Locking Plate Series - Distal Tibial Compression Locking Bone Plate .

Locking Plate Series - Distal Tibial Compression Locking Bone Plate .

            Distal tibial pilon fractures mebɔ o, si nye 10% le fractures siwo ƒo xlã afɔkpodzia me. Lãmetsi falɛfalɛ siwo le ƒunukpeƒea ƒe akpa si le didiƒe la metoa mɔ si mesɔ gbɔ o nu le lãkusi falɛfalɛwo ƒe xɔxlɔ̃ si mesɔ gbɔ o, si wɔnɛ be woƒe gbagbã sesẽna ɖe edzi. Wonya pilon ƒe gbagbã be eƒe lãme gblẽ, eƒe lãkusiwo ʋuʋu, kple abi siwo le lãkusi falɛfalɛwo ŋu. Le tɔtrɔ siwo va le ƒunukpeƒewo ƒe sɔsɔ kple abɔ kple afɔ ƒe sɔsɔ me ta la, abi ƒe akpa gãtɔ hiã be woawɔ dɔ na wo. Ele be woatrɔ asi le amekoko ƒe atikewɔwɔ si ŋu kakaɖedzi le ŋu wòasɔ ɖe ƒunukpeƒetetedɔ ƒomevi aɖewo koŋ nu, abi siwo woxɔ le lãkusi falɛfalɛwo ŋu, kple dɔnɔwo. Ɣeyiɣi si sɔ na amekokoe nye nu vevitɔ si ana woakpɔ dzidzedze.

     

            Nuveviwɔame ƒe mɔnuwo .

High - Energy Injuries: dzea anyi tso kɔkɔƒe, skiing, ʋufɔkuwo, kple bubuawo.

Ŋutasẽnuwɔwɔ ƒe mɔfiame: axial compression; tɔtrɔ ƒe ʋuʋudedi ƒe ŋusẽ; Varus ƒe ʋuʋudedi ƒe ŋusẽ; Valgus ƒe ʋuʋudedi ƒe ŋusẽ.

Varus zi ŋutasẽnu:   si bɔ ɖe sɔhɛwo me wu, kple nuveviwɔame si nu sẽ wu eye wòxɔ abi geɖe le ŋusẽ me. Fli si le gbagbãm la le sagittal plane me, eye zi geɖe la, fibula la me gblẽna o.

Valgus force violence:   si bɔ ɖe ame tsitsiwo me wu, kple nuveviwɔame si mesẽ o eye wòxɔ abi le ŋusẽ si mede ŋgɔ o me. Fracture line la le coronal plane me eye zi geɖe la, edoa ƒome kple fibular fracture.

Nɔnɔmetatawo me dodokpɔwo .

            Woɖea akɔta ƒe ŋgɔgbe, axadzi, kple mortise view x - rays siwo wozãna ɖaa le afɔkpodzi. X - keklẽ si ƒe didime de blibo le afɔkpodzi ate ŋu afia alesi woɖoe ɖe ɖoɖo nu kple klo ƒe ƒunukpeƒe si le etame. Le dɔnɔ aɖewo siwo ƒe gbagbã sesẽ wu gome la, woxɔa X - Rays of the contralateral limb be woana nufiame aɖe si dzi woato agbugbɔ agbã eye woade dzesi ŋutilã ƒe wɔwɔme alo dzidzime ƒe tɔtrɔ siwo li do ŋgɔ.

            Woateŋu agblɔ abixɔxɔ ƒe mɔnu la ɖi tso fibular fracture ƒomevi si le x - rays dzi eye wodae ɖe hatsotso me be: compressive ŋutasẽnuwɔwɔ (valgus deformity), tensile ŋutasẽnuwɔwɔ (varus), axial loading (intact fibula). Ne fibula la me gblẽ o la, zi geɖe la, enyea abi si woxɔna le lãkusi me (ƒomevi B ƒomevi B) ƒe akpa aɖe. Axial agbatsɔtsɔ ƒe abixɔxɔ menaa ʋuʋu geɖe o gake ehea axial agba gbogbo aɖe ɖe distal tibia dzi, kple articular surface fragments sue geɖe kple prognosis si me mekɔ o si nye evelia na articular cartilage compression. Woate ŋu agblɔ afisi wogbã kakɛkakɛ le ƒe ʋuʋu ƒe mɔfiame tso axadzi x - ray si ɖe talar ƒe ʋuʋu ƒe ƒomevi fia (zi geɖe la, ŋgɔgbe ƒe ʋuʋu).

            Eve - didime kple etɔ̃ - didime CT gbugbɔgawɔ le vevie. Woate ŋu ana nyatakaka siwo dometɔ aɖewoe nye alesi gbegbe ƒu ƒe gbagbã ƒe agbɔsɔsɔme, ƒu kakɛwo ƒe nɔƒe kple woƒe xexlẽme, kple afisi woaʋu le.

Ƒomedodowo ƒe hatsotsowo me toto .

Amekoko si menye amekoko o .

            Amekoko si menye amekoko o na distal tibial pilon fractures mebɔ o. Nusiwo wokpɔ la nye gbagbã ƒomevi siwo woɖe tso teƒe sue aɖe kple dɔnɔ siwo ŋu dɔléle siwo kpe ɖe eŋu le siwo dzia amekoko ƒe atikewɔwɔ ƒe afɔkua ɖe edzi. Woate ŋu atsɔ plaster immobilization awɔ atike na ƒunukpeƒetetedɔ siwo me tɔtrɔ sue aɖe ko le le lãkusi ƒe ɖoɖo bliboa me to aŋɔ si me womeɖea asi le o me amekoko manɔmee hã. Wozãa aŋenu le gɔmedzedzea me vaseɖe esime ʋuʋudedia nu fa, eye emegbe wotsɔa aŋɔ si wotsɔna ƒoa aŋɔe la dea eme. Tɔtrɔ sesẽ siwo vaa tibial alo articular ƒe anyigba ƒe sɔsɔme ate ŋu ahe kuxiwo vɛ le abɔ kple afɔ ƒe sɔsɔ kple wo nɔewo me. X - ray dodokpɔ siwo yia edzi la hiã be woatsɔ akpɔ egbɔ be wowɔ ɖeka le ƒomedodo kple abɔ kple afɔ ƒe ɖoɖo nu.

            Woate ŋu ada dɔ na ame ƒe lãme ƒe gbagbã le lãme na ame hã le amekoko me. Le lãkusi ƒe gbagbã siwo ƒe gbagbã ƒe ʋuʋu mede milimeta 2 o eye woate ŋu abu afɔɖeɖe si mede 3 mm o ŋu la, woate ŋu abu atikewɔwɔ si menye amekoko o ŋu na dɔnɔ siwo ƒe dɔwɔwɔ ƒe nudidiwo mede o.

Amekoko ƒe dzesiwo .

Amekoko ƒe ɣeyiɣi ɖoɖo .

            (1) Atikewɔwɔ Kpata: Dislocations dzi ɖeɖe kpɔtɔ kple eƒe tsɔtsɔ ɖe wo nɔewo ŋu; gbagbãƒe siwo le ʋuʋu ɖi; ʋukawo me abi siwo do ƒome kplii; Compartment Syndrome.

            (2) gbãtɔ - afɔɖeɖe (afɔtiwo ƒe didime gbugbɔgaɖoanyi kple woƒe sɔsɔme): calcaneal traction; gotagome fixation; fibular fractures ƒe tsɔtsɔ ɖe edzi kple ememe, seɖoƒe si seɖoƒe li na si le ʋuʋu ɖi kple ememe ƒe megbeƒu ƒe ʋuʋu le ememe ƒe ʋuʋu; ʋuka me ʋu ƒe sisi nu tsitsi.

            (3) Evelia - Afɔɖeɖe: Anɔ abe 10 - 14 le ŋkeke 10 megbe la, ʋuʋu kple ememe fixation le tibial fracture.

            (4) Lãmetsi falɛfalɛwo ƒe nɔnɔme siwo woatsɔ awɔ dɔ na ame eveliae nye: ʋu ƒe sisi le amekokoƒea, lãkusi ƒe gbugbɔgadzɔ le ƒunukpeƒetetedɔ ƒe ʋuʋudediwo me, abi si le lãkusi siwo le ʋuʋu ɖi si me dɔlékui aɖeke mele o ƒe abidada, lãkusi falɛfalɛwo ƒe ʋuʋu ƒe anyidzedze, kple ŋutigbalẽa ƒe ʋuʋu.

Amekoko ƒe mɔnuwo .

            (1) Na fli si wotso la nasɔ gbɔ ɖe edzi.

            (2) Kpɔ gbagbãƒewo katã gbɔ kple amekokomɔnu ʋɛtɔ kekeake.

            (3) Ƒo asa na teƒe siwo lãkusi falɛfalɛwo ƒe nɔnɔme mede ame dzi le o.

            (4) Bu mɔ si dzi woato axɔ abi la ŋu.

            (5) Bu plate la ƒe nɔƒe ŋu kpɔ.

•                     Le fractures with varus deformity gome la, wotia medial buttress plate, eye wozãa anteromedial mɔnu.

•                     Le gbagbã siwo me valgus ƒe nɔnɔme madeamedzi le gome la, wotiaa axadzi ƒe akɔtaɖonu ƒe agba, eye wozãa mɔnu si nye anterolateral.

•                     Ele be didime si le lãɖeɖe eveawo dome nanye 5 - 7 cm ya teti.

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