4. A : Can speak, C-spine not tender, full ROM
B : Equal breath sound both lungs, CCT –ve
C : BP 122/75 mmHg, PR 112 bpm, no active
external hemorrhage
D : E4V5M6, Pupils 3 mm RTLBE
E : Rt.wrist tenderness and swelling, no
deformity,AW 1x2 cm at rt arm, no
ecchymosis, radial pulse 2+, cap refill<2s
normal sensation
5. A : no drugs & food allergy
B : No current medication
P : Unknown underlying disease
L : 15.00 pm
E :ขับ MC ล้มเอง แขนขวากระแทกพื้น
6. GA : AThai man good consciousness
HEENT : not pale conjunctivae, anicteric
RS : clear, equal breath sound
CVS : full, regular pulse, normal S1S2
Abdomen : soft, not tender, no guarding
7. Ext : Rt.wrist tenderness and swelling, no
deformity,AW 1x2 cm at rt arm, no
ecchymosis, radial pulse 2+, cap refill<2s
normal sensation, can’t wrist extension &
flexion due to pain, can hand grip
10. A distal end radius fracture occurs about 1
inch from the end of the bone
11. Most common orthopaedic injury
- younger patients - high energy
- older patients - low energy / falls
,osteoporosis
Cause
- Fall onto outstretch arm
12. Pain and swelling around the wrist
Deformity
Paresthesia or numbness in the fingers to
exclude any median or ulnar nerve injury
13. Film wrist AP
- Radial inclination
- Radial height
16. View Measurement Normal Acceptable criteria
AP Radial height 13 mm <5 mm shortening
Radial inclination 23 degrees change <5°
Articular stepoff congruous <2 mm stepoff
LAT Volar tilt 11 degrees
dorsal angulation <5° or
within 20° of contralateral
distal radius
21. AP slab
Short arm cast with three point fixation 3-4
wk
22. Close reduction : traction , increase deformity
and reverse mechanism
Short arm cast with three point fixation :
Colle’s fracture
Long arm cast and position elbow flex 90 , full
supination , slight dorsiflexion wrist and ulna
deviation : Smith’s fracture
4-6 wk
23.
24. No displacement ( Stepping articular surface
<1mm)
-Traction & Long arm cast with three point
fixation
25. volar or dorsal conminution
articular margins fractures
dorsal angulation >5° or >20° of contralateral
distal radius
>5mm radial shortening
progressive loss of volar tilt and loss of radial
length following closed reduction and casting
Osteoporosis
26. Early
- Compartment syndrome
- EPL rupture
- Carpal tunnel syndrome
prevent by avoiding immobilization in excessive
wrist flexion
Late
- Malunion
- Prolong stiffness