Tapulima / Lima Lima gugu ma Trauma: Faʻailoaina Diagnostic | El Paso, TX.

Tapulima & Lima Lima

• Distal Radius & Ulnar Fractures (Colles, Smith's, Barton's, Chauffeur's, DiePunch) - faigata e le 50% ulnar styloid Fx, auala TFC, DRUJ dislocation, scapholucky lig dissociation, lunate / perilucky dislocation)
• Carpal ponaivi Fracture & dislocations (scaphoid, triquetrum, hamate Fx & Lunate / perilucky dislocation)
• Ligaments dissociation (Scapholunate dissociation, le faʻamaonia o le lunotriquetral)
• Metacarpal & Phalangeal gau (Bennett, Rolando, Game keeperFx / Stener lesion, Boxer Fx)
• Pediatric manuʻa manuʻa (green-stick Fx, Torus Fx, Punou / palasitika faʻaletonu, Salter-Harris manuʻa)
• I tulaga uma, e manaʻomia le togafitiga o togafitiga Orthopedic

• Kolisi fx: m / cd / t FOOSH + pronation. m / c inOSP / tamaitai matutua. E laʻititi i alii ma pe a manaʻomia le DEXA e aloese ai mai le lafu Fx ma isi mea faapena. Young pts: malosi tele-malosi. E masani lava ona faaopoopo-articular.50% -cases faʻaalia Ulna styloid (US) Fx.
• Faʻalavelave faʻalavelave: faʻamaʻaloga o le taumafataga o le afiafi, CRPS, DJD, faʻamaʻi o le tino.
• Ata: x-rad ua lava, CT i complex Fx, MRI fesoasoani i loimata ma le TFC.
• Rx: pe afai e faʻaopoopo-articular ma <5-mm distal radius faʻapuʻupuʻuina ma <5-tikeri dorsal angulation tapunia faʻaititia + lafoina ua lava. ORIF i mataupu lavelave.
• MFaʻamatalaga Dx: distal rad impaction / faʻapuʻupuʻu, dorsal angulation o distal fasi, vaʻai totoʻa pe afai intra-articular faʻaopoopoina, 50% US Fx

• Smith Fx: Goyrand i tusitusiga Farani. Faʻapea ua fesuiaʻi Colles, a leai e toeititi lava tutusa, Ie, 85% faʻaopoopo-faʻapitoa, 50% US Fx, OSP / matutua fafine, talavou pts-maualuga-malosi faʻalavelave. Eseesega: masiniFOOSFaʻatasi ai ma le tapulima faʻapipiʻi faʻapea m. Laititi atu
• Laasaga o ata: (silasila Colles Fx) C
• Faʻalavelave faʻalavelave: tutusa i le Colles Fx
• Rad Dx: 85% faʻaopoopoga faʻapitoa i le volar (pito i luma) o le vaega vaʻavaʻa, faʻasalaga faʻasalalau. Iloilo ma le faaeteete le solia o le tulafono ma le masalosalo i le faalauteleina o le igoa lea e mafai ona faaigoa o le Smith type 2 poʻo le toe liliu Barton Fx (isi)
• Rx: faʻapena tutusa e pei o Colles.

• Barton fx: FOOSH, le aʻafiaga o le faʻalavelave faʻalavelave e tutusa ma le Kolisi ae o le laina Fx e faʻalautele mai le itu i luga o le tino i le faʻasalaga o le radiocarpal e mafua mai i le faʻaaogaina o le taavale.
• Ata: 1st sept x-radiography e masani ona suʻesuʻeina e le CTto faʻaopoopoga faʻaopoopoga Fx ma le fuafuaina o galuega
• Rad Dx: faʻasolosolo faʻamalosi Fx faʻasalalau mai le taʻaloga i totonu o le faʻaogaina o le leitiola ma se fesuiaiga o le suiga, o le vavalalata vavalalata o le kapeta
• Afai o le laina Fx e alu ese mai le itu i totonu o le tapulima tapunia e igoa ia Reversed Barton Smith kiliki 2 (pito i luga lalo)
• Faʻafitauli: tutusa ma soo se mea fx fete
• Rx: faʻatasi ma le ORIF

• Chauffeur's / backfire Fx aka Hutchinson Fx: FX o le Radial styloid. O le igoa e mafua mai i le taimi e amata ai le taavale i le a lima uila e mafai ona toe faʻafoʻi ai le faʻaogaina o le tapulima ma le faʻavaveina o le tapulima.
• Ata: x-radiography ua lava. E mafai ona aoga le CT pe a fai e le faigofie ona faʻaalia e le x-ray.
• Faʻamaumauga: leai se faʻapotopotoga, malunion, DJD, scapholunate dissociation, faʻamalo / faʻalavelave faʻaleagaina
• Rx: faʻamalositino faʻatasi ai ma faʻataʻitaʻiga uma mataupu d / t i totonu o faʻamatalaga

• Die-Punch Fx: gaioiga Fx e le Lunate ponaivi i distal articularLosai fossa o le Radius. IntraarticularFx. Maua lona igoa mai se metotia e faʻafuaseʻi (faʻafiafiaina) se pu i masini gaosi "oti-punch." FOOSH manuʻa.
• Ata: 1st laasaga x-ray, atonu o le equivocal d / t o le atuatuvale o le Fossa Lunate ona o le CT numera sili ona malamalama.
• Rad Dx: faʻaleagaina o le fossa region with extension-articular Fx extension. E mafai ona tuʻuina atu o se Fxarticular Fx o le Distal Radius.
• Rx: faagaoioia d / t intra-articular Fx

Fausia arcs o Gilula i le iloiloina o manua. O se laasaga tāua e manaʻomia e aloese ai mai le faʻaaogaina o suiga laiti i le faʻaogaina o taavale ma le faʻasolosolo faʻaoga

• Paʻu Scaphoid Fx: m / c Fx bone bones. O le tapuni lima o le / / TFOOSH na vaeluaina. O le nofoaga o le Fx e sili ona taua i le faʻataʻitaʻiga: Taʻitaʻi-m / c nofoaga (70%). Tau maua 70-100% avanoa o le AVN. Polokalame Fx: 20-30% faʻatasi ai ma se tulaga lamatia tele o le le o faʻatasi. O le faʻamalosi-10% o loʻo faʻaalia ai le lelei sili atu. O le distal pole Fx o le m / c i tamaiti. Faailoga o le inisiua autu; tiga i le snuffbox.
• Ata: 1st step-x-radiography ae o le 15-20% misia d / t faʻataulaitu Fx. Manatu faʻapitoa manaʻomia. Ma o le MRI e sili ona maaleale ma faʻapitoa mo vave gafa Fx. Bone scintigraphy has98 / 100% faʻapitoa & maaleale esp. 2-3 aso pe a maeʻa le amataga. Key rad. Dx: Fx laina pe a faʻamaonia, fesuiaʻiga ma le pupuni o scaphoid (navicular) gaʻo pad, iloiloina mo scapholucky faʻateʻaina. Afai o le latalata ivi foliga mai sclerotic-AVN tupu. MRI: maualalo ile T1 & maualuga ile T2 / STIR / FSPD d / t ivi edema, e mafai ona matauina se laina maualalo signalFx.
• Rx: O le Spica cast e tatau ona faʻaaoga pe afai e masalomia masalosalo e oo lava i w / o x-ray findings. Mo le puʻupuʻese-cast mo le 3-mo mo le faʻasologa o 5-mo le faʻamalosia. ORIF poʻo le faʻasolosolo faʻasolosolo faʻatasi ma se faʻataʻitaʻiga a Herbert.

Scapholunate Ligaments Faʻafitauli

• SNAC tapulima: scaphoid non-union advanced collaps. E masani d / t le tuʻufaʻatasia ma faʻateʻaina o scapholucky ligament (SLL) ma le alualu i luma radiocarpal ma intercarpalDJD. O le Proximal scaphoid fragment e faʻapipiʻi i le Lunate ma le faʻamamaina o le mama ma le faʻasologa o igoa mama i luga o x-ray.
• O le tapuni o le SNAC e masani ona oʻo i le DISI
• Rx: DJD agai i luma e mafai ona oʻo atu i le fath-corner arthrodesis

• Scapholunate agavaʻa faʻafuaseʻi (lima faʻaoga SLAC): SLLdissociation ma alualu i luma intercarpal ma radiocarpal DJD ma volar poʻo dorsal carpal suiga (DISI & VISI). Mafuaaga: afaina, CPPD, DJD, Kienboch faamaʻi (AVN o Lunate), Preiserdisease (AVN o Scaphoid).
• SLL dissociation o le a taitai atu ai i le Dorsal poo VolarIntercarlate aka Intercarpal Segmental Instability (DISIER VISI).
• Rad Dx: Dx mafuaʻaga autu. O faʻataʻitaʻiga X e faʻaalia ai le faʻamalosi poʻo le leo o le Lunat i le faʻateleina poʻo le faʻaitiitia o le scapholunate angle i luga o le vaaiga lautele. I luga o le vaaiga i luma: Terry Thomas po o le faalauteleina o le mamao o le scapholunate 3-4-mm o le pito i luga o le masani.
• RIMRI mafai ona fesoasoani ile ligament iloiloina ma muai taotoga fuafuaina
• Rx: masani ona faʻatautaia ma le DJD. Faʻatonuga fa-fa

• Triquetrum Fx: 2nd m / c carpal ponaivi Fx. M / C dorsal itu e faʻamalosia e le malosi Dorsal radiocarpal ligament. Mafuaaga: ALOFA.
• Ata: x-radiography tapulima tapulaʻa ua lava. Sili faʻaalia luga o le faʻaaliga lautele o se aveʻesea ponaivi ponaivi latalata i le dorsum o le Triquetrum. E ono fesoasoani le CT pe a faʻatonuina leitio.
• Rx: tausiga tausi
• Faʻamaumauga: seasea, e ono aʻafia pea le tiga i luga o le pito o le tapulima

• mātau o le Hamate Fx: m / c tupu i taʻaloga palate (kirikiti, pesipolo, hockey, aʻafiaga e le kalapu tapolo, ma isi) 2% o carpusFx.
• Ata: x-radiography ono le mafai ona iloa se Fx seʻi vagana o le "carpal tunnel view" e faʻaaogaina. E ono fesoasoani le CT pe a fai o x-ray e le faʻamalieina.
• Togafitiga: tiga, tofotofoga toso lelei, vaivai, tiga uu. Loloto ulnar n. E mafai ona afaina le paranesi i totonu o le alalaupapa o Guyon.
• Rx: masani e le o faʻamalositino, ae o le taimi le tumau e le o se faʻapotopotoga e ono manaʻomia ai le faʻasalaga.
• DDx: bipartite hamate

• Fiafia vs. Faʻaletonu dislocation: O le sui o le m / c e vaʻaia le ponaivi gaʻo. O le aotelega o le manua o le gaʻo. Ae peitai, e masani ona misia!
• E tupu i le FOOSH ma le tapulima ua faʻalauteleina ma ua le toe faʻaaoga. Ata: 1st laasaga x-ray. Faʻafesoʻotaʻi pe manaʻomia se faʻamaʻi faʻalavelave manua fuafuaina CT numera.
• Key Rad DDx: DDx Lunate mai faʻalavelave faʻafuaseʻi. Faʻateʻa Lunate: ua leai se fesoʻotaʻiga a le lunate ma le radius radius 'ua masaʻa teacup i luga o le itu. Faʻaletonu le mautonu: Lunate tausia lona fesoʻotaʻiga ma distal faataamilosaga e ui lava i le Capitatedorsally dislocated. Lunate dislocation o loʻo fesoasoani tele e faʻailoa ai le pie sign d / t Lunate overlapping the Capitate
• Rx: faʻaititia faʻafuaseʻi ma le faʻaleleia o le faʻaaogaina o ligaments

Metacarpal & Phalangeal Manua

• Bennett Fx: intra-articular but noncomminuted impact-type Fx o le faʻavae o le 1st MC ponaivi o le limamatua. X-radiography ua lava.
• Rad Dx: vaevaega tafatolu o le ponaivi i luga o le vaega o le 1st MCbase, e masani lava i le susulu radial o le vaega o totoe o le 1st MC
• Faʻafitauli: DJD, non-union, etc.
• Rx: faʻapitoa i le le faʻamalosia / le faʻapipiʻi e manaʻomia ai se tausiga
• Rolando Fx: fesoasoani le Bennett faʻatasi ma le Y poʻo le T-faatulagaga. Faʻasalaga sili ona faigata. E le maluelue e manaʻomia le tausiga

• Taʻu lima taʻavale lima lima: masani faʻamatalaina o se masani loimata o le `` lignar (medial) kolisi ligamenti i le 1stMCP i le Igilisi Gamekeepers 'na faia le ua mimilo / fasiotia o tamaʻi taʻaloga. O se manuʻa tuga e mafai foi ona faaigoaina o le limamatua o Skier. O lenei manua e mafai ona ligamentous w / oa gau ma se avulsion manuʻa i le 1st proximal phalanx base.
• Faʻalavelave: Faʻasalaga o le lino poʻo le faʻaaogaina o le ligament liʻa i luga o le musika o le Adductor muscle e le mafai ona faʻamaloloina ai / o le gaosiga o taʻavale. E manaʻomia le MRI Dx.
• Aloese mai mafaufauga mamafa o le mafaufau lea e mafai ona faatosinaina ai se Stenerlesion
• Ata: x-radiography mulimuli ai MRI i Dx Stenerlesion. MSK US mafai ona faʻaaogaina pe a le maua MRI.
• LesStener lesion on MRI & MSUS: ulnar collateral stump e sili atu ona papaʻu ia Adductor pollicis aponeurosis ma foliga mai o se maualalo o le faʻailoga tele-e pei o le tupuʻaga na taʻua o le "yo-yo i luga o le string sign" lipotia uma i MRI ma MSK US.
• Rx: masani ona galue

• Pusa Fx: m / c MC Fx. O le faʻaopoopo-faʻapitoa masani masani leai-comminuted poʻo laiti comminuted Fx ala m / c le 5th ma o nisi taimi le 4th MCneck-ulu fauga (taimi uma e ala i le pou) mafua ai volar ulu angulation. Faʻatulagaina: faʻatonutonu aʻafiaga pei o le uʻuina o lima o le tuʻiina o luga luga (faʻataʻitaʻi, ponaivi o ponaivi / pa puipui) o lea 95% i tama talavou.
• Ata: x-radiography lima faasologa ua lava
• Rad Dx: Fx laina e felafolafoaʻi pe faʻafefeteina e MCneck faʻatasi ai ma le faʻaogaina ole ulu. Iloilo le maualuga o le faʻaaogaina, taua le lipoti.
• Rx: e masani ona le faʻaaogaina ma puʻupuʻu o le alavai ma fuainumera faʻapipiʻi. (www.aafp.org/afp/2009/0101/p16.html)
• NB Afai o le tutusa metotia motusia le 2ndand 3d MC i le tutusa anatomic eria, e ono manaʻomia taotoga faʻaaoga.

• Phalangeal lima Fx: m / c skeleton Fx (10% o Fx uma). Taʻaloga taʻaloga ma fale gaosi oloa
• Ata: x-radiography ma faasologa o lima poo PA / tala i luga ole tamatamai lima o le a lava
• Rad Dx: pe a fai o le prox phalanx Fx, o le distal fragment e faʻasolitulafono faʻatasi ma le prox fragment dorsally. Distal phalanx atonu e faʻasolosolo tulimanu. Matauga taua: manua moega fao, lea na manatu o le tatala Fx ma le aitalafu o siama.
• Rx: peʻa <10-tikeri angulation-buddy-taping ma le minoi faʻasolosolo. CRPP vs. ORIF mafai ona mafaufauina i ni faʻalavelave laʻititi-Orthopedic hand surgeon referral
• Faʻalavelave: leai se lafo, necrosis, siama.E mafua mai i le toesea
• Mo faʻaopoopo manua masani: PIP o m / c dislocated soʻoga. Mullet (Baseball) tamatamailima, Jersey tamatamai lima ma isi manuʻa vaʻai i:
• www.aafp.org/afp/2012/0415/p805.html

 

 

• Felon: sapalai siama o le tamatamai lima pulupulu masani ma Staph.Aureus. Mafuaʻaga: tui nila (suka), paronychia, fao sikuea, ma isi m / c i le faʻasino igoa ma lima matua, faʻaalia ma le tiga, fulafula, ma isi
• D / t faapitoa pulup anatomy theinfection> fulafula e oʻo atu i pulp compartment syndrome-mamafa ma nekrosis.
• Rx: faʻamalositino ma faʻalavelave faʻalavelave i le DIP, faʻavaivai / faʻapipiʻi

Faigaluega a le tamaʻi maʻi

• Faʻataunuʻu Fx: Greenstick Fx, Torus (Buckle) Fx, Punou (Palasitika) faʻaletonu / Fx. D / t FOSHe.g. paʻu ese mai le pa manuki. m / c aafia ai <10-tausaga le matua.
• Faʻamatalaga Faʻamatalaga Ata: tikeri o le faʻafefe / faʻafefe, epiphyseal tuputupu aʻe o manu (Salter-Harris faʻavasegaga)
• Rx: masani e le o faʻaogaina (tapunia ma tapuni)

• Distal Radioulnar Soʻotaga (DRUJ) Faʻaletonu-masani manua mulimuli ane afaina pei o FOOSFaʻatasi ma tapulima hyperextension ma feauauaʻii ma faʻalavelaveina o DRUJ ligament ma TFCcomplex. Avulsion o ulnar styloid ma le 'eseʻese poʻo le faʻamatuʻu eseʻesega o distal ulnar e tatau ona maitauina.
• Laasaga o ata: x-ray muamua, MRI e mafai ona iloa ligaments ma le TFC leaga, e mafai e MSKUScan ona fesoasoani i le vevesi o liga.
• Faʻaaliga: vaʻaia le DRUJ volar (luga o le ata) ma le taʻe (image pito i lalo) le faʻavae.

Tapulima & Lima galu

• Wrist DJD-masani lava lona lua ile faʻaletonu, scapholucky faʻamavaeina, SLAC, SNAC tapulima, CPPD, Keinboch poʻo Preiser Faamaʻi ma isi
• E mafai ona oʻo atu i le tele o mea e leiloa
• Faʻataʻitaʻiga: e masani ona maua mai le JSL radiocarpal, sclerosis subchondral, osteophytosis, cyclicical cysts, ma tino vavalalata. E masani lava ona faʻaosoosoina le faʻaleagaina o le vaʻaia ma le faʻapitoa faʻatasi.
• MRI e mafai ona aoga i le vave iloa o le faʻafeeseeseaiga o le leʻofaʻi, Lunate / Navicular AVN.
• Rx: conservative vs. faagaioiga.

• DJD lima: Matua taatele. Moni muamua OA. MCP-e le afaina lava w / o DIP & PIP
• A faʻamamaina MCP OA faʻapea mafaufauinaCPPD & Hemochromatosis (Hook-pei osteophytes)
• Falemaʻi:
• Tauleʻa tausaga
• E masani ona leai se faʻaletonu sei vagana ai le 1 CM CMC OA
• DIPs-Heberden fodes, PIPs-Bouchard
• Erosive OA (o nisi taimi e faʻaigoaina o le `` faʻamamaina o le OA '')
• O le Spectrum o le OA ae o loʻo faʻatupuina erosions vavalalata faʻatatau i DIPs ma PIPsemesinaʻi ma uiga masani - gullwing foliga. Leai se pupuga faʻapipiʻi (leai CRP, RF, Aneti-CCP Ab) masani i fafine feololo / matutua fafine, pei o Lima OA, e masani ona vaaia i aiga

gugu Rheumatoid

• Ratuumatoid Arthritis (RA) -faʻamaʻi pipisi faʻamaʻi faʻamaʻi o le le iloa etiology, taulaʻi synovial soʻoga, tendons ma tele systemic aafia ai (mama, CVS, Ocular, Paʻu, ma isi) Pathology: Tcell> Macrophage / APC> faʻalauteleautoimmune gaioiga mafua ai pannus faʻatulagaina ma faifai malie faʻaleagaina o ST , cartilage, ponaivi, ma isi aano. 3% FafineVS.1% Tane. Siʻosiʻomaga faʻaosofia: faʻamaʻi, afaina, ulaula, ma isi i se tagata gafatia gofie. 20-30% ono le atoatoa pe a maeʻa le 10-tausaga.
• Dx: falemaʻi, falefaigaluega, faʻataʻitaʻiga.Symmetrical Polyarthritis esp. i MCP, tapulima (2nd & 3RD MCP)