di proksimal humerus frakshכn na wan pan di kכmכn frakshכn dεm na trauma כtpidik, εn mכst proksimal humerus frakshכn na lכw-εnεji כstioporotik frakshכn na di ol pipul dεm.
pan tap we di mכtalman in proksimal humerus frakshכn dεm kin trit kכnsyuv wan, 10-15% pan di frakshכn dεm stil nid כspitul tritmεnt, we inklud insishכnal rεdukshכn plet fikseshכn, klos rεdukshכn intramεdul nel intanεt fikshכn, εn jכyn riplesmεnt.
Di disayd fɔ tritmɛnt nid fɔ bi bay di sikman in bɔdi, aw i de si insɛf, wetin i de op fɔ in maynd, ɛn di kayn we aw i brok.
Riset ɛn fiks di imejensi fraktrɔs
【Rɛkɔmɛndishɔn】Fɔ proksimal humeral big tuberositi (NEER tayp 2 patɛl fraktrɔs) fraktrɔs we dɛn kɔba wit sɔldɔm dislɔkeshɔn, prɛ-ɔpareshɔn CT ɛgzamɛn, pas fɔ fraktrɔs na di ɔspitul nɛk rijyɔn, ripɔzishɔn ɛn brek wit traumatik sɔldɔm bres ɔnda imejensi anestezi (ɛkspɛkt rɛkɛmɔndeshɔn rit: 100%; strɔng rɛkɛmɔndeshɔn rit:: 76.2%).
2. Prɛ-ɔpareshɔn akyu pen kɔntrol
【Rɛkɔmɛndishɔn】Di pasɛnt dɛn we gɛt proksimal humerus fraktrɔs gɛt prɛfɛkshɔn fɔ prɛ-ɔpareshɔn analjɛsia wit ɔral asetaminofɛn ɔ NSAID, ɛn dɛn kin ad ɔral opioid if di ifɛkt nɔ gud (ɛkspɛkt rɛkɛmɔndeshɔn rɛt: 100%; strɔng rɛkɛmɔndeshɔn rɛt: 73.8%).
3. Pri-ɔpareshɔn mishɔnari ɛdyukeshɔn
[Rɛkɔmɛndishɔn] Dɛn fɔ du ɛdyukeshɔn bifo dɛn du ɔpreshɔn pan difrɛn we dɛn ɛn we gɛt bɔku tin dɛn fɔ du. (Ɛkspɛkt rɛkɛmɔndeshɔn rɛt: 100%; strɔng rɛkɛmɔndeshɔn rɛt: 83.8%)
4. Pri-ɔpareshɔn nyutrishɔnal asɛsmɛnt ɛn sɔpɔt tritmɛnt
【Rɛkɔmɛndishɔn】Fɔ kɔmplit nyutrishɔn skrinin fɔ di pasɛnt dɛn insay 24 h afta dɛn admit dɛn ɛn fɔ gi nyutrishɔn intavɛnshɔn fɔ di pasɛnt dɛn we gɛt nyutrishɔn risk. (Ɛkspɛkt rɛkɛmɔndeshɔn rɛt: 98.5%; strɔng rɛkɛmɔndeshɔn rɛt: 55.9%)
5. Pεriכpεraytiv glukכs asesmεnt εn rεgulεshכn in dayabεtik pasεnt
【Rεkכmεndεshכn】Di rεkomεndεd glycemic kכntrכl tכgεt fכ mכst dayabεtik pasεnshכn dεm we de כnda εlektif כpεrayshכn na 7.8 to 10.0 mmol/L.
6. Manejmɛnt fɔ sɔft tisu swɛlin insay di periɔpareshɔn tɛm
【Rɛkɔmɛndishɔn】Fɔ di pasɛnt dɛn we de du ɛlektiv ɔpreshɔn fɔ proksimal humerus fraktrɔs, dɛn kin gi bɔku fizik we fɔ ridyus di swɛlin insay di periɔpareshɔn tɛm. (Ɛkspɛkt rɛkɛmɔndeshɔn rɛt: 98.5%; strɔng rɛkɛmɔndeshɔn rɛt: 80.9%)
7. Prɛ-ɔpareshɔn it mɛnejɛmɛnt
【Rɛkɔmɛndishɔn】 Di wan dɛn we gɛt ɛlektiv ɔpreshɔn kin it klia drink 2 awa bifo dɛn du di ɔpreshɔn ɛn it dɛn we gɛt stach ɔ dairy prodakt 6 awa bifo dɛn du di ɔpreshɔn. (Ɛkspɛkt rɛkɛmɔndeshɔn rɛt: 100%; strɔng rɛkɛmɔndeshɔn rɛt: 76.5%)
8. Pεriכpεraytiv urinary kateta mεnejmεnt
【Rɛkɔmɛndishɔn】Dɛn nɔ kin rɛkɔmɛnd fɔ mek dɛn yuz rutin periɔparetiv urinary kateshɔn fɔ ɔpreshɔn fɔ proksimal humerus fraktrɔs (Ɛkspɛkt rɛkɛmɔndeshɔn rit: 100%; Strɔng rɛkɛmɔndeshɔn rit: 78.6%)
9. Prכfylaktik aplikεshכn fכ pεriכpεraytiv antimaykrobial drog dεm
【Rεkכmεndεshכn】Fכ pasεnshכn dεm we gεt proksimal hכmerus frakshכn we nid εndoprosthεsis כ jכyn riplesmεnt, dεn rεkomεnd fכ prכfylaktik yus fכ fכs εn sεkכn jεnereshכn sεfalosporin fכ infεkshכn prεvεnshכn insay di pεriכpεraytiv pεriכd. (Ɛkspɛkt rɛkɛmɔndeshɔn rɛt: 97.1%; strɔng rɛkɛmɔndeshɔn rɛt: 73.5%)
10. Pik fɔ yuz anestezi
【Rɛkɔmɛndishɔn】Dɛn rikɔmɛnd fɔ adopt di we aw dɛn de yuz rijinal blɔk kɔmpawnd jenɛral anestezi, pik drɔgs fɔ avɔyd fɔ mek di sistɛm ɔgan disfɔkshɔn we ol pipul dɛn gɛt, ɛn pe atɛnshɔn fɔ mek di monitarin strɔng (ɛkspɛkt rɛkɛmɔndeshɔn rɛt: 100%; strɔng rɛkɛmɔndeshɔn rɛt: 71.4%).
11. Intra-ɔpareshɔn blɔd prɛshɔn kɔntrol
[Rɛkɔmɛndishɔn] Dɛn fɔ pe atɛnshɔn mɔdaret ridɔkshɔn pan blɔd prɛshɔn fɔ ridyus intraɔpareshɔn blɔd lɔs fɔ proksimal humeral fraktrɔs, bɔt ol pasɛnt dɛn we gɛt bɔku bɔku kɔmɔrɔbiditi fɔ pe atɛnshɔn fɔ mek dɛn kɔntinyu fɔ gɛt ɛmodaynamik stebiliti fɔ avɔyd inadekwayt pɔrfyushɔn pan tisu ɛn ɔgan dɛn (ɛkspɛkt rɛkɛmɔndeshɔn rɛt: 100%; strɔng rɛkɛmɔndeshɔn rɛt: 61.9%).
12. Intra-ɔpareshɔn volyum mɛnejɛmɛnt
[Rεkכmεndεshכn] Impliment wan gol-oriεnt fכ mεnejmεnt stratεji, εn dεn kin gi vasoaktiv drog dεm prכfylaktik wan di tεm we dεn de du jεnarכl anεsthεsia fכ mek fכ mek fכs fכ lכd כvalod (εkspεrt rεkomεndεshכn rεt: 100%; strכng rεkomεndεshכn rεt: 69.1%).
13. Intraɔpareshɔn blɔd mɛnejɛmɛnt
[Rɛkɔmɛndishɔn dɛn] Dɛn nɔ kin fayn fɔ mek dɛn gɛt di proksimal humeral fraktrɔs we dɛn de du di ɔpreshɔn, mɔ pan di wan dɛn we dɔn ol, ɛn dɛn kin gi blɔd transfyushɔn ɛn tranexamic asid we dɛn de du ɔpreshɔn. intra-opεraytiv chεk fכ HGB <80g/L rεkomεnd fכ transfyushכn fכ allogeneic bכdi (εkspεrt rεkomεndεshכn rεt: 100%; strכng rεkomεndεshכn rεt: 73.8%).
14. Prɛvenshɔn fɔ intraɔpareshɔn haypotɛmia
[Rɛkɔmɛndishɔn] Di pasɛnt dɛn we gɛt proksimal humeral fraktrɔs fɔ strɔng di intraɔpareshɔn tɛmpracha monitarin ɛn tek difrɛn mɛsej fɔ mek dɛn kɔntinyu fɔ gɛt di kɔr tɛmpracha pas 36°C (ɛkspɛkt rɛkɛmɔndeshɔn rɛt: 100%; strɔng rɛkɛmɔndeshɔn rɛt: 76.2%).
15. Di we aw dɛn kin pik di we aw dɛn kin du ɔpreshɔn
(1) Frakshכn stej fכ proksimal humerus
[Rεkכmεndεshכn] dεn rεkomεnd fכ Neer in stej fכ proksimal hכmerus frakshכn stej (εkspεrt rεkכmandεshכn rεt: 100%; strכng rεkomεndεshכn rεt: 83.3%).
(2) Di we aw dɛn kin du ɔpreshɔn
Dɛn fɔ pik di ɔspitul plan bay di fraktrɔs mɔfɔlɔji, bon kwaliti, di pɔsin in fisiɔlɔjik ɛn saykolojik stetɔs ɛn ɔda tin dɛn we gɛt fɔ du wit am.
[Rεkכmendashכn] dεn kin pik di intanεt fikseshכn mεtirial akɔdin to di frakshכn tכp εn bon dεnsiti, lεk plet כ intramεdul nel; fɔ ol pipul dɛn we gɛt ɔstioporosis we at fɔ riset ɔ fiks, 4-pat fraktrɔs (ɛn fraktrɔs dislɔkeshɔn), 3-pat fraktrɔs wit siriɔs ɔstioporosis, split fraktrɔs ɛn anatomical nɛk frakshɔn, dɛn kin pik atifishal sɔldɔm jɔyn, ɛn dɛn kin rɛkɛmand fɔ riples di rivas sɔldɔm jɔyn if dɛn kam togɛda wit rotator kɔf injuri (ɛkspɛkt rɛkɛmɔndeshɔn rit:: 100% (Strɔng rɛkɛmɔndeshɔn rɛt: 71.4%).
![Proksimal humerus fraktrɔs]()
Figure 1 wan 65 ia ol uman wit 4 pat frakshכn pan di proksimal humeral adductor insεshכn εn allograft fibular implant plet fikseshכn wit insishכn εn riposishכn.
16. Ples we dɛn put di wund drenaj tiub
[Rɛkɔmɛndishɔn] Indikashɔn fɔ nɔ put drenaj tyub: 1 Minimally invasive ɔpreshɔn tɛknik (MIPPO ɛn intramedullary nailing); 2 Di blɔd we de kɔmɔt smɔl. indikεshכn dεm fכ put drenaj tכb: 1 via pεktoral dεltoid aprכch, Locking plate fiksεshכn כ sכlda jכint riplesmεnt; 2 signifyant bכdi frכm di wund sεf (εkspεrt rεkomεndεshכn rεt: 100%; strכng rεkomεndεshכn rεt: 71.4%).
17. Fɔ lɔk wund
【Rɛkɔmɛndishɔn】Dɛn bin lɔk di ɔspitul insayshɔn bay simpul intarapt, layt-bay-layer sutura (ɛkspɛkt rɛkɔmɛndishɔn rɛt: 100%; strɔng rɛkɛmɔndeshɔn rɛt: 76.2%).
18. Di it we pɔsin kin it afta di ɔpreshɔn
【Rɛkɔmɛndishɔn】Di pasɛnt dɛn kin it drink dɛn we nɔ gɛt dregs tru dɛn mɔt wans dɛn wek afta dɛn dɔn ɔpreshɔn, ɛn bigin fɔ it nɔmal it bak afta 1-2 h if nɔ bad riakshɔn nɔ de.
19. Pכstכpεraytiv posishכn sεlεkshכn εn εli aktiviti
【Rɛkɔmɛndishɔn】Di pasɛnt dɛn nɔ nid fɔ ledɔm flat na di pilo afta dɛn dɔn ɔpreshɔn dɛn, dɛn kin adopt sɛmi-rɛkumbent pozishɔn ɛn dɛn kin muv na grɔn afta dɛn wek. Di traumatik sholda bres fɔ brek.
20. Di analjɛsik mɛzhɔ dɛn we dɛn kin du afta dɛn dɔn ɔpreshɔn
【Rɛkɔmɛndishɔn】Dɛn kin rikɔmɛnd fɔ yuz rijinal blɔk we dɛn kin yuz rijinal blɔk we dɛn jɔyn wit rɛgyula 'bakgrɔn dos' fɔ NSAID, ɛn if nid de, dɛn kin yuz analjɛsia pɔmp dɛn we dɛn kin put insay di bɛlɛ ɔ di periferik nɛv blɔk we dɛn kin gi dɛnsɛf analjɛsia pɔmp (ɛkspɛkt rɛkɛmɔndeshɔn rit: 100%; strɔng rɛkɛmɔndeshɔn rit:: 78.6%).
21. Prɛvenshɔn fɔ nɔs ɛn vɔmit afta dɛn dɔn ɔpreshɔn
[Rɛkɔmɛndishɔn] Dɛn fɔ gi ɔl di sik pipul dɛn prɔfylaktik antiɛmɛtik mɛrɛsin 30 min bifo di ɔpreshɔn dɔn. (Ɛkspɛkt rɛkɛmɔndeshɔn rɛt: 97%; strɔng rɛkɛmɔndeshɔn rɛt: 47.8%)
22. Fɔnishɔnal rihabiliteshɔn
【Rɛkɔmɛndishɔn】Di pasɛnt dɛn we gɛt fiks ɛn stebul proksimal humerus fraktrɔs fɔ stat fɔ du rihabiliteshɔn ɛgzampul as ali as i pɔsibul afta dɛn dɔn ɔpreshɔn. di rihabiliteshכn εksεsayz dεm de εp fכ bεtε fכ bεtε fכ mek di כp pat fכ wok bak (εkspεrt rεkomεndεshכn rεt: 100%; Strכng rεkomεndεshכn rεt: 92.9%).
23. Dischaj krayteria ɛn fɔlɔp
【Rɛkɔmɛndishɔn】Dɛn fɔ mek prɛktikal dischaj krayteria, ɛn dɛn fɔ fala di pasɛnt dɛn ɔltɛm fɔ at le 6 mɔnt (ɛkspɛkt rɛkɛmɔndeshɔn rɛt: 100%; strɔng rɛkɛmɔndeshɔn rɛt: 83.3%).
Aw fɔ Bay Ɔtpidik Implant ɛn Ɔtpidik Instrumɛnt dɛn!
Fɔ CZMEDITECH , wi gɛt wan rili kɔmplit prodak layn fɔ ɔtpidik ɔpreshɔn implant ɛn kɔrɛspɔndɛns inschrumɛnt, di prɔdak dɛn inklud spayna implant dɛn, di nel dεm we de insay di mεdula, trauma plet, Locking plate, kraynia-maksilofashial, prostɛsis we dɛn kin yuz fɔ mek pɔsin in bɔdi, pawa tul dɛn we dɛn kin yuz, External Fixators, atrɔskɔpi we dɛn kin du, vetɛriana kia ɛn dɛn sɔpɔtin inschrumɛnt sɛt dɛn.
Apat frɔm dat, wi dɔn mekɔp wi maynd fɔ kɔntinyu fɔ divɛlɔp nyu prɔdak ɛn mek di prɔdak layn dɛn bɔku, so dat wi go mit di ɔspitul nid fɔ mɔ dɔktɔ ɛn pasɛnt dɛn, ɛn bak fɔ mek wi kɔmni gɛt mɔ kɔmpitishɔn na di wan ol wɔl Ortopedik implanti dɛn ɛn inschrumɛnt industri.
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