I. Thuhmahruai .
Distal Humerus hi medial leh lateral column te a ni a, chung zingah chuan epicondyles leh condyles te pawh a tel a ni.
II a ni. Surgical tih dan tur .
Distal humerus fractures hi direct trauma (eg, tlak) emaw indirect force (eg, twisting emaw muscle pull) emaw avanga lo awm a ni.
iii a ni. Post-op a tihdam theih dan tur .
AO classification hian distal humerus fractures chu chi thum-ah a then a, chungte chu A , B , leh C .
iv. Zirna result .
Surgical treatment hian AO principles a zawm a: taksa peng tihtlem, stable fixation, leh a hmaa tihdamna.
V. Case report .
Locking plate hian biomechanical stability sang zawk a pe a, a bik takin osteoporotic bone-ah chuan a tha zawk.
VI. Sawiho
CZMedItech hian model pathum a pe a, chungte chu extraarticular (01.1107), lateral (5100-17), leh medial (5100-18) plate te an ni.
vii a ni. Tawpna
Surgical treatment hian AO principles a zawm a: taksa peng tihtlem, stable fixation, leh a hmaa tihdamna.
Distal tibial fractures hi a awm fo a, traditional treatment-ah chuan limitation a awm bawk .
Distal tibial fracture hi lower limb fracture chi khat a ni tlangpui. Traditional treatment-ah chuan locking plate leh antegrade intramedullary nails te hian an harsatna an nei vek a ni. locking plate hian postoperative infection emaw soft tissue necrosis emaw a thlen thei a, dam rei theihna a thlen thei bawk; Antegrade nail te hi a tlem berah invasive ni mahse, khup ruh a tichhia thei a, natna a thlen thei a, fixation tha lo emaw malalignment emaw a thlen thei a, recovery a tikhawlo thei bawk.
Locking plate te chu:
Soft tissue chhiatna nasa tak, infection rate sang, dam rei tawh
Antegrade nail te chu:
Khup ruh hliam hlauhawmna, fixation tha tawk lo, malalignment awlsam tak
A chinfel dan thar: Distal Tibial Nail (DTN) .
A novel treatment option—Distal Tibial Nail (DTN)—chuan distal tibial fractures enkawlna atan a retrograde design danglam tak hmanga enkawlna tur thlirna thar a siam a ni.
Retrograde insertion design hian approach thar a pe a ni .
Damlo dinhmun leh tihtlem dan tur buatsaih dan .
Damlo chu supine position-ah dah a ni. Displaced fractures chu kut hmanga reducible tur a ni a; A tul chuan DTN dah hmain reduction forceps hmang la. Accompanying fibular fracture a awm chuan fibular alignment dik tak chuan tibial reduction a pui thei a ni. Fibular shaft fractures chu intramedullary nail hmangin a stabilise thei bawk. Ankle vel a fracture awm tan chuan fibula anatomical reduction leh fixation te hi malalignment awm loh nan tibial reduction hmaah dah tur a ni. Open fractures with existing external fixation ah chuan nail chu fixator enkawl laiin reduction a awm theih nan dah theih a ni.
Supine position, a tul chuan reduction forceps hman tur a ni .
Tibial tihtlem dan dik tak hriat theih nan fibular fracture management hi dah pawimawh hmasa phawt ang che.
Medial malleolus tip-ah hian 2–3 cm longitudinal incision siam a ni a, chu chuan superficial deltoid ligament a pholang a ni. Guide pin chu malleolus tip (Fig. 2A) tip-ah emaw, a medial deuh emaw a dah a, articular surface atanga 4–5 mm a hlaah a dah a ni. Lateral view-ah hian intercondylar groove kaltlangin insertion a awm tih a lang (Fig. 2b), posterior tibialis muscle tihchhiat loh nan. Superficial deltoid ligament chu then la, chutah chuan reamer hmangin medullary canal chu metaphyseal region thlengin a ti lian ang (Fig. 2C). Nail dah luh nan proximal medial cortex bulah cancellous bone chu la chhuak rawh (Fig. 2D). DTN size tih chian nan trial nail dah la (Fig. 2E). Iatrogenic medial malleolar fracture ven nan hammering emaw twisting tam lutuk emaw tih loh tur. Distal screw te chu ankle joint emaw fracture site emaw ah lut lo turin nail depth siamrem rawh. Fixation hi interlocking screw hmangin proximal leh distal-in a thleng thei a ni.
Incision: .
A rilru a buai em em a, a rilru a hah em em bawk a. 創造的な異なる異な Malleolus TIP TIP .
Guide pin a awmna tur hmun:
Joint surface atanga 4–5 mm a hla a ni.
Reaming & Trial nail:
Ream up to the metaphysis, nail size confirm .
Nail dahna tur: 1.1.
Hammering tih loh tur, joint venhim nan depth siamrem .
Fixation: 1.1.
Interlocking screw te chu proximally leh distal takin .
DTN dah dan tur .
Immediate ankle joint mobility leh foot-to-floor contact chu postoperatively
non-weight bearing kar 4–6 chhung a awm theih nan
kar 8–12 inkar full weight-bearing thlengin a kal theih a, chutih rualin callus formation leh pain a enfiah bawk.Ankle joint activity chu operation zawh veleh tan nghal a ni .
Kar 4–6 chhung zet taksa rihna nei lo turin .
Kar 8–12-ah taksa rihna pum puiah a inthlak zauh zauh ang .
Damlo 10 te enkawl zui zel tur a ni.
Zirna pakhat chuan damlo 10 a enkawl a (Table 1). Thla 3 hnuah post-op-ah chuan case 7 a dam tawh a; Damlo zawng zawng hian thla 6 chhungin damna an nei vek a ni. Varus leh recurvatum deformities case pakhat theuh a awm a. Hrisel lohna, natna hrik kai, implant nena inzawm harsatna, leh iatrogenic injury te hmuh a ni lo (Table 2).
Thla 3 chhungin case 7 a dam a; Thla 6 chhunga tihdam vek .
2 natna khirh tak tak (1 varus, 1 recurvatum) .
Infection awm lo, implant complication, leh reduction hloh .
Kum 69 mi, mipa damlo .
Fracture chi hrang hrang:
Transverse tibial fracture + fibular fracture .
Complication: 1.1.
Soft tissue crush hliam .
Post-op a ni:
Incision te te 6 chauh, kum 1 chhunga damna famkim
Figure 3 & 4 te hi:
Radiographic leh postoperative recovery thlalak te a awm bawk.
DTN tan indication a awm .
He zirchiannaah hian AO 43-A leh C1 fracture te a tel a; C2 pawh ngaihtuah a ni. DTNs hi a sei zawng 7 mm leh 8 mm a awm a, hei hian proximal interlocking screw dahna tur a ruat a ni. Articular surface atanga 2–9 cm a sanga fracture awmte hi DTN fixation atana candidate tha tak an ni. Indications chu AO 42 fractures thleng pawhsei theih a ni.
AO 43-A, C1-a hman theih a ni a, C2 leh 42-a tihpun ngaihtuah a ni.
Joint surface atanga 2–9 cm a hlaa fractures te tana outcome tha ber .
Biomechanical stability a awm em?
Retrograde nail hian medial locking plate leh antegrade nail te nena khaikhin chuan axial leh rotational stiffness a nei tha zawk. Greenfield leh a thawhpui te chuan an zir chiang a. Biomechanical testing an neihah DTN-a distal screw pahnih hmangin compressive stiffness 60–70% leh torsional stiffness 90% chu screw pathum nen khaikhin chuan an hmu thei tih an hmuchhuak. DTN hian load hnuaia fracture fragment movement a ti tlem a. Thla 3 chhunga dam lo case 3-ah chuan factors te chu soft tissue chhiatna, medullary expansion, fracture awmna, leh osteoporosis te an ni. DTNS hi size pathum chauh a awm a, distal fixation hi screw pathum chauh a nih avangin canal zau tak emaw osteoporotic bone emaw-ah chuan stability tling lo a pe thei a ni. Chutiang hunah chuan fimkhur taka taksa rihna (weight-bearing) hi fimkhur taka kalpui tur a ni.
Locking plate leh antegrade nail te aiin a tha zawk
Fixation strategy rawt: 2 proximal + 3 distal screws
DTN 1000 a thatna te.
Locking plate nena khaikhin chuan intramedullary nails hian soft tissue a tichhia tlem zawk a, a bik takin kum upa lam damlo leh high-energy trauma avanga soft tissue hliam na tak nei tan a tha hle. He zirchiannaah hian DTNs te chu incision te te paruk chauh hmangin an dah a, soft tissue complication an nei lo. Hetianga an tih hian khup flexion a ngai lo va, tihtlem a nih theihna a ti tlem a, khup natna (eg, knee arthritis emaw post-TKA emaw) nei tan pawh a tha hle.
Minimally invasive, tar leh high-energy trauma patient te tan a tha hle
Knee flexion a ngai lo, limited knee mobility atan a tha
Surgical risk leh fimkhur dan tur .
A hlauhawmna chu posterior tibialis muscle hliam leh medial malleolar fracture te a ni. Medial malleolar fractures te hi tension band wiring, plating emaw pawn lam fixation emaw hmanga enkawl theih a ni.
Fibular notch chhunga screw penetration awm loh nan fimkhur a ngai a ni. Positioning device hian DTN chu a rit avangin posterior rotation a thlen thei a; Screw pahnihna chu fibula lam hawi turin siam la (Fig. 4C).Harsatna awm thei te: 1.1.
Posterior tibialis hliam, medial malleolar fracture a ni.
Enkawltu:
Tension band, plating emaw pawn lam fixator emaw a ni thei bawk.
Screw direction leh positioning device weight ah chuan intraoperative attention a ngai a ni .
Clinical tehkhin dan .
Antegrade nail-a nonunion leh malalignment rate chu 0–25% leh 8.3–50% a ni a; Plate locking atan chuan 0–17% leh 0–17% te an ni. He zirchiannaah hian case zawng zawng hian union an nei vek a, 20% chauhvin deformity >5° an nei a, traditional methods nen tehkhin theih a ni.Infection rates: superficial infection chu antegrade nail tan 0–8.3% leh locking plate tan 0–23% a ni a Deep infection hi 0–23% leh 0–8.3% a ni. He zirchianna hian soft tissue complication a nei lo tih a sawi a, alternative pahnih a phak lo.Functional scores:
Antegrade nail-ah hian Aofas score a awm a, chungte chu 86–88 (type A), 73 (type C); Plate locking: 84–88 (type A) .
He zirchianna: Aofas Average: 92.6.
EQ-5D-5L: Plate khar dan: 0.62–0.76; He zirchianna: 0.876.
safe-Q (ke leh ke ruh damlote): 67–75; He zirchianna: 83–91.7 (Table 3)
Union rate, deformity rate, leh infection rate te hian traditional methods te chu a phak lo hle a ni.
Functional score (Aofas, EQ-5D-5L, Safe-Q) te hian result tha tak a nei a ni.
A tawi zawngin, DTN hian locking plate leh antegrade intramedullary nails aiin advantage a pe a, distal tibial fractures enkawlna atana solution tha tak a entir bawk.
DTN hian invasiveness tlem a nei a, stability sang tak a nei a, a dam thuai thei bawk.
Traditional treatment ai chuan a danglamna hlu tak a ni a, promote tlak a ni bawk .
Yamakawa Y, Uehara T, Shigemoto K, leh a dangte chuan an ziak a. Far distal tibia fractures te chu distal tibial nail hmanga stabilization result hmasa ber: prospective, multicenter case series study[j]. A rilru a buai em em a, a rilru hah em em bawk a. 111634.111634.11.1.
a (2024年12月31日). A rilru a hah lutuk chuan a rilru a buai em em a, a rilru a hah lutuk chuan a rilru a buai em em bawk a. A rilru a buai em em a, a rilru a hah em em bawk a. A rilru a hah lutuk chuan a rilru a buai em em a, a rilru a hah lutuk chuan a rilru a buai em em bawk a.
