A distal radius fracture, also known as wrist fracture, is a break of the part of the radius bone which is close to the wrist. Symptoms include pain, bruising, and. La fractura de Colles se caracteriza por una posición hacia atrás y hacia afuera de la mano en relación a la muñeca. Fractura de Colles. Learn more about Fractura de Colles at Virginia Complete Care for Women DefiniciónCausasFactores de riesgoSíntomasDiagnósticoTratamientoPrevenció.. .

A distal radius fracturealso known as wrist fractureis a break of the part of the radius bone which is close to the wrist. In younger people, these fractures typically occur during sports or a motor vehicle collision. Treatment is with casting for six weeks or surgery.

Distal radius fractures are common. People usually present with a history of falling on an outstretched hand and complaint of pain and swelling around the wrist, sometimes with deformity around the wrist.

Any pain in the limb of the same side should also be investigated to exclude associated injuries to the same limb. Swelling, deformity, tenderness, and loss of wrist motion are normal features on examination of a person with a distal radius fracture. Reverse deformity is seen in volar angulation Smith’s fracture. The wrist may be radially deviated due to shortening of the radius bone.

Fractura de Colles by Makoke Robles on Prezi

Decreased sensation fracturaa the thenar eminence can be due to median nerve injury. Swelling and displacement can cause compression on the median nerve which results in acute carpal tunnel syndrome and requires prompt treatment.

Very rarely, pressure on the muscle components of the hand or forearm is sufficient to create a compartment syndrome. The most common cause of this type of fracture is a fall on an outstretched hand from standing height, although some fractures will be due to high-energy injury. People who fall on the outstretched hand are usually fitter and have better reflexes when compared to those with elbow or humerus fractures.

The characteristics of distal radius fractures are influenced by the position of the hand at the time of impact, the type of surface at point of contact, the speed of the impact, and the strength of the bone. Distal radius fractures typically occur with the wrist bent back from 60 to 90 degrees. If the wrist is bent back less, then proximal forearm fracture would occur, but if the bending back is more, then the carpal bones fracture would occur.

With increased bending back, more force is required to produce a fracture. More force is required to produce a fracture in males than females. Risk of injury increases in those with osteoporosis. Common injuries associated with distal radius fractures are interosseous intercarpal ligaments injuries, especially scapholunate 4. There is an increased risk of interosseous intercarpal injury if the ulnar variance the difference in height between the distal end of the ulna and the distal end of the radius is more than 2mm and there is fracture into the wrist joint.

Ulnar styloid process fracture increases the risk of TFCC injury by a factor of 5: However, it is unclear whether intercarpal ligaments and triangular fibrocartilage injuries are associated with long term pain and disability for those who are affected.

Diagnosis may be evident clinically when the distal radius is deformed, but should be confirmed by X-ray. The differential diagnosis includes scaphoid fractures and wrist dislocations, which can also co-exist with a distal radius fracture. Occasionally, fractures may not be seen on X-rays immediately after the injury. X-ray of the affected wrist is required if a fracture is suspected.

Posteroanterior, lateral, and oblique views can be used together to describe the fracture.

fractura de Colles – English Translation – Word Magic Spanish-English Dictionary

A CT scan is often performed to further investigate the articular anatomy of the fracture, especially for fracture and displacement within the distal radio-ulnar joint. Various kinds of information can be obtained from X-rays of the wrist: There are many classification systems for distal radius fracture. There are three major groups: A—extra-articular, B—partial articular, and C—complete articular which can further subdivided into nine main groups and 27 subgroups depending on the degree of communication and direction of displacement.

However, none of the classification systems demonstrate good liability. A qualification modifier Q is used for associated ulnar fracture. Correction should be undertaken if the wrist radiology falls outside the acceptable limits: Treatment options for distal radius fractures include nonoperative management, external fixation, and internal fixation. Indications for each depend on a variety of factors such as the patient’s age, initial fracture displacement, and metaphyseal and articular alignment, with the ultimate goal to maximize strength and function in the affected upper extremity.

Treatment is often directed to restore normal anatomy to avoid the possibility of malunion, which may cause decreased strength in the hand and wrist. Distal radius fractures are often associated with distal radial ulnar joint DRUJ injuries, and the American Academy of Orthopaedic Surgeons recommends that postreduction lateral wrist X-rays should be obtained in all patients with distal radius fractures in order to preclude DRUJ injuries or dislocations.

The majority of distal radius fractures are treated with conservative nonoperative management, which involves immobilization through application of plaster or splint with or without closed reduction. Variations in immobilization techniques involve the type of cast, position of immobilization, and the length of time required in the cast.

For those with low demand, cast and splint can be applied for two weeks. In those who are young and active, if the fracture is not displaced, the patient can be followed up in one week.

If the fracture is still undisplaced, cast and splint can be applied for three weeks.

If the fracture is displaced, then manipulative reduction or surgical stabilisation is required. Shorter immobilization is associated with better recovery when compared to prolonged immobilization. Therefore, follow up within the first week of fracture is fraxtura. Subsequent follow ups at two to three weeks are therefore also important. Where the fracture is undisplaced and stable, nonoperative treatment involves immobilization.

Initially, a backslab or a fracthra tong splint is applied to fracturw swelling to expand and subsequently a cast is applied.

However, an above-elbow cast may cause long-term rotational contracture. However, neutral and dorsiflex position may not affect the stability of the fracture. In displaced distal radius fracture, in those with low demands, the hand can be cast until the person feels fracturw.

If the fracture affects the median nerveonly then is a reduction indicated. If the post reduction radiology of the wrist is acceptable, then the person can come for follow up at one, two, or three weeks to look for any displacement of fractures during this period. If the reduction is maintained, then the cast should continue for 4 to 6 coples. If the fracture is displaced, surgical management is the proper treatment. Therefore, periodic reviews are important to prevent malunion of the displaced fractures.

Closed reduction of a distal radius fracture involves first collee the affected area with a hematoma blockintravenous regional anesthesia Bier’s blocksedation or a general anesthesia. The deformity is then reduced with appropriate closed manipulative depending on the type of deformity reductionafter which a splint or cast is placed and an X-ray is taken to ensure that the reduction was successful.

The cast is usually maintained for about 6 weeks.

Failure of nonoperative treatment leading to functional impairment and anatomic deformity is the largest risk associated with conservative management. Prior studies have shown that the fracture often redisplaces to its original position even in a cast.

In people over 60, functional impairment can last for more than 10 years. Despite these risks ce nonoperative treatment, more recent systematic reviews suggest that when indicated, nonsurgical management in the elderly population may lead to similar functional outcomes as surgical approaches.

In these studies, no significant differences in pain scores, grip strength, and range of motion in patients’ wrists occurred when comparing conservative nonsurgical approaches with surgical management. Although the nonsurgical group exhibited greater anatomic misalignment such as radial deviation, and ulnar variance, these changes did not seem to have significant impact on overall pain and quality of life. The techniques of surgical management include open reduction internal fixation ORIF fradtura, external fixationpercutaneous pinningor some combination of the above.

The choice of operative treatment is often determined by the type of fracture, which can be categorized broadly into three groups: Significant advances have been made in ORIF treatments. Two newer treatment are fragment-specific fixation and fixed-angle volar plating. These attempt fixation rigid enough to allow almost immediate mobility, in an effort to minimize stiffness and improve ultimate function; no improved final outcome from early mobilization prior to 6 weeks after surgical fixation has been shown.

Distal radius fracture

The alignment of the DRUJ is also important, as this can be a source of a pain and loss of rotation after final healing and maximum recovery. An arthroscope can be frwctura at the time fractuta fixation to evaluate for soft-tissue injury. Structures at risk include the triangular fibrocartilage complex and the scapholunate ligament. Scapholunate injuries in radial styloid fractures where the fracture line exits distally at the scapholunate interval should be considered.

Prognosis varies depending on dozens of variables. If the anatomy bony alignment is not properly restored, function cplles remain poor even after healing.

Restoration of bony alignment is not a guarantee of success, as soft tissue contributes significantly to the healing process. These fractures are the most common of the three groups mentioned above that require surgical management. Manipulative reduction and immobilization were thought to be appropriate for metaphyseal unstable fractures.

However, several studies suggest this approach is largely ineffective in patients with high functional demand, and in this case, more stable fixation techniques should be used. Surgical options have been shown to be successful in patients with unstable extra-articular or minimal articular distal radius fractures. These options include percutaneous pinning, external fixation, and ORIF using plating. Patients with low functional demand of their wrists can be treated successfully with nonsurgical management; however, in more active and fit patients with fractures that are reducible by closed means, nonbridging external fixation is preferred, as it has less serious complications when compared to other surgical fravtura.

If the fractures are unlikely to be reduced by closed means, open reduction with internal plate fixation is preferred.

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These fractures, although less common, often collez surgery in active, healthy patients to address displacement of both the joint and the metaphysis. The two mainstays of treatment are bridging external fixation or ORIF. Percutaneous pinning is preferred to plating due to similar clinical and radiological outcomes, as well as lower costs, when compared to plating, despite increased risk of superficial infections.

Impairment is the abnormal physical function, such as lack of forearm rotation. It is measured clinically. Disability is the lack of ability to perform physical daily activities. Examples of scoring system based on clinical assessment are: These scores includes assessment of range of motiongrip strength, ability to perform activities of daily living, and radiological picture.

However, none of the three scoring system demonstrated good reliability. These scoring systems measures the ability of a person to perform a task, pain farctura, presence of tingling and numbness, the effect on activities of daily living, and self-image. Both scoring systems show good reliability fracturx validity.

Get this from a library! Lecciones de criminología. [Carmelo Flores Cazorla]. Lecciones de criminología / Carmelo Flores Cazorla. By: Flores Cazorla, Carmelo. Material type: materialTypeLabel BookPublisher: Caracas: Vadell Hermanos. Lecciones de criminología. By Carmelo Flores Cazorla. About this book. Reviews . User reviews. We haven’t found any reviews in the usual places. Write review.

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John Steinbeck’s short story “The Chrysanthemums” is about a proud, strong woman named Elisa Allen who feels frustrated with her present life. Her frustration. Complete summary of John Steinbeck’s The Chrysanthemums. eNotes plot summaries cover all the significant action of The Chrysanthemums. The Chrysanthemums study guide contains a biography of John Steinbeck, literature essays, quiz questions, major themes, characters, and a.

The high grey-flannel fog of winter closed off the Salinas Valley from the sky and from all the rest of the world. On every side it sat like a lid on the mountains and made of the great valley a closed chrysanthemym. On the broad, level land floor the gang plows bit deep and left the black earth shining like metal where the shares had cut.

On the foothill ranches across the Salinas River, the yellow stubble fields seemed to be bathed in pale cold sunshine, but there was no sunshine in the valley now in December. The thick willow steinneck along the river flamed with sharp and positive yellow leaves. It was a ateinbeck of quiet and of waiting. The air was cold and tender.

“The Chrysanthemums” by John Steinbeck | Literary Fictions

A light wind blew up from the southwest so that the farmers were mildly hopeful of a good rain before long; but fog and rain did not go together. The cattle on the higher slopes were becoming shaggy and rough-coated. Elisa Allen, working in her flower garden, looked down across the yard and saw Henry, her husband, talking to two men in business suits.

The three of them stood by the tractor shed, each man with one foot on the side of the little Fordson. steeinbeck

They smoked cigarettes joh studied the machine as they talked. Elisa watched them for a moment and then went back to her work. Her face was lean and strong and her eyes were as clear as water. She wore heavy leather gloves to protect her hands while she worked.

She looked down toward the men by the tractor shed now and then. Her face was eager and mature and handsome; even her work with the scissors was over-eager, over-powerful. The chrysanthemum stems seemed too chrysaanthemum and easy for her energy. She brushed a cloud syeinbeck hair out of her eyes with the back of her glove, and left a smudge of earth on her cheek in doing it. Behind her stood the neat white farm house with red geraniums close-banked around it as high as the windows.

It was a hard-swept looking little house, with hard-polished windows, and a clean mud-mat on the front steps.

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Elisa cast another glance toward the tractor shed. The strangers were getting into their Ford coupe. She took off a glove and put her strong fingers down into the forest of new green chrysanthemum sprouts that were growing around the old roots. She spread the leaves and looked down among the close-growing stems. No aphids were there, no sowbugs or snails or cutworms. Her terrier fingers destroyed such pests before they could get started.

He chrysanthemuk come near quietly, and he leaned over the wire fence that protected her flower garden from cattle and dogs and chickens.

Elisa straightened her back and pulled on the gardening glove again. My mother had it. She could stick anything in the ground and make it grow. They were from the Western Meat Company.

I sold those thirty head of three-year-old steers. Got nearly my own price, too. Henry put on his joking tone. She heard her husband calling Scotty down by the barn. And a little later she saw the two men ride up the pale yellow hillside in search of the steers. There was a little square sandy bed kept for rooting the chrysanthemums. With her trowel she turned the soil over and over, and smoothed it and patted it firm.

Then she dug ten parallel trenches to receive the sets. Back at the chrysanthemum bed she pulled out the little crisp shoots, trimmed off the leaves of each one with her scissors and laid it on a small orderly pile. A squeak of wheels and plod of hoofs came from the road. The country road ran along the dense bank of willows and cotton-woods that bordered the river, and up this road came a curious vehicle, curiously drawn. It was an old spring-wagon, with a round canvas top on it like the cover of a prairie schooner.

It was drawn by an old bay horse and a little grey-and-white burro. A big stubble-bearded man sat between the cover flaps and drove the crawling team. Underneath the wagon, between the hind wheels, a lean and rangy mongrel dog walked sedately. Words were painted on the canvas in clumsy, crooked letters.

stfinbeck The black paint had steijbeck down in little sharp points beneath each letter. Elisa, squatting on the ground, watched to see the crazy, loose-jointed wagon pass by. It turned into the farm road in front of her house, crooked old wheels skirling and squeaking. The rangy dog darted from between the wheels and ran ahead.

Instantly the two ranch shepherds flew out at him. Then all three stopped, and with stiff and quivering tails, with taut straight legs, with ambassadorial dignity, they slowly circled, sniffing daintily. Now the newcomer dog, feeling outnumbered, lowered his tail and retired under the wagon with raised hackles and bared teeth. The man caught up her laughter and echoed it heartily. He climbed stiffly down, over the wheel. The horse and the donkey drooped like unwatered flowers.

Elisa saw that he was a very big man. Although his hair and beard were graying, he did not look old. His worn black suit was wrinkled and spotted with grease. The laughter had disappeared from his face and eyes the moment his laughing voice ceased. His eyes were dark, and they were jobn of the brooding that gets in the eyes stdinbeck teamsters and of sailors.

The calloused hands he rested on the wire fence were cracked, and every crack was a black line. He took off ojhn battered hat. Elisa stood up and shoved the thick scissors in her apron pocket. He drew a big finger down the chicken wire and made it sing.

I go from Seattle to San Diego and back every steiinbeck. Takes all my time. About six months each way. I aim to follow nice weather. Elisa took off her gloves and stuffed them in the apron pocket with the scissors.

He leaned confidentially over the fence. I mend pots and sharpen knives and scissors. You got any of them things to do? I got a special tool. But it sure does the trick. His face fell to an exaggerated sadness. His voice took on a whining undertone. I know folks on the highway clear from Seattle to San Diego. They save their things for me to sharpen up because they know I do it so good and save them money.

His eyes left her face and fell to searching the ground. They roamed about until they came to the chrysanthemum bed chryzanthemum she had been working.

I raise them every year, dteinbeck than anybody around here. The man leaned farther over chrysantyemum fence. I know a lady down the road a piece, has got the nicest garden you ever seen.

Got nearly every kind of flower but no chrysanthemums. And then she can transplant them. She tore off the battered hat and shook out her dark pretty hair. Come into the yard. While the man came through the picket fence Elisa ran excitedly along the geranium-bordered path to the back of the house. And she returned carrying a big red flower pot. The chrysanthemmum were forgotten now. She kneeled on the ground by the starting bed and dug up the sandy soil with her fingers and scooped it into the bright new flower pot.

Then she picked up the little pile of shoots she had prepared. With her strong fingers she pressed them into the sand and tamped around them with her knuckles. The man stood over her. These will take root in about a month. Then she must set them out, about a foot apart in fhrysanthemum rich earth like this, see?