Inter rotator fracture chhunga fixation a hlawhchham chuan engtin nge ni ang?

Hip fracture hian kum tin United States-ah puitling 500,000 velin a nghawng nia chhut a ni. Nunphung quality-ah nghawng lian tak an nei a, tunah hian damdawi ina thihna 3-7% vel an ni a, kum khat chhunga thihna rate chu 19.4-58% vel an ni. Hip fracture zawng zawng zinga a chanve vel chu intertrochanteric (IT) fracture a ni. IT fracture enkawlna atana implant hman tlanglawn ber pahnih chu cephalomedullary nail (CMN) leh sliding hip screw (SHS) te an ni.

Technology lama hmasawnna awm mah se, ruh discontinuity leh fixation failure te, femoral head penetration ang chi te hi a la awm reng a, a tichhe thei hle. Tun hnaia zirchianna hrang hrangah chuan tunlai implant hmanga resection rate 6% thleng a awm tih hmuhchhuah a ni. Fixation failure thlen theihna tur risk factors chu tip-tip distance (TAD) >25 mm, fracture repositioning tha tawk lo, fracture pattern nghet lo, cephalic spikes femoral head sir lam emaw, a hnuai lam emawa awm, leh cervical stem angle internal rotation te a ni. Tar leh ruh natna hi fixation failure nen a inzawm bawk.

Damlo leh tih dan tur

Hei hi khawpui lian takah healthcare system chhunga awm institution pahnih-a enkawl damlote retrospective survey a ni. January 2018 atanga September 2021 thlenga IT fracture initial fixation a hlawhchham hnua cement-reinforced revision fixation dawng zawng zawngte case logs chu institutional review board-in a pawmpui hnuah zawhfel a ni. Revision surgery neih chhunga cement reinforcement hman a nih dan chu electronic medical record (EMR) hmanga operative record leh postoperative radiographs enfiahna hmangin a nemnghet a ni. IT fracture-a initial CMN emaw SHS fixation hlawhchham hnua revision fixation-a cemented strengthening chhinchhiahna nei zawng zawngte chu kan telh vek a (Figure 1). Femoral neck emaw subtrochanteric fracture nei damlo te, cement reinforcement hmanga revision fixation nei lo te, revision surgery hmasa bera arthroplasty nei te kan paih chhuak a ni.

Figure 1. Hmeichhe kum 76 mi chu a femur (A) intertrochanteric fracture vangin intramedullary nailing a nei a, thla 2 hnuah implant incision (B) vangin hip na a na reng a ni.

Surgery hman dan tur

CMN hmanga initial fixation dawngtu damlote tan chuan modified head nail replacement leh bone cement reinforcement kan ti a. A tirah chuan greater trochanter proximal side-ah 5-cm incision siam a ni a, guide wire chu nail proximal side-ah dah a ni a, open reamer hmangin nail proximal side atang chuan ruh zawng zawng lakchhuah a ni. A dawtah chuan hexagonal screwdriver hmangin CMN chunglam fixation screw chu an tizau leh a (Figure 2).

Figure 2, intraoperative fluoroscopy-ah hian hexagonal screwdriver chuan a hmaa nailed set screw chu a engage a, a loose a.

Chumi hnuah chuan iliotibial fascia (ITB) fascia kaltlangin 1-2 cm transverse incision an siam thla a. Lu nail hmasa ber chu reverse threaded guide hmangin lakchhuah a ni (Figure 3). Femoral head perforation a awm chuan, joint chhunga cement a leak loh nan distal locking screw nei hollow guide hman a ni (Figure 3A). A bik takin, matrix chu triple cannula pawn lam layer pahnih lakchhuah hnuah inject hmasak a ni a, chutah chuan pawn lam layer pahnih dah lehin perforated area-ah dah a ni.

Figure 3, Damlo dang pakhat intraoperative anteroposterior (A) leh lateral (B) images-ah chuan femoral head-ah interstitial bone defect graft a awm tih a lang.

A dawtah chuan limb chu traction a ni a, chutah chuan fracture chu revision fixation atan exostosis tam zawkah dah leh a ni. Malunion emaw fibrous healing emaw a awm chuan percutaneous osteotomy hi 1/4' bone gouge hmangin anterolateral approach hmangin an ti thin. Hei hi a tul lo hle a, mahse a tul chuan cervical stem angle tha zawk (target >130°) siam nan a tangkai hle.

Chumi hnuah chuan screw emaw spiral blade thar emaw chu femoral head-a subchondral bone chhungah femoral neck axis-ah dah a ni a, lu chhunga lut lo turin fimkhur a ngai (Figure 4). Screw hi tumruh taka dah a ni a, a hmaa nail tract awm tawh kha pumpelh a, mahse a tawp lam chu femoral head lai takah a la kawhhmuh a ni. (Thlalak 5) 1.1.

Figure 4, Damlo dang anteroposterior (A) leh lateral (B) images-ah hian lu nail thar kalna kawngah kerfing needle dah luh a ni.

Figure 5, intraoperative fluoroscopy-ah hian guide wire path-ah cephalomedullary blade thar dah a ni a, chu chu a hnuah set screw hmanga tihkhauh a ni.

A tawp berah chuan femoral head chu injectable bone cement system hmangin bone cement hmangin an khat a (Figure 6). Real-time radiograph hmangin leh cement cannula thuk leh orientation siamrem hmangin joint chhunga extrusion awm lo turin fimkhur a ni.

Figure 6, Imaging-ah chuan a tir lamah cement a pung (A), zawi zawiin a filling (B) a, femoral head defect a fill thlengin (C).

SHS initial fixation dawngtu damlote tan chuan SHS chu kan la chhuak a, CMN sei tak kan dah a ni. greater trochanter hnuaiah central-a 5-cm incision siam a, ITB hriatchhuah hnuah, incision chu lateral plate thlengin dissected a ni. Plate screw zawng zawng chu hand screwdriver remchang hmangin lakchhuah a ni a, chumi hnuah lateral plate chu lakchhuah a ni. Chumi hnuah chuan tension screw te chu a hmaa kan sawi tawh ang khan reverse thread guide hmangin an la chhuak a, chu chuan fracture chu valgus degree lian zawkah dah leh a ni. Chumi hnuah chuan a hmaa kan sawi tawh ang khan greater trochanter tip-ah cm 5-a sei incision siam a ni. Greater trochanter tawp hnai ber ah guide wire dahin femoral stem chhungah hmasawn tir a ni. Guidewire kalna kawngah hian open reamer dah a ni. Chumi hnuah chuan ball-tipped guidewire sei tak chu patella level hnuai lama distal femur lai takah thread a ni. A dawtah chuan progressive reaming an ti a, chu chu backbone-ah tremor an hriat thlengin an ti a. Kan damlo zawng zawngte hian TFN-ADVANCED (TFNa) proximal femoral intramedullary nailing system (DePuy-Synthes, Raynham, MA) hmangin CMN nail sei tak kan dawng vek a.

Sawiho

Kan technique hian revision fixation neih laiin bone cement reinforcement kan hmang a. Osteoporotic proximal femur fractures initial fixation atana bone cement reinforcement hi zirchian a ni tawh a, biomechanical leh clinical result tha tak a awm tawh bawk. Tun hnaia review pakhatah chuan bone cement reinforcement hian failure load a ti sang zawk a, implant displacement a ti tlem a, nonreinforced fixation nena khaikhin chuan complication leh reoperation a tlem zawk tih a tarlang. Randomized, multicenter prospective study-ah pawh cement-reinforced group-ah hian reoperation emaw, CMN displacement symptomatic episodes emaw a awm lo tih a sawi a, nonreinforced group-a case paruk nen khaikhin chuan.

Hip fracture vanga thihna hi a tam hle. Tun hnaia zirchianna hrang hrangah damdawi ina thihna rate chu 3-7% vel a ni tih an sawi a, kum khat chhunga thihna hi 19.4% aṭangin 58%-ah a tlahniam a ni. A bik takin IT fracture hian kum khat chhunga thihna 27% a thlen tih hmuhchhuah a ni. Kan clinical series-ah hian in-hospital mortality a awm lo a, kum khat chhunga thihna rate chu 13.6% a ni a, hei hi literature nena khaikhin chuan a hniam hle. Surgery hnua khum hmaa kal theihna hi thihna hniam zawk nen a inzawm avangin, kan series-a ambulation tha leh functional outcome hian kan damlote thihna tlem zawk hmuhchhuah chu a hrilhfiah thei a ni.

Tawpna

Cement-reinforced revision fixation hi damlo tar, acetabular bone stock tling tak nei, non-infected intertrochanteric fracture fixation failure atana hmanraw tangkai, him leh man tlawm tak a ni.

Primary intertrochanteric fractures fixation hlawhchham hnua revision fixation leh cement-reinforced treatment nei damlote chuan hun rei tak chhunga clinical leh quality-of-life outcome tha tak tak an nei a ni. He procedure hi acetabular articular surface tam zawk chu a vawn tlat a, lu nail chu femoral neck chhunga awm reng a nih chuan chauh hman a ni. Kum upa lam damlo chak lo zawkte revision arthroplasty tihkhawtlai dan ngaihtuah chuan, he procedure hian he damlo pawla operation hun leh senso tihtlem rualin harsatna lian tham him tak leh tangkai taka tihziaawmna kawngah thutiam a lantir a ni.

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