Tibial fracture, suprapatellar intramedullary nailing technique hmanga tih theih a ni.

Intramedullary tibial nailing: A thlen theihna leh alignment, anterior knee pain

Intramedullary fractures-a intramedullary nailing-a surgical approach hi a pawimawh hle a, chu chu entry point dik tak hmanga intramedullary nail dah luh theihna tur te, intra-articular knee structures tihchhiat tlem nan te, leh fracture repositioning tha ber leh nail entry dik tak neih theihna tur te a ni.

Tibial stem fractures atana classic approach chu infrapatellar median emaw infrapatellar parapellar approach emaw a ni. Heng approach te hi mid-segment fractures, postoperative valgus, anterior, emaw combined deformities te tan proximal fracture tam zawkah a awm fo thin tih te hi tarlan ni mahse.

Proximal tibial fractures-a malalignment awm chhan ber chu khup flexion laiin quadrips tendon leh nail tip leh implant insertion laiin posterior tibial cortex inkara mechanical conflict a chhuah avanga deformity a ni. Patella hian sagittal plane-a axial nail luh a veng bawk (Fig. 1A, B). Chuvangin, point hmuh theihna kawng dang chu medial parapatellar incision hmangin a ni a, chu chuan lateral nail insertion-ah medial tlemte a thlen a ni (Figs. 1C leh 2). Nail chu intramedullary canal distal atanga fracture thlenga a luh rual chuan proximal portion chu valgus ah a tilt a (Figure 2). A tawpah chuan anterior compartment muscle-a resting tension hian valgus-ah a thawhhlawk deuh hlek a ni (Figure 3).

Figure 1 A,B Infrapatellar approach pangngai hmangin patella hian nail axial entry a veng a, chu chuan anterior apical sagittal alignment leh valgus coronal alignment te chu a deformity tlangpui a ni. c Intramedullary nail alignment atan Parapatellar approach hmangin.

Figure 2 Medial Parapatellar incision hmanga entry point hnaih chuan medial tlem atanga lateral nail insertion a thlen thin. Nail chu medullary canal distal atanga fracture (A) thlenga a luh rual chuan proximal portion chu valgus (b) ah a tilt a.

Figure 3 Anterior muscle compartment ( A )-a chawlh hahdamna tension chuan ectopic arrangement fiah lo tak a siam ( B ) .

Tibia chu hmun zau zawka pin hian intraoperative knee flexion na tak nena inzawm harsatna a awm loh nan a pui a ni. He technique hi Gelbke, Jakma et al. Kum 2010 khan a lar chho zel a, tun hnaiah a lar chho zel a, a chhan chu tibia hi almost straight limb position-a pin hian fracture manipulation leh repositioning a ti awlsam a ni. Fluoroscopy hi technically chuan tih a awlsam ta hle a ni. Suprapatellar nailing atana fluoroscopy hun hi infrapatellar nailing aiin a tawi zawk tih an sawi. Chu bakah, nail insertion angle (sagittal plane-a) chu infrapatellar nail aiin he approach-a tibia longitudinal axis nen hian a inmil zawk a Hei hian nail tip leh posterior cortex inkara mechanical conflict a veng a, chu chuan fracture reduction a ti awlsam hle.

Postoperative anterior knee pain hi a kaihhnawih harsatna a ni. Fracture vei zinga 50-70%-ah chuan anterior knee pain a awm tih hmuhchhuah a ni a, damlo zinga 30% chauhvin an chhunga thing an lakchhuah hnuah natna tihdamna an tawk a ni. Patellar tendon leh hoffa fat pad hman theihna nena inzawm scar formation hi postoperative khup natna thlentu a ni tih an chhut. Chu bakah, suprapatellar approach hian saphenous nerve branch branch branch traditional incision a pumpelh a, chu chuan anterior knee a ti na leh sensory dullness a veng thei bawk (Figure 4). Quadriceps tendon hmanga nail pass a, chu chuan patellar tendon chu a awm reng a, postoperative khup natna rate chu nasa takin a tihhniam niin a lang.

Proximal fractures result tha tak avang hian clinical practice-a indication te chu fracture zawng zawngah pawh tihzauh a ni.

Engtik laiin nge suprapatellar intramedullary nail hi hman tur?

A thatna te .

• Semi-extended knee position hian nail insertion laiin muscle strength leh retention relaxing hmangin fracture manipulation leh repositioning a tichak a ni.

• Proximal, segmental leh distal fractures te postoperative dislocation risk a hniam zawk a, technique pangngai nen khaikhin chuan

• Nailing operation hi technically chuan tih a awlsam zawk .

• Nail insertion hi 'single surgeon procedure' angin tih theih a ni

• Fluoroscopy hun a ti tlem .

• Patellar tendon a tichhia lo a, post-stapling anterior khup natna a tlahniam lo.

• Multi-team procedure-a tih awlsam zawk, multiple trauma-a tih ang chi

  
  

Indication te .

• Extra-articular fracture a awm a, a chhuahna tur hmun a awm lo.

• A rilru a buai em em a, a rilru a hah em em bawk a. (AO 42A-C type)

• Segmental tibial diaphyseal fracture (AO 42C chi) .

• Distal tibial extra-articular fractures leh simple intra-articular distal extension fractures (AO 43A leh C1 types) te hi a awm a.

• Floating khup .

• Patellar ossification leh patellar tendon ossification a awm bawk.

• Patellar tendon level-a hliam bawlhhlawh .

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