del Piñal / Luchetti / Mathoulin Arthroscopic Management of Distal Radius Fractures

1. Auflage 2010
ISBN: 978-3-642-05354-2
Verlag: Springer
Format: PDF
Kopierschutz: 1 - PDF Watermark

E-Book, Englisch, 264 Seiten

Reihe: Medicine (R0)

Seeing is believing. This is the title of a new campaign promoted by the International Agency for Prevention of Blindness to raise funds to help tackle avoidable loss of sight in poorly developed countries, truly an admirable initiative. This book could have used a similar leitmotiv: if you see what happens inside of a joint, you will be able to believe in your patient’s symptoms. But it would not be right. Arthroscopy is not out there just to make a diagnosis; it was not developed just to certify that the patient’s complaints are based on something physical. Arthroscopy was introduced to help patients, to make our treatments more reliable, to have better control of our p- cedures. It is merely a tool, indeed, but a marvelous one which nobody should und- score among all surgical options we have when it comes to solving wrist trauma. Seeing is understanding. This could be another leitmotiv for these authors’ c- paign to get more hand surgeons to incorporate arthroscopy in their practices. Certainly, mastering these newly developed techniques help understanding the patient’s problems. But again, that statement would also be misleading for not always what we see through the scope is the real cause of dysfunction. The enemy may be outside of the capsular enclosure. Indeed, arthroscopy provides lots of useful inf- mation, but the surgeon need not accept biased interpretations of the patient’s pr- lem based only on what appears on the screen.

Zielgruppe

Professional/practitioner

Autoren/Hrsg.

del Piñal, Francisco

Luchetti, Riccardo

Mathoulin, Christophe

Inhaltsverzeichnis

Pre-Operative Assessment in Distal Radius Fractures.- Portals and Methodology.- Management of Simple Articular Fractures.- Treatment of Explosion-Type Distal Radius Fractures.- Management of Distal Radius Fracture-Associated TFCC Lesions Without DRUJ Instability.- Arthroscopic Management of DRUJ Instability Following TFCC Ulnar Tears.- Radial Side Tear of the Triangular Fibrocartilage Complex.- Arthroscopic Management of Scapholunate Dissociation.- Lunotriquetral and Extrinsic Ligaments Lesions Associated with Distal Radius Fractures.- Management of Concomitant Scaphoid Fractures.- Perilunate Dislocations and Fracture Dislocations/Radiocarpal Dislocations and Fracture Dislocations.- The Role of Arthroscopy in Postfracture Stiffness.- Treatment of the Associated Ulnar-Sided Problems.- Arthroscopic-Assisted Osteotomy for Intraarticular Malunion of the Distal Radius.- The Role of Arthroscopic Arthrodesis and Minimal Invasive Surgery in the Salvage of the Arthritic Wrist: Midcarpal Joint.- Arthroscopic Radiocarpal Fusion for Post-Traumatic Radiocarpal Arthrosis.

Leseproben

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Introduction

The determinants of clinical outcome following distal radial fracture are multi-factorial and may provide several challenges to the treating surgeon. These can be considered under the following headings: patient history including medical co-morbidities, functional demands and injury history; examination findings including the condition of the soft tissue envelope and neurological status; radiographic parameters including fracture characteristics, articular involvement, stability features and associated injuries to the ulna or carpus. Finally, classifi- cation of the injury may aid treatment selection and prognostic prediction. With vigilant pre-operative planning, the surgeon can ensure the best outcome for an individual patient.

History
The expectations of the individual and society have increased over the past few decades such that poor results are less acceptable in modern hand surgery. Functional disability and degenerative osteoarthritis may result from distal radius fractures, but they may not correlate with the subjective assessment of outcome or satisfaction. Age, hand dominance, occupation, compliance and functional demands should all be considered.

Details of the mode of injury should be sought as this will inform our understanding of the energy applied to the limb. Most distal radius fractures are sustained as a result of a fall from standing height with the wrist in an extended position. These are considered low-energy injuries. In most cases the soft tissue injury is minimal, although in elderly patients with a more fragile soft tissue envelope and poorer protective reflexes the injury may be more extensive. With the wrist extended, the point of maximal load in the scaphoid and lunate fossa of the distal radius moves from a relatively volar position towards the dorsal lip.

Therefore, an axial load applied in this position will result in the typical injury pattern with comminution of the dorsal cortex and dorsal angulation of the distal fragment. A fall from a height of greater than two metres, sporting injuries and motor vehicle accidents are highenergy injuries. The soft tissue envelope may be significantly disrupted in these patients, and the fracture may be comminuted. The clinician should be alert to the possibility of injury elsewhere in the ipsilateral extremity, other musculoskeletal trauma and injury to other systems.

The young patient with a distal radius fracture will typically have been subject to a high-energy injury with complex fracture patterns and extensive soft tissue damage but will have high functional demands. The injury will often require invasive treatment to restore distal radial anatomy. Wrist function may also be critical in the older patient who, for example, requires the use of a walking aid to maintain independence, or suffers dysfunction of the contralateral arm. The patient with multiple injuries requires further consideration, especially those who may require use of their arm to aid their mobility or rehabilitation. Medical co-morbidities are a critical factor when considering operative management. Benefits of various Pre-Operative Assessment in Distal Radius Fractures"