성인간호학실습 - A+/정형외과/OS/손목골절/케이스스터디/성인간호학

문서 내 토픽

1. Closed fracture of distal radius

손목은 Radius(요골, 노뼈), Ulna(척골, 자뼈)로 이루어져 있으며 그 중 radius는 엄지손가락 쪽에 있다. 손목 관절에 연결된 radius 부분을 distal radius(원위부 요골)라고 하며 이 부분이 부러지는 것을 distal radius fracture(원위부 요골 골절)라고 한다. distal radius fracture은 보통 넘어져서 발생하며, 자동차 사고, 자전거 사고, 스키 사고 또는 다른 스포츠 활동에서도 발생할 수 있다. distal radius fracture은 다른 골절과 연관되지 않으면서 독립적으로 발생할 수 있고, distal ulna(원위부 척골) 골절과 함께 발생할 수도 있다. 이 경우 distal radius and ulna fracture라고 한다. distal radius가 골절되는 각도에 따라 Colles fracture와 Smith fracture로 분류된다.
2. Symptoms of a distal radius fracture

1) Immediate pain with tenderness when touched 만지면 아프고 유연함 2) Bruising and swelling around the wrist 손목 주위에 멍이 들고 부어오름 3) Deformity - the wrist being in an odd position 변형 - 손목의 위치가 이상함
3. Diagnosis of a distal radius fracture

단순 X-ray 검사를 통해 쉽게 진단되며, 관절이 심하게 침범된 경우 CT 촬영이 필요하기도 하다.
4. Treatment for a distal radius fracture

원위부 골절의 치료 방법에 대한 결정은 다음을 포함한 많은 요인에 의해 좌우될 수 있다. 1) Fracture displacement 골절된 뼈가 이동했는지 여부 2) Comminution 골절이 여러 곳에 발생했는지 여부 3) Joint involvement 관절 손상 여부 4) Associated ulna fracture and injury to the median nerve 척골 골절과 정중신경 손상 여부 5) Whether it is the dominant hand 지배적인 손의 여부(오른손잡이, 왼손잡이) 6) Your occupation and activity level 직업 및 활동 수준 하지만 어떤 경우에나 즉각적인 골절 치료는 편안함과 통증 조절을 위해 골절 부위를 원위치로 되돌려 놓은 정복(reduction) 후 부목(splint)를 적용하여 고정하는 것이다. 골절의 정복은 국소마취 하에 이루어진다.
5. Nonsurgical Treatment

원위부 요골의 골절 위치가 좋은 경우 부목(splint)나 석고붕대(cast)를 적용한다. 이는 뼈가 치유될 때까지 최종 치료제로 사용되며, 보통 cast는 최대 6주 동안 유지된다. 그 후에는 탈부착이 가능한 손목 부목을 사용한다. cast가 제거되면 물리치료를 시작하여 손목의 기능과 힘을 강화한다. 편위된 골절은 국소마취 하에 폐쇄 정복(close reduction)을 실시하여 해부학적 정렬로 교정한 후 splint나 cast로 고정한다.
6. Surgery for Distal Radius Fractures

수술은 골절이 불안정하거나 cast로 치료할 수 없는 골절에 사용된다. 수술은 보통 손목의 volar 부위(맥박이 느껴지는 곳)를 절개하여 시행되며 이 방법으로 골절 부위에 완전히 접근할 수 있다. 골절편들은 하나 이상의 플레이트와 나사로 제자리에 고정된다. 경우에 따라서는 해부학적 구조를 재정립하기 위해 손목 뒤쪽의 절개가 필요하다. 골절편이 여러 개일 경우 플레이트와 나사로 고정하지 못할 수 있다. 이 경우 추가 와이어가 있거나 없는 외부 고정 장치를 사용해 파편을 고정할 수 있다.
7. Closed reduction with internal fixation (CRIF)

골절 부위를 열지 않고 간접적으로 부러진 뼈의 조각들을 올바른 위치에 다시 놓이게 하는 정형외과적 수술법이며 이 위치는 와이어, 핀 또는 금속판을 사용하여 제자리에 고정된다. 이 시술은 골절편을 재정렬하고 내부고정을 이용해 골절편을 안정시켜 뼈 골절 관리에 도움을 준다.
8. Outlook of a distal radius fracture

골절은 보통 6주 후에 치유되지만, 상처가 심할 경우 더 오래 걸릴 수 있다. 완전한 회복은 길게는 1년이 걸릴 수 있다. 팔을 정상으로 되돌리기 위해서는 물리치료와 재활이 필요할 수 있다. 이는 사지의 에너지 증진에 도움을 준다. 수술 후 최소 2개월 동안은 가벼운 활동을 하는 것이 좋다. 손이 완전히 회복되기 전에 약간의 뻣뻣함을 경험할 수 있다. 골절의 심각성에 따라, 이는 최대 2년까지 지속될 수 있다.

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1. Closed fracture of distal radius

A closed fracture of the distal radius is a common injury that occurs when the bone at the end of the forearm near the wrist breaks without breaking through the skin. This type of fracture is often caused by a fall onto an outstretched hand or a direct blow to the wrist. The distal radius is the most commonly fractured bone in the body, and these fractures can range in severity from a simple crack in the bone to a more complex, displaced fracture. Proper diagnosis and treatment are crucial to ensure proper healing and restoration of wrist function.
2. Symptoms of a distal radius fracture

The main symptoms of a distal radius fracture include pain, swelling, and deformity of the wrist. Patients may also experience difficulty moving the wrist and hand, as well as numbness or tingling in the fingers. In some cases, the fracture may cause the wrist to appear bent or crooked. Other common symptoms include bruising, tenderness, and an inability to bear weight on the affected hand. It is important for patients to seek medical attention promptly if they suspect a distal radius fracture, as prompt diagnosis and treatment can help prevent long-term complications and ensure the best possible outcome.
3. Diagnosis of a distal radius fracture

Diagnosing a distal radius fracture typically involves a physical examination and imaging tests. During the physical exam, the healthcare provider will assess the patient's range of motion, check for tenderness and swelling, and look for any deformities or instability in the wrist. Imaging tests, such as X-rays, may be ordered to confirm the presence and severity of the fracture. In some cases, additional imaging tests, such as a CT scan or MRI, may be necessary to get a more detailed view of the fracture and surrounding structures. Prompt and accurate diagnosis is crucial for determining the appropriate treatment plan and ensuring the best possible outcome for the patient.
4. Treatment for a distal radius fracture

The treatment for a distal radius fracture depends on the severity and type of the fracture, as well as the patient's age, overall health, and activity level. The primary goals of treatment are to restore the normal alignment and function of the wrist, minimize the risk of complications, and facilitate a timely and complete recovery. Treatment options may include nonsurgical approaches, such as immobilization with a cast or splint, or surgical interventions, such as open reduction and internal fixation (ORIF) or percutaneous pinning. The healthcare provider will work closely with the patient to develop the most appropriate treatment plan based on the individual's needs and the specific characteristics of the fracture.
5. Nonsurgical Treatment

Nonsurgical treatment for a distal radius fracture is often the first-line approach, particularly for stable, non-displaced fractures. This may involve immobilizing the wrist with a cast or splint to allow the bone to heal. The healthcare provider may also recommend exercises and physical therapy to maintain range of motion and prevent stiffness. Nonsurgical treatment can be effective for many patients, but it is important to follow the healthcare provider's instructions carefully and attend all scheduled follow-up appointments to monitor the healing process and ensure the best possible outcome. In some cases, however, surgical intervention may be necessary to properly align and stabilize the fracture.
6. Surgery for Distal Radius Fractures

Surgery may be recommended for distal radius fractures that are more severe, unstable, or displaced, or for patients who have certain underlying medical conditions or activity levels. The goal of surgical treatment is to restore the normal alignment and function of the wrist by stabilizing the fracture and allowing for proper healing. Common surgical techniques include open reduction and internal fixation (ORIF), where the bone fragments are realigned and held in place with plates, screws, or other hardware, and percutaneous pinning, where small pins are used to hold the bone fragments in place. The specific surgical approach will depend on the type and severity of the fracture, as well as the patient's individual needs and preferences. Careful post-operative care and rehabilitation are essential for achieving the best possible outcome.
7. Closed reduction with internal fixation (CRIF)

Closed reduction with internal fixation (CRIF) is a surgical technique used to treat certain types of distal radius fractures. In this procedure, the healthcare provider manipulates the bone fragments back into their proper alignment without making an open incision. Once the fracture is reduced, the provider uses internal fixation devices, such as plates, screws, or pins, to hold the bone fragments in place and stabilize the fracture. CRIF is often preferred over open reduction and internal fixation (ORIF) because it is less invasive and can help minimize the risk of complications, such as infection or damage to surrounding tissues. However, CRIF may not be suitable for all types of distal radius fractures, and the healthcare provider will carefully evaluate the patient's individual case to determine the most appropriate surgical approach.
8. Outlook of a distal radius fracture

The outlook for a distal radius fracture can vary depending on the severity of the injury, the treatment approach, and the patient's overall health and recovery. With proper diagnosis, treatment, and rehabilitation, most patients with a distal radius fracture can expect to regain a significant degree of wrist function and return to their normal activities. However, some patients may experience long-term complications, such as persistent pain, stiffness, or loss of range of motion, particularly if the fracture was more severe or if there were complications during the healing process. Regular follow-up with the healthcare provider, adherence to the recommended treatment plan, and diligent participation in physical therapy are all crucial for achieving the best possible outcome. Overall, the outlook for a distal radius fracture is generally good, but it is important for patients to work closely with their healthcare team to ensure a successful recovery.