Lower extremity fracture te tan closed reduction surgery neih a ni.

Closed reduction hi minimally invasive technique a ni a, thisen kalna hloh lo, natna hrik kai theihna tur hlauhawm lo, functional recovery rang, medical cost nasa taka tihtlem, unstable fracture hrang hrang, femoral neck fractures, femoral stem fractures, tibiofibular te closed reduction hollow nail leh intramedullary pin fixation hmanga enkawlna atan hman theih a ni a ke ruh tliak, humeral stem a tliak, . etc., incisional reduction hmanga thisen kal chhiatna tihbo.

Femur kawngkhar a tliak

(I) Traction (Traction) a ni

Damlo chu khumah dah a ni a, tibial tuberosity traction chu a hliam tuar chu neutral position-ah mild internal rotation hmangin an ti a. Traction rit zawng hi mi hrang hrangah a inang lo va, a tlangpuiin kg 6-9 vel a ni a, traction hun chhung hi darkar 12 aia rei lo tur a ni. Damlo 90% chuan traction hmangin repositioning an ti thei a ni.

(B) khar a ni a, manipulative repositioning a ni

Traction hian repositioning mamawh a tlin loh chuan manual repositioning tih belh theih a ni a, epidural anesthesia hnuaiah:

1. MC Elvenny tih dan a ni

A tum ber chu pelvis fix a, pawn lam atanga a natna chu rotate a, traction force tihpun a, chutah chuan a chhunga rotate leh internally retract a, a nghawng chu repositioning tumna tihhlawhtlin a ni.

2. Leadbetter hman dan

Damlo chu leiah a muhil a, a hip leh khup natna chu 90°-in a ben a, a taksa peng natna vei femoral axis-ah minute 2 atanga 3 chhung a traction a, chutah chuan a taksa peng natna chu a chhungah rotate la, lightly flex a, resetting hnuah, a ke natna chu zawi zawiin a hniam tir a, a ke natna chu pawn lam atanga rotated anga a lan loh chuan a tam zawk chu resetting hlawhtling tak a ni. Internal fixation an tih hma hian C-arm machine hmangin verify a ni.

(C) Percutaneous needle hmanga chhui chhuah dan

A chunga kan sawi takte hmanga repositioning tih theih a nih loh chuan, a tlangpuiin femoral head chu a chhe tawh emaw, lu leh kawr inkarah rotational separation a awm tawh emaw (Figure 1A), emaw, lu leh kawr inkar hmun khatah insertion a awm tih a tilang tlangpui. (Hei hi Garden II, III, IV chi hrang hrangah a thleng thei). Chutiang a nih chuan lu leh kawng ruh tliak dovetail turin a ke ruh natna chu rotate chu a hlawk tawh lo. Incision leh repositioning awm loh nan percutaneous needle prying technique hmangin fracture chu reposition theih a ni.

• 3.0- atanga 3.5-mm-a sei ruh zungbun zungbun (bone circular needle) chu inguinal ligament leh femoral artery inzawmna hnuai cm 1 atanga 2-a zau vun kaltlangin dinglam hawiin femoral head hmalam thlengin dah a ni a, chu needle chu C-arm machine enkawlna hnuaiah femoral head lairil thlengin thuk zawkin a inher a ni (Figure 1B).

• Prying force tichak turin he needle nen hian bone circular needle pahnihna chu 4-5 mm parallel-in dah theih a ni a, needle tawp chu vun pawnah dah theih a ni.

• Greater trochanter hmang hian 3.5 mm diameter bone circular needle pahnih chu cervical stem angle leh anterior tilt angle angin percutaneous-in an drilled a, femoral neck fracture distal end thlengin (fracture kal tlang suh) needle tawp chu vun pawnah an awmtir a ni.

• Operator chuan needle tail set hnih chu a kut pahnih hmangin a chelh a, lu leh kawng ruh tliak section te chu assistant thawhhonain a inmil theih nan a siamrem thin (Figure 1C-E).

• Alignment a satisfactory hnuah greater trochanter-a bone round pin dah chu femoral head-ah screw-in temporary fixation atan an hmang a, chutah chuan hollow screw engemaw zat chu femoral head-ah dah a ni (Figure 1F).

A chunga kan sawi tak closed reduction method hian femoral neck fracture 98% vel chu a mamawh reduction a ti thei a ni. Fracture alignment tha zawk, closed emaw incised emaw pawh nise, prognosis a tha zawk. A tlangpuiin X-ray-a fracture dislocation degree kan hmuh hi fracture dislocation degree tak tak aiin a tlem zawk a ni. Fracture alignment hian fracture tihdamna leh femoral head necrosis awm theihna tur direct-a nghawng a neih avangin fracture alignment hnuah X-ray film chungchangah hian thutlukna dik tak neih a ngai a ni. S-shaped curve chu a smooth emaw interrupted emaw a nih loh chuan femoral neck fracture hian anatomical repositioning a thleng lo tih a tilang a ni (Figure 2).

Figure 1 Femoral neck fracture chu percutaneous needle prying hmanga dah thar leh a ni

Figure 2 Femoral neck fracture X-ray-ah hian anatomical alignment-ah pawn lam curve chhunzawm zel leh non-anatomical alignment-a pawn lam curve tihtawp a ni

Femoral stem tihchhiat a ni

Closed reduction technique hian femoral stem fracture alignment-ah a pui thei a, fracture tawp thlenga soft tissue emaw thisen supply emaw tichhe lovin, intramedullary nail hmanga internal fixation atan pawh hman theih a ni.

• Epidural anesthesia hnuaiah hian damlo chu khumah a muhil a (hetih lai hian a kut leh ke vun chu sterilized a la ni lo), assistant pakhat chuan a ke ruh natna bawnghnute chu a chelh a, assistant dang chuan damlo ke ruh chu puan belt hmangin a hrual a, chu chuan traction chu a do let a, a ke ruh chu neutral position-ah a awm a, khup patella chu chunglam hawiin (femoral stem fracture chu a ni a tlangpuiin a rotate lo va, muscle-in a displace lo pulling, leh traction hmanga automatic-a siamthat theih a nih avangin operator chuan stem tawp chhe tawha anterior-posterior leh lateral displacement siamthat chauh a mamawh a ni).

• Operator chuan a kut pahnih hmangin kut leh ke natna chu a hual vel a, kut chu a vawn khawm a (Figure 3 leh Figure 4), a kut pahnih oblique clamping force hmangin fracture-a anterior-posterior leh lateral displacement chu vawi khatah a siam tha leh thin.

• Entirnan, femur fracture proximal segment chu pawn lam leh hmalam hawia dah a nih chuan forearm pakhat hmangin fracture proximal segment chu chhung lam leh hnuai lam hawiin squeeze a ni. Forearm dang chuan distal fracture segment chu pawn lam leh chunglam hawiin a squeeze a, chu chuan clasping force chu a lo borrow a (resetting physician chuan resetting hmain fracture displacement direction leh displacement distance dik takin a hre tur a ni), chutiang chuan fracture chu vawi khatah hlawhtling taka reset theih a ni. Repositioning process chhung hian assistant chuan traction force a tipung tur a ni a, femur chu a inher loh nan a veng tur a ni.

• Fracture end chu basically lapped a nih chuan ruh rubbing sound nalh tak a hriat a ngai a, hetih lai hian assistant chuan traction chu a la vawng reng tur a ni a, mahse traction force chu a tihtlem tur a ni.

• Fracture chu C-arm machine hmanga basically aligned a nih chuan (mislignment tlem a la awm chuan fracture tawp te chu a inmil theih nan adjustment engemaw zat siam la), traction chu vawng reng la, a nghawng chu disinfect la, towel chu theh darh la, chutah chuan intramedullary nail fixation ti rawh.

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Fig. 3 Fracture-a anterior-posterior leh lateral displacement chu a rualin siamthat a ni a, kut pahnih chu a natna ke ruh chu khuh a, kut chu inzawm khawm a, kut hmawr pahnih clamping force hmangin siam hat a ni.

Figure 4 Femoral stem ruh tliak repositioning mechanics schematic

• Fracture displacement lian tak nei, closed manipulation hlawhtling lo emaw comminuted fracture nei damlote tan chuan surgical traction bed hmangin instrumental force engemaw zat hmangin closed reduction hman theih a ni a, hei hian femoral stem fracture closed reduction chu effective takin a ti zo thei bawk.

• Traction frame-a traction atan a nghawng limb dah a, C-arm examination-a overlapping fracture displacement chu siamthat a nih thu a lan hnuah, a hliam distal end chu a chhung lam hawiin siamrem theih a ni a, chu chuan femoral stem orthostatic image-a alignment leh alignment chu a siam ṭha lehzual thei a ni.

• Traction hnuaia thigh muscles tension hian femoral stem fracture-ah soft tissue splinting role a play theih avangin, femoral stem fracture tam zawk hian orthogonal x-ray image-ah alignment lungawithlak zawk an hmu thei a ni.

• Mahse, hetih lai hian gravity nghawng hnuaia fracture segment distal end-a support ha tak a awm loh avangin femoral stem-a distal fracture segment chu a tam zawk chu hnunglam lamah a inthlak a, hetih lai hian sterile towel-a khuh brace chu sterilization leh vun buatsaih leh sterile sheet dah hnuah distal fracture end hnunglam lamah dah theih a ni bawk hmun danga insawn chhuahna distal fracture end chu brace san zawng siamrem hmangin siamthat theih a ni.

• Distal fracture segment hnunglam displacement chu siamthat a la nih loh chuan greater trochanter emaw pyriform fossa emaw apex-ah percutaneous-in proximal nail din theih a ni a, chutah chuan intramedullary repositioning rod chu femur-a proximal fracture segment-a medullary cavity-ah dahin, intramedullary repositioning rod handle chu raised a ni moderate takin hmalam pan a ni repositioning rod lever hmanga femur proximal fracture chu hnunglam hawia tihhniam nan, chutiang chuan posteriorly displaced distal fracture nen alignment siam leh turin,

• Fracture chu align a nih hnuah distal fracture cavity-ah guide pin sei tak dahin closed reset chu tihfel a ni. Intramedullary repositioning rod hian proximal femur-a proximal fracture-a awm fo thin flexion, abduction leh external rotation deformities te siamthatna kawngah a tangkai hle a ni (Figure 5).

• Residual lateral displacement atan chuan intramedullary rod curved end hawnna chu siamrem theih a ni a, chu chuan long guide pin chu distal fracture cavity chhungah a hruai lut a, chu chuan closed reduction chu a ti zo ta a ni.

• Closed reduction tih dan dang chu Schanz nail chu displaced fracture end sir lama bone cortex-ah screw-in screw-in a fracture end chu Schanz nail hmangin closed reduction atan siamrem a ni (Figure 6). Fracture chu lungawithlak taka a align hnuah intramedullary nail chu fracture proximal leh distal medullary cavity-ah dahin internal fixation chu a zo ta a ni (Figure 7).

  
  

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Figure 5 Intramedullary repositioning rod hmanga closed repositioning atana proximal fracture segment manipulation

Figure 6 Fracture tawp lama unilateral bone cortex-a Schanz nail dah hmanga closed reduction

Figure 7 Schanz nail hmanga femoral stem multisegmental comminuted fracture-a closed reduction intramedullary nail fixation tih a ni

Ankle ruh tliak

(A) Operation hmaa inbuatsaihna

• Radiographic diagnosis: Standard ankle imaging evaluation-ah hian phase 3 a awm tur a ni: anteroposterior (Figure 8), ankle point (15° of internal rotation) (Figure 9), leh lateral (Figure 10).

• Ankle joint nasa taka a hliam chuan internal leh external ankle leh talus chu degree hrang hrang 11-ah a inthlak ang (Figure 11). Static radiographs hian ankle joint stability dik takin a tarlang lo. Stress radiograph leh MRI hian ankle joint stability leh ligament chhiatna tehna a ti tha thei hle (Figure 12).

• Chutiang a nih chuan, repositioning leh fixation dik taka kaihruai theih nan ke ruh hliam chi chu a hliam mechanism leh a hliam tuar kut leh ke radiological data hmangin dik taka hriat a ngai a ni.

• A châng chuan medial ankle fracture awlsam tak hi 'Maisonneuve fracture' complex zawka tel a ni thei a, chutah chuan proximal fibula fracture leh combined ligament injury te pawh a tel a, chuvangin tibiofibula pumpui chu radiographically-in enfiah vek tur a ni.

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Figure 8 Hma leh hnung lam dinhmun

Figure 9 Ankle point (15° chhunga inherna) 1.1.

Figure 10 Lateral position

Figure 11 Fracture displacement chu dislocation nen a inzawm niin a lang

Figure 12 Stress radiograph (triangular ligament tihchhiat) a ni.

(II) Anesthesia tih hi a ni

Femoral leh sciatic nerve anesthesia hi ei thin a ni tlangpui.

(C) reset dan tur (reset) dan

Closed repositioning-a posterior-external rotation type hi external ankle-internal ankle-posterior ankle-inferior tibiofibular union angin tih a ni. Posterior rotation-internal rotation type hi internal ankle-external ankle tih dan anga tih a ni.

• Posterior-external rotation type IV-ah chuan damlo chu supine-ah dahin, khup chu 90°-ah flexed-in calf triceps a relax a ni.

• Assistant pahnih chuan thigh leh ke popliteal part chu an chelh ve ve a, traction chu fracture deformity lam hawiin an hmang a (hliam tizual lo turin traction force chu a tam lutuk tur a ni lo).

• Ke hrualtu assistant chuan pawn lam rotation deformity siamthat nan ke chu chhung lam hawiin a rotate a (Figure 13). Distal end chu tibial lam hawiin a nawr a, distal tibia chu fibular lam hawiin a nawr laiin, assistant chuan chhung lam hawiin a hnunglam hawiin ankle joint chu a tizau a, chu chuan pawn lam ankle leh talus te inthlak danglamna chu a siam tha a ni (Figure 14).

• Internal rotation-internal rotation-dorsal extension position chu vawng reng tur a ni. Tichuan posterior ankle fracture block chu kut zungtang pahnihin an chelh a, kut zungtang pali chuan distal tibia chu an hual vel a, kutpui pahnih hian distally-in an nawr a, an squeeze a, chutih rualin distal tibia chu hnuai lam hawiin posterior ankle chu reset turin an hrual bawk (Figure 15).

• A tawpah chuan operator chuan medial ankle chu a kut zungtang hmangin hnunglam leh hnuai lamah a nawr a, chu chu reset turin a ti a (Figure 16). Assistant pahnih chuan ke leh ke ruh chu fixation atana inbuatsaihna atan internal rotated-internal rotation-dorsal extension position-ah an vawng reng thin.

Figure 13 Pawn lam rotation deformity traction siamthatna

Figure 14 Pawn lam ke ruh leh talus lateral displacement siamthat dan

Figure 15 Posterior ankle shift siamthat dan

Figure 16 Internal ankle displacement siamthat dan

Post-rotation-internal repositioning process hi post-rotation-external repositioning process nen a inkalh a, internal ankle-external ankle order angin an ti thin.

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