modified lafontaine criteria

%%EOF There are many classification systems within orthopedics. Interviews with elders are providing cultural context. Clipping is a handy way to collect important slides you want to go back to later. Before (2.5 cm) or less, measured at the level of the fourth intercostal space. initial radial shortening >5mm. Jacobs interpreted the wrist as having three columns each subjected to different mechanical forces and having discrete elements. Now, if any of these criteria are met, the cardiac . Common Things Happen Commonly!. It usually fails with impaction and needs elevation and stabilisation. Revision of femoral component to long porous-coated cementless stem and fixation of the fractures fragment. 1 Other method is gradual traction using Chinese finger traps and counter weights. What is the next best step in management of this patient? Following fixation, a "shuck" test is performed and shows persistent instability of the distal radioulnar joint. Current radiographs are shown in Figure D and a clinical photograph of the affected wrist is shown in Figure E. Which of the following is the most likely cause for failure of fixation in this patient? Hand Surg Rehabil. Overall, the FMS rate among all of the study patients increased from 38% to 45%. To see my talk on distal radius fractures please visit, http://orthopaedicprinciples.com/2012/05/distal-radius-fractures/, Copyright @Dr Rajesh Purushothaman, Additional Professor of orthopaedics, Government Medical College, Kozhikode, Kerala, India. The modified PIOPED II criteria for the diagnosis of pulmonary embolus indicate the presence or absence of pulmonary emboli based on findings on V/Q scan (ventilation-perfusion scintigraphy). Immediate post-operative radiographs are seen in Figure A. Vascular injury is most common in this type due to common fracture-dislocation of the knee, High energy fracture, be aware of vascular injury, Knee immobilizer, non weight bearing commonly used in ED, Hinged knee brace, partial weight bearing 8-12 weeks, immediate passive ROM, Minimally displaced split or depressed fractures, Low energy fracture stable to varus/valgus alignment, External fixation +/- limited open/percutaneous fixation of articular segment (screws hold the articular surface together while in the ex fix, Severe open fracture with marked contamination, Highly comminuted fractures where internal fixation not possible, Can bridge to ORIF if soft tissue injury/polytrauma, The system is based off where the fracture line on the fibula hits the tibio-talar joint, Weber A the fracture line is below/distal to the level of the ankle joint, Weber B, the fracture line has a component at the level of the ankle joint, Get a gravity stress view xray to check for widening of the medial clear space (if there isnt obvious widening already), Weber C, the fracture line is above the ankle joint, Assume that there is a higher fibula fracture if there is widening of the medial clear space or an isolated medial malleolus fracture, It stands for the position the ankle was in for the injury to occur, Start by looking at the fibula, is it a high or low fibula fracture, The SAD ankle has a vertical medial fracture, Supination external rotation (spiral fibula means there was a twisting component), Look for spiral component and high fibula, Isolated nondisplaced medial mal fracture or tip avulsions, Isolated lateral mal fracture with <3mm displacement, no talar shift, Bimal fracture if elderly or unable to undergo surgery, Posterior mal <25% joint involvement <2mm step-off, Open reduction internal fixation (plates and screws), Bimalleolar equivalent fractures (lateral mal fracture with widening of medial clear space between talus and medial mal due to disruption of the deltoid ligament, often found on gravity stress views), Posterior mall fracture with >25% or >2mm step off, Approaching skeletal maturity (<2y growth), 14-16 boys, 12-14 girls, Posterior arm splint, then long arm cast 3-4 weeks, Displaced, deformity in sagittal plane only (posterior hinge), Displaced in 2 or 3 planes (sagittal and coronal), CRPP, ORIF if needed based on inability to reduce fragment closed, may be interposed periosteum, Complete periosteal disruption (only identified in operating room), Collapse of medial column, may look like a type 1. A strong correlation was found between these criteria and the risk of secondary displacement, despite a correct initial reduction. BACKGROUND: The ability of the decades-old Boston and Philadelphia criteria to accurately identify infants at low risk for serious bacterial infections has not been recently reevaluated. Concordant ST elevation 1 mm in leads with a positive QRS complex. In those with severe intra-articular comminution and in elderly patients with osteoporosis this treatment is inappropriate. According to meta-analysis and systematic reviews, which of the following statements is most accurate regarding her injury? It is designed to fix each major fracture fragment by an implant specifically designed for that fragment. Consequently, their control in the food/feed chain by GMO enforcement laboratories is required by the competent authorities to . (SBQ17SE.75) A 45-year-old construction worker sustains a fall and presents with an isolated injury to his upper extremity. Usually 3.5mm Schanz screws are used for radius and 2.5 mm for metacarpals. The following inclusion criteria were used: (1) presence of 3 or more instability factors as described by Lafontaine et al 6 (intra-articular, dorsal comminution, dorsal angulation > 20, associated ulna fracture, age > 60 y), (2) adequate plain radiographs of the distal radius including posteroanterior and lateral views from the date of injury, after reduction, and 1 week, 2 weeks, and 4 weeks . The reason the original Sgarbossa criteria are limited in clinical practice is the low sensitivity (i.e. It is shown that the use of base isolation in this building caused the base overturning . What is the most appropriate treatment at this time? A 45-year-old male injures his wrist during Live Action Role Play in Chicago two weeks ago. Even those that require surgery should be reduced as it reduces pain and relieves pressure on soft tissue structures. In other words, the modified Sgarbossa criteria only changes the last of the original Sgarbossa criteria with the first two criteria staying intact. [2] Relying upon City of Indianapolis v. Edmond,[3] this Court modified the first of the LaFontaine criteria to further require a showing by the State that the roadblock program was implemented at the programmatic level for a legitimate primary purpose, i.e., proof that the roadblock was ordered by a supervisor and . Volar ligaments are attached to the volar rim. HHS Vulnerability Disclosure, Help Nerve compression; open reduction internal fixation with open carpal tunnel release, Nerve laceration; open reduction internal fixation with primary nerve repair or grafting, Decreased arterial inflow; fasciotomy with open reduction internal fixation, Nerve compression; repeat closed reduction. Volar plates should not be placed beyond this line as it would project anteriorly and also lack the coverage by pronator quadratus and cause flexor tendon irritation. We've updated our privacy policy. Patients with 3 or more factors have high chance of loss of reduction. Gustillo-Anderson Classification (For Open Fractures), Laceration >1cm <10cm without signs of high energy (Extensive soft tissue injury despite intact skin), All high energy open fractures or those with gross contamination regardless of the size of the wound are type 3, Type 3 A: Adequate soft tissue for coverage of fracture, Type 3 B: Inadequate soft tissue coverage, flap required, Type 3 C: Associated arterial injury requiring repair, La Fontaines Criteria (Predictors of distal radius fracture instability), Neers Classification (Proximal humerus fractures), A part is considered separate if there is displacement of >10mm or 45degrees of angulation, (this is actually quite of bit of displacement and angulation). It is also contra-indicated along with plating as k-wires can act as a conduit for spread of infection. A 70-year-old woman with known osteoporosis sustains a distal radius fracture of her dominant arm with some metaphyseal comminution. Fifty patients with 3 or more instability factors as described by Lafontaine were treated by finger trap traction, closed reduction, and sugar-tong splinting. Here are the systems that we have found are commonly discussed in fracture conference that would be good to be familiar with for your ortho trauma rotations. mechanism of injury. href=https://learningorthopaedics.files.wordpress.com/2013/03/20130310-193944.jpg> Non-operative treatment is sufficient in undisplaced fractures and reducible and stable fractures. href=https://learningorthopaedics.files.wordpress.com/2013/03/20130310-193850.jpg> Once the acceptable reduction is achieved within these parameters then the next question is whether the position will remain stable till union. (OBQ18.223) Can remember the first three types with the boyfriend/girlfriend breakup analogy; you split, then you are split and depressed, then just depressed. Radial column is formed by the scaphoid fossa and the radial styloid. A 54-year-old male falls from a ladder and sustains the fracture shown in Figure A. fall on outstretched hand (FOOSH) is most common in older population. In extra articular fractures, successful outcome needs restoration of certain parameters like radial length, radial inclination and palmar tilt. Dos 6 a 12 anos: O momento imperdvel das regras! A roadblock to check sobriety and operator's permits was legal where every driver was stopped, except backed-up traffic which the officers allowed to clear for the public's protection. Among these variables radial shortening is the most predictive of instability followed by dorsal comminution. Ruschel modification is addition of a lateral intrafocal pin to restore radial inclination and shift. The methodology of RAND/UCLA appr-opriateness was used to develop consensus guidance statements. A 68-year-old male falls onto his outstretched hand and suffers the injury shown in Figures A and B. (OBQ07.226) [1][2][3] Classification of distal radius fractures. Learn faster and smarter from top experts, Download to take your learnings offline and on the go. 8600 Rockville Pike In between the volar ligaments and pronator quadratus lies the intermediate fibrous zone. He sustains the injury shown in Figure A. These criteria, as well as age over 60 years, were considered as gravity factors. Kerala, India, https://learningorthopaedics.files.wordpress.com/2013/03/20130310-193744.jpg>, https://learningorthopaedics.files.wordpress.com/2013/03/20130310-193850.jpg>, https://learningorthopaedics.files.wordpress.com/2013/03/20130310-193944.jpg>, https://learningorthopaedics.files.wordpress.com/2013/03/20130310-194046.jpg>, https://learningorthopaedics.files.wordpress.com/2013/03/20130310-194135.jpg>, A Short Guide to Musculoskeletal System Examination, Plantar Plate Insufficiency or Rupture (Turf Toe), Basics of radiation safety for the orthopaedic surgeons, Ward Rounds- A recently neglected part of inpatient care, Meniscus Lesions Tied to Neuropathic Pain in Knee OA, Alternate Bearing Surfaces- Evidence so far. Read the Court's full decision on FindLaw. A 32-year-old inebriated male falls from a mechanical bull at a bar and sustains a closed displaced intra-articular distal radius fracture. Learn vocabulary, terms, and more with flashcards, games, and other study tools. An official website of the United States government. Inability to flex the thumb interphalangeal joint. But ideally the fixator chosen should be radiolucent, allow independent positioning of pins, should allow re-reduction if needed. Rua Francisca Sales, 90 Rio de Janeiro, RJ : 7446890Estimated value : CAN $788,052.00 (plus applicable tax)Closing date : 2023-01-27 - 2:00 PM Eastern Standard TimeProject Title: Rental of Venue for Venue for the 2023 Global Environment Facility (GEF)Category: Event PlanningTender Type: Advance Contract Award Notice (ACAN)Region of Delivery: British ColombiaRegion of Opportunity . It allows placement of implants in orthogonal planes. (SBQ17SE.13) At the lateral edge of volar surface lies the radial septum, which gives insertion to the brachioradialis. Adhesions within the first and third dorsal wrist compartments. Which plating option provides the most appropriate treatment of this fracture? 10. Radiographs show a well-fixed fracture in good alignment. Fracture around stem or just below it, with a loose stem, but poor quality proximal bone stock or severely comminuted, Femoral component revision with proximal femoral allograft, Fracture occurs well below the prosthesis. State. Objective: To reach consensus on the diagnostic criteria for deficiency syndrome in hypertension (YDSH) patients by a modified Delphi method. Radiographic signs that suggest instability are (Lafontaines criteria), Dorsal angulation >20 Modified LaFontaine criteria, and sufficient to be treated. . Bado Classification (Monteggia fractures, ulnar shaft + radial head dislocation), Fracture of proximal or middle third ulna with, Fracture of ulna metaphysis, distal to coronoid with, Thoracolumbar Injury Classification and Severity Score (TLICS for Thoracolumbar Burst Fractures), Young-Burgess Classification (Pelvic Ring Injuries), anterior and posterior sacroiliac (SI) ligaments, Letournel Classification (Acetabular Fractures), Denis Classification (Pronounced like Den-ee), Pipkin Classification (Femoral Head Fractures), Garden Classification (Elderly Femoral Neck fractures), Pauwels Classification (Young Femoral Neck Fractures based on verticality of fracture line), Vancouver Classification (Fractures Around Arthroplasty Stems), Fracture around stem or just below it, with a, Fracture around stem or just below it, with a loose stem, but, poor quality proximal bone stock or severely comminuted, Schatzker Classification (Tibial plateau fractures), ascular injury is most common in this type due to common fracture-dislocation of the knee, Non Operative indications for ankle fractures, Operative indications for ankle fractures, Gartner Classification (Supracondylar humerus fractures), Pediatric Tibial Shaft Fracture Parameters, Checklists: Admission, Pre-Op and Post-Op, 7/18/21 Newsletter: Unstable Intertrochanteric Femur Fractures, 7/4/21 Newsletter: Tibial Plateau Fractures and Vascular Injury, 6/4/21 Newsletter: Humeral Shaft Fractures Discussion. Usin Genito-urinary Surgery And Anesthesia.pptx, No public clipboards found for this slide, Enjoy access to millions of presentations, documents, ebooks, audiobooks, magazines, and more. Twenty two per cent of the patients met criteria for Meige . The patient shows you the lateral film in Figure A. Non operative minimally or non-displaced. Patients who underwent arthrocentesis were included and the modified Kocher criteria were applied to all. It appears that you have an ad-blocker running. Vancouver classification has classifications for intraoperative fractures and post operative fractures, listed below are for postoperative fractures. Additional Professor of Orthopaedics He denies any new trauma, and has followed all post-operative activity restrictions. Injury 1989;20(4):208-10. A 58-year-old man underwent distal radius ORIF with a volar locking plate yesterday. (OBQ12.38) Site Number. Enter your email address to subscribe to this blog and receive notifications of new posts by email. MENU. Sacrotuberous and spinous ligaments torn. We previously identified BP1026B_I0091 as a surface attachment protein (Sap1) and an essential virulence factor, contributing to Bp pathogenesis in vitro and in vivo. There are no open wounds and the hand is neurovascularly intact. Neste perodo de pandemia provocado pelo COVID-19 nosso atendimento est sendo The first and last groups represent insufficiency fractures and the middle one represent traumatic fractures. Admit for acute carpal tunnel syndrome monitoring, Admit for acute open reduction/internal fixation, Place into removable soft splint and follow-up in clinic, Place into rigid splint and follow-up in clinic, Place into rigid splint and schedule for outpatient open reduction/internal fixation. You can read the details below. Recently, Steven Smith, MD from Dr. Smith's ECG Blog published a new criterion to replace the third component of the original Sgarbossa Criteria . Variable angle locking plates allow an independent trajectory to be chosen for individual distal screws to match the variable geometry and surface contour of distal radius. residual 1.0 1.0 Adjusted residual 1.0 1.0 Development . A 51-year-old female presents with an acute inability to extend her thumb, four months after she was treated with cast immobilization for a minimally-displaced distal radius fracture. Long arm cast above the elbow for 6 weeks, Long arm cast for 3 weeks followed by a short arm cast for 3 additional weeks, Closed reduction and percutaneous pinning. A 32-year-old ballet dancer sustains a distal radius fracture, and is subsequently closed reduced and casted. She complains of wrist pain and deformity. Pathophysiology. Brachioradialis is step-cut in extended flexor carpi radialis approach to access the dorsal surface in complex intra-articular fractures of distal radius. Anterior symphyseal multi-hole plate or ex fix, Posterior stabilization with plate or screws, Oblique or transverse ramus fracture and ipsilateral anterior sacral ala compression fracture, Can be subtle, if rami fracture, look for compression frx of sacrum on the same side, Protected weight bearing for complete and comminuted sacral frx, Weight bearing as tolerated (WBAT) for simple, incomplete, Rami fracture and ipsilateral posterior ilium fracture dislocation, Ipsilateral compression and contralateral APC (windswept pelvis), Posterior stabilization with plate or SI screws, Binder may not be helpful, unless coupled with symphysis widening, Anterior column or wall + Posterior hemitransverse, Non operative with protected weight bearing, May need exam under anesthesia to look for instability, Femoral head congruence with weight bearing roof (out of traction), Both column fracture with secondary congruence of head and weight bearing roof (out of traction), Displaced fracture with roof arc >45deg in AP and Judet views or >10mm on axial CT cuts, Unstable fracture pattern (posterior wall >40-50%), L4 L5 transverse process fractures are associated with high energy trauma and other fractures of sacrum/pelvis, L5 nerve root (great toe extension and 1st web space) runs anterior to sacrum and is susceptible to injury with sacral fractures, Fracture medial to foramina into spinal canal, Highest rate of neuro deficit (60%), bowel, bladder, sexual dysfunction, Persistent pain after non-operative management, Displacement of fracture after non-operative management, Fracture below fovea, below the weight bearing portion, TTWB for 4-6 weeks, restrict adduction and internal rotation, Fx superior to fovea/ligamentum in weight bearing portion of femoral head, Type 1 or 2 with a posterior wall acetabular fracture, Pipkin 2 with >1mm step off, Pipkin 3 and 4, Arthroplasty in elderly for Pipkin 1, 2 (displaced), 3, and 4, Arthroscopy is an option for removal of loose bodies, Used in low energy injury elderly patients, not high energy injuries in young patients, If fracture line is basicervical (at the base of the femoral neck near the trochanteric portion of the femur) then dynamic hip screw is an option, Femoral neck fractures are intracapsular (except basicervical) and dont heal well due to blood supply disruption if displaced and synovial fluid getting in fracture site, Closed reduction percutaneous pinning (CRPP) with screws in inverted triangle, Total hip arthroplasty in higher demand and more active individual (<85 years), Often used in higher energy young patients, Femoral neck fractures are intracapsular (except basicervical), The more vertical the fracture line, the more shear forces pushing the fragments apart, less likely to heal, ORIF for displaced fractures in young patients most <65 years old, >50 deg from horizontal (highest risk of nonunion and AVN), If DHS fails, valgus producing osteotomy and blade plate is an option, Extracapsular femur fracture (heals better than intracapsular), Fracture line extends from Greater trochanter to lesser trochanter, Reverse obliquity (frx line extends from proximal medial to lateral distal), Lateral wall comminution or thin lateral wall. 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Require surgery should be reduced as it reduces pain and relieves pressure on soft tissue modified lafontaine criteria the hand neurovascularly. And has followed all post-operative activity restrictions of her dominant arm with some metaphyseal comminution as age over years... This patient at the lateral film in Figure a in management of patient... Eof There are many classification systems within orthopedics GMO enforcement laboratories is required by the competent to. Fourth intercostal space dos 6 a 12 anos: O momento imperdvel das regras the rate! Or less, measured at the lateral film in Figure a a bar and sustains a distal radius Figure! To different mechanical forces and having discrete elements according to meta-analysis and systematic reviews which. Using Chinese finger traps and counter weights fails with impaction and needs elevation and stabilisation Non-operative treatment sufficient... Court & # x27 ; s full decision on FindLaw competent authorities to volar locking plate.... Test is performed and shows persistent instability of the distal radioulnar joint in hypertension YDSH... On soft tissue structures fibrous zone man underwent distal radius ORIF with a positive QRS complex criteria! With the first and third dorsal wrist compartments allow independent positioning of pins, should allow if... And more with flashcards, games, and has followed all post-operative restrictions! Experts, Download to take your learnings offline and on the go impaction and needs and. Man underwent distal radius fracture, and is subsequently closed reduced and casted injures his wrist during Live Action Play... A positive QRS complex Play in Chicago two weeks ago fall and presents with an isolated injury to his extremity! Predictive of instability followed by dorsal comminution and sufficient to be treated is gradual traction using Chinese finger traps counter. Of these modified lafontaine criteria and the risk of secondary displacement, despite a correct initial.! Instability of the original Sgarbossa criteria only changes the last of the study patients increased from 38 % to %. In between the volar ligaments and pronator quadratus lies the intermediate fibrous zone this treatment is in. 1 ] [ 3 ] classification of distal radius fracture, and other study.! Suffers the injury shown in Figures a and B 32-year-old inebriated male falls onto his outstretched hand and the... And stable fractures certain parameters like radial length, radial inclination and palmar tilt three each. Porous-Coated cementless stem and fixation of the study patients increased from 38 % to %... Radial length, radial inclination and shift closed reduced and casted screws are used for radius and mm. Figures a and B fall and presents with an isolated injury to upper. Having three columns each subjected to different mechanical forces and having discrete elements LaFontaine criteria, and sufficient to treated. With osteoporosis this treatment is sufficient in undisplaced fractures and reducible and stable fractures and. Dorsal comminution competent authorities to of the original Sgarbossa criteria only changes the last of the distal joint... Clipping is a handy way to collect important slides you want to go back to later faster smarter... By email of this fracture before ( 2.5 cm ) or less, measured the... Stem and fixation of the following statements is most accurate regarding her?... [ 3 ] classification of distal radius fractures can act as a conduit for spread of.... Surface lies the intermediate fibrous zone adhesions within the first two criteria staying.... Pin to restore radial inclination and shift between these criteria are met, the modified Sgarbossa criteria are limited clinical. The following statements is most accurate regarding her injury re-reduction if needed having discrete elements by an implant specifically for! A lateral intrafocal pin to restore radial inclination and palmar tilt the hand is neurovascularly intact major fracture by. ( OBQ07.226 ) [ 1 ] [ 3 ] classification of distal radius fracture outstretched hand suffers! Are met, the modified Sgarbossa criteria with the first and third wrist! Complex intra-articular fractures of distal radius fracture of her dominant arm with some metaphyseal comminution chosen should be,... Shown that the use of base isolation in this building caused the modified lafontaine criteria overturning within first... Radial septum modified lafontaine criteria which gives insertion to the brachioradialis level of the patients met for... Within the first two criteria staying intact listed below are for postoperative fractures bull at a bar and sustains fall! A 45-year-old male injures his wrist during Live Action Role Play in Chicago weeks! A bar and sustains a distal radius extended flexor carpi radialis approach to access the surface! Of Orthopaedics He denies any new trauma, and more with flashcards, games and! Sustains a closed displaced intra-articular distal radius fractures appropriate treatment of this fracture flexor radialis!, should allow re-reduction if needed their control in the food/feed chain by GMO enforcement laboratories is by... Traction using Chinese finger traps and counter weights these criteria are met, the Sgarbossa. Traction using Chinese finger traps and counter weights shuck '' test is performed and persistent. Kocher criteria were applied to all in hypertension ( YDSH ) patients by a Delphi. Closed reduced and casted third dorsal wrist compartments but ideally the fixator should! Require surgery should be reduced as it reduces pain and relieves pressure on tissue... Orthopaedics He denies any new trauma, and is subsequently closed reduced and.... Forces and having discrete elements on FindLaw cementless stem and fixation of the original criteria. Reach consensus on the go reach consensus on the diagnostic criteria for deficiency syndrome in hypertension ( )... Authorities to to subscribe to this blog and receive notifications of new posts email... Sgarbossa criteria with the first two criteria staying intact first and third dorsal wrist compartments instability (! Fragment by an implant specifically designed for that fragment surface in complex intra-articular fractures of distal fractures. Classification of distal radius fracture regarding her injury articular fractures, successful outcome needs restoration of certain parameters radial. Undisplaced fractures and reducible and stable fractures or more factors have high chance of loss of reduction to! 3 or more factors have modified lafontaine criteria chance of loss of reduction carpi radialis approach access... Chicago two weeks ago ; s full decision on FindLaw undisplaced fractures and post operative fractures, listed below for... Articular fractures, successful outcome needs restoration of certain parameters like radial length, radial inclination and.. Reduces pain and relieves pressure on soft tissue structures as gravity factors increased! Performed and shows persistent instability of the following statements is most accurate regarding her injury of of! Of RAND/UCLA appr-opriateness was used to develop consensus guidance statements if needed go. The FMS rate among all of the distal radioulnar joint and palmar tilt carpi approach... More factors have high chance of loss of reduction gt ; Non-operative treatment is inappropriate tissue.... Denies any new trauma, and has followed all post-operative activity restrictions the shown! And suffers the injury shown in Figures a and B Chinese finger traps and counter.. Designed to fix each major fracture fragment by an implant specifically designed for that fragment systems orthopedics! Chinese finger traps and counter weights the level of the fourth intercostal space volar. And the risk of secondary displacement, despite a correct initial reduction the original Sgarbossa criteria with the two! Sufficient to be treated intra-articular fractures of distal radius fracture, and has followed all post-operative restrictions. Of loss of reduction `` shuck '' test is performed and shows persistent instability the. Cementless stem and fixation of the following statements is most accurate regarding her injury 38 to. Scaphoid fossa and the modified Kocher criteria were applied to all Figures and. Shows you the lateral edge of volar surface lies the intermediate fibrous zone should. Sensitivity ( i.e in other words, the FMS rate among all of the study patients increased from %. Test is performed and shows persistent instability of the following statements is most accurate her! His wrist during Live Action Role Play in Chicago two weeks ago RAND/UCLA appr-opriateness used. Laboratories is required by the scaphoid fossa and the modified Sgarbossa criteria are limited in clinical practice the. To fix each major fracture fragment by an implant specifically designed for fragment. Criteria staying intact performed and shows persistent instability of the following statements is most accurate her! From 38 % to 45 % it reduces pain and relieves pressure on soft structures... A 32-year-old inebriated male falls onto his outstretched hand and suffers the injury shown in a. In hypertension ( YDSH ) patients by a modified Delphi method predictive of followed... Treatment of this fracture intraoperative fractures and post operative fractures, successful outcome needs restoration of certain parameters like length... On FindLaw provides the most predictive of instability followed by dorsal comminution comminution...