Book contents
- Frontmatter
- Dedication
- Contents
- List of contributors
- Preface
- Acknowledgments
- Part I Upper extremity
- Chapter 1
- Chapter 2
- Chapter 3
- Chapter 4
- Section I Fractures of the proximal radius
- Section II Fractures of the radial shaft
- Section III Fractures of the distal radius
- Chapter 5
- Chapter 6
- Part II Pelvis and acetabulum
- Part III Lower extremity
- Part IV Spine
- Part V Tendon injuries
- Part VI Compartments
- References
- Index
Section III - Fractures of the distal radius
from Chapter 4
Published online by Cambridge University Press: 05 February 2015
- Frontmatter
- Dedication
- Contents
- List of contributors
- Preface
- Acknowledgments
- Part I Upper extremity
- Chapter 1
- Chapter 2
- Chapter 3
- Chapter 4
- Section I Fractures of the proximal radius
- Section II Fractures of the radial shaft
- Section III Fractures of the distal radius
- Chapter 5
- Chapter 6
- Part II Pelvis and acetabulum
- Part III Lower extremity
- Part IV Spine
- Part V Tendon injuries
- Part VI Compartments
- References
- Index
Summary
OPEN REDUCTION AND INTERNAL FIXATION (ORIF) FOR DISTAL RADIUS FRACTURES: VOLAR APPROACH
Indications
Displaced, irreducible extra-articular fractures (A3).
Unstable, partial intra-articular fractures (B1, B2, B3), or complete (C2, C3).
Fractures requiring bone grafting.
Palmarly displaced short oblique fractures.
Volar Barton's.
Fractures with primary instability.
Pre-operative planning
Clinical assessment
Mechanism of injury: grading from low- to highvelocity trauma.
Typical deformity, swelling, tenderness.
Evaluate neurovascular status of the hand.
Assess soft tissue damage.
Evaluate patient for age, hand dominance, occupation, and level of activity.
Check for associated ligamentous lesions of fractures of carpal bones.
Radiological assessment
High-quality anteroposterior and lateral radiographs (Fig. 4.37a,b).
Oblique films (45? pronated and supinated).
Assess degree of fragment displacement, quality of bone, whether the fracture is intra-articular or extraarticular, direction of displacement,metaphysealcomminution.
CT scan if the diagnosis is not clear in plain radiographs.
Timing of surgery
Immediatelywhenthefractureisopenorprimarycompression of the median nerve is present.
After 5-6 days if there is important soft tissue swelling (after reduction of the initial displacement and immobilization in a plaster splint).
Operative treatment
Anaesthesia
At induction, administration of prophylactic antibiotics as per local hospital protocol.
General anaesthesia is preferable. Avoid a regional anaesthetic/block in acute injuries as it masks symptoms indicating compartment syndrome in the immediate post-operative period.
Apply a tourniquet to the upper armif not contraindicated (situations in which the soft tissue envelope is extremely traumatized).
Table and equipment
AOsmall-fragmentset 3.5mmor Jupiter plating system (Fig. 4.38).
Standard osteosynthesis set as per local hospital protocol.
Fluoroscopy is necessary for intraoperative imaging.
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- Information
- Practical Procedures in Orthopaedic Trauma Surgery , pp. 76 - 89Publisher: Cambridge University PressPrint publication year: 2006