year period. Patients are allocated by a central web-based randomization tool. The primary objective is to determine differences in the Short Form 36 (SF-36) Physical Component Score (PCS) between volar locked plating and closed reduction and casting of intraarticular, comminuted distal radius fractures in patients >65 years of age one year after the fracture.
Secondary outcomes include differences in other SF-36 dimensions, the EuroQol-5D questionnaire, the Disability of the Arm, Shoulder, and Hand (DASH) instrument. Also, the range of motion in the affected wrist, activities of daily living, complications (including secondary ORIF and revision surgery), as well as serious adverse events will be assessed. Data obtained during the trial will be used for later health-economic evaluations.
The trial architecture involves a central statistical unit, an independent monitoring institute, and a data safety monitoring board. Following approval by the institutional review boards of all participating centers, conduct and reporting will strictly adhere to national and international rules, regulations, and recommendations (e.g., Good Clinical Practice, data safety laws, and EQUATOR/CONSORT proposals). Background Distal radial fractures represent the most common injuries in humans and make up a considerable workload in orthopaedic and surgical departments worldwide. In population-based investigations, incidence rates vary from 5.7 to 124. Download Mario Advance 2 Rom. 6 per 10,000 person-years[-]. Together with fractures of the proximal humerus, vertebral bodies and the proximal femur, fractures of the distal radius typically mark the onset of symptomatic osteoporosis[-]. Established treatment options comprise closed reduction and cast stabilization, external fixation, and open reduction with internal plate fixation (ORIF).
The first two options may be combined with percutaneous K-wire pinning. According to a Cochrane Review of randomized controlled trials (RCT) and later clinical investigations[-], the most effective, efficient, and safe method of treating complex intraarticular wrist fractures remains unclear. To date, a single RCT has compared ORIF to casting (19 and 23 patients, respectively) [], suggesting a higher likelihood of excellent function with ORIF than with closed reduction (risk ratio [RR] 0.69, 95% confidence interval [CI] 0.48 - 1.00). The same trial also compared ORIF to external fixation (19 and 18 patients), without any difference in the rates of excellent function (RR 0.95, 95% CI 0.59 - 1.52). Two trials in 2004 and 2005 suggest better functional outcomes with external fixation compared to internal fixation with dorsal Pi-plates [-].
In recent years, angle-stable, volar locking plates have been propagated and enthusiastically used for surgical fixation of distal radial fractures, especially in the osteoporotic bone. The underlying biomechanical principle of angle-stable locked plating is that uni-cortical, threaded screws fixed in the screw hole of the plate ('internal fixator') reduce shear forces, thereby preventing loosening of the surgical construct. However the available clinical evidence in favor of this principle is limited to case series of moderate to poor quality [-]. The currently largest reported series of 114 patients also signals high complication rates with volar locking plate fixation of complex wrist fractures. Although functional outcomes after one year were reasonable, 31 patients (27%, 95% CI 19 - 36%) faced complications, mainly tendon irritation, carpal tunnel syndrome, and complex regional pain syndrome (CRPS) []. Regardless of these critical reports, volar locked plating has emerged as the surgical standard of care for managing distal radial fractures in Europe and the US[].
Introduction; Comments. AO Manual of Fracture Management - Hand and Wrist. This book offers an outstanding hands-on approach to the treatment of key fractures of the hand, scaphoid, and distal radius (including soft- tissue injuries). All of the content is based on case studies and each case provides step-by-step. A 33-year-old right-hand dominant surgeon fell, sustaining a comminuted, dorsally displaced, intra-articular right distal radius fracture. On postoperative day 6, range of motion was begun, followed by aggressive 5 days per week occupational hand therapy. AO Principles of Fracture Management. AO principles of fracture management (book and CD-ROM). Ruedi and William M. Stuttgart: Georg Thieme, 2000. ISBN: 3-13-117441-2. Article Info & Metrics eLetters PDF. This is a PDF-only article. The first page of the PDF of this article appears below. PDF extract preview.
• Abstract Restoration of anatomic relations correlates highly with functional outcome in the hand. The priorities in treatment are a stable, well-maintained reduction and early motion. Prolonged immobilization, especially in a nonfunctional cast, can lead to a vicious cycle of pain, swelling, and unresolved edema. Edema fluid is a proteinaceous exudate that will congeal into scar tissue around joints and tendons and cause joint stiffness, contracture, and tendon adhesions. Muscle atrophy, brawny skin /induration, and osteoporosis follow. Reflex sympathetic dystrophy may sometimes occur and further complicate the picture. This constellation of symptoms and physical changes has been called “fracture disease.” Like proud flesh and suppuration in soft tissue healing, it is not a necessary part of fracture repair and can be avoided.
Prevention is the best treatment. All fracture treatment, whatever the method, must be geared to achieve stability and function to prevent these complications. • Alan E. Freeland • 1 • 2 • Michael E. Jabaley • 3 • 4 • James L. Hughes • 5 • 6 • 1. Section of Hand Surgery University of Mississippi Medical Center Jackson USA • 2.
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Jackson Veteran’s Administration Hospital, Mississippi Methodist Rehabilitation Center, Blake Clinic for Crippled Children and Mississippi Children’s Rehabilitation Center Jackson USA • 3. Division of Plastic Surgery University of Mississippi Medical Center Jackson USA • 4. Dominic’s-Jackson Health Services Center, Mississippi Baptist Medical Center, River Oaks Hospital, Mississippi Methodist Rehabilitation Center Jackson USA • 5. Division of Orthopaedic Surgery University of Mississippi Medical Center Jackson USA • 6. Jackson Veteran’s Administration Hospital, Mississippi Methodist Rehabilitation Center, Blake Clinic for Crippled Children and Mississippi Children’s Rehabilitation Center Jackson USA About this chapter.
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Fracture management can be divided into nonoperative and operative techniques. The nonoperative approach consists of a closed reduction if required, followed by a period of immobilization with casting or splinting. Closed reduction is needed if the fracture is significantly displaced or angulated. [] Pediatric fractures are generally much more tolerant of nonoperative management, owing to their significant remodeling potential. [] If closed reduction is inadequate, surgical intervention may be required.
Indications for surgical intervention include the following: •. The initial management of fractures consists of realignment of the broken limb segment (if grossly deformed) and then immobilizing the fractured extremity in a splint. The distal neurologic and vascular status must be clinically assessed and documented before and after realignment and splinting. If a patient sustains an open fracture, achieving hemostasis as rapidly as possible at the injury site is essential; this can be achieved by placing a sterile pressure dressing over the injury site (see ).
Once the initial assessment, evaluation, and management of any life-threatening injury are completed, the open fracture is treated. Hemostasis should be obtained if there is significant ongoing bleeding, though bone bleeding is best reduced by anatomic reduction. Gross contaminants can be removed if possible and the soft-tissue wound can be covered by a sterile dressing moistened with normal saline. Harsher adjuncts, such as iodine solutions, are not recommended, because of their cytotoxic effects. [] Tetanus immunization should be provided if the patient does not have current immunity. 3rd Gen Intel Core I7 Extreme Edition. Rodriguez et al reported on the use of an evidence-based antibiotic protocol based on open fracture grade, in which patients with grade I or II fractures received cefazolin (clindamycin in the case of allergy) and those with grade III fractures received ceftriaxone (clindamycin and aztreonam in the case of allergy) for 48 hours; aminoglycosides, vancomycin, and penicillin were excluded from the protocol.