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FRACTURES DE L’EXTREMITE INFERIEURE DU RADIUS

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Les fractures de l’extrémité inférieure du radius sont définies comme une solution de continuité de l’extrémité inférieure du radius, limitée par l’interligne de l’articulation radio-carpienne en bas et par une ligne transversale passant à 4 cm ou à 3 travers de doigts de cet interligne en haut.

Publicada em: Saúde e medicina
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FRACTURES DE L’EXTREMITE INFERIEURE DU RADIUS

  1. 1. FRACTURES DE L’EXTREMITE INFERIEURE DU RADIUS Service de chirurgie orthopedique CHU _ SBA Dr Benabderrahmane Dr Degga http://www.MedeSpace.net Share what you know,learn what you don’t
  2. 2. <ul><li>Les fractures de l’extrémité inférieure du radius sont définies comme une solution de continuité de l’extrémité inférieure du radius, limitée par l’interligne de l’articulation radio-carpienne en bas et par une ligne transversale passant à 4 cm ou à 3 travers de doigts de cet interligne en haut . </li></ul>
  3. 3. <ul><li>L’extrémité inférieure du radius est volumineuse de forme prismatique quadrangulaire présentant quatre faces : </li></ul><ul><ul><li>face externe , se prolonge par l’apophyse styloïde. </li></ul></ul><ul><ul><li>face interne , correspond a la cavité sigmoïde du radius qui s’ articulaire avec la tête du cubitus, </li></ul></ul><ul><ul><li>c’est l’articulation RUI </li></ul></ul><ul><ul><li>face postérieure, «  tubercule de LISTER ». </li></ul></ul><ul><ul><li>face inférieure   ; représente la surface articulaire </li></ul></ul><ul><ul><li>(la glène radiale ) </li></ul></ul>
  4. 4. <ul><li>De face </li></ul><ul><ul><li>Bascule frontale de glène(ligne glénoïdienne)25° </li></ul></ul><ul><ul><li>La ligne bistyloidienne </li></ul></ul><ul><ul><li>Index radioulnaire inferieure=02mm </li></ul></ul>
  5. 5. <ul><li>De profil </li></ul><ul><ul><li>La bascule sagittale de la glène 10° </li></ul></ul>
  6. 6. <ul><li>Ces fractures sont d’une extrême fréquence, elles viennent en première position de toutes les fractures de l’appareil locomoteur, </li></ul><ul><li>Sujet âgé (> 50 ans) en raison de l’ostéoporose et notamment chez la femme à cause de la ménopause. </li></ul><ul><li>Par contre les fractures métaphysaires du ¼ inférieur surviennent particulièrement chez l’enfant (7 – 17 ans). </li></ul>
  7. 7. <ul><li>Le mécanisme est presque toujours indirect, chute sur la paume de la main, il est exceptionnel direct. </li></ul><ul><li>Le massif osseux carpien est considéré comme une enclume sur laquelle vient s’écrasé à l’épiphyse radiale. </li></ul><ul><li>il existe deux types de mécanismes : </li></ul><ul><ul><li>Par compression- extension. </li></ul></ul><ul><ul><li>Par compression flexion . </li></ul></ul>
  8. 8. <ul><li>La classification de CASTAING (1964) basée sur le mécanisme fracturaire. </li></ul><ul><li>On distingue deux types : </li></ul><ul><ul><ul><li>les fractures par COMPRESSION EXTENSION à déplacement postérieur. </li></ul></ul></ul><ul><ul><ul><li>les fractures par COMPRESSION FLEXION à déplacement antérieur </li></ul></ul></ul>
  9. 9. <ul><li>Ce sont toutes les fractures dont le déplacement ou la bascule est en arrière (postérieur) de l’épiphyse radiale par rapport au fragment proximal. </li></ul><ul><li>Fractures extra-articulaires:  « fracture de POUTEAU COLLES » </li></ul><ul><li>Fractures articulaires   </li></ul><ul><ul><li>fracture potentielle de CASTAING : ou fracture a troisième fragment postero-interne. </li></ul></ul><ul><ul><li>fracture en T sagittal : </li></ul></ul><ul><ul><li>fracture en T frontal :   </li></ul></ul><ul><ul><li>fracture en croix : </li></ul></ul><ul><ul><li>Autres: </li></ul></ul><ul><ul><ul><ul><li>fracture de la styloïde radiale et fracture cunèenne Externe. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>fracture cunèenne interne. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>fracture éclatement défiant toute analyse anatomopathologique. </li></ul></ul></ul></ul>
  10. 12. <ul><li>Fractures extra-articulaires  : </li></ul><ul><ul><li>fracture de GOYRAND-SMITH  </li></ul></ul><ul><ul><li>Le déplacement est antérieur réalisant la déformation en «  ventre de fourchette ». </li></ul></ul><ul><li>Fractures articulaires  : </li></ul><ul><ul><li>Fractures marginales antérieurs . </li></ul></ul><ul><ul><li>Elles peuvent être simples ou complexes. </li></ul></ul>
  11. 15. DIAGNOSTIC
  12. 16. <ul><li>Deux clichés, de face et de profil du poignet centrés sur l’interligne radio-carpienne, permettent : </li></ul><ul><ul><li>Préciser le type anatomo-pathologie. </li></ul></ul><ul><ul><li>Analyse les déplacements. </li></ul></ul><ul><ul><li>Rechercher d’éventuelles lésions associées </li></ul></ul><ul><ul><li>Noter l’existence d’une ostéoporose. </li></ul></ul>
  13. 17. <ul><li>Favorable : bien traitées, les fractures de l’extrémité inférieure du radius guérissent avec récupération fonctionnelle totale. </li></ul><ul><li>Complications immédiates : </li></ul><ul><ul><li>ouverture cutanée, rare. </li></ul></ul><ul><ul><li>lésions vasculo-nerveuses, exceptionnelles. </li></ul></ul><ul><li>Complications secondaires : </li></ul><ul><ul><li>œdème sous plâtre </li></ul></ul><ul><ul><li>déplacement secondaire,. </li></ul></ul><ul><li>Complications tardives : elles sont fréquentes, </li></ul><ul><ul><li>les cals vicieux, après réduction imparfaite ou déplacement secondaire. </li></ul></ul><ul><ul><li>complications trophiques ; syndrome algodystrophique </li></ul></ul><ul><ul><li>syndrome du canal carpien </li></ul></ul>
  14. 18. <ul><ul><li>BUTS </li></ul></ul><ul><ul><ul><ul><ul><li>Obtenir une réduction le plus anatomique possible. </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Assurer la stabilité de la fracture. </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Restaurer la fonction. </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Éviter les séquelles fonctionnelles . </li></ul></ul></ul></ul></ul>
  15. 20. 1. BF 2. IRCI 3. BS 4. FCA <ul><li>1 . La bascule frontale du toit du radius de 25° sur la radiographie de face. </li></ul><ul><li>2. La bascule sagittale du toit du radius de 10° sur la radiographie de profil. </li></ul><ul><li>3. L’index radio ulnaire inf (2mm). </li></ul><ul><li>4. « franchissement de la corticale antérieure » </li></ul><ul><li>c’est le passage de la corticale antérieure du fragment inférieur en avant de la corticale antérieuredu fragment supérieur </li></ul>
  16. 26. Embrochage intramedullaire de PY
  17. 29. <ul><li>Déplacement secondaire  </li></ul><ul><li>Raideur du poignet. </li></ul><ul><li>Cal vicieux. </li></ul><ul><li>Syndrome algodystrophique . </li></ul>
  18. 30. <ul><li>Lésions tendineuses induites par les broches. </li></ul><ul><li>Lésions nerveuses induites également par les broches (branche dorsale du nerf radial). </li></ul><ul><li>Sépsis. </li></ul><ul><li>Migration des broches. </li></ul>
  19. 31. <ul><li>Ostéite. </li></ul><ul><li>Raideur du poignet. </li></ul><ul><li>Cal vicieux. </li></ul><ul><li>Syndrome algodystrophique. </li></ul>
  20. 32. MERCI pour VOTRE ATTENTION

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