정형외과 의사를 위한 모든 hand, wrist fracture 상세 설명

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1. Distal radius fracture

원위 요골 골절은 가장 흔한 골절 중 하나로, 성인 골절의 15-20%를 차지합니다. 나이가 들수록 발생률이 증가하며, 특히 여성에서 더 많이 발생합니다. 골다공증이 주요 위험 요인입니다. 골절 분류로는 Fernandez and Jupiter 분류와 AO 분류가 널리 사용됩니다. 치료 계획 수립 시 골절의 불안정성, 관절면 침범 여부, 전위 정도 등을 고려해야 합니다. 비수술적 치료와 수술적 치료(경피적 핀고정, 관혈적 정복 및 내고정) 등 다양한 치료 방법이 있습니다.
2. Fracture and Dislocation of carpus

수근골 골절 및 탈구는 복잡한 손상으로, 수근골 간 인대와 관절면의 점진적인 파열이 특징입니다. 주요 손상으로는 주상골 골절, 월상골 주위 골절 및 탈구, 주상월상 탈구 등이 있습니다. 진단을 위해 X선 검사와 함께 골스캔, CT, MRI 등의 영상 검사가 필요합니다. 치료는 조기 정복 및 안정화가 중요하며, 수술적 치료(관혈적 정복 및 내고정)이 필요할 수 있습니다.
3. Scaphoid fracture

주상골 골절은 손목 손상 시 흔히 발생하는 골절로, 주상골의 특이한 혈액 공급 체계로 인해 불유합 및 무혈성 괴사의 위험이 높습니다. 진단을 위해 이학적 검사와 영상 검사(X선, CT, MRI)가 필요합니다. 치료는 골절 유형과 전위 정도에 따라 달라지며, 비수술적 치료(석고 고정)와 수술적 치료(경피적 나사 고정, 관혈적 정복 및 내고정) 등이 있습니다.
4. Perilunate fracture and dislocation

월상골 주위 골절 및 탈구는 월상골과 인접 수근골 및 요골 간의 점진적인 인대 및 골성 연결 파열이 특징입니다. 진단을 위해 X선 검사와 함께 골스캔, CT, MRI 등의 영상 검사가 필요합니다. 치료는 조기 정복 및 안정화가 중요하며, 수술적 치료(관혈적 정복 및 내고정)이 필요합니다.
5. Scapholunate dislocation

주상월상 탈구는 주상골과 월상골 간의 인대 손상으로 인한 불안정성이 특징입니다. 진단을 위해 이학적 검사와 영상 검사(X선, MRI, 관절경)가 필요합니다. 급성기에는 석고 고정 또는 경피적 핀고정 등의 비수술적 치료를 시행하며, 만성기에는 수술적 치료(인대 봉합, 골 이식 등)가 필요할 수 있습니다.
6. Hand fracture and dislocation

수부 골절 및 탈구는 다양한 형태로 발생할 수 있습니다. 원위 지골 골절, 지관절 탈구, 중위 지골 골절, 근위 지골 골절, 중수골 골절, 중수수근관절 탈구 등이 대표적입니다. 진단을 위해 이학적 검사와 영상 검사가 필요하며, 치료는 골절 및 탈구의 유형과 정도에 따라 달라집니다. 대부분 비수술적 치료(부목 고정, 석고 고정 등)를 시행하지만, 필요 시 수술적 치료(정복 및 내고정)를 고려할 수 있습니다.
7. Thumb CMC joint dislocation, metacarpal fractures, MP joint dislocations

엄지 중수수근관절 탈구, 엄지 중수골 골절, 중수지관절 탈구 등은 엄지 손가락 손상의 대표적인 유형입니다. 진단을 위해 이학적 검사와 영상 검사가 필요하며, 치료는 손상 유형에 따라 달라집니다. 대부분 정복 및 고정 치료를 시행하지만, 복잡 탈구나 불안정성이 있는 경우 수술적 치료(인대 봉합, 재건술 등)가 필요할 수 있습니다.

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1. Distal radius fracture

Distal radius fractures are one of the most common fractures encountered in orthopedic practice. They can occur due to a variety of mechanisms, including falls onto an outstretched hand, motor vehicle accidents, and high-energy trauma. The management of these fractures depends on the specific fracture pattern, displacement, and associated injuries. Conservative treatment with immobilization may be appropriate for minimally displaced, stable fractures, while more displaced or unstable fractures often require surgical intervention to restore anatomic alignment and allow for early mobilization. Factors such as patient age, activity level, and presence of concomitant injuries must be carefully considered when developing the optimal treatment plan. Careful assessment and appropriate management of distal radius fractures is crucial to minimize the risk of long-term complications, such as post-traumatic arthritis, malunion, and loss of wrist function.
2. Fracture and Dislocation of carpus

Fractures and dislocations of the carpal bones can be complex and challenging injuries to manage. These injuries often result from high-energy trauma, such as motor vehicle accidents or falls from a height, and can involve single or multiple carpal bones. Careful assessment of the injury pattern, including the degree of displacement and associated ligamentous injuries, is essential for developing an appropriate treatment plan. Conservative management with immobilization may be appropriate for stable, minimally displaced injuries, but many carpal fractures and dislocations require surgical intervention to restore anatomic alignment and stability. Surgical techniques may include open reduction and internal fixation, ligament repair or reconstruction, and/or limited or complete carpal bone excision. Successful management of these injuries requires a thorough understanding of carpal anatomy and biomechanics, as well as meticulous surgical technique to minimize the risk of long-term complications, such as post-traumatic arthritis, instability, and loss of wrist function.
3. Scaphoid fracture

Scaphoid fractures are a common injury, particularly in young, active individuals. These fractures can be challenging to diagnose and manage due to the complex anatomy of the scaphoid and the risk of complications, such as avascular necrosis and nonunion. Careful clinical assessment, including a high index of suspicion for occult fractures, and appropriate imaging studies are essential for accurate diagnosis. The management of scaphoid fractures depends on the location and displacement of the fracture, as well as the presence of associated injuries. Nondisplaced or minimally displaced fractures may be treated conservatively with immobilization, while more displaced or unstable fractures often require surgical intervention, such as open reduction and internal fixation, to promote fracture healing and prevent long-term complications. Prompt diagnosis and appropriate treatment of scaphoid fractures is crucial to optimize outcomes and minimize the risk of long-term disability.
4. Perilunate fracture and dislocation

Perilunate fractures and dislocations are complex and high-energy injuries that can result in significant long-term disability if not properly managed. These injuries involve disruption of the carpal ligaments and/or fractures of the carpal bones, leading to instability and malalignment of the wrist. Careful assessment of the injury pattern, including the degree of displacement and associated injuries, is essential for developing an appropriate treatment plan. Surgical intervention, often involving open reduction and internal fixation, is typically required to restore anatomic alignment and carpal stability. Successful management of these injuries requires a thorough understanding of carpal anatomy and biomechanics, as well as meticulous surgical technique to minimize the risk of long-term complications, such as post-traumatic arthritis, instability, and loss of wrist function. Prompt diagnosis and appropriate treatment of perilunate fractures and dislocations is crucial to optimize outcomes and prevent long-term disability.
5. Scapholunate dislocation

Scapholunate dislocations are a type of carpal instability injury that can result in significant wrist dysfunction if not properly managed. These injuries involve disruption of the scapholunate ligament, leading to abnormal motion and malalignment of the carpal bones. Careful assessment of the injury pattern, including the degree of displacement and associated injuries, is essential for developing an appropriate treatment plan. Conservative management with immobilization may be appropriate for stable, minimally displaced injuries, but many scapholunate dislocations require surgical intervention to restore anatomic alignment and carpal stability. Surgical techniques may include open reduction and ligament repair or reconstruction, as well as limited or complete carpal bone excision. Successful management of these injuries requires a thorough understanding of carpal anatomy and biomechanics, as well as meticulous surgical technique to minimize the risk of long-term complications, such as post-traumatic arthritis, instability, and loss of wrist function. Prompt diagnosis and appropriate treatment of scapholunate dislocations is crucial to optimize outcomes and prevent long-term disability.
6. Hand fracture and dislocation

Fractures and dislocations of the hand can be complex and challenging injuries to manage, as they can involve single or multiple bones and joints, and can result in significant functional impairment if not properly treated. These injuries often result from high-energy trauma, such as motor vehicle accidents or falls from a height, and can be associated with soft tissue injuries, neurovascular compromise, and other concomitant injuries. Careful assessment of the injury pattern, including the degree of displacement and associated injuries, is essential for developing an appropriate treatment plan. Conservative management with immobilization may be appropriate for stable, minimally displaced injuries, but many hand fractures and dislocations require surgical intervention to restore anatomic alignment and joint stability. Surgical techniques may include open reduction and internal fixation, ligament repair or reconstruction, and/or limited or complete bone excision. Successful management of these injuries requires a thorough understanding of hand anatomy and biomechanics, as well as meticulous surgical technique to minimize the risk of long-term complications, such as post-traumatic arthritis, instability, and loss of hand function. Prompt diagnosis and appropriate treatment of hand fractures and dislocations is crucial to optimize outcomes and prevent long-term disability.
7. Thumb CMC joint dislocation, metacarpal fractures, MP joint dislocations

Injuries to the thumb, including CMC joint dislocations, metacarpal fractures, and MP joint dislocations, can be particularly debilitating due to the important role of the thumb in hand function. These injuries often result from high-energy trauma, such as falls or motor vehicle accidents, and can be associated with significant soft tissue damage and neurovascular compromise. Careful assessment of the injury pattern, including the degree of displacement and associated injuries, is essential for developing an appropriate treatment plan. Conservative management with immobilization may be appropriate for stable, minimally displaced injuries, but many of these injuries require surgical intervention to restore anatomic alignment and joint stability. Surgical techniques may include open reduction and internal fixation, ligament repair or reconstruction, and/or limited or complete bone excision. Successful management of these injuries requires a thorough understanding of thumb and hand anatomy and biomechanics, as well as meticulous surgical technique to minimize the risk of long-term complications, such as post-traumatic arthritis, instability, and loss of hand function. Prompt diagnosis and appropriate treatment of thumb, metacarpal, and MP joint injuries is crucial to optimize outcomes and prevent long-term disability.