Closed reduction surgery a ɛma ntini no mu paapae a ɛba fam.

Closed reduction yɛ ɔkwan a ɛnyɛ den pii a wɔfa etc., a ɛma mogya a ɛsen no sɛe no fi hɔ denam incisional reduction so.

akyi berɛmo no kɔn mu a ɛpaapae .

(i) twe a wɔtwe adwene si so .

Wɔde ɔyarefo no si mpa so, na wɔde tibial tuberosity traction a ne nsa ne ne ho no yɛ no wɔ baabi a ɛnyɛ nea ɛwɔ afã biara a ne mu no di akɔneaba kakra. Ntwerɛ mu duru no gu ahorow wɔ onipa biara mu, mpɛn pii no kilogram 6-9, na ɛnsɛ sɛ bere tenten a wɔde twetwe no boro nnɔnhwerew 12. Ayarefo 90% betumi anya gyinabea foforo denam traction so.

(b) manipulative reposition a wɔatoto mu .

Sɛ traction antumi anyɛ repositioning ahwehwɛde ahorow no a, wobetumi de manual repositioning aka ho, wɔ epidural anesthesia ase:

1. MC Elvenny Ɔkwan a wɔfa so yɛ adwuma no .

Atirimpɔw no ne sɛ wobesiesie akyi berɛmo no, akɔ akyi wɔ akyi berɛmo no mu na ama tumi a ɛtwetwe no ayɛ kɛse, na afei wɔadan no wɔ mu na wɔatwe akwaa a ɛka no no afi mu na ama wɔatumi ayɛ botae a ɛne sɛ wɔbɛsan de wɔn ho asi hɔ no.

2. Leadbetter kwan .

Ɔyarefo no da fam, kotow asen ne kotodwe a ayɛ basaa no 90°, twe a ɛtwetwe no fa asen no fã a ɛwɔ ne nsa ne ne nan no ho simma 2 kosi 3, afei ɔdannan ne nan no wɔ ne nan mu na ɔde ne nsa no bɔ kakra, bere a wasan asiesie no akyi no, ɔde brɛoo brɛ ne nan no ase, na sɛ ɛte sɛ nea ne nan a ɛka no no adannan ne ho wɔ akyi a, ne fã kɛse no ara kyerɛ sɛ ɛbɛkɔ so ayɛ yiye. Ansa na wɔreyɛ emu fixation no, wɔde C-ARM afiri no dii dwuma de dii ho adanse.

(c) Ɔkwan a wɔfa so yɛ ade a wɔde hyɛ nipadua mu .

Sɛ wɔmfa akwan a ɛwɔ atifi hɔ no so antumi ankɔ baabi foforo a, ɛtaa kyerɛ sɛ asen no ti no abubu anaasɛ mpaapaemu bi aba ti ne kɔn ntam (Mfonini 1A), anaasɛ wɔde biribi ahyɛ mu wɔ baabi a ɛda ti ne kɔn ntam. (Eyi betumi aba turo II, III, anaa IV ahorow no mu biara mu). Wɔ eyi mu no, ɔhonam akwaa a ɛho ayɛ fĩ no a wobɛdannan no ma ayɛ ti ne kɔn mu akisikuru no nyɛ adwuma bio. Nea ɛbɛyɛ na wɔakwati sɛ wobetwa mu na wɔasan de asi baabi foforo no, wobetumi de afiri a wɔde twe ade a ɛwɔ nipadua no mu no adi dwuma de asan de abubu no asi baabi foforo.

• Wɔde nnompe kurukuruwa a ne kɛse yɛ mm 3.5 kosi 3.5 no hyɛ honam ani 1 kosi 2 a ɛwɔ inguinal ligament no ne asen no mu ntini a ɛwɔ asen no ti no anim no ase, na wɔde ade no dannan kɔ akyiri kodu femoral ti no mfinimfini wɔ C-Arm afiri no so a ɛwɔ soro no ase (mfonini 1b.

• Nea ɛbɛyɛ na ahyɛ tumi a ɛma ɛyɛ mmerɛw no mu den no, wobetumi de nnompe kurukuruwa a ɛto so abien ahyɛ mu 4-5 mm a ɛne ade yi hyia, na wɔagyaw ade no awiei wɔ honam ani.

• Wɔnam trochanter kɛse no so fa honam ani ntini abien a ne kɛse yɛ mm 3.5 a ne kɛse yɛ mm 3.5 no mu sɛnea awotwaa no dua no anim te ne anim a ɛdan anim no, na ɛdu asen kɔn mu a ɛpaapae no awiei a ɛwɔ akyirikyiri no ho (ntwam wɔ akisikuru no mu) na ɛma nhama no awiei fi honam ani.

• Ɔdefoɔ no kura needle tails mmienu no ne ne nsa mmienu nyinaa na ɔsesa ti ne kɔn mu a ɛpaapae no afã ahodoɔ no ma ɛne ne yɔnko hyia ne ɔboafoɔ no adwumayɛ (Mfonini 1C-E).

• Bere a alignment no ayɛ nea ɛfata akyi no, wɔde dompe kurukuruwa pin a wɔde hyɛ trochanter kɛse no mu no hyɛ asen no ti mu ma ɛyɛ bere tiaa mu de, na afei wɔde nkɔnsɔnkɔnsɔn pii hyɛ asen no ti no mu (Mfonini 1F).

Ɔkwan a wɔfa so tew so a wɔato mu a yɛaka ho asɛm wɔ atifi hɔ no betumi ama nea wɔhwehwɛ no so atew bɛyɛ 98% wɔ asen mu kɔn mu a ɛpaapae no mu. Dodow a abubu no hyia yiye, sɛ́ ɛyɛ nea wɔato mu anaasɛ wɔatwitwa mu no, dodow no ara na nkɔmhyɛ no yɛ papa. Mpɛn pii no, sɛnea akisikuru no mu paapae a wɔada no adi wɔ x-ray so no sua sen sɛnea akisikuru no mu paapae ankasa no. Esiane sɛ mpaapaemu no hyia no nya akisikuru no ayaresa so nkɛntɛnso tẽẽ ne sɛnea ebetumi aba sɛ asen no ti no bɛtetew no nti, ɛho hia sɛ wonya x-ray sini no ho atemmu a ɛteɛ wɔ akisikuru no akyi. Sɛ S-shaped curve no nyɛ mmerɛw anaasɛ ɛnyɛ nea wɔatwa mu a, ɛkyerɛ sɛ asen mu kɔn mu abubu no nnuu anatomical repositioning (Mfonini 2).

Mfonini 1 Asen mu kɔn mu abubu a wɔde ade a ɛwɔ nipadua no mu a prying ayɛ no foforo .

Mfonini 2 Femoral neck fracture x-ray a ɛwɔ abɔnten curve a ɛkɔ so wɔ nipadua mu alignment mu ne abɔnten curve a wɔatwa mu wɔ non-anatomical alignment mu .

Asen mu dua a ɛpaapae .

Ɔkwan a wɔfa so tew so a wɔato mu no betumi aboa ma asen no mu ntini a ɛpaapae no ahyia a ɛrensɛe ntini a ɛyɛ mmerɛw anaa mogya biara a ɛkɔ abubu no awiei, na wobetumi de adi dwuma de ahyɛ mu ma wɔde nnadewa a ɛwɔ ntini no mu ahyɛ mu.

• Wɔ epidural anesthesia ase no, ɔyarefo no da mpa no so petee (wɔnnyaw no mma ne honam akwaa a ayɛ mmerɛw no were saa bere yi), ɔboafo biako kura nantwinini a ɔyare no fã a ɛka no, na ɔboafo foforo no de ntama abɔ ɔyarefo no asen mu ntini no de siw ɔtwetwe no ano, na ne nan no ntaa ntwa ne ho nkɔ soro wɔ ne ho na ne ntini no nkɔ soro wɔ ne ti no anim na ɛma ne ho m’akɔtow no anim na ɛma ne ho ntutu no anim na ɛma ne ho yɛ no dwonku no anim na ɛma ne ti no kɔ soro na ɛma ne ti no gyina hɔ na n’atifi no anim no hwɛ ne nan no anim na ɛma ne ho yɛ no dwonku no anim na ɛma ne ho yɛ no dwonku no. twe, na wobetumi asiesie no ara denam traction so, enti nea ehia ara ne sɛ nea ɔde di dwuma no besiesie anterior-posterior ne lateral displacement a ɛwɔ dua no awiei a abubu no).

• Nea ɔde di dwuma no de nsa abien no nyinaa di dwuma de twa ne nan no ho hyia na ɛkura nsa no mu (Mfonini 3 ne Mfonini 4), na ɔteɛteɛ anim-akyi ne afã a ɛpaapae no prɛko pɛ denam tumi a ɛkyekyere no a ɛyɛ oblique a ɛwɔ nsa abien no nyinaa so no so.

• Sɛ nhwɛso no, sɛ wɔde asen mu akisikuru no fã a ɛbɛn no tu kɔ abɔnten na ɛkɔ anim a, wɔde anim biako piapia ɔfã a ɛbɛn no kɔ mu kɔ mu ne fam. Abasa foforo no piapia distal fracture fã no kɔ akyi na ɛkɔ soro de fɛm clasping force no (ɛsɛ sɛ oduruyɛfo a ɔresan no no nya atemmu a ɛfata wɔ fracture displacement direction ne displacement distance ho ansa na wɔasan ayɛ no), sɛnea ɛbɛyɛ a wobetumi asan de abubuw no asi hɔ yiye bere koro mu. Wɔ repositioning nhyehyɛe no mu no, ɛsɛ sɛ ɔboafo no ma traction tumi no yɛ kɛse na ɛma femur no ntumi nkyinkyin.

• Sɛ wɔde lapped no lapped no titiriw a, ɛsɛ sɛ wɔte nnyigyei a ɛyɛ mmerɛw a wɔde petepete nnompe so, saa bere yi, ɛsɛ sɛ ɔboafo no da so ara kura traction mu, nanso ɛtew tumi a ɛtwetwe no so.

• Sɛ C-Arm afiri no ne akisikuru no hyia titiriw (sɛ ɛda so ara yɛ nea ɛne ne ho nhyia kakra a, yɛ nsakrae bi de hwɛ hu sɛ akisikuru no ano hyia a), ɛma ɛtwetwe no kɔ so tra hɔ, ɔyare mmoawa no fã a ɛka no na wɔtrɛw mpopaho no mu, na afei wɔyɛ nnadewa a wɔde hyɛ mu no.

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Mfonini 3 Wɔteɛteɛ anim-akyi ne akyi a ɛkɔ anim no mu no bere koro mu denam nsa abien no a wɔde kyekyere akwaa a ayɛ basaa no ho na wɔde nsa no bom, de tumi a ɛwɔ nsa abien no nyinaa a wɔde kyekyere wɔn ho no di dwuma.

Mfonini 4 Femoral stem fracture repositioning mechanics schematic .

• Wɔ ayarefo a wɔn mu apaapae kɛse, manipulation a wɔatoto mu a wontumi nyɛ anaasɛ comminited fractures no fam no, wobetumi de oprehyɛn a wɔde twe ade adi dwuma de atew so a wɔde nnwinnade bi a wɔde di dwuma wom, a ebetumi nso awie asen mu ntini a ɛpaapae no so tew a wɔatoto mu yiye.

• Bere a wɔde akwaa a ɛka ho no ahyɛ traction frame no so ama traction na c-arm nhwehwɛmu no kyerɛ sɛ wɔateɛteɛ fracture a ɛka bom no mu no, wobetumi asiesie ɔfã a ɛwɔ akyirikyiri no awiei a ɛka ho no akɔ mu de asan de alignment ne alignment no aba bio wɔ orthostatic image of the femoral stem.

• Esiane sɛ asen mu ntini no mu nhyɛso wɔ traction ase no betumi adi dwuma a ɛyɛ mmerɛw a ɛma ntini no mu paapae wɔ asen no mu nti, asen mu ntini a ɛpaapae no mu dodow no ara betumi anya nhyiam a ɛma abotɔyam kɛse wɔ orthogonal x-ray mfonini no mu.

• Nanso, saa bere yi, esiane mmoa a etu mpɔn a enni hɔ wɔ mpaapaemu fã no awiei a ɛwɔ akyirikyiri no wɔ tumi a ɛtwe ade ba fam no nkɛntɛnso ase nti, asen mu ntini no fã a ɛwɔ akyirikyiri no fã kɛse no ara yɛ akyi, na saa bere yi de, wobetumi de mpopaho a aduru nnim a wɔde akataso akata so no ahyɛ akyi fã a ɛwɔ akyi no ne akyi a wɔde ayɛ no ne wɔn a wɔde wɔn ho ahyɛ mu no ma wɔayɛ wɔn honam ani ne sɛnea wɔde wɔn ho ahyɛ mu no asiesie wɔn ho Wobetumi asiesie distal fracture awiei no denam brace no sorokɔ a wɔbɛsesa so.

• Sɛ wɔda so ara nsiesie distal fracture fã no akyi kwan a ɛkɔ akyiri no a, wobetumi de nnadewa a ɛwɔ akyi no asi hɔ wɔ ɔkwan a ɛkɔ soro wɔ trochanter kɛse no atifi anaasɛ pyriform fossa no so, na afei wɔde ROD a ɛwɔ intradullary repositioning no mu no hyɛ medullary cavity of the proximal fracture no mu . Sɛnea ɛbɛyɛ a wɔbɛma asen no mu abubu a ɛbɛn no akɔ akyi denam poma a wɔde si baabi foforo no lever a wɔde bedi dwuma no so, na ɛnam so ama ɛne distal fracture a ɛwɔ akyi no ayɛ pɛpɛɛpɛ no, .

• Bere a wɔde abubu no ahyia akyi no, wɔde akwankyerɛ pin tenten bi hyɛ distal fracture cavity no mu ma wowie closed reset no. Poma a wɔde si hɔ a wɔde si hɔ no tu mpɔn titiriw wɔ sɛnea wɔteɛteɛ flexion, abduction, ne abɔnten so a ɛkyinkyini no mu deformities a ɛtaa ba wɔ proximal fractures a ɛwɔ proximal femur no mu (Mfonini 5).

• Sɛnea ɛbɛyɛ a residual lateral displacement no, wobetumi asiesie intramedullary rod no awiei a ɛyɛ kurukuruwa no ano de akyerɛ akwankyerɛ pin tenten no kwan akɔ distal fracture cavity no mu de awie closed reduction no.

• Ɔkwan foforo a wɔfa so tew so ne sɛ wɔde schanz nnadewa bɛbɔ nnompe no mu wɔ fracture awiei a ɛkɔ akyiri no afã na wɔde schanz nnadewa no asiesie fracture awiei no ama wɔatoto mu (Mfonini 6). Bere a wɔde abubu no ahyia yiye awie no, wɔde nnadewa a ɛwɔ intramedullary no mu no hyɛ ntini a ɛbɛn ne nea ɛwɔ akyirikyiri a ɛwɔ abubuw no mu no mu de wie emu fixation no (Mfonini 7).

  
  

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Mfonini 5 Proximal fracture segment no a wɔde di dwuma ma closed repositioning a wɔde intramedullary repositioning poma no di dwuma .

Mfonini 6 a wɔatoto mu a wɔatew so denam schanz nnadewa a wɔde ahyɛ nnompe a ɛwɔ afã biako no mu wɔ mpaapaemu no awiei .

Mfonini 7 Closed reduction intramedullary nail fixation a ɛwɔ multisegmental comminited fracture of the femoral stem a wɔde schanz nnadewa no di dwuma .

Ankle a ɛpaapae .

(a) ahosiesie a wɔyɛ ansa na wɔayɛ oprehyɛn .

• Radiographic diagnosis: Ɛsɛ sɛ standard ankle imaging evaluation no ka 3 fass: anteroposterior (Mfonini 8), ankle point (15° a ɛwɔ mu a ɛkyinkyini) (Mfonini 9), ne lateral (Mfonini 10).

• Sɛ ankle joint no pira kɛse a, wɔbɛtu mu ne akyi ankle ne talus no akɔ digrii ahodoɔ 11 (Mfonini 11). Static radiographs nkyerɛ sɛnea ankle joint no gyina pintinn no pɛpɛɛpɛ. Stress radiographs ne MRI betumi ama nhwehwɛmu a ɛfa sɛnea ankle joint ne ligament sɛe no gyina pintinn no ho (Mfonini 12).

• Wɔ saa tebea yi mu no, ɛsɛ sɛ wɔde ɔkwan a wɔfa so pira ne mframa a ɛwɔ nipadua no mu no kwan a wɔfa so pira ne ne nan no ho nsɛm a ɛwɔ nipadua no mu no kyerɛ sɛnea ɛbɛyɛ yiye sɛnea ɛbɛyɛ a wɔbɛkyerɛ sɛnea wɔbɛsan de asi baabi foforo ne nea wɔde si hɔ no kwan yiye.

• Ɛtɔ mmere bi a, medial ankle fracture a ɛnyɛ den betumi ayɛ 'maisonneuve fracture' a ɛyɛ den kɛse no fã, a ɛsan nso ka fibula a ɛpaapae a ɛbɛn ne ligament opira a wɔaka abom ho, enti ɛsɛ sɛ wɔde radiograph hwehwɛ tibiofibula no nyinaa mu.

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Mfonini 8 Anim ne akyi gyinabea .

Mfonini 9 Ntini no ntini (15° a ɛwɔ mu a ɛkyinkyini) .

Mfonini 10 lateral gyinabea .

Mfonini 11 Ɛda adi sɛ mpaapaemu a ɛwɔ baabi a ɛpaapae no ne dislocation no aka ho .

Mfonini 12 Nhyɛso radiograph (abiɛsa a ɛwɔ anim a ɛyɛ mmerɛw) .

(ii) aduru a wɔde kum nipadua no .

Wɔtaa nom asen ne sciatic nerve anesthesia.

(c) Reset Technique .

Wɔyɛ akyi-akyi a ɛkyinkyini no su a wɔatoto mu no sɛnea ɛte wɔ akyi ankle-internal ankle-posterior ankle-inferior tibiofibular union no mu. Wɔyɛ akyi a ɛkyinkyini-mfinimfini no type no wɔ nhyehyɛe a ɛwɔ mu ankle-external ankle mu.

• Wɔ akyi-akyi a ɛkyinkyini type IV no mu no, wɔde ɔyarefo no si fam na wɔbɔ ne kotodwe no wɔ 90° so ma nantwi ba no triceps no dwo.

• Aboafo baanu kura popliteal fã a ɛwɔ asen ne nan no mu sɛnea ɛte biara, na wɔde traction di dwuma wɔ ɔkwan a ɛma mpaapaemu no yɛ mmerɛw no so (ɛnsɛ sɛ traction tumi no yɛ nea ɛboro so na amma opira no mu ayɛ kɛse).

• Ɔboafoɔ a ɔtwe nan no dannan ne nan no kɔ mu de siesie abɔnten so a ɛkyinkyini no mu dɛmdi no (Mfonini 13). Bere a ɔrepia akyirikyiri awiei no akɔ tibial fã no so na ɔretwe tibia a ɛwɔ akyirikyiri no akɔ fibular fã no, ɔboafo no dan ne ho wɔ ne mu na n’akyi trɛw ne nansoaa no mu de siesie akyi ankle ne talus no a ɛkɔ no (Mfonini 14).

• Kura mu rotation-internal rotation-dorsal ntrɛwmu gyinabea no. Afei akyi ankle fracture block no kura nsateaa abien no nyinaa, nsateaa anan no twa distal tibia no ho hyia, na thumbs no nyinaa pia na ɛpia kɔ akyirikyiri, bere a wɔtwe tibia a ɛwɔ akyirikyiri no kɔ fam de san de akyi ankle no si hɔ (Mfonini 15).

• Awiei koraa no, nea ɔde di dwuma no piapia mfinimfini ankle no kɔ akyi ne fam de ne nsateaa no san si so (Mfonini 16). Aboafoɔ mmienu hwɛ nan ne wɔn nansoaa so wɔ mu a ɛkyinkyini-mfinimfini rotation-dorsal extension gyinabea no de siesie wɔn ho ma fixation.

Mfonini 13 Traction nteɛso a ɛfa abɔnten so kyinhyia mu dɛmdi ho .

Mfonini 14 Nsiesiei a ɛfa akyi ankle ne talus no akyi a ɛkɔ .

Mfonini 15 Nsiesiei a ɛfa akyi ankle shift ho .

Mfonini 16 Nsiesiei a wɔyɛ wɔ ankle a ɛkɔ mu no mu .

Post-rotation-internal repositioning nhyehyɛe no yɛ nea ɛne post-rotation-external reposition nhyehyɛe no bɔ abira na wɔyɛ no wɔ nhyehyɛe a ɛwɔ mu ankle-external ankle mu.

Sɛnea wobɛtɔ nnompe mu nneɛma a wɔde hyɛ nipadua mu ne nnompe mu nnwinnade a wɔde yɛ aduan, .

Ma Czmeditech , yɛwɔ aduru a wɔde yɛ nnompe mu oprehyɛn a edi mũ yiye ne nnwinnade a ɛne no hyia, nneɛma a ɛka ho ne . akyi berɛmo a wɔde hyɛ nipadua mu ., nnadewa a wɔde hyɛ nipadua no mu ., Trauma mprɛte ., Mprɛte a wɔde to mu ., atiridiinini-maxillofacial ., Nneɛma a wɔde yɛ nipadua no ., Nnwinnade a ɛma ahoɔden ., abɔnten so fixators ., Arthroscopy ., Mmoa ho ayaresa ne wɔn adwinnade a ɛboa.

Bio nso, yɛasi yɛn bo sɛ yɛbɛkɔ so ayɛ nneɛma foforo na yɛatrɛw nneɛma a wɔyɛ mu, sɛnea ɛbɛyɛ a yebedi nnuruyɛfo ne ayarefo pii oprehyɛn ahiade ho dwuma, na yɛasan nso ama yɛn adwumakuw no asi akan kɛse wɔ wiase nyinaa nnompe mu nneɛma a wɔde hyɛ nipadua mu nyinaa mu.

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