A hnuaia technique te hi eng technique nge intertrochanteric fractures siamthat nan hman thin?

Femur-a intertrochanteric fracture, intertrochanteric fracture tia hriat bawk hi extra-articular capsule fracture a ni. Intertrochanteric fracture lan chhuahna ber chu local pain leh swelling nasa tak, extensive ecchymosis, damlo ding thei lo emaw, kal thei lo emaw, shortening nasa tak, a natna vei limb chhung leh pawn lama rotation deformity, leh hip joint chu eng lam hawi pawha active leh passive movement tihkhawtlai te hi a ni.

Epidemiology chungchang a ni

1. A tam zawk hi ruh natna nena inzawm an ni a, kum upa lam zingah a tam ber a, mipa aiin hmeichhia an tam zawk.

2. A thlen dan hi hnam, mipa leh hmeichhia leh bial nena inzawm a ni.

3. tarte hliam tlangpui, intertrochanteric fracture of femur kum zat chu kum 75.2 a ni. Hmeichhia leh mipa inkara intertrochanteric fracture kum ah hian danglamna lian tham a awm lo.

4. Trochanter-a thisen a kal tam avangin a ruh tliak hi a dam lo fo thin a, mahse hip inversion a awm a awlsam a, damlo kum upa zawkte khumah rei tak mutna avanga harsatna a awm tam zawk a, natna leh thihna rate pawh 15%-20% a ni a, chuvangin kum upa lam zingah chuan ruh tliak hnuhnung ber an ti a ni.

Hliam awm dan (mechanism) a ni

1. Thalai puitling hi a tam zawk chu chakna sang tak nei hliam an ni a, thluak, rilru, pum leh hliam hmun dangte ngaihven tur a ni; tarte hi a tam zawk chu tar function of the limbs coordination response agility tlahniam leh tlak vang a ni.

2. Direct violence: trochanter area lian zawkah direct-a nghawng a nei. Taksa chu a tlak laiin lateral force hmanga leiah a tlak chuan.

3. Indirect violence: tlu laiin taksa a inher a, hip chu a rualin inversion leh forward angle stress a tawk thin.

4. Pathological fracture, ruh natna awm tlangpui zinga mi.

5. Intertrochanteric fracture hi indirect violence avanga lo awm a ni ber.

Clinical lama a lan chhuah dan

1. Basic presentation chu femoral neck fracture nen a inang a, local pain, swelling leh functional limitation of the affected limb a awm.

2. Extra-articular capsule fracture a nih avangin joint capsule-ah hian khapna a awm lo va, chuvangin lower limb-a shortened external rotation (90 degrees) deformity hi a na zawk.

3. Axial percussion avanga natna.

4. Local hematoma hi a na hle a, subcutaneous bruising nasa zawk a awm thei bawk.

5. Damlo tar zawkah chuan femoral neck patient aiin an upa zawk tlangpui a, damlo zinga a tam zawk chu a hmain stroke an lo nei tawh bawk.

Diagnosis tih a ni

Trauma langsar tak tak, kut leh ke natna, leh chetna tlem te chanchin. Kawng hnuai lam shortening leh external rotation deformity chu 90° thlengin a lang chiang hle. Diagnosis hriat chian nan X-ray examination neih a ngai fo a, typing hi radiographs hmanga tih a ni. Intertrochanteric fracture symptoms hi femoral neck fracture symptoms nen a inang a, mahse a hnuhnung zawk hi a hmasa zawk aiin a na lo zawk a, local pain, swelling, function loss, leh affected limb tih tawi te a ni a, a natna vei limb hian a tam zawk chu mild hip flexion leh knee flexion leh external rotation deformity a nei a, a tlangpuiin 45°-60° inkar a ni.

Lampang

Fracture chi hnih zingah hian AO leh Evans-Jensen fracture te hi hman tlanglawn ber an ni a, heng pahnih zingah hian AO fracture type hi a tam ber a ni.

Evans-Jensen chuan a type a

Type I: Intertrochanteric fracture awlsam tak, fracture line chu superior atanga inferior thlenga inthlak, displacement leh stability awm lo.

Type II: Displacement chu rotor avulsion fracture te tak te nen a inzawm a, mahse femoral spur chu a la awm reng a (femoral spur chu ruh plate dense tak, femoral neck chhung thuk takah leh rotor te tak te body junction chhunga awm a ni.

Type III: Trochanteric fracture lian zawk leh femoral spur-a fracture accumulation inzawmkhawm, displacement nen, a tam zawkah chuan posterior inter-rotor fracture a awm thin.

Type IV: 3-part fracture leh lesser trochanter-a comminuted fracture inzawmkhawm, chu chu femoral neck leh greater trochanter-a coronal surface burst fracture nen a lang thei.

Type V: hnunglam lateral leh medial unsupported fracture (type III leh IV te inzawmkhawm).

Type R: hmalam intertrochanteric fracture, superior medial atanga inferior lateral thlenga oblique fracture line nei, chu chu rotor fracture te tak te leh femoral spine tihchhiatna nen a inzawm thei.

AO type a ni

A1.1 Fracture line chu inter-rotor line kal tlangin a kal a

A1.2 Trochanter lian zawk kal tlanga fracture

A1.3 Lesser trochanter hnuai lama fracture kal tlang

A2.1 Ruh 1 comminuted hmanga ruh tliak

A2.2 Ruh chi hrang hrang comminuted tam tak awmna fracture

A2.3 Lesser trochanter hnuai lam cm 1 aia sei fracture

A3.1 Oblique shape awlsam tak

A3.2 Transverse shape awlsam tak

A3.3 Thutiam siam

Enkawlna hrang hrang

Fracture-te internal fixation stability hi a tlangpuiin thil panga-ah a innghat a, chungte chu: ruh quality, fracture chi, tihtlem, internal fixation thlan dan, leh ruh nena inzawm internal fixation awmna hmun te hi a ni. Fracture repositioning hi internal fixation hnua stability atan a pawimawh a, anatomic reposition emaw stable non-anatomic reposition emaw neih tum tur a ni. A tawi zawngin, repositioning tum ber chu fracture stability neih hi a ni. Repositioning dan hi closed emaw incisional emaw pawh a ni thei. Fracture chi hrang hrang chu eng ang pawhin buaithlak mah se, closed reduction hi tih hmasak a ngai a ni.

• Power Hip Dowel (DHS) hmanga siam a ni.

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DHS Power Hip Screws hman tangkai dan ber.

• Screw hian femoral head chhungah fixation effect nasa tak a nei a, osteoporosis a awm pawhin.

• Sleeve-a gliding mechanism hian nail tawp chu femoral head emaw acetabulum-ah a lut thei lo va, negative gravity chu ruh-ah direct-in a thlen thei lo.

• Power gliding mechanism hian fracture chu a hmunah a vawng reng a, non-union a ti tlem bawk.

• Compression leh gliding function pahnih a nei a, dynamic leh static compression effect a nei bawk.

  
  

• Power Hip Dowel (DCS) hmanga siam a ni.

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  DCS leh 95 degree cutting plate te chu anticrotal fracture te tan:

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DCS power condylar screw thatna ber chu.

• A chhe lai dinhmun bik a zirin screw luhna tur chu dik takin a thlang thei a, a hnathawh pawh a awlsam hle.

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• Power compression tension screw hi plate nen angle dik takah a awm a, hei hian hip-a biomechanical mamawh a phuhruk a ni. Weight-bearing lai hian negative force chu plate arm tawi takah dah hmasak a ni a, chutah chuan screw tinah a darh a, chutiang chuan stress chu a darh zau a, fixation chu a danglam bik hle.

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• Fracture-a DCS screw tam tlem chuan a nghetna a tipung a, fracture area chu bridge leh fix theih a ni a, chu chuan postoperative complications a tihtlem phah a ni.

A rilru a buai em em a, a rilru a hah em em bawk a. Proximal Femoral Locking Intramedullary nail (PFN) .

PFN fixation a thatna te.

• Nail diameter te zawk (a tlangpuiin 9mm), dilation tel lovin drive in theih a ni. (Gamma nail caudal end thicker zawk aiin a chungnung zawk - 17mm)

• PFN proximal end hian camber degree 6 vel a nei a, hei hian valgus angle a ti tlem a, traction laiin internal retraction chak tak neih a ngai tawh lo.

• A chunglam tawp lamah chuan femoral head chhungah screw pahnih dah theih a ni a, anti-rotation screw leh femoral neck-ah double nail bearing dah belh a ni a, hei hian fatigue resistance a tipung a ni.

• Distal locking hole leh main nail distal end (tapered extension) inkar hlat zawng a rei zawk a, hei hian femoral stem-a stress concentration a tihziaawm thei a ni.

• Trauma a tlem zawk.

Gammar nail a awm

Gammar nail fixation hman thatna.

• Minimally invasive intramedullary fixation method a ni a, incision tlemte leh trauma tlem ber a awm bawk.

• Gamma nail hian intramedullary nail leh tension screw inzawmkhawm hmangin upper femur leh femoral neck chu nghet takin a inzawm khawm a, intramedullary nail chu distal self-locking nail hmangin a fix a, hei hian rotation leh shortening displacement a veng a, fixation rintlak tak a pe bawk.

Gammar-a hmasawnna - PFNA

Internal fixator thlan dan (PFNA) a ni.

• Femur-a intertrochanteric fracture nghet lo tak takte tan built-in tha tak a ni.

• Femoral head leh neck chu nghet takin a fix a, fracture end rotation a veng bawk.

• Medial support hloh hnua ruh resorption avanga collapse, inversion deformity, leh insert hmanga femoral head atanga cut out ang chi complication te a veng thei.

• Intertrochanteric fracture zawng zawng deuhthaw tan a tha a, a bik takin unstable fracture (eg anterior intertrochanteric fracture) leh combined osteoporosis tan a tha.

• Complication engemaw zat a la awm a, chu chu femoral head avulsion ang chi a ni a, chu chuan internal fixation dang thlak theih a ni lo.

Artificial Joint thlak danglam a ni

Femur-a intertrochanteric fracture a awm chuan artificial joint replacement surgery neih theihna tur indication:

• Kum 80 chunglam.

• Intertrochanteric fracture comminuted leh nghet lo tak a awm.

• Bone osteoporosis hi a lang chiang hle a, internal fixation hi a tha taka siamthat a harsa hle.

• Hliam hmaa hip emaw khup emaw inhernaah hian tihkhawtlai lian tham a awm lo.

• Taksa pum dinhmun hian surgery hmanga enkawlna chu a tuar thei a ni.

Hun rei tak khumah enkawl theih loh damlote.

A thatna: operation hnua leia dah hmasak. Khum-a harsatna awmte chu pumpelh rawh. Dam rei theihna hun pawhsei leh nunphung tihchangtlun.

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