Distal Tibia Fracture Management: Nusita Retrograde IM Nailing Wɔ dɔ Wu Plate Fixation le Soft Tissue Compromise me
Kɔdzi: Hospital Nacional de Traumatología, Lima, Peru
Amekola: Ðɔkta Carlos Eduardo Vega, MD (Ƒemekawo ƒe Nuveviwɔame)
Ɣletiŋkeke si dzi dɔlélea dzɔ le: September 2025 |
Agbalẽ si wota: December 2025
Dɔnɔdzikpɔƒe ƒe Kpuie: Wozã XC Medico ƒe retrograde intramedullary nail (DTN) system tsɔ kpɔ ŋutsu aɖe si xɔ ƒe 38 si xɔ abi le eƒe afɔkpodzi si le didiƒe ʋĩ la gbɔ. Togbɔ be lãmeka falɛfalɛawo gblẽ vevie hã la, ƒu ƒe ɖekawɔwɔ sesẽ le dɔnɔa ŋu le kwasiɖa 12 me, egatrɔ va eƒe kpekpeme dzi bliboe le kwasiɖa 16 me, eye wògblɔ be kuxi aɖeke menɔ eŋu o. Nudzɔdzɔ sia ɖe nusitae DTN ƒe tsɔtsɔ ɖe megbe nyo wu plate fixation ne lãmeka falɛfalɛwo ƒe agbalẽkotokuwo gblẽ la fia.
Ɖoɖowɔɖi: Kuxi si le Distal Tibia Fractures ŋu
Distal tibia fractures nye 7-12% le tibial fractures katã me eye wohea amekoko ƒe kuxi tɔxɛwo vɛ. Distal tibia ƒe ŋutilã ƒe wɔwɔme—metaphyseal nuto si keke tsɔ kpe ɖe lãkusi falɛfalɛ suetɔ kekeake si tsyɔ nu le ŋgɔgbe kple titina ƒe akpa dzi—na be afɔku le ʋuka si le ʋuʋu ɖi si wozãna tsã la me léle ɖe te le nuveviwɔame ƒe nɔnɔme siwo me woxɔ abi le wo gbã alo lãmeka falɛfalɛwo ƒe nugbegblẽ sesẽwo me.
Le ŋutinya me la, amekolawo ɖoa ŋu ɖe ʋuʋu si le ʋuʋu ɖi kple plate fixation ŋu, si bia be woatso ŋgɔgbe kple titina ƒe akpa gã aɖe to lãkusi siwo ŋu abi le me. Le abi siwo woxɔna le abi siwo wogbã me la, mɔnu sia dzia dɔlékuiwo ƒe agbɔsɔsɔ ɖe edzi va ɖoa 15-25% eye wònaa lãmeka falɛfalɛwo ƒe dɔyɔyɔ sesẽna. Retrograde intramedullary nailing (DTN) ƒoa asa na kuxi siawo to afɔkpodzi ƒe gegeƒe si mewɔa nu boo aɖeke o zazã me, si naa nusiwo de ŋgɔ wu dona tsoa eme le nɔnɔme siwo tututu me plate fixation sesẽna wu me.
'Menye mɔnu bubu si woate ŋu azã ɖe plate fixation teƒe koe Retrograde DTN nye o—enye tiatia nyuitɔ ne lãmeka falɛfalɛwo gblẽ.' — Ðɔkta Carlos Eduardo Vega, Attending Trauma Surgeon
Nya la Gbɔgblɔ: Nuveviwɔame si Wogbã Kple Metaphyseal Fracture
Dɔnɔ: Miguel Rodríguez Santana (womeyɔ eƒe ŋkɔ o), ƒe 38, xɔtudɔdzikpɔla
Nuveviwɔame: Ʋufɔku si me ʋufɔku si ƒe kpekpeme nye tɔn 2 scaffolding bar gbã ɖe ɖusifɔ ƒe anyime (aɖabaƒoƒo 3 ƒe nutete)
Ɣeyiɣi si woɖo ɖi na OR: gaƒoƒo 8 le abixɔxɔ megbe
Gbagbã ƒe Nɔnɔme: Transverse distal metaphyseal tibia fracture + oblique distal fibula fracture
Dɔnɔdzikpɔƒe ƒe Dzodzro
Miguel va do kple abi vevie, ecchymosis, kple lãmeka falɛfalɛwo ƒe ʋuʋu le ŋgɔgbe kple titina ƒe afɔkpodzi. Wodzidze xɔmenuwo ƒe nyaƒoɖeamenu 45 mmHg (dzidzenu si ŋu woatsi dzi ɖoe nye 30-40 mmHg), si fia be afɔku le akpata ƒe dɔléle sesẽ me. Woate ŋu akpɔ ʋu ƒe sisi le didiƒe; ahɔhɔ̃mekawo ƒe dodokpɔ si me gblẽ o. Vevietɔ la, ŋutigbalẽa gakpɔtɔ nɔ tutu—si nye viɖe na ɖaƒoƒo ɖe megbe elabena abi siwo le ʋuʋu ɖi mesesẽna be woaɖee ɖe go o.
Nɔnɔmetatawo Ŋuti Numekuku
Gbagbã ƒe Nɔnɔme:
- Tibia: Transverse fracture le distal metaphyseal nuto me, ~8cm le afɔkpodzi ƒe mortise dzi
- Fibula: Gbagbã bɔbɔe si le tsia dzi le etɔ̃lia si le didiƒe
- Metaphyseal ƒe kekeme ƒe sɔsɔme: Isthmal ƒe didime 10.5mm vs metaphyseal ƒe kekeme 28mm (2.7× flare)
- Lãmetsi Falɛfalɛwo ƒe Nɔnɔme: Nuveviwɔame sesẽ si woxɔna le lãmekawo me kple ʋuʋudedi kple ʋuʋudedi; abi aɖeke meli si le ʋuʋu ɖi o
Amekoko ƒe Mɔnu: Retrograde DTN vs. Plate Fixation
Le Miguel ƒe abixɔxɔ gome la, wotia megbedede intramedullary nailing wu plate fixation le biomechanical kple soft tissue ŋu bubu ta:
| Factor |
Retrograde DTN |
Open Plate Fixation |
Clinical Implication |
| Lãmetsi Falɛfalɛwo Ƒe Ʋuʋu |
Minimal (afɔkpodzi ƒe gege ɖe eme) . |
Do gã aɖe si woɖe le ŋgɔgbe kple titina |
DTN ƒoa asa na lãmenugbagbeviwo ƒe akpa siwo me nuveviwɔame le |
| Dɔlékuiwo ƒe Afɔku (Crush) . |
3-8% . |
15-25% ƒe xexlẽme. |
DTN ɖea dɔlékuiwo xɔxɔ ƒe afɔkua dzi kpɔtɔna 50-75% . |
| Dɔwɔwɔ ƒe Ɣeyiɣi |
Aɖabaƒoƒo 60-80 |
Aɖabaƒoƒo 90-120 |
Atike si naa alɔ̃dɔdɔ ame kpuie wu |
| Metaphyseal Dziɖuɖu |
3-point distal locking (dzogoe etɔ̃ ƒe ʋuʋu) . |
Plɛti ƒe kadodo ɖeɖeko |
DTN naa dzogoe ƒe liƒo si de ŋgɔ wu |
| Nuƒoƒoƒu Kaba |
POD 1 ate ŋu adzɔ |
POD 3-5 (abi ŋuti dzitsitsiwo) . |
DTN na be woate ŋu awɔ atike kabakaba wu |
Amekokomɔnu: Afɔɖeɖe ɖesiaɖe ƒe DTN Fixation
Afɔɖeɖe 1: Fibula Fixation (Afɔɖeɖe Gbãtɔ Vevietɔ) .
Susu si tae: Le afɔkpodzi ƒe gbagbã siwo le didiƒe si me fibula le gome kpɔm le me la, fibula wɔa dɔ abe didime ƒe nɔnɔmetata ene. Ne womeɖee le ŋutilã ƒe wɔwɔme nu o la, afɔkpodzi dzi ɖeɖe kpɔtɔ mali ke o. Wotso 5cm megbe-axadzi, woɖe gbagbã dzi kpɔtɔ, eye wotsɔ 4.5mm compression plate (3 screws proximal, 3 distal to fracture) blae. Fluoroscopic kpeɖodzi ɖo kpe fibula ƒe didime kple alesi wòsɔ ɖe wo nɔewo nu dzi. Ɣeyiɣi: Aɖabaƒoƒo 15
Afɔɖeɖe 2: Retrograde DTN ƒe Gegeɖeƒe ƒe Dzesidede
Teƒe si woage ɖo: Afɔkpodzi titina, 1.5cm le titina malleolus me, ŋgɔgbe vaseɖe megbe tibial tendon dede eme. Teƒe sia si wowɔa ŋutilã ƒe wɔwɔme le la kpɔa egbɔ be ɖa si trɔna ɖe megbe la ato lãkusia ƒe titina eye wòaɖe afɔku si le ahɔhɔ̃mekawo ƒe wɔwɔmewo me dzi akpɔtɔ.
Afɔɖeɖe 3: Wotu Ðeɖekpɔkpɔ kple Mɔfiame Ka
Wozã traction kple fluoroscopic guidance tsɔ ɖe gbagbãƒea dzi kpɔtɔ va ɖo ŋutilã ƒe wɔwɔme ƒe ɖoɖo nu. Wodo mɔfianu ka aɖe ɖe ŋgɔ wògbugbɔ yi megbe tso afisi wòge ɖo le didiƒe, to afisi wògbã le, eye wòge ɖe afɔkpodzi si te ɖe eŋu, si woɖo ɖe titina le lãkusia me. Ɣeyiɣi: Aɖabaƒoƒo 15
Afɔɖeɖe 4: Medullary Canal Reaming
Woɖe tɔdzisasrãa ɖe wo nɔewo yome tso 9mm va ɖo 11.5mm ƒe didime. Le 2.7× flare ratio (wide metaphysis) ta la, wokpɔ nyuie etɔxɛe be woaƒo asa na cortical perforations le metaphyseal nutoa me. Ɣeyiɣi: Aɖabaƒoƒo 12
Afɔɖeɖe 5: Intramedullary Nail Dede
Nusi Wozã: XC Medico Distal Tibial Intramedullary Nail – Nusiwo wotsɔna tsia megbe ƒe ɖoɖo
- Kekeme: 11mm (cannulated, titanium akɔbli)
- Didime: 340mm
- Atsyã: Anterior curve vi aɖe si sɔ kple anatomic tibia contour
- Nusi wotsɔ wɔe: Grade 5 titanium alloy (ISO 13485, CE ƒe ɖaseɖigbalẽ)
Wotsɔa ɖaa dea megbe le mɔfianu ka la dzi. Esi wòyi ŋgɔ va ɖo metaphyseal flare me la, fluoroscopic imaging ɖo kpe edzi be ɖaa ƒe nugbɔ gakpɔtɔ le intra-articular (le metaphyseal bone me, ke menye le ƒunukpeƒewo ƒe teƒe o) eye wòto vovo abe 8mm ene tso articular la ƒe anyime. Ɣeyiɣi: Aɖabaƒoƒo 15
Afɔɖeɖe 6: Teƒe Etɔ̃ Distal Locking (Afɔɖeɖe Vevitɔ) .
Screw Configuration: Wotsɔ distal locking screw etɔ̃ da ɖe dzogoe etɔ̃ ƒe nɔnɔme me be woakpɔ metaphyseal nuto gbadzaa dzi:
- Proximal Distal Screw: Wodae 6cm ɖe afɔkpodzi ƒe ƒunukpeƒe dzi → Varus/valgus dziɖuɖu
- Titina Distal Screw: Wodae 3-4cm ɖe afɔkpodzi ƒe ƒunukpeƒe dzi → Rotational control
- Distal Screw: Wodae 1-2cm ɖe afɔkpodzi ƒe ƒunukpeƒe dzi → Plantarflexion/dorsiflexion mɔxexe
3-point fixation sia wɔa 'triangulation effect' si nyo wu dual-screw alo single-screw systems na metaphyseal fractures. Ɣeyiɣi: Aɖabaƒoƒo 20
Afɔɖeɖe 7: Ʋuʋu si Te Ðe Eŋu
Wotsɔ proximal locking screw ɖeka de isthmal level be woaxe mɔ ɖe didime ƒe kpuiƒe kple rotational displacement nu. Ɣeyiɣi: Aɖabaƒoƒo 8
Afɔɖeɖe 8: Fasciotomy hena Compartment Syndrome Mɔxexe Ðe Dɔléle Nu
Esi wònye be abi si woxɔna le ame ŋu ƒe mɔnu kple akpata ƒe nyaƒoɖeamenu si dzi ɖe edzi do ŋgɔ na dɔwɔwɔ nɛ (45 mmHg) ta la, wowɔ ŋgɔgbe kple axadzi ƒe akpa eve ƒe fasciotomy be woatsɔ axe mɔ ɖe akpata ƒe dɔléle sesẽ nu (2-5% ƒe dzɔdzɔ le abi siwo woxɔ le ŋeŋe me). Ɣeyiɣi: Aɖabaƒoƒo 10
Dɔwɔwɔ ƒe Ɣeyiɣi Katã: Aɖabaƒoƒo 72 | Fluoroscopic Exposure: Nɔnɔmetata 6 | Ʋu ƒe Bubu: 125 mL
Dɔwɔwɔ Le Dɔwɔwɔ Megbe Nusɔsrɔ̃ Kple Emetsonuwo
Dɔwɔwɔ vɔ megbe Enumake (POD 0-1) .
Vevesese Dzi Ðuɖu: VAS 3/10 le morphine 4mg IV q4h dzi. Woɖua wo dzi nyuie togbɔ be wotso fasciotomy hã.
Nɔnɔmetatawo ɖeɖe: Radiografwo ɖo kpe ŋutilã ƒe wɔwɔme dzi ɖeɖe kpɔtɔ bliboe dzi esi wotsɔ gavi siwo katã wotsɔ xea mɔe la ɖo teƒe nyuitɔ kekeake.
Nuƒoƒoƒu Kaba (POD 1-7) .
- POD 1: Afɔkpodzi ƒe ʋuʋu ƒe didime si mewɔa naneke o si wodze egɔme (plantarflexion-dorsiflexion 20°) .
- POD 2: Trɔtrɔ ɖe vevesesenutsitike siwo woano ŋu; fasciotomy incisions si wokpɔa egbɔ kple ɖoɖowɔɖi siwo wozãna ɖaa
- POD 3: Kpekpeme tsɔtsɔ abe alesi woɖe mɔe ene (WBAT) kple afɔzɔla takpɔkpɔ
- POD 7: Afɔkpodzi blibo si le dɔ wɔm ROM; azɔlizɔzɔ meta 50 le eɖokui si kple afɔzɔla
Ɣeyiɣi Titina ƒe Haya (Kwasiɖa 6) .
- Ʋuʋu: Afɔkpodzi ƒe ʋuʋu 12°, afɔkpodzi ƒe ʋuʋu 35° (si gogo alesi wòle dzɔdzɔmee) .
- Vevesese: VAS 1/10 ƒe xexlẽme
- Azɔlizɔzɔ: Enɔa eɖokui si kple atizɔtiwo; kpekpeme tsɔtsɔ ƒe akpa aɖe ƒe ŋgɔyiyi dze egɔme
- Radiographs: Calus bridging gbãtɔ dzena; hardware le nɔnɔme deblibo me, zero loosening
Ɣeyiɣi Didi ƒe Emetsonu (Kwasiɖa 12) .
- Kpekpeme-tsɔtsɔ: Kpekpeme-tsɔtsɔ bliboe ƒe azɔlizɔzɔ le eɖokui si
- Afɔkpodzi ƒe Ʋuʋu: Afɔkpodzi ƒe ʋuʋu 14°, afɔkpodzi ƒe ʋuʋu 42°, inversion/eversion normal
- Vevesese: VAS 0/10 ƒe kpekpeme; gbesiagbe dɔwɔna siwo ŋu seɖoƒe meli na o
- Nɔnɔmetatawo ɖeɖe: Ƒu ƒe kadodo sesẽ kple callus tsitsi ƒe tɔdzisasrã ƒe gbagbãƒe
- Dɔwɔwɔ: Wotrɔe yi xɔtudɔ si me wowɔa dɔ le bɔbɔe me
- Kuxi siwo dona tso eme: ZERO—xɔtunu siwo meɖea asi le wo ŋu o, dɔlékui aɖeke megale wo ŋu o, womewɔa dɔ nyuie o
Nusita XC Medico ƒe DTN Dɔwɔɖoɖoa Naa Nu Deŋgɔwo
XC Medico ƒe Distal Tibial Intramedullary Nail – Retrograde Fixation System hea viɖe vevi ene vɛ na lãmeka falɛfalɛ siwo gblẽa nu le ame ŋu ƒe nyawo:
- ✓ Three-Point Distal Locking: Dzogoe etɔ̃ ƒe ɖoɖo tɔxɛ kpɔa metaphyseal nuto gbadzaa dzi nyuie wu hoʋlila siwo nye ɖeka / eve-screw
- ✓ Cannulated Design: Enaa mɔfianu ka dede eme, ɖea ɖoɖowɔɖi ƒe nusɔsrɔ̃ ƒe ʋuʋudedi dzi kpɔtɔna eye wònaa eƒe nyateƒetoto nyona ɖe edzi
- ✓ Titanium Grade 5: Kplɔ̃wo katã zãa titanium-kpe si dze TC20 (ISO 13485, CE ƒe ɖaseɖigbalẽ, FDA 510(k) si woɖe ɖa le nuveviwɔame ta)
- ✓ Proven Track Record: XC Medico tsɔ trauma implants 20,000+ yi kɔdzi 500+ le xexeame katã kple 98.9% ƒe nyonyome ƒe sedziwɔwɔ
Le xɔtunua ŋutɔ godo la, XC Medico naa nudɔdɔ kabakaba (ŋkeke 7 ƒe ɣeyiɣi si woɖo ɖi, ŋkeke 3 ƒe ʋuɖoɖo kabakaba li), ŋkeke 30 ƒe tɔtrɔgbɔ siwo womebia nya aɖeke o, kple ɣleti 36 ƒe mɔɖegbalẽ si wotsɔ dea ame me —nu veviwo na nuveviwɔamedɔwɔƒe siwo kpɔa dɔléle gbogbo siwo womate ŋu agblɔ ɖi o dzi.
Kukuɖenuŋu si Wotsɔ Sɔ Kple Wo Nɔewo: Dɔlékuiwo ƒe Agbɔsɔsɔme Kple Emetsonuwo
| Metric |
Retrograde DTN |
Open Plate (Anterior-Medial) |
Antegrade IM Nail |
| Dɔlékuiwo ƒe Agbɔsɔsɔme (Crush Injury) . |
3-8% ⭐ |
15-25% ƒe xexlẽme. |
6-12% ƒe xexlẽme. |
| Klo ƒe Vevesese |
0-2% ⭐ |
N/A |
8-15% ƒe xexlẽme. |
| Union ƒe Agbɔsɔsɔme |
94-98% ⭐ ƒe xexlẽme |
92-96% ƒe xexlẽme. |
90-94% ƒe xexlẽme. |
| Dɔwɔwɔ ƒe Ɣeyiɣi |
60-80 min ⭐ |
90-120 min |
80-100 min |
| Kpekpeme-tsɔtsɔ le Gbãtɔ |
POD 2-3 ⭐ ƒe ƒuƒoƒo |
POD 5-7 ƒe xexlẽdzesiwo |
POD 2-3 ƒe ƒuƒoƒo |
Kɔdzi & Mamãla ƒe Asixɔxɔ ƒe Nyagbɔgblɔ
Viɖe Siwo Le Dɔdaƒe
- Mɔxexe ɖe dɔlékuiwo nu: Eɖea afɔkua dzi kpɔtɔna 50-75% ne wotsɔe sɔ kple plate fixation le crush injuries → dɔlékuiwutike ʋɛ aɖewo, kɔdzi nɔnɔ kpuie, agbanɔamedzi si bɔbɔ ɖe anyi
- Dɔwɔwɔ ƒe Dɔwɔwɔ Nyuie: Aɖabaƒoƒo 20-40 ƒe ɣeyiɣi dzi ɖeɖe kpɔtɔ le nya ɖeka me → nya geɖe gbesiagbe, nyo wu OR throughput
- Lãmetsi Falɛfalɛwo Takpɔkpɔ: Lãmetsiŋusẽ ƒe lãɖeɖe suetɔ kekeake → lãmekawo ƒe dɔyɔyɔ kabakaba, kuxiwo ƒe agbɔsɔsɔme dzi ɖena kpɔtɔna
- Amekola ƒe Dzidzemekpɔkpɔ: Nusiwo ate ŋu ado tso eme, nusɔsrɔ̃ kabakaba wu kple cannulated design
Ganyawo ƒe Asixɔxɔ na Numalawo
Asitsatsa ƒe Mɔnukpɔkpɔ: Distal tibia fractures le dzidzim ɖe edzi 8-12% ƒe sia ƒe le Latin Amerika. Kɔdzi akpa gãtɔ gakpɔtɔ zãa agbalẽviwo ƒe nutete le amekolawo nyanya ta, si wɔnɛ be sukudede kple nudzadzra ƒe mɔnukpɔkpɔ ɖedzesi aɖe va li.
Ga home & Margin ƒe Kpɔɖeŋu:
- DTN Dɔwɔɖoɖo (XC Medico): $5,200 USD
- Mamãlawo ƒe Fetu (Dzidzenu): 28-32% = $1,456-1,664 le nya ɖesiaɖe me
- Nutome ƒe Agbɔsɔsɔme ƒe Akɔntabubu: 60-80 distal tibia cases/ƒe
- Ƒe Sia Ƒe ƒe Gakpɔkpɔ si Mamalawo ate Ŋu Akpɔ: $87,360-133,120
Hoʋiʋli ƒe Ðoƒe: 'Míaƒe DTN ɖoɖo si trɔna ɖe megbe ɖea dɔlékuiwo xɔxɔ ƒe afɔku dzi kpɔtɔna 50-75% le abi siwo woxɔ le abi siwo wogbã me. Ema fia be tɔtrɔ ʋɛ aɖewo koe woawɔ, dɔnɔwo ƒe emetsonuwo nyo wu, eye dɔwɔƒewo ƒe agbanɔamedziwo dzi ɖe kpɔtɔ. Wò amekolawo akpɔ vovototo si le woƒe dɔléle 5 gbãtɔwo me.'
Èle klalo be yeawɔ Retrograde DTN Fixation ŋudɔa?
XC Medico naa amekolawo ƒe hehe blibo, mɔ̃ɖaŋununya ƒe kpekpeɖeŋu tsitotsito, kple mama ƒe hadomeɖoɖo tɔxɛwo na nuveviwɔame dɔwɔƒewo le Latin Amerika katã.
Bia Kɔdzi Habɔbɔ & Asixɔxɔ
Wɔ míaƒe XC Medico Trauma Implant Catalog ƒe kɔpi | Wɔ ɖoɖo ɖe Virtual Product ƒe wɔwɔfia ŋu | Bia Amekoko Ŋuti Hehenanuwo
Nya Siwo Wobiana Enuenu: Retrograde DTN vs. Traditional Approaches
Q: Aleke teƒe etɔ̃ ƒe distal locking xea mɔ na malunion?
A: Kplu ɖeka alo eve ƒe ɖoɖo siwo wozãna tsã la ɖoa ŋu ɖe plate-bone ƒe kadodo ŋu be woaxe mɔ ɖe dzogoe ƒe ʋuʋu nu. Le metaphyseal nuto gbadzawo me la, varus/valgus alo plantarflexion/dorsiflexion angulation si menya kpɔna dzea sii bɔbɔe o ate ŋu adzɔ kokoko le screw dede teƒewo dome. XC Medico ƒe teƒe etɔ̃ ƒe didiƒe ʋuʋu (proximal, middle, distal screws) wɔa 'triangulation cage' si xea mɔ na ʋuʋu le yameʋu etɔ̃awo katã me—varus/valgus, plantarflexion/dorsiflexion, kple rotation. Esia le vevie ŋutɔ le metaphyseal fractures me afisi ƒu ƒe kekeme ateŋu agbɔ 25mm.
Q: Nukae nye nusɔsrɔ̃ ƒe mɔnu na retrograde nailing?
A: Le amekola siwo si nuteƒekpɔkpɔ le le plate fixation alo antegrade nailing me gome la, nusɔsrɔ̃ ƒe ɣeyiɣia le kpuie nukutɔe (5-10). Mɔnu si wozãna tsɔ yia megbe na afɔkpodzi si le titina la le tẽ, eye XC Medico ƒe ɖa si wotsɔa ʋuƒo wɔe ƒe nɔnɔme ɖea mɔ na mɔfianu ka ƒe ɖoɖo hafi wotsɔa wo ɖokui nana ɖe ɖaa ŋu. Míenaa amekoko ŋuti video siwo me kɔ, IFU ƒe nuŋlɔɖi siwo wowɔna afɔɖeɖe ɖesiaɖe, kple hehenana ƒe kpekpeɖeŋu le teƒea.
Q: Ðe nanewo li siwo tsi tre ɖe DTN si wogbugbɔna yia megbe ŋua?
A: Ƒã hafi atike siwo tsi tre ɖe dɔlélea ŋu le mɔ aɖe nu mebɔ o. Nusiwo tsi tre ɖe eŋu keŋkeŋ dometɔ aɖewoe nye metaphyseal fractures siwo wogbã vevie kple <2cm distal fragment (siwo mebɔ le ɖoƒe sia o) alo afɔkpodzi ƒe ƒunukpeƒetetedɔ si nɔ anyi do ŋgɔ. Le gbagbã ƒe nɔnɔme bɔbɔewo me la, ate ŋu asɔ kokoko be woatsɔ aŋe ablae ne lãkusi falɛfalɛwo me mekɔ o, gake DTN si trɔna yi megbe medea ŋgɔ gbeɖe o—ɖeko wònaa viɖe bubuwo (dɔlékuiwo ƒe afɔku dzi ɖeɖe kpɔtɔ, ʋuʋu do ŋgɔ) ga si woxena ɖe edzi manɔmee.
Nyataƒoƒo: Retrograde DTN nye Belélename ƒe Dzidzenu
Miguel ƒe nyaa nye nusitae akɔta ƒe ʋuʋu le megbe va zu beléle na akɔta ƒe gbagbã siwo le didiƒe ƒe dzidzenu, vevietɔ ne lãkusi falɛfalɛwo ƒe gbagbã le eme la ƒe kpɔɖeŋu. Wokpɔ abixɔxɔ ƒe mɔ̃ si wotsɔ gbãa nu, si zi geɖe abia be woaɖe lãkusi falɛfalɛ geɖe ɖa hafi woate ŋu alé agbalẽa ɖe te la, to lãɖeɖe sue ade siwo ƒe ƒuƒoƒo nye <10cm ƒe lãɖeɖe me—si nye dɔwɔwɔ na ame ƒe nuveviwɔame dzi ɖeɖe kpɔtɔ ŋutɔ.
Emetsonuwo ƒoa nu le wo ɖokui si: ƒuwo ƒe ƒoƒo ɖekae sesĩe le kwasiɖa 12 me, kuxi aɖeke mele eŋu o, dɔwɔwɔ ƒe hayahaya bliboe, kple tɔtrɔ yi dɔme kabakaba. Le plate fixation me la, dɔnɔ sia adze ŋgɔ dɔlékui ƒe afɔku 15-25%, lãɖeɖe gãwo, kple kɔdzi nɔnɔ ŋkeke 3-5 didi wu.
Le mamala siwo le Anyiehe Amerika ƒe nuveviwɔamedɔwɔƒewo subɔm gome la: Retrograde DTN tsi tre ɖi na adzɔnu siwo ƒe asixɔxɔ de ŋgɔ, si kpɔa ŋusẽ gã aɖe, si naa dɔnɔwo ƒe dɔwɔwɔ nyona ɖe edzi esime wòɖea kɔdzi ƒe gazazãwo dzi kpɔtɔna. Kɔdzi siwo xɔa megbedede ƒe ŋutete la kpɔa hoʋiʋli ƒe viɖe le woƒe nutome nuveviwɔame ƒe asi me. Amekolawo kpɔa nusɔsrɔ̃ ƒe mɔnu siwo le kabakaba wu eye wokpɔa emetsonu siwo woate ŋu agblɔ ɖi wu. Dɔnɔwo hayana kabakaba eye kuxi ʋɛ aɖewo koe dona tso wo me.
Adzɔnuwo Ŋuti Nyatakakawo & Dɔwɔnuwo
Te ɖe XC Medico ŋu
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