TAILIEUCHUNG - Gãy xương: Lựa chọn điều trị

Gãy xương của quá trình olecranon của xương trụ thường xảy ra như là kết quả của một tai nạn xe máy-xe hoặc xe gắn máy, ngã, hoặc hành hung. Gãy xương Nondisplaced có thể được điều trị bằng bất động một thời gian ngắn sau đó dần dần tăng phạm vi chuyển động. | Olecranon Fractures Treatment Options David J. Hak MD and Gregory J. Golladay MD Abstract Fractures of the olecranon process of the ulna typically occur as a result of a motor-vehicle or motorcycle accident a fall or assault. Nondisplaced fractures can be treated with a short period of immobilization followed by gradually increasing range of motion. Open reduction and internal fixation is the standard treatment for displaced intra-articular fractures. Stable internal fixation with figure-of-eight tension-band wire fixation for simple transverse fractures allows early motion to minimize stiffness. Use of two knots produces symmetric tension at the fracture site and provides more rigid fixation than a single knot. Care should be taken to ensure that the tension-band wire and the proximal ends of the Kirschner wires are positioned deep to the triceps fibers to prevent wire migration. If the anterior cortex is engaged overpenetration of the wires into the soft tissues should be avoided. Plate fixation is appropriate for severely comminuted fractures distal fractures involving the coronoid process oblique fractures distal to the midpoint of the trochlear notch Monteggia fracture-dislocations of the elbow and nonunions. For comminuted fractures and nonunions a dorsally applied limited-contact dynamic-compression plate with supplemental bone graft should be utilized to support comminuted depressed articular fragments. A one-third tubular hook-plate can be used for fractures with a small proximal fragment for which additional fixation of the olecranon tip is desired. Fragment excision and triceps advancement is appropriate in selected cases in which open reduction seems unlikely to be successful such as in osteoporotic elderly patients with severely comminuted fractures. J Am Acad Orthop Surg 2000 8 266-275 Olecranon fractures which are relatively common in adults are a diverse group of injuries ranging from simple nondisplaced fractures to complex fracture-dislocations of

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