1. 適應症

• 骨折無明顯位移，或位移可手法復位且穩定者

• 年長或活動量低的病人，即使骨折有輕微錯位，但不影響生活品質

• 病人本身不適合手術（如合併慢性疾病、麻醉風險高等）

2. 治療方式

• 徒手復位（closed reduction）：將錯位骨頭用外力復位。

• 石膏或支架固定：通常須固定約4~6週，視骨折穩定性與癒合情況調整。

• 定期回診拍X光追蹤骨頭對位情況。

3. 衛教重點

• 固定期間保持患肢抬高，減少腫脹與疼痛。

• 若出現麻木、皮膚變色、疼痛加劇，可能為循環或神經受壓，請即時回診。

• 石膏避免受潮，可使用防水套或塑膠袋包裹。

• 復健依醫師指示開始：初期以手指、肩關節活動為主，逐步增加手腕活動與力量訓練。

• 手術後傷口需保持乾淨乾燥，按時服藥預防感染。

• 傷口若紅腫滲液、發燒，需立即回診。

• 傷口拆線通常為術後10~14天。

• 物理治療按計畫展開：早期避免關節僵硬，後期加強肌力與活動度。

• 術後可安排1~3個月的追蹤，包括X光檢查觀察癒合情形。

• 飲食補充蛋白質、鈣質與維生素D，有助骨骼修復。

• 
  

問題

建議回應

石膏好癢怎麼辦？

可用吹風機冷風吹入，但不要用棍棒或衣架搔癢，以免造成皮膚破損。

開刀會留下疤嗎？

傷口會有疤痕，但會逐漸淡化。也可術後使用矽膠片或疤痕凝膠協助減淡。

什麼時候可以恢復正常活動？

視骨折癒合與復健進度，一般需6週至3個月，重複使用患肢前應諮詢醫師。

? Third proximal phalanx oblique old fracture

固定cast就好

不過需要確認neurovascular integrity

這期間可以用不同的cast或是sling

• 我們會用石膏或支架固定，讓骨頭自行癒合。

⸻

🩹 二、治療與照護重點

1. 固定期間（約4～6週）

• 手腕與前臂需保持固定，不要拆開或移動石膏。

• 保持手部乾燥清潔，洗澡時可用塑膠袋套住避免進水。

• 若感覺石膏太緊、手指腫脹、麻木、發青或劇痛，要立刻回診。

2. 抬高手臂

• 前幾天可用枕頭或吊帶將手抬高於心臟，可減少腫脹與疼痛。

3. 活動手指

• 雖然手腕固定，但可以輕輕活動手指（握拳、伸直），避免僵硬與血液循環不良。

4. 疼痛控制

• 依醫師指示使用止痛藥。

• 若疼痛持續或加劇，要再回診。

⸻

🍎 三、生活建議

• 避免搬重物或用受傷的手支撐身體。

• 不要自行拆石膏或嘗試「按摩復位」。

• 回診時醫師會安排追蹤X光，確定骨頭持續在正確位置。

⸻

💪 四、復健階段

• 固定移除後，可能會有僵硬或肌肉無力。

• 醫師可能會安排物理治療或手腕運動訓練，要依照指示復健。

• 初期不要太用力轉動或推撐，循序漸進恢復活動力。

⸻

🕒 五、何時要回診或急診

• 手或手指顏色變深、發紫、腫脹劇烈或麻木

• 石膏破裂或濕掉

• 疼痛越來越嚴重

• 發燒或懷疑感染

橈骨骨折（radial fracture）如果不需要手術，表示是穩定性骨折（例如遠端橈骨輕微移位、或青枝骨折等），此時最重要的是正確固定與病人衛教，避免移位、促進癒合、減少併發症。

以下是一份詳細的病人衛教重點，可以直接用於臨床講解或書面衛教單：

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🩺 橈骨骨折非手術治療衛教

一、治療方式說明

您的骨折屬於穩定性骨折，不需要手術。

主要治療方式是外固定（例如石膏 cast、夾板 splint、或支具 brace）。

固定的目的：

讓骨頭在正確位置癒合

減少疼痛與腫脹

防止再次受傷

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二、固定期間注意事項

✅ 保護與姿勢

保持患肢抬高（高於心臟），可減少腫脹與疼痛。

前3–5天最腫，請避免長時間垂手或懸空。

睡覺時可用枕頭墊高手臂。

🧊 冰敷

若有腫脹或疼痛：

前48小時內可冰敷，每次15–20分鐘，每2–3小時一次。

避免冰塊直接接觸皮膚（可用毛巾包覆）。

❌ 請勿

不要用力壓、搖晃或自行取下石膏／支架。

不要放入異物或抓癢（例如用筷子、筆等伸入石膏內），避免皮膚破損。

避免手臂承重或提重物，直到醫師允許。

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三、活動與復健

固定期間，肩膀與手指要持續活動：

每天多次活動手指，開合拳頭，以防僵硬與腫脹。

肩膀可輕微活動，避免冰凍肩。

等醫師評估後（約3–6週），逐步開始手腕與前臂的活動訓練。

若醫師安排復健，請按時回診與配合物理治療。

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四、疼痛與藥物

若有疼痛，可依醫囑服用止痛藥（如 acetaminophen 或 NSAID）。

若疼痛突然加劇、腫脹明顯或手指麻木，不要自行加藥，請立即回診。

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五、何時需要回診或求醫 🚨

請立即回醫院或急診，如果出現以下情況：

手指劇痛、腫脹、發白或發紫、冰冷、無法活動（可能為血流受阻）

感覺麻木、刺痛、或石膏內灼熱疼痛

石膏破損、鬆脫、或潮濕有異味

發燒或傷口滲液

不小心跌倒或再次外傷

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六、回診與追蹤

一般需在1週內回診檢查石膏鬆緊與X光追蹤。

醫師會根據骨癒合情形決定何時拆除固定（通常約4–6週）。

拆

除後需持續做關節活動與肌力訓練。

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七、恢復期提醒

骨折癒合後，手腕或前臂可能一時僵硬、無力，這是正常現象。

經過2–3週的復健通常可逐步恢復功能。

完全癒合約需6–8週（依個人年齡與骨質狀況而異）。

急性期照護

在受傷後一週內，應充分休息並維持患肢抬高，以促進靜脈回流、減少腫脹與疼痛。可在24至48小時內間歇冰敷（每次20分鐘），但避免冰塊與皮膚直接接觸以防凍傷。若有持續麻木、手指發紫、劇痛等情形，須警覺為循環受阻，應儘速就醫。

固定期間運動訓練

在固定期間，未受傷的關節應持續活動，如手指、手腕、膝踝等主動收縮運動，以防血栓與關節僵硬；長期臥床者需每兩小時翻身一次，預防壓瘡。

復健與回診

骨折癒合約需6至12週，拆除固定後，常見關節僵硬或肌肉萎縮，應在醫師評估下進行循序復健，包括關節活動、熱敷與按摩等，以恢復功能。應按時回診追蹤X光與復原情形，避免提前負重導致移位。

飲食與營養

攝取足夠的鈣、維生素D、蛋白質與Omega-3脂肪酸，有助於骨痂生成與組織修復。建議均衡飲食並多曬太陽，必要時可配合補充保健品。

需立即回診的警訊

• 固定部位劇烈疼痛、腫漲或麻木惡化

• 患肢顏色變紫、冰冷

• 發現異味、分泌物或皮膚潰爛

• 不慎跌倒或撞擊患處後出現疼痛加劇

• The Injury: "You have a wrist fracture, which means a break in one of your forearm bones near your wrist. Because the pieces are in a good position (or have been put back into a good position, called a reduction), we can treat it without surgery."

• The Treatment: "The main treatment is immobilization. We are using a cast/splint to hold the bones perfectly still and in the correct alignment so they can heal. This is a very common and effective way to treat this kind of break."

• Note to Family: Explain the typical duration (often 4-6 weeks in a cast, but this can vary) and the need for follow-up X-rays (usually weekly for the first few weeks) to ensure the bone fragments stay aligned. 

• Healing Timeline: "The bone will usually take about 4 to 6 weeks to feel solid, but it can take 6 to 12 months for your strength, full comfort, and flexibility to completely return." 

II. Essential Cast/Splint Care (Home Instructions)

• Keep it Dry: "Your cast/splint must stay completely dry. Water can weaken the cast material or cause skin irritation and infection underneath. When showering or bathing, use two layers of plastic bags taped above the cast or a waterproof cast protector."

• Keep it Clean: "Do not put anything down inside the cast to scratch an itch, like pencils, rulers, or coat hangers. This can cause a serious skin injury or infection. If it's itchy, you can try blowing cool air from a hair dryer into the ends of the cast." 

• Do Not Modify: "Never attempt to cut or remove the cast/splint yourself. If the cast becomes cracked or damaged, call our office immediately."

III. Managing Swelling and Pain

• Elevation is Critical: "For the first few days, and anytime you notice swelling, you need to keep your hand elevated above the level of your heart. You can do this by resting your elbow on a table and propping your hand up on pillows, or carrying it in a sling if directed by the provider. Swelling slows down healing and increases pain." 

• Ice: "Applying an ice pack (wrapped in a thin towel) to the area outside the cast, especially over the fracture site, can help with pain and swelling. Use it for 15-20 minutes at a time, every few hours as needed." 

• Pain Management: "Pain is normal, especially for the first week. Use over-the-counter pain relievers (like acetaminophen or ibuprofen, as directed by a doctor) regularly as prescribed. Do not wait for the pain to become severe before taking medication." 

IV. Moving Uninjured Joints (Crucial for Recovery)

• Fingers and Thumb: "It is extremely important to move all of your uninjured joints, especially your fingers and thumb, frequently throughout the day. Make a full fist and then fully straighten your fingers at least 10 times every hour while you are awake. This prevents stiffness and helps reduce swelling." 

• Elbow and Shoulder: "Perform full range of motion exercises for your elbow and shoulder several times a day to prevent stiffness in those joints as well."

V. When to Call the Doctor Immediately (Warning Signs)

Stress the importance of calling the office or going to the emergency room if the patient experiences any of the following:

• Severe or Unrelenting Pain: Pain that is not relieved by elevation or pain medication, or pain that suddenly gets much worse.

• Numbness or Tingling: Loss of feeling, or pins-and-needles sensation in the fingers or thumb.

• Color Change in Fingers: Fingers are pale, white, or blue.

• Inability to Move Fingers: You cannot move your fingers or thumb easily.

• Odor or Drainage: Foul odor or wetness coming from inside the cast. 

• Cast Problems: The cast is cracked, very loose, or feels excessively tight.

VI. The Rehabilitation Phase (What's Next)

• After the Cast is Removed: "When the cast comes off, your wrist will look a bit thin, the skin may be dry, and the wrist will feel stiff and weak. This is completely normal." 

• Therapy: "We will likely refer you to a Physical or Occupational Therapist. They are experts who will give you specific exercises to regain your movement, strength, and function. Attending therapy and doing your home exercises is essential to getting your wrist back to normal."

• Activity Restrictions: "After the cast is off, you will need to start slow. You will likely wear a removable splint for protection and should avoid any heavy lifting, pushing, or high-impact activities (like contact sports) for a period of time, as directed by your provider."

• Doing（行動）：了解個案目前正在做什麼，行為如何影響現實生活。

• Evaluation（評估）：協助個案評估現有行為是否有助於達成目標或滿足需求。

• Plan（計劃）：制定具體、可行、立即性的改變計劃，幫助個案承諾並執行行動

| W | Wants | What do you want and need in your life (e.g., from your relationships, job, or self)? |

| D | Doing | What are you doing (your current actions, thoughts, feelings) to try and get what you want? |

| E | Evaluation | Is your current doing helpful or unhelpful? Is it moving you closer to or further away from your wants? |

| P | Planning | What specific, actionable plan will you commit to doing differently to achieve your wants? |

W

Wants

想要什麼

了解個案的需求、目標、價值觀

D

Doing / Direction

正在做什麼／方向

探討個案目前的行為與努力方向

E

Evaluation

評估

幫助個案評估目前行為是否有效、有助於達成想要的結果

P

Planning

計畫

協助個案擬定具體可行的行動計畫，改變不適當行為

The abbreviation WDEP has different meanings depending on the clinical context:

## Primary Medical Meanings:

### 1. WDEP in Reality Therapy/Counseling Psychology

Wants

Doing

Evaluation

Planning

This is a framework used in reality therapy and counseling, developed by William Glasser. It’s commonly taught in psychiatric/behavioral health rotations and involves:

- Wants: What does the patient want?

- Doing: What are they currently doing?

- Evaluation: Is what they’re doing helping them get what they want?

- Planning: What’s the plan to achieve their goals?

### 2. WDEP in Neonatal/Pediatric Medicine

Widely Disseminated Ectopic Pulmonary calcification

- A rare pathological condition seen in neonates

### 3. Context-Specific Usage

Without additional clinical context, WDEP could also be institution-specific shorthand used in:

- Documentation systems

- Treatment protocols

- Research study acronyms

## Most Likely Context for PGY-1:

As a PGY-1 resident, you’ll most commonly encounter WDEP in:

- Psychiatry rotations (reality therapy framework)

- Patient counseling documentation

- Behavioral health assessments

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Could you provide more context about where you encountered this abbreviation? (e.g., patient chart, lecture, specific rotation) This would help me give you the most relevant interpretation for your clinical situation.

Source Note: This information is based on standard medical terminology and psychiatric/psychological assessment frameworks commonly taught in residency programs. For institution-specific acronyms, consult your hospital’s abbreviation list or documentation guidelines.​​​​​​​​​​​​​​​​

用來幫助個案釐清自己要什麼、在做什麼、做得是否有效、以及接下來怎麼改變。

這四個字母代表四個步驟：

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1️⃣ W — Wants（想要什麼）

先了解個案真正的想法與需求。

> 你最希望的是什麼？

你想要達到什麼樣的結果？

這件事對你來說有什麼意義？

這一步讓個案自己說出內在動機，找出他行為背後的願望。

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2️⃣ D — Doing（正在做什麼）

幫個案覺察目前的行為、思考與情緒。

> 你現在為了達成那個目標，正在做些什麼？

你最近的做法是怎樣？

當這件事發生時，你通常怎麼反應？

透過「正在做的事」來讓他看到自己的模式。

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3️⃣ E — Evaluation（評估）

請個案自己評估現在的行為是否真的有幫助。

> 你覺得現在這樣做，有幫助你接近目標嗎？

如果沒有，有什麼地方想改變？

這一步的重點是自我覺察與負責任，不是批評，而是幫他自己看到問題。

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4️⃣ P — Planning（計畫）

最後，協助個案訂出具體可行的行動計畫。

> 那你想從哪一步開始試著改變？

明天你可以做什麼小改變？

我們要怎麼追蹤成效？

這一步讓他能付諸實行，不只想改變，而是開始改變。

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🌿 總結

> WDEP = 想要什麼 → 正在做什麼 → 有效嗎 → 下一步怎麼做

Evaluation

Plan