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Ther hand is placed on distal fragment break up impaction wrist is hyperextended dorsal displacement and rotation is corrected apply traction and countertraction continue thumb pressure on distal fragment distal fragment dorsal cortex apposed with proximal radial and dorsal angulation corrected apply ulnar and volar pressure over distal fragment assess if length is restored palpate radial styloid management: finger trap reduction (technique 2) anesthesia as above break up impaction by hyperextending wrist place index finger and thumb in finger traps apply counterweight to upper arm manipulate fracture as above management: immobilization with sugar tong splint fluoroscopy (c-arm) confirms alignment during splinting assistant applies steady traction at hand wrist in slight pronation avoid volar flexion of wrist risk of median nerve compression (carpal tunnel) apply cast padding from mcp heads to above elbow apply felt pad to volar surface of proximal fragment splint with 10 cm wide, 12 plaster plies around elbow dorsal half ends at mcp heads mold over the distal fragment volar half ends 1-2 cm distal to fracture maintain wrist in ulnar deviation wrap a strip of plaster around distal splint include distal mcp keep strip proximal to distal palmar crease ace wrap sugar tong in place management: isolated distal radius fracture non-displaced distal radius fracture (torus fracture) immobilize in a short arm cast for 3 weeks displaced and overlapping distal radius fracture ulna fracture also see colles fracture management above ulna greenstick fracture complete ulna fracture for adequate reduction manage as colles fracture ulna intact or greenstick fracture do not re-fracture reduction may be quite difficult maximally supinate wrist digital pressure to replace the distal radius alignment is paramount re-align as best as possible apposition is secondary to alignment bayonet apposition is acceptable management: discharge instructions ice for 72 hours elevation maintain active range of motion of fingers and shoulder shoulder sling do not use longer than 2-3 days risk of shoulder stiffness management: orthopedic referral indications distal radius dorsal angulation >5 to 10 degrees radial inclination change >5-10 degrees radial height shortening >2 mm young athletes, or those with occupation or hobby requiring highly functional hand and wrist rotational deformity tolerated (criteria contingent on 50% apposition or greater) age >8 years: refer for >10 degrees rotational deformity age <. cheap generic viagra buy generic viagra buy viagra online buy viagra medicaresupplementspecialists.com/pfz-buy-online-viagra-pa/ http://medicaresupplementspecialists.com/pfz-sale-viagra-rp/ buy generic viagra buy generic viagra viagra online buy cheap viagra Our MissionThis Month @ St. John'sWorship & MusicGatherings & KidsHarvest & MissionPastors' Blog