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Attitude diagnostique et thérapeutique en présence d'un poignet traumatique aigu

Diagnosis and treatment of wrist injuries

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Summary

Acute ligamentous tears of the wrist are frequently underestimated, even for partial or small bones fractures. In such cases, plan X-rays are often normal but it does not correspond to a normal wrist. According to the findings of a precise clinical examination, dynamic X-rays, an arthrograhy, a CT scan or an arthroscopy will complete the diagnosis. If correct and coherent diagnosis is conducted in the days following the injury, an adapted treatment could be done. Such an attitude avoids evolution to chronic instability of more inconstant therapeutic and results.

Résumé

Les auteurs rappellent la fréquente sous-estimation des lésions ligamentaires intracarpiennes lors des traumatismes aigus du poignet. Il en est de même de certaines lésions osseuses. Des radiographies standards normales ne doivent pas conclure à la bégninité. C'est pourquoi un examen clinique précis doit être réalisé. Au moindre doute il sera complété par des radiographies dynamiques, une arthrographie, un arthro-scanner, voire par une arthroscopie. Seule une démarche diagnostique précise, réalisée dans les jours suivants le traumatisme, permet d'adapter le geste thérapeutique à la lésion. Ainsi sera évité l'évolution vers l'instabilité chronique de traitement difficile et de résultat plus aléatoire.

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Voche, P., Blum, A., Dap, F. et al. Attitude diagnostique et thérapeutique en présence d'un poignet traumatique aigu. Orthop Traumatol 4, 149–154 (1994). https://doi.org/10.1007/BF01788453

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