di Distal Tibial Intramedullary Nail (DTN) dεn indikεt fכ difrεn tibial kכndishכn dεm, we inklud simpul, spiral, kכmminut, lכng oblique, εn sεgmεnt shaft frakshכn (patikul fכ di distal tibia), εn bak distal tibial mεtaphyseal frakshכn, nכn-/mal-yunion; i kin yuz am bak, bכku tεm wit spεshal divays dεm, fכ mεnεj di bon dεm we de fכm כ di limb lεngth dεm we nכ de lεng (lεk fכ lεng כ sכt).
distal tibial frakshכn na wan kכmכn kayn lכw limb frakshכn. Tradishכnal tritmεnt dεm lεk lכk plet dεm εn antegrεd intramεdul nel dεm εvri wan gεt in dכw. di plet dεm we dεn lכk kin mek infεkshכn dεm afta dεn dכn כpεrayshכn כ sכft tisu nεkrכsis, we kin mek i gεt rεkכvεshכn fכ lכng tεm; pan ɔl we di antegrɛd nel dɛn nɔ kin invayd smɔl, dɛn kin pwɛl di knee joyn, mek pɔsin fil pen, ɛn i kin gɛt risk fɔ mek i nɔ fiks ɔ nɔ alaynɛd fayn, we kin mek i nɔ ebul fɔ wɛl.
2Nyu sɔlvishɔn: Distal Tibial Nɛl (DTN) .
wan nyu tritmεnt opshכn—Distal Tibial Nail (DTN)—de gi nyu we fכ mεnεj di distal tibial frakshכn wit in yכnik rεtrogrεd disayn.
Fig. 1: DTN retrogrɛd insɛshɔn dizayn
II. Di we aw dɛn fɔ du di ɔpreshɔn
1Patient posishun ɛn ridyushɔn pripiamɛnt
Dɛn kin put di pɔsin na di say we i de slip. di fraktכs dεm we dεn displεs fכ rεdukshכn wit an; if nid de, yuz rεdukshכn fכs fכ εp bifo yu put di DTN. if fibula frakshכn de we de wit am, di rayt fibular alaynsmεnt kin εp di tibial rεdukshכn.
Di men tin dɛn we yu fɔ tink bɔt: Supine position, yuz ridyushɔn fɔs if nid de. Prioritiz fibular fraktכs mεnejmεnt fכ mek sכh se di tibial rεdukshכn kכrekt.
2DTN insεshכn prosidכs
2–3 cm lכnjitudinal insishכn de mek na di tכp pan di mεdial maleolus fכ εkspכz di supεrfishal dεltoid ligament. wan gayd pin de insay כ sכmtεm mεdial to di tכp fכ di maleolus, 4–5 mm frכm di artikulכr sεf.
di ankכl jכint aktiviti de stat wantεm afta dεn כpεrayshכn
Avɔyd fɔ bia wet fɔ 4–6 wik
sכmtεm transishכn to ful wet-bεri na 8–12 wik
rεgulεr rεdyografik mכnitri di tεm we di rεkכvεshכn fεz de
IV. Di Rizult fɔ Stɔdi
1Klinik Autkam fɔ 10 Pasɛnt dɛn
Wan stɔdi bin fala 10 pasɛnt dɛn. Bay 3 mɔnt post-op, 7 kes dɛn bin dɔn wɛl; ɔl di pasɛnt dɛn bin ajɔst to wɛl insay 6 mɔnt. Wan kes εvri wan pan di varus εn rεkכrvatum difכmiti bin apin. Nɔ lɔs pan ridɔkshɔn, infɛkshɔn, kɔmplikeshɔn dɛn we gɛt fɔ du wit implant, ɔ iatrogenic injuri dɛn nɔ bin si.
Post-op: Na 6 sכm sכm insεshכn nכmכ, komplit hεl insay 1 ia
Sɔma fɔ di tritmɛnt
DTN implant tru minimal insishכn wit εksεlεnt sכft tisu prεzεvεshכn. Fibular fraktכs we dεn stεbyul wit intramεdula nel. Patient achiv ful rikavari wit no komplikashon.
Imej we dɛn kin yuz bifo dɛn du ɔpreshɔn
Wantɛm wantɛm Post-op
3-mɔnt Fɔl-ɔp
1-ia Hiling
VI. Tɔk bɔt
1Bayomekanikal Stebiliti
rεtrogrεd nel dεm gεt supεriכr akshal εn rotashכnal stiffnεs kכmpεr to mεdial lכk plet dεm εn antegrεd nel dεm. Grinfild ɛn ɔda pipul dɛn. kכnεkt bayomεkanikal tεst we sho se we dεn yuz tu distal skru dεm na di DTN i achyv 60–70% pan di kכmpreshכn stiffnεs εn 90% pan di tכrshכnal stiffnεs kכmpεr to tri skru dεm.
2Advantej dɛn we DTN gɛt
we yu kכmpεr wit di plet dεm we de lכk, di intramεdul nel dεm de mek sכft tisu dεm nכ de damej sכft tisu dεm, we i fayn fכ ol pasεnshכn dεm εn di wan dεm we gεt siriכs sכft tisu injuri frכm hכy-εnεji trauma. Di prosidur nɔ nid fɔ fleks di ni, we de ridyus di risk fɔ ridyus di lɔs ɛn mek i fayn fɔ di sik pipul dɛn we nɔ de muv di ni.
3Klinik Kɔmpiashɔn
di nכnunion εn malalaynmεnt rεt fכ di antegrεd nel dεm na 0–25% εn 8.3–50%, rispεktivli; fכ lכk plet, 0–17% εn 0–17%. insay dis stכdi, כl di kes dεm achyv union, εn na כnli 20% bin gεt difכmiti >5°, we kכmparabl wit tradishכnal mεtכd dεm.
VII. Dɔn
fכ sכmari, DTN de gi advantej oba di lכk plet dεm εn antegrεd intramεdula nel dεm εn i de riprizent wan ifektiv sכlushכn fכ trit distal tibial frakshכn dεm. DTN ficha minimal invasiveness, hεy stεbiliti, εn rεkכvεshכn kwik. Na valyu ɔda tritmɛnt pas tradishɔnal tritmɛnt ɛn i fayn fɔ mek pipul dɛn no bɔt am.
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