Ext.Chanikarn Tongruang

ผูป่้วยชายไทย อายุ 16 ปี

ภมูลิ าเนา จงัหวดันครราชสมีา

อาชพี นกัเรยีน

CC : ปวดแขนขวา 3 ชม. ก่อนมาโรงพยาบาล

3 ช ัว่โมงก่อนมาโรงพยาบาล ผูป่้วยขบั MC ลม้เอง แขน ขาขวากระแทก

พื้น มอีาการปวดบรเิวณแขนขวาไปถงึขอ้มอื มแีผลถลอกบรเิวณแขน ขาขวา

ขยบัขอ้มอืขวาไมไ่ด ้ก ามอืได ้ขยบัน้ิวได ้ไมช่า ไมอ่่อนแรง ไมม่ศีีรษะกระแทก

พื้น ไมห่มดสต ิจ าเหตกุารณไ์ด ้

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

A : no drugs & food allergy B : No current medication P : Unknown underlying disease L : 15.00 pm E :ขบั MC ลม้เอง แขนขวากระแทกพื้น

GA : A Thai 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

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

Closed fracture Rt distal end radius

A distal end radius fracture occurs about 1 inch from the end of the bone

Most common orthopaedic injury - younger patients - high energy - older patients - low energy / falls

,osteoporosis Cause

- Fall onto outstretch arm

Pain and swelling around the wrist Deformity Paresthesia or numbness in the fingers to

exclude any median or ulnar nerve injury

Film wrist AP - Radial inclination - Radial height

Film wrist lateral - Volar tilt

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

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

AP slab Short arm cast with three point fixation 3-4

wk

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

No displacement ( Stepping articular surface <1mm)

- Traction & Long arm cast with three point fixation

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

Early - Compartment syndrome - EPL rupture - Carpal tunnel syndrome prevent by avoiding immobilization in excessive wrist flexion Late - Malunion - Prolong stiffness