Tibial fracture, suprapatellar intramedullary nailing hmanga tihbuai a ni

Intramedullary tibial nailing: access leh alignment, khup hmalam na

Tibial fracture-te intramedullary nailing-a surgical approach hi a pawimawh hle a, chu chu intramedullary nail chu entry point dik tak kal tlanga dah theih nan, intra-articular knee structures tihchhiat tlem nan leh fracture repositioning tha ber leh nail entry dik tak neih theih nan a ni.

Tibial stem fracture atana hmanraw hmanlai ber chu infrapatellar median emaw infrapatellar parapatellar approach emaw a ni. Heng approach te hi mid-segment fracture tan chuan hman tur ni mahse, postoperative valgus, anterior, emaw combined deformities hi proximal fracture tam zawkah a awm fo thin.

Proximal tibial fracture-a malalignment awm chhan ber chu khup flexion laiin quadriceps tendon a pulling avanga deformity leh implant insertion laiin nail tip leh posterior tibial cortex inkara mechanical conflict vang a ni. Patella hian sagittal plane-a axial nail luh a veng bawk (Fig. 1a, b). Chuvangin, point-a luh dan tlangpui dang chu medial parapatellar incision hmangin a ni a, chu chuan medial to lateral nail insertion tlem a thlen thin (Figs. 1c leh 2). Nail chu fracture atanga distal intramedullary canal a luh rual chuan proximal portion chu valgus ah a tilt a (Figure 2). A tawp berah chuan anterior compartment muscle-te resting tension hian valgus-ah hian tlem a thawhhlawk hle (Figure 3).

Figure 1 a,b Infrapatellar approach hmanlai hmang hian patella hian nail axial entry a veng a, chu chuan anterior apical sagittal alignment leh valgus coronal alignment common deformity a thlen thin. c Intramedullary nail alignment atan parapatellar approach hman.

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

Figure 3 Resting tension in the anterior muscle compartment (a) chuan ectopic arrangement fiah lo tak (b) a siam a.

Tibia chu hmun zau zawka pin hian intraoperative knee flexion na tak nena inzawm harsatna a awm loh nan a pui a ni. technique chu Gelbke, Jakma et al. kum 2010 khan a lar chho zel a, tun hnaiah a lar chho zel a, a chhan chu tibia chu a ke leh ke dinglam deuha pin chuan fracture manipulation leh repositioning a awlsam phah a ni. Fluoroscopy hi technically chuan tih a awlsam tawh hle. Suprapatellar nailing-a fluoroscopy hun hman hi infrapatellar nailing aiin a rei zawk tih an sawi. Chu bakah, nail insertion angle (sagittal plane-ah) chu he approach-ah hian infrapatellar nail aiin tibia longitudinal axis nen a inmil zawk a hei hian nail tip leh posterior cortex inkara mechanical conflict a veng a, chu chuan fracture tihtlem a ti awlsam hle.

Postoperative anterior knee pain hi a kaihhnawih harsatna a ni. Fracture vei zinga 50-70% velin anterior knee na an nei tih hmuhchhuah a ni a, internal plant an lakchhuah hnuah 30% chauhvin natna reh an nei a ni. Patellar tendon leh Hoffa fat pad-a luh theihna nena inzawm scar siam hi operation hnua khup natna thlentu a nih thu an chhut. Chu bakah, suprapatellar approach hian saphenous nerve patellar branch branch chu traditional incision a pumpelh a, chu chuan anterior knee numbness leh sensory dullness a veng thei bawk (Figure 4). Quadriceps tendon kal tlanga nail pass a, chu chuan patellar tendon chu a awm reng a, postoperative knee pain rate chu nasa takin a tihhniam niin a lang.

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

Engtikah nge suprapatellar intramedullary nail hi hman tur?

A thatna te

• Semi-extended knee position hian nail insertion laiin muscle strength leh retention a ti relax a, fracture manipulation leh repositioning a tichak a ni

• Technique pangngai nena khaikhin chuan proximal, segmental leh distal fracture-a postoperative dislocation risk a hniam zawk

• Nailing operation hi technically chuan tih a awlsam zawk

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

• Fluoroscopy hun a tihtlem

• Patellar tendon a chhiat loh bakah post-stapling anterior knee pain a tlahniam bawk

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

  
  

Indication te chu

• Extra-articular fracture a awm a, chu chu proximal tibia (AO 41A type) a ni.

• Tibial diaphysis (AO 42A-C type) tihchhiatna awlsam tak (comminuted fracture) a awm.

• Segmental tibial diaphyseal fracture (AO 42C type) a awm a, a chhuahna tur hmun hi a awm lo.

• Distal tibial extra-articular fracture leh simple intra-articular distal extension fracture (AO 43A leh C1 chi hrang hrang) te a awm bawk.

• Khup tui chunga awm

• Patellar ossification leh patellar tendon ossification te pawh a awm bawk

• Patellar tendon level-a hliam bawlhhlawh

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