Fracturile epifizei distale a radiusului (FEDR) sunt cele mai frecvente fracturi cunoscute in traumatologie, datorita mecanismului de producere. La acestea contribuie tendinta de a amortiza caderile prin sprijin pe mana, dar si scaderea rezistentei structurilor anatomice, produsa in special de osteoporoza. Aceste leziuni se pot intalni la orice varsta, fiind mai frecvente insa la varstnici, mai ales de sex feminin. Fracturile distale de radius cu deplasare dorsala sunt amintite in literatura anglosaxona ca si fracturi Colles indiferent de configuratia fracturii, gradul cominutiei, varsta pacientului sau mecanismul traumatic.
In literatura de specialitate sunt numeroase controverse privitor la alegerea tratamentului optim in cazul fracturii distale de radius. Lorenz Bohler inca din 1923 a recunoscut ca nu reducerea ci mentinerea acestuia creaza dificultati. Tratamentul optim urmareste restaurarea motilitatii complete fara redoare si durere a incheieturii mainii.
Pentru atingerea acestui obiectiv se alege metoda de tratament in functie de particularitatile cazului. In concluzie, tratamentul poate fi diferit de la caz la caz.
Relatate pentru prima data in 1814 de catre ABRAHAM COLLES, fracturile epifizei distale de radius reprezinta cea mai frecventa fractura din lumea animala. In aceeasi ordine de idei FEDR reprezinta 16 din totalul fracturilor inregistrate in sectiile de urgenta.
Studiile epidemiologice arata doua varfuri de incidenta corespunzatoare perioadelor de 6-10 ani si 60-70 de ani, cu un avantaj de partea sexului feminin (f: b = 2 - 3: l). La adulti linia de fractura trece la 2-3 cm deasupra articulatiei - radiocarpiene, la copii planul fracturii este situat in zona cartilajului de crestere. De asemenea s-a constatat ca aceste fracturi sunt mai frecvente toamna si iarna. FEDR sunt mai frecvente in mediul soferilor, unde sunt cunoscute ca fracturi prin retur de manivela.
Mecanismul principal incriminat in aparitia FEDR este caderea pe mana. In functie de pozitia mainii (flexie sau extensie) se clasifica in doua mari tipuri: deplasarea dorsala a fragmentului proximal al FEDR (POUTEAU-COLLES), sau deplasarea ventrala a fragmentului proximal (GOYRAND-SMITH). Aceste doua tipuri de fracturi sunt cele mai frecvent intalnite, dar mai exista numeroase variante.
De la prima descriere in literatura a FEDR, tratamentul aplicat acestor tipuri de fracturi, a evoluat de la simpla reducere urmata de imobilizare, pana la reducerea sangeranda, osteosinteza, imobilizare externa, etc.
Indicatiile terapeutice si complicatiile FEDR vor fi prezentate pe parcurs.
II. PARTEA TEORETICA 1. ANATOMIE Radiusul, os lung, pereche situat pe partea laterala a antebratului.
Prezinta un corp si doua extremitati. Extremitatea distala (epifiza) care prezinta interes in lucrarea de fata are o forma piramidala, prezentand patru fete si o baza.
Fata mediala - prezinta scobitura ulnara, destinata articularii cu capul ulnei Fata laterala - prezinta un sant pentru trecerea ...
AGEE J. M. - "DISTAL RADIUS FRACTURES, MULTIPLANAR LIGAMENTOTAXIS" - IN BERGER, R. EXTERNAL FIXATION. HAND CLINICS, 1993
ALBU I. STOICA E. - "ARTICULATIA RADIOCARPIANA. IN PAPILIAN, ANATOMIA OMULUI" - EDITURA DIDACTICA SI PEDAGOCICA, BUCURESTI, 1974
ALTISSIMI M. MANCINI G. B. AZZARA A. - "EARLY AND LATE DISPLACEMENT OF FRACTURES OF THE DISTAL RADIUS. THE PREDICTION OF INSTABILITY" - INT. ORTHOP. , 1994
ARO H. T. CHAO E. Y. S - "BIOMECHANICS AND BIOLOGY OF FRACTURE REPAIR UNDER EXTERNAL FIXATION" - IN BERGER, R. EXTERNAL FIXATION. HAND CLINICS, 1993
AXELROD T. S. J. TILE M. - "FRACTURES OF THE DISTAL RADIUS. IN SCHATZKER, THE RATIONALE OF OPERATIVE FRACTURE CARE SPRINGER" 1991
AXELROD T. S. MCMURTRY R. Y. - "OPEN REDUCTION AND INTERNAL FIXATION OF COMMINUTED, INTRA - ARTICULAR FRACTURES OF THE DISTAL RADIUS" - J. HAND SURG. , 1990
BERGER R. - "THE USE OF THE AGEE - WRIST JACK IN THE TREATMENT OF DISTAL RADIUS FRACTURES. MULTIPLANAR IIGAMENTOTAXIS" - IN CZIFFER E. MINIFIXATION. EXTERNAL FIXATION OF SMALL BONES. LITERATURA MEDICA BMJ PUBLISHING, BUDAPEST, 1994
BRADWAY J. K. AMADIO P. C. COONEY W. P. - "OPEN REDUCTION AND INTERNAL FIXATION OF DISPLACED, COMMINUTED INTRA - ARTICULAR FRACTURES OF THE DISTAL END OF THE RADIUS" - J. BONE JOINT SURG. 1989
COONEY W. P. - "EXTERNAL FIXATION OF DISTAL RADIUS FRACTURES. CLINICAL ORTHOP" 1983
COONEY W. P. - "FRACTURES OF THE DISTAL RADIUS, CLASSIFICATION AND INDICATIONS FOR EXTERNAL FIXATION" - IN CZIFFER E. MINIFIXATION. EXTERNAL FIXATION OF SMALL BONES. LITERATURA MEDICA - BMJ PUBLISHING, BUDAPEST, 1994
CRENSHAW A. H. - "FRACTURES OF DISTAL RADIUS" - IN CAPBELL'S OPERATIVE ORTHOPAEDICS. NINTH EDITION, 1998
CZIFFER E. - "DISTALIS RADIUS - AS ULNATORASEK" - IN OPERATIV TORESKEZELES. SPRINGER BUDAPEST, 1997
ELLIS J. - SMITH'S AND BARTON'S FRACTURES. A METHOD OF TREATMENT" - J. BONE JOINT SURG, 1965
FAZAKAS I. GHERMAN E. GHERGULESCU N. - "FRACTURILE EXTREMITATII DISTALE A RADIUSULUI" - IN CURS DE TRAUMATOLOGIE OSTEOARTICULARA. LITOGRAFIA IMF CLUJ, 1973
FEKETE GY. - "TORASEK AS FICAMOK" - MEDICINA KONYVKIAD BUDAPEST, 1987.
FERNANDEZ D. L. JACOB R. P. - "THE TREATMENT OF WRIST FRACTURES WITH THE SMALL AO EXTERNAL FIXATION DEVICE" - IN UHTHOFF, H. K. CURRENT CONCEPTS OF EXTERNAL FIXATION, SPRINGER - VERLAG, BERLIN, 1982
FERNANDEZ D. L. - "FRACTURES OF THE DISTAL RADIUS, OPERATIVE TREATMENT" - IN HECKMANN, J. D. INSTRUCTIONAL COURSE LECTURES. AMER. ACAD. ORTHOP. SURG. , 1993
FERNANDEZ D. L. JUPITER J. B. - "FRACTURES OF THE DISTAL RADIUS" - SPRINGER, VERLAG, BERLIN, 1995
GARTLAND J. J. WERLEY C. W. - "EVALUATION OF HEALED COLLES FRACTURES. J. BONE JOINT SURG" 1951
GEISSLER W. B. FERNANDEZ D. L. LAMEY D. M. - "DISTAL RADIOULNAR JOINT INJURIES ASSOCIATED WITH FRACTURES OF THE DISTAL RADIUS" - CLIN. ORTHOP. , 1996
HASTINGS H. LEIBOVIC S. J. - "INDICATIONS AND TECHNIQUES OF OPEN REDUCTION, INTERNAL FIXATION OF DISTAL RADIUS FRACTURES" - ORTHOP. CLIN. NORTH. AM. , 1993
JAKIM I. PIETERSE H. S. SWEET M. B. - "EXTEMAL FIXATION FOR INTRAARTICULAR FRACTURES OF THE DISTAL RADIUS" - J. BONE JOINT SURG. [BR]. 1991
JUPITER J. B. FERNANDEZ D. L. TOH C. L. - "OPERATIVE TREATMENT OF VOLAR INTRA - ARTICULAR FRACTURES OF THE DISTAL END OF THE RADIUS" - J. BONE JOINT SURG. [AM], 1996
KAPANDJI A. I. - "TREATMENT OF ARTICULAR DISTAL RADIAL FRACTURES BY INTRAFOCAL PINNING WITH ARUM PINS" - IN SAFFAR P. COONEY W. P. FRACTURES OF THE DISTAL RADIUS. MARTIN DUNITZ LTD. , LONDON, 1995
KNIRK J. L. JUPITER J. B. - "INTRA - ARTICULAR FRACTURES OF THE DISTAL END OF THE RADIUS IN YOUNG ADULTS" - J. BONE JOINT SURG. [AM], 1986
LUCACIU D. HOPULELE, S. HOPULELE I. - "TRAUMATOLOGIE OSTEOARTICULARA (GHID PENTRU MEDICII REZIDENTI)" - EDITURA MEDICALA UNIVERSITARA "IULIU HATIEGANU" CLUJ - NAPOCA, 2001
LUCACIU D. - "TRAUMATOLOGIE OSTEOARTICULARA" - EDITURA MEDICALA UNIVERSITARA "IULIU HATIEGANU" CLUJ - NAPOCA, 2000
MOILER M. NAZARIAN S. KOCH P. SCHATZKER J. - "COMPREHENSIVE CLASSIFICATION OF FRACTURES OF LONG BONE" - SPRINGER - VERLAG BERLIN, 1990
NAGY O. - "TRAUMATOLOGIE OSTEOARTICULARA" - LITOGRAFIA UMF TARGU - MURES, 2001
RAYHACK J. - "THE HISTORY AND EVOLUTION OF PERCUTANEOUS PINNING OF DISPLACED DISTAL RADIUS FRACTURES" - ORTHOP. CLIN. 1993
RIEUNAU G. - "FRACTURES DE I'EXTREMITE INFERIEURE DU RADIUS" - IN MANUEL DE TRAUMATOLOGIE. MASSON, PARIS 1976
RIKLI D. A. , REGAZZONI P. - "FRACTURES OF THE DISTAL END OF THE RADIUS TRATED BY INTEMAL FIXATION AND EARLY FUNCTION" - A PRELIMINARY REPORT OF 20 CASES. J. BONE JOINT SURG. [BR]. 1996
ROEDI T. P. MURPHY W. M. - "AO PRINCIPLES OF FRACURE MANAGEMENT THE ELECTRONIC PUBLICATION" - THIEME STUTTGART - NEW YORK 2000
SEITZ W. H. JR. FROIMSON A. I. - "AUGMENTED EXTEMAL FIXATION OF UNSTABLE DISTAL RADIALFRACTURES" - J. HAND SURG. [AM], 1991
SEITZ W. H. J JR. PUTNAJ M. DICK H. - "LIMITED OPEN SURGICAL APPROACH FOR EXTERNAL FIXATION OF DISTAL RADIUS FRACTURES" - J. HAND SURG. 1990
SOBOTTA - "ATLAS DER ANATOMIE DAS MENSCHEN" - ELECTRONISCHE BIBLIOTHEK. AEURsA(C) URBAN & SCHWARZENBERG 1997
STEFFEN J. T. EUGSTER T. JAKOB R. P. - "TWELVE YEARS FOLLOW - UP OF FRACTURES OF THE DISTAL END OF THE RADIUS TREATED WITH THE AO EXTERNAL FIXATOR" - INJURY, 1994
SZABO R. M. - "FRACTURES OF THE DISTAL RADIUS" - IN CHAPMAN'S ORTHOPAEDIC SURGERY, 2000
SZEPLAKI A. - "FIXATOR EXTERN METALO - ACRILIC PROPRIU" - IN TEZA DE DOCTORAL UMF CLUJ - NAPOCA, 1998
SZEPLAKI A. - "IMBUNATATIREA TRATAMENTULUI FRACTURII EXTREMITATII DISTALE A RADIUSULUI" - IN TEZA DE DOCTORAT UMF CLUJ - NAPOCA, 1998
TROIANESCU A. BURGHELE. T. - "PATOLOGIE CHIRURGICALA. FRACTURILE EPIFIZEI DISTALE A RADIUSULUI" - EDITURA MEDICALA, BUCURESTI, 1976
VOINEA J. A. GORUN N. - "OSTEOSINTEZA METALICA A EPIFIZEI RADIALE DISTALE" - IN PRACTICA OSTEOSINTEZEI METALICE. EDITURA DIDACTICA SI PEDAGOGICA BUCURESTI, 1976
WOLFE S. EASTERLING K. YOO H. - "ARTHROSCOPIC ASSISTED REDUCTION OF DISTAL RADIUS FRACTURES" ARTHROSCOPY 1995
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