5 Intramedullary nail application principles ani opereli fɛɛrɛw!

Nailing intramedullaire ka sariyakolo jɔnjɔnw .

1. Nailing intramedullaire tariku .

San 1910, lilienthal aluminum intramedullary nails (aluminiyɔmu kɔnɔnatumuw) kɛra ka senkɔniw kariw furakɛ.

San 1913, Schone ye warijɛ kɔnɔna nails kɛ ka bolokɔni karilenw furakɛ. 

Kuntscher (1900-1972) ye dɛmɛba don intramedullary nail fixation la. 

San 1960 ni 1970 waatiw tun ye waati ye min tun bɛ kɛ ka ɲɛsin fɛnɲɛnamafagalanw yiriwali teliya ma. 

N ka jamana bɛ baara kɛ n’u ye kosɛbɛ kabini san 1990 waatiw la.

2. Da wulilen dɔgɔyali ani dagalen dɔgɔyali .

1. Farikolo yɔrɔ karilenw bɛ se ka dɔgɔya opereli fɛ yeli tilennen kɔrɔ walima ka u datugu X-ray kɔlɔsili la.

2. Open reduction fracture kɛnɛya waati ka jan, opereli kɔnɔ joli bɛ caya, ani da wulilen bɛ joli bɔli tiɲɛ ka taa a fɛ ka se kari laban ma.

3. A ka ɲi ka baara kɛ ni dɔgɔyali dasirilen ye ka kɛɲɛ ni a seko ye. Traction reducer bɛ se ka kɛ, walima tigɛ fitinin bɛ se ka kɛ kari-plan na ka pry ani ka dɔgɔya, o bɛ kɛ sababu ye ka joli bɔli dɔgɔya fo ka se kari laban ma.

4. Walasa ka dɔgɔyali dagalen dɛsɛ, kolo yɔrɔ flipping walima a lamini farikolo yɔrɔw tigɛtigɛ, ani kari yɔrɔ belebelebaw, opereli da wulilen dɔgɔyali bɛ se ka kɛ.

3. FIXTION MECHAGNEMENT DE LAIL INTRAMEDULLARIE .

1. Intramedullary nail kɔnɔna fixation fɛɛrɛ ye symétrique central internal splint fixation ye.

2. Ka kari sirili ni kɔnɔboli ye, o ye fixation de stress-distributing ye, a tɛ fixation de stress-shielding ye, o min bɛ nafa don callus cogoya la.

3. Cɛmancɛ-filɛli ka fisa ni kɛnɛma-filɛli ye teori la, min bɛ se ka fanga bolokɔni dɔgɔya, ka valgus angulation ni kɔnɔna fiɲɛbɔli dɛsɛ dɔgɔya.

4. Intramedullary nail fixation bɛ basigi di ka jigin dagalen walima da wulilen dɔgɔyali danma.

4.Nails intramedullaires nafa .

1. Gɛlɛyaw ka dɔgɔn .

2. Opereli taamasiɲɛw bonya .

3. Fixation (Firasiyɔn) jɔnjɔn .

4. Joli baara daminɛni daminɛ .

5. A daminɛ na girinya bɛ se ka kɛ .

6. A bɛ se ka kɛ ka fara ɲɔgɔn kan ni kɔnɔna fiɲɛ wɛrɛw ye .

suguya ni fɛɛrɛ jɔnjɔnw .

1. Kɔnɔbara basigilenw datugucogo ani u datugubaliw .

2. Dynamic ani static locking intramedullary nails .

3. Medullary expansion ani non-medullary fixation techniques .

4. Fixation techniques da wulilenw ni dagalenw .

Interlocking ani non-interlocking .

Kɔnɔbara gansanw bɛ sabati axiale (axiale) sabatili man ɲi ani torsionnel (banakisɛ) fanga ka dɔgɔn, nka u bɛ elasticité (sɔgɔsɔgɔninjɛ) dɔ sɔrɔ ani u bɛ se ka segin u cogo kɔrɔ la, o bɛ kɛ sababu ye ka intrabone sliding (intrabone sliding) dɔɔni dɔrɔn.

Kɔnɔnatumuw ni ɲɔgɔn cɛ, olu bɛ se ka wuli ka ɲɛ ani ka u kɛlɛ, ka u jɔ ka ɲɛ, ka u jɔ ka ɲɛ, ani ka bɛn biologiki fixation principe ma. U bɛ kɛ ka caya farikolo yɔrɔw kolo janw na. Kɛrɛnkɛrɛnnenya la, yɔrɔ caman ani kari minnu bɛ tigɛ, olu bɛ sabati ka ɲɛ ka tɛmɛ fɛnɲɛnamafagalanw kan minnu bɛ sɔrɔ dɔgɔtɔrɔso kɔnɔ.

Fixation statique (fixation statique) ka fanga .

Static locking intramedullary nails bɛ degun masike dɔɔnin dɔrɔn de bɔ ani sisan u fanba bɛ lafasa ka ɲɛsin fanga sɔrɔli ma min tɛ fɛn ye.

Ni kari minnu ma kɛnɛya kalo 6 ka se kalo 8 ma opereli kɔfɛ, kolotugudaw sɔgɔli walima u falenni ni u falenni ye ni fanga ye, olu bɛ kɛ ka caya.

Dinamizasiyɔn bɛ se ka kɛ fɛɛrɛ ye walasa ka kari kɛnɛya sabati. A man ɲi tuma bɛɛ barisa a bɛ se ka kɛ sababu ye ka farikolo yɔrɔ dɔw surunya ani ka u wuli.

marrow expansion ani non-marrow expansion .

Marrow ka bonya bɛ se ka kɔnɔw don minnu kɔnɔna na, u cɛmancɛ ka bon ani u fanga ka bon, o bɛ kɛ sababu ye ka baarakɛcogo dege joona ani ka nɛgɛ karilenw hakɛ dɔgɔya.

Marrow ka bonya bɛ se ka kolo nɔgɔ caman bɔ ni kolotugudaw ye, o bɛ se ka kɛ sababu ye ka kari kɛnɛya.

Marrow ka bonya bɛna balofɛnw ni endosteal membrane joli tiɲɛ, nka joli siraw bɛ se ka segin ka kɛ ɲɛgɛnɛsira kɔnɔ. Marrow ka bonya bɛ se ka dɔ fara joli-sira-funu kan fana farikolo yɔrɔ nugulamaw farikolo la, o bɛ kɛ sababu ye ka kari kɛnɛya sabati.

Kɔnɔbara falenni bɛ dɔ fara banakisɛ sɔrɔli ni joli bɔli kan, wa a ka kan ka kɛ ni hakilisigi ye kari da wulilenw na, jogin caman, ani jogin gɛlɛnw.

Nafa minnu bɛ sɔrɔ medullary expansion na .

1 Medullary expansion kɔfɛ, contact yɔrɔ min bɛ kɔnɔbara basigilen ni kolo cɛ, o bɛ bonya, o bɛ fixation sabatili ɲɛ. 

2 Medullary expansion kɔfɛ, a bɛ se ka kɛ ka ɲɛgɛnɛsira kɔnɔna na, o bɛ se ka kɛ sababu ye ka ɲɛgɛnɛsira kɔnɔna fanga bonya ani ka dɔ bɔ wuluwulu karilenw hakɛ la. 

3 Kolow nɔgɔli medulari falenni kɔfɛ, o bɛ se ka kolo kura jɔ, o min bɛ se ka kɛ sababu ye ka kari kɛnɛya.

Ni aw ye a suma ni medullary expansion intramedullary nails ye, nail intramedullaire minnu tɛ caya, olu bɛ nafa ninnu sɔrɔ .

1 Baarakɛcogo waati surunya ani joli dɔgɔyali. 

8 Aw bɛ joli bɔli bali ka bɔ endosteal joli la ni farikolo yɔrɔ nugulamaw joginni jugumanba bɛ a la.

Nail intramedullaire (Nail intramedullaire) tali .

Humeral interlocking intramedullary nail .

Taamaʃyɛnw bɛ sɔrɔ wuluwuluw la .

Kɔnɔbara kɔnɔna nail minnu bɛ ɲɔgɔn minɛ, olu taamasiɲɛ minnu bɛ sɔrɔ sɔgɔsɔgɔninjɛ furakɛli la, olu ye: kari minnu bɛ joli siraw ni farikolo yɔrɔ dɔw tiɲɛ, jogin caman, kari sabatilenw, banakɔtaa banaw, ani ɲɛgɛnɛsiraw kariyɔrɔ surunw.

Range min bɛ se ka labɛn, o bɛ daminɛ 2cm la humeral kunkolo jukɔrɔ ka se 3cm ma Olecranon fossa sanfɛ. Aw bɛ se k’a sugandi k’a labɛn ka bɔ a kamankun na ni kɔnɔnatumu ye min bɛ sɔrɔ ɲɛfɛ walima ka bɔ kɔkili la ni kɔkili ye.

Humeral wuluw jogo .

Opereli fixation methods for humeral shaft fractures ye plate fixation ani intramedullary nail fixation ye.

Plate fixation (plate fixation) bɛ ni anti-rotation (banakisɛfagalan) barikama ye ani anti-bending (jiritigɛ kɛlɛli) ani a bɛ jɔ ka ɲɛ, nka opereli bɔnɛ ka bon, a sɔrɔli bɛ se ka kɛ ka caya, wa a bɛ se ka tiɲɛ nɔgɔya la.

Bi wuluwuluw ni ɲɔgɔn cɛ nɛgɛw ni u yɛrɛ datugucogo bɛ se sɔrɔ nɛgɛ gansanw ka dɛsɛw kan i n’a fɔ aksidan basigibaliya, jiginni kunbɛncogo jugu, ani fixation wɛrɛ mago bɛ a la, walasa ka kari ka jɔ kosɛbɛ, joli bɔli ka dɔgɔn, farikolo yɔrɔ nugulamaw bɔli ka dɔgɔn, ani medullary expansion is started to local kolo transplantation, the loading earnly, ani canlyly, callly, and callly.

Femoral interlocking intramedullary nail .

Taamasiɲɛw bɛ sɔrɔ senkɔniw na minnu bɛ ɲɔgɔn minɛ .

Kari suguya bɛɛ 2cm 2cm jukɔrɔ trochanteric vertebra ani ka tɛmɛ 9cm kan ka bɔ gɛnɛgɛnɛ joli la.

Kɔnɔbara cɛmancɛ yɔrɔ karilen kɔrɔw.

Banabagatɔ minnu ka plati kɔnɔna fixation dɛsɛra.

Femoral interlocking nail ka baarakɛcogo .

Nafa minnu bɛ sɔrɔ masinw na .

Senkɔniw ka fanga bolo min bɛ sɔrɔ fɛnɲɛnamafagalanw na kariw sirili kama, o janya ka bon ni nɛgɛdaga ta ye, wa fanga bɛ tila ɲɔgɔn na kolo bɛɛ cɛmancɛ la, o min kurulen don ani min bɛ sɔgɔsɔgɔ.

Kɔnɔbara minnu bɛ da kɔnɔ, olu dakun fila bɛɛ bɛ kolo bɛɛ kɛ ka bɔ sanfɛla la ka taa duguma, ani dasirilan minnu bɛ dakun yɔrɔjan na, olu bɛ se ka kɔnɔboli bolokɔni girinya dɔgɔya kolo la, ka a bali ka surunya ani ka wuli, ani ka sabatili ni jɔli hakɛ caman sɔrɔ ka bɔ a la.

Gamma interlocking intramedullary nail .

Gamma wuluw taamasiɲɛw .

A bɛ tali kɛ peritrochanterie kari suguya caman na, kɛrɛnkɛrɛnnenya la subtrochanteric fractures.

Gamma gamma (Nail reconstruction) taamasiɲɛw .

Subtrochanterie kari caman, trochanterie faralen ɲɔgɔn kan ni senkɔniw kari ye.

Nafa minnu bɛ Gamma Nail la .

A bɛ labɛn ni kɔkili kuru sliding ni intramedullary nail technology faralen ye ɲɔgɔn kan, a kunba bɛ surunya medullary cavity kɔnɔna na ka tɛmɛ hip plate dynamique kan, o la gamma bɛ banabagatɔ girinya ka surunya senkɔniw ka kalkar la ka tɛmɛ hip plate dynamique kan, o bɛ dɔ fara a doncogo fanga kan. Walasa ka farikolo yɔrɔ dɔw kari minnu bɛ kɛ ni kɔritiki cɛmancɛ ye, gamma nail bɛ a yɛrɛ tanga kari anatomy reconstruction mako ma, o la a nafa ka bon ka fara kari walima ka kari ka kɛ subtrochanterie ye.

Kɔnɔbara basigilen kɔfɛla la .

Kɔnɔbara basigilenw taamasiɲɛw bɛ sɔrɔ kɔfɛ .

A bɛ kɛ kɛrɛnkɛrɛnnenya la supracondylar femoral fractures, i n’a fɔ supracondylar communter fractures ani intercondylar 'T' ani 'y' comminuted fractures incrient the articular surface.

A bɛ se ka kɛ fana senkɔniw karilenw na senkɔniw ka isthmus jukɔrɔ.

senkɔniw, senkɔniw ni ɲɛgɛnɛsiraw, ani ɲɛgɛnɛsiraw ni ɲɔgɔn cɛ kari ka bɔ 20cm kɔnɔ ka bɔ gɛnɛgɛnɛ kolotuguda la.

Minnu ma se ka plate fixation (plate fixation) sɔrɔ.

Kɔnɔbara basigilen kɔfɛla jogo .

Supracondylar femoral fracture ye kari jugumanba ye ni gɛlɛya bɛ a la fɔlɔ, a dɔgɔyali ani filanan, kɔnɔna jɔli barikama. Gɛlɛyaw ka ca i n’a fɔ karibaliya ani kɛnɛyali kɔfɛ.

Kɔnɔnatumuw ni ɲɔgɔn cɛ nailing intramedullary ye fɛɛrɛ ye min bɛ kɛ ka caya walasa ka distal femur fracture furakɛ san laban ninnu na, min bɛ se ka kɛ ni masinw sabatili ɲuman ye, o bɛ se ka kɔfɛla jiginni ni a jiginni jiginni kunbɛn ka ɲɛ, ani ka dɛmɛ don kolotugudaw lamagacogo daminɛ na.

Supracondylar combined femoral stem fracture bɛ siri ni supracondylar janyalen ye intramedullary nailing la, o bɛ gɛlɛya ɲɛnabɔ min ɲɛnabɔli ka gɛlɛn ni senkɔni kɔnɔna nailing ye. Minɛn in baara ka nɔgɔn, a bɛ kɛ tiɲɛ ye a jɔyɔrɔ la, a bɛ se ka da a kan a jɔli la, wa banabagatɔ bɛ se ka gɛnɛgɛnɛ farikoloɲɛnajɛw kɛ joona opereli kɔfɛ.

Tibial interlocking intramedullary nails .

Tibial nailing taamasiɲɛw .

Kɔnɔbara basigilenw bɛ sɔrɔ senkɔni cɛmancɛ la 1/3 la: kari minnu bɛ kɛ ni fɛn wɛrɛw ye, karili surun oblique, pseudarthrose.

Kari basigibaliw bɛ sɔrɔ 60% kɔnɔ cɛmancɛ senkɔni janya la: kari minnu bɛ metafizi kɛrɛfɛ, kari janw, segin-ka-bɔ, kariw, kari tigɛlenw, kari ni kolo tiɲɛniw ye.

Tibial nailing jogo .

Tibia kɔnɔ nailing intramedullary interlocking bɛ kɛ ka caya senkɔni cɛmancɛ karilenw na.

Hali n’a bɛ se ka kɛ fana senkɔniw kariyɔrɔ gɛrɛgɛrɛw ni yɔrɔjanw na, gɛlɛya hakɛ bɛ caya, balodɛsɛ bɛ kɛ ka caya, kari laban bɛ kɛ ni ≧1cm ye 1/2 la, ani fiɲɛ 1/4 bɛ dɛsɛ.

Sɛbɛnw y’a jira ko kolotugudaw karilen kɔfɛ ka tɛmɛ tibia karili surun kan fibula fixation routine kɔfɛ.

Opereli fɛɛrɛw .

Minɛn kɛrɛnkɛrɛnnenw labɛnni ka kɔn opereli ɲɛ .

Orthopedic bed (traction bed) walima opereli dilan min bɛ kɛ ni fluoroscopic ye; Retractor; Ja intensifier (Ja) .

Sugandili ɲuman kɛra kɔnɔbara janya la endoprothèses ɲɛfɛ ka kɔn operasiyɔn ɲɛ .

Radiographie .

Contralateral bolokɔni janya sumani .

Diamètre intramedullaire intramedullaire .

X-ray isthmus bonya .

Intramedullary nail janya sumani .

1.Sɔrɔdasiw ka dantigɛli C-Arm Machine jukɔrɔ .

Kolow dakunw yɔrɔjan ni u surunyalen tun bɛ fiɲɛ cɛmancɛ la; Ruler tun bɛ bɛn ni diaphyse ye.

2.Sumani janya ka kɛɲɛ ni farikolo yɔrɔ taamasiɲɛw ye .

senkɔni: sɔgɔsɔgɔninjɛ belebeleba kun → gɛnɛgɛnɛ yɔrɔ lateral walima patella sanfɛla; Tibia: gɛnɛgɛnɛ yɔrɔ cɛmancɛ-lamini → senkɔni joli ɲɛfɛla fan dɔ la sen kɔfɛ.

Intramedullary ongles insertion technique - dondaw kɛcogo .

Axis longitudinal de la cavité medulaire dans un strair .

A ma surunya kosɛbɛ dondaw la .

Janya bɛnnen: Dilated - Long; Undilated - surun .

(Donni yɔrɔ dantigɛli tilennen; pulp dilation tɛ, farikolo yɔrɔ nugulamaw lakanani tɛ wajibiya)

Parallel femoral intramedullary nail point point .

Donda yɔrɔ labɛnni senkɔni kɔnɔ nail kɔnɔ min bɛ taa ɲɔgɔn fɛ .

Hip flexion ani adduction .

Incision longitudinale proximal à la trochanter belebeleba .

A tɛ yɔrɔ jan kɔfɛ .

guide pinɛ bilali .

Siginiden nɔgɔlenw bilali .

Retrograde femoral intramedullary nail entry point .

30° Gɛnɛgɛnɛ flexion .

Axis jan guide pin sira kelen na ni femoral stem ka medullary cavity ye .

Kirschner pinɛ donli senkɔni yɔrɔjan na patellar ligament fɛ ka tɛmɛ bolokɔni lakanani fɛ: orthogonal - middle of the intercondylar fossa of the femur Lateral - Blumensaat ka layini .

PCL daminɛyɔrɔ ni joginni tɛ .

paralɛli tibial intramedullary nail don yɔrɔ .

Medullary Cavity cɛmancɛ la .

Tibial plateau ɲɛfɛla ɲɛfɛla .

A bɛ se ka kɛ cogo min na ka sɔrɔ a ma tiɲɛni kɛ plateau .

Gɛnɛgɛnɛ flexion maksimali .

Tibial tibial tuberosity-inferior pole de patella along the medullary cavity .

Aw bɛ medullary cavity da wuli: guide pin at 15° ka sagittal plane de la longitudinal axis of the tibial stem .

Ja intensifier jɔyɔrɔ .

Fɛɛrɛw tigɛcogo .

Kuranko fanga dɔgɔyali .

Kari kuraw .

Manuel dɔgɔyali .

Kɔrɔlen kari ni pseudoarthose ye, sklerose bɛ sɔrɔ medullary cavity kɔnɔ .

tourniquet tɛ sɔrɔ inflation kɔnɔ .

Joli labɔli ye nɛnɛmafɛn bɛɛ la ɲuman ye .

Repositioning techniques .

Nailing intramedullaire parallèle parallèle .

Kun minnu b’a jira ko gɛlɛya bɛ sɔrɔ senkɔniw karilenw seginni na .

Dugukolo nɔgɔlenw sirili tɛ a to ka se kolo ma tigitigi .

Needle Entry Point tɛ se ka ye ka ɲɛsin a ma .

hip joint adduction → Iliac fascia tension → SORTENING .

Tibial kari dɔgɔyali .

Manipulation .

A fanba ye farikolo jukɔrɔla ye ani a Palpate ka nɔgɔn .

Kari sabatilen - a cɛmancɛ walima a yɔrɔjan A ni B suguya kari .

oblique fractures - overkill .

Intramedullary nailing→Dispacement baarakɛminɛnw .

Dɔgɔyali fɛɛrɛw .

Point Reduction Forceps .

Tibia; Percutané walima joginda tali .

Retracteurs belebelew (Braces) .

dɔgɔyali min bɛ kɛ kɔfɛ; A bɛ kɛ ni bolo surun ye .

SCHANZ SURS TIƝƐNI .

1 Femur, Tibia

6 A bɛ surunya kari sira la i n' a fɔ a bɛ se ka kɛ cogo min na .

3 Proximale fracture cortical utilisation .

1Use a universel chuck ni t-handle ye walasa ka manɛwɛrɛ nɔgɔya .

Nail Poller .

1metaphyseal fracture (min bɛ fanga layini latilen, ka segin a cogo kɔrɔ la, ka baara kɛ kokura)

1 Tibia distal walima femur (sɔgɔsɔgɔninjɛ → degun) karili oblique

3 Ɲɛgɛn kɔnɔna na, nɛgɛ minnu jɔyɔrɔ man ɲi, olu bɛ don medulari kɔrɔ la opereli filanan senfɛ .

1 A doncogo jugu, proximal fracture alignment jugu (screw bilalen bɛ ka ɲɛsin enplant ma min bɛ se ka kɛ)

tourniquet wide extra .

1 .

1 A bɛ fara a kan ni samali ye walima ni a bɛ se ka kɛ fɛn ye min bɛ se ka kɛ fɛn ye .

3 Aw bɛ a kɛ ni hakili ye joginda jugumanbaw la .

1 A ka surun .

1 A bali medulariw ka bonya la jamana inflated cogo la .

Nail locking sequence: distal o kɔ proximal .

Nafaw .

Knockback nɔgɔya, kari kariw degunni; danfara bɔli ka bɔ ɲɔgɔn na; dɔgɔyali baarakɛcogo.

Dɔgɔyali fɛɛrɛw ka ɲɛsin opereli ma min bɛ kɛ ni waati latɛmɛni ye & min tɛ fɛn ye .

Gɛlɛya minnu bɛ se ka sɔrɔ opereli kɔfɛ .

Axial deformité (Shortening, Angulation ani walima Displacement) .

Bonya in ka granulate tissu .

Kolow daminɛ na .

sklerose de fractures bɛ kari ni medullary cavity dadonni ye .

koloci .

Gɛlɛya minnu bɛ se ka sɔrɔ opereli kɔnɔ .

Deflection de la expander ni intramedullary nail → intramedullary nail doncogo ka ɲɛsin kɔrisi ma .

Angular deformité → Retracteur .

Dislocation de ends tigɛlenw → Poller ka nail, plate fixation .

Fɛɛrɛ minnu bɛ kɛ ka fanga sinsinniw bali minnu tɛ bɛn .

Proximal - don yɔrɔ bɛnnen .

Distal - Nail intramedullary min bɛ medullary cavity cɛmancɛ la .

Nailing intramedullaire gɛlɛyaw .

★Banabanaw .

★nerve tiɲɛni .

★Factures kɛnɛyali tiɲɛnen .

★Dɔgɔtɔrɔw ka kari .

Kɛnɛma jiginni, torsion, valgus, kɔnɔna jiginni, angulation .

★Jiginni kɛrɛfɛ .

★Fat Embolism .

★Heterotopique ossification .

★Pulmonaire Embolisme .

★Re-Fracture .

★Trombose .

★joint stiffness .

★Non-on-union ka kari, kolo tɛ tɔniko la .

★Don kɔnɔna fixation dɛsɛ .

★Limb ka surunya .

★O wɛrɛ .

Gɛlɛyaw--banakisɛfagalanw .

1.A daminɛ na, da wulilenw jatera ka kɛ sababu ye ka kɔnɔboli kunbɛn.

2.Opereli kɔfɛ banakisɛ sɔrɔli kari dafalenw na, o bɛ bɔ farikolo yɔrɔ nugulama jogincogo ni a nɔgɔyacogo la .

Banakisɛ sɔrɔli da wulilen kɔfɛ, o bɛ bɔ farikolo yɔrɔ nugulama jogincogo ni a nɔgɔli cogoya la ka fara farikolo yɔrɔ nɔgɔlenw furakɛcogo kan.

3.Thinner intramedullary nails bɛ dɔ fara banakisɛ sɔrɔli kan; locking intramedullary nails fixation tɛ bonya, wa a kolo dakunw bɛ .

Kɔnɔbara kɔnɔna na, nɛgɛ sirili min tɛ bonya, o man ɲi kosɛbɛ, ni kolo dakun karilen lamagacogo mikoroskɔpi fɛ ka fara a kɔnɔna tolen kan, o min ka nɔgɔn banakisɛw falenni na.

4. Medullary fixation expanded ani dantɛmɛnen baara tɛ dɔrɔn ka kari sabatili ɲɛ, nka a bɛ yɔrɔ salen dɔ dabɔli fana bali.

Syndrome de embolisme fat .

1.FE minnu bɛ kɛ ni kolo karilen janw ye, olu sɔrɔli ye 0,5% fo 2% ye.

2. Medula ka bonya ani medula ka bonyabaliya tɛ nɔba bila fogonfogon fiɲɛ na.

3.Ni aw bɛ medulla bonya, o fɛɛrɛ ka kan ka kɛ ka a mugumugu nɔgɔya la, ka a yɛrɛ tanga fanga caman ma ani ka baara gɛlɛn kɛ.

4.FEw sɛgɛsɛgɛli min bɛ sen na sisan, o bɛ sariyaw ta hali bi minnu labɛnna Gurd fɛ san 1974, wa furakɛli min kɛra a sɛgɛsɛgɛli kɔfɛ, o bɛna furakɛli waati ɲuman bila kɔfɛ, wa a bɛ se ka kɛ kɔlɔlɔ juguw ye.

Kari kɛnɛyali min bɛ mɛn sen na ani kolow labɔbaliya .

Fɛn suguya caman bɛ nɔ bila kari kɛnɛya la kɔnɔbara basigilen kɔfɛ, wa a sababuw bɛ se ka sɛgɛsɛgɛ nin cogo la.

1.Tissue soft embedded in the fracture end .

2. Faratiw ka faraw karili labanw .

3. Banabagatɔ si hakɛ kɔrɔba .

4. ka kari da wuli, ka farikolo yɔrɔ dɔw jogin kosɛbɛ, ka sigida jolidɛsɛ jugumanba walima banakisɛ sɔrɔ.

5. ƝƐNAJƐW MINNU BƐ SƆRƆ INTRAMEDULARY ƝƐNAJƐ .

6. Jabɛtibana walima bana wɛrɛw faralen ɲɔgɔn kan.

Dɔgɔtɔrɔso kariw .

Furakɛli minnu bɛ sɔrɔ furakɛli siratigɛ la, olu ye kari filananw ye kosɛbɛ minnu bɛ sɔrɔ fɛnɲɛnamafagalanw (manipulation) kɛcogo jugu fɛ, minnu bɛ kɛ ka ɲɛgɛnɛsiralabanaw siri.

Opereli kɔnɔ jateminɛ ka kan ka kɛ ka ɲɛsin .

1. Nail dondaw sugandili tiɲɛnen bɛ se ka kɛ sababu ye ka kari ka surunya.

2. Aw kana fanga sɔrɔ ka medula ka bonyali la.

3. Pulp expansion dondaw ka kan ka kɛ sira kelen fɛ ni wuluw doncogo sira ye.

4. Aw kana fanga kɛ ni aw bɛ fɛnɲɛnamafagalanw don a dakun yɔrɔjan na.

Dimi bɛ sɔrɔ a kɛrɛfɛ joli la .

1. Ɲɛgɛnɛsiraw kɔnɔ, ɲɛgɛnɛsiralabanaw ani hali kolotugudaw la, joli-sira-funu bɛ kɛ ni joli-sira-funu ye min bɛ kɛ ni joli 1 ye a dɔgɔyalenba la.

2. Tibial plateau bɛ siri meniscus cɛmancɛ da la ni gɛnɛgɛnɛ jiginni ye ani ka yɔrɔ lakananen dɔ kɛ tibial tuberosity sanfɛ fo ka se nin yɔrɔ in ma. Ni sɔgɔsɔgɔninjɛ yɔrɔ ka surun kojugu kɔnɔbara sanfɛla la walima a cɛmancɛ la, o ka bon kojugu, o bɛ se ka tiɲɛni kɛ kɔnɔbara basigilen na, o bɛ na ni gɛnɛgɛnɛ dimi ye opereli kɔfɛ.

3. Kɔnɔbara kɔnɔna na, kɔnɔboli ni kolosinsinnan hɛtɛrotopiki bɔli gɛrɛgɛrɛli ye kɔdimi sababuba ye kɔnɔbara basigilen opereli kɔfɛ.

4. Kɔnɔbara kɔnɔna na, nɛgɛ minnu bɛ kɛ ka ɲɛgɛnɛ kɛ, olu bɔli gɛrɛgɛrɛli la, ka ɲɛgɛnɛsiralabanaw ni wulilanw wuli, olu de ye kamankun dimi sababuba ye kɔnɔbara basigilen kɔnɔ.