The skeleton of the wrist is made up of two bones, the radius and the ulna. In fractures of the wrist, the bone that most frequently breaks is the radius, so it is more academic to speak of fractures of the distal radius and not of the wrist.
They usually occur in elderly people with osteoporotic disease after falls from their own height, however, high-energy trauma such as traffic accidents or contact sports, are a frequent cause of fractures of the distal radius in young patients.
SYMPTOM: Pain and deformity in the wrist.
DIAGNOSIS: The diagnosis is made through simple radiographs and in the case of intra-articular fractures it is useful to perform a CAT scan
TREATMENT: It is important to differentiate extraarticular fractures (those that respect the radiocarpal joint) of joint fractures (in which the fracture line affects the articular cartilage). Orthopedic treatment: If the fracture is not displaced, the bone is of good “quality”, and it is an extra-articular fracture: the indicated treatment can be performed by immobilization with plaster or orthosis for 5-6 weeks.
If the fracture is displaced and / or the bone quality is bad, surgical intervention is indicated. This operation will aim to “reduce” the wrist and place an osteosynthesis system to keep the bone in place. There are several methods of osteosynthesis, the most common are:
– Synthesis with needles: After the reduction of the fracture 1.5 mm needles are used that go through the skin leaving them inside the plaster with the intention of maintaining the reduction for 5 weeks. From that moment, it is possible to perform the safe extraction of the needles and start the mobilization.
– Reduction and synthesis with screw: some fractures can be treated with this method to which it is necessary to add a plaster.
– Osteosynthesis with plate: this is the most used technique. Through a small palmar incision in the wrist a reduction of the fragments is made and the fracture is fixed with a plate and screws. This technique allows to ensure the perfect reduction of the fracture obtaining the best results. In the case of intra-articular fractures, the complementary use of arthroscopy may be necessary to assist the fracture and prevent joint steps from remaining. Plate osteosynthesis allows early mobilization from the day of the intervention without the need for any type of immobilization.
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