Humeral stem fracture leh technical point te chu surgery hmanga enkawl a ni

Postoperative weight restriction hi a tam berah kilogram khat vel a ni tur a ni a, chu chu fracture healing nasa tak a awm hma loh chuan (a tlangpuiin thla thum).Humeral stem fractures (HSF) hi a awm fo a, fracture zawng zawng zinga 1% atanga 5% vel a ni. Kum khatah mi 100,000-ah 13 atanga 20 vel a ni a, kum upat danah a pung tih hmuhchhuah a ni.HSF hian bimodal age distribution a nei a, a peak hmasa ber chu high-energy trauma hnua mipa kum 21 leh 30 inkar zingah a thleng a, a tlangpuiin comminuted fractures leh associated soft tissue injuries a awm thin. Peak pahnihna hi hmeichhia kum 60 leh 80 inkarah a awm a, a tlangpuiin low-energy trauma hnuah a thleng thin.

Surgery hmanga enkawl a ni

一 tih a ni. Incisional repositioning plate hmanga chhungril lam fixation

Indication te: 1.1.

• HSF-a radial nerve palsy (RNP) hi surgery tihna a ni lo a, a chhan chu mahni insiamthatna rate sang tak nen a inzawm tlat a ni (a hnuaia - Complications/Radial Nerve pawh en bawk ang che).

• A dang pawhin, vascular injury eng pawh siamthat emaw bypass ngai emaw chu a fracture surgery hmanga enkawlna atan absolute indication a ni a, rigid fixation hian vascular anastomosis a humhim avangin.

• Hetiang a nih chuan plate hmanga internal fixation hi IMN aiin a rang zawk a, a rintlak zawk bawk a, a chhan chu vascular repair hi direct approach (a tlangpuiin medial approach) hmanga tih a nih vang a ni.

• Proximal emaw distal intra-articular extension nei HSF hi plate nei ORIF hi a tha zawkna dinhmun dang a ni.

  
  

Surgery hmanga thil tih theihna: .

• Proximal leh/ emaw middle third-a awm fracture te chu classic anterolateral approach hmangin enkawl a ni.

• A tul hunah chuan he approach hi distally-ah extended a ni a, humerus pumpui chu a lang chhuak vek a ni.

• Mahse, distal intra-articular fracture tan chuan hetiang approach hi a tha lo.

• Distal third-a fracture te hi triceps split approach hmangin a lang tlangpui.

• Distal leh middle third fracture tan chuan Gerwin et al30-te sawi dan modified posterior approach hian humerus 76-94% (radial nerve release leh septal release a zirin) a expose thei a ni.

  
  

Surgery hman dan tur: .

• Damlo chu anterolateral approach atan beach chair position-ah dah a ni. Arm brace hman hian humeral stem alignment a vawng reng thei a ni. Posterior exposure atan chuan lateral position hi duh ber a ni.

• Optimal plate construction hi 4.5 mm steel plate emaw a tlukpui emaw a ni a, a fracture site chung leh a hnuaiah cortices 6 tal a khuh tur a ni a, mahse cortices 8 hi a tha zawk.

• A tul hunah chuan fragment plate te tak te leh lian tak inzawmkhawm a tha a, chu chu repositioning (transverse fracture emaw butterfly fragment) vawng reng turin third tubular plate tawi tak (transverse fracture emaw butterfly fragment) a ni a, chu chu fracture final fixation atan 4.5 mm plate te tak te nen supplement a ni.

• Distal third fracture tan chuan epiphyseal fixation chak tak awm theihna turin posterior lateral column preformed plate (3.5/4.5) hman a tha.

  
  

HSF-a locking screw hman chungchang hi sawisel a la ni reng a ni

• Bone quality tha tak nei comminuted fracture tan locking plate leh non-locking plate te khaikhin chuan structure pahnih tan torsion, bending emaw axial stiffness-ah biomechanical advantage a awm lo.

• Kawng lehlamah chuan ruh quality tha lo hmachhawn a nih chuan locking plate hman hi a hlawkthlak thei hle.

• Gardner leh a thawhpuiten biomechanical study an neihah chuan, a bik takin osteoporotic fracture model-ah chuan non-locking structure 34 chu locking emaw hybrid structure aiin a stable lo zawk tih a chiang hle.

Minimally invasive plate splicing hi surgical option a ni a, hlawhtlinna rate sang tak leh complication rate hniam tak a pe niin a lang. Mahse, retrospective study-ah damlo 76 an tel a, van de Wall et al. humeral stem fracture-a absolute stability chauh hian radiographic healing time chu relative stability nena khaikhin chuan nasa takin a ti tawi tih an hmuchhuak.

Operation hnua enkawl dan: .

• A tlangpuiin plate hmangin stable fixation an hmu thin. Chutiang chuan damlo chu a kekawrte emaw, a kekawrte emaw chetna range-in a tihkhawtlai lohvin active leh active-assisted activities a tih phalsak a ni.

• Sling hi natna tihdam nan ni engemaw zat hman theih a ni.

• Postoperative weight restriction chu a tam berah kilogram khata awm tur a ni a, chu chu fracture healing nasa tak a awm hma loh chuan (a tlangpuiin thla thum chhung).

• Damlo naupang zawkte chu phalna hmunah chuan rit phurh phalsak an ni (eg, kea kal theihna turin kekawrte mamawh), mahse damlo kum upa zawkte tan chuan hei hi case-by-case-a sawiho tur a ni.

Results report a ni

• Plating hnua damna rate chu 87% atanga 96% inkar a ni a, a dam hun chhung chu kar 12 a ni.

• Complication rates hi 5% atanga 25% inkar a ni a, nonspecific complication awm tam ber chu infection, osteonecrosis, leh malunion te hi a ni.

• Medically derived RNP hi humeral stem approach tam zawk tan chuan risk a ni. Streufert et al50 chuan ORIF hmanga enkawl HSF case 261 an enfiah a, medically derived RNP chu anterolateral approach 7.1%, separated triceps approach 11.7%, leh preserved triceps approach 17.9%-ah a awm tih an hmuchhuak.

• Chuvangin, open dissection zawng zawngah radial nerve hi hriatchhuah leh venhim a pawimawh hle.

  
  

二 tih a ni. Intramedullary nail a awm

Indication te: 1.1.

• Theory-ah chuan IMN hian plating aiin biomechanical leh surgical lama hlawkna tha zawk a pe thei a ni

• Biomechanical lam atanga thlir chuan device intramedullary positioning hi humeral stem mechanical axis nen a inmil a ni.

• Hemi avang hian implant hi bending force hniam zawk hnuaiah dah a ni a, load sharing tha zawk a awm thei bawk. Intramedullary nailing atana surgical indications chu plating hman dan nen a inang vek a ni.

• Mahse, kan sawi tawh ang khan fracture thenkhat chu nailing aiin plating atan a tha zawk.

• Fracture characteristic leh pattern IMN aia tha zawka hmuhchhuah chu pathologic leh impending fractures, segmental lesions, leh osteoporotic fractures te hi a ni.

• Simple mid-third transverse fractures pawh hi IMN tan chuan indication tha tak a ni.

• Tin, nail hi incision tenau zawk hmanga dah theih a ni a, hei hian plating technique nena khaikhin chuan soft tissue stripping a ti tlem a ni.

• Hei hi humerus middle third fracture-ah chuan a dik hle.

Surgery tih dan tur: .

• Hetiang tihna atana damlo dinhmun tha ber chu beach chair-ah a ni. Arm brace hman hi shaft alignment vawn that bakah distal freehand locking screw tihnaah pawh a tangkai hle.

• Point of entry hi nail design-ah a innghat a, mahse a tlangpuiin greater tuberosity leh humeral head articular surface inzawmna hmunah a awm a, chu chu rotator cuff muscles te chu a luhchilh a ngai tihna a ni.

• Hetiang procedure atan hian supraspinatus tendon hmuh theih nan deltoid division approach tih a tha.

• Dik tak chuan supraspinatus tendon lai takah humeral head a luh chuan sagittal plane-ah lu lai takah a awm ang.

• Fluoroscopy hnuaia keratomile hman a pawimawh a, chu chuan sagittal leh coronal plane-ah te entry point chu pawmtlak takah a awm em tih enfiah a ngai a ni.

• Chumi hnuah chuan direct vision hnuaiah supraspinatus tendon chu longitudinally-a hawn hmain guide wire chu hmasawn leh tur a ni.

• A dawt leh tur chu Kirschner needle chunga canal hawn a, fracture chu traction leh/ emaw external manipulation nena inmil a nih leh nih loh enfiah a, chutah chuan intramedullary canal-a guide chu elbow thlenga hmasawn a ni.

• Reaming hi damlo naupang zawkte tan a hlawkthlak tih hmuhchhuah a ni a, damlo kum upa zawkah chuan a tul ngai lo tih hmuhchhuah a ni.

• Distal bolt dahna atan chuan AP locking hi a him zawk a, myocutaneous nerve injury hlauhawmna tihziaawmna turin 2-3 cm approach tlem a ngai a ni.

• A tawp berah chuan paralleling IMN hi retrograde IMN aiin a tha zawk a, a chhan chu a hnuhnung zawkte hian harsatna bik a nei a, chung zingah chuan medically induced supracondylar fractures, elbow extension hloh, leh heterotopic ossification te pawh a tel a ni.

  
  

Nail thlan sei zawng hi ngaihven bik a ngai a, nail sei lutuk hian technical error pahnih a thlen thei a ni:

• Impact nail laiin fracture hmunah distraction a awm

• leh/ emaw subacromial space chhunga nail rawn chhuak te

  
  

Proximal third helix emaw long oblique fracture emaw tan chuan ziaktute chuan fracture tihtlem nan miniature open approach hman a rawt a, chu chu ring tie wire hmanga fixation neih a ni. Dik tak chuan he fracture subtype atan hian deltoid muscle hian proximal fracture fragment chu a abduct duh a, pectoralis major chuan distal fracture fragment chu medial-ah a hruai a, hei hian osseous nonunion emaw delayed healing emaw a tipung a ni.

Operation hnua enkawl dan tur

• Damlote chu an tuar theih ang angin active leh active-assisted movement of the shoulder and elbow tih turin an fuih a ni.

• Sling hi natna control nan ni engemaw zat hman theih a ni.

• Postoperative weight lifting restrictions chu a tam berah kilogram khat vel a ni a, chu chu fracture healing a lan hma loh chuan (a tlangpuiin thla thum chhung).

• A tam zawkah chuan weight bearing hi phal a ni

  
  

Report-a thil hmuhchhuahte chu:

• HSF enkawlna atana locking nail device hman dan chungchanga literature hi a inmil lo hle. Khawthlang lamah chuan ruh nonunion report rate hi a danglam hle (0% leh 14% inkar) a ni a, nail thlah upa zawkte zingah a tam ber a ni. A lehlamah chuan, a hmaa literature-ah khan shoulder complication (natna, impingement, motion emaw chakna hloh te pawh tel) (6% atanga 100% inkar) a awm tih an lo sawi tawh bawk.

• Buaina ṭhenkhat chu he isovascularity hmun pawimawh takah hian nail chhuak, scar tissue leh/ emaw rotator cuff hliam avanga chronic tendon dysfunction avanga subacromial trauma vang a ni thei.

• Lehkhabu ziaktu engemaw zatin he hypovascular region hi pumpelh dan hrang hrang leh fimkhur taka tendon siamthat dan tur an sawi a, chungte chuan shoulder dysfunction rates a hniam zawk tih an hmuchhuak a ni.

  
  

HSF hi conservative treatment hian damlo 80% tal zingah functional outcome tha tak leh healing rates sang tak a pe a ni. Hemi avang hian HSF tam zawk tan chuan enkawlna duh ber a la ni reng a ni. Alignment hi pawm theih loh a nih chuan surgery ngaihtuah tur a ni. Hei hi kum 55 chunglam, proximal third oblique fracture (lower healing rate) neia rawn langte tan chuan a dik hle. Surgical treatment chungchangah chuan literature-ah hian plate leh IMN inkarah hian healing rates emaw radial nerve complications-ah danglamna lian tham a awm lo a, mahse shoulder complications (impingement leh reduced range of motion) erawh IMN-ah hian a tam zawk thung. Chuvangin, cuff hi a luhna hmunah leh khar lai pawhin uluk takin enkawl a ngai a ni.

Lam CZMEDITECH a ni

He khawvela mi tinte hian healthcare service tha zawk an phu tih rinnain a hruai a ni. CZMEDITECH hian  midangte hlau lova nunpui turin thahnemngai takin hna a thawk thin. Kan thil siam leh kan ke penna avanga hlawkna nasa tak hmu leh nun tha zawk nei damlote chu ram 70 chuangah an inzar pharh a, chutah chuan damlo, doctor leh thawhpui te pawhin  CZMEDITECH a ni hma an sawn theih nan an rinchhan a nih chuan kan chhuang hle. Kan siam orthopedic implant zawng zawng hian quality standard sang ber a tlin vek a ni.

Kum 13 kalta khan orthopaedic implant hmangin kan zinkawng mak tak hi kan tan a. A kal zelnaah chuan production line chu diversified in implant for... ruhro (spine) a ni, lungchhiatthlak, lu (cranial-maxillofacial) a ni, prosthesis hmanga siam a ni, power hmanrua, . pawn lam atanga fixator te, arthroscopy  leh ran enkawlna , bakah hian instrument te . surgical procedure kaihhnawih atana hman tur

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