خداوند بخشنده و مهربان Distal radial malunion Dr hossein akbari aghdam MD Assisted professor of Isfahan medical faculty Not all distal radial malunion are symptomatic ID: 269307
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به نام
خداوند بخشنده و مهربانSlide2
Distal radial malunion
Dr hossein akbari aghdamM.DAssisted professor of Isfahan medical facultySlide3Slide4
Not all distal radial
malunion are symptomaticSlide5
causes
Failure to achavie or maintainin reductionMarked comminutionSever osteoporosisDisruption of DRUJOlder patient
Iadequate
duration or type of immobilizationSlide6
Exteraarticular
deformityIntraarticular deformityDistal radioulnar joint incongruity or instabilitySlide7Slide8
Intact distal radius
Radial inclination 22 degreeRadial heiht 11 _12 mmVolar tilt 11 _12 degreeUlnar variance +_2 mmSlide9Slide10Slide11Slide12Slide13
Malunion parameters
Intraarticular incongruity >2 mmDorsal angulation >20 degrees10<degree if carpus not alignRadial inclination <10 degreesSlide14Slide15
clinic
PainMechanicalDystrophicROMDruj instabilityGrip strengthSlide16
graphy
Ap and lat view of both wristSlide17
Operative treatment
Pain and functional deficits interfere with daily activityMinimally symptomatic young ‘ active patientsContrandication
: reflex sympathetic dystrophy
synSlide18
1.correct deformity
Intraarticulatextraarticular2. treat DRUJ pathology3.salvage proceduresSlide19
Extraarticular malunion
Early or delay surgeryType of internal fixationPalte and screwIntramedullaryExternal fixatorSlide20
Plate and screw
2.4 locking plate Fixed angleVariable angleVolardorsalSlide21Slide22Slide23
Intramedullary fixation
Intramedullary nailSlide24Slide25
External fixator
NonbridgebridgeSlide26
Bone graft
Bone graftSlide27
Open or close wedge
Young active patient open wedgeOsteoprosis ‘ distal ulna procedureClose wedgeSlide28Slide29Slide30Slide31
Distal radius osteotomy technique. (A) Saw-cut parallel to joint. (B, C) Re-alignment of the radius to corrected position. (D) Placement of bone graft. (E) Placement of plate. (F) Final plate fixation. Reprinted with permission from Weiss and Fern...Slide32Slide33
Intraarticular malunion
Intraarticular osteotomy young active patientIn simple articular fracture patternsSalvage procedures
Post traumatic arthritis
Total wrist arthrodesis in young high demand
Osteoarthritis limited to radiocarpal
Partial arthrodesis
Radiolunate
arthrodesisSlide34
DRUJ incongruity and arthrosis
Source of persistent compliantsPainDecrease rotationDecrease grip strengthSlide35
Ulnar shortening
Resection of the distal ulna