CASO CLINICO DE TRAUAMTOLOGIA Y ORTOPEDIA 2

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JosePCuesta2

CASO CLINICO 1

Salud y medicina

PRESENTACIÓN DE CASOS CLINICOS
R1 T/O
CARLOS ADRIAN LLIGUISACA HIDALGO
JOSE FELIZ PIGUAVE CUESTA

CASO 1:
• FEMENINO DE 20 AÑOS
• APP: NO REFIERE
-INGRESA POR CC DE APROX 4 DIAS DE EVOLUCION POSTERIOR A TRAUMA INDIRECTO CAIDA HACIA
ATRÁS Y APOYANDO LA MANO SOBRE EL BORDE RADIAL DE LA MISMA.
-EXAMEN FISICO : DOLOR + EDEMA EN LA BASE DEL PRIMER METACARPIANO, SE OBSERVA HEMATOMA
EN REGION TENAR MANO DERECHA + LIMITACION FUNCIONAL DE ORTEJO AFECTO.

RX: LUXO-FRACTURA IMPACTADA
DE BASE DE 1ER METACARPIANO

CLASIFICACION DE GREEN MODIFICADA
• A - FRACTURAS EXTRAARTICULARES
• A1: FX TRANSVERSA A NIVEL DE
METAFISIS ( ESTABLE)
• A2: FX OBLICUA A NIVEL DE METAFISIS
(INESTABLE)
• A3: FX CONMINUTA A NIVEL DE
METAFISIS ( TOTALMENTE INESTABLE)
• B- FRACTURAS INTRAARTICULARES
• B1: FX-LUXACION DE LA BASE (BENNET)
• B2: FX CONMINUTA Y ARTICULAR DE LA
BASE ( ROLANDO)

PROPUESTA QX
LAS FRACTURAS DE TRAZO OBLICUO A NIVEL DE METAFISIS SON MUY INESTABLES POR LO QUE SI LOS INTENTOS DE REDUCCION CERRADA Y FIJACION
PERCUTANEA CON CLAVIJAS DE KIRSCHNER FRACASAN, SE DEBE REALIZAR REDUCCION ABIERTA Y FIJACION CON PLACA Y TORNILLOS DE MINIFRAGMENTOS

$• Fractura-luxación de BENNETT • Es una fractura fácil de reducir, pero muy difícil de contener. • Si el fragmento es grande, se realiza síntesis con tornillo por vía dorsal y si es pequeño, reducción cerrada y estabilización con la técnica de Iselin, Wagner, o Wiggins. • Actualmente asociamos la artroscopia para una reducción anatómica en este tipo de fracturas.$

CASO CLINICO DE TRAUAMTOLOGIA Y ORTOPEDIA 2

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CASO CLINICO DE TRAUAMTOLOGIA Y ORTOPEDIA 2

1. PRESENTACIÓN DE CASOS CLINICOS R1 T/O CARLOS ADRIAN LLIGUISACA HIDALGO JOSE FELIZ PIGUAVE CUESTA

2. CASO 1: • FEMENINO DE 20 AÑOS • APP: NO REFIERE -INGRESA POR CC DE APROX 4 DIAS DE EVOLUCION POSTERIOR A TRAUMA INDIRECTO CAIDA HACIA ATRÁS Y APOYANDO LA MANO SOBRE EL BORDE RADIAL DE LA MISMA. -EXAMEN FISICO : DOLOR + EDEMA EN LA BASE DEL PRIMER METACARPIANO, SE OBSERVA HEMATOMA EN REGION TENAR MANO DERECHA + LIMITACION FUNCIONAL DE ORTEJO AFECTO.

3. RX: LUXO-FRACTURA IMPACTADA DE BASE DE 1ER METACARPIANO

4. CLASIFICACION DE GREEN MODIFICADA • A - FRACTURAS EXTRAARTICULARES • A1: FX TRANSVERSA A NIVEL DE METAFISIS ( ESTABLE) • A2: FX OBLICUA A NIVEL DE METAFISIS (INESTABLE) • A3: FX CONMINUTA A NIVEL DE METAFISIS ( TOTALMENTE INESTABLE) • B- FRACTURAS INTRAARTICULARES • B1: FX-LUXACION DE LA BASE (BENNET) • B2: FX CONMINUTA Y ARTICULAR DE LA BASE ( ROLANDO)

5. PROPUESTA QX LAS FRACTURAS DE TRAZO OBLICUO A NIVEL DE METAFISIS SON MUY INESTABLES POR LO QUE SI LOS INTENTOS DE REDUCCION CERRADA Y FIJACION PERCUTANEA CON CLAVIJAS DE KIRSCHNER FRACASAN, SE DEBE REALIZAR REDUCCION ABIERTA Y FIJACION CON PLACA Y TORNILLOS DE MINIFRAGMENTOS

8. • Fractura-luxación de BENNETT • Es una fractura fácil de reducir, pero muy difícil de contener. • Si el fragmento es grande, se realiza síntesis con tornillo por vía dorsal y si es pequeño, reducción cerrada y estabilización con la técnica de Iselin, Wagner, o Wiggins. • Actualmente asociamos la artroscopia para una reducción anatómica en este tipo de fracturas.

CASO CLINICO DE TRAUAMTOLOGIA Y ORTOPEDIA 2

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CASO CLINICO DE TRAUAMTOLOGIA Y ORTOPEDIA 2