Proximal humerus fracture enkawl dan tur i hria em?

Proximal humerus fractures hi trauma orthopedics-a fracture awm tam ber pakhat a ni a, proximal humerus fracture tam zawk hi tarte zingah low-energy osteoporotic fractures a ni.

Proximal humerus fracture tam zawk hi conservative-a enkawl theih ni mah se, 10-15% chu surgical treatment a la ngai a, chutah chuan incisional reduction plate fixation, closed reduction intramedullary nail internal fixation, leh joint replacement te a tel a ni.

Enkawlna thutlukna chu damlo taksa dinhmun, a hriatna, rilru lam beisei, leh ruh tliak chi hrang hranga innghat a ngai a ni.

1. Emergency fractures te reset leh fixation .

【Recommendation】for proximal humeral greater tuberosity (neer type 2 partial fracture) fractures te chu shoulder dislocation nen a inzawm a, preoperative CT examination tih loh chu surgical neck region-a fractures tih loh chu, emergency anesthesia hnuaia traumatic shoulder brace hmanga reposition leh braking tih loh chu (expert recommendation rate: 100%

2. Operation hmaa acute pain control .

【Recommendation】Patients with proximal humerus fracture hian oral acetaminophen emaw NSAID emaw hmanga preoperative analgesia an duh zawk a, a nghawng a tha lo a nih chuan oral opioids te pawh dah belh theih a ni bawk (expert recommendation rate: 100%; strong recommendation rate: 73.8%).

3. Operation hmaa missionary zirtirna pek .

[Recommendation] Preoperative education hi diversified leh multi-modal hmanga kalpui tur a ni. (Expert rawtna rate: 100%; rawtna chak tak: 83.8%)

4. Operation hmaa ei leh in endik leh anpui thei tur enkawlna .

【Recommendation】Admission atanga 24 h chhunga damlote nutritional screening kimchang leh nutritional risk nei damlote tan nutritional intervention pek. (Expert rawtna rate: 98.5%; rawtna chak tak: 55.9%)

5. Zunthlum vei te tan perioperative glucose assessment leh regulation .

【Recommendation】Diamte elective surgery nei tam zawkte tan glycemic control target rawt a ni a, 7.8 to 10.0 mmol/L a ni.

6. Perioperative period chhunga soft tissue swelling enkawl dan .

【Recommendation】Proximal humerus fracture atana elective surgery nei damlote tan, perioperative period chhunga a hring tihziaawmna turin physical method tam tak pek a ni. (Expert rawtna rate: 98.5%; rawtna chak tak: 80.9%)

7. Operation hmaa ei leh in enkawl dan .

【Recommendation】 elective surgery nei damlote chuan surgery hma darkar 2 h leh starchy foods emaw dairy products emaw surgery hma darkar 6 velah clear beverages an ei thei ang. (Expert rawtna rate: 100%; rawtna chak tak: 76.5%)

8. Perioperative urinary catheter enkawl dan .

【Recommendation】routine perioperative urinary catheterization hi proximal humerus fracture surgery atan hman a tha lo (expert recommendation rate: 100%; strong recommendation rate: 78.6%).

9. Perioperative antimicrobial damdawi te chu prophylactic hmanga hman theih a ni.

【Recommendation】Proximal humerus fractures nei damlote tan endoprosthesis emaw joint replacement emaw a ngai a, perioperative period-a infection venna atan first- leh second-generation cephalosporins prophylactic hman a tha. (Expert rawtna rate: 97.1%; rawtna chak tak: 73.5%)

10. Anesthesia thlan dan .

【Recommendation】Anesthesia hi regional block compound general anesthesia method hmanga hman a, damlo tarte systemic organ dysfunction aggravating lo turin damdawi thlan a, monitoring tihchak nan ngaihven a tha (expert recommendation rate: 100%; strong recommendation rate: 71.4%).

11. Intraoperative thisen sang chungchanga buaina .

[Recommendation] Proximal humeral fractures-te tan intraoperative blood loss tihtlem nan thisen sang tihtlem chu ngaihven tur a ni a, mahse comorbidity tam tak nei damlo tar zawkte chuan tissue leh organ-te perfusion tha tawk lo turin hemodynamic stability vawn reng an duh tur a ni (Expert recommendation rate: 100%; strong recommendation rate: 61.9%.

12. Intraoperative volume enkawl dan .

[Recommendation] Goal-oriented fluid management strategy kalpui la, leh fluid overload venna atan general anesthesia neih chhungin vasoactive drugs chu prophylactically-in pek theih a ni (Expert recommendation rate: 100%; strong recommendation rate: 69.1%).

13. thisen chhunga thisen kal dan .

[Recommendations] Intraoperative controlled hypotension hi proximal humeral fractures tan chuan a tha lo hle a, a bik takin kum upa lam damlote tan chuan intraoperative blood transfusion leh tranexamic acid te hi hman theih a ni. HGB <80g/L intraoperative check chuan allogeneic thisen pek a rawt a (Expert Recommendation Rate: 100%; Recommendation Rate chak tak: 73.8%).

14. Intraoperative hypothermia laka invenna .

[Recommendations] Proximal humeral fracture nei damlote chuan intraoperative temperature monitoring an tichak a, core temperature 36°C aia sang an neih theih nan hmalakna hrang hrang an siam tur a ni (expert recommendation rate: 100%; strong recommendation rate: 76.2%).

15. Surgical approach thlan dan .

(1) Proximal humerus-a fracture staging .

[Recommendation] Neer-a staging hi proximal humerus fracture staging atan a tha ber a (expert recommendation rate: 100%; strong recommendation rate: 83.3%).

(2) Surgical approach 1.1.

Surgical plan hi fracture morphology, ruh quality, patient’s physiological leh psychological status leh a kaihhnawih thil dangte hmanga thlan tur a ni.

[Recommendation] Internal fixation material chu fracture chi leh ruh density, plate emaw intramedullary nail emaw a zirin thlan theih a ni a Osteoporosis vei tar, reset emaw fix emaw harsa, 4-part fracture (leh fracture dislocation), 3-part fracture with severe osteoporosis, split fracture leh anatomical neck fracture, artificial shoulder joint replacement te chu thlan a ni a, reverse shoulder joint replacement hi rotator cuff injury rate nen a inzawm chuan a rawt a ni (expertation rate: 100%: 100%.

Figure 1 Hmeichhe kum 65 mi, proximal humeral adductor insertion leh allograft fibular implant plate fixation with incision leh repositioning nei hmeichhia kum 65 mi.

16. Hliam drainage tube dahna hmun .

Drainage tube dahna tur atana indication [recommendations] 1 Minimally invasive operation techniques (MIPPO leh intramedullary nailing) 2 Thisen chhuah tlem. Drainage tube dahna tur indications: 1 via pectoral deltoid approach, locking plate fixation emaw shoulder joint replacement emaw 2 Hliam chung atanga thisen chhuak nasa tak (expert recommendation rate: 100%; recommendation rate nghet tak: 71.4%).

17. Hliam khar .

【Recommendation】Surgical incision chu simple interrupted, layer-by-layer sutures hmangin khar a ni a (expert recommendation rate: 100%; strong recommendation rate: 76.2%).

18. Operation hnua dam lehna ei leh in .

【Recommendation】damlote chuan operation hnua an harh veleh hmui hmangin dregs-free drinks an ei thei a, adverse reaction a awm loh chuan 1-2 h hnuah normal diet an ei leh thei bawk.

19. Operative-a dinhmun thlan leh a hma lama hnathawh dan tur .

【Recommendation】patients te hian operation hnuah pillow-ah muhil an ngai lo va, semi-recumbent position an hmang thei a, an harh hnuah pawh floor-ah an che thei bawk. Traumatic shoulder brace chu brake a ni tur a ni.

20. operation hnua tihdamna tih dan tur .

【Recommendation】Postoperative analgesia chu proximal humeral fractures nei damlote chuan NSAIDs regular 'background dose' nena inzawm regional blockade hman a tha a, a tul chuan thisen kal tlanga analgesia pump emaw peripheral nerve block self-administered analgesated rates emaw, stronged a recommendation rates (exppertation) a ni bawk (expertastered rates; Rate: 78.6% a ni.

21. Postoperative natna leh rilru hahna venna .

[Recommendation] Damlo zawng zawngte chu operation zawh hma min 30 chhungin prophylactic antiemetic damdawi pek vek tur a ni. (Expert rawtna rate: 97%; rawtna chak tak: 47.8%)

22. Hnathawh dan tur siam that .

【Recommendation】Patients fixed leh stable proximal humerus fracture nei te chuan operation hnuah a hma thei ang bera rehabilitation exercise an tan tur a ni. Rehabilitation exercises hian upper limb hnathawh that zawk nan a pui a (expert recommendation rate: 100%; strong recommendation rate: 92.9%).

23. Discharge criteria leh zawm dan tur .

【Recommendation】practical discharge criteria siam tur a ni a, damlote chu thla 6 tal enkawl fo tur a ni (expert recommendation rate: 100%; strong recommendation rate: 83.3%).

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