5 intramedullary nail application gɔmeɖosewo kple amekokomɔnu!

Gɔmeɖose vevi siwo ku ɖe intramedullary nailing ŋu

1. Ŋutinya si ku ɖe intramedullary nailing ŋu

Le ƒe 1910 me la, wozã Lilienthal aluminum intramedullary nails tsɔ da akɔta ƒe asike ƒe gbagbã.

Le ƒe 1913 me la, Schone zã klosalo ƒe ɖa siwo le lãkusi me tsɔ da abɔta ƒe gbagbã. 

Kuntscher (ƒe 1900-1972) wɔ akpa gã aɖe le ɖa si wotsɔ blaa ɖa le lãkusi me me. 

Ƒe 1960 kple 1970 ƒeawo nye ɣeyiɣi si me ɖa siwo le lãkusi me va do kabakaba. 

nye dukɔa le wo zãm le agbɔsɔsɔ gã me tso ƒe 1990-awo me ke.

2. Ðeɖekpɔkpɔ le gaglãgbe kple edziɖeɖekpɔtɔ si wotu

1. Woate ŋu aɖe abɔ kple afɔ ƒe gbagbã dzi akpɔtɔ to amekoko me ne wokpɔ nu tẽ alo axee le X-ray ƒe ŋkuléle ɖe wo ŋu me.

2. Open reduction fracture healing time didi vie, ʋu si dona le amekoko me sɔ gbɔ wu, eye open reduction gagblẽa ʋu si yia fracture ƒe nuwuwu la me.

3. Wokafui be woazã nusiwo dzi woɖena kpɔtɔna si wotu alesi woate ŋui. Woate ŋu azã nusi ɖea ʋu ƒe hehe dzi kpɔtɔna, alo woate ŋu atso nu sue aɖe le ʋua ƒe gbagbãƒea be wòaɖe ʋua ahaɖe edzi akpɔtɔ, si ana ʋu si naa ʋu si le gbagbãƒea ƒe nuwuwu la nagado kplamatse o.

4. Le ƒu ƒe kakɛwo ƒe kpododonu si wotu, ƒu kakɛwo ʋuʋu alo wo to lãkusi siwo ƒo xlã wo me, kple ƒu kakɛ gã siwo woɖe le teƒe bubu gome la, woate ŋu azã amekoko ƒe ʋuʋu dzi ɖeɖe kpɔtɔ.

3. Fixation mɔnu si nye ɖa si le lãkusi me

1. Mɔnu si wozãna tsɔ léa ɖa le lãkusi me ememetɔe nyea titina ememe lãkusi si sɔ kple wo nɔewo.

2. Nutete ƒe ƒoƒo to intramedullary nail dzi nye nuteɖeamedzi-ma fixation, ke menye stress-shielding fixation, si nyo na callus ƒe nɔnɔme o.

3. Central fixation nyo wu cortical external fixation le nukpɔsusu nu, si ate ŋu aɖe ŋusẽ ƒe alɔnu dzi akpɔtɔ, aɖe valgus angulation ƒe dzɔdzɔ kple ememe fixation ƒe kpododonu dzi akpɔtɔ.

4. Intramedullary nail fixation naa gɔmeɖoanyi na closed reduction alo seɖoƒe ʋuʋu ʋuʋu.

4.Viɖe siwo le intramedullary ɖawo ŋu

1. Kuxi siwo mebɔ o

2. Amekoko ƒe dzesiwo ƒe lolome si keke ta

3. Fixation sesĩe

4. Hehexɔxɔ le ƒunukpeƒewo ƒe dɔwɔwɔ ŋu kaba

5. Kpekpeme tsɔtsɔ kaba

6. Woate ŋu azãe ɖekae kple ememe fixation bubuwo

Ƒomevi Veviwo Kple Mɔnu Siwo Wozãna

1. Intramedullary nails siwo wotu kple esiwo womexe o

2. Dynamic kple static locking intramedullary ɖawo

3. Medullary kekeɖenudɔ kple non-medullary fixation mɔnuwo

4. Fixation mɔnu siwo le ʋuʋu ɖi kple esiwo wotu

Nusiwo do ƒome kple wo nɔewo kple esiwo mewɔ ɖeka kple wo nɔewo o

Nail dzro siwo le lãkusi me ƒe axial meli ke nyuie o eye woƒe torsional strength medea ŋgɔ boo o, gake woƒe tete ɖe wo nɔewo ŋu vie eye woate ŋu ahaya le woƒe tɔtrɔ megbe, si wɔnɛ be ƒu me ʋuʋu sue aɖe ko.

Intramedullary nails siwo tsia tre ɖe wo nɔewo ŋu ƒe ŋusẽkpɔɖeamedzi nyo wu be woatsi tre ɖe tɔtrɔ kple nutete ŋu, woƒe fixation li ke nyuie, eye wowɔ ɖeka kple gɔmeɖose si nye be bioological fixation. Wozãa wo geɖe le abɔwo ƒe ƒu didiwo me. Vevietɔ le akpa geɖe ƒe gbagbã kple esiwo wogbã gome la, woƒe liƒo nyo wu ɖa dzro siwo le lãkusi me.

Dynamization na static fixation

Static locking intramedullary nails mewɔa nuteɖeamedzi masking boo aɖeke o eye fifia woʋlia wo ta zi geɖe be woawɔ dynamization ƒe afɔɖeɖe si menye edziedzi o.

Le ƒu gbagbã siwo mehaya le ɣleti 6 va ɖo 8 le dɔwɔwɔ vɔ megbe o gome la, zi geɖe la, wozãa ƒu ƒe ʋuʋu le teƒea alo tsɔa ŋusẽ si wotsɔna ɖɔlia ƒu siwo keke ɖe enu le lãkusi me.

Woate ŋu azã ŋusẽdodo abe mɔnu si dzi woato ado gbagbã ƒe dɔyɔyɔ ɖe ŋgɔ ene. Womekafui edziedzi o elabena ate ŋu ana abɔ kple afɔ nanɔ kpuie eye wòana wòatrɔ.

Aɖuɖɔtoe ƒe kekeɖenudɔwɔwɔ kple esi menye ʋumenugbagbeviɣidɔ o ƒe kekeɖenudɔwɔwɔ

Aɖuɖɔtoe ƒe keke ate ŋu ade ɖa siwo le lãkusi me siwo ƒe didime lolo wu eye ŋusẽ lolo wu, si nyo na dɔwɔwɔ ƒe hehexɔxɔ kaba eye wòɖea ɖa siwo gbãna ƒe agbɔsɔsɔ dzi kpɔtɔna.

Ƒumeŋuɖui ƒe keke ate ŋu ana ƒu ƒe gbagbã gbogbo aɖewo nado eye ƒumeŋuɖui ƒe ŋusẽkpɔɖeamedzi, si nyo na ƒu gbagbã ƒe dɔyɔyɔ.

Ʋumenugbagbeviɣiwo ƒe keke agblẽ nunyiame ƒe ʋukawo kple lãmenugbagbeviwo ƒe ʋu ƒe sisi me, gake ʋukawo ate ŋu agbugbɔ awɔ ake le ɖa siwo le lãkusi me ƒe do me. Ʋumenugbagbeviɣi ƒe keke ate ŋu ana ʋu nayi edzi le lãmeka falɛfalɛ siwo ƒo xlãe hã me, si ana ʋuka ƒe gbagbã ƒe dɔyɔyɔ nado.

Aɖuɖɔtoe ƒe keke ɖe enu dzia dɔlékui kple ʋuka me ʋu ƒe sisi ƒe mɔnukpɔkpɔ ɖe edzi vie, eye ele be woaɖɔ ŋu ɖo le ʋu ƒe gbagbã siwo le ʋuʋu ɖi, abi geɖe xɔxɔ, kple abi siwo sesẽ ŋu.

Viɖe siwo le medullary expansion ŋu

1 Ne medullary keke ɖe enu vɔ la, afisi kadodo le intramedullary nail kple ƒu dome dzina ɖe edzi, si wɔnɛ be fixation la li ke nyuie wu. 

2 Le medullary kekeɖenudɔwɔwɔ megbe la, woate ŋu azã intramedullary nail si ƒe didime lolo wu, si naa intramedullary nail ƒe ŋusẽ dzina ɖe edzi eye wòɖea ɖa siwo gbãna ƒe agbɔsɔsɔ dzi kpɔtɔna. 

3 Ƒu ƒe gbagbã le medullary expansion megbe ateŋu ana ƒu yeyewo nadzɔ, si nyo na ƒu gbagbã ƒe dɔyɔyɔ.

Ne wotsɔe sɔ kple medullary expansion intramedullary nails la, viɖe siwo gbɔna le nonexpanded intramedullary nails ŋu

1 Dɔwɔwɔ na ame ƒe ɣeyiɣi kpuitɔ eye ʋu si dona le ame ŋu mesɔ gbɔ o. 

2 Womedoa kplamatse ʋu ƒe sisi le lãmenugbagbeviwo me boo o le nɔnɔme siwo me lãmeka falɛfalɛwo xɔ abi vevie me.

Dɔwɔwɔ le ɖa si le lãkusi me

Humeral interlocking intramedullary ɖa si le lãkusi me

Nusiwo fia be woawɔ humeral nails

Nusiwo fia be woakpɔ akɔta ƒe ɖa siwo do ƒome kple wo nɔewo le akɔta ƒe lãkusi ƒe gbagbãwo dada me enye: ƒu ƒe gbagbã siwo me ʋukawo kple lãmekawo gblẽ, abi geɖe, gbagbã siwo meli ke o, dɔléle ƒe gbagbã, kple akɔta ƒe gbagbã le proximal.

Afisi woateŋu aɖɔ ɖo la tso 2cm le humeral ta te va ɖo 3cm le olecranon fossa tame. Àte ŋu atiae be yeaɖɔe ɖo tso abɔta kple antegrade intramedullary nail alo tso abɔta kple retrograde nail.

Nɔnɔme siwo le humeral nails ŋu

Amekoko ƒe mɔnu siwo wozãna tsɔ léa akɔta ƒe asike ƒe gbagbãwoe nye plate fixation kple intramedullary nail fixation koŋ.

Plate fixation ƒe ŋutete sesẽ le esi tsia tre ɖe tɔtrɔ kple be wòabɔbɔ ŋu eye wòlénɛ ɖe te sesĩe, gake amekoko ƒe nuveviwɔame lolo, dɔléle ƒe kakaɖedzi lolo, eye radial nerve la gblẽna bɔbɔe.

Egbegbe ɖa siwo ƒoa ƒu ɖe ƒunukpeƒewo ŋu eye wotsia wo ɖokui ŋu ɖua ɖa dzro siwo le lãkusi me ƒe gbɔdzɔgbɔdzɔwo abe axial instability, rotation control nyuie o, kple alesi wòhiã be woaɖɔe kpee dzi, ale be woatɔ te gbagbãƒea sesĩe, ʋu si bu la le sue, lãkusi falɛfalɛa ƒe ɖeɖe mesɔ gbɔ o, eye medullary ƒe kekeme sɔ kple ƒu si wodona le teƒea, agbaa sɔ pɛpɛpɛ woma la, callus la dzena kaba, eye woate ŋu adze kamedede si wɔa dɔ gɔme le amekoko vɔ megbe.

Femoral interlocking intramedullary nail si le lãkusi me

Dzesi siwo fia be afɔkpodzi ƒe ɖa siwo do ƒome kple wo nɔewo

Gbagbã ƒomevi ɖesiaɖe 2cm le trochanteric vertebra te eye wòwu 9cm tso klo ƒe ƒunukpeƒe.

Afɔkpodzi ƒe titina ƒe gbagbã xoxowo.

Dɔnɔ siwo ƒe plate ememe fixation do kpo nu.

Femoral interlocking nail ƒe nɔnɔmewo

Mɔ̃ɖaŋununya ƒe viɖewo

Ŋusẽ ƒe alɔ si le afɔkpodzi ƒe ɖa si le lãkusi me si wotsɔ ɖɔa ƒu gbagbãwo ɖo la didi wu gakpowo tɔ, eye ŋusẽa ma ɖe ƒu bliboa ƒe titina ƒe axadzi sɔsɔe, si mebɔbɔna be woabɔbɔ ahawɔe wòatrɔ o.

Kpe siwo xea mɔ na ƒua ƒe nuwuwu eveawo nana ƒua wɔa blibo tso etame va se ɖe ete, eye ɖa siwo xea mɔ na ƒua ƒe nuwuwu si le didiƒe ate ŋu aɖe ɖa si le ƒua me ƒe alɔ si le ʋuʋum la dzi akpɔtɔ, axe mɔ na kpuiƒe kple tɔtrɔ, eye wòana wòali ke eye wòali ke nyuie wu hena ƒua ƒe gbagbã.

Gamma si Do Ƒome Kple Wo Nɔewo Ƒe Aɖuɖɔtoe

Gamma nail ƒe dzesiwo

Woate ŋu azãe na peritrochanteric fractures ƒomevi vovovowo, vevietɔ subtrochanteric fractures.

Gamma nail si keke ta (nail si wogbugbɔ tu) ƒe dzesiwo

subtrochanteric gbagbã gãwo, trochanteric tsɔ kpe ɖe femoral shaft fractures ŋu.

Viɖe siwo le Gamma nail ŋu

Woto akɔta ƒe gavi si wotsɔna ƒua du kple ɖa si le lãkusi me ƒe mɔ̃ɖaŋununya tsaka me, eye ɖa vevitɔa te ɖe akɔta ƒe doa ƒe eme wu akɔta ƒe ʋuƒo si le ŋusẽ kpɔm, eyata Gamma ɖa kplɔa dɔnɔa ƒe kpekpeme te ɖe afɔkpodzi ƒe kpe ŋu wu akɔta ƒe ʋuƒo si trɔna, si wɔnɛ be nusi wotsɔ dea ɖa ƒe mɔ̃ ƒe ŋusẽ dzina ɖe edzi. Le subtrochanteric fractures si me medial cortical comminution le gome la, Gamma nail la ƒoa asa na fracture anatomy gbugbɔgatu ƒe hiahiã, eyata eɖea vi na intertrochanteric fractures alo subtrochanteric fractures.

Retrograde intramedullary afɔkpodzi ƒe ɖaƒoƒo

Nusiwo fia be afɔkpodzi ƒe ɖa siwo trɔna yi megbe

Wozãnɛ koŋ na supracondylar femoral fractures, siwo dometɔ aɖewoe nye supracondylar comminuted fractures kple intercondylar 'T' kple 'Y' comminuted fractures siwo lɔ articular surface ɖe eme.

Woate ŋu azãe hã na afɔkpodzi ƒe gbagbã le afɔkpodzi ƒe isthmus te.

Femoral shaft, supracondylar femoral, kple intercondylar fractures le 20CM me tso klo ƒe ƒunukpeƒe.

Amesiwo do kpo nu le plate fixation me.

Femoral nailing si yia megbe ƒe nɔnɔmewo

Supracondylar femoral fracture nye gbagbã sesẽ aɖe si sesẽna le gbãtɔ, edzi ɖeɖe kpɔtɔ kple evelia, ememe nuléle sesẽ me. Kuxiwo abe gbagbã ƒe non-union kple dɔyɔyɔ si tsi megbe ene bɔ ŋutɔ.

Retrograde interlocking intramedullary nailing nye mɔnu si wozãna zi geɖe tsɔ daa akɔta ƒe gbagbã le didiƒe ʋĩ le ƒe ʋɛ siwo va yi me, si ƒe mɔ̃ɖaŋununya li ke nyuie, ate ŋu akpɔ megbeʋuʋu kple tɔtrɔ le ƒunukpeƒea ƒe nuwuwu si le didiƒe dzi nyuie, eye wòkpena ɖe ƒunukpeƒea ƒe ʋuʋu kabakaba ŋu.

Wotsɔa aŋe si didi ɖe akɔta ƒe ke ƒe gbagbã si wotsɔ ƒo ƒui la ɖɔa afɔkpodzi ƒe ƒunukpeƒe ƒe gbagbã ɖo, si kpɔa kuxi si gbɔ kpɔkpɔ sesẽ to afɔkpodzi ƒe lãkusi me ƒoƒo ɖe wo nɔewo ŋu me gbɔ. Dɔwɔnua zazã le bɔbɔe, eƒe nɔƒe sɔ pɛpɛpɛ, kakaɖedzi le eŋu le eɖoɖo me, eye dɔnɔa ate ŋu awɔ klo ƒe kamedede siwo wɔa dɔ kaba le amekokoa megbe.

Tibial interlocking intramedullary ɖa siwo le lãkusi me

Nusiwo woatsɔ awɔ tibial nailing

Gbagbã siwo li ke le afɔkpodzi ƒe titina 1/3: gbagbã siwo le ŋgɔgbe, gbagbã kpui siwo le tsia dzi, pseudarthrosis.

Gbagbã siwo meli ke o le titina afɔkpodzi ƒe didime ƒe 60% me: gbagbã siwo te ɖe metaphysis ŋu, gbagbã didi siwo le spiral me, gbagbã siwo le akpa vovovowo me, gbagbã siwo wogbã, gbagbã siwo me ƒu ƒe gbɔdzɔgbɔdzɔ le.

Nɔnɔme siwo le tibial nailing ŋu

Wozãa interlocking intramedullary nailing of tibia zi geɖe na mid tibia ƒe gbagbã.

Togbɔ be woate ŋu azãe hã na afɔkpodzi ƒe gbagbã le proximal kple distal hã la, kuxiawo ƒe agbɔsɔsɔme sɔ gbɔ wu, malunion dzɔna zi geɖe, gbagbãƒea ƒe nuwuwu ƒe ʋuʋu ≧1cm le dɔléleawo ƒe 1/2 me, eye fixation ƒe 1/4 do kpo nu.

Agbalẽwo ka nya ta be nu nyui aɖe dona tso abɔta ƒe gbagbã si le didiƒe me wu afɔkpodzi si te ɖe eŋu ƒe gbagbã le fibula ƒe ƒoƒo edziedzi megbe.

Amekoko ƒe mɔnuwo

Dzadzraɖo ɖe dɔwɔnu tɔxɛwo ŋu do ŋgɔ na dɔwɔwɔ nɛ

Ƒumeŋutinunya ƒe aba (traction bed) alo amekoko ƒe aba si wozãna ɖaa si me wozãa fluoroscopic le; nusi wotsɔna gbugbɔa nu ɖe ​​megbe; nɔnɔmetata ƒe ŋusẽdoame.

Tiatia nyuie le intramedullary nail didime ŋu na endoprostheses do ŋgɔ na dɔwɔwɔ nɛ

Radiograph ƒe fotoɖeɖe

abɔ kple afɔ ƒe didime dzidzedze le axadzi

Intramedullary ɖa ƒe didime

x-ray isthmus ƒe kekeme

Intramedullary ɖa ƒe didime dzidzedze

1.Translucent dziɖula tameɖoɖo kplikpaa le C-alɔ mɔ̃ te

Ƒua ƒe nugbɔ siwo le didiƒe kple esiwo te ɖe eŋu la nɔ keklẽa ƒe titina; dziɖula la sɔ kple diaphysis la.

2.Length dzidzedze le ŋutilã ƒe anyigba ƒe dzesiwo nu

Femur: trochanter si lolo wu ƒe nugbɔ → klo ƒe axadzi teƒe alo patella ƒe ati si le etame; tibia: klo ƒe teƒe si le titina → afɔkpodzi ƒe ƒunukpeƒe ƒe ŋgɔgbekpa le afɔ ƒe akɔta ƒe ʋuʋu me.

Intramedullary Nail Insertion Technique - Mɔnu si wozãna tsɔ gena ɖe eme

Medullary cavity ƒe didime ƒe axa si le fli dzɔdzɔe dzi

Mete ɖe afisi woage ɖo ŋu akpa o

Didime si sɔ: dilated - didi; undilated - kpuie

(Woɖo kpe afisi woge ɖo le mɔ si mele tẽ o dzi; womehiã be woakeke aŋe ɖe enu o, womehiã be woakpɔ lãkusi falɛfalɛwo ta o)

Parallel femoral intramedullary nail ƒe gege ɖe eme

Dzadzraɖo ɖe afisi woage ɖo ŋu na afɔkpodzi ƒe lãkusi si sɔ kple wo nɔewo

Akɔta ƒe ƒoƒo kple adduction

Longitudinal incision si te ɖe trochanter gãtɔ ŋu

Menye ɖe megbe akpa o

Mɔfiame ƒe pin la ƒe ɖoɖo

Lãmetsi falɛfalɛ ƒe akpoxɔnua ɖoɖo

Retrograde femoral intramedullary nail ƒe gege ɖe eme

30° klo ƒe ʋuʋu

Mɔfianu ƒe ʋuƒoa ƒe axa didi le mɔ ɖeka dzi kple afɔkpodzi ƒe ati si le didiƒe ƒe medullary cavity

Kirschner pin la dede afɔkpodzi si le didiƒe to patellar ligament dzi to ametakpɔnu ƒe abɔta: orthogonal - titina le akɔta ƒe intercondylar fossa; lateral - Blumensaat ƒe fli

PCL ƒe gɔmedzedze nuveviwɔame manɔmee

Parallel tibial intramedullary ɖa ƒe gege ɖe eme

Le medullary cavity ƒe titina

Tibial plateau ƒe ŋgɔgbekpa dzi

Kɔkɔ alesi wòanya wɔe evɔ magblẽ nu le gbadzaƒea o

Klo ƒe ʋuʋu si sɔ gbɔ wu

Lã tibial tuberosity-inferior pole of patella le medullary cavity la ŋu

Ʋu medullary cavity: mɔfiame pin le 15° yi sagittal plane si le tibial stem ƒe didime axis

Nɔnɔmetata ƒe ŋusẽdoamenu ƒe nɔƒe

Marrowing mɔnuwo

Elektrikŋusẽ ƒe ŋusẽ dzi ɖeɖe kpɔtɔ

gbagbã yeyewo

Asi dzi ɖeɖe kpɔtɔ

xoxo gbagbã kple pseudoarthrosis, sclerosis le medullary cavity

Tourniquet aɖeke mele ga ƒe asixɔxɔ te o

ʋu ƒe sisi nye fafanu nyuitɔ kekeake

Mɔnu siwo wozãna tsɔ trɔa asi le teƒe bubuwo ŋu

Parallel femoral intramedullary nailing si sɔ kple wo nɔewo

Susu siwo ta wòsesẽna be woagbugbɔ afɔkpodzi ƒe gbagbãwo aɖo te

Lãmetsi falɛfalɛ siwo le kpekpem la meɖea mɔ be woage ɖe ƒua me tẽ o

Womate ŋu akpɔ afisi aŋea gena ɖo le susu me tẽ o

Akɔta ƒe ƒunukpeƒe ƒe ʋuʋu → iliac fascia ƒe tete → gbagbã ƒe kpuiƒe

Tibial ƒe gbagbã dzi ɖeɖe kpɔtɔ

Ameflunyawo gbɔgblɔ

Woƒe akpa gãtɔ nɔa ŋutigbalẽ te eye asikaka eŋu le bɔbɔe

Stabilized fracture - titina alo didiƒe A kple B ƒomevi gbagbã

Oblique fractures - amewuwu fũu akpa

Intramedullary nailing→dɔwɔnu siwo wotsɔna ʋua lãme na ame

Afɔɖeɖe siwo kpena ɖe wo dzi ɖeɖe kpɔtɔ ŋu

Point dzi ɖeɖe kpɔtɔ ƒe forceps

tibia ƒe afɔkpodzi; tome alo abi zazã

Retractor gãwo (akɔtaɖonu) .

dzi ɖeɖe kpɔtɔ si tsi megbe; abɔ kple afɔ ƒe kpuiƒe

Ɣeyiɣi kpui aɖe ƒe Schanz-gaviwo

1 Afɔkpodzi, afɔkpodzi

2 Te ɖe fli si me wogbãe ŋu alesi wòanya wɔe

3 Proximal gbagbã ɖeka cortical zazã

4Zã xexeame katã ƒe chuck si ŋu T-handle le hena afɔɖeɖe bɔbɔe

Poller ƒe ɖa

1Metaphyseal fracture (ŋusẽ ƒe fli ɖɔɖɔɖo, gbugbɔgaɖoanyia li ke, dɔwɔwɔa gbugbɔgaɖoanyi)

2 afɔkpodzi alo afɔkpodzi si le didiƒe ƒe gbagbã si le tsia dzi (shear stress → pressure) .

3 Intramedullary nails siwo womeɖo nyuie o la gena ɖe medullary channel xoxoa me le amekoko evelia me

4 Teƒe si woge ɖo nyuie o, proximal fracture alignment menyo o (woda gavi ɖe tsitrenu ɖe ​​endoplant ƒe ʋuʋu si ate ŋu adzɔ ŋu)

Tourniquet si keke wu

1 afɔkpodzi ƒe lãkusi

2 wotsɔa traction alo retractor kpena ɖe eŋu

3 Zãe kple ŋuɖɔɖɔɖo le lãmeka falɛfalɛwo ƒe abi sesẽwo me

4 Na wòanɔ kpuie

5 De se ɖe medullary expansion nu le inflated nɔnɔme me

Nail locking sequence: didiƒe ʋĩ emegbe proximal

Viɖe siwo le eŋu

ƒoƒo bɔbɔe, gbagbãƒe ƒe nutete; kaklã ɖeɖeɖa; dɔwɔwɔ siwo dzi ɖena kpɔtɔna.

Dɔwɔwɔ dzi ɖeɖe kpɔtɔ ƒe mɔnuwo na amekoko si tsi megbe & nonunion

Kuxi siwo ate ŋu ado goe ne amekokoa tsi megbe

Axial deformity (kpuie, dzogoe kple alo ʋuʋu) .

Tsitsi le ƒe granulation lãkusi

Ƒu ƒe ʋuʋudedi gbãtɔ

Sclerosis of fracture gbãna ne wotu medullary cavity

Ƒumeŋuɖui ƒe dɔléle

Kuxi siwo ate ŋu ado mo ɖa le dɔwɔwɔ nɛ me

Exander kple intramedullary nail ƒe deflection → intramedullary nail ƒe gege ɖe cortex me

Dzogoe ƒe nɔnɔme madeamedzi → retractor

Nuwuwu siwo wotso ƒe ʋuʋu → Poller ƒe ɖa, plate fixation

Mɔnu siwo woatsɔ axe mɔ ɖe ŋusẽ ƒe fli siwo mesɔ o nu

Proximal - teƒe si sɔ

Distal - intramedullary nail le medullary cavity titina

Kuxi siwo dona tso Intramedullary Nailing me

★Dɔlékuiwo xɔxɔ

★Lãmetsiŋusẽ ƒe gbegblẽ

★Gbugbɔgagbã ƒe dɔyɔyɔ si tro

★Atikewɔwɔ ƒe Gbagbãƒewo

Gotagome tɔtrɔ, torsion, valgus, ememe tɔtrɔ, dzogoe

★ƒunukpeƒeveame si te ɖe eŋu

★Ami ƒe ʋuka me ʋu ƒe sisi

★Heterotopic ƒu ƒe ʋuʋu

★Aklã me ʋu ƒe sisi

★Gbugbɔ gbã

★Trombosis ƒe dɔléle

★Ƒoƒu ƒe sesẽ

★Non-union of fracture, ƒu ƒe nonunion

★Ememe fixation ƒe kpododonu

★Afɔ kple afɔ ƒe kpuie

★Bubuwo

Kuxiwo--Dɔlékuiwo xɔxɔ

1.Le gɔmedzedzea me la, wobu gbagbãƒe siwo le ʋuʋu ɖi be enye nusi tsi tre ɖe intramedullary nailing ŋu.

2.The dzɔdzɔ le dɔwɔwɔ vɔ megbe dɔlékui le ʋuʋu gbagbãwo nɔ te ɖe nɔnɔme si me lãmeka falɛfalɛwo xɔ abi kple ɖiƒoƒo

Dɔlékui ƒe dzɔdzɔ le lãmeka falɛfalɛwo ƒe gbagbã megbe nɔ te ɖe alesi lãmeka falɛfalɛawo xɔ abi kple ɖiƒoƒo ƒe nɔnɔme kpakple alesi wokpɔa lãkusi falɛfalɛawo dzii dzi.

3.Thinner intramedullary ɖawo dzia mɔnukpɔkpɔ si li be woaxɔ dɔlékuiwo ɖe edzi; non-expanded locking intramedullary nails fixation menyo kura o, eye ƒu ƒe nugbɔwo hã mewɔe o

Nail fixation intramedullary intramedullary si mekeke o la menyo tututu o, eye ƒua ƒe nuwuwu si gbã la ƒe ʋuʋu le nusuekpɔmɔ̃ me kpakple do si susɔ, si le bɔbɔe na dɔlékuiwo ƒe tsitsi.

4. Menye ɖeko medullary fixation si keke ɖe enu kple esi keke ɖe enu si seɖoƒe li na zazã nana be ʋuʋudedia ƒe liƒo nyona ɖe edzi ko o, ke eƒoa asa na teƒe kuku hã wɔwɔ.

Ami ƒe Ʋuʋudedi ƒe Dɔléle

1.FES ƒe dzɔdzɔ le tubular ƒu didiwo ƒe gbagbã me nye 0.5% va ɖo 2%.

2. Medulla ƒe kekeɖenudɔwɔwɔ kple medulla ƒe kekemaɖemaɖe mekpɔa ŋusẽ gã aɖeke ɖe aklã ƒe yaƒoƒo dzi o.

3.Ne keke medulla la, ele be aɖaŋua nanye blewuu kneading, aƒo asa na ŋusẽ geɖe akpa kple dɔwɔwɔ sesẽ.

4.fefe si wokpɔna le FES ŋu la gakpɔtɔ xɔa dzidzenu siwo Gurd do ɖa le ƒe 1974 me, eye atikewɔwɔ le dɔlélea didi vɔ megbe ahe ɣeyiɣi nyuitɔ si woatsɔ akpɔ dɔlélea gbɔe ɖe megbe eye ate ŋu ahe emetsonu sesẽwo vɛ.

Ƒu ƒe gbagbã ƒe dɔyɔyɔ si tsi megbe kple ƒu ƒe nonunion

Nu vovovowo kpɔa ŋusẽ ɖe ɖa ƒe gbagbã ƒe dɔyɔyɔ dzi le ɖa si le lãkusi me ƒe ƒoƒo vɔ megbe, eye woate ŋu adzro nusiwo gbɔ wòtso me ale.

1.soft tissue embedded le gbagbã ƒe nuwuwu

2. Mamã le transverse fracture nuwuwu

3. Dɔnɔa ƒe tsitsi

4. Ʋuka ƒe gbagbã le gaglãgbe, lãmeka falɛfalɛwo ƒe abi vevie, ʋumenugbagbeviɣidɔ sesẽ le teƒea alo dɔlékuiwo xɔxɔ.

5. Intramedullary nail fixation nyuie o

6. Suklidɔ alo dɔléle bubu siwo wozãna tsɔ ƒoa ƒui.

Atikewɔwɔ me Gbagbãƒewo

Atikewɔwɔ ƒe gbagbã koŋ nyea gbagbã evelia si tsoa asitɔtrɔ le eŋu le mɔ gbegblẽ nu le ɖa si wotsɔ blaa ɖa le lãkusi me gbɔ.

Ele be woalé ŋku ɖe eŋu le dɔwɔwɔ nɛ me

1. Tiatia si mesɔ o le afisi ɖaa age ɖo ate ŋu ana ɖaa nagbã.

2. Mègatutu medulla ƒe kekeme sesẽe o.

3. Ele be afisi ʋuʋudedi ƒe kekeɖenudɔa le la nanɔ mɔ ɖeka dzi kple afisi wotsɔ ɖaa de eme.

4. Mègazã ŋusẽ ne èle ɖa siwo le lãkusi me dem eƒe nuwuwu si le didiƒe o.

Vevesese le ƒunukpeƒe siwo te ɖe wo ŋu me

1. Ne wotsɔa ɖa si le lãkusi me la dea lãmeka falɛfalɛwo kple ƒunukpeƒe ƒe lãkusi gɔ̃ hã si te ɖe ƒunukpeƒe 1 ya teti ŋu.

2. Tibial plateau la do ƒome kple medial meniscus ƒe ŋgɔgbekpa to klo ƒe lãkusi si le tsia dzi eye wòwɔa teƒe si le dedie le tibial tuberosity tame vaseɖe afisia. Ne afisi woƒoa ɖa le la te ɖe etame akpa alo ɖa si le lãkusia me ƒe didime lolo akpa la, ate ŋu agblẽ nu le ƒunukpeƒea ƒe wɔwɔme ŋu, si ana klo nase veve le dɔwɔwɔ vɔ megbe.

3. Intramedullary nail ƒe protrusion si te ɖe eŋu kple heterotopic ossification ye nye nu vevi siwo hea akɔtave vɛ le femoral intramedullary nail dɔwɔwɔ vɔ megbe.

4. Intramedullary nails ƒe protrusion si te ɖe eŋu, proximal locking nail irritation kple rotator cuff interference nye nu vevi siwo gbɔ abɔta vevesese tsona le humeral intramedullary nailing megbe.