5 Intramedullary Nail zazã ƒe gɔmeɖosewo kple amekokomɔnu!

Gɔmeɖose vevi siwo ku ɖe intramedullary nailing ŋu .

1. History of intramedullary nailing .

Le ƒe 1910 me la, wozã Lilienthal aluminum intramedullary ɖa tsɔ da afɔkpodzi ƒe asike ƒe gbagbã.

Le ƒe 1913 me la, Schone zã klosalo ƒe lãkusiwo tsɔ da abɔta ƒe gbagbã. 

Kuntscher (ƒe 1900-1972) wɔ akpa gã aɖe le lãkusi me ƒoƒo me. 

Ƒe 1960 kple 1970 ƒeawo nye ɣeyiɣi si me lãkusiwo va le tsitsim kabakaba. 

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

2. Ðeɖekpɔkpɔ le gaglãgbe kple edzi ɖeɖe kpɔtɔ si wotu .

1. Woate ŋu awɔ dɔ na abɔ kple afɔ ƒe gbagbã le ŋkume tẽ alo woaxee le X-ray ƒe ŋkuléle ɖe eŋu te.

2. Open reduction fracture dɔyɔyɔ ɣeyiɣi didi vie, intraoperative bleeding nye geɖe wu, eye gaglãa dzi ɖeɖe kpɔtɔ gagblẽa ʋu ƒe sisi yi ɖagbã ƒe nuwuwu.

3. Wokafui be woazã nu siwo dzi woɖe kpɔtɔ si wotu ɖe nu dzi alesi woate ŋui. Woate ŋu azã traction reducer, alo woate ŋu aɖe nu sue aɖe le fracture plane la dzi atsɔ aɖe ʋu ƒe sisi dzi akpɔtɔ, si ana woaɖe nusiwo doa kplamatse ʋu si le gbagbãƒea ƒe nuwuwu dzi akpɔtɔ.

4. Le nuɖeɖe ɖe nu dzi ɖeɖe kpɔtɔ ƒe kpododonu, ƒu kakɛwo ʋuʋu alo wo ƒoƒo ɖe lãkusi siwo ƒo xlã wo me, kple ƒu ƒe gbagbã ƒe kakɛ gã siwo woɖe ɖa ta la, woate ŋu azã amekoko ƒe ɖeɖekpɔkpɔ le ʋuʋu ɖi me.

3. fixation mechanism of intramedullary nail .

1. Mɔnu si nye intramedullary nail ememe fixation nye symmetrical titina ememe splint fixation.

2. Afɔkpodzi ƒe ƒuƒoƒo ƒe fixation to intramedullary nail nye nuteɖeamedzi-mamã ƒe fixation, ke menye nuteɖeamedzi-shielding fixation, si sɔ na syping of callus.

3. Central fixation de ŋgɔ wu cortical external fixation, si ate ŋu aɖe ŋusẽ ƒe alɔ dzi akpɔtɔ, aɖe valgus angulation kple ememe fixation ƒe kpododonu ƒe dzɔdzɔ dzi akpɔtɔ.

4. Intramedullary nail fixation naa gɔmeɖokpe na closed reduction alo limited open reduction.

4.Viɖewo le lãkusi me ɖawo .

1. Kuxi ʋɛ aɖewo koe li .

2. Amekoko ƒe dzesiwo ƒe lolome si keke ɖe enu .

3. Firm Fixation .

4. Hehenana ƒe hehexɔxɔ gbãtɔ le ƒuƒoƒo me .

5. Kpekpeme gbãtɔ ƒe tsɔtsɔ .

6. Woate ŋu azãe ɖekae kple ememe fixation bubuwo .

Basic ƒomeviwo kple aɖaŋuwo .

1. Ʋu ƒe ʋuʋu kple ʋuʋudedi si meʋu o .

2. Dynamic kple static locking intramedullary nails .

3. Medullary kekeɖenudɔwɔwɔ kple non-medullary fixation techniques .

4. Mɔnu siwo wozãna tsɔ léa nu ɖe ​​nu ŋu siwo woʋuna kple esiwo wotu .

Interlocking kple non-interlocking .

Intramedullary nails dzrowo ƒe axial li ke nyuie eye torsional strength si le sue ŋutɔ, gake woƒe tete aɖe le wo ŋu eye woate ŋu ahaya le woƒe deformation megbe, si wɔnɛ be intrabone sliding sue aɖe koe nɔa wo ŋu.

Intramedullary nails siwo le wo nɔewo ŋu la ƒe anti-trotation kple anti-compression ƒe ŋusẽkpɔɖeamedziwo nyo wu, fixation stability nyui, eye wowɔ ɖeka kple gɔmeɖose si nye biological fixation. Wozãa wo geɖe le abɔwo ƒe ƒu didiwo me. Vevietɔ na akpa vovovowo kple ƒuƒoƒo ƒe gbagbã, woƒe liƒo nyo wu lãkusi dzrowo.

Dynamization of static fixation .

Static locking intramedullary nails wɔa stress masking sue aɖe ŋutɔ eye fifia woʋlia non-routine action of dynamization ta.

Le ƒu gbagbã siwo mehaya le ɣleti 6 va ɖo 8 me le dɔwɔwɔ vɔ megbe o gome la, wozãa ƒu ƒe ƒoƒo ɖe teƒe ɖeka le teƒea alo wotsɔa lãkusi siwo keke ɖe enu siwo me ʋuʋudedi le la ɖɔliɖɔli.

Woate ŋu azã dynamization abe mɔnu si dzi woato ado ƒu ƒe gbagbã ɖe ŋgɔ ene. Womekafui edziedzi o elabena ate ŋu ana abɔ kple afɔ ƒe kpuiƒe kple tɔtrɔ ƒe nɔnɔme natrɔ.

Marrow kekeɖenudɔwɔwɔ kple kekeɖenudɔwɔwɔ si menye marrow o .

Marrow kekeɖenudɔwɔwɔ ate ŋu ade lãkusi me ɖa siwo ƒe didime lolo wu eye ŋusẽ le wo ŋu wu, si sɔ na dɔwɔwɔ ƒe hehexɔxɔ kaba eye wòɖea ɖa gbagbãwo ƒe agbɔsɔsɔ dzi kpɔtɔna.

Lãmetsiwo ƒe keke ɖe enu ate ŋu ana ƒu ƒe akpa gã aɖe si me ƒumeŋuɖui ƒe ŋusẽkpɔɖeamedzi le, si sɔ na gbagbã ƒe dɔyɔyɔ.

Lãmetsiwo ƒe keke ɖe enu agblẽ nu le nunyiame ƒe ʋukawo kple lãkusi ƒe lãkusi ŋu, gake ʋukawo ate ŋu agbugbɔ awɔ le lãkusi siwo le lãkusia me ƒe do me. Lãmetsiŋusẽ ƒe keke ɖe enu hã ate ŋu ana ʋu nayi edzi anɔ lãkusi falɛfalɛ siwo ƒo xlãe me, si ana be ƒunukpeƒetetedɔ ƒe dɔyɔyɔ nanyo ɖe edzi.

Lãmetsiŋusẽ ƒe keke ɖe enu dzina ɖe edzi vie be dɔlékuiwo kple ʋuka me dɔléle ƒe mɔnukpɔkpɔ dzina ɖe edzi, eye ele be woaɖɔ ŋu ɖo le eƒe gbagbã le gaglãgbe, abi geɖe xɔxɔ, kple abi siwo nu sẽ ta.

Viɖe siwo le medullary kekeɖenudɔwɔwɔ ŋu .

1 Le medullary kekeɖenudɔwɔwɔ megbe la, kadodo ƒe teƒe si le lãkusi si le lãkusia me kple ƒu dome dzina ɖe edzi, si wɔnɛ be fixation ƒe liƒo nyona ɖe edzi. 

2 Le medullary kekeɖenudɔwɔwɔ megbe la, woate ŋu azã ɖa si ƒe didime lolo wu si ƒe didime le abe lãkusi ene, si dzia ɖa si le lãkusia me ƒe ŋusẽ ɖe edzi eye wòɖea ɖa gbagbãwo ƒe agbɔsɔsɔ dzi kpɔtɔna. 

.

Ne wotsɔe sɔ kple medullary expansion intramedullary nails la, viɖe siwo gbɔna le lãkusi siwo me womekeke ɖe enu o me .

1 Ɣeyiɣi kpuitɔ kekeake ƒe dɔwɔwɔ kple ʋu si me ʋu le ʋɛ wu. 

2 Womedea nu ʋu ƒe sisi le lãmenugbagbeviwo me le nɔnɔme siwo me woxɔ abi vevie le lãkusiwo me la me o.

Atike si wotsɔna ƒoa ɖae ƒe dɔwɔwɔ .

Humeral Interlocking Intramedullary Nail .

Nusiwo fiaa humeral nails .

Nusiwo fia be humeral interlocking intramedullary nails le humeral shaft fractures dada mee nye: gbagbã kple ʋukawo kple lãmekawo ƒe gbegblẽ, abi geɖe, ƒunukpeƒetetedɔ si meli ke o, dɔléle ƒe gbagbã, kple humeral fractures si le proximal.

Afisi woate ŋu aɖɔ ɖo la le 2cm te le humeral ta la te va ɖo 3cm le Olecranon fossa la tame. Àte ŋu atiae be yeatsɔ antegrade intramedullary nail aɖɔe ɖo tso abɔta alo tso abɔta kple retrograde nail.

Akɔta ƒe ɖawo ƒe nɔnɔmewo .

Amekoko ƒe fixation mɔnuwo na humeral shaft fractures koŋ nye plate fixation kple intramedullary nail fixation.

Plate fixation ƒe anti-trotation kple anti-bending ŋutetewo le eye wòle sesẽm, gake amekoko ƒe nuveviwɔamea lolo, dɔlékui ƒe kakaɖedzi sɔ gbɔ, eye radial nerve gblẽna bɔbɔe.

Egbegbe humeral interlocking kple self-locking nails ɖua gbɔdzɔgbɔdzɔ siwo le intramedullary ɖa dzrowo abe axial instability, poor rotation control, kple hiahiã na fixation bubu, ale be fracture la li ke, ʋu ƒe tsɔtsɔ yi ŋgɔe, eye medullary striping la le sue, eye medullary is is evenly, eye medullary is.

Femoral Interlocking Intramedullary Nail .

Nusiwo fiaa afɔtiwo ƒe ƒuƒoƒo siwo ƒoa ƒu ɖe wo nɔewo ŋu .

Gbagbã ƒomeviwo katã 2cm le trochanteric vertebra te kple esi wu 9cm tso klo ƒe ƒunukpeƒe.

Afɔkpodzi ƒe akpa si le titina ƒe gbagbã xoxowo.

Dɔnɔ siwo ƒe plate ememetɔ si do kpo nu.

Features of femoral interlocking nail .

Mɔ̃ɖaŋununya ƒe viɖewo .

Afɔdzideƒe ƒe ŋusẽ ƒe alɔ si wotsɔ ƒoa ƒu ɖe lãkusia me hena ɖa ƒe gbagbãwo ɖɔɖɔɖo didi wu gakpo gbadzɛwo tɔ, eye womãa ŋusẽa ɖe ƒu bliboa ƒe titina axis dzi, si mele bɔbɔe be woabɔbɔ eye wòagblẽ o.

Aɖatsi siwo wotsɔna ƒoa ɖa le lãkusia ƒe nugbɔ eveawo nana be ƒu la ƒoa ƒu ɖekae tso etame vaseɖe ete, eye ɖaƒoƒo siwo le eƒe nugbɔ didi la ate ŋu aɖe lãkusi si le ƒu me ƒe torque arm dzi akpɔtɔ, axe mɔ na shorteing kple rotations, eye woakpɔ liƒo kple sesẽ si sɔ gbɔ wu na fracture fixation.

Gamma interlocking intramedullary nail .

Gamma ɖa ƒe dzesiwo .

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

Gamma ɖa si keke ɖe enu (gbugbɔgaɖɔɖo ƒe ɖa) ƒe dzesiwo .

Subtrochanteric fractures kɔkɔ, trochanteric si wotsɔ ƒo ƒu kple afɔkpodzi ƒe asike ƒe gbagbã.

Viɖe siwo le Gamma Nail ŋu .

Wotoe vɛ to akɔta ƒe ʋuƒo si wotsɔa ʋuʋudedi ƒoa ƒui kple ɖaƒoƒo ƒe mɔ̃ɖaŋununya si wotsɔ ƒoa ƒu ɖe lãkusi me la ƒoƒo ƒu me, eye ƒoƒoe vevitɔa te ɖe lãkusia ƒe akpa si le eme ŋu wu akɔta ƒe akpa si le ʋuʋum, eyata gamma ɖa la kplɔa dɔnɔa ƒe kpekpeme ɖe afɔkpodzi ƒe calcar ŋu wu akɔtagbalẽvi si le ʋuʋum, si dzia mɔ̃ɖaŋununya ƒe ŋusẽ si le lãkusia me ɖe edzi. Le subtrochanteric fractures si me medial cortical comminution le gome la, gamma nail ƒo asa na alesi wòhiã be woagbugbɔ awɔ ŋutilã ƒe wɔwɔme, eyata eɖea vi na intertrochanteric fractures alo subtrochanteric fractures.

Retrograde Intramedullary Afɔkpodzi ƒe Afɔdzideƒe .

Nusiwo ɖea akɔta ƒe ɖawo fiana le megbe .

Wozãnɛ koŋ na supracondylar femoral ƒe gbagbã, siwo dometɔ aɖewoe nye supracondylar comnumed fractures kple intercondylar 't' kple 'y' comminud fractures siwo ku ɖe articular surface ŋu.

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 agba me.

Nɔnɔme siwo le retrograde femoral nailing .

Supracondylar femoral fracture nye gbagbã vevie si me kuxi sesẽ le le gbãtɔ, edziɖeɖekpɔ kple evelia, ememe fixation sesẽ. Kuxiwo abe fracture non-union kple Healing Healing si tsi megbe ene ƒe dzɔdzɔ sɔ gbɔ ŋutɔ.

Retrograde interlocking intramedullary nailing nye mɔnu si wozãna zi geɖe tsɔ daa akɔta ƒe akpa si le didiƒe le ƒe ʋɛ siwo va yi me, si me mɔ̃ɖaŋununya ƒe liƒo nyui le, ate ŋu aɖu megbe ƒe ʋuʋu kple tɔtrɔ ƒe ʋuʋu si le gbagbãƒea ƒe nuwuwu didi dzi nyuie, eye wòkpena ɖe ƒunukpeƒe ƒe ʋuʋu gbãtɔ ŋu.

Supracondylar nye afɔkpodzi ƒe ke ƒe gbagbã si woƒo ƒu la nye esi wotsɔ supracondylar intramedullary nailing didi ɖo, si kpɔa kuxi si gbɔ kpɔkpɔ sesẽ gbɔ to akɔta ƒe lãkusi si wotsɔ ƒo ƒu ɖe akɔta ƒe lãkusi me. Dɔwɔnua zazã le bɔbɔe, eƒe nɔnɔme sɔ pɛpɛpɛ, woate ŋu aka ɖe edzi le fixation me, eye dɔnɔa ate ŋu awɔ klo ƒe kamedede kaba le amekoko vɔ megbe.

Tibial interlocking intramedullary nails .

Nusiwo fia be woatsɔ awɔ tibial nailing .

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

Akpa siwo me li ke o le titina ƒe afɔkpodzi ƒe didime ƒe 60% me: ƒuƒu siwo te ɖe metaphysis ŋu, ƒunukpeƒewo ƒe gbagbã legbewo, akpa vovovowo ƒe gbagbã, ƒu gbagbã siwo me ƒu ƒe gbagbã le.

Tibial ƒe lãgbalẽgolo ƒe nɔnɔmewo .

Wozãa afɔkpodzi ƒe ƒoƒo ɖe ʋuka me ƒe ƒoƒo ɖe wo nɔewo ŋu zi geɖe na afɔkpodzi ƒe titina ƒe gbagbã.

Togbɔ be woateŋu azãe hã na proximal kple distal tibia ƒe gbagbã hã la, kuxi ƒe agbɔsɔsɔme sɔ gbɔ wu, malunion dzɔna zi geɖe wu, fracture end la ƒe ≧1cm ƒe ʋuʋu le 1/2 me le nɔnɔmeawo me, eye 1/4 le fixation me do kpo nu.

Agbalẽwo ka nya ta be nu nyui si dona tso ʋuka siwo le didiƒe ƒe gbagbã me wu proximal tibia fracture le fibula ƒe fibula ɖoɖo edziedzi megbe.

Amekokomɔnu .

Dɔwɔnu Tɔxɛwo dzadzraɖo do ŋgɔ na dɔwɔwɔ na ame .

Ƒumeŋuɖui ƒe aba (abati si wotsɔa agbawo ɖona) alo amekoko ƒe aba si wotsɔa fluoroscopic wɔe si wozãna ɖaa; retractor; Nɔnɔmetata ƒe ŋusẽdodo.

Tiatia si sɔ le intramedullary ɖa ƒe didime na do ŋgɔ na dɔwɔwɔ endoprostheses .

Radiograph .

Alɔ abɔ kple afɔ ƒe didime ƒe didimedzidzenu .

Intramedullary ƒe ɖa ƒe didime .

X-ray isthmus ƒe kekeme .

Intramedullary ƒe ɖa ƒe didime dzidzedze .

1.Translucent dziɖula ƒe tameɖoɖo kplikpaa le C-Arm mɔ̃ te .

Ƒua ƒe nugbɔ siwo le didiƒe kple esiwo te ɖe wo nɔewo ŋu la nɔ keklẽa ƒe titina; Dzidzenua sɔ kple diaphysis la.

2.didime dzidzedze le ŋutilã ƒe anyigba ƒe dzesiwo nu .

Afɔkpodzi: Trochanter si lolo wu ƒe nugbɔ → klo ƒe teƒe si le axadzi alo patella ƒe atikpo si le etame; Tibia: Medial-lateral klo ƒe teƒe → ŋgɔgbe ƒe akpa si le afɔkpodzi ƒe ƒunukpeƒe le afɔ ƒe dorsiflexion me.

Intramedullary nail insertion technique - mɔnu si dzi woato age ɖe eme .

Longitudinal axis of the medullary cavity le fli dzɔdzɔe dzi .

Menye ɖe wòte ɖe afisi woage ɖo ŋu fũ o .

didime si sɔ: Dilated - didi; Undilated - Kpuie ko .

(Kpeɖodzi si mele tẽ o le afisi wogena ɖo ŋu; no pulp dilation, no soft tissue protection mehiã o)

Parallel femoral intramedullary nail entry point .

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

Hip flexion kple adduction .

Longitudinal incision si te ɖe trochanter gãtɔ ŋu .

Menye didiƒe akpa le megbe o .

Mɔfiame Pin la ɖoɖo ɖe teƒe aɖe .

Akpoxɔnu si le lãkusi falɛfalɛa me ɖoɖo ɖe teƒe aɖe .

Retrograde femoral intramedullary nail entry point .

30° klo ƒe ʋuʋu .

Mɔfiame pin la ƒe axa didi si le mɔ ɖeka dzi kple afɔkpodzi ƒe lãkusi si le didiƒe ƒe medullary cavity .

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

PCL ƒe gɔmedzeƒe .

Parallel tibial intramedullary nail entry point .

le medullary cavity ƒe titinamɔ dzi .

Tibial Plateau ƒe ŋgɔgbekpa dzi .

kɔkɔ alesi woate ŋui evɔ womagblẽ nu le gbadzaƒea ŋu o .

Klo ƒe ʋuʋu si sɔ gbɔ wu .

Incision tibial tuberosity-ame si le anyime ƒe atikpo si le patella le medullary cavity .

Ʋu medullary cavity: guide pin at 15° to sagittal plane of the longitudinal axis of the tibial stem .

Nɔnɔmetata ƒe Dɔwɔƒe ƒe Nɔnɔme .

Aɖaŋudɔwo wɔwɔ ƒe aɖaŋuwo .

Elektrikŋusẽ ƒe ŋusẽ dzi ɖeɖe kpɔtɔ .

Fractures yeyewo .

Asiɖeɖe le eŋu kple asi .

Akɔta ƒe gbagbã kple pseudoarthrosis, sclerosis le medullary cavity .

Tourniquet aɖeke mele ga ƒe asixɔxɔ dzi o .

Ʋu ƒe sisi nye fafanu nyuitɔ kekeake .

Mɔnuwo Gbugbɔgaɖoanyi ƒe Mɔnuwo .

Parallel femoral intramedullary nailing .

Susu siwo tae wòsesẽna be woagbugbɔ afɔkpodzi ƒe gbagbãwo aɖo anyi .

Lãmetsi falɛfalɛ siwo le ɣie meɖea mɔ be woate ŋu age ɖe ƒua me tẽ o .

Womate ŋu akpɔ aŋe si wotsɔna gena ɖe eme la le susu me tẽ o .

Hip joint adduction → Iliac fascia tension → Fracture shortening

Tibial ƒe gbagbã dzi ɖeɖe kpɔtɔ .

Ameflunyawo .

akpa gãtɔ nyea ŋutigbalẽ te eye wofaa asi ɖe wo ŋu bɔbɔe .

Fli si woli ke - titina alo didiƒe A kple B ƒomevi ƒe gbagbã .

Oblique fractures - overkill .

Intramedullary Nailing→Atikewɔnuwo ƒe Dɔwɔnuwo .

Afɔɖeɖe siwo wowɔna tsɔ ɖea wo dzi kpɔtɔnae .

Point Reduction Forceps .

afɔkpodzi; Percutaneous alo abi zazã .

Retractors gãwo (braces) .

dzi ɖeɖe kpɔtɔ si wohe ɖe megbe; Abɔ kple afɔ ƒe kpuiƒe .

Ɣeyiɣi kpui aɖe ƒe SCHANZ Screws .

1 Afɔkpodzi, afɔkpodzi

2 Alesi wòte ɖe gbagbãƒea ŋu alesi woate ŋui .

3 Proximal fracture ɖeka cortical zazã .

2Sese a universal chuck with a t-handle for easy maneuvering .

Poller Nail .

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

2 Ʋu ƒe akpa si le didiƒe alo afɔkpodzi ƒe gbagbã si le tsia dzi (Shear stress → pressure)

.

1

Tourniquet si keke ɖe enu wu .

1 Tibia .

2 Wotsɔ traction alo retractor kpe ɖe eŋu

1 Zãe kple ŋuɖɔɖɔɖo le abi sesẽ siwo le lãkusi falɛfalɛwo me ŋu .

1 Na wòanɔ kpuie .

6 xe mɔ ɖe medullary kekeɖenudɔwɔwɔ nu le dukɔ si me ya le la me .

Nail locking sequence: Distal then proximal .

Viɖewo .

Blackback bɔbɔe, compression of fracture breaks; vovototodedeameme ɖeɖeɖa; Dɔwɔwɔwo dzi ɖeɖe kpɔtɔ ƒe dɔwɔnawo.

Mɔnu siwo dzi ɖena kpɔtɔna le dɔwɔwɔ na ame si tsi megbe & si me womedea senion o me .

Kuxi siwo woate ŋu ado goe le amekoko si wohe ɖe megbe ŋu .

Axial deformity (Shortening, angulation kple alo displacement) .

Tsitsi le ƒe granulation tissue .

Ƒumeŋuɖui gbãtɔwo .

Sclerosis of fracture breaks kple medullary cavity ƒe nutsotso .

Ƒumeŋuɖui .

Kuxi siwo ate ŋu ado mo ɖa le dɔwɔwɔ na ame me .

Expander kple intramedullary nail ƒe ʋuʋu → Intramedullary nail ƒe gege ɖe lãkusi me .

Angular deformity → Retractor .

Dislocation of setled ends → Poller ƒe ɖa, plate fixation .

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

Proximal - Teƒe si sɔ si dzi nàto age ɖe eme .

Distal - Intramedullary nail le medullary cavity titina .

Kuxi siwo dona tso lãkusi me ƒoƒo me .

★Dɔlékuiwutike .

★Drɔ̃ nu le nusiwo gblẽ ŋu .

★Wotɔtɔ gbagbãwo le gbagbãwo ŋu .

★Atikewɔwɔ ƒe gbagbãƒewo .

gotagome tɔtrɔ, torsion, valgus, ememe tɔtrɔ, angulation .

★Akpɔnɔ si te ɖe eŋu si te ɖe eŋu .

★Ami ƒe ʋuʋu .

★Heterotopic ossification .

★Adzɔkaka na aklãdɔ .

★Gbugbɔna-gbeɖiɖi .

★Thrombosis .

★Joint Sesẽ .

★Non-union of fracture, ƒu nonunion .

★Ememe fixation ƒe kpododonu .

★Abɔ ƒe kpuiƒe .

★bubuwo .

Kuxiwo--dɔlékuiwutikewo .

1.Ga kaba la, wobua gbagbãƒe siwo le ʋuʋu ɖi be wonye nusiwo tsi tre ɖe intramedullary nailing ŋu.

2.Dɔléle vɔ̃ɖi ƒe dzɔdzɔ le ʋuʋudedi siwo le ʋuʋu ɖi me nɔ te ɖe alesi wòxɔa abi le lãkusi falɛfalɛwo me kple ɖiƒoƒo ƒe nɔnɔme me .

Dɔlékui ƒe dzɔdzɔ le eƒe gbagbã le ʋuʋu vɔ megbe nɔ te ɖe alesi wòxɔa abi le lãkusi falɛfalɛwo me kple eƒe ɖiƒoƒo kpakple alesi wokpɔa lãkusi falɛfalɛa dzii dzi.

3.Thinner intramedullary nails dzia mɔnukpɔkpɔ si li be woaxɔ dɔlékuiwo ɖe edzi; Non-expanded locking intramedullary nails fixation menyo tututu o, eye ƒu ƒe nugbɔwo le .

Aɖatsi si wotsɔna ƒoa ɖae si womekeke ɖe enu o la menyo tututu o, eye ƒu ƒe nugbɔ si gbã la ƒe ʋuʋu le nusuekpɔmɔ̃ me kpakple do susɔea, si le bɔbɔe na dɔlékuiwo ƒe tsitsi.

4. Menye ɖeko medullary fixation si keke ta eye wòkeke ɖe enu si keke ɖe enu zazã nana be gbagbãƒea ƒe liƒo nyona ɖe edzi ko o, ke eƒoa asa na teƒe kuku aɖe wɔwɔ hã.

Ami Embolism Syndrome .

1.FES ƒe ƒu ƒe gbagbã legbewo ƒe FES ƒe dzɔdzɔ nye 0.5% va ɖo 2%.

2. Medulla ƒe keke ɖe enu kple medulla ƒe kekeme si mekeke ɖe enu o mekpɔa ŋusẽ ɖe aklã ƒe yaƒoƒo dzi boo o.

3.Ne wole medulla la kekem ɖe enu la, ele be aɖaŋua nanɔ ƒoƒom blewuu, aƒo asa na ŋusẽ kple dɔwɔwɔ sesĩe akpa.

4.FES ƒe dzesi si le edzi yim fifia la gakpɔtɔ le dzidzenu siwo GURD do ɖa le ƒe 1974 me la xɔm, eye atikewɔwɔ le dɔlélea didi vɔ megbe ana ɣeyiɣi nyuitɔ si woatsɔ ada dɔa nahe ɖe megbe eye ate ŋu ahe emetsonu sesẽwo vɛ.

Wohe ɖe megbe le gbagbãƒe ƒe dɔyɔyɔ kple ƒu me nonunion .

Nu vovovowo kpɔa ŋusẽ ɖe ƒuƒu ƒe gbagbã dzi le ɖa ƒe ƒoƒo ɖe lãkusi me megbe, eye woate ŋu adzro nusiwo gbɔ wòtso me abe alesi gbɔna ene.

1.Lãmelã si wotsɔ ƒo ƒu ɖe gbagbãƒea ƒe nuwuwu .

2. Vovototo si le ŋgɔgbeƒuƒu ƒe nuwuwu ƒe nuwuwu .

3. Ƒe si dɔnɔa xɔna wu .

4. Ʋuʋu ƒe gbagbã, abi gã aɖe si le lãkusi falɛfalɛwo ŋu, ʋumenugbagbeviɣidɔ sesẽ alo dɔlékuiwo xɔxɔ le nutoa me.

5. Intramedullary ƒe ɖaƒoƒo madeamedzi .

6. Suklidɔ alo dɔléle bubu siwo wotsɔ ƒo ƒui.

Atikewɔwɔ ƒe gbagbãƒewo .

Atikewɔwɔ me ƒe gbagbãƒewo koŋue nye evelia ƒe gbagbã siwo tsoa asitɔtrɔ le ame ŋu le mɔ si mesɔ o nu le ɖaƒoƒo le lãkusi me me.

Ele be woalé ŋku ɖe dɔwɔwɔ na ame le dɔwɔwɔ me ŋu be .

1. Tiatia si mesɔ o le ɖa ƒe gege ɖe teƒe si woate ŋu age ɖo ate ŋu ana woagbã le proximal.

2. Mègaƒoe sesĩe le medulla la ƒe kekeɖenudɔwɔwɔ me o.

3. Ele be pulp expansion ƒe mɔnu nanɔ mɔ si sɔ kple mɔfiame si le ɖaƒoƒo ƒe mɔfiame nu.

4. Mègazã ŋusẽ ne èle ɖa siwo le lãkusia me dem nugbɔ si le didiƒe la me o.

Vevesese le ƒunukpeƒe siwo te ɖe wo ŋu me .

1. Aɖatsi si le lãkusi me dada ɖe eme lɔ lãkusi falɛfalɛ kple ƒunukpeƒetetedɔ gɔ̃ hã ɖe eme le ƒunukpeƒe 1 ya teti ƒe nuto me.

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

3. Proximal protrusion of intramedullary nail kple heterotopic ossification nye nusiwo koŋ gbɔ akɔta ƒe vevesese tsona le afɔkpodzi ƒe lãkusi ƒe dɔwɔwɔ vɔ megbe.

4. Proximal protrusion of intramedullary nails, proximal locking nail irritation kple rotator cuff interference nye nusiwo koŋ gbɔ abɔta ƒe vevesese tsona le humeral intramedullary nailing megbe.