of 19/19
7/21/2019 Fx scaphoid Blum http://slidepdf.com/reader/full/fx-scaphoid-blum 1/19 K ^dmlge >22?9::;?=4-6< © >22?. Ìmltlghs Crdhïdlsfs mf ^dmlgegolf. Ìmltì pdr Fesfvlfr @dssgh QDQ. ]gus mrglts rìsfrvìs cgr`dtlgh `ìmladef aghtlhuf ef pglht sur… Ef mldohgstla mfs crdaturfs rìafhtfs mu sadpjgçmf ; rfvuf mf ed elttìrdturf D Neu` (4), N Qdufr (4), ^ Mftrfleef (4), KR [dnfe (4), C Rlfrruaal (4), \ _lttf (4) ft C Mdp (>) fs crdaturfs mu sadpjgçmf sght efs crdaturfs mu adrpf efs peus crìqufhtfs. Feefs rfprìsfhtfht fhvlrgh 6 % mf e“fhsf`nef mfs crdaturfs ft 4/42 222 mfs aghsuetdtlghs mf trdu`dtgegolf (4). Feefs dccfatfht peus pdrtlauelêrf`fht e“jg``f kfuhf. Feefs sght peus rdrfs ajfz efs fhcdhts (`glhs mf 4 % mfs crdaturfs mu sadpjgçmf) gu ajfz efs vlfleedrms adr, mdhs afs trdhajfs m“îof, ef rdmlus prìsfhtf uhf crdoleltì peus l`pgrtdhtf. Mf peus, dvdht 46 dhs, e“gs fst l``dturf ft ef adrtledof qul fhtgurf ef hgydu m“gs- slcladtlgh pgurrdlt kgufr uh rýef m“d`grtlssfur. Ef `ìadhls`f ft e“ìvgeutlgh hdturfeef mfs crdaturfs mu sadpjgçmf ag`pgrtfht fhagrf qufequfs lhafrtltumfs (>). Hìdh`glhs, le fst nlfh ìtdnel qu“uh mldohgstla tdrmlc ag`prg`ft e“fccladaltì mu trdl- tf`fht grtjgpìmlquf. Le pfut aghmulrf â ed psfumdrtjrgsf, ed hì- argsf mu crdo`fht pgedlrf supìrlfur, â e“drtjrgsf ft du ageedpsus mu adrpf (1-6). Af rlsquf duo`fhtf aghslmìrdnef`fht dprês ed trglslê`f sf`dlhf m“ìvgeutlgh (1). Afs ag`peladtlghs mght ef rf- tfhtlssf`fht cghatlghhfe duo`fhtf dvfa ef tf`ps, dccfatfht fs- sfhtlfeef`fht efs trdvdleefurs `dhufes. @deorì efs prgorês rìafhts mf ed ajlrurolf (orfccgh vdsauedrlsì pìmlaueì), afs ag`peladtlghs pfuvfht oìhìrfr mfs lhadpdaltìs pfr`dhfhtfs pdrtlfeefs (LRR) gu l`pgsfr uh rfaedssf`fht prgcfsslghhfe. Vh mldohgstla ft uhf prl- sf fh ajdrof prìagafs dppdrdlssfht mgha hìafssdlrfs. Ef nledh rdmlg-aelhlquf lhltlde rfprìsfhtf ed prf`lêrf ìtdpf mldo- hgstlquf `dls sd vdefur fst `ìmlgarf. E“fxd`fh aelhlquf fst trgp pfu spìalclquf ft ed rdmlgordpjlf stdhmdrm trgp pfu sfhslnef (3-46). Mfs ìtumfs dhalfhhfs suooêrfht quf efs crdaturfs sght `lfux vlslnefs 46 kgurs dprês ef trdu`dtls`f lhltlde, fh rdlsgh m“uhf rìsgrp- tlgh pìrlcrdaturdlrf (43-4?). Rgur afs rdlsghs, efs pdtlfhts prìsfhtdht uhf susplalgh mf crdaturf mu sadpjgçmf mght ef nledh rdmlgordpjl- quf lhltlde fst hgr`de sght jdnltufeef`fht rfvus pgur uh aghtrýef aelhlquf ft rdmlgordpjlquf dprês uhf l``gnlelsdtlgh mf 42 â 46 kgurs. Ed vdefur mf afttf strdtìolf fst aghtfstìf mfpuls mf hg`- nrfusfs dhhìfs adr feef h“f`pëajf pds ed survfhuf mf psfumdrtjrg- sfs. Rdr aghsìqufht, mdhs mf hg`nrfux afhtrfs, efs aghtrýefs sf pgursulvfht kusqu“â 3 sf`dlhfs m“ìvgeutlgh, tgut fh l``gnlelsdht ef pdtlfht. Afttf prdtlquf pfr`ft mf mìtfatfr tgutfs efs crdaturfs mu sadpjgçmf ft mf ag``fhafr uh trdltf`fht fccladaf pgur afeefs qul hf sght pds mìpedaìfs. Afpfhmdht, sgh rftfhtlssf`fht prgcfsslghhfe ft sgh l`pdat ìaghg`lquf sght aghslmìrdnefs ft feef fst m“dutdht peus lhdaafptdnef quf peus mf 62 % mfs pdtlfhts h“ght pds mf crdaturf (44, 4:->4). Mf peus, ef sulvl mfs pdtlfhts pfut ëtrf deìdtglrf. @deorì afs lhsucclsdhafs, afs strdtìolfs rfstfht sguvfht utlelsìfs, pdrcgls fh rdlsgh mf e“daaês mlcclalef â uh pedtfdu tfajhlquf pfrcgr`dht. Rdr dleefurs, efs cdux hìodtlcs mu nledh rdmlgordpjlquf lhltlde rforgu- pfht mfs eìslghs três mlccìrfhtfs. Afrtdlhfs sght m“dutjfhtlqufs crda-  Dnstrdat ^ìsu`ì  ]jf mldohgsls gc rfafht sadpjglm crdaturfs; ^fvlfw gc tjf eltfrdturf  K ^dmlge >22?9::;?=4-6< Crdaturfs gc tjf sadpjglm drf tjf `gst ag``gh adrpde crdaturfs. D rfvlfw gc tjf eltfrdturf lhmladtfs tjdt tjf prfvdefhaf gc tjf crdaturf lh tjf adsf gc aelhlade susplalgh ls efss tjdh 62%. D qudelty Z-rdy fxd`lhdtlgh rf`dlhs fssfhtlde ds dh lhltlde mldohgstla tgge lh tjf fvdeudtlgh gc sadpjglm crdaturfs. Lts sfhsltlvlty vdrlfs crg` 6< tg ?<%. Rdtlfhts wltj hfodtlvf Z- rdys prfsfht wltj dngut 4:.?% gc sadpjglm crdaturfs9 6% gc nrulsfm sadpjglm9 41% gc rdmlus crdaturfs dhm ?% gc `lsafeedhfgus nghf efslghs. Lc hgt trfdtfm prg`ptey, d sadpjglm crdaturf `dy nf ag`pguhmfm ny hgh- uhlgh wltj dssgaldtfm rlsi cdatgrs suaj ds dvdsauedr hfargsls dhm gstfgdrtjrltls. Aghslmfrlho tjfsf rlsis, pdtlfhts wltj suspfatfm sadpjglm crdaturf wltj hgr`de Z-rdys, rgutlhfey uhmfrog wrlst l``gnlelzdtlgh uhtle l`dolho aghclr`s gr mfhlfs tjf prfsfhaf gc crdaturf. Aghsfqufhtey, `grf tjdh jdec gc tjf pdtlfhts uhmfrog wrlst l``gnlelzdtlgh hffmefssey. ]jls `dy jdvf d hfodtlvf l`pdat gh tjflr prgcfsslghde elcf dhm pfrsghde datlvltlfs wjlef rfprfsfhtlho d jloj `fmlade agst. @^L ls tjf l`dolho tfajhlquf gc ajglaf cgr susplalgus gr hfodtlaf Z- rdys. @MA] ls efss agstey tjdh @^L gr nghf sadh, rfdmley dvdlednef dhm jlojey fccfatlvf cgr trdu`d pdtlfhts nut ls edais daaurday dhm sjguem nf usfm wltj adutlgh lh tjls lhmladtlgh. Efs crdaturfs mu sadpjgçmf sght crìqufhtfs. E“ìtumf mf ed elttìrdturf `ghtrf quf, mfvdht uhf susplalgh aelhlquf mf crdaturf mu sadpjgçmf, ed prìvdefhaf mf afttf eìslgh fst lhcìrlfurf â 62 %. Vh nledh rdmlgord- pjlquf stdhmdrm mf qudeltì mglt rfstfr ed prf`lêrf ìtdpf mldohgstlquf. Le mìtfatf efs crdaturfs mu sadpjgçmf dvfa uhf sfhslnleltì vdrldht fhtrf 6< ft ?< %. Efs pdtlfhts dvfa mfs rdmlgordpjlfs hgr`defs ght fh `gyfhhf uhf crdaturf mu sadpjgçmf mdhs 4:,? % mfs ads, uhf aghtuslgh mu sadpjgçmf mdhs 6 % mfs ads, uhf crdaturf mu rdmlus mdhs 41 % mfs ads ft uhf dutrf crdaturf mdhs ? % mfs ads. Vhf crdaturf mu sadpjgçmf `de trdltìf aghmult â mfs ag`peladtlghs mght ef rftfhtls- sf`fht prgcfsslghhfe ft sgalìtde fst ìefvì. Mdhs ed strdtìolf aedsslquf, pgur prìvfhlr af rlsquf, efs pdtlfhts prìsfhtdht uhf susplalgh mf crdaturf mu sadpjgçmf mght ef nledh rdmlgordpjlquf lhltlde fst hgr`de nìhìclalfht m“uhf l``gnlelsdtlgh pfhmdht 42-46 kgurs, vglrf 3 sf`dlhfs. Reus mf 62 % mf afs pdtlfhts sunlssfht mgha uhf l``gnl- elsdtlgh ft uh drrët mf trdvdle lhutlefs. E“L^@ rfprìsfhtf ed `ìtjgmf mldohgstlquf lmìdef fh ads mf rdmlgordpjlfs hgr`defs gu mgutfusfs. Ef sadhhfr vgeu`lquf prìsfhtf uhf prìalslgh peus cdlnef quf e“L^@ ft sgh dhdeysf mglt rfstfr prumfhtf.  Ify wgrms; _rlst, crdaturfs. _rlst, VQ. _rlst, A]. _rlst, @^. Qadpjglm. Mfmladtfm @^L.  @gts-aeìs ; Rglohft, crdaturf. L^@. Qadhhfr. Qadpjgçmf. L^@ mìmlìf. E (4) Qfrvlaf m“L`dofrlf Ouleegz, AJV, ><, dvfhuf mf Edttrf-mf-]dsslohy, 6=222 Hdhay. (>) Qfrvlaf mf ajlrurolf pedstlquf ft rfaghstr uatrlaf, Jýpltde Kfdhhf m“Dra, rgutf hdtlghdef =, 6=>22 Mg``drtlh-efs-]gue. Agrrfspghmdhaf ; D Neu` F-`dle ; d.neu`Baju-hdhay.cr

Fx scaphoid Blum

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  • 7/21/2019 Fx scaphoid Blum

    1/19

    K dmlge >22?9::;?=4-6< >22?. mltlghs Crdhdlsfs mf dmlgegolf.

    mlt pdr Fesfvlfr @dssgh QDQ. ]gus mrglts rsfrvs cgr`dtlgh `mladef aghtlhuf ef pglht sur

    Ef mldohgstla mfs crdaturfs rafhtfs mu sadpjgmf ;

    rfvuf mf ed elttrdturf

    D Neu` (4), N Qdufr (4), ^ Mftrfleef (4), KR [dnfe (4), C Rlfrruaal (4), \ _lttf (4) ft C Mdp (>)

    fs crdaturfs mu sadpjgmf sght efs crdaturfs mu adrpf efs peuscrqufhtfs. Feefs rfprsfhtfht fhvlrgh 6 % mf efhsf`nefmfs crdaturfs ft 4/42 222 mfs aghsuetdtlghs mf trdu`dtgegolf

    (4). Feefs dccfatfht peus pdrtlauelrf`fht ejg``f kfuhf. Feefssght peus rdrfs ajfz efs fhcdhts (`glhs mf 4 % mfs crdaturfs musadpjgmf) gu ajfz efs vlfleedrms adr, mdhs afs trdhajfs mof, efrdmlus prsfhtf uhf crdolelt peus l`pgrtdhtf. Mf peus, dvdht46 dhs, egs fst l``dturf ft ef adrtledof qul fhtgurf ef hgydu mgs-slcladtlgh pgurrdlt kgufr uh ref md`grtlssfur.Ef adhls`f ft evgeutlgh hdturfeef mfs crdaturfs mu sadpjgmfag`pgrtfht fhagrf qufequfs lhafrtltumfs (>). Hdh`glhs, le fstnlfh tdnel quuh mldohgstla tdrmlc ag`prg`ft efccladalt mu trdl-tf`fht grtjgpmlquf. Le pfut aghmulrf ed psfumdrtjrgsf, ed h-argsf mu crdo`fht pgedlrf suprlfur, edrtjrgsf ft du ageedpsusmu adrpf (1-6). Af rlsquf duo`fhtf aghslmrdnef`fht dprs edtrglsl`f sf`dlhf mvgeutlgh (1). Afs ag`peladtlghs mght ef rf-tfhtlssf`fht cghatlghhfe duo`fhtf dvfa ef tf`ps, dccfatfht fs-sfhtlfeef`fht efs trdvdleefurs dhufes. @deor efs prgors rafhtsmf ed ajlrurolf (orfccgh vdsauedrls pmlaue), afs ag`peladtlghspfuvfht ohrfr mfs lhadpdalts pfr`dhfhtfs pdrtlfeefs (LRR) gu

    l`pgsfr uh rfaedssf`fht prgcfsslghhfe. Vh mldohgstla ft uhf prl-sf fh ajdrof pragafs dppdrdlssfht mgha hafssdlrfs.Ef nledh rdmlg-aelhlquf lhltlde rfprsfhtf ed prf`lrf tdpf mldo-hgstlquf `dls sd vdefur fst `mlgarf. Efxd`fh aelhlquf fst trgppfu spalclquf ft ed rdmlgordpjlf stdhmdrm trgp pfu sfhslnef(3-46). Mfs tumfs dhalfhhfs suoorfht quf efs crdaturfs sght lfuxvlslnefs 46 kgurs dprs ef trdu`dtls`f lhltlde, fh rdlsgh muhf rsgrp-tlgh prlcrdaturdlrf (43-4?). Rgur afs rdlsghs, efs pdtlfhts prsfhtdht

    uhf susplalgh mf crdaturf mu sadpjgmf mght ef nledh rdmlgordpjl-quf lhltlde fst hgr`de sght jdnltufeef`fht rfvus pgur uh aghtrefaelhlquf ft rdmlgordpjlquf dprs uhf l``gnlelsdtlgh mf 42 46 kgurs. Ed vdefur mf afttf strdtolf fst aghtfstf mfpuls mf hg`-nrfusfs dhhfs adr feef hf`pajf pds ed survfhuf mf psfumdrtjrg-sfs. Rdr aghsqufht, mdhs mf hg`nrfux afhtrfs, efs aghtrefs sfpgursulvfht kusqu 3 sf`dlhfs mvgeutlgh, tgut fh l``gnlelsdht efpdtlfht. Afttf prdtlquf pfr`ft mf mtfatfr tgutfs efs crdaturfs musadpjgmf ft mf ag``fhafr uh trdltf`fht fccladaf pgur afeefs qulhf sght pds mpedafs. Afpfhmdht, sgh rftfhtlssf`fht prgcfsslghhfeft sgh l`pdat aghg`lquf sght aghslmrdnefs ft feef fst mdutdhtpeus lhdaafptdnef quf peus mf 62 % mfs pdtlfhts hght pds mf crdaturf(44, 4:->4). Mf peus, ef sulvl mfs pdtlfhts pfut trf dedtglrf. @deorafs lhsucclsdhafs, afs strdtolfs rfstfht sguvfht utlelsfs, pdrcgls fhrdlsgh mf edaas mlcclalef uh pedtfdu tfajhlquf pfrcgr`dht.Rdr dleefurs, efs cdux hodtlcs mu nledh rdmlgordpjlquf lhltlde rforgu-pfht mfs eslghs trs mlccrfhtfs. Afrtdlhfs sght mdutjfhtlqufs crda-

    Dnstrdat ^su`

    ]jf mldohgsls gc rfafht sadpjglm crdaturfs; fvlfw gc tjf eltfrdturf

    K ^dmlge >22?9::;?=4-622 Mg``drtlh-efs-]gue.Agrrfspghmdhaf ; D Neu`F-`dle ; d.neu`Baju-hdhay.cr

  • 7/21/2019 Fx scaphoid Blum

    2/19

    K ^dmlge >22?9::

    ?=>

    Crdaturfs rafhtfs mu sadpjgmf

    D Neu` ft de.

    turfs kustlcldht uhf l``gnlelsdtlgh succlsdhtf pgur prvfhlr ed psfu-mdrtjrgsf. Mdutrfs agrrfspghmfht mfs aghtuslghs gssfusfs. Feefs sftrdmulsfht pdr mfs `largcrdaturfs trdnauedlrfs lhmtfatdnefs ed rd-mlgordpjlf gu du sadhhfr. Feefs hf sght rvefs quf pdr eL^@ gu edsalhtlordpjlf qul `ghtrfht uh m`f `mueedlrf mlccus gu uhf jy-pfrclxdtlgh `gmrf mf egs. Feefs crdolelsfht egs tf`pgrdlrf`fht, efrfhmdht peus vuehrdnef uh hguvfdu trdu`dtls`f `dls le fst prg-ndnef quuhf l``gnlelsdtlgh mf agurtf murf fh dssurf ed ourlsgh.El`dofrlf `gmfrhf mglt kgufr uh ref l`pgrtdht ms ed prlsf fhajdrof lhltldef mu pdtlfht. Feef mglt el`lhfr cgr`feef`fht uhfcrdaturf ft vltfr dlhsl uhf l``gnlelsdtlgh lhutlef. Feef mglt od-ef`fht mtfatfr efs crdaturfs gaauetfs mght afrtdlhfs dccfatfht uhdutrf gs quf ef sadpjgmf. Fhclh, eL^@ mfvrdlt odef`fht dlmfr `lfux adrdatrlsfr efs mlccrfhtfs eslghs dclh mfh mclhlr ef prg-hgstla ft ef trdltf`fht efs peus dmqudts. Vhf fhqutf lhtfrhdtlg-hdef rafhtf `ghtrf quf efs prdtlqufs ght t `gmlclfs pdr efstfajhlqufs ml`dofrlf `gmfrhf (>>). Vh fccgrt mjdr`ghlsdtlghrfstf hafssdlrf pgur fh d`elgrfr ed agjrfhaf ft ed pfrtlhfhaf.Mdhs tgus efs ads, ed elttrdturf rafhtf pedlmf fh cdvfur muh

    `fleefur daas eL^@.Ef nut mf aft drtlaef fst mf rdppfefr efs mghhfs aedsslqufs aghafr-hdht ef mldohgstla mfs crdaturfs rafhtfs mu sadpjgmf, mf `gh-trfr pdrtlr mfs mghhfs mf ed elttrdturf ft mfxf`pefs prals, efslhsucclsdhafs mfs strdtolfs aedsslqufs ft mf prgpgsfr mfs drnrfsmldohgstlqufs peus pfrcgr`dhts.

    Ef nledh rdmlg-aelhlquf lhltlde

    Ef mldohgstla mf crdaturf mu sadpjgmf rfpgsf mdhs ed ordhmf d-kgrlt mfs ads sur edhd`hsf, efxd`fh aelhlquf ft ef nledh rdmlg-

    ordpjlquf. Ed crdaturf survlfht ef peus sguvfht egrs muhf ajutfsur ef pglohft fh jypfrfxtfhslgh. Feef fst peus rdrf`fht elf uhajga mlrfat sur ef mgs mf ed `dlh, egrs muh agup mf pglho fhcefxlgh.Ef slohf aelhlquf ef peus aedsslquf fst ed mguefur ed prfsslgh mfed tdndtlrf dhdtg`lquf mght ed sfhslnlelt ft ed spalclalt sghtrfspfatlvf`fht mf 1). Ed mguefur ed prfsslgh mutunfrauef mu sadpjgmf prsfhtf uhf sfhslnlelt sl`ledlrf (:? %),`dls uhf spalclalt eorf`fht suprlfurf (6? %) (>1). Ed vdefurmfs dutrfs slohfs aelhlqufs (mguefurs ed ag`prfsslgh mdhs edxfmf ed prf`lrf ageghhf, mguefurs rdmldefs fh mvldtlgh uehdlrfcgraf gu aghtrf rslstdhaf, m`f mf ed tdndtlrf dhdtg`lquf,

    fta.) fst aghtrgvfrsf (>=->3). pdrtlr muhf rfvuf mf ed elttrdtu-rf, Mgrsdyft de.

    aghstdtfht quf ed vdefur prmlatlvf mf efxd`fhaelhlquf vdrlf fhtrf 41 ft 3< % dvfa uhf `gyfhhf mf >4 % (>?).Rdr aghtrf, sd vdefur prmlatlvf hodtlvf fst jdnltufeef`fhtaghslmrf ag``f sdtlscdlsdhtf. Ednsfhaf mf sfhslnlelt mgu-egurfusf du hlvfdu mf ed tdndtlrf dhdtg`lquf ft mu tunfrauefsadpjgmlfh pfr`ft prdtlquf`fht mfxaeurf efxlstfhaf muhfcrdaturf mu sadpjgmf (>, >:).Ef nledh rdmlgordpjlquf fst ed prf`lrf tdpf mldohgstlquf mfscrdaturfs mu sadpjgmf `dls efs lhalmfhafs rdelsfs sght trs vdrld-nefs fh cghatlgh mfs afhtrfs. Le fst hdh`glhs dm`ls quf qudtrf lh-almfhafs du `glhs mglvfht trf rdelsfs ; uhf lhalmfhaf mf cdaf mf

    pglohft fh pgsltlgh hfutrf dvfa uh rdygh pgstrg-dhtrlfur, uhflhalmfhaf mf prgcle ft mfux lhalmfhafs, mltfs mu sadpjgmf. Efs lhal-mfhafs mf cdaf ft mf prgcle rfstfht lhmlspfhsdnefs pgur pralsfr efsrdppgrts mfs gs mu adrpf (>). Le sdolt jdnltufeef`fht mfs lhalmfhafs mfQajrfai 4 (pglho mf`l-cfr`, prghdtlgh (pglho mf`l-cfr`, prghdtlgh =6

    , rdygh mlrfatfur vfrtlade). Qajfrhnfro prg-pgsf odef`fht ed rdelsdtlgh muhf lhalmfhaf mf cdaf pglho cfr`fh prghdtlgh pgur aedssfr efs crdaturfs (11).Mfs lhalmfhafs suppe`fhtdlrfs mglvfht trf rdelsfs fh ads mfmgutf (1=). Efs aelajs fh strfss sf`nefht d`elgrfr eorf`fht efspfrcgr`dhafs mu nledh rdmlgordpjlquf stdhmdrm. Ef aelaj mf cdaf,fh prghdtlgh dvfa mvldtlgh uehdlrf dxl`def, jgrlzghtdelsf ef sad-pjgmf ft tfhm spdrfr sfs crdo`fhts. Ef aelaj mf cdaf, pglho sfr-r fh prghdtlgh, fhtrdhf, elhstdr mf elhalmfhaf mf cdaf pglho cfr-`, uhf fxtfhslgh mu adrpf pfr`fttdht mjgrlzghtdelsfr efsadpjgmf ft mf nlfh ef modofr. Rgur quf af aelaj dlt uhf vdefurdkgutf, uh sfrrf`fht datlc mu pglho fst hafssdlrf ; ed prfsslghfxfraf pdr ed ttf mu adpltdtu` sur ed prf`lrf rdhof mfs gs mu

    adrpf cdaleltf ed mtfatlgh mfs crdaturfs fhorfhfs mu sadpjgmf ftmfs fhtgrsfs sadpjg-euhdlrfs (1>, 16) (clo. 4)

    . Ed mguefur f`pajfrdrf`fht afttf `dhuvrf. Afttf lhalmfhaf rf`pedaf ef aelaj mfcdaf pglho cfr`. Feef pfut trf rdelsf mf cdgh ag`pdrdtlvf (13).Efs prlhalpdefs aedsslcladtlghs utlelsfs sght afeefs mf ^ussf, Jfr-nfrt ft mf Qajfrhnfro. ^ussf aedssf efs crdaturfs mu sadpjgmf fh1 adtogrlfs fh cghatlgh mf egrlfhtdtlgh mu trdlt mf crdaturf ; jg-rlzghtde gnelquf, trdhsvfrsde, vfrtlade gnelquf (1?). Jfrnfrt spd-rf efs crdaturfs stdnefs (typfs D), efs crdaturfs lhstdnefs (typfs N),efs rftdrms mf aghsgelmdtlgh (typf A) ft efs psfumdrtjrgsfs (ty-pfs M) (1:) (clo. >)

    . Qajfrhnfro aedssf efs crdaturfs fh 3 typfs prlh-alpdux mght edhdeysf sf cdlt fh prdtlquf agurdhtf sur ef aelaj mf

    cdaf pglho sfrr, fh rfprdht ed pgsltlgh mu trdlt pdr rdppgrt edtunrgslt rdmldef ft ed elohf agrtladef mldhf ed peus mfhsf (11,1 ==2 pdtlfhts, Juhtfrft de.

    `ghtrfht quf 43 % mfs crdatu-rfs mu sadpjgmf sght `aghhufs sur ef nledh rdmlgordpjlquf

  • 7/21/2019 Fx scaphoid Blum

    3/19

    K dmlge >22?9::

    D Neu` ft de.

    Crdaturfs rafhtfs mu sadpjgmf

    ?=1

    lhltlde (4=). Edhdeysf mdrtlaefs rafhts pgrtdht sur mfs pdtlfhtsprsfhtdht uhf susplalgh aelhlquf mf crdaturf mu sadpjgmf ftmght efs rdmlgordpjlfs lhltldefs sght hgr`defs `ghtrf quf efpgurafhtdof mf crdaturfs `aghhufs mu sadpjgmf vdrlf fhtrf? ft 62 %, dvfa uhf `gyfhhf mf 4:,? % (tdnefdu LL)

    . Efs cdux h-odtlcs efs crdaturfs gaauetfs agrrfspghmfht mfs crdaturfslhag`petfs, fhorfhfs gu mght ed tgpgegolf hf pfr`ft pds mf efsmtfatfr sur efs aelajs stdhmdrm (clo. :-44)

    .Ed spalclalt mu nledh rdmlgordpjlquf fst tgut kustf nghhf (4=).Qfegh Mldsft de.

    , efs cdux pgsltlcs dttflohfht >2 % (=2). Afux-alsght els uhf frrfur mdhdeysf mf ed tunrgslt rdmldef, mu ngrmsuprlfur mu tunfrauef mlstde, ed supfrpgsltlgh mf efxtr`lt lh-crlfurf mu rdmlus gu ed prsfhaf muh trgu hgurrlalfr (>). Fh-

    clh, ed rfprgmuatlnlelt lhtfr-gnsfrvdtfur mf af nledh fst mlgarf.Feef vdrlf fhtrf =2 ft ?3 % (44, 41) (clo. 4>)

    .Hgtghs fhclh quf ed mlspdrltlgh mf ed ndhmf ordlssfusf prlsad-pjgmlfhhf sur elhalmfhaf mf cdaf fst vgadtrlaf, dls hl sfhslnef,hl spalclquf (=4-=6).

    Ed strdtolf aedsslquf

    Cdaf du rlsquf mf aghhdtrf uhf crdaturf gaauetf, efs strdtolfsmldohgstlqufs ght vgeu `dls fh ednsfhaf mf rfag``dhmdtlghspralsfs, feefs rfstfht trs vdrldnefs sfegh efs qulpfs (>>, =3-=?).

    Clo. 4 ; Crdaturf mu sadpjgmf mtfatf sur ef aelaj mf cdaf pglho sfrr.d Ef aelaj mf cdaf fh mvldtlgh uehdlrf hf `ghtrf duauhf crdaturf.n Ef aelaj mf cdaf pglho sfrr rvef uhf crdaturf mf typf S mf Qajfrhnfro (ceajf).

    d n

    Clo. > ; Aedsslcladtlgh mJfrnfrt.]ypf D 0 crdaturfs stdnefs 9 D4 ;crdaturf mu tunfrauef 9 D> ; crdaturf hgh mpedaf mf edtunrgslt. ]ypf N 0 crdaturfs lhstdnefs 9 N4 ; crdaturf mu4/1 mlstde 9 N> ; crdaturf mpedaf mf ed tunrgslt 9 N1 ;crdaturf mu pef prgxl`de 9 N= ; crdaturf-mlsegadtlgh 9 N6 ;crdaturf ag``lhutlvf.

    Clo. 1 ; Aedsslcladtlgh mf Qajfrhnfro sur ef aelaj mf cdaf pglhocfr` (gu sfrr). Qur afttf lhalmfhaf, ef ngrm mlde mu sad-pjgmf dppdrdt sgus ed cgr`f muhf elohf mfhsf aghadvf.Ed tunrgslt rdmldef, nlfh vlslnef, mel`ltf ef ngrm lhcrlfurmf ed cdaf suprlfurf drtlauedlrf. Qlx vdrlts sght lhmlvl-mudelsfs. L ; Rgedlrf 9 LL ; Agrpgrdef jdutf 9 LLL ; Agrpgrdefndssf 9 LS ; ]rdhs-tunrgsltdlrf 9 S ; Rlfm 9 SL ; ]unfrauef mls-tde, d) pftlt crdo`fht, n) crdo`fht lhtfr`mldlrf, a) orgscrdo`fht.

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    ?==

    Crdaturfs rafhtfs mu sadpjgmf

    D Neu` ft de.

    Ed aedsslquf l``gnlelsdtlgh petrf ft aghtref rdmlgordpjlquf 42-46 kgurs prsfhtf uhf cdlnef fccladalt (>>). Feef rfstf af-pfhmdht edrof`fht utlelsf, sglt pdr aghhdlssdhaf mfs mghhfsrafhtfs mf ed elttrdturf, sglt surtgut fh rdlsgh mf ed cdlnef mlspg-hlnlelt mfs tjgmfs mfxpegrdtlgh peus pfrcgr`dhtfs.Nlfh quduauhf tumf hdlt adeaue ed vdefur mldohgstlquf mfefxd`fh aelhlquf 42-46 kgurs dprs ef trdu`dtls`f lhltlde, le fst

    egolquf mf pfhsfr quf sd sfhslnlelt ml`lhuf ft quf sd spalclaltduo`fhtf pdr rdppgrt du nledh lhltlde. Afttf sltudtlgh fst susafp-tlnef mdoordvfr efs aghsqufhafs mf elhsucclsdhaf mu nledh rdmlg-ordpjlquf.Mdhs uhf tumf uetlafhtrlquf prgspfatlvf rdppgrtf pdr @uhi

    ft de.

    , pgrtdht sur 4 26> pdtlfhts dvfa 462 crdaturfs mtfatfs sur efnledh rdmlgordpjlquf lhltlde ag`pgrtdht 6 lhalmfhafs, efs rdmlg-ordpjlfs rdelsfs 46 kgurs dprs ef trdu`dtls`f rvedlfht 3,3 %mf crdaturfs suppe`fhtdlrfs (=:). Mdhs mdutrfs tumfs, ef hg`-nrf mf crdaturfs suppe`fhtdlrfs mldohgstlqufs tdlt lhcrlfur > % ft peuslfurs dutfurs fstl`fht datufeef`fht qufeefs hghtduauhf vdefur dkgutf (4?, 42, =2). Mf peus, ed rfprgmuatlnlelt

    mf af nledh fst `mlgarf, vglrf `duvdlsf. Feef fst mfhvlrgh 62 %sfegh ]lfe-vdh Nuue ft de.

    (42-44) ft mf 11 % fh `gyfhhf sfeghEgw ft dny (4?).

    Aghtrdlrf`fht dux lmfs rfufs, af nledh ghtrf glhs mf eslghsquf efs aelajs lhltldux (clo. 41).

    Mdhs uhf tumf mf ]lfe-vdh Nuuepgrtdht sur mfs pdtlfhts suspfats mf crdaturf mu sadpjgmf, ed sfh-slnlelt mfs rdmlgordpjlfs stdhmdrm pdssf mf 32 % egrs mu nledhlhltlde 12 % egrs mu nledh mf aghtref. ]gukgurs sfegh ]lfe-vdhNuueft de.

    , fh ads mf hodtlvlt mu nledh lhltlde, uhf strdtolf mldo-hgstlquf, cghmf sur ed rdelsdtlgh mf aelajs rdmlgordpjlqufs mf

    aghtref 46 kgurs, aghmulrdlt uh tdux mf psfumdrtjrgsf mf=,? % (=

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    K dmlge >22?9::

    D Neu` ft de.

    Crdaturfs rafhtfs mu sadpjgmf

    ?=6

    Clo. 3 ; Crdaturfs uetlpefs ajfz uh pdtlfht prsfhtdht uhf susplalgh mf crdaturf mu sadpjgmf.d Aelaj mf cdaf ghtrdht uhf crdaturf mu tunfrauef mlstde mu sadpjgmf.n Aelaj mf cdaf pglho sfrr ghtrdht fh gutrf uhf crdaturf mf typf LS.a Aelaj mf prgcle ghtrdht uhf crdaturf mf rfngrm drtlauedlrf dhtrlfur mu rdmlus.m-f Agupfs sdolttdefs du sadhhfr aghclr`dht efs crdaturfs mu sadpjgmf ft mu rdmlus.c Agupf dxldef ghtrdht uhf dvueslgh gssfusf mf ed pgrtlgh pde`dlrf mu elod`fht sadpjg-euhdlrf (ceajf).

    d na mf c

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    ?=3

    Crdaturfs rafhtfs mu sadpjgmf

    D Neu` ft de.

    Clo. ? ; Rsfumdrtjrgsf mu sadpjgmf ajfz uh pdtlfht prsfhtdht uhf susplalgh mf crdaturf mu sadpjgmf dprs uhf ajutf.d-n Aelajs mf cdaf (d)ft mf prgcle (n). Ef trgp nfe dspfat mf crdaturf, efs ogmfs ft ed saergsf mfs crdo`fhts, ed ndsauef pde`dlrf mu crdo-`fht mlstde mu sadpjgmf, lfux vlslnef sur ef aelaj mf prgcle, ed ndsauef mgrsdef mu euhdtu` (MLQL) ft edrtjrgsf styeg-rdmldef ft mlg-adrplfhhf t`glohfht sdhs duauhf d`nlout mf edhalfhhft mu prgafssus.

    d n

    ]dnefdu LLCrqufhaf mfs crdaturfs mu sadpjgmf ajfz efs pdtlfhts prsfhtdht uhf susplalgh mf crdaturf mu sadpjgmf dvfa mfs rdmlgordpjlfs lhltldefshgr`defs.

    tumfs Hg`nrfmf ads

    ^crfhtlfe mldohgstlquf ft dutrfs tjgmfs mldohgstlqufs Hg nrf (%) mf crdaturfsmu sadpjgmf

    Nrls`dr 44 (44 %)

    @urpjy 4

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    7/19

    K dmlge >22?9::

    D Neu` ft de.

    Crdaturfs rafhtfs mu sadpjgmf

    ?=?

    Ed salhtlordpjlf

    Ed salhtlordpjlf gssfusf, rdelsf du `glhs =: jfurfs dprs eftrdu`dtls`f lhltlde, fst uhf tfajhlquf muhf trs ordhmf sfhslnl-elt mdhs ef mldohgstla mfs crdaturfs mu pglohft. Elhtrt mf afttffxpegrdtlgh fst afpfhmdht el`lt pdr sd `mlgarf spalclalt, sdcdlnef rsgeutlgh spdtldef ft el`pgsslnlelt mdhdeysfr ed agrtladefft ed trdnauedtlgh gssfusf (44-4>, >>, =3, 6). Qgh tumf pgrtdlt sur 6= pdtlfhts dvfa< % mf crdaturfs gaauetfs, dutjfhtlclfs sur ef nledh rdmlgordpjl-quf rdels 42-4= kgurs dprs ef trdu`dtls`f. Fh rfajfrajdht uhfrupturf agrtladef, eajgordpjlf prsfhtdlt uhf sfhslnlelt mf422 % ft uhf spalclalt mf ). Jduofr hgtdlt afpfhmdht quletdlt mlcclalef mdcclr`fr ed vdefur mf afttf tfajhlquf mdhs ef mldo-hgstla mfs crdaturfs pgedlrfs suprlfurfs.

    Clo. : ; Crdaturf gaauetf mu sadpjgmf.d Ef nledh rdmlgordpjlquf lhltlde fst hgr`de.n Mfvdht ed cgrtf susplalgh aelhlquf, uh sadhhfr fst rdels ; le fst hgr`de.a-m Vhf L^@ fst degrs rdelsf ; feef ghtrf uhf crdaturf nlagrtladef.

    d na m

  • 7/21/2019 Fx scaphoid Blum

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    ?=:

    Crdaturfs rafhtfs mu sadpjgmf

    D Neu` ft de.

    Clo. < ; Crdaturf mf typf SL mf Qajfrhnfro aghhuf sur efs aelajs stdhmdrm fhrdlsgh mf ed tgpgegolf mu trdlt.

    d-n Ed crdaturf hd pds t lmfhtlclf sur ef nledh rdmlgordpjlquf lhltlde.a-f Agupf dxldef sadhgordpjlquf, agupf mdhs ef ordhm dxf mu sadpjgmf ft

    @R^ mdhs ef ordhm dxf mu sadpjgmf m`ghtrdht dls`fht ed crdaturf mls-tdef. Le sdolt muhf crdaturf nlagrtladef mght efxtfhslgh fst lal lfux vlslnefsur ed @R^.

    c-o Agupfs dxldef ft crghtdef fh CQF ]> dvfa Cdt Qdt ghtrdht ed crdaturf ft uhm`f mfs pdrtlfs geefs fhtrf ef sadpjgmf ft efs tfhmghs mu eghodnmuatfur ft mu agurt fxtfhsfur mu pguaf ft fh rfodrm mu ceajlssfur rdmldemu adrpf.

    d na mf co

  • 7/21/2019 Fx scaphoid Blum

    9/19

    K dmlge >22?9::

    D Neu` ft de.

    Crdaturfs rafhtfs mu sadpjgmf

    ?= dvfa Cdt Qdt ft QF ]4 rvedht ed crdaturf.

    d nam f

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    K ^dmlge >22?9::

    ?62

    Crdaturfs rafhtfs mu sadpjgmf

    D Neu` ft de.

    Clo. 44 ; Crdaturfs mu sadpjgmf ft mu trlqutru` ft fhtgrsf sadpjgeuhdlrf.d Aelaj mf cdaf pglho sfrr ghtrdht uhf pgsslnef crdaturf mu sadpjgmf ft uh mldstdsls sadpjgeuhdlrf.n Aelaj mf prgcle ghtrdht uhf duo`fhtdtlgh mf edhoef sadpjgeuhdlrf ft uhf crdaturf mu trlqutru`.a @R^ agrghdef aghhdlssdht ed crdaturf mu sadpjgmf (ed crdaturf trlqutrdef tdlt vlmfhtf).m Agupf crghtdef fh CQF ]> dvfa Cdt Qdt aghclr`dht ed crdaturf mu sadpjgmf ft rftrguvdht ed crdaturf mu trlqutru`. EL^@ fst mf du-

    vdlsf qudelt fh rdlsgh mu pgrt mf ed rslhf.

    d na m

    ]dnefdu LLLCrqufhaf mfs crdaturfs dutrfs quf afeefs mu sadpjgmf ajfz efs pdtlfhts prsfhtdht uhf susplalgh mf crdaturf mu sadpjgmf dvfa mfs rdmlgordpjlfslhltldefs hgr`defs.

    tumfs Hg`nrf

    mf ads

    ^crfhtlfe mldohgstlquf Hg`nrf (%)

    mf crdaturfsmu rdmlus

    Hg`nrf (%) mf crdaturfs

    mfs dutrfs gs mu adrpf,mfs `tdtdrslfhsgu mf ed styegmf uehdlrf

    Hg`nrf tgtde (%)

    mf crdaturfs dutrfsquf ef sadpjgmf

    ]lfe-vdh Nuue 4

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    D Neu` ft de.

    Crdaturfs rafhtfs mu sadpjgmf

    ?64

    Clo. 4> ; Cdux pgsltlc mf ed rdmlgordpjlf stdhmdrm ajfz uh pdtlfht vlatl`fmuh daalmfht mf trdvdle.Ef mgutf, sur ef aelaj stdhmdrm ft ef sadh-hfr, d aghmult uhf l``gnlelsdtlgh muhf sf`dlhf puls mf hgu-vfdux aghtrefs rdmlgordpjlqufs ft uh sadhhfr ft clhdef`fht uhf L^@. Du tgtde, ef pdtlfht durd t l``gnlels lhutlef`fht4 gls. af kgur, le hf prsfhtf hl crdaturf, hl psfumdrtjrgsf mu

    sadpjgmf.d Aelaj mf cdaf ghtrdht uhf pgsslnef eslgh (ceajf).n @R^ fhtrftfhdht ef mgutf (ceajf), dls edhg`delf aghstdtf hfst

    vlslnef quf sur uhf sfuef agupf ft hf sf prgkfttf pds du `fhlvfdu quf sur ed rdmlgordpjlf stdhmdrm.

    a Agupf mdhs edxf mu sadpjgmf hf `ghtrdht pds mf eslgh.m-f Agupfs crghtdefs fh CQF ]> dvfa Cdt Qdt ft QF ]4 el`lhdht tgutf

    crdaturf.

    d na mf

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    K ^dmlge >22?9::

    ?6>

    Crdaturfs rafhtfs mu sadpjgmf

    D Neu` ft de.

    Ef sadhhfr

    Ef sadhhfr fst uhf tfajhlquf mf peus fh peus sguvfht utlelsf fhtrdu`dtgegolf, fh rdlsgh mf sd ordhmf mlspghlnlelt ft mf sfs pfr-cgr`dhafs mldohgstlqufs efvfs, ``f fh prsfhaf muh petrf(??-?< pdtlfhts prsfhtdht uhf susplalgh aelhlquf mf crdaturfmu sadpjgmf ft mfs rdmlgordpjlfs lhltldefs hgr`defs, 1: % mfspdtlfhts prsfhtdlfht uhf crdaturf mu sadpjgmf sur efs aelajsrdelss 3 sf`dlhfs dprs ef trdu`dtls`f lhltlde, af nledh tdht ed

    Clo. 41 ; Crdaturf mu sadpjgmf lfux vlslnef sur efs aelajs lhltldux quf sur efs aelajs K46.d Aelaj mf cdaf pglho sfrr lhltlde ghtrdht ed crdaturf.n Aelaj mf cdaf pglho sfrr K46 ; ed crdaturf fst pflhf pfrafptlnef.a-m Agupfs crghtdefs fh QF ]4 ft CQF ]> dvfa Cdt Qdt aghclr`dht ed crdaturf ft rvedht uhf aghtuslgh mu trlqutru`.

    d na m

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    D Neu` ft de.

    Crdaturfs rafhtfs mu sadpjgmf ?61

    Clo. 4= ; ajgordpjlf ghtrdht uhf crdaturf mu sadpjgmf dvfa uhfrupturf agrtladef(ceajf nedhajf) ft uh j`dtg`f fhrfodrm(ceajf hglrf).

    Clo. 46 ; Rgsltlghhf`fht mu pglohft pgur ed rdelsdtlgh mf agupfssadhgordpjlqufs mdhs ef ordhm dxf mu sadpjgmf.

    Clo. 43 ; Crdaturf mu sadpjgmf vlslnef sur ed rdmlgordpjlf stdhmdrm dls hgh lmfhtlclf du sadhhfr sur efs agupfs dxldefs hl sur efs @R^.d Aelaj mf cdaf pglho sfrr ghtrdht ed crdaturf.n Agupf mdhs edxf mu sadpjgmf ghtrdht de ed crdaturf (ceajf).a @R^ mdhs edxf mu sadpjgmf hf ghtrdht pds ed crdaturf.m L^@ aghclr`dht ed crdaturf.

    d na m

  • 7/21/2019 Fx scaphoid Blum

    14/19

    K ^dmlge >22?9::

    ?6= Crdaturfs rafhtfs mu sadpjgmf D Neu` ft de.

    rcrfhaf. Ed malslgh tjrdpfutlquf (murf ml``gnlelsdtlgh)tdlt cghmf sur efs mghhfs aelhlqufs ft efs aghtrefs rdmlgord-pjlqufs fccfatus >, = ft 3 sf`dlhfs dprs ef trdu`dtls`f lhltlde,sfegh ed strdtolf jdnltufeef mf elhstltutlgh. Ef sadhhfr ft eL^@

    tdlfht rdelss ef ``f kgur, mdhs efs 3 kgurs sulvdht ef trdu`d-tls`f. Ed sfhslnlelt mu sadhhfr tdlt mf ?1 %. Le mtfatdlt ed tgtd-elt mfs crdaturfs dvfa uhf dttflhtf agrtladef ft `aghhdlssdlt efscrdaturfs trdnauedlrfs purfs. Qd spalclalt tdlt mf 422 %. EL^@prsfhtdlt uhf sfhslnlelt ft uhf spalclalt mf 422 %, `dls pdraghtrf, elmfhtlcladtlgh mf edttflhtf agrtladef hd pu trf cdltf qufmdhs 1: % mfs ads. ]rflzf dutrfs crdaturfs dvfa dttflhtf agrtladefgu trdnauedlrfs purfs dccfatdht ef rdmlus gu efs dutrfs gs mu adrpftdlfht mtfatfs pdr eL^@ ft alhq pdr ef sadhhfr (:1).Mdhs uhf tumf rafhtf pgrtdht sur 12 pdtlfhts, Dmfyft de.lhsls-tfht mdvdhtdof sur efs cdux pgsltlcs mu sadhhfr (:=). Afttf tumfaghafrhf 41 crdaturfs hgh mpedafs mu sadpjgmf, vlslnefs sur ed

    rdmlgordpjlf stdhmdrm, ft 4? ads sdhs crdaturf mu sadpjgmf surefs aelajs suaafsslcs kusqu 3 sf`dlhfs. Efs sadhhfrs ght t eusuhf prf`lrf cgls pdr : efatfurs ft uhf mfuxl`f cgls pdr 6 efa-tfurs. Ed sfhslnlelt ft ed spalclalt gyfhhfs ed prf`lrf efatu-rf pgur ef mldohgstla mf crdaturf tdlfht rfspfatlvf`fht mf :< ft

  • 7/21/2019 Fx scaphoid Blum

    15/19

    K dmlge >22?9::

    D Neu` ft de. Crdaturfs rafhtfs mu sadpjgmf ?66

    mdhs ef ordhm dxf mu sadpjgmf, cdaleltfht ed mtfatlgh muh mped-af`fht fhtrf efs crdo`fhts. EL^@ fst rdelsdnef dvfa ef pgrt

    muhf rslhf dls ed qudelt mf efxpegrdtlgh fst detrf.EL^@ prsfhtf mf hg`nrfux dutrfs dvdhtdofs. Feef fst fh fsu-rf mf mlccrfhalfr uhf crdaturf muhf aghtuslgh gssfusf. Vhf crda-turf fst adrdatrlsf pdr uhf lhtfrruptlgh mfs trdvfs ft/gu mf edagrtladef. Vhf sl`pef aghtuslgh gssfusf sf trdmult pdr uh m`f`mueedlrf lrrouelfr, peus gu glhs tfhmu, sdhs crdaturf lmfhtl-cldnef (:1,

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    K ^dmlge >22?9::

    ?63 Crdaturfs rafhtfs mu sadpjgmf D Neu` ft de.

    sadpjgmf. Le ag`pgrtf uhf l``gnlelsdtlgh dhtlnrdajlg-pde`dlrfpfhmdht < 4> sf`dlhfs dvfa uh drrt mfs datlvlts dhufeefs. Ef

    trdltf`fht ajlrurolade fst prcrdnef fh ads mf cdaturf prgxl`def(typf L gu LL mf Qajfrhnfro), fh ads mf rftdrm mldohgstlquf guajfz efs pdtlfhts qul pgur mfs rdlsghs prgcfsslghhfeefs gu spgrtl-vfs raed`fht uhf rfprlsf peus pragaf mfs datlvlts. Af trdltf-`fht fst hafssdlrf egrsquf ed crdaturf fst mpedaf (>) (clo. 4:).Ef trdltf`fht mfs aghtuslghs gssfusfs mu sadpjgmf hd cdlt egn-kft mduauhf tumf spalclquf. Qle fst dm`ls quf afs eslghs sghtmf ngh prghgstla ft ourlssfht peus vltfs quf efs crdaturfs, feefsag`pgrtfht hdh`glhs mfs `largcrdaturfs trdnauedlrfs susafp-tlnefs mf crdolelsfr egs ft mf ef rfhmrf peus vuehrdnef dux trdu`d-tls`fs uetrlfurs (, >?, =?, = sf`dlhfs, muhf strdtolf (N) cghmf

    sur uh sulvl rdmlgordpjlquf pfhmdht 3 sf`dlhfs ft muhf strdt-olf (A) rfpgsdht sur ed rdelsdtlgh muhf salhtlordpjlf gssfusfajfz efs pdtlfhts mght efs rdmlgordpjlfs lhltldefs sght hgr`defs.Efs agts mldohgstlqufs, efs agts tjrdpfutlqufs, ed murf ml`-`gnlelsdtlgh ft ef hg`nrf mf psfumdrtjrgsf ght t adeaues pgurajdquf strdtolf. Qfegh efs dutfurs, efs strdtolfs (N) ft (A) ght uhagt oegnde qulvdefht ft ed strdtolf (D) agtf fhvlrgh 46 %`glhs ajfr quf efs pramfhtfs. Fh rfvdhajf, feef ohrf =,? % mfpsfumdrtjrgsfs. Ed strdtolf (N) fst afeef qul fhtrdhf ed peus egh-ouf murf `gyfhhf ml``gnlelsdtlgh (:,3 sf`dlhfs) (=?, 4).

    Duauhf tumf qulvdefhtf hd t rdelsf fh Crdhaf ft le fst mlc-clalef mf trdhspgsfr afs rsuetdts. Fh Crdhaf, efs mpfhsfs `ml-adefs mlrfatfs muhf strdtolf lhaeudht eL^@ (gu ed salhtlordpjlfgssfusf) sght dpprgxl`dtlvf`fht mfux cgls peus efvfs quf afeefsmf ed strdtolf aedsslquf lhaeudht fh `gyfhhf mfux aghtrefs

    Qusplalgh aelhlquf mfcrdaturf mu sadpjgmf

    Nledh rdmlgaelhlquf lhltldedvfa du glhs = lhalmfhafs

    L^@

    + Mgutfux gu

    Crdaturf musadpjgmf

    Crdaturf musadpjgmf

    Aghtuslgh musadpjgmf

    Crdaturfmu rdmlus

    Crdaturfmuh

    dutrf gs

    Rds mfeslgh

    gssfusf

    ^slhfdhtl-

    nrdajlg-pde`dlrf

    guajlrurolf

    pfrautdhf

    ^slhfdhtl-

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    Clo. 4< ; Qtrdtolf mldohgstlquf lmdef mdhs efscrdaturfs mu sadpjgmf ft l`peladtlghstjrdpfutlqufs.

  • 7/21/2019 Fx scaphoid Blum

    17/19

    K dmlge >22?9::

    D Neu` ft de. Crdaturfs rafhtfs mu sadpjgmf ?6?

    rdmlgordpjlqufs ft mfux aghcfatlghs muh dppdrfle rlolmf ml`-`gnlelsdtlgh. Afttf fstl`dtlgh hd quf pfu mf vdefur adr ed mtfr-`lhdtlgh mf el`pdat clhdhalfr mfs mlccrfhtfs strdtolfs mgltlhtorfr efs drrts mf trdvdle lhutlefs ft ef agt mf ed prlsf fh ajdr-of mfs psfumdrtjrgsfs qul survlfhhfht ajfz efs pdtlfhts lhsuccl-sd``fht sulvls.Du tgtde, `deor sfs lhsucclsdhafs, ef nledh rdmlgordpjlquf lhl-tlde mglt rfstfr ed prf`lrf tdpf mldohgstlquf mfs crdaturfs musadpjgmf ft sd qudelt mglt trf gptl`def. Fh ads mf mgutf gu mfhodtlvlt mf af nledh, ed mfuxl`f tdpf mpfhm mf ed mlspghl-nlelt mu pedtfdu tfajhlquf ft mf sfs pfrcgr`dhafs. EL^@ fstlhmlsautdnef`fht ed `tjgmf ed peus pfrcgr`dhtf. Qgh agthfst pds mlccrfht mf afeul mf ed salhtlordpjlf gssfusf `dls sghdaas rfstf trs el`lt. Ed pedaf mf eajgordpjlf hfst pds aedlrf-`fht mclhlf ft `deor sfs pfrcgr`dhafs, feef rfstf fhagrf pfuprdtlquf mdhs afttf lhmladtlgh (>, >>). Ef sadhhfr vgeu`lquffst uh fxd`fh pfrcgr`dht `dls sd rsgeutlgh spdtldef mglt trfgptl`lsf ft efs ads mgutfux gu mlsagrmdhts mglvfht aghmulrf mdutrfs fxpegrdtlghs ft hgtd``fht eL^@.

    Ed pedaf mf ed salhtlordpjlf mdhs ed strdtolf mldohgstlquf mfscrdaturfs mu sadpjgmf ft mfs gs mu adrpf fst aghtrgvfrsf.EDA^ (D`frladh Ageefof gc ^dmlgegoy) aghslmrf aft fxd`fhlhdpprgprl, `dls le rfstf prdtlqu mdhs mf hg`nrfux afhtrfs mftgus efs aghtlhfhts (>>, 42:). Efs tfajhlqufs jynrlmfs, tfeefs quf efQRFA]/A] qul ag`nlhfht efs dvdhtdofs mf ed salhtlordpjlf ftmu sadhhfr, pgurrdlfht prsfhtfr uh lhtrt mldohgstlquf daaru(42. Qajfrhnfro C. ^fafht sadpjglm crdaturfs (wltjlh tjf clrst tjrffwffis). Ajlr @dlh >2269>=;44?-14.

    1. Edhojgcc G, Dhmfrsfh KE. Aghsfqufhafs gc edtf l `gnlelzdtlgh gcsadpjglm crdaturfs. K Jdhm Quro YNrP 422494?;646->=.

    3. ]lfe-vdh Nuue @@, Nrgfijulzfh ]J, vdh Nffi FK, Ngssuyt [email protected] gc sadpjglm crdaturfs; tjf rgef gc huaefdr fmlalhf. K Hu-ae @fm 4

  • 7/21/2019 Fx scaphoid Blum

    18/19

    K ^dmlge >22?9::

    ?6: Crdaturfs rafhtfs mu sadpjgmf D Neu` ft de.

    >.

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    crdaturfs gc tjf wrlst gc tjf sadpjglm; fdrey mldohgsls ny jloj-spdtlde-rfsgeutlgh sghgordpjy. DK^ >22>94?:;4>1

  • 7/21/2019 Fx scaphoid Blum

    19/19

    D Neu` ft de. Crdaturfs rafhtfs mu sadpjgmf ?62229>6;132249>>2;>14-6.

    ?3. Qfhdee KD, Cdleed [email protected], Nguccdrm KD, vdh Jgesnffai @. Vetrdsguhm

    cgr tjf fdrey mldohgsls gc aelhladeey suspfatfm sadpjglm crdaturf. KJdhm Quro YD`P >22=9>22691=;>>2-1?.

    ?:. _detfr C, Eumlo ], Lgaju` Q, Neu` D. @uetl-mftfatgr A] lh`usaueg-sifeftde mlsgrmfrs. KN^-N]^ >2219:3;3-44.

    ?2229:4;46=-:.

    42=. ^ggeifr _, @dds @, Nrgfijulzfh DJ. Mldohgsls dhm trfdt`fht gcsadpjglm crdaturfs, adh hgh-uhlgh nf prfvfhtfm7 Draj Grtjgp]rdu`d Quro 422?94=;>-6.

    42?. Odfnefr A, Iuied A, Nrfltfhsfjfr @, ]rdtthlo Q, @lttengfai @,Sfasfl S. @dohftla rfsghdhaf l`dolho gc gaauet sadpjglm crdaturfs.K ]rdu`d 4