Naupang ruh tliak sei tak takte surgical stabilization atana hmanraw hman tlanglawn tak chu elastically stabilized intramedullary nails (ESINs) a ni. Radius, ulna, femur, a chang chuan tibia leh humerus-a unstable fracture enkawlna atan hman a ni nasa hle. Naupang ruh sei tak takte pathological fracture enkawlna atan pawh hman a ni. ESIN hian fracture site hawn lohvin closed fracture fixation a pe a, point thum stability a pe a, transverse, short oblique fracture-ah pawh a sei zawng leh rotation a humhim bawk. Load-sharing implant a nih angin, ke ruh chu a hmaa a kal theih phah a ni. A tlangpuiin, elastically stable intramedullary nails te hi fracture healing hnuah lakchhuah thin a ni.
Femoral fractures a awm thin
Femoral fractures-a ESIN awm theihna tur chu: kum 4 leh 14 inkar leh multiple trauma chhunga femoral fractures .
Damlo chu orthopaedic traction table-ah dah a ni a, boot lian leh te chu naupang ke lian leh te ang zela siam a ni. Fluoroscope hi a natna vei thigh antero-posterior (AP) leh latero-lateral (LL) view hmuhna atan a ngai a, hip atanga khup level thlenga femur hmuh theih turin dah a ni. Reduction hmuh dan chu AP leh LL view pahnih ah check a ni a, rotation pawh verified a ni bawk .
Nail thlan dan Nail diameter hian nail thlan dan tlangpui a zawm tur a ni. A hnuaia classification hi alternative variant atan hman theih a ni a, chu chu naupang kum nena inzawm a ni:
- Kum 6–8 inkar: 3 mm a sei;
- Kum 9–11 inkar: 3.5 mm a sei;
- Kum 12–14 inkar: 4 mm a sei.
Nail sei zawng hi distal growth cartilage atanga greater trochanter growth cartilage thlenga hlat zawng nen a inang a ni .
Diaphyseal ruh tliak a awm
The proximal leh middle third Proximal leh middle third-a diaphyseal fracture a awm chuan C-shaped approach, distal metaphysis kaltlangin nail-te retrograde-a dah luh chu thlan a ni. Proximal fracture-ah chuan nail proximal tip chu a ben a, mid-diaphyseal fracture-ah chuan nail lai tak chu curved a ni thung. Operation tawp lamah chuan transverse fracture a awm chuan, residual distraction awm loh nan fragment te chu an impact a, hei hian a ke hnuai lam sei zawng inang lo takah mawhphurtu a ni thei a ni. Oblique emaw comminuted fracture emaw a nih chuan distal tip chu bent a ni a, ruh chhungah a impact a, chu chuan fragments te telescoping leh nail te migration a awm loh nan.
Heng fracture te hi natural tendency chu operation hnuah 5–10 mm shortening induce nghal a ni a, chu chu fracture consolidation laiin stimulation of growth hmangin a compensate ang
Tibial a ti chhe thei
Damlo dinhmun leh inbuatsaihna Damlo chu tihtlem awlsam zawk nan orthopaedic table-ah dah a ni. Intraoperative control atan chuan fluoroscope awm hi a ngai a ni. Operative field ah hian khup pawh a tel tur a ni .
Nail te chu insertion a ni
Elastic nails te hi proximal metaphysis ah antegrade in an dah fo thin a, antero-lateral leh anteromedial location ah te an dah thin .
Nail diameter hi damlo kum a zirin 2.5 leh 4 mm inkar a ni. Nail hmasawn nan hammer hman hi phal a ni a, mahse fimkhur taka hman tur a ni.
Reduction quality hi nail diameter leh a bending degree atanga enfiah a ni.
Reduction a famkim hmain nail te hi distal metaphysis cancellous bone ah impact tur a ni lo; chutiang a nih loh chuan siamthatna kalphung chuan osteosynthesis a tichhe thei a ni.
Impaction hmain fragment-te rotation enfiah a ni a, residual varus deformity a awm chuan nail bending lutuk hian hei hi siamthat a ni. Operation tawp lamah chuan traction chu a relax a, fragment te chu a impact a ni.
Comminuted fracture a nih chuan ruh pawn lama nail awmte proximal tips chu 90°-ah bent a ni a, cortical bone-ah impacted a ni a, chu chuan fragments telescoping a awm loh nan.
Humeral tihchhiatna (Humeral fractures) a awm
Humeral fracture-a ESIN awm dan hi a fracture hmun a zirin a inang lo: proximal metaphysis emaw diaphysis emaw. Humerus surgical neck fractures-ah chuan ESIN hi hman a ni a, a chhan chu conservative treatment-a immobilization mamawh hun chhung a tihtlem avangin
Diaphyseal fracture a awm chuan radial nerve lesions awm mahse elastic nail hman a ngai a ni.
Nail dah dan Nail hi retrograde method hmanga dah a ni. Insertion point te hi supracondylar area lateral margin-ah hmuh a ni a, postero-lateral direction leh proximal inclination nei a ni. Entry point te hi drill hmanga siam a ni a, a chhan chu he hmuna cortical bone hi a khauh em em a ni. Nail diameter hi 2.5 leh 3.5 mm inkar a ni a, an ben dan pawh a inang vek bawk. Nail te hi vertical manual pressure leh rotating movement hmanga dah a ni. Proximal metaphyseal area-a fracture chu a tlem thei ang bera tihtlem theih a nih loh chuan nail 1800 rotation hian he tihtlem hi a ti awlsam hle. Mahse, tihtlem theih a nih loh chuan open reduction hmain proximal fragment-ah Kirschner guide-wire dah a ni. Oblique diaphyseal fracture a awm chuan nail te chu medullary canal atanga chhuakin hnunglam hawia radial nerve sulcus ah a migrate loh nan a pawimawh hle. Nail pahnih hian fracture site an pelh hnuah proximal metaphysis-a cancellous bone-ah an impact a ni.
Forearm a tliak
Forearm fracture-a orthopaedic treatment hi pawm a ni a, mahse spontaneously remodeled angulation-a allowed limits chu hriat lar tak a ni. Heng limit te hi a pelh chuan emaw, orthopaedic treatment a hlawhchham a nih chuan, forearm fractures ah closed reduction leh ESIN tih a ni
Operative technique Damlo chu dorsal decubitus-ah dah a ni a, a kut hmawr natna chu radiotransparent table-ah dah a ni.
Nail hmante diameter hi 2.5 leh 3 mm inkar a ni. Ulnar nail chu a dinglam deuh vek a, radial nail erawh chuan radius-a pronatory curve siam that leh nan marked bending a nei thung.
Fixation hi a tlangpuiin ruh tihtlem awlsam zawk atanga tan a ni. Radius atan chuan entry point chu distal metaphysis-ah hmuh a ni a, distal growth cartilage chung lamah, thumb extendor sei leh tawi tendons inkarah a awm a ni. Cortical bone chu incision te tak te hmangin a lang a, hole an drill a, chu chu circular movement hmangin a ti lian a ni. Nail hi medullary canal-ah fracture site thlengin dah a ni. Fracture reduction tih a ni a , nail chu fluoroscopic control hnuaiah proximal fragment ah hmasawn tir a ni .
Ulna tan pawh hetiang bawk hian tih a ni a, antegrade technique hmangin, entry point chu olecranon medial margin-ah dah a ni.
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