Distal Tibia Fracture Management: Mun na Retrograde IM Nailing bɛ baara kɛ ka tɛmɛ plate fixation kan soft tissue compromise kɔnɔ
Dɔgɔtɔrɔso: Hospital Nacional de Traumatología, Lima, Peru
Operelikɛla: Dɔgɔtɔrɔ Carlos Eduardo Vega, MD (Joliw)
Bana don: Sɛtanburukalo san 2025 |
Sɛbɛn min bɔra: Desanburukalo san 2025
Dɔgɔtɔrɔso kuncɛlen : Cɛ dɔ min si ye san 38 ye, ni joginni ye a senkɔni yɔrɔjan na, o furakɛra ni XC Medico ka retrograde intramedullary nail (DTN) system ye. Hali ni farikolo yɔrɔ nɔgɔlenw tiɲɛna kosɛbɛ, banabagatɔ ye kolotuguda jɛlen sɔrɔ dɔgɔkun 12 kɔnɔ, a seginna a girinya dafalen na dɔgɔkun 16 kɔnɔ, wa a ye gɛlɛya zeru fɔ. Nin ko in b’a jira mun na DTN sirili kɔfɛ, o ka fisa ni plati sirili ye ni farikolo yɔrɔ nɔgɔlenw enveloppew tiɲɛna.
Kuma daminɛ: Gɛlɛya min bɛ sɔrɔ senkɔni yɔrɔjan karilenw na
Senkɔni yɔrɔjan karilenw bɛ kɛ senkɔni karilenw bɛɛ la 7-12% ye ani u bɛ opereli gɛlɛya kɛrɛnkɛrɛnnenw lase u ma. Distal tibia’s anatomie — metaphyseal region large ni faralen ɲɔgɔn kan ni farikolo yɔrɔ nɔgɔlenw datugucogo fitinin ye ɲɛfɛla-cɛmancɛ fan fɛ — o bɛ laadalata da wulilen sirili kɛ farati ye joginda la ni joginw ye minnu bɛ sɔgɔsɔgɔ walima ni farikolo yɔrɔ nɔgɔlenw tiɲɛni jugumanba bɛ u la.
Tariku kɔnɔ, operelikɛlaw tun bɛ u jigi da da wulilen dɔgɔyali kan ani plati sirili la, o min bɛ kɛ sababu ye ka ɲɛfɛla-cɛmancɛ tigɛ kosɛbɛ ka tɛmɛ farikolo yɔrɔ joginlenw fɛ. Joginw na minnu bɛ kɛ ni sɔgɔsɔgɔninjɛ ye, o fɛɛrɛ in bɛ dɔ fara banakisɛw sɔrɔli hakɛ kan fo ka se 15-25% ma ani ka farikolo yɔrɔ nɔgɔlenw kɛnɛyali gɛlɛya. Retrograde intramedullary nailing (DTN) bɛ o gɛlɛyaw bali ni senkɔni dondaw ye min tɛ fɛn caman kɛ, o bɛ nɔ ɲumanw di cogoyaw la tigitigi, plate fixation bɛ gɛlɛya sɔrɔ yɔrɔ minnu na kosɛbɛ.
'DTN kɔsegin tɛ dɔrɔn fɛɛrɛ wɛrɛ ye min bɛ kɛ ka tɛmɛn plati fixation kan—a ye sugandili ɲuman ye ni farikolo yɔrɔ nɔgɔlenw tiɲɛna.' — Dɔgɔtɔrɔ Carlos Eduardo Vega, Attending Trauma Surgeon
Ko jiracogo: Joginni min bɛ kɛ ni sɔgɔsɔgɔninjɛ ye ni Metaphyseal Fracture ye
Banabagatɔ: Miguel Rodríguez Santana (tɔgɔ ma fɔ), san 38, jɔli ɲɛmɔgɔ
Jogin: Mobili kasaara ni 2 ton 2 scaffolding bar crush ka kininbolo sen (miniti 3 degun)
Waati boloda ka taa OR: sanga 8 jogin kɔfɛ
Karicogo: Transverse distal metaphyseal tibia fracture + oblique distal fibula fracture
Dɔgɔtɔrɔso ka jateminɛ
Miguel y’a jira ni funu jugumanba ye, echymosis ani farikolo yɔrɔ nɔgɔlenw sɔgɔsɔgɔli senkɔni ɲɛfɛla-cɛmancɛ kan. Dakun tansiyɔnw suman na milimɛtɛrɛ 45 (haminanko hakɛ ye milimɛtɛrɛ 30-40 ye), o b’a jira ko farati bɛ se ka kɛ yɔrɔ la min bɛ wele ko syndrome acute. Distal pulses tun bɛ se ka ye; hakili-la-sɛgɛsɛgɛli min ma tiɲɛ. Min nafa ka bon kosɛbɛ, o ye ko fari tora datugulen na—nafa min bɛ a la ka ɲɛsin nɛgɛdaga kɔfɛla ma barisa a tali tɛ gɛlɛya joginda dabɔlenw fɛ.
Jaw Sɛgɛsɛgɛli
Kari cogoya:
- Tibia : Kari tigɛlen kɔfɛ metaphyseal yɔrɔ jan na, ~8cm senkɔni mortise sanfɛ
- Fibula : Kari nɔgɔman min bɛ kɛ ni oblique ye a sabanan yɔrɔjan na
- Metafisiyali bonya hakɛ: Isthmal diameter 10,5mm vs metaphyseal bonya 28mm (2,7× flare)
- Farikolo nɔgɔlenw cogoya : Jogin jugumanba min bɛ kɛ ni sɔgɔsɔgɔninjɛ ye ni kirinni ni kirinni ye; joginda da wulilen tɛ
Opereli fɛɛrɛ: DTN kɔfɛta ni plati fixation
Miguel jogin na, nɛgɛtigɛbana kɔfɛla sugandira ka tɛmɛ plate fixation kan ka da biyomekaniki ni farikolo yɔrɔ nɔgɔlenw jateminɛni kan:
| Factor |
Retrograde DTN |
Open Plate Fixation |
Clinical Implication |
| Tissue soft (yɔrɔ nɔgɔlenw) tigɛcogo |
Minimal (donni senkɔni) . |
Fɛnɲɛnɛma-cɛmancɛ tigɛcogo belebeleba |
DTN bɛ a yɛrɛ tanga farikolo yɔrɔw ma minnu bɛ jogin |
| Banakisɛ sɔrɔli farati (Crush) . |
3-8% ye . |
15-25% ye . |
DTN bɛ banakisɛw sɔrɔli farati dɔgɔya 50-75% . |
| Baarakɛwaati |
Miniti 60-80 kɔnɔ |
Miniti 90-120 kɔnɔ |
Anestezi tali waati kunkurunnin |
| Metafisiyali Kɔlɔsili |
3-point distal locking (kɛrɛ saba) . |
Plate contact dɔrɔn |
DTN bɛ sabatili kɛrɛnkɛrɛnnen di |
| Mobilizasiyɔn fɔlɔ |
POD 1 bɛ se ka kɛ |
POD 3-5 (joginda haminankow) . |
DTN bɛ se ka furakɛli teliya |
Opereli kɛcogo: DTN fixation step-by-step
Taabolo fɔlɔ : Fibula Fixation (Taabolo fɔlɔ kɔrɔlen) .
Kun : Senkɔni yɔrɔjan karilenw na ni fibula sen bɛ a la, fibula bɛ kɛ i n’a fɔ janya misali. Ni a ma dɔgɔya farikolo la, senkɔniw dɔgɔyali tɛna sabati. Santimɛtɛrɛ 5 kɔfɛla tigɛ kɛra, ka kari dɔgɔya, ka sɔrɔ ka a siri ni 4,5mm degun plati ye (3 vis proximles, 3 distals à la fracture). Fluoroscopie confirmation ye fibula janya ni a ɲɔgɔnna sɛgɛsɛgɛ. Waati: Miniti 15
2nan : DTN dondaw dɔnni kɔfɛ
Donda yɔrɔ : Senkɔni cɛmancɛ, santimɛtɛrɛ 1,5 cɛmancɛ malleolus kɔnɔ, ɲɛfɛla ka taa kɔfɛ senkɔniw doncogo la. Nin farikolo yɔrɔ in b’a to nɛgɛ min bɛ kɔsegin, o bɛ tɛmɛ ɲɛgɛnɛsira cɛmancɛ fɛ ani ka farati dɔgɔya farikoloɲɛnajɛw la.
Taabolo 3nan : Dɔgɔyali ni ɲɛminɛlan dagalen
Ni baara kɛra ni traction ni fluoroscopie guidance ye, o karilen dɔgɔyara ka kɛ anatomic alignment ye. Ɲɛjiralan dɔ tun bɛ taa ɲɛfɛ ka taa kɔfɛ ka bɔ dondaw yɔrɔ jan na, ka tɛmɛ kariyɔrɔ fɛ, ka don senkɔni kɛrɛfɛ, min bilalen bɛ cɛmancɛ la ɲɛgɛnɛsira la. Waati: Miniti 15
Taabolo 4nan : Medullary Canal Reaming (Kɔnɔbara basigilen).
Kanal in tun bɛ sɔgɔsɔgɔ ka tugu ɲɔgɔn na ka bɔ milimɛtɛrɛ 9 na ka se milimɛtɛrɛ 11,5 ma. Ni an y’a jateminɛ ko 2,7× flare ratio (metaphyse large), ladonni kɛrɛnkɛrɛnnen kɛra walasa ka cortical perforations bali metaphyseal yɔrɔ la. Waati: Miniti 12
Taabolo 5nan : Aw bɛ wulu don ɲɛda la
Fɛn min bɛ baara kɛ ni a ye: XC Medico Distal Tibial Intramedullaire Nail – Sistɛmu min bɛ kɛ ka fɛnw bila kɔfɛ
- Diamètre: 11mm (kanula, titanium alliage)
- Janya: 340mm
- Dilancogo: Kuru ɲɛfɛla dɔɔni min bɛ bɛn senkɔni anatomique contour ma
- Fɛn min bɛ kɛ: Titaniyɔmu 5nan (ISO 13485, CE ka seereyaw)
O nɛgɛ in tun bɛ don kɔfɛ ka taa ɲɛ ɲɛminɛlan kan. Ni a bɛ taa ɲɛ ka don metafisiki tasuma na, ja minnu bɛ kɛ ni fluoroscopie ye, olu y’a jira ko wulu kun tora joli kɔnɔ (metafizi kolo kɔnɔ, a tɛ kɛ kolotuguda yɔrɔ la) ni a janya bɛ se milimɛtɛrɛ 8 ma ka bɔ kolotuguda yɔrɔ la. Waati: Miniti 15
Taabolo 6nan : Kɔrɔsili yɔrɔ saba (Taabolo kɔrɔlen) .
Visw labɛncogo: Viru saba minnu bɛ yɔrɔjan datugu, olu bilala kɛrɛ saba cogo la walasa ka metafizi yɔrɔ belebeleba kɔlɔsi:
- Vis distal proximale : A bɛ bila santimɛtɛrɛ 6 senkɔni joli sanfɛ → Varus/valgus control
- Viru Distal cɛmancɛ: A bɛ bila santimɛtɛrɛ 3-4 senkɔni joli sanfɛ → Yɛlɛmacogo kɔlɔsili
- Distal Screw : A bɛ bila santimɛtɛrɛ 1-2 senkɔni joli sanfɛ → Senkɔni sɔgɔli/kɔkɔli kunbɛnni
Nin 3-point fixation in bɛ 'triangulation effect' dɔ Dabɔ min ka fisa ni dual-screw walima single-screw systems ye metaphyseal fractures kama. Waati: Miniti 20
Taabolo 7nan : Kɔrɔbɔli kɛrɛfɛ
Kɛrɛfɛla datugulan kelen bilala sɔgɔsɔgɔninjɛ hakɛ la walasa ka janya surunyali ni jiginni bali. Waati: Miniti 8
Taabolo 8nan : Fasciotomie pour la prévention de la syndrome de compartiment
Ni an y’a jateminɛ ko sɔgɔsɔgɔninjɛ jogincogo ani opereli ɲɛfɛla tansiyɔn wulilen don (45 mmHg), ɲɛfɛla ni kɛrɛfɛyɔrɔw fasyotomi kɛra fan fila fɛ walasa ka yɔrɔ jugumanba bali (2-5% bɛ sɔrɔ sɔgɔsɔgɔninjɛ joginw na). Waati: Miniti 10
Opereli waati bɛɛ lajɛlen: miniti 72 | Fluoroscopique Exposition: Ja 6 | Joli bɔli : mililitiri 125
Opereli kɔfɛ kalan ni a kɔlɔlɔw
Opereli kɔfɛ teliya la (POD 0-1) .
Dimi kunbɛnni : VAS 3/10 bɛ kɛ mɔrini kan miligaramu 4 IV kɔnɔ lɛrɛ 4 kɔnɔ. A bɛ kɔlɔsi ka ɲɛ hali ni fasciotomie tigɛlenw kɛra.
Jaw tacogo: Jalajɛw y’a jira ko farikolo yɔrɔw dɔgɔyali dafalen don ni da tuguli juruw bɛɛ bilalen don cogo ɲuman na.
Mobilizasiyɔn joona (POD 1-7) .
- POD 1: Senkɔni lamagacogo pasif min bɛ daminɛ (plantarflexion-dorsiflexion 20°) .
- POD 2 : Tɛmɛni ka taa dimimadafura da la; fasciotomie tigɛcogo minnu ɲɛnabɔra ni protocoles standards ye
- POD 3 : Girinyali tali i n’a fɔ a bɛ se ka muɲu cogo min na (WBAT) ni taamakɛla lakanani ye
- POD 7: ROM active senkɔni dafalen; taama-taama mɛtɛrɛ 50 a yɛrɛma ni taamakɛla ye
Kɛnɛya sabatili (Dɔgɔkun 6) .
- Lamaga: Kɔrɔnfɛla 12°, senkɔni 35° (kɛrɛnkɛrɛnnenya la) .
- Dimi: VAS 1/10
- Taama-taama: A yɛrɛmahɔrɔnyalen don ni berew ye; girinya-taama yɔrɔ dɔ ɲɛtaa daminɛna
- Radiographes: Calus bridging fɔlɔ bɛ ye; fɛnɲɛnamafagalanw bɛ jɔyɔrɔ dafalen na, zeru lajɔli
A kɔlɔlɔ kuntaalajan (Dɔgɔkun 12) .
- Kisɛ-taama: Kisɛ-taama dafalen taama-taama yɛrɛmahɔrɔnyalen
- Senkɔni lamaga : Kɔrɔnfɛla 14°, senkɔniw 42°, inversion/eversion normal
- Dimi: VAS 0/10; don o don baara minnu tɛ dantigɛ
- Ja lajɛ: Kolow jɛlen gɛlɛn ni callus bridging fracture site kɔgɔlen
- Baarakɛcogo: A seginna ka taa jɔli baara nɔgɔman na
- Gɛlɛya minnu bɛ sɔrɔ a la: ZERO—fɛnɲɛnamaw lajɔli tɛ, banakisɛ tɛ, jɛɲɔgɔnya jugu tɛ
Mun na XC Medico ka DTN Sistɛmu bɛ nɔ ɲumanw di
XC Medico ka Distal Tibial Intramedullary Nail – Retrograde Fixation System bɛ na ni nafa nafama naani ye farikolo yɔrɔ nɔgɔlenw tiɲɛni ko la:
- ✓ Three-Point Distal Locking: Kɛrɛnkɛrɛnnenya la, triangulation design kɛrɛnkɛrɛnnen bɛ metaphyseal region belebele kɔlɔsi ka ɲɛ ka tɛmɛ single/dual-screw ɲɔgɔndanw kan
- ✓ Cannulated Design : A bɛ sira di guide wire donli ma, ka taabolo kalanni curve dɔgɔya ani ka tiɲɛni ɲɛ
- ✓ Titanium Grade 5 : Nɛgɛ bɛɛ bɛ baara kɛ ni titanium alloy ye min bɛ se ka TC20 sɔrɔ (ISO 13485, CE certified, FDA 510(k) cleared for trauma)
- ✓ Track Record Proven: XC Medico ye trauma implants 20.000+ lase dɔgɔtɔrɔso 500+ ma diɲɛ kɔnɔ ni 98,9% ye jogoɲumanya labatoli ye
Fɛnɲɛnɛma yɛrɛ kɔfɛ, XC Medico bɛ jiginni teliya di (tile 7 kɔnɔna na, tile 3 teliya la, tile 30 seginni minnu tɛ ɲininkali kɛ, ani kalo 36 fɛnw doncogo garanti —o ye ko kɔrɔbaw ye joginda yɔrɔw bolo minnu bɛ ko hakɛw ɲɛnabɔ minnu tɛ se ka fɔ ka ɲɛ.
Sɛgɛsɛgɛli min bɛ kɛ ni ɲɔgɔn ye : Banakisɛ sɔrɔli hakɛ ni a kɔlɔlɔw
| Metric |
Retrograde DTN |
Open Plate (Anterior-Medial) |
Antegrade IM Nail |
| Banakisɛ sɔrɔli hakɛ (Crush Injury) . |
3-8% ⭐ |
15-25% ye . |
6-12% ye . |
| Gɛnɛgɛnɛ Dimi |
0-2% ⭐ ye |
N/A |
8-15% ye . |
| Union Taux (Union Taux). |
94-98% ⭐ ye |
92-96% ye . |
90-94% ye . |
| Baarakɛwaati |
Miniti 60-80 ⭐ |
90-120 miniti kɔnɔ |
80-100 miniti kɔnɔ |
| Kisɛ-taama daminɛ na |
POD 2-3 ⭐ ye |
POD 5-7 ye |
POD 2-3 ye |
Dɔgɔtɔrɔso & Jagokɛlaw ka nafa jiracogo
Nafa minnu bɛ sɔrɔ kɛnɛyaso la
- Banakisɛ kunbɛnni : A bɛ farati dɔgɔya ni 50-75% ye ni i ye a suma ni plati sirili ye joginniw na → banakisɛfagalanw ka dɔgɔn, dɔgɔtɔrɔso la waati ka surun, a jalaki bɛ dɔgɔya
- Baarakɛcogo ɲuman : miniti 20-40 waati lakanani ko kelen na → ko caman tile kɔnɔ, ka ɲɛ OR baara kɛcogo ɲuman
- Farikolo nɔgɔlenw marali : A tigɛcogo ka dɔgɔn → farikolo yɔrɔw kɛnɛyali teliya la, gɛlɛyaw hakɛ bɛ dɔgɔya
- Operelikɛla wasa: A kɔlɔlɔw bɛ se ka fɔ ka ɲɛ, kalan teliya ni dilancogo kanulalen ye
Nafa min bɛ sɔrɔ sɔrɔko siratigɛ la, o ye jatebɔlaw ye
Suguda cogoya : Senkɔni yɔrɔjan karilenw bɛ ka caya ni 8-12% ye san o san Ameriki Latin jamanaw na. Dɔgɔtɔrɔso fanba bɛ baara kɛ hali bi ni plati fixation ye k’a sababu kɛ operelikɛlaw ka dɔnniya ye, o bɛ kalan ni feereli sira nafama dɔ lawuli.
Prix & Margin Model: Bamako, Mali.
- DTN Sistɛmu kɔfɛ (XC Medico): $5200 USD
- Jagokɛlaw ka hakɛ (Standard): 28-32% = $1456-1664 ko kelen na
- Sigida hakɛ jateminɛ : senkɔni yɔrɔjan banabagatɔ 60-80/san
- San o san, jatebɔla ka sɔrɔ seko: $87,360-133.120
Competitive Positioning: 'An ka DTN kɔfɛta bɛ dɔ bɔ banakisɛ sɔrɔli farati la ni 50-75% ye joginw na minnu bɛ sɔgɔsɔgɔ. O bɛ baara kɛ ni seginnkanni dɔgɔyali ye, banabagatɔ ka sɔrɔ ka ɲɛ, ani ka sigida ka jalaki dɔgɔya. Aw ka operelikɛlaw bɛna danfara ye u ka bana 5 fɔlɔw la.\
Yala aw labɛnnen don ka Retrograde DTN Fixation waleya wa?
XC Medico bɛ operelikɛlaw ka kalan dafalen di, ka dɛmɛ caman di fɛɛrɛko siratigɛ la, ani ka jɛɲɔgɔnya danma di jagokɛlaw ma, ka ɲɛsin joginda yɔrɔw ma Ameriki Latin jamana bɛɛ kɔnɔ.
Dɔgɔtɔrɔso jɛɲɔgɔnya & sɔngɔko ɲini
Télécharger an ka XC Medico Trauma Implant Catalogue | Aw ye waati boloda ka ɲɛsin fɛn dilannenw jirali ma min bɛ kɛ ni Virtuel ye | Aw ye ɲini opereli kalanfɛnw
Ɲininkali minnu bɛ kɛ tuma caman na: Retrograde DTN vs. Traditional Approaches
J: Distal locking min bɛ kɛ yɔrɔ saba la, o bɛ malunion bali cogo di?
A: Laadalata minnu bɛ kɛ ni kuru kelen walima fila ye, olu bɛ u jigi da plati ni kolo kan walasa ka angulation bali. Metafisiyali yɔrɔ janw na, varus/valgus walima plantarflexion/dorsiflexion angulation subtile bɛ se ka kɛ hali bi kuru dondaw ni ɲɔgɔn cɛ. XC Medico ka yɔrɔ saba dabɔli yɔrɔjan (kɛrɛfɛ, cɛmancɛ, yɔrɔjan juruw) bɛ 'triangulation cage' dilan min bɛ lamaga bali plan saba bɛɛ la—varus/valgus, plantarflexion/dorsiflexion, ani rotation. O nafa ka bon kosɛbɛ metafizi karilenw na yɔrɔ minnu na kolo bonya bɛ se ka tɛmɛ milimɛtɛrɛ 25 kan.
J: Kalanbolo ye mun ye ka ɲɛsin kɔfɛla sɔgɔli ma?
A: Operelikɛlaw minnu bɛ se ka plate fixation walima antegrade nailing dɔn, kalan kɛcogo ka surun kosɛbɛ (5-10). Fɛɛrɛ min bɛ kɛ ka kɔsegin senkɔni cɛmancɛ la, o ye tilennen ye, wa XC Medico ka wuluwulu dilanni min bɛ kɛ ni kanula ye, o bɛ sira di ka nɛgɛ bila sira bilasirali la sani a ka i yɛrɛ di wulu ma. An bɛ opereli wideyow ɲɛfɔlenw di, IFU sɛbɛnw minnu bɛ kɛ senfɛ-senfɛ, ani kalan dɛmɛni yɔrɔ la.
J: Yala taamasiɲɛ dɔw bɛ yen minnu bɛ se ka kɛ sababu ye ka DTN kɔsegin wa?
A: Banakisɛfagalan minnu bɛ tali kɛ ɲɔgɔn na, olu man ca. Banakisɛfagalan dafalenw ye metafizi karilenw ye minnu tigɛlen don kosɛbɛ ni u yɔrɔjan yɔrɔ ye <2cm ye (a man teli ka kɛ nin hakɛ in na) walima senkɔni jolilabanaw min tun bɛ yen ka kɔrɔ. Karicogo nɔgɔmanw na, plati sirili bɛ se ka sɔn hali bi ni farikolo yɔrɔ nɔgɔlenw ma jɛya, nka DTN min bɛ segin kɔfɛ, o tɛ dɔgɔya abada—a bɛ nafa wɛrɛw di dɔrɔn (banakisɛ sɔrɔli farati ka dɔgɔn, mobilizasiyɔn ka kɔn) k’a sɔrɔ musaka ma caya.
Kuncɛli: Retrograde DTN ye ladonni sariya ye
Miguel ka ko bɛ misali di mun na sɔgɔsɔgɔninjɛ min bɛ kɛ kɔfɛ, o kɛra senkɔni yɔrɔjan karilenw ladonni sariya ye, kɛrɛnkɛrɛnnenya la ni farikolo yɔrɔ nɔgɔlenw tiɲɛni bɛ yen. Kurukuru jogincogo, min tun bɛna kɛ sababu ye ka farikolo yɔrɔ nɔgɔlenw bɔli caman kɛ walasa ka plati siri, o ɲɛnabɔra ni tigɛ misɛnnin wɔɔrɔ ye minnu bɛɛ lajɛlen bɛ <10cm tigɛli la—o ye opereli joginda dɔgɔyaliba ye.
O kɔlɔlɔw bɛ kuma u yɛrɛ kan: kolotugudaw jɛlen dɔgɔkun 12 kɔnɔ, gɛlɛya zeru tɛ sɔrɔ, baarakɛcogo dafalen, ani segin teliya la baara la. Plas fixation (plate fixation) la, nin banabagatɔ in tun bɛna banakisɛ sɔrɔli farati 15-25% sɔrɔ, a tun bɛna tigɛ ka bonya, ani ka tile 3-5 kɛ dɔgɔtɔrɔso la.
Ka ɲɛsin jatebɔlaw ma minnu bɛ baara kɛ Ameriki Saheliyanfan bɔnɛko yɔrɔw la: Retrograde DTN bɛ fura suguya dɔ jira min nafa ka bon, min bɛ nɔba bila mɔgɔ la, min bɛ banabagatɔw ka sɔrɔw ɲɛ ka sɔrɔ ka dɔgɔtɔrɔso musakaw dɔgɔya. Dɔgɔtɔrɔso minnu bɛ seko ni dɔnko kɔfɛta ta, olu bɛ nafa sɔrɔ ɲɔgɔndan na u ka mara kɔnɔ bɔnɛ sugu la. Operelikɛlaw bɛ kalan teliya sɔrɔ ani ka sɔrɔw sɔrɔ minnu bɛ se ka fɔ ka ɲɛ. Banabagatɔw bɛ kɛnɛya joona ni gɛlɛya caman tɛ u la.
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