distalra橈骨遠(yuǎn)端 ppt課件

1、AP view radiograph of an intraarticular distal radius fracture.,Lateral view radiograph of an intraarticular distal radius fracture.,BARE AREA,,EPL,2mc,,The bare area of the radius is identified.,A 5-mm incision is made

2、over the bare area of the radius.,A fine clamp is used to dissect gently down to boneto avoid damage to neurologic and vascular structures.,Once the clamp is on bone, two Ragnell retractors are used to retract the tendo

3、ns to either side of the radius. A small key elevator is used to clean an area of bone for the pin cannulas.,,BONE,Bone is visualized at the base of the incision, confirmingthat there is no danger to the superficial rad

4、ial nerve orother structures.,A cannula system is used for drilling and half-pin placement.,After the hole is drilled, the inner cannula is removed and the pin is placed through the outer cannula.,To determine the loca

5、tion of the second pin, a pin clamp is used.,After both proximal pins are placed, fluoroscopy confirms the appropriate length.,The distal pins are placed into the second metacarpal. The mark on the metacarpal indicat

6、es the first pin, placed near the base of the second metacarpal. The second pin is placed distal to this using a pin clamp as a guide to its location.,,The forearm after the two sets of pins are placed. The connecti

7、ng rods are applied to the frame, then the initial reduction is performed.,The initial reduction is performed by flexing the elbow,slightly supinating the forearm and pulling gentle traction.,The frame is then tightene

8、d in this position andradiographs are obtained with 10 degrees ofangulation in each direction.,A small dorsal incision can be made for the percutaneous reduction of impacted fragments as well as for bone grafting.,A

9、curved osteotome is used to elevate an impacted ulnar-sided fragment.,A curved osteotome is used to elevate an impacted ulnar-sided fragment.,While the fragment is being held in place, a K-wire can be driven across fr

10、om the styloid into the fragment,holding it in a reduced position.,Allograft bone or other bone graft substitute may be introduced into the dorsal defect at this point.,Clinical picture of the external fixator and perc

11、utaneous pin in place.It is important at this time to test that full flexion of the MP and IPjoints is possible, as well as motion of the thumb, confirming thatnone of the tendons are impinged and that there is not ov