Femur-a Intertrochanteric Fractures tih awmzia sawifiahna
Intertrochanteric fractures of the femur (trochanteric fractures tia hriat bawk) tih hian femoral neck bul atanga lesser trochanter chunglam level thlenga fracture thleng a kawk a ni. A lan chhuah dan chu local pain, swelling, ecchymosis te a ni. Damlote chu an kal thei lo va, a ke ruh chu a tawi a, a adduction a, a pawn lam a inher a, hip joint pawh a che thei lo.
Heng fracture te hian taksa a fracture zawng zawng 3% - 4% leh hip fracture 35.7% a ni. Kum upat dan azirin a vei nasa hle a, kum 70 chunglam zingah a tam zawk a, mipa aiin hmeichhiaah a tam zawk bawk.
A rilru a buai em em a, a rilru a hah em em bawk a. Applied Anatomy of Intertrochanteric Fractures of the Femur
Ward-a Triangle a ni
Femoral neck trabeculae inzawmkhawmna central area-ah hian triangular vulnerable area a lo awm a. Tar ruh natna vei zingah chuan he hmun hi thau chauhvin a khat a ni.
Femoral Calcar a ni
Bone plate dense tak chu hnunglam - femoral neck leh shaft inzawmna atanga medial-a awm lesser trochanter thlenga thuk. Femoral shaft-a posterior - medial cortex chu cancellous bone-a tihzauh a ni a, proximal femur-a eccentric load hmanna hmun a ni.
Hip Bone Trabeculae te chu a grade dan tur a ni
Proximal femur-a mechanical strength grade dan:
(1) Grade 6; (2) Pawl 5-na; (3) Pawl 4-na; (4) Pawl 3-na; (5) Pawl 2-na; (6) Pawl 1-na
Femur-a Intertrochanteric Fractures-a hliam awm dan
Damlo Tleirawl zingah High - energy Hliam
Damlo naupangte intertrochanteric fracture hi high - energy injury, hmun sang atanga tlak leh car accident vang a ni tlangpui. Heng dinhmunte hian ruh tliak na tak a thlen thei a, damlote chu a kaihhnawih hliam, lu, ruhro, leh thoracic leh abdominal organ-a hliam awm leh awm loh uluk taka enfiah a ngai a ni.
Damlo Tarte Tlukna thlentu (Fctors of Falls) te
Kum upa lam zingah intertrochanteric fracture 90% hi tlu vang a ni. Tarte tlu duhna thlentu thilte chu mit hmuhna ṭha lo, taksa ruh chakna tlahniam, thisen sang nghet lo, thiltih theihna tlahniam, thisen kalna lam natna, leh ruh leh ruh natna te a ni.
Tluin a tliak a nih leh nih loh chu a hnuaia thil panga te hian a hril a ni: ruh natna nasat dan te, a tlakna lam te, a bik takin hip emaw hip hnaih ber hmun emaw leia a tlak chuan, tlakna chakna tihtlem nan protective reflexes a tling tawk lo, hip soft tissue-te’n chakna tling tawk an lakluh theih lohna, leh hip ruh chakna tling lo.
Tharum thawhna chi hrang hrang leh thiltih dan
Direct Violence: High - energy injuries hian hip-ah direct-in hna a thawk a, chu chu traffic accident emaw, hip direct-a a tlakna hmuna tlak emaw a ni a, chu chuan fracture a thlen thin.
Indirect Violence: Taksa torsion hian hip chu varus leh forward angulation stress a thlen thin. Lesser trochanter chu fulcrum atan a hmang a, nasa takin a compress a, iliopsoas muscle pulling effect pawh a awm thei a, butterfly - ang maia ruh fragment a siam thei bawk. Trochanter lian zawk hian gluteus medius muscle a hip nasat avangin ruh chi hrang hrang a siam thei bawk.
Femur-a Intertrochanteric Fracture awmte chu clinical classification-ah a awm a
Evans Classification a ni
Clinical practice-a hman tlanglawn ber. Evans chuan intertrochanteric fracture hi chi hnih ah a then a:
Type I:Trans - trochanteric fractures Reduction hma leh hnua a stability a zirin subtype 4-ah then leh a ni:
Ia: Two - part fracture awm lovin displacement a awm.
Ib: Two - part fracture with displacement, medial cortex chu a intact deuh a, a fracture chu reduction hnuah a stable a ni.
c: Lesser trochanter chu free a ni a, fracture displacement leh varus deformity a awm a; emaw, trochanter lian zawk chu ruh chi hrang hrang a ni.
Id: Intertrochanteric fracture bakah hian trochanter lian zawk leh te zawk te chu ruh chi hrang hrangah an chang a, varus deformity a awm bawk.
Chung zingah chuan type Ia leh Ib te hi stable type an ni a, a bak zawng chu unstable type an ni.
Type II:Reverse - oblique intertrochanteric fractures
Type II hi reverse - trochanteric fracture a ni a, a fracture line chu greater trochanter hnuai atanga lesser trochanter chunglam thlengin oblique-in a inzar pharh a ni.
AO Classification a ni
Type A1: Trochanter kaltlangin part hnih - part fracture awlsam tak, medial bone cortex leh intact lateral bone cortex te chu a thlawp tha hle.
Intertrochanteric line-ah chuan.
Trochanter lian zawk kaltlangin.
Lesser trochanter kaltlangin.
Type A2: Trochanter kaltlangin comminuted fractures a awm a, medial cortex chu plane pahnih-ah fracture a awm a, mahse lateral bone cortex erawh a awm reng thung.
Medial fracture fragment pakhat nen.
Medial fracture fragment engemaw zat a awm bawk.
Lesser trochanter hnuaiah cm 1 aia zau a sei.
Type A3: Reverse - intertrochanteric fractures, lateral cortex pawh a tliak bawk.
Oblique a ni.
Transverse a ni.
Comminut a ni.
A tlangpuiin type A1.1 atanga A2.1 hi stable anga ngaih a ni a, type A2.2 atanga A3.3 te hi unstable anga ngaih a ni bawk.
Femur-a Intertrochanteric Fracture awmte chu Surgery hmanga enkawl a ni
Surgical treatment thil tum bulpui ber chu intertrochanteric fracture tihtlem hnua firm fixation neih theihna tur a ni. Fixation nghetna chu a hnuaia thil awmteah hian a innghat a ni: ruh quality, fracture type, reduction, internal fixation device design, leh internal fixation material dahna hmun.
Tun hnaiah intertrochanteric fracture enkawlna atana internal fixation materials siam chhuah leh update chhunzawm zel a ni. Chumi zingah chuan intramedullary fixation, PFNA leh INTERTAN te hi standard internal fixation device atan hman a ni tlangpui.
Femur-a Intertrochanteric Fracture enkawlna atana hman tur PFNA
PFNA hi Osteoporotic intertrochanteric fracture nghet lo tak tak Evans Ic, Id, leh Type II te tan hman a ni. Performance tha zawk, anti - rotational ability tha tak, operation hun rei lo, thisen hloh tlem, complication tlem, leh proximal locking nail cut - out theihna a hniam zawk a, enkawlna lama thatna chiang tak a lantir.
PFNA hi osteoporotic intertrochanteric fracture nghet lo (Evans type Ic, Id, leh II ang chi) tan a ni. Anti-rotation property tha tak neiin performance tha zawk a lantir a, operation hun a tawi zawk a, thisen a hloh tlem zawk a, harsatna a nei tlem zawk bawk. System-a helical blade design hian ruh chu a ti compact tha hle a, holding power chak tak a pe a, femoral head atanga cut-out hlauhawmna nasa takin a tihziaawm a, therapeutic advantage hrang hrang a pe bawk.
INTERTAN hian Femur-a Intertrochanteric Fracture enkawlna atan hman a ni
Tunlai damdawi lam technology lo thang zel a nih tak avangin INTERTAN hi intramedullary nail chi thar a ni a, a bik takin femur-a intertrochanteric fracture enkawlna atana siam a ni. A nail bulpui cross - section chu trapezoidal a ni. Proximal interlocking combined nail nena hman dun a nih chuan 'Z' effect a veng thei a ni. Femoral lu atanga secondary nail rawn chhuak dah belh hian lag screw anti - rotational effect a tipung a ni. He intramedullary nail hian hmanna hrang hrang a nei a, ruh natna nasa tak nei tan pawh a tha hle.
INTERTAN hi novel intramedullary nail a ni a, intertrochanteric fracture tan bik a siam a ni a, tunlai medical technology lama hmasawnna a lantir a ni. A main nail hian trapezoidal cross-section a nei a, hei hian stability a ti sang zawk a ni. Proximal section hian integrated interlocking construct (lag screw leh compression screw) a hmang a, hei hian 'Z-effect' (screw pakhat chu a hnungtawlh a, pakhat chu femoral head a luhchilh laiin) chu a titawp thei hle. Set screw dang dah belh chuan lag screw chu femoral head chhungah a project lehzual thei a, chu chuan a anti-rotation capability a tipung a ni. He nail hian indication hrang hrang a nei a, a bik takin osteoporosis na tak nei tan a tha hle.
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