Elastically stabilized intramedullary nails (esins) hi naupangte ruh tliak (long bone fractures) surgical stabilization atana hman tlanglawn tak a ni. Radius, ulna, femur, leh a chang chuan tibia leh humerus-a fracture nghet lo 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 fractures-ah length leh rotation a humhim bawk. Load-sharing implant angin, a ke ruh chu a hma thei ang bera kal theihna a siam a ni. A tlangpuiin, fracture dam hnuah elastically stable intramedullary nails te chu an la chhuak thin.
Femoral fractures .
Femoral fracture-a ESIN awm dan tur chu: kum 4 leh 14 inkar leh multiple trauma chhunga femoral fractures te a ni .
Damlo chu orthopedic traction table-ah dah a ni a, boot lian leh te chu naupang ke lian leh te ang zela siam a ni. Fluoroscope hi antero-posterior (AP) leh latero-lateral (LL) views atanga a kawrfual natna vei te hmuh theih nan a mamawh a, chu chu hip atanga knee level thlenga femur hmuh theihna turin dah a ni. Reduction hmuh dan chu AP leh LL views pahnih ah hian enfiah a ni a, rotation pawh verified a ni .
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 nen a inzawm tlat a ni:
- Kum 6–8 chhung: 3 mm diameter;
- Kum 9–11 chhung: 3.5 mm diameter;
- Kum 12–14 chhung: 4 mm diameter.
Nail sei zawng hi distal growth cartilage atanga greater trochanter growth cartilage thlenga hlat zawng nen a inang a ni .
Diaphyseal fractures .
Proximal leh middle third te chu proximal leh middle third-a diaphyseal fracture-ah chuan C-shaped approach, distal metaphysis kaltlangin retrograde retrograde dah a ni. Proximal fracture-ah chuan nail-te proximal tip chu a ben a, mid-diaphyseal fracture-ah chuan nail lai tak chu a curve a ni. Operation tawp lamah chuan, transverse fractures-ah chuan, fragments te chu residual distraction awm lohna turin an nghawng a, chu chu a hnuai lam ke hnuai lam sei zawng inang lo tak a nih chuan mawhphurtu a ni thei. Oblique emaw comminuted fractures emaw a nih chuan distal tip chu a ben a, ruh chhungah a tlak a, chu chuan a then telescoping leh nail te telescope a awm loh nan a hmang thin.
Heng ruh tliakte natural tendency chu operation hnua 5–10 mm shortening induce nghal a ni a, chu chu fracture consolidation laiin growth stimulation hmangin a rul ang
Tibial fractures .
Damlo dinhmun leh buatsaih damlo chu damlo chu reduction awlsam zawk nan orthopedic table-ah dah a ni. Fluoroscope awmna hi intraoperative control atan chuan tih ngei ngei tur a ni. Operative field ah chuan khup a tel tur a ni .
Nail-te dah luh .
Elastic nail te hi proximal metaphysis ah antegrade an dah fo thin a, antero-lateral leh anteromedial hmunah te an dah thin .
Nail diameter hi 2.5 leh 4 mm inkar a ni a, chu chu damlo kum a zirin a ni. Nail hmasawnna atana hammer hman phal a ni a, mahse fimkhur taka hman tur a ni.
Reduction quality chu nail diameter leh degree of bending hmangin a enkawl a ni.
Nail te hi reduction a famkim hmain distal metaphysis cancellous bone ah a tlak loh tur a ni; Chutiang a nih loh chuan siamthatna kalphung chuan osteosynthesis a tichhe thei a ni.
Impaction hmain fragments rotation chu enfiah a ni a, residual varus deformity awmnaah chuan hei hi nail bending lutuk hmangin siamthat a ni. Operation tawp lamah chuan traction a relax a, a fragment te chu a tlakbuak a ni.
Comminuted fractures-ah chuan ruh pawna awm, nail-te proximal tips chu 90°-ah ben a ni a, cortical bone-ah a lut a, chu chuan fragments telescoping a veng thei a ni.
Humeral fractures te pawh a awm nual bawk.
Humeral fracture-a esin awm dan indication chu fracture site a zirin a danglam a: proximal metaphysis emaw diaphysis emaw a ni. Humerus-a surgical neck fracture-ah chuan Esin chu conservative treatment-a immobilization mamawh hun a tihtlem avangin a tarlang a ni.
Diaphyseal fracture-ah chuan elastic nail hman dan chu radial nerve lesions awm leh awm lohah a tarlang a ni.
Nail dah luh dan Nail te chu retrograde method hmangin an dah lut thin. Insertion point te chu supracondylar area lateral margin ah hmuh a ni a, postero-lateral direction leh proximal inclination a nei a ni. He hmuna cortical bone hi a harsat em avangin drill hmanga entry point siam a ni. Nail diameter hi 2.5 leh 3.5 mm inkar a ni a, an ben dan inang vek a ni. Nail te hi vertical manual pressure leh rotating movement hmanga dah a ni. Proximal metaphyseal area-a fracture chu a tling tawka tihtlem theih a nih loh chuan, nail-te 1800 rotation chuan he tihtlem hi a ti awlsam a ni. Mahse, tihtlem theih a nih loh chuan Kirschner guide-wire chu open reduction hmain proximal fragment-ah dah a ni. Oblique diaphyseal fractures-ah chuan medullary canal atanga chhuak a, radial nerve sulcus-a posterior-a migrating nail awm loh a pawimawh. Nail pahnih hian fracture site an pelh hnuah proximal metaphysis-a cancellous bone-ah an lut a ni.
Forearm fractures .
Orthopedic treatment in forearm fractures chu pawm a ni a, mahse spontaneously remodeled angulation phal chin chu hriat lar tak a ni. Heng limit te hi a pelh chuan emaw, orthopedic treatment failure a nih chuan, closed reduction leh ESIN chu forearm fractures ah a tarlang a ni.
Operative Technique Damlo chu dorsal decubitus-ah a awm a, a hmawr natna chu radiotransparent table-ah a awm a ni.
Nail hman diameter hi 2.5 leh 3 mm inkar a ni. Ulnar nail chu a dinglam deuh a, radial nail erawh chuan radius-a pronatory curve siam that leh theihna turin marked bending a nei thung.
Fixation hi a tlangpuiin ruh atanga tan a ni a, chu chu tihtlem awlsam zawk a ni. Radius tan chuan entry point chu distal metaphysis-ah hmuh a ni a, distal growth cartilage chungah, thumb-a extensor sei leh tawi tendon inkar ah hmuh a ni. Cortical bone chu incision te tak te hmangin a lang a, hole an drill a, chu chu circular movement hmangin an ti lian a ni. Nail chu medullary canal chhungah fracture site thlengin a dah lut a. Fracture reduction tih a ni a , nail chu fluoroscopic control hnuaiah proximal fragment ah a kal a .
Chutiang bawkin ulna tan pawh, antegrade technique hmangin, olecranon medial margin-a entry point hmangin an kalpui bawk.
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