Ɔspitul tritmɛnt fɔ di humeral stem fraktrɔs ɛn tɛknikal pɔynt dɛn

di weit rεstrikshכn we de afta di כpεrayshכn fכ mεnten na maksimכm wan kilogram te dεn achy signifyant frakshכn hilin (usually tri mכnt).Humeral stem fractures (HSF) na rili kכmכn, we de akכnt fכ lεk 1% to 5% pan כl di frakshכn dεm. di anual insidεns na 13 to 20 pan 100,000 pipul dεm εn dεn fכnshכn se i de inkrεs wit di ej.HSF gεt bimodal ej distribushכn, wit di fכs pik we de apin pan man dεm bitwin 21 εn 30 ia ej fכ fכlכ hεy-εnεji trauma, we kin rεsult in kכmminuted frakshכn εn asosiet sכft tisu injuri. di sεkכn pik kin apin pan uman dεm we ol bitwin 60 εn 80 ia, bכku tεm dεn kin fala di trauma we nכ gεt lכw εnεji.

Ɔspitul tritmɛnt

一 we dɛn kɔl. Intanɛt fikseshɔn wit insishɔnal ripɔzishɔn plet

Di tin dɛn we de sho se:

• Radial nerve palsy (RNP) na HSF nɔto indikashɔn fɔ ɔpreshɔn bikɔs i gɛt fɔ du wit ay rit fɔ spontan rikavari (luk bak - Kɔmplikeshɔn/Radial Nɛv dɔŋ ya).

• כda we de fכ du dat, eni vaskul injuri we nid fכ ripa כ baypas na absכlut indikεshכn fכ כspitul tritmεnt fכ di frakshכn, as rigid fiksεshכn de protεkt di vaskulεr anastomosis.

• insay dis patikyula kes, intanεt fiksεshכn wit plet de fast εn i kin rili bi pas IMN biכs dεn de du di vaskulכr ripa tru wan dayrekt aprכch (usually na mεdial aprכch).

• HSF wit proksimal כ distal intra-atikul εkstenshכn na כda situeshכn we ORIF wit plet dεm na bεtε opshכn.

  
  

Di ɔpreshɔn we dɛn de du: .

• frakshכn dεm we de na di proksimal εn/כ midul tכd dεn de trit dεm yuz di klas anterolateral aprכch.

• we nid de, dεn kin εkstendi dis apכch distal fכ mek di כl humerus kכmכt.

• כltu, dεn nכ rεkomεnd dis apכch fכ distal intra-artikulכr frakshכn.

• di frakshכn dεm na di distal tכd kin kכmכt na di trisεps split aprכch.

• fכ distal εn midul tכd frakshכn, di modifyed posita apכch we Gerwin et al30 dεskrεb kin εkspכz 76-94% pan di humerus (dipεnd pan raydial nεv rilis εn septal rilis).

  
  

Di we aw dɛn kin du ɔpreshɔn: .

• Dɛn kin put di sikman na bich chia pozishɔn fɔ di anterolateral aprɔch. di yus fכ wan arm bres de εp fכ mεnten di humeral stem alaynmεnt. fכ posita εkspכzכn, di lateral posishכn na di posishכn we dεn kin fכs fכ.

• di כptimal plet kכnstrכkshכn kכnsis fכ 4.5 mm stεl plet כ ​​ikwal εn i fכ kכba at le 6 kכtis dεm oba εn dכn di fraktכs sayt, bכt 8 kכtis dεm na dεn fכs.

• we nid de, dεn kin rεkomεnd fכ kכmbayn sכm εn big fragmεnt plet, lεk sכt tכd ​​tכbul plet fכ mεnten riposishכn (transvas frakshכn כ bכtaflay fragmεnt), we dεn kin supliment wit wan sכm 4.5 mm plet fכ fayn fiksεshכn fכ di frakshכn.

• fכ distal tכd frakshכn, dεn rεkomεnd fכ wan posita lateral kכlכm prεfכm plet (3.5/4.5) fכ alaw strכng εpiphyseal fikseshכn.

  
  

Di yus fɔ lɔk skru na HSF stil gɛt kɔntroversi

• we yu kכmpεr lכk plet wit nכn-lכk plet fכ kכminεt frakshכn wit gud bon kwaliti, nכ bayomεkanikal advantej de fכ tכshכn, bεnd כ akshal stiffnεs fכ di tu strכkchכ dεm.

• Bɔt we dɛn gɛt prɔblɛm wit di bon kwaliti dɛn we nɔ fayn, i kin fayn fɔ yuz plet dɛn we de lɔk.

• Insay wan bayɔmɛkanikal stɔdi we Gardner ɛn ɔda pipul dɛn bin du. spεshal fכ כstioporotik frakshכn mכdel dεm, 34 nכn-lכk strכkchכ dεm bin sכmtεm lεs stebul pas lכk כ haybrid strכkchכ dεm.

Minimally invasive plate splicing na sכjεkshכn opshכn we de sho se i de gi ay sakses rεt εn lכw komplikεshכn rεt. Bɔt insay wan retrospektiv stɔdi we involv 76 pasɛnt dɛn, van de Wall ɛn ɔda pipul dɛn. dεn sho se absכlut stεbiliti fכ di humeral stεm frakshכn nכmכ de sכt sכmtεm sכt rεdyografik hilin tεm kכmpεr to rilitiv stεbiliti.

Di we aw dɛn de du di wok afta dɛn dɔn du di ɔpreshɔn: .

• Bɔku tɛm, dɛn kin gɛt stebul fikseshɔn wit di yus fɔ plet. So, dεn kin alaw di sikman fכ du aktv εn aktif-asist aktiviti dεm we nכ de limited bay di rεnj fכ muvmεnt fכ in sכlda כ εlbo.

• Yu kin yuz di sling fɔ sɔm dez fɔ mɛn di pen.

• di weit rεstrikshכn afta di כpεrayshכn fכ mεnten na maksimכm wan kilogram te dεn rich signifyant frakshכn hilin (usually tri mכnt).

• Dɛn kin alaw yɔŋ pasɛnt dɛn fɔ bia wet usay dɛn alaw am (ɛgz., dɛn nid fɔ gɛt krach fɔ waka), bɔt pan di wan dɛn we dɔn ol, dɛn fɔ tɔk bɔt dis wan bay wan.

Ripɔt di rizɔlt dɛn

• di hεlin rεt afta dεn plet bin de frכm 87% to 96%, wit wan min hεlin tεm fכ 12 wik.

• di komplikashכn rεt de kכmכt frכm 5% to 25%, wit di mכst kכmכn nכn spεsifi k komplikashכn dεm lεk infεkshכn, כstionekrכsis, εn malunion.

• RNP we dεn kכl mεdikal na risk fכ mכst humeral stεm aprכch dεm. Streufert et al50 rivyu 261 kes dɛm fɔ HSF we dɛn trit wit ORIF ɛn dɛn si se RNP we kɔmɔt frɔm mɛrɛsin apin insay 7.1% pan di anterolateral aprɔch, 11.7% pan di separet trisɛps aprɔch, ɛn 17.9% pan di prɛzɛv trisɛps aprɔch.

• fכ dat, i rili implεnt fכ no εn protεkt di raydial nεv insay כl di opin disekshכn dεm.

  
  

二 we dɛn kɔl. Nɛl we de insay di mɛdula

Di tin dɛn we de sho se:

• Tiori, IMN kin gi bayomekanikal ɛn ɔspitul bɛnifit dɛn we bɛtɛ pas pletin

• frכm bayomεkanikal standpכint, di divays in intramεdula posishכn de alaynd wit di mεkanikal aks fכ di humeral stεm.

• fכ dis rizin, di implant de sכbjεkt to lכw bεnd fכs dεm εn i de alaw fכ bεtε lod sherin. di sכjεkshכn indikεshכn fכ intramεdula nel na di sem lεk fכ plet.

• Bɔt lɛk aw wi bin dɔn tɔk, sɔm fraktrɔs dɛn kin fayn fɔ plet pas fɔ nel.

• di frakshכn kכntribyushכn dεm εn di patεn dεm we dεn fכnshכn se dεn bכku pas IMN na patכlayz εn impending frakshכn, sεgmεnt lεshכn, εn כstioporotik frakshכn.

• Simpul mid-tכd transvas frakshכn dεm na gud indikεshכn dεm bak fכ IMN.

• apat frכm dat, dεn kin put di nel insay tru wan sכm sכm say we dεn kכl, we de ridyus di sכft tisu strip we yu kכmpεr wit di pletin tεknik.

• dis na tru mכtalman fכ frakshכn dεm na di midul tכd pat pan di humerus.

Tɛknik fɔ ɔpreshɔn: .

• Di optimal pesin posishun fɔ dis prosidur na pan bich chia. Di yus fɔ wan an bres rili yusful fɔ mek di shaft alayns ɛn bak fɔ du distal frihan lɔk skru dɛn.

• di poynt fכ enta de dipכnt pan di disayn fכ di nel, bכt כltεm i de na di jכnkshכn fכ di big tuberosity εn di artikulכr sεf fכ di humeral ed, we min se di rotator kכf mכsul dεm fכ go insay.

• fכ dis prosidכs, i rεkomεnd fכ du wan dεltoid divεlכpmεnt aprכch fכ si di supraspinatus tεndon.

• infakt, we i go insay di humeral ed na di midul pan di supraspinatus tεndon, i go fכnshכn insεf na di sεntrכm pan di ed insay di sajital plen.

• i imכtant fכ yuz di kεratomile כnda fכroskopi fכ mek sכh se di εntri pכynt de na akseptabl posishכn insay כl tu di sajital εn koronal plen dεm.

• afta dis, di gayd waya fכ go bifo fכ opin di supraspinatus tεndon lכnjitudinal כnda dayrekt vishכn.

• di nεks step na fכ opin di kanal oba di Kirschner nidul, fכ mek sכh se di frakshכn de alayne wit trakshכn εn/כ εksternal manipulεshכn, εn afta dat fכ advans di gayd insay di intramεdula kanal dכn to di εlbo.

• Dɛn dɔn si se rimin kin fayn fɔ yɔŋ pipul dɛn ɛn nɔto ɔltɛm i kin nid fɔ ol pipul dɛn.

• fכ distal bolt plesmεnt, AP lכk de sef εn i nid fכ sכm sכm 2-3 cm aprכch fכ ridyus di risk fכ mayokatan nεv injuri.

• fכ finish, paralel IMN bεtεh pas rεtrogrεd IMN biכs fכ di spεsifi k kכmplikεshכn dεm fכ di lεta inklud mεdikal indyuz suprakכndylar frakshכn, lכs כf εlbo εkstenshכn, εn hεterotopik כsifikεshכn.

  
  

Dɛn nid fɔ pe spɛshal atɛnshɔn to di lɔng we di nel we dɛn pik, bikɔs nel dɛn we tu lɔng kin mek dɛn mek tu mistek dɛn we dɛn mek wit tɛknik:

• Distrakshɔn na di say we di fraktrɔs de we di nel de impak

• εn/כ nel dεm we de kכmכt na di subakromial spεs

  
  

fכ proksimal tכd hεliks כ lכng oblik frakshכn, di כta dεm rεkomεnd fכ sכm sכm opin apכch fכ ridyus di frakshכn we dεn fכlכ fכ fiks wit wan ring tay waya. in fakt, fכ dis frakshכn sכbtayp, di dεltoid mכsul kin tεnd fכ abdukt di proksimal frakshכn fragmεnt we di pεktoralis mεjכr de pul di distal frakshכn fragmεnt mεdial, we de inkrεs di risk fכ di כs nכnunion כ dilay hiling.

Manejmɛnt we dɛn kin du afta dɛn dɔn ɔpreshɔn

• Dɛn kin ɛnkɔrej di sik pipul dɛn fɔ du aktif ɛn aktif-asist muvmɛnt dɛn na di sholda ɛn ɛlb as dɛn kin telɛret.

• Yu kin yuz sling fɔ sɔm dez fɔ kɔntrol di pen.

• di posכpεraytiv weit liftin rεstrikshכn dεm de mεnten na maksimכm wan kilogram te di frakshכn hεl fכ klia (usually tri mכnt).

• Bɔku tɛm, dɛn kin alaw fɔ bia wet

  
  

Di tin dɛn we dɛn dɔn ripɔt:

• Di buk dɛn we de tɔk bɔt aw fɔ yuz lɔk nel divays fɔ di manejmɛnt fɔ HSF nɔ kɔrɛkt. na wan say, di rεt we dεn ripot fכ bon nכnunion de hεvi vεryuable (bitwin 0% εn 14%), wit di hεyest insidεns insay ol jεnereshכn fכ nel dεm. na di כda say, dεn bin ripot di insidεns fכ di sכlda komplikεshכn dεm (inklud pen, impingement, lכs fכ muv כ trεnk) (we de kכmכt frכm 6% to 100%) insay di fכs buk dεm.

• pat pan di prכblεm kin εksplen bay subakromial trauma bikoz fכ di krεse tεndon disfכnkshכn we kכz fכ protruding nel dεm, ska tisu εn/כ rotator kכf injuri na dis krichכl εria fכ isovascularity.

• sεvεra awta dεn dεskrεb difrεn we dεm fכ avכyd dis haypovaskul rijyכn εn rεpair di tεndon insay wan diskrεt we, we dεn sho lכw rεt fכ di sכlda disfכnkshכn.

  
  

Kɔnsɔvativ tritmɛnt fɔ HSF dɔn gi gud fɛnshɔnal autkam ɛn ay hiling rɛt insay at le 80% pan di pasɛnt dɛn. Fɔ dis rizin, i stil de bi di tritmɛnt we dɛn kin pik fɔ bɔku HSF. If dɛn nɔ gri fɔ mek dɛn alaynɛd, dɛn fɔ tink bɔt fɔ du ɔpreshɔn. dis na tru tru fכ pasεnshכn dεm we pas 55 ia we de prεzεnt wit proksimal tכd oblique frakshכn (lכw hεlin rεt). Fɔ tɔk bɔt ɔspitul tritmɛnt, di buk dɛn nɔ sho ɛni impɔtant difrɛns bitwin plet ɛn IMN pan di hiling rit ɔ raydial nɛv kɔmplikeshɔn, bɔt sɔldɔm kɔmplikeshɔn (impingement ɛn ridyus rɛnj ɔf muvmɛnt) kin mɔs wit IMN. So, dɛn fɔ tek tɛm manej di kɔf na di say we dɛn de go insay ɛn we dɛn de lɔk am.

Bɔt CZMEDITECH we de wok fɔ di kɔmni

Na di fet we de drɛb am se ɔlman na dis planɛt fɔ gɛt bɛtɛ wɛlbɔdi savis. CZMEDITECH  de wok wit pawa fɔ ɛp ɔda pipul dɛn fɔ liv we dɛn nɔ de fred. Wi de prayz we di pasɛnt dɛn we bin bɛnifit bɔku ɛn gɛt bɛtɛ layf bikɔs ɔf wi prɔdak ɛn wi futprin dɔn go bifo to pas 70 ɔda kɔntri dɛn, usay di sik pipul dɛn, dɔktɔ dɛn ɛn patna dɛn ɔl de abop pan  CZMEDITECH we de wok fɔ di kɔmni fɔ go bifo. Ɛvri ɔtpidik implant we wi mek de mit di ay kwaliti standad.

Wi bin stat di ekstra ɔdinari joyn wit ɔtpidik implant 13 ia bifo. In di prכsεs, di prodakshכn layn dεn dכn divεrsif insay implant fכ spayna, shɔk, kraynia-maksilofashial, prostɛsis we dɛn kin yuz fɔ mek pɔsin in bɔdi, pawa tul dɛn, . eksternal fiksatɔ dɛn, atrɔskɔpi  ɛn veterinari kia , wit di inschrumɛnt dɛn  we dɛn kin yuz fɔ du ɔpreshɔn we gɛt fɔ du wit am.

Ɔl wi raw matirial dɛn na frɔm tɔp kwaliti saplay dɛn na domestik ɛn ɔda kɔntri dɛn. We i kam pan kwaliti, wi nɔ de ɛva spay kɔst na wi mishɔn fɔ de wan stɛp bifo, we de mek wi sɛt wi yon tɛst lab fɔ mek shɔ se di raw matirial kwaliti. Ɔl wi prodakshɔn mashin dɛn na frɔm USA, Jamani, Japan ɛn tɔp brand dɛn na Domestic fɔ mek shɔ se ɛvri prɔdak we wi mek, kɔrɛkt.

Dɛn kin spɛn bɔku tɛm ɛn tray fɔ du risach bɔt di impɔtant tin dɛn we dɛn go du ɛn fɔ mawnt di las prɔdak. Wi gɛt profeshɔnal risach tim, prodakshɔn tim ɛn QC tim fɔ mek shɔ se di bɛst kwaliti ɛn wi sɛl tim sɔpɔt fɔ sɔlv ɔl di prɔblɛm dɛn ɛn gi di bɛst afta-sɛl savis.

Wi rili lɛk wi fet, wi de kɔntinyu fɔ push di limit dɛn fɔ wi no-aw fɔ gi ay kwaliti, inovashɔn prodak sɔlvishɔn fɔ ɔl wi klaynt dɛn ɔlsay na di wɔl ɛn wi de tray tranga wan fɔ mɔtalman wɛlbɔdi.