دورية أكاديمية
أعرض في EDS

[Distal radius fracture-tactic and approach].

التفاصيل البيبلوغرافية
العنوان: [Distal radius fracture-tactic and approach].
عنوان ترانسليتريتد: Distale Radiusfrakturen – Taktik und Zugangswahl.
المؤلفون: van Veelen NM; Klinik für Orthopädie und Unfallchirurgie, Luzerner Kantonsspital, Spitalstrasse, 6000, Luzern, Schweiz. Nicole.vanveelen@luks.ch., Babst R; Klinik für Orthopädie und Unfallchirurgie, Luzerner Kantonsspital, Spitalstrasse, 6000, Luzern, Schweiz.; Fakultät für Gesundheitswissenschaften und Medizin, Universität Luzern, Frohburgstrasse 3, 6002, Luzern, Schweiz., Link BC; Klinik für Orthopädie und Unfallchirurgie, Luzerner Kantonsspital, Spitalstrasse, 6000, Luzern, Schweiz., van de Wall BJM; Klinik für Orthopädie und Unfallchirurgie, Luzerner Kantonsspital, Spitalstrasse, 6000, Luzern, Schweiz., Beeres FJP; Klinik für Orthopädie und Unfallchirurgie, Luzerner Kantonsspital, Spitalstrasse, 6000, Luzern, Schweiz.
المصدر: Operative Orthopadie und Traumatologie [Oper Orthop Traumatol] 2023 Dec; Vol. 35 (6), pp. 352-369. Date of Electronic Publication: 2023 Jul 03.
نوع المنشور: English Abstract; Journal Article
اللغة: German
بيانات الدورية: Publisher: Springer Country of Publication: Germany NLM ID: 9604937 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1439-0981 (Electronic) Linking ISSN: 09346694 NLM ISO Abbreviation: Oper Orthop Traumatol Subsets: MEDLINE
أسماء مطبوعة: Publication: Berlin : Springer
Original Publication: München : Urban & Vogel, c1989-
مواضيع طبية MeSH: Wrist Fractures* , Radius Fractures*/diagnosis , Radius Fractures*/surgery , Wrist Injuries*/complications , Wrist Injuries*/surgery , Tendon Injuries*, Humans ; Female ; Middle Aged ; Treatment Outcome ; Bone Wires/adverse effects ; Fracture Fixation, Internal/methods ; Bone Plates/adverse effects
مستخلص: Objective: The aim of surgical treatment is fracture healing with restored alignment, rotation, and joint surface. Stable fixation allows for functional postoperative aftercare.
Indications: Displaced intra- and extra-articular fractures which either could not be adequately reduced or in which a secondary displacement is to expected due to instability criteria. The following factors are considered instability criteria: age > 60 years, female, initial dorsal displacement > 20°, dorsal comminution, radial shortening > 5 mm, palmar displacement.
Contraindications: The only absolute contraindication is if the patient is deemed unfit for surgery due to concerns regarding anesthesia. Old age is a relative contraindication, as it is currently debated whether older patients benefit from the operation.
Surgical Technique: The surgical technique is guided by the fracture pattern. Palmar plating is most commonly performed. If the joint surface needs to be visualized, a dorsal approach (in combination with another approach or alone) or arthroscopically assisted fixation should be chosen.
Postoperative Management: In general, a functional postoperative regime can be carried out after plate fixation with mobilization without weightbearing. Short-term splinting can provide pain relief. Concomitant ligamentous injuries and fixations, which are not stable enough for functional aftercare (such as k‑wires) require a longer period of immobilization.
Results: Provided the fracture is reduced correctly, osteosynthesis improves functional outcome. The complication rate ranges between 9 and 15% with the most common complication being tendon irritation/rupture and plate removal. Whether surgical treatment holds the same benefits for patients > 65 years as for younger patients is currently under debate.
(© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)
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فهرسة مساهمة: Keywords: Dorsal approach; Osteosynthesis; Palmar approach; Surgical procedures, operative; Surgical techniques
Local Abstract: [Publisher, German] OPERATIONSZIEL: Ziel der operativen Versorgung ist neben der ossären Heilung auch die anatomische Wiederherstellung von Achse, Rotation und der Gelenkfläche. Eine stabile Fixation ermöglicht die funktionelle Nachbehandlung. [Publisher, German] Dislozierte intra- oder extraartikuläre distale Radiusfrakturen, die unzureichend geschlossen reponiert werden können oder bei denen aufgrund von Instabilitätskriterien eine erneute Dislokation zu erwarten ist. Zu den Instabilitätskriterien gehören folgende Faktoren: Alter > 60 Jahren, weibliches Geschlecht, initiale dorsale Abkippung > 20°, dorsale Trümmerzone, Radiusverkürzung > 5 mm, palmare Abkippung. [Publisher, German] Eine absolute Kontraindikation besteht nur, wenn der Patient/die Patientin aus anästhesiologischer Sicht nicht operabel ist. Ein hohes Alter ist eine relative Kontraindikation, da es noch umstritten ist, ob ältere Patienten von der Operation profitieren. [Publisher, German] Die Operationstechnik richtet sich nach dem Frakturmuster. Am häufigsten erfolgt eine palmare Plattenosteosynthese. Bei Notwendigkeit der Einsicht ins radiokarpale Gelenk sollte ein dorsaler Zugang (isoliert oder in Kombination mit palmarem Zugang) oder eine arthroskopisch assistierte Versorgung erfolgen. [Publisher, German] Grundsätzlich ist nach erfolgter Plattenosteosynthese eine funktionelle Nachbehandlung mit belastungsfreier Mobilisation möglich. Eine kurzfristige Ruhigstellung mittels abnehmbarer Schiene kann zur Schmerzlinderung beitragen. Begleitende Bandverletzungen oder nichtübungsstabile Osteosynthesen (z. B. K‑Draht) können eine längere Ruhigstellung erforderlich machen. [Publisher, German] Bei korrekter Reposition führt die Osteosynthese zu verbesserten funktionellen Ergebnissen. Die Komplikationsrate beträgt zwischen 9 und 15 %, wobei am häufigsten Sehnenirritationen/-rupturen sowie Plattenentfernungen beschrieben werden. Bei Patienten > 65 Jahren ist aktuell noch umstritten, ob die operative Versorgung wie bei jüngeren Patienten der konservativen Behandlung überlegen ist.
تواريخ الأحداث: Date Created: 20230703 Date Completed: 20231206 Latest Revision: 20231206
رمز التحديث: 20231215
DOI: 10.1007/s00064-023-00818-6
PMID: 37395767
قاعدة البيانات: MEDLINE
الوصف
تدمد:1439-0981
DOI:10.1007/s00064-023-00818-6