Tibial fractures, suprapatellar intramedullary nail fɛɛrɛ

Kɔnɔbara basigilen fɛɛrɛ min bɛ kɛ senkɔniw karilenw na : ni a bɛ kɛ ni suprapatellar, transarticular approach ye ni gɛnɛgɛnɛ bɛ kɔrɔta 20-30° la ani ka a tangalan kɛrɛnkɛrɛnnen dɔ kɛ walasa ka bolokɔniw kɔnɔna yɔrɔw lakana.

01.Tibial Intramedullary Nailing (Kɔnɔbara basigilen).: sɔrɔli ni ɲɔgɔndɛmɛ, gɛnɛgɛnɛ ɲɛfɛla dimi

Opereli sɔrɔli ka ɲɛsin senkɔniw karilenw sɔgɔli ma, o nafa ka bon walasa ka senkɔni kɔnɔnatumu don don yɔrɔ ɲuman fɛ, ka tiɲɛni dɔgɔya gɛnɛgɛnɛw kɔnɔ, ani ka kariyɔrɔw sigicogo ɲuman sɔrɔ ani ka doncogo ɲuman sɔrɔ.

Fɛɛrɛ kɔrɔ minnu bɛ kɛ ka tibial stem fractures sɔrɔ, olu ye infrapatellar walima parapatellar cɛmancɛ fɛɛrɛw ye. Hali ni nin fɛɛrɛ ninnu jiralen don cɛmancɛ yɔrɔ karilenw na, opereli kɔfɛ valgus, anteriores, walima syndesmotiques deformités ka teli ka kɛ kariw la minnu ka surun kosɛbɛ.

Senkɔni kɛrɛfɛla karilenw ka ɲɔgɔndɛmɛbaliya sababuba ye sɔgɔsɔgɔninjɛ ye min bɛ sɔrɔ senkɔni naani samali fɛ gɛnɛgɛnɛ kuruli waati ani masinko gɛlɛya min bɛ wulu kun ni kɔfɛla kɔkolo cɛ fɛn donta waati. Patella fana bɛ nɛgɛ doncogo aksidan bali sagittal plane kɔnɔ (Ja 1a, b). O la, doncogo wɛrɛ min ka teli ka kɛ yɔrɔ la, o ye cɛmancɛla parapatellar tigɛcogo ye, o bɛ na ni nɛgɛ donni ye dɔɔni cɛmancɛ la ka taa kɛrɛfɛ (ja 1c ani 2). Ni wulu donna ɲɛgɛnɛsira kɔnɔ min ka jan ni kari ye, a kɛrɛfɛyɔrɔ bɛ kɔrɔta ka kɛ fɛnɲɛnamafagalan ye (Jaa 2). A laban na, ɲɛfɛla so fasaw ka lafiɲɛbɔ tension bɛ dɛmɛ dɔɔni kɛ ectropion (ɛktropiyɔn) la (Ja 3).

Jaa 1 a,b Ni aw bɛ baara kɛ ni infrapatellar fɛɛrɛ kɔrɔlen ye, patella bɛ nɛgɛ doncogo axial bali, o bɛ na ni anterior apical sagittal alignment ni ectropion coronal alignment deformité commune ye.c Intramedullary nail alignment kɛra ni parapatellar fɛɛrɛ ye.

Jaa 2 Ni i gɛrɛla dondaw la ni cɛmancɛ parapatellar tigɛcogo ye, o bɛ na ni nɛgɛ donni ye dɔɔni cɛmancɛ la ka taa kɛrɛfɛ. Ni wulu donna ɲɛgɛnɛsira la min bɛ kari yɔrɔ jan (a), a kɛrɛfɛyɔrɔ bɛ kɔrɔta ka kɛ tasumamugu ye (b) .

Jaa 3 ɲɛfɛla farikolo yɔrɔ lafiɲɛbɔ la ( a ) bɛ kɔnɔbara kɔkanna labɛncogo nɔgɔlen dɔ lase ( b ) .

Ni aw ye senkɔni sɔgɔ ka a bila yɔrɔ la min ka jan, o bɛ dɛmɛ ka gɛlɛyaw bali minnu bɛ sɔrɔ gɛnɛgɛnɛ kurulen jugumanba fɛ opereli kɔnɔ.Fɛɛrɛ in ɲɛfɔra Gelbke, Jakma et al. san 2010 la, wa a ye mɔgɔw diyabɔ nin san laban ninnu na bawo ni i ye senkɔni sɔgɔ ni a bɛ se ka kɛ senkɔni tilennen ye, o bɛ karilenw kɛcogo nɔgɔya ani ka a bila yɔrɔ wɛrɛ la. Fluoroscopie kɛcogo nɔgɔyara fɛɛrɛko siratigɛ la. a jirala ko fluoroscopie waati min bɛ kɛ suprapatellar nailing na , o ka surun kosɛbɛ ka tɛmɛ infrapatellar nailing kan . Ka fara o kan, wulu doncogo yɔrɔ (sagittal plane kɔnɔ) bɛ bɛn senkɔni janya yɔrɔ ma ni nin fɛɛrɛ in ye ka tɛmɛ nɛgɛdaga infrapatellar kan; o bɛ masinw ka ɲɔgɔnkanu bali wulu kun ni kɔfɛla cɛ, o bɛ karilenw dɔgɔyali nɔgɔya.

Gɛnɛgɛnɛ ɲɛfɛla dimi opereli kɔfɛ, o ye gɛlɛya ye min bɛ tali kɛ o la. Gɛnɛgɛnɛ ɲɛfɛla dimi fɔra banabagatɔ 50-70% la minnu karilen don, banabagatɔ 30% dɔrɔn de bɛ dimi mada a labanyɔrɔ bɔli kɔfɛ. A jateminɛna ko sɔgɔsɔgɔninjɛ sɔrɔli ni Hoffa ka tulumafɛnw ye, o bɛ se ka kɛ gɛnɛgɛnɛ dimi sababu ye opereli kɔfɛ. Ka fara o kan, suprapatellar fɛɛrɛ bɛ a yɛrɛ tanga laadala tigɛ ma min ye ka saphenous nerve patellar bolo bolo tigɛ, o bɛ gɛnɛgɛnɛ ɲɛfɛla sɔgɔsɔgɔli ni dulled sensation bali (Jaa 4). Ni aw ye wulu tɛmɛ senkɔni naani fɛ, o la, a bɛ senkɔni to a cogo la, a bɛ i n’a fɔ o bɛ dɔ bɔ kosɛbɛ gɛnɛgɛnɛ dimi hakɛ la opereli kɔfɛ.

Jaa 4 Jɛɲɔgɔnya min bɛ saphenous nerve ni tibialis obliqua nail sɔrɔli danfaralenw cɛ

K’a sababu kɛ kari gɛrɛgɛrɛw nɔ ɲuman ye, taamasiɲɛ minnu bɛ kɛ dɔgɔtɔrɔso la, olu cayara ka se kari bɛɛ ma.

Gɛlɛya minnu bɛ se ka sɔrɔ ɲɛgɛnɛsira kɔnɔ sɔgɔsɔgɔninjɛ la suprapatellar fɛɛrɛ la:

- A bɛ se ka reaming debris to gɛnɛgɛnɛ joli la. Nka, kɛnɛyaso ka ko kɛlenw ni senkɔniw sɔgɔli kɔfɛ, olu ma kɔlɔlɔ si jira waati kunkurunnin walima waati jan kɔnɔ.

- fɛn min donna a kɔnɔ, o bɛ bɔ cogo di, a karilen kɛnɛyalen kɔfɛ ? Hali ni a bɛ se ka kɛ fɛɛrɛko siratigɛ la ka wuluwulu bɔ senkɔniw kɔnɔ ni fɛɛrɛ ye min bɛ kɛ ni senkɔni sanfɛla ye, o fɛɛrɛ in ka gɛlɛn wa operelikɛla fanba b’a fɛ ka wuluwulu bɔ senkɔniw kɔnɔ ni fɛɛrɛ ye min bɛ kɛ ni senkɔniw ye.

02.Suprapatellar intramedullary nail ka kan ka kɛ tuma jumɛn?

Nafa minnu b’a la

- Gɛnɛgɛnɛ jɔcogo tilancɛ bɛ karicogo nɔgɔya ani ka dɔ bɔ a la ni farikolo fanga lafiyali ye ani ka a minɛ wulu dontuma na.

- Opereli kɔfɛ, kari minnu bɛ kɛ kɛrɛfɛ, yɔrɔ minnu na, ani minnu bɛ yɔrɔjan, olu ka ɲɔgɔndɛmɛbaliya farati ka dɔgɔn ni i ye a suma ni laadala fɛɛrɛw ye

- Nɛgɛdaga ka nɔgɔn fɛɛrɛko siratigɛ la

- Nɛgɛdaga bɛ se ka kɛ i n'a fɔ 'opereli kelen kɛcogo'.

- Fluoroscopie waati dɔgɔyali

- Tiɲɛni tɛ kɛ senkɔniw na ani gɛnɛgɛnɛ ɲɛfɛla dimi ka dɔgɔn nɛgɛdaga kɔfɛ

- A kɛli ka nɔgɔn ekipu caman kɛcogo la, i n’a fɔ a bɛ kɛ cogo min na ni politrauma ye.

Nafa minnu bɛ a la

- Farati bɛ gɛnɛgɛnɛ kolotugudaw ni joli-sira-funu-kɔnɔfɛn wɛrɛw tiɲɛni na

- Gɛnɛgɛnɛbana farati bɛ bonya

- Fɛn min donna a kɔnɔ, o bɔli bɛ se ka kɛ fɛɛrɛ wɛrɛ ye

Taamaʃyɛnw

- Senkɔni kɛrɛfɛla karilenw (Type AO 41A) .

- Tibial diaphyse karilen nɔgɔmanw (suguya AO 42A-C) .

- Tibial diaphyse segmental (AO 42C suguya) .

- Senkɔni yɔrɔjan karilenw karilenw kɔkanna ni bolokɔniw kɔnɔ yɔrɔjan karilenw (suguya AO 43A ni C1) .

- Gɛnɛgɛnɛ min bɛ panpan

A furakɛcogo minnu bɛ se ka kɛ

- Gustilo grade 3C senkɔniw karilenw dabɔlen don ka a sababu kɛ kolotugudaw ka bana farati ka bon, hali ni kolotugudaw ka bana farati cayalenba ma fɔ kari dafalenw na

- Farikolo yɔrɔ nɔgɔlenw ɲɛjibɔ juguman, nɔgɔ walima banakisɛ sɔrɔli ɲɛda sanfɛla yɔrɔ la

- Gɛnɛgɛnɛ kɛcogo ipsilateral (a tɛ se ka kɛ a danma) .

- Gɛnɛgɛnɛ fusili

- Gɛnɛgɛnɛw jiginni kojugu >20°

- Ipsilateral tibial plateau fracture min bɛ kɛ ni wulu dondaw ye, o ye a kunbɛncogo ye min bɛ se ka kɛ

- Fɛn minnu bɛ don mɔgɔ kɔnɔ minnu bɛ wulu dondaw bali

- Ipsilateral patella fracture (a tɛ se ka kɛ a danma) .

03. Opereli kɛcogo

1 Farikolo jɔcogo ani a filɛcogo

Jaa 5 Banabagatɔ bɛ da a da la tabali kan min bɛ yeelen bɔ, o min bɛ a to sen tilalen don. Bolo karilen bɛ to ka jɛngɛ a yɛrɛ ma ani ka sɛbɛnfura dɔ bila gɛnɛgɛnɛ kolotuguda jukɔrɔ (a) walasa ka gɛnɛgɛnɛ kurulen 10-30° sɔrɔ 

(b) (b). C-bolo bɛ bila a fan dɔ fɛ. Sen min ma bana, o bɛ jigin 10-30° ka bɔ a tilennen na walasa ka ja lajɛ ka ɲɛ kɛrɛfɛla la.

2Aw bɛ pikirijikɛlan donyɔrɔ ɲuman ɲini

Jaa 6 Nin fɛɛrɛ in bɛ taamasiɲɛ kɛ ni senkɔni sɔgɔsɔgɔninjɛ ye, senkɔni tuberosity ani senkɔni ɲɛfɛla. Fari tigɛcogo janyalen santimɛtɛrɛ 2 bɛ kɛ santimɛtɛrɛ 1-1,5 la ka surunya ɲɛdawolo sanfɛla la. Kɔnɔbara naani bɛ bɔ kɛnɛ kan ani cɛmancɛ janya tigɛli bɛ kɛ senkɔni fiyɛw fan fɛ. Suprapatellar recess bɛ da wuli ani operelikɛla bolokɔnincininw bɛ don gɛnɛgɛnɛ na ka bɔ patella duguma walasa ka don nɔgɔya jateminɛ. Ni aw ye senkɔni janya dɔɔni, o bɛ se ka kɛ sababu ye ka se ka don gɛnɛgɛnɛ na. Langenbeck retractor (Langenbeck retractor) donli walasa ka patella kɔrɔta dɔɔni, o fana bɛ se ka kɛ sababu ye ka doncogo ɲɛ. Ni kolotuguda yɔrɔ ka dɔgɔn kosɛbɛ ani ni minɛnw dilanni ka gɛlɛn, cɛmancɛ walima kɛrɛfɛ dɛmɛnan bɛ se ka tigɛ a kɛrɛfɛ walasa ka senkɔni tilayɔrɔba dɔ bɔ a fan kelen fɛ.

3Kɔnɔnatumuw lakanani

Jaa 7 Senkɔni senkɔniw lakanani ka bɔ joginw na minnu bɛ sɔrɔ opereli fɛ, o ye opereli kɛcogo kuntilenna jɔnjɔn dɔ ye. O la, lakanani bololanɛgɛw ka kan ka kɛ minɛn ni nɛgɛ dontuma na.a Minɛn minnu bɛ kɛ ka don joli sira fɛ, olu ye donna bololanɛgɛw ye, kɛnɛma (nɔgɔlen) ni kɔnɔna (nɛgɛ) lakanani bololanɛgɛw, trocar pinɛw, ani nɛgɛsira porose.b Donan bololanɛgɛw bɛ lajɛ ni lakana bololanɛgɛ ye ani kɛnɛma (nɔgɔlen) ani kɔnɔna (nɛgɛ) lakanani bololanɛgɛ, a trocar pin, ani a ye porose wire guide ye. Trocar pikirijikɛlan bɛ lajɛ ni lakanalan bololanɛgɛ ye ani a doncogo bololanɛgɛ.b Jigin bololanɛgɛ ni fiɲɛbɔyɔrɔ dingɛw ye kɛrɛfɛ. Kɔnɔbara min bɛ donna bololanɛgɛ sanfɛ, o bɛ bololanɛgɛ lajɛlen bali ka bɔ a la bala la

4 Aw bɛ ɲɛminɛlan don a kɔnɔ ka a jɔyɔrɔ ladilan

Jaa 8a Bolo lajɛlen bɛ don senkɔni jukɔrɔ ka tɛmɛ senkɔni kolotuguda fɛ ka taa donyɔrɔ ɲininen fan fɛ senkɔni kan (Jaa 9). A ka ca a la, senkɔni bɛna lamaga dɔɔni cɛmancɛ la walima kɛrɛfɛ minɛn dontuma na. A ka ca a la, sɔgɔsɔgɔninjɛ min bɛ senkɔni kolotuguda la, o bɛ trocar pikirijikɛlan bila a jɔyɔrɔ ɲuman na a yɛrɛma.

Jaa 8b Jiginni dafara awiyɔn fila bɛɛ la ni fluoroscopie ye ani ka latilen yɔrɔ minnu na a mago bɛ a la. O kɔfɛ, trocar pikirijikɛlan bɛ bila a nɔ na ni ɲɛjiralan porose ye, o ye ɲɛminɛlan ye min bɛ tɛmɛ ɲɛjiralan cɛmancɛ dingɛ fɛ ani a kun bɛ don tibial metaphyse proximal kɔnɔ walasa ka a jɔcogo ɲuman sɔrɔ.

Jaa 8c Ni ɲɛjiralan bɛ yɔrɔ la min man ɲi, ɲɛjiralan filanan bɛ se ka kɛ ka ladilan dɔɔni kɛ a jɔyɔrɔ ɲuman na ɲɛjiralan porose fɛ, fo ka se milimɛtɛrɛ 4,3 ma a caya la I n’a fɔ a bɛ se ka nɔgɔya ka daminɛ ni ɲɛminɛlan ye ka a bila donyɔrɔ ɲuman na ni dɛmɛ tɛ. O kɔfɛ, fɛn min bɛ don a kɔnɔ ni ɲɛminɛlan ye, o bɛ sɔgɔsɔgɔ ɲɛminɛlan kan.

5 Medulla oblongata ka bonya

Jaa 9a Ka ɲɛgɛnɛsira da wuli ka bɔ donyɔrɔ ɲuman na, o ye fɛɛrɛ kɔrɔba ye opereli la. Fɛn min bɛ ɲɛfɛla ni kɔfɛla la, o ye senkɔni kɔkanna sɔgɔsɔgɔninjɛ cɛmancɛ fan ye. Kɛrɛfɛla la, donyɔrɔ ɲuman bɛ sɔrɔ jiginni yɔrɔ la min bɛ kɛ ni bolokɔni ɲɛfɛla ni ɲɛda ɲɛfɛla cɛ.

Jaa 9b Ɲɛjiralan jɔyɔrɔ ɲuman bɛ bɛn senkɔniw ma ɲɛfɛla kɔfɛla la ani ka surunya ɲɛfɛla la ni a bɛ se ka kɛ kɛrɛfɛla la. Guidewire bɛ teli ka taa kɔfɛ.

Jaa 9c Ni pini walima nɛgɛ tɛ se ka don a kɔnɔ ka ɲɛ, ni aw ye nɛgɛ walima pini datugu, o bɛ dɛmɛ ka nɛgɛ bila a jɔyɔrɔ ɲuman na. 

Nɛgɛw balili bɛ kɛ metafizi yɔrɔ la min ka bon ni ɲɛjiralan walima nɛgɛso tɛ se ka kɛ cɛmancɛ la ka kɛɲɛ ni kolo janya ye walima ni karicogo bɛnbaliya tora a yɔrɔ kelen walima a fila bɛɛ la wulu dontuma na.

Jaa 10 Nin waati in na, a ka ɲi ka bolokɔni lajɛlen siri senkɔni na ni milimɛtɛrɛ 3,2 ɲɛminɛlan ye. O bɛ lajɛba bali ka bɔ senkɔni na.

Jaa 11 Milimɛtiri 12,0 bɔgɔdaga bɛ bila kɔnɔna lakanani bolokɔni fɛ ka jigin ka tɛmɛ ɲɛminɛlan fɛ ka taa kolo la. Medullary canal bɛ da wuli ni sɔgɔli ye fo ka se santimɛtɛrɛ 8-10 ma ani ka ɲɛminɛlan dɔ don senkɔni kɛrɛfɛla la.

6 Kariw dɔgɔyali

Jaa 12a Nin waati in na, an bɛ karilen in lasegin.

Jaa 12b Ka kɛɲɛ ni kari yɔrɔ n’a cogoya ye, dɔgɔyali baarakɛminɛn suguya caman bɛ se ka kɛ i n’a fɔ farikolojidɛsɛ furakisɛw, kɔseginfɛnw, fɛn tiɲɛnenw plati misɛnninw, ani fɛnw datugulanw walasa ka ɲɔgɔn sɔrɔ ka ɲɛ. Ni sɔgɔsɔgɔninjɛ karilen bɛ dɔgɔya, tuma dɔw la hali ni fɛn wɛrɛw donna a kɔnɔ, sani aw ka ɲɛgɛnɛsira da wuli ni sɔgɔli ye. Reaming bere bɛ taa ɲɛ yɔrɔjan fɛ ka don distal tibial metaphysis cɛmancɛ la. A bilali kɔfɛ, nɛgɛ janya ni a cɛmancɛ bɛ dɔn. Ni a mago bɛ a la, aw bɛ senkɔni kanal bonya fo ka se a cɛmancɛ ɲininen ma ni aw bɛ a kɛ ka a kɛ ni milimɛtɛrɛ 0,5 ye. Da min bɛ lakana bolokɔni bololanɛgɛ kɔnɔ, o bɛ a to ka nɔgɔw ko ani ka u sama ka bɔ joli la, reaming waati. Ni a bɛ se ka kɛ, a ka ɲi ka wuluwulu dɔ kɛ min janya ka dɔgɔn ni milimɛtɛrɛ 10 ye. Nin wulu suguya in ka 5,0 mm Locking Bolt bɛ se ka dɛsɛ ka tɛmɛ 4,0 mm Locking Bolt kan min bɛ kɛ ka wulu finmanw kɛ. A ka ca a la, wuluwuluw janya bɛ dɔn ni fluoroscopique ruler ye.

7Aw bɛ wuluwulu don senkɔni kɔnɔ

Jaa 13a Nɛgɛ doncogo reaming bere fɛ fluoroscopie fɛ. Aw ye aw janto a la ko sɔgɔsɔgɔninjɛ min bɛ kɛ ka ɲɛgɛnɛsira ɲɛfɛla don a la, o bolo janya ka bon ni ɲɛgɛnɛsira ɲɛfɛla ta ye barisa fari tigɛyɔrɔ ni senkɔniw dondaw cɛ janya fana ka jan.

Jaa 13b Aw ye aw janto a la ko kurulen (Herzog curve) min bɛ ɲɛgɛnɛsira kɔnɔna na, o tɛ se ka don nɛgɛ kɔnɔbara lakanani bololanɛgɛ fɛ. O la, kɔnɔna lakanani bolokɔni ka kan ka bɔ bololanɛgɛ lajɛlen na sani ka nɛgɛ don (b; aw ye sigida 'Filiw, faratiw ani gɛlɛyaw' lajɛ). Aw bɛ ɲɛgɛnɛsiralabanaw jɔyɔrɔ laban lajɛ ɲɛfɛla-kɔfɛla ni kɔfɛla lajɛw la. Aw bɛ reaming bere bɔ. Ni nɛgɛ ka kan ka wuli, aw bɛ reaming bere to a nɔ na ka nɛgɛ kura don bere la. Milimɛtiri 5 taamasiɲɛ minnu bɛ doncogo bolo kan, olu bɛ fɛn donta juguman jira senkɔni gɛrɛgɛrɛ la (sɛbɛn ɲɛ 14). (Jaa 14nan)

8 Kɔrɔbɔli yɔrɔjan ni kɛrɛfɛla

Jaa 14a Kɛrɛnkɛrɛnnenya la ani yɔrɔjan datugucogo bɛ bɔ karicogo kɛrɛnkɛrɛnnenw na. Proximal locking bɛ se ka kɛ ni bolokɔni laɲini ye. Distal locking bɛ kɛ ni bolo ye walima ni radiopaque drill guide ye. Ni aw b’a fɛ, a bɛ se ka kɛ ni kuncɛfura ye, o bɛ kolo bali ka bonya ka taa ɲɛgɛnɛsira kɔnɔna na, wa a bɛ kɛ sababu ye ka fɛn donta bɔli nɔgɔya kɔfɛ. Kɛrɛnkɛrɛnnenya la, wulu minnu donna ka tɛmɛ, olu bɔli ka nɔgɔn ni u labanw janya bɛnnen don. A laban dawolo janya ɲininen bɛ suman ni taamasiyɛn dɔ donli ye bolokɔni kan walima ni ɲɛminɛlan dɔ donli ye laɲini bolo fɛ.

Jaa 14b Ɲɛjiralan kuncɛ bɛ ɲɛgɛnɛsira kɔnɔna na, a kɛrɛfɛla jira. Kuru min bɛ laɲini bolo ni nɛgɛ cɛsiri, o ka kan ka bɔ walasa ka laban da don a kɔnɔ. A laban da bɛ tɛmɛ donna bololanɛgɛ barika fɛ. Donni bololanɛgɛ bɛ to a nɔ na. O bɛ laban dawolo ni ɲɛgɛnɛsira kɔnɔbara sanfɛla bɛn ɲɔgɔn ma ani ka a bali ka tunun gɛnɛgɛnɛ na. Ni aw ye ɲɛminɛlan don barajuru dakun dawolo la ka don wuluwulu kɛrɛfɛla la, o fana bɛ dɛmɛ don ka laban dawolo bila a jɔyɔrɔ ɲuman na wuluwulu kɔnɔna na. Nin wale in laban na, aw ka kan ka kɔgɔji sterili ko walasa ka nɔgɔ tɔw bɛɛ ko.

04. Kɔlɔsiliw

Fɛn minnu ka kan ka kɛ opereli kɛcogo la

- Ni kolotugudaw tun bɛ yen ka kɔrɔ, senkɔniw lamagacogo dantigɛlen bɛ se ka kolotugudaw bali. Ni aw ye cɛmancɛ walima kɔkanna dɛmɛnan yɔrɔ kɛrɛfɛla tigɛ ka bɔ cɛmancɛ fan fɛ, o bɛ trocar pin donli nɔgɔya.

- Gɛnɛgɛnɛ ipsilateral prothèse tɛ taamasiɲɛ gɛlɛn ye ka ɲɛsin suprapatellar pinning ma. Nka, aw ye aw janto a la ko a bɛ se ka kɛ ko a tɛ se ka se ka se ka kɛ a daminɛyɔrɔ la min bɛ kɛ tuma bɛɛ, n’o ye sɔgɔsɔgɔninjɛ kɛrɛfɛla sɔgɔli kɛcogo ye.

- Kariw la minnu bɛ ni bolokɔniw janya ye, juru wɛrɛw bɛ se ka don a kɔnɔ walasa ka bolokɔni karilen yɔrɔ lamaga. A ka ɲi ka nin kuru ninnu bila sani nɛgɛ ka don a la walasa ka bolokɔni karilen jiginni filanan bali.

Tibia karilen kɛrɛfɛ jateminɛw

Tibial proximal fractures ye tibial fractures ye minnu ka gɛlɛn ka tɛmɛ tɔw bɛɛ kan ka ɲɛgɛnɛ kɛ, wa u bɛ dondaw tigitigi de wajibiya (i n’a fɔ a ɲɛfɔlen don cogo min sanfɛ). O kari ninnu ka kan ka dɔgɔya sani u ka sɔgɔ walasa ka fanga fɛn o fɛn bɛ fɛn tiɲɛ, o kɛlɛ ani ka ɲɛtaa caman sɔrɔ. Tuma dɔw la, ni aw ye senkɔni bananen bila ka ɲɛ yɔrɔ la min janyalen don a tilancɛ la ani ka donyɔrɔ tigitigi sɔrɔ ani ka wulu ni wuluwulu bila koronawirisi ni wuluwuluw la, o bɛna kɛ sababu ye ka senkɔni sinsinni kɛ ka ɲɛ sɔgɔsɔgɔninjɛ kɔfɛ.

Nka a ka c’a la, dɔgɔyali manɛwɛrɛ dɔw ka kan ka kɛ walasa ka o karilenw sigiyɔrɔ kura sɔrɔ ani k’u mara cogo la min bɛ mɔgɔ wasa. Ni kari sira nɔgɔn don ani ni a bɛ kɛ kɛrɛ fɛ, sirilan nɔgɔmanw walima coaptation clamps nɔgɔmanw, minnu bilalen don farikolo la, olu bɛ se ka kɛ ka reset sɔrɔ ani ka a mara sɔgɔli waati. Ni sirilan ma dafa walima ni kariyɔrɔ tɛ a yɛrɛ juru don sirili la, tulumugu walima balili kuruw bɛ se ka dɛmɛ ka a bali ka wuli ka taa yɔrɔ wɛrɛ la ani ka a bila yɔrɔ jugu la (Jaa 15). O juruw bɛ bila kɔfɛ nɛgɛ jɔyɔrɔ ɲininen na kɛrɛfɛla lajɛ la ani kɛrɛfɛla la ka taa nɛgɛ jɔyɔrɔ ɲininen na ɲɛfɛla-kɔfɛla lajɛ la. O juruw bilali ka ɲɛ walasa ka u labɛn ka ɲɛ, o bɛ se ka kɛ gɛlɛya ye.

Jaa 15 Kurukuru minnu bɛ bila nɛgɛsira ɲininen kɛnɛma na ɲɛfɛ ni kɔfɛla la (a) ani nɛgɛsira ɲininen kɔfɛ kɛrɛfɛla la (b) minnu bɛ bɔgɔdaga fanga kɛlɛ

Fɛɛrɛ wɛrɛ min bɛ se ka kɛ kosɛbɛ, o ye ka kariyɔrɔ siri waati dɔɔni kɔnɔ farikolo yɔrɔ la (Jaa 16). A ka ca a la, tubabufura fitini dɔ min bɛ ni kɔribolo datugulan kelen fila walima saba ye, o bɛna kari minɛ ka dɔgɔya jirisunw labɛnni ni wulu dontuma na. Plate bɛna o jiginni fila bɛɛ kɔlɔsi. Fari ka kan ka to a nɔ na ni yɔrɔ jɔlen tɛ yen walasa ka dɔgɔyali bɔnɛ bali min ka teli ka kɛ plati bɔli kɔfɛ. Nin plati min bɛ ni kɔri kuru kelen ye, o tɛ gɛlɛya, wa a tɛna nɔ bila wulu sabatili la. Reset plate fɛɛrɛ bɛ se ka kɛ kari dafalenw ni karilenw datugulenw bɛɛ la.

Jaa 16 Datugulan fitinin dɔ bɛ se ka sɔrɔ ni kɔribolo kelen ye, ka to a cogo la farikolo la. A ka ca a la, fasa ka kan ka to a nɔ na sɔgɔli kɔfɛ. a Valgus deformité fɔlɔ min bɛ sɔrɔ senkɔni kɛrɛfɛ karilen na. b Kariyɔrɔ fitinin dɔ bɛ bila cɛmancɛ la walasa ka kariyɔrɔ seginni sɔrɔ ani ka a mara nɛgɛtigɛtuma na. c Falan tɛ bɔ sɔgɔli kɔfɛ barisa a bɛ sabatili wɛrɛ di

Labɛnbaliya, Faratiw ani gɛlɛyaw

- Lakanali bolokɔni jiginni opereli senfɛ, o bɛ se ka kɛ sababu ye ka gɛnɛgɛnɛw ni gɛnɛgɛnɛw tiɲɛ (Jaa 17). Lakanali bolokɔni ka kan ka don a kɔnɔ kokura pewu.

- Ni aw ye Protective Sleeve kɔrɔta dɔɔni, o bɛ se ka reamer kunkolo bɔli juguya. Fluoroscopie bɛ dɛmɛ ka gɛlɛya dɔn. Ni aw ye a tangalan ladilan kokura, o bɛna gɛlɛya in ɲɛnabɔ (Ja 18) .

- Nail Lock-Up : Nin fɛn donta bɛ se ka siri nɛgɛ bolokɔni na a kɛrɛfɛla kurulen na (Herzog curve). Walasa ka wulu laban don, nɛgɛdaga ka kan ka bɔ, ka kɛnɛma plastiki bolokɔni nɔgɔlen dɔrɔn to. Ni wulu sirilen don, a ka kan ka bɔ pewu tuguni ani ka a don a kɔnɔ kokura nɛgɛ kanni bɔlen kɔfɛ plastiki kanɛli dɔrɔn fɛ.

Jaa 17 Lakanali bolokɔni bɔli ni a ma kɔlɔsi ni fluoroscopie ye, o bɛ se ka kɛ sababu ye ka gɛnɛgɛnɛ jogin

Jaa 18 a Lakanalikɛlan kɔrɔtalen walima a kɔrɔtalen bala la, o bɛ se ka kɛ sababu ye ka reamer bɔli bali, barisa reamer kun bɛ se ka jam. b Fluoroscopique inspection ni alignment correction bɛ a to ka reamer kun bɔ. c Reamer kun bɛ se ka bɔ ni reamer kun tɛ a nɔ na. d Reamer kun bɛ se ka bɔ ni reamer kun tɛ a nɔ na.

Sɛbɛn minnu bɛ tali kɛ o la

Hessmann MH, Buhl M, Finkemeier C, Khoury A, Mosheiff R, Blauth M. Senkɔni karilenw sɔgɔli sanfɛla la. Oper Orthop Traumatol (banakisɛfagalan min bɛ wele ko Traumatol). 2020 Ɔkutɔburukalo;32(5):440-454.