Tibial fractures, suprapatellar intramedullary nail technique .

Intramedullary nailing technique a wɔde yɛ tibial fractures: ɛnam suprapatellar, transarticular kwan so a kotodwe no abɔ wɔ 20-30° ne protective tube pɔtee bi a ɛbɛbɔ intra- articular structures no ho ban.

01.Tibial intramedullary nnadewa .: kwan a wɔfa so kɔ hɔ na ɛne ne ho hyia, kotodwe a ɛwɔ anim no mu yaw .

Oprehyɛn kwan a wɔfa so nya tibial fractures intramedullary no ho hia na ama wɔatumi de nnadewa a ɛwɔ intramedullary no mu no afa baabi a ɛfata a ɛkɔ mu no mu, na ama asɛe a ɛwɔ nkotodwe no mu a ɛwɔ ntini no mu no so atew, na wɔanya abubuw a wɔde si baabi foforo a eye sen biara ne nnadewa a wɔde hyɛ mu yiye.

Akwan a wɔtaa fa so yɛ tibial stem fractures no ne infrapatellar anaa parapatellar akwan a ɛwɔ mfinimfini no. Ɛwom sɛ wɔkyerɛ sɛ saa akwan yi yɛ mfinimfini a ɛpaapae mfinimfini de, nanso valgus akyi valgus, anterior, anaa syndesmotic deformities taa ba wɔ abubuw a ɛbɛn kɛse mu.

Ade titiriw a ɛde malalignment ba proximal tibial fractures mu ne deformity a efi quadriceps tendon a wɔtwe bere a wɔrebɔ nkotodwe ne mfiri ntawntawdi a ɛda nnadewa no ano ne akyi tibial cortex ntam bere a wɔde rehyɛ mu no. Patella no nso siw axial entry a ɛwɔ nnadewa no mu wɔ sagittal plane no mu (Mfonini 1A, B). Enti, ɔkwan foforo a wɔtaa fa so kɔ asɛm no mu ne sɛ wɔde parapatellar incision, a ɛde nnadewa a wɔde hyɛ mu kakra wɔ medial-to-lateral no ba (Mfonini 1C ne 2). Bere a nnadewa no hyɛn intramedullary canal no mu kɔ akyirikyiri kosi abubu no so no, wɔdan ɔfã a ɛbɛn no kɔ exostosis mu (Mfonini 2). Awiei koraa no, nhyɛso a ɛwɔ anim dan mu ntini no mu no boa kakra ma ectropion no (Mfonini 3).

Mfonini 1 A,B Wɔde infrapatellar kwan a wɔtaa fa so no di dwuma no, patella no siw axial entry a ɛwɔ nnadewa no mu no ano, na ɛde anterior apical sagittal alignment ne ectropion coronal alignment.C intramedullary nail alignment a wɔtaa yɛ no di dwuma denam parapatellar kwan no so.

Mfonini 2 Ɛrebɛn kwan a wɔfa so kɔ mu no denam medial parapatellar incision so no ma wɔde medial to lateral nail insertion kakra. Bere a nnadewa no rehyɛn medullary canal no mu akyirikyiri kosi akisikuru no mu (A) no, wɔdannan ɔfã a ɛbɛn no ma ɛyɛ ogya (b) .

Mfonini 3 Nhyɛso a ɛwɔ ntini a ɛwɔ anim no mu a ɛrehome ( a ) no ma ectopic nhyehyɛe a ɛyɛ anifere ( B ) .

Sɛ wɔde nnadewa bɔ tibia no mu ma ɛyɛ gyinabea a ɛtrɛw kɛse a, ɛboa ma wɔkwati nsɛnnennen a ɛbata kotodwe a wɔde yɛ oprehyɛn no mu a emu yɛ den ho.Gelbke, Jakma et al. Wɔ afe 2010 mu na agye din wɔ nnansa yi mfe mu efisɛ nnadewa a wɔde bɔ tibia no wɔ ɛkame ayɛ sɛ ne nsa ne ne nan gyina hɔ tẽẽ no ma fracture manipulation ne repositioning yɛ mmerɛw. Fluoroscopy abɛyɛ nea ɛyɛ mmerɛw wɔ mfiridwuma mu. Wɔabɔ amanneɛ sɛ fluoroscopy bere a wɔde yɛ suprapatellar nailing no yɛ tiaa kɛse sen infrapatellar nnadewa . Bio nso, nnadewa a wɔde hyɛ mu no anim (wɔ sagittal plane no mu) ne tibia no tenten a ɛwɔ saa kwan yi so no hyia kɛse sen infrapatellar nnadewa a wɔde yɛ no; Eyi siw mfiri a ɛbɔ nnadewa no ano ne akyi ntini no ntam, na ɛnam so ma mpaapaemu no so tew.

Oprehyɛn akyi kotodwe mu yaw yɛ ɔhaw a ɛfata. Wɔabɔ amanneɛ sɛ wɔn kotodwe a ɛwɔ anim no mu yɛ wɔn yaw wɔ ayarefo 50-70% mu, na ayarefo no mu 30% pɛ na wɔyare ɛyaw a ɛma wɔn ho tɔ wɔn bere a wɔayi wɔn akyi no afi hɔ akyi. Wɔabu akontaa sɛ akuru a ɛfa akuru a ɛwɔ patellar tendon ne Hoffa srade pad no ho no yɛ nea ebetumi ama obi akotow wɔ oprehyɛn akyi. Nea ɛka ho no, suprapatellar kwan no kwati atetesɛm mu ntwitwiridii a ɛne sɛ wobetwa saphenous nerve no patellar nkorabata no nkorabata no, a ɛkwati nkotodwe a ɛwɔ anim ne nkate a ɛyɛ kusuu (Mfonini 4). Ɛte sɛ nea nnadewa no a wɔde fa quadriceps tendon no mu, na ɛnam so ma patellar tendon no yɛ nea ɛnyɛ hwee no ma koma mu yaw a ɛba wɔ oprehyɛn akyi no so tew kɛse.

Mfonini 4 Abusuabɔ a ɛda saphenous nerve ntam ne akwan horow a wɔfa so kɔ tibialis obliqua nnadewa no mu .

Esiane nea eye a efi mu ba a ɛbɛn no nti, wɔatrɛw nsɛnkyerɛnne a ɛwɔ ayaresabea adwumayɛ mu no mu akɔ akisikuru no nyinaa mu.

Ɔhaw ahorow a ebetumi aba wɔ intramedullary nailing ho wɔ suprapatellar kwan no so:

- betumi agyaw reaming debris wɔ kotodwe nkwaa mu. Nanso, ayaresabea osuahu a ɛfa asen mu nnadewa a ɛkɔ akyi ho no nkyerɛɛ nkɛntɛnso bɔne biara a ɛba bere tiaa anaa bere tenten.

- kwan sedee wobeyi afiri mu no afiri mu bere a abubuo no akyi no asa? Ɛwom sɛ mfiridwuma mu no ɛbɛyɛ yiye sɛ wobeyi nnadewa bi a ɛwɔ ntini no mu no afi hɔ denam suprapatellar kwan so de, nanso ɔkwan a wɔfa so yɛ no yɛ nea wɔhwehwɛ na oprehyɛn ho animdefo dodow no ara pɛ sɛ woyi nnadewa a ɛwɔ ntini no mu no fi hɔ denam infrapatellar kwan so.

02.Bere bɛn na ɛsɛ sɛ wɔde suprapatellar intramedullary nail di dwuma?

Mfaso a ɛwɔ so .

- Semi-extended kotodwe gyinabea ma kwan ma fracture manipulation ne reduction denam ahome ntini tumi ne retention bere a nnadewa mu.

- a ewo asiane a ewo mu se wobeye oprehyɛn akyi no, abubuo a ewo akyire, segmental, ne distal fractures a wode toto atetesɛm mu akwan ho .

- nnadewa ye mfiridwuma mu mmerɛw se wobeye .

- Nailing ye yie se 'oduruyfoo baako a owo ho nhyehy e'.

- a woatew so fluoroscopy .

- a ensɛee patellar tendon no na ennya nsem a ewo akyi a ewo akyi kotodwe mu a ewo ho .

- a ɛyɛ mmerɛw sɛ wobɛyɛ wɔ multi-team nhyehyɛe mu, sɛnea ɛte wɔ polytrauma ho no.

Mfomso ahorow .

- a ewo ho ma kotodwe mu ntini ne nsem afoforo a ewo ntini mu no nsɛe .

- a ewo ho ma kotodwe mu yaree no ye .

- a wobeyi afiri mu no betumi ahwehwe kwan soronko .

Nneɛma a ɛkyerɛ .

- a ewo ntini a ewo akyi a ewo asen mu a ewo asen mu (Type AO 41A) .

- a ɛyɛ mmerɛw a wɔde ayɛ tibial diaphysis (type AO 42A-C) no mu abubuw .

- Segmental tibial diaphysis a ɛpaapae (ɔkwan AO 42C) .

- extra-articular ne simple intra-articular distal extension fractures a ɛwɔ distal tibia no mu (types AO 43A ne C1) .

- kotodwe a ɛsensɛn nsu so .

Nneɛma a wɔde bɔ abira .

- Gustilo grade 3C open fractures of the tibia esiane asiane a ɛwɔ nkwaa mu a ɛkɔ soro nti, ɛwom sɛ wɔammɔ asiane a ɛkɔ soro a ɛwɔ nkwaa mu no ho amanneɛ wɔ open fractures .

- a ɛyɛ mmerɛw a ɛyɛ mmerɛw a ɛtetew, efĩ anaasɛ ɔyare mmoawa wɔ suprapatellar mantam no mu .

- ipsilateral kotodwe a wɔde hyɛ nipadua mu (relative contraindication) .

- kotodwe mu a wode bɛhyɛ .

- nkotodwe a wɔatrɛw mu >20° .

- ipsilateral tibial plateau fracture a ɛfa nnadewa a ɛkɔ mu no ho no yɛ contraindication a ɛfa ho .

- Implants a esiw nnadewa a ewo mu no kwan .

- ipsilateral patella abubuo (relative contraindication) .

03. Oprehyɛn akwan .

1 nipadua gyinabea ne adwene .

Mfonini 5 Ɔyarefo no da supine so wɔ radiolucent table a ɛma kwan ma wɔpaapae nan mu. Wogyaw akwaa a abubu no sɛn hɔ a ɛnyɛ hwee na wɔde nhoma mmobɔwee bi si kotodwe no ase (A) na ama wɔanya nkotodwe a wɔabɔ no 10-30° . 

(b). Wɔde C-Arm no si ɔfã a ɛne no bɔ abira no so. Wɔde nan a enni so no si fam 10-30° fi horizontal na ama wɔatumi ayɛ mfonini a ɛfata wɔ akyi gyinabea.

2 Hwehwɛ ade a ɛfata a wɔde hyɛ mu .

Mfonini 6 Saa kwan yi yɛ nea wɔde patella, tibial tuberosity, ne anterior tibial cortex no dua no hyɛ no agyirae. Wɔyɛ honam ani hwɛbea a ɛyɛ tenten 2 cm 1-1.5 cm a ɛbɛn patella no ase a ɛkorɔn no. Quadriceps tendon no da adi na wɔyɛ mfinimfini kwan tenten bi wɔ ntini no nhama no kwan so. Suprapatellar recess no bue na oduruyɛfo no nsateaa fi patella no ase kɔ kotodwe no mu de hwɛ sɛnea ɛyɛ mmerɛw sɛ wobɛkɔ hɔ. Sɛ wɔtrɛw akwaa no mu kakra a, ebetumi ama kwan a wɔfa so kɔ kotodwe no so no ayɛ mmerɛw. Langenbeck retractor a wɔde hyɛ mu ma patella no kɔ soro kakra no nso betumi ama kwan a wɔfa so kɔ hɔ no ayɛ kɛse. Sɛ joint space no yɛ teateaa paa na instrumentation yɛ den a, medial anaa lateral support band no betumi ayɛ nea ɛbɛn no sɛnea ɛbɛyɛ a ɛbɛyɛ semi-dislocace patella no akɔ ɔfã biako.

3 a ɛbɔ ho ban .

Mfonini 7 Patellofemoral cartilage no ho banbɔ a ɛfiri oprehyɛn a ɛfa opira ho no yɛ botaeɛ titire a ɛwɔ oprehyɛn no mu no mu baako. Enti, ɛsɛ sɛ wɔde nsa a ɛbɔ ho ban di dwuma bere a wɔde adwinnade ne nnadewa rehyɛ mu no.Adwinnade a wɔde fa mu no bi ne nsa a wɔde hyɛ mu, akyi (nsu a ɛyɛ mmerɛw) ne nsateaa a ɛbɔ ho ban, trocar pin, ne nhama a wɔde fa nhama so.B Wɔde nsa a wɔde hyɛ mu nsa a wɔde bɔ wɔn ho ban no boaboa ano a wɔde abɔ ho ban ne afiri a wɔde bɔ wɔn ho ban (a ɛyɛ mmerɛw, ne nea ɛwɔ mu. Trocar ade no ne nsa a ɛbɔ ho ban ne nsa a wɔde hyɛ mu no boaboa ano.B Mounting Handle a ɛwɔ lateral ventilation holes. Knob a ɛwɔ nsa a wɔde hyɛ mu no atifi no siw nsa ano aduru no a ɛbɛtetew wɔ akwanhyia mu no ano .

4 Fa akwankyerɛ nhama no hyɛ mu na siesie ne gyinabea .

Mfonini 8A Wɔde nsa ano nhyiam no hyɛ patella no ase denam patellofemoral joint no so kɔ beae a wɔpɛ sɛ ɛkɔ tibia no so (Mfonini 9). Mpɛn pii no, patella no bɛkɔ mfinimfini kakra anaasɛ afã bi bere a wɔde nnwinnade rehyɛ mu no. Mpɛn pii no, groove a ɛwɔ patellofemoral joint no mu no kyerɛ trocar needle no kwan ma ɛyɛ nea ɛfata.

Fig. 8B gyinabea no sii so dua wɔ plane abien no nyinaa mu denam fluoroscopy so na wɔteɛteɛɛ mu wɔ baabi a ɛho hia. Afei wɔde akwankyerɛ hama a ɛwɔ abon a ɛyɛ porous, akwankyerɛ nhama a ɛfa akwankyerɛ nhama no mfinimfini tokuru no mu na wɔde ne ti hyɛ proximal tibial metaphysis no mu na ama wɔatumi ahwɛ ahu sɛ ɛwɔ gyinabea a ɛteɛ no si trocar need no ananmu.

Mfonini 8C Sɛ akwankyerɛ nhama no wɔ gyinabea a ɛnyɛ papa a, wobetumi de akwankyerɛ nhama a ɛto so abien adi dwuma de ayɛ nsakrae kakra wɔ gyinabea pa mu denam akwankyerɛ nhama a ɛwɔ porous no so, a ɛbɛkɔ akodu mm 4.3 sɛ ɔkwan foforo no, ebia ɛbɛyɛ mmerɛw sɛ wobefi ase de akwankyerɛ nhama no asi hɔ a obiara rensiesie no wɔ ɔkwan a eye sen biara a wɔfa so hyɛn mu no so. Afei wɔde adwinnade a wɔde hyɛ mu a ɛwɔ akwankyerɛ nhama no so no twetwe guidewire no so.

5 Medulla oblongata no ntrɛwmu .

Fig. 9A Opening the Medullary Cavity from the Ideal Entry Point yɛ anammɔn a ɛho hia wɔ oprehyɛn no mu. Wɔ anteroposterior plane no mu no, eyi ne mfinimfini fã a ɛwɔ akyi tibial spur no mu. Wɔ akyi kwan no mu no, beae a ɛfata a ɛkɔ mu no wɔ nsakrae a ɛda articular surface ne anterior cortex ntam no so.

Fig. 9b Guidewire no gyinabea a ɛfata no ne tibial axis a ɛwɔ anteroposterior plane no mu no hyia na ɛbɛn sɛ ɛne anim cortex no bɛyɛ pɛ sɛnea ɛbɛyɛ yiye wɔ lateral projection no mu. Guidewire no taa tu wɔ akyi.

Mfonini 9c Wɔ nsɛm a ɛfa pin anaa nnadewa ho no, wontumi mfa nnadewa anaa pin no nhyɛ mu yiye no boa ma wɔkyerɛ nnadewa no kwan kɔ baabi a ɛfata. 

Wɔde nnadewa a wɔde siw ano di dwuma wɔ metaphyseal region a ɛtrɛw no mu bere a wontumi mfa akwankyerɛ nhama anaa nnadewa no nsi mfinimfini sɛ ɛne dompe no fã a ɛyɛ tenten no hyia anaasɛ bere a mpaapaemu a ɛnyɛ pɛpɛɛpɛ wɔ wimhyɛn biako anaa abien no nyinaa mu no kɔ so tra hɔ bere a wɔde nnadewa rehyɛ mu no.

Mfonini 10 Wɔ saa gyinabea yi mu no, wɔkamfo kyerɛ sɛ wɔmfa 3.2 mm guide wire no nsi nsa ano nhyiam no so wɔ femoral condyle no mu. Eyi mma nhyiam no mfi tibia no mu.

Mfonini 11 Wɔde 12.0 mm hollow drill bit no fa mu de bɔ ho ban na ɛsiane fa akwankyerɛ nhama no mu kɔ dompe no mu. Wɔbue medullary canal no denam drilling a ɛkɔ bun a ɛyɛ 8-10 cm mu na wɔde akwankyerɛ hama a ɛwɔ ball-ended ahyɛ proximal tibia no mu.

3 .

Mfonini 12A Wɔ saa gyinabea yi mu no, yɛsan de fracture no si hɔ.

Mfonini 12B Ɛgyina faako a abubuo no wɔ ne ne nsɛsoɔ so no, wɔbɛtumi de nnwinnadeɛ ahodoɔ a ɛma wɔtew so te sɛ percutaneous clips, retractors, fragment mprɛte nketewa, ne screws a wɔde siw ano adi dwuma na ama wɔatumi ayɛ no pɛpɛɛpɛ. Wɔ proximal tibial fracture reduction mu no, ɛtɔ mmere bi mpo a, ɛdefa nneɛma foforo a wɔde hyɛ nipadua no mu mmoa so, ansa na wɔabue medullary canal no denam drilling so. Reaming poma no kɔ anim wɔ akyirikyiri na wɔde hyɛ distal tibial metaphysis no mfinimfini. Sɛ wɔsan de si baabi foforo wie a, wɔkyerɛ nnadewa no tenten ne ne kɛse. Sɛ ɛho hia a, ma tibial canal no nyɛ kɛse kodu diameter a wopɛ no so denam reaming so wɔ 0.5 mm increments mu. Nneɛma a ɛbue wɔ nsa a ɛbɔ ho ban no mu no ma wotumi hohoro nneɛma a asɛe no mu na wɔtwe fi nkwaa no mu bere a wɔreyɛ reaming no. Sɛ ɛbɛyɛ yiye a, wɔkamfo kyerɛ sɛ wɔmfa nnadewa a ne kɛse yɛ mm 10 nni dwuma. 5.0 mm locking bolt ma saa nnadewa yi yɛ nea ɛko tia huammɔdi sen 4.0 mm locking bolt a wɔde yɛ nnadewa a ɛyɛ fɛ no. Mpɛn pii no, wɔde fluoroscopic ruler na ɛkyerɛ nnadewa a ɛwɔ intramedullary no tenten.

9 intramedullary nnadewa a wɔde hyɛ mu .

Mfonini 13A nnadewa a wode fa reaming poma no mu wo fluoroscopy ase. Hyɛ no nsow sɛ nsa a wɔde hyɛ mu ma suprapatellar nnadewa no ware sen nea ɛwɔ infrapatellar nnadewa no mu efisɛ kwan a efi honam ani ntwitwiridii no so kosi tibial nnadewa no so no nso yɛ tenten.

Mfonini 13b Yɛsrɛ sɛ hyɛ no nsow sɛ wɔrentumi mfa bend (herzog curve) a ɛwɔ intramedullary nail no awiei a ɛbɛn no mu no mfa dade a ɛbɔ ho ban a ɛwɔ mu no mu nhyɛ mu. Enti, ɛsɛ sɛ woyi nsateaa a ɛbɔ ho ban no fi nsa nhyiam no mu ansa na wɔde nnadewa no ahyɛ mu (b; hwɛ ɔfã 'mfomso, asiane ne nsɛnnennen'). Hwɛ gyinabea a etwa to a ɛwɔ intramedullary nail no mu wɔ anim-akyi ne akyi hwɛbea no mu. Yi reaming abaa no fi hɔ. Sɛ ɛho hia sɛ wɔsesa nnadewa no a, gyaw reaming rod no wɔ nea ɛwɔ hɔ no mu na fa nnadewa foforo no hyɛ poma no mu. 5 mm agyiraehyɛde a ɛwɔ nsa a wɔde hyɛ mu no so no kyerɛ sɛnea aduru a wɔde hyɛ mu no mu dɔ wɔ proximal tibia no mu (Mfonini 14). (Mfonini 14) .

1 distal ne proximal locking .

Mfonini 14A proximal ne distal locking configurations gyina fracture su pɔtee bi so. Wobetumi de abasa a wɔde asi wɔn ani so ayɛ proximal locking. Distal locking yɛ freehand a ɛyɛ adwuma anaasɛ ɛnam radiopaque drill guide a wɔde di dwuma so. Sɛ wopɛ a, wobetumi de ano aduru adi dwuma, a ɛmma dompe ntumi nnyin nkɔ intramedullary nnadewa no awiei a ɛbɛn no mu na ɛma ɛyɛ mmerɛw sɛ wobeyi nea wɔde ahyɛ mu no afi hɔ akyiri yi. Titiriw no, nnadewa a wɔde ahyɛ mu boro so no yɛ mmerɛw sɛ wobeyi bere a wɔde awiei nkataso a ne tenten fata di dwuma no. Wɔnam agyiraehyɛde bi a wɔde hyɛ nsa no so anaasɛ akwankyerɛ hama a wɔde fa aiming nsa no mu a wɔde hyɛ mu no so susuw awiei no tenten a wɔpɛ no so.

Mfonini 14b Guidewire no ano kyerɛ gyinabea a ɛbɛn a ɛwɔ intramedullary nail no mu. Ɛsɛ sɛ woyi screw a ɛka aiming nsa no bata nnadewa no ho no ho na ama wɔde awiei kyɛw no ahyɛ mu. Awiei cap no fa toa a ɛwɔ nsa a wɔde hyɛ mu no mu. Nsa a wɔde hyɛ mu no da so ara wɔ hɔ. Eyi ma awiei kyɛw no ne intramedullary nnadewa no atifi hyia na ɛmma ɛyera wɔ kotodwe no mu. Sɛ wode guidewire no fa barrel end cap no mu kɔ nnadewa no awiei a ɛbɛn no mu a, ɛboa nso ma ɛkyerɛ awiei no kwan ma ɛkɔ ne gyinabea a ɛfata wɔ intramedullary nnadewa no awiei a ɛbɛn no mu. Wɔ adeyɛ no awiei no, ɛsɛ sɛ wɔhohoro nkyene aduru a aduru nnim ho na ama nneɛma nketenkete biara a aka no ahohoro nneɛma nketenkete biara a aka no ho.

04. AKWANKYERƐ .

Ahwɛyiye a wɔyɛ ma oprehyɛn a wɔyɛ no oprehyɛn .

- wɔ nsɛm a ɛfa nnompe mu yareɛ a ɛwɔ hɔ dada ho no, patellar motion a wɔabara no betumi asiw nkwaa a ɛkɔ mu no ano. Medial anaa lateral support band no fã a ɛbɛn no a wɔatwa afi medial fã no so no ma ɛyɛ mmerɛw sɛ wɔde trocar pin no bɛhyɛ mu.

- ipsilateral kotodwe prosthesis nyɛ ade a ɛyɛ katee a ɛne suprapatellar pinning nhyia. Nanso, hyɛ no nsow sɛ ebia ɛrentumi nyɛ yiye sɛ wobenya baabi a wɔtaa fi ase wɔ proximal tibial nailing procedure no mu.

- wo abubuo a ewo articular extension mu no, wobetumi de nkɔnsɔnkɔnsɔn foforo ahyɛ mu ma articular fracture component no ntumi nkɔ so. Wɔkamfo kyerɛ sɛ wɔmfa saa nkɔnsɔnkɔnsɔn yi nsi ansa na wɔde nnade ahyɛ mu na amma articular fracture no ankɔ baabi foforo.

Proximal tibia fracture ho nsusuwii .

Proximal tibial fractures ne tibial fractures a ɛyɛ den sen biara sɛ wɔde bɛbɔ nnadewa na ɛhwehwɛ sɛ wɔde kɔ mu pɛpɛɛpɛ (sɛnea wɔaka ho asɛm wɔ atifi hɔ no). Ɛsɛ sɛ wɔtew saa mpaapaemu yi so ansa na wɔde nnade abɔ mu de asiw tumi biara a ɛresɛe no ano na ama ayɛ yiye kɛse. Wɔ tebea horow bi mu no, sɛ wode ne nsa no fã a ɛka no si baabi a ɛfata wɔ baabi a ɛtrɛw fã bi na wunya baabi pɔtee a wobɛkɔ mu na wode nnadewa no ahyɛ medullary kwan no mu wɔ coronal ne sagittal axes no mu a, ɛbɛma tibia no ahyia yiye bere a wode nnade abɔ no awie no.

Nanso, wɔ nsɛm dodow no ara mu no, ɛho hia sɛ wɔyɛ nneɛma bi a wɔde tew so na ama wɔanya saa mpaapaemu yi a wɔde wɔn ho to so a ɛma abotɔyam na wɔakura mu. Sɛ fracture line no yɛ mmerɛw na ɛyɛ angled a, simple pointed resetting clamps anaasɛ coaptation clamps, a wɔde si hɔ, betumi adi dwuma de anya na wɔahwɛ so reset bere a wɔde nnadewa abɔ no. Sɛ krampɔn no nnɔɔso anaasɛ fracture plane no ntumi mfa krampɔn no mma a, pollen anaasɛ screws a esiw ano no betumi aboa ma wɔasiw displacement ne malposition ano (Mfonini 15). Wɔde saa nkɔnsɔnkɔnsɔn yi si akyi kɔ nnadewa gyinabea a wɔpɛ wɔ akyi hwɛbea no so na ɛwɔ akyi wɔ nnadewa gyinabea a wɔpɛ wɔ anim-akyi hwɛbea no so. Sɛ wɔde saa nkɔnsɔnkɔnsɔn yi si hɔ yiye ma reset pa a, ebetumi ayɛ asɛnnennen.

Mfonini 15 Nhama a wɔde to mu a wɔde ato nnadewa kwan a wɔpɛ no akyi wɔ anim ne akyi hwɛbea (a) ne nnadewa kwan a wɔpɛ no akyi wɔ ɔfã a wɔhwɛ no mu (b) counteracting deformation forces .

Ɔkwan foforo a etu mpɔn yiye ne bere tiaa mu fixation a fracture no wɔ anatomic gyinabea (Mfonini 16). Mpɛn pii no, asinasin ketewaa bi a ɛyɛ nhama a ɛwɔ cortical locking screws abien anaa abiɛsa a ɛwɔ cortical locking mu no bɛkura fracture no so atew bere a wɔresiesie ntini no na wɔde nnade ahyɛ mu no. Mprɛte no bedi displacements abien no nyinaa so. Ɛsɛ sɛ wogyae mprɛte no wɔ nea ɛwɔ so no mu bere tenten a nsonsonoe biara nni hɔ a ɛyɛ pintinn a ɛbɛma wɔakwati sɛ wɔbɛtew so a mpɛn pii no ɛba bere a wɔayi mprɛte no akyi no. Saa mprɛte a ɛwɔ cortical screw biako yi nyɛ den na ɛrenka sɛnea nnadewa no gyina pintinn no. Wobetumi de reset plate technique no adi dwuma ama mpaapaemu a ɛbue ne nea wɔato mu nyinaa.

Mfonini 16 Wobetumi anya mprɛte ketewa bi a wɔde to mu a ɛwɔ cortical screw biako na wɔahwɛ so wɔ anatomic reposition mu. Mpɛn pii no, ɛsɛ sɛ wogyae prɛte no wɔ nea ɛwɔ hɔ no akyi bere a wɔabɔ no nnadewa awie no. valgus a edi kan a ɛyɛ mmerɛw a ɛwɔ proximal tibial fracture mu. B Wɔde mprɛte ketewa bi a abubu a ɛwɔ cortical screw biako gu mu wɔ mfinimfini sɛnea ɛbɛyɛ a wobenya na akɔ so ayɛ fracture repositioning bere a wɔrebɔ nnadewa no. C Mprɛte no nnyigye bere a wɔde nnadewa abɔ awie no efisɛ ɛma ɛyɛ pintinn foforo .

Misalignment, Asiane ne Nsɛnnennen .

- intraoperative displacement of the protective sleeve betumi ama cartilage ne intra-articular kotodwe no asɛe (Mfonini 17). Ɛsɛ sɛ wɔsan de nsa a ɛbɔ ho ban no hyɛ mu koraa.

- a ewo nsa a ewo ho a ewo ho kakra no betumi ama reamer ti a woayi afi mu no ayɛ den. Fluoroscopy boa ma wohu ɔhaw no. Nsakrae a wɔbɛsan asiesie wɔ nsa a ɛbɔ ho ban no ho no bedi ɔhaw no ho dwuma (Mfonini 18) .

- Nail lock-up: implant no betumi akyeakyea wo dade nsateaa no mu wo proximal bend (herzog curve). Sɛ wɔde nnadewa a etwa to bɛhyɛ mu a, ɛsɛ sɛ woyi dade afiri no fi hɔ, na ɛka plastic nsateaa a ɛyɛ mmerɛw no nkutoo. Sɛ nnadewa no gyina a, ɛsɛ sɛ woyi fi hɔ koraa bio na wɔsan de nea wɔde ahyɛ mu no si hɔ bere a wɔayi dade kankyee no afa plastic kankyee no nkutoo mu awie no.

Mfonini 17 Sleeve a wɔtwe fi ho a ɛbɔ ho ban a wonhu fluoroscopic no betumi ama woakotow apira .

Mfonini 18 a ɛdannan anaasɛ ɛdannan wɔ akwanhyia mu a ɛbɔ ho ban no betumi asiw reamer a woyi fi hɔ no kwan, efisɛ reamer ti no betumi ayɛ jam. b A fluoroscopic nhwehwɛmu a ɛwɔ alignment correction ma kwan ma woyi reamer ti no fi hɔ. c Wobetumi ayi reamer ti no afi hɔ sɛ reamer ti no nni hɔ a. d Wobetumi ayi reamer ti no afi hɔ sɛ reamer ti no nni hɔ a.

Nsɛm a wɔde gyina hɔ ma .

Hessmann MH, Buhl M, Finkemeier C, Khoury A, Mosheiff R, Blauth M. Suprapatellar a wɔde nnadewa abɔ tibia no mu abubu. Oper a wɔde yɛ aduru a ɛma obi yɛ ade tra so. 2020 Oct;32(5):440-454.