Views: 0 Author: Sayt Ɛditɔ Pɔblish Taym: 2025-07-07 Ɔrijin: Ples
di tibial shaft na wan pan di say dεm we kכmכn fכ frakshכn, we de mek 13.7% pan כl di frakshכn dεm na di bכdi. di distal tibia gεt anatomical kכntribyushכn dεm lεk pwεl bכdi saplai kכmpεnsεshכn εn sכft tisu kכvεreshכn sכft. Wans fraktכs apin, di sכft tisu dεm we de pwεl εn di lokal blכd saplai we de kכmprכmis kin mek i at fכ fraktכs fכ hεl. apat frכm dat, di hכy prכbabiliti fכ kכnkurεnt fכbכl frakshכn εn instεbiliti de mek di sεlεkshכn fכ wan aprכpriet sכjεkshכn aprכch implεnt.
di kכros-sekshכn fכ di mid-to-כpa tibial shaft na triangul, we di lכw tכd na kwadrilatar. di jכnkshכn fכ di midul εn lכw tכd dεm na rεlatεvli sכmtεm εn i de riprizent wan tεnshכn in shep, we de mek am kכmכn sayt fכ frakshכn.
di antεriכr tכd pat pan di tibia na di skin nכmכ de kכba am we nכ de kכba di mכsul dεm, we de mek i izi fכ opin frakshכn usay di bon fragmεnt dεm de pכyz di skin. ivin insay klos fraktכs, mכst tibial frakshכn kin kכmכn wit damej pan di skin εn di sכbkutan tisu. di mid-tibia nכ de kכva di mכsul dεm, εn fכ fascial kompartimεnt dεm de we de rawnd di tibia εn fibula. di insidεns fכ kכmpartmεnt sεndrכm de hכy pan tibial frakshכn we yu kכmpεr wit כda frakshכn dεm.
di AO/OTA Arabik nכmba klasifikasiכn de dεsignet tibial shaft frakshכn dεm as 4 (tibia) 2 (shaft). Tayp A kכrεkt to simpul frakshכn wit wan frakshכn layn, we na di tכp we kכmכn pas כl. Tayp B frakshכn dεm gεt wan intamεdiεt wed-shεp fragmεnt. Tayp C frakshכn dεm de kכz fכ hכy-εnεji trauma εn na kכmminut sεgmεnt frakshכn dεm.
Tayp I: di wund lεngth less dan 1 cm, כltεm na rεlatεv klin pankshכn wund wit di bon tכp we de kכmכt tru di skin. Sɔft tisu damej nɔ bɔku, wit nɔ injuri we de krɔs. di frakshכn na simpul, transvas, כ sכt oblik, we nכ de kכmכt.
Tayp II: di wund pas 1 cm, wit mכr εksεnshכn sכft tisu dεm we de damej bכt nכ avulshכn כ flap fכmeshכn. sכft tisu de sho mild to mכdarεt krεshכn injuri, mכdarεt kכntaminεshכn, εn mכdarεt kכminishכn fכ di frakshכn.
Tayp IIIA: pan ɔl we bɔku avulshɔn injuri ɔ flap fɔmɛshɔn, ɔ ay-ɛnaji trauma ilɛksɛf di wund saiz, na di rayt sɔft tisu kɔvarej de oba di fraktrɔs.
Tayp IIIB: Bכku sכft tisu dεm we dεn dכn pwεl εn lכs, wit pεriost strip εn εkspos bon, we de kam wit siriכs kכntaminεshכn.
Tayp IIIC: I gɛt fɔ du wit di at injuri we nid fɔ ripa.
Di tritmɛnt dɛn we nɔto ɔspitul fɔ tibial fraktrɔs inklud bres, plasta ɛksternal fikseshɔn, trakshɔn, manual ridyushɔn, ɛn fɔ yuz ɛksternal fikseshɔn freym. di opshכn dεm fכ כpכshכn inklud lכk plet intanεt fiksεshכn εn intramεdulari nel, wit כda wan dεm.
Intramedullary nailing fixation na tin we bɔku trauma ɔtpidik sajin dɛn lɛk bikɔs ɔf in simpul ɔspitul prosidur, smɔl smɔl say dɛn we dɛn kɔt, smɔl trauma, ɛn we i izi fɔ pul di nel afta di fraktrɔs dɔn wɛl. i de gi strכng intanεt fiksεshכn, we de alaw fכ εli posכpεraytiv fכnshכnal εksεsayz εn avכyd lokal εn sistεmik kכmplikεshכn dεm. Dɛn advantej ya de alaynɛd wit di AO prinsipul dɛm fɔ tritmɛnt.
di anterior oblique kכt na di proksimal εnd de mek i nכ iritashכn to di patellar ligament.
advans proksimal lכk disayn de inkrεs di stεbiliti we dεn want fכ di proksimal fragmεnt.
distal oblique locking opshכn fכ mek di sכft tisu dεm nכ damej εn fכ inkrεs stεbiliti fכ di distal fragmεnt.
Lɔk skru we dɛn mek wit dabl lid trɛd fɔ mek i izi fɔ put am insay.
lכk disayn fכ strכng fiksεshכn, ridyus postכpεraytiv fragmεnt dislכkeshכn.
mכlti pכynt dεm fכ fiksεshכn de gi angul stεbiliti εn stebul sכpכt fכ tibial palteau.
Di divays gɛt wan adaptiv ajɔstmɛnt fɛnshɔn, wit in mɔfɔlɔjik chenj dɛn we dɛn sho na di ilɛshɔn dɛn ɔnda ɔl tu di prɛ-kɔmpreshɔn (lɔs stet) ɛn post-kɔmpreshɔn (tayt fit) kɔndishɔn dɛn.
mכlti fiksεshכn mεtכd frכm proksimal εn distal, de indikεt כltimat proksimal εn distal tibial frakshכn.
di distal εnd fכ di men nel gεt flat disayn, we de mek i izi fכ put insay di mεdula kεviti.
tu angul lכk skru dεm na di proksimal εnd de mek di frakshכn sεgmεnt nכ de rכt εn displεs.
wan spεshal anatomical kכva de mek sכh se di men nel de optimally posishכn insay di mεdula kεviti.
Tri intasektin angul lɔk skru dɛn na di distal ɛnd de gi ifɛktiv sɔpɔt ɛn fikseshɔn.
i fayn fכ mכst tibial shaft frakshכn dεm (midshaft εn sכm distal/proksimal frakshכn dεm), we כda tכp dεm (εgz., DTN כ εkspεrt Nεl) dεn dεn dεn fכ spεsifi k anatomical rijyכn dεm כ kכmpleks frakshכn dεm.
di standad apכch (parapatellar כ transpatellar) de fala wan we dεn establish fayn fayn wan wit wan lכw lanin kεrv, we spεshal apכch (eg, suprapatellar) nid כda tεknikal trenin.
we yu kompare to spεshal nel dεm lεk di εkspεrt Nεl כ DTN, standad tibial intramedullary nel dεm tipikli mכr afordabl, we de mek dεn fit fכ rutin kes dεm.
Kכmpatibl wit yunivasal instrכmεshכn (εgz., skru dεm we de lכk, divays dεm we de tכgεt), we spεshal nel dεm (εgz., εkspεrt Nεl wit mכlti-dayrεkshכnal lכk sistεm) kin nid prכpriet tul dεm.
| Tayp | Bɛst Indikashɔn dɛn | Kɔr Advantej dɛn |
|---|---|---|
| Ekspɛkt Nail | Komplex shaft fraktrɔs, ɔstioporosis | Multi-planar lɔk, ay stebiliti |
| Nail we de na di suprapatellar | Proksimal fraktrɔs, pipul dɛn we fat pasmak | Suprapatellar aprɔch, de ridyus di antεriɔ knee kɔmplikeshɔn dɛn |
| DTN | Distal fraktrɔs (nia di anklɛ jɔyn) . | Multi-directional distal locking, de rεsist sכt |
| Standart Nɛl | Mid-shaft simpul fraktrɔs dɛn | Simpul ɔpreshɔn, we nɔ de tek bɔku mɔni |
Drill Instruments : I gɛt drɔl bit, rim, ɛn ɔda tul dɛn we dɛn kin yuz dairekt fɔ drɔ bon.
Targeting Devices : Instrument fɔ posishun ɛn gayd drilin ɔ implant ples, lɛk gayd waya, gayd sliv, ɛn aym divays.
Fikseshɔn Instrumɛnt : Na tul dɛn we dɛn kin yuz fɔ kɔnɛkt, lɔk, ɔ ajɔst di implant dɛn, lɛk yunivasal jɔyn, rench, skru, ɛn hama.
Tul dεm fכ mכsu : Instכmεnt dεm fכ mכsu dip, posishכn, כ εp fכ כpεrayshכn, lεk dip gej, rεdukshכn fכsεp, εn bon awl (AWL).
Imej Evalueshɔn: Pri-ɔpareshɔn X-ray/CT fɔ kɔnfɔm di kayn fraktrɔs, di mɛdula kanal dayamita ɛn di lɔng, wit mɛzhɔmɛnt fɔ di kɔntralatɛral tibia as rɛfrɛns.
posishכn: supin posishכn wit knee flekshכn 90°-120° εn sכm hip adukshכn (fכ ridyus di patεla tεndon tεnshכn). wan triangul raydiolusεnt fכm kin sכpכt di popliteal fכs fכ trakshכn.
Sterile Draping: Standart limb stεrilayzεshכn εn draping, we de mek sכh se C-am mobiliti.
Manual Traction: Assistant de aplay longitudinal traction we di sajin de palpate tibial crest ɛn anteromedial surface fɔ ajɔst di alaynɛshɔn (lɛngth, rotashɔn, anguleshɔn).
Instrumɛnt-Asisted:
Joystick Technique: Schanz skru dεm we dεn put insay proksimal/distal fragmεnt dεm fכ lev rεdukshכn.
Pεrkyutan Klam: Pכynt rεdukshכn fכs fכ oblik/spiral frakshכn.
distrakt: big distrakt we dεn put korona (proksimal Schanz skru paralel to tibial pletכ, distal pin insay talus כ distal tibia) fכ mεnten di lεngth.
Di say dɛn we yu go si:
εntri pכynt 1cm distal to antεriכr tibial platכ ed, alaynd wit mεdula aks.
Fluoroskopik kכnfכmeshכn: AP vεyus de alayns wit tibial krεst, lateral vεyus paralel tibial aks.
Instrumɛnt dɛn fɔ Opin:
Kanul drɔl oba gaydway (wit protɛktiv sliv) ɔ kɔba sɔlid awl.
Han rimεr (6-8mm) fכ ol frakshכn wit kanal oklushכn.
Gaydway Plesmɛnt: Bol-tipped gaydwayr bɛn 10-15mm na tip fɔ fraktrɔs pasej. Fluoroskopik kכnfכmeshכn na distal fyzial ska (ankכl sεntr).
Rimin Prɔtokɔlɔ:
Fleksibul rimεr dεm we de stat na 8mm, we de inkrεs 0.5mm te kכrtikכl 'chatter' (tipikli 1-1.5mm > nel dayamita).
Notis: We pɔsin pul di wata wan wan tɛm, i kin klin di dɔti; avɔyd di tɛmal nɛkrɔsis.
Ditarminɛshɔn fɔ lɔng tɛm:
Intraopεraytiv mεzhɔmεnt: Gaydway כvlεp mεtכd כ fluoroskopik rula (εntri pכynt to ankכl jכint).
mek sכh se di nel tip rich di fysial ska we nכ gεt proksimal protrushכn.
Teknik we dɛn kin yuz fɔ put di tin dɛn we dɛn dɔn put insay:
Han-advans ova gaydway; ajɔst ridyushɔn if rɛsistɛns de apin.
Mentεn rεdukshכn di tεm we yu de pas fכ distal frakshכn.
Strateji fɔ Sikyɔn
Lεngth-stebul fraktכs: Proksimal lכk fכs (singl skru alaw dynamization).
Lεngth-unstable/comminuted fractures: Distal lכk fכs we dεn de fala 'bakslap' fכ kכmprεs.
Prɔksimal Lɔk
≥2 skru via aim divays (multidayrekshכnal fכ proksimal frakshכn).
Distal Lɔk we dɛn kin yuz
Fluoroskopik tεknik: Sεntrכl bim pεrpindikul to skru ol dεm ('pafεkt sεkshכn'), pεrkyutan drכlin.
≥2 skru fכ distal frakshכn (may kכmbayn AP/oblique orientεshכn).
εnd Kכp: Opshכnal insεshכn (de mek di bכni nכ gro insay), mek sכh se di jכint nכ de kכmכt.
Wound Klos: Layered patellar tεndon ripa wit lכs sכbkutan sutura.
Rihabiliteshɔn kwik kwik wan:
Limb ɛlevɛshɔn; mכnitor fכ kכmpartmεnt sεndrכm insay 24hrs.
initiate aktv jכint mobilayzεshכn (ankכl pכmp, kכ fכlεkshכn) pan POD 1-2.
Weyt-Bɛrin Prɔtokɔlɔ:
pat pan di wet-bεri fכ 6 wik (adjust per stability), i de go bifo fכ ful we di kכlכs de apia.
Fɔ fala: Klinik/raydiolojikal ɛvalueshɔn na 2, 6, ɛn 12 wik.
Di edkwata: Raynham, Masachusɛt, Amɛrika
Flagship Prodakt dɛn:
εkspεrt Tibial Nεl (ETN) – dεn dεn dεn am fכ stεbiliti insay kכmpleks tibial frakshכn dεm.
T2 Tibial Nail – I de gi εnhans fiksεshכn εn kכmpreshכn.
Ki Strɔng: Strɔng R&D, glob ɔl distribyushɔn, ɛn intagreshɔn wit trauma sɔlvishɔn.
Di edkwata: Kalamazoo, Michigan, Amɛrika
Flagship Prodakt dɛn:
T2 Tibial Nail – Modular sistεm fכ tibial shaft frakshכn.
Gamma3 Tibial Nail – I de kכmbayn intramedullary nailing wit lכk opshכn dεm.
Ki Strɔng: Advans rɔbɔtiks (Mako), sɔlvishɔn dɛn we nɔ de invayd smɔl, ɛn strɔng trauma pɔtfɔlio.
Di edkwata: Lɔndɔn, UK
Flagship Prodakt dɛn:
TRIGEN Tibial Nail – Dɛn mek am fɔ mek i izi fɔ put am insay ɛn fɔ mek i stebul.
IM Tibial Nail – Intramedullary fixation fכ tibial frakshכn.
Ki Strɔng: Fokus pan spɔt mɛrɛsin ɛn trauma, nyu tin dɛn.
Di edkwata: Changzhou, Chaina
Flagship Prodakt dɛn:
Distal Tibial Intramedullary Nail (DTN) – Dɛn dɔn ɔptimayz fɔ distal fraktrɔs.
Ekspɛkt Tibia Intramedullary Nail – Ay-strɛng taytaniɔm alɔy dizayn.
Suprapatellar Approach Tibial Intramedullary Nail – di insεshכn we nכ de invayt bכku bכku wan.
Tibial Intramedullary Nail – Vεrsaytil fikseshכn opshכn dεm.
Ki Strɔng: sɔlvishɔn dɛn we nɔ de tek bɔku mɔni, we de mek pipul dɛn de na di wɔl mɔ ɛn mɔ.
Di edkwata: Wɔsaw, Indiana, Amɛrika
Flagship Prodakt dɛn:
ZNN Tibial Nail – Anatomik dizayn fɔ impɔtant fit.
Natural Nail System – I de falamakata di natura bon mɛkanik.
Ki Strɔng: Strɔng insay jɔyn rikostrɔkshɔn, bayolojikal intagreshɔn, ɛn pɔsnalayz sɔlvishɔn.
Di edkwata: Lɔysvil, Tɛksas, Amɛrika
Flagship Prodakt dɛn:
LON Tibial Nail (Lateral Orthopedic Nail) – Dɛn mek am fɔ latɛral ɛntrɛ aprɔch.
Ki Strɔng: Dɛn spɛshal pan bon growth stimulashɔn, limb difɔmiti kɔrɛkshɔn.
CZMEDITECH de gi kɔmprɛhɛnsif tibial nel sɔlvishɔn fɔ proksimal, distal, ɛn kɔmpleks fraktrɔs, wit inovativ dizayn dɛn (ɛgz., mɔlti-dayrɛkshɔn lɔk, suprapatellar aprɔch) we kɔmparabl to di glob ɔl lida brand dɛn pan bayɔmɛkaniks ɛn klinik autkam.
Prodakt dɛn we dɛn kin mek