External fixator .

1.Ŋgɔdonya .

Woateŋu azã gotagome fixation atsɔ akpɔ 'localized damage control' na gbagbãƒe siwo me lãkusi falɛfalɛwo gblẽ nu le vevie eye abe atikewɔwɔ si ŋu kakaɖedzi le ene na gbagbã geɖe. Ƒu ƒe dɔléle nye nu vevi aɖe si ɖea gotagome fixation zazã fiana. Woate ŋu azã gotagome fixation hã hena nɔnɔme madeamedziwo ɖɔɖɔɖo kple ƒuwo ŋudɔwɔwɔ.

2 .Nukatae Zã An . External fixation . 

2.1 Viɖe siwo le gotagome fixation ŋu .

- Ʋu ƒe sisi yi ƒu me ƒe tɔtɔ sue aɖe ko.

- Ŋusẽkpɔɖeamedzi sue aɖe le lãkusi falɛfalɛwo ƒe xɔxlɔ̃ dzi.

- Woate ŋu azãe kabakaba le nɔnɔme kpatawo me.

- Fixation of open kple contaminated fractures.

- Enaa be woama nu yeyewo eye woanɔ anyi ɖaa le gbagbãƒewo manɔmee.

- Duta ŋutilã si mesɔ gbɔ o ƒe anyinɔnɔ le dɔléle gome.

- Ebia nuteƒekpɔkpɔ kple amekoko ƒe aɖaŋu si mesɔ gbɔ o wu incisional reduction kple ememe fixation (ORIF) si wozãna ɖaa.

- Woate ŋu awɔ ƒuwo ŋudɔwɔwɔ kple woƒe nɔnɔme gbegblẽ ƒe ɖɔɖɔɖo.

2.2 Nufiafiawo na gotagome fixation .

2.2.1 Gɔmeɖeɖe siwo le ʋuʋu ɖi .

External fixation bracing nye mɔnu siwo wozãna hena ɣeyiɣi kpui aɖe alo definitive immobilization of open fractures la dometɔ ɖeka eye woɖee fia vevietɔ le abi sesẽ siwo le lãkusi falɛfalɛwo me ƒe anyinɔnɔ me. External fixation braces ɖea vi na gbagbã siwo ŋu dɔlékuiwo ƒe afɔku le ŋutɔ, abe vava ɖe atikewɔƒea kple/alo abi ƒe ɖiƒoƒo megbe ene. Ɣeyiɣi didi aɖee nye sia si gotagome fixation nye mɔnu si ŋu viɖe le ŋutɔ na abi mawo eye wogabunɛ kokoko be enye sika ƒe dzidzenu.

2.2.2 Ƒutsotsoe siwo wotu .

Nusiwo woatsɔ awɔ gotagome fixation zazã ɖe gbagbãƒe siwo wotu ŋue nye ɣeyiɣi kpui aɖe ƒe ʋuʋu na dɔnɔ siwo ŋu polytrauma sesẽ le, kple lãmeka falɛfalɛ siwo wotu ƒe ʋuʋudedi sesẽ alo abi siwo woɖe ɖa. Le nɔnɔme siawo me la, woate ŋu awɔ ɣeyiɣi kpui aɖe ƒe ʋuʋu to gotagome fixator zazã me le adzɔge tso afisi abi la le, anyo wu ne wole adzɔge tso afisi woawɔ dɔ na ame le gbɔ, be woatsɔ ada abi si le lãkusi falɛfalɛa ŋu esime wole abɔ kple afɔ ƒe ɖoɖowɔwɔ me.

2.2.3 Nuveviwɔame geɖe .

Ele be woabu gotagome fixation frame dɔdamɔnu aɖe ŋu ne wole dɔwɔwɔ na dɔnɔ siwo xɔ abi zi geɖe la dzi kpɔnu. Viɖe vevi siwo le gotagome fixation ŋue nye be wòali ke kabakaba le ƒunukpeƒea ƒe gbagbã ŋu, ekpena ɖe ame ŋu wòɖea vevesese dzi kpɔtɔna, eɖea ʋu ƒe dodo dzi kpɔtɔna, eye wòɖea systemic inflammatory response syndrome dzi kpɔtɔna be woakpɔ egbɔ bɔbɔe.

2.2.4 Ƒumeŋuɖui ƒe akpa si le ƒunukpeƒewo .

Zi geɖe la, gotagome fixation bracing nye ɣeyiɣi kpui aɖe ƒe dzidzenu si kpɔa lãkusi falɛfalɛwo ƒe nutsyɔnu si mebɔbɔ o ta le gbagbãƒe siwo meli ke o alo ƒunukpeƒetetedɔ sesẽ siwo le ƒunukpeƒewo me; Enye tiatia hã na ƒunukpeƒewo ƒe ʋuʋu alo lãkusiwo ɖɔɖɔɖo afisiwo ƒe akpa ɖeka ƒe ememe ʋuʋu mate ŋu adzɔ o. Woate ŋu aƒo ƒu ɖe ƒunukpeƒe gãwo katã ŋu le mɔ sia nu, gake zi geɖe la, asibidɛ, klo, kple afɔkpodzi.

2.2.5 Ƒu alo lãkusi falɛfalɛwo ƒe gbegblẽ .

Le dɔnɔ siwo ƒe lãkusi falɛfalɛwo kple ƒu ƒe gbagbã sesẽ gome la, woate ŋu azã gotagome fixation frames atsɔ ana abɔ kple afɔ ƒe akpa ɖeka nadidi ɖe edzi eye emegbe woagbugbɔ abɔ kple afɔ ƒe didime aɖo anyi to distraction osteogenesis me le akpa evelia me.

2.2.6 External fixation frame si wozãna abe dɔwɔnu ene na indirect reset .

Ne woɖe eƒe gbagbã dzi kpɔtɔ vɔ la, ne woda ememe fixation plate alo intramedullary nail la, woate ŋu alé be nɛ to gota fixator la tutu me. Ɣeaɖewoɣi la, woate ŋu alé gotagome fixator ɖe asi hena ɣeyiɣi aɖe be wòana fixation bubu ne ememe fixation la mesẽ o. Wokpɔe be gotagome fixators alo femoral distractors wɔa akpa vevi aɖe le tibial intramedullary nail me. Wotsɔa gavi ƒoa schnee pin ɖe megbe ƒe akpa si le proximal tibial intramedullary nail entry point la me eye wògena ɖe afɔkpodzi ƒe ƒu me, eye wotsɔa ati didi aɖe blanɛ. Esia naa teƒe si woda sɔ le le teƒe aɖe eye wòtrɔa asi le eƒe akpa si wogbã ƒe didime, eƒe tɔtrɔ, kple eƒe axadzi hã ŋu hafi dea lãkusi si le lãkusia me la ɖe klo ƒe nɔnɔme si wobɔbɔ alo esi wokeke ɖe enu la me.

Tibial intramedullary nail placement kple gotagome fixation bracket retraction .

3.Gɔmeɖosewo le gotagome fixation brace dɔwɔwɔ .

3.1 Biomechanical ƒe akpawo .

De pin 2 ya teti ɖe gbagbãƒe gã ɖesiaɖe me to ŋutilã ƒe nɔnɔme ƒe dedienɔnɔ ƒe akpaa dzi, eye woama pinwo ɖe wo nɔewo ŋu le teƒe geɖe alesi woate ŋui. Ne lãkusi falɛfalɛwo ƒe nɔnɔmewo ɖe mɔ la, ele be woatsɔ fixation pins la aɖo afisi te ɖe gbagbãƒea ƒe nuwuwu ŋu alesi woate ŋui, gake mele be wòage ɖe fracture end hematoma me alo ɖe skin denudation ƒe teƒea o. Ne wowɔ ɖoɖo ɖe ememe fixation didi ŋu la, ele be fixation pins naƒo asa na amekoko ƒe ʋuʋudedi siwo ate ŋu anɔ anyi kple amekoko ƒe mɔɖeɖe (amekoko ƒe teƒe). Ele be woatsɔ ka siwo doa ka kple wo nɔewo la aɖo ƒu gbɔ alesi woate ŋui be woali ke. Nusiwo gbɔna ƒe liƒo nɔ te ɖe nusiwo gbɔna dzi.

- Adzɔge le fixation pins tso fracture end gbɔ: zi alesi wògogo sesẽtɔ la.

- Fixation pins ƒe dometsotso ɖe fracture block ɖesiaɖe me: zi alesi wòloloe la, zi nenemae wòlolo wu.

- Adzɔge le didime ƒe kadodo ƒe atiwo tso ƒu gbɔ: zi alesi wòte ɖe sesẽe ŋu.

- Kadodo ƒe atiwo ƒe xexlẽme: Eve sesẽ wu ɖeka.

- gotagome fixation frame ƒe ɖoɖowɔwɔ (tso ŋusẽ si le anyi wu dzi va ɖo esi kɔkɔ wu dzi): yameʋu ɖeka/a-nɔnɔme/biplane.

- External fixation frame si wotsɔ ƒo ƒu kple ememe fixation (Tension screws): ƒã hafi wozãnɛ elabena elastic kple strong fixation ƒe tsakatsaka nye ɣeyiɣi kpui aɖe ko.

- Schanz screws alo schnee pins ƒe didime: 6mm ƒe flexural ŋusẽ ƒe teƒe eve nye 5mm.

a. Unilateral ɖeka-yameʋu ɖeka-kadodo gotagome fixation frame. Adzɔge tso pin gbɔ tso gbagbãƒe ƒe nuwuwu (X).

Zi alesi wògogoe la, zi nenemae wòli ke. Adzɔge tso pin vovovowo gbɔ tso fracture block gã la gbɔ (y): Zi alesi wòdidi wu la, zi nenemae wòali ke.

Zi alesi wole adzɔge ʋĩi la, zi nenemae wòli ke. Adzɔge tso didime ƒe kadodo ƒe atiwo gbɔ tso ƒu gbɔ (Z): Zi alesi wòte ɖe eŋu la, zi nenemae wòte ɖe eŋu.

b. Akpa ɖeka, uniplanar, 3-rod combination external fixator nye xɔtuɖoɖo nyui aɖe na dɔwɔwɔ vovovowo, si me tɔtrɔ ɖe teƒe bubu hã le.

Kpɔɖeŋu na dɔ vovovowo wɔwɔ, siwo dometɔ aɖewoe nye aɖaŋu siwo wogbugbɔ ɖona.

C. Uniplanar eve-kadodo ƒe gotagome fixation frame.

d. akpa ɖeka ƒe ɖoɖo (▲ ƒe ɖoɖowɔwɔ).

E. Akpa eve ƒe ɖoɖowɔwɔ kple fixation pins siwo gena ɖe eme. Fifia ƒã hafi wozãnɛ.

External fixation si meli ke o la hea fracture gbedada ƒe ɖoɖoa ɖe megbe, gake nenema ke gotagome fixation frame si sesẽ akpa hã.

Ehiã ɣeaɖewoɣi be woawɔ dynamize stable fixation eye woadzi agbaa ɖe edzi to kpekpeme tsɔtsɔ ƒe akpa aɖe alo blibo me eye/alo woatrɔ gotagome fixation frame ƒe ɖoɖo.

3.2 Fixed Needle Placement Techniques .

- Na ŋutilã ƒe wɔwɔme nyuie be nàƒo asa na abixɔxɔ le lãmekawo, ʋukawo kple lãkusiwo ŋu.

- Mègana fixation pins alo screws nage ɖe ƒunukpeƒea o.

- Ƒo asa na fracture ends kple hematomas.

- Ƒo asa na teƒe siwo ŋutigbalẽ ƒe ʋuʋu alo ʋuʋudedi le.

- Do ŋgɔ na ƒu ƒe lãkusi be nàƒo asa na dzoxɔxɔ ƒe gbegblẽ (si kplɔa ring necrosis).

- Ele be fixation pins nanye didime si sɔ be woawɔ frame si sɔ.

3.2.1 Akɔtaƒu .

Zi alesi drill alo fixation pin ɖaɖɛ le la, zi nenemae dzoxɔxɔa dzi ɖena kpɔtɔnae. Zi alesi ʋuƒoa le du dzii la, zi nenemae dzoxɔxɔa akɔ ɖe edzii. Dzoxɔxɔ ƒe nugbegblẽ le ƒu ŋu nye nusi ŋu wotsi dzi ɖo vevie elabena esia ate ŋu ana ƒu kuku si ŋu asigɛ le nadzɔ, si hã ate ŋu ana woaɖe asi le wo ŋu kaba eye/alo woaxɔ dɔlékuiwo. Ele be fixation pin siwo woda ɖe teƒe nyuitɔ la nalé cortices eveawo siaa nyuie, gake mele be nugbɔa nage ɖe eme akpa o.

3.2.2 Diaphysis .

Le epiphysis me la, dzoxɔxɔ wɔwɔ menye kuxi o. Ate ŋu anɔ dedie wu be woazã gavi siwo tsia wo ɖokui nu le afisia, elabena ele bɔbɔe be woado do siwo wodo do ŋgɔ ne wole gaviawo me. Ele be woaƒo asa na fixation pin ƒe gege ɖe ƒunukpeƒea elabena afɔku li be aŋenu ƒe dɔléle nado ɖe ƒunukpeƒea me.

3.2.3 Dedienɔnɔ ƒe teƒewo .

Be amekolaa naƒo asa na abixɔxɔ le lãmekawo, ʋukawo, lãkusiwo, kple lãmekawo ŋu la, ele be wòanya afɔtia ƒe ŋutilã ƒe wɔwɔme nyuie le eƒe akpa siwo katã wotso la me eye wòazã dedienɔnɔ ƒe teƒe si woatsɔ aɖo fixation pinwo.

Figure 3.3.3-2 dedienɔƒe na gotagome fixation pin ɖoɖo.

Afɔdzideƒe aɖe.

Nɔnɔmetata 3.3.3-2 (yi edzi) .

B Tibia.

Nɔnɔmetata 3.3.3-2 (yi edzi) .

C humerus, megbekpɔkpɔ.

Ne wozãe le yameʋu ɖeka me la, mehiã be woatsɔ schanz-gavi la ayi ŋgɔgbeti ƒe ʋuƒo si le ŋgɔgbe la me o. Afɔti si le ŋgɔgbea ƒe ta ƒe ƒuƒu le lãkusi si le lãkusi me la ŋu eye tomekuku ana dzoxɔxɔ si gbɔ eme nado, si ate ŋu ana ƒumeŋuɖui evelia nado. Le distal tibia me la, afɔku li be woaxɔ abi le anterior tibialis tendon kple extensor digitorum lãmekawo me.

4. Akpawo .

4.1 Tube-Rod ƒe ɖoɖo .

4.1.1 SCHANZ SKIWO . 

Schanz screws nye akpa aɖe si wotsɔ ka ƒo ɖe fixation pins. Wole didime vovovowo me, didime (ati ƒe didime, ka ƒe didime) kple aɖaŋuɖoɖo vovovowo. Schanz screw si wozãna ɖaa ƒe nugbɔ nye nugbɔ si le abe trocar ene (Fig. 3.3.3-3a) eye zi geɖe la, ebiaa be woatsɔe aɖoe do ŋgɔ.

Figure 3.3.3-3 SCHANZ SKUWO.

A standard socket pin-nɔnɔme ƒe nugbɔ.

b ɖokui-ƒuƒu ƒe nugbɔ.

Self-wrilling kple self-tapping pins ƒe nugbɔ ɖaɖɛ tɔxɛ aɖe le esi si ate ŋu aku ka ahatso ka le ɣeyiɣi ɖeka me ne wotsɔe ƒo ɖe eme. Wotrɔ asi le wo ŋu be woazã le metaphysis me (Fig. 333-3B).

SCHANZ Screws li le gakpo, titanium alo hydroxyapatite si wofa ɖe eŋu me. Hydroxyapatite si ŋu wofa nu ɖo ate ŋu alé ƒu nyuie, si ana ƒu natsi kaba eye woaƒo asa na eƒe ʋuʋu. PIN sia ƒomevi sɔ na dɔnɔ siwo si gotagome fixators le ɣeyiɣi didi aɖe.

4.1.2 Steiner ƒe pinwo .

Zi geɖe la, wozãa steiner pinwo abe fixation pin siwo gena ɖe ƒuwo me ene. Woƒe aɖaŋuɖoɖowo le abe drill sleeves ene eye ehiã be woawɔ do ŋgɔ le cortical bone me hafi ade eme.

4.1.3 Tube/Atiwo .

Le tube/rods ƒe nɔnɔmewo nu la, kpɔɖeŋu vovovo 4 ye li:

• Gã: 11 mm tube/rod, Schanz screws nye 4 ~ 6 mm.

• Medium: 8 mm tube/rod, schanz screws nye 3 ~ 6 mm.

• Sue: 4 mm tube/rod, schanz screws 1.8 va ɖo 4 mm.

• Mini: 2 mm ɖoɖo na asibidɛwo, atsyã si wozãna ɖaa, kple multi-pin clamp na K-kawo ɖɔɖɔɖo kple 2 mm atikplɔwo.

Wotsɔa carbon fiber rods siwo ƒe nɔnɔme le abe do ŋgɔ ene, siwo le abe curved ene, kpena ɖe ɖoɖo sia ƒe modules ŋu. Le teƒe sesẽwo abe asibidɛ ene la, T-joint modules hã li.

4.1.4 Kpowo .

Wozãa clamps la tsɔ doa ka kple tube/rod kple fixation pins. Woate ŋu atsɔ clamp (tube-tube) si sɔ aƒo ka na tube/atiwo hã ɖe wo nɔewo ŋu.

Nɔnɔmetata 3.3.3-5 Klamwo .

A self-locking clamp na scanz screws kple tube/rods ƒe kadodo.

B ƒokpli clamp na kadodo eve ati alo tube.

C Xexeame Katã ƒe Multi-Pin Klamp.

d tube-tube clamp hena ʋuƒo eve ƒe kadodo.

4.2 Akpa ɖeka ƒe gotagome fixation frame systems .

Woate ŋu atsɔ clamps siwo wotsɔ gavi eve alo klatsa siwo wowɔ ɖe ɖoɖo nu la akpɔ fracture block la dzi. Woate ŋu atsɔ titina ka si wotsɔ ka wɔe la akpe ɖe eŋu hena susuhenuwo alo nutete hena ƒu didi kple/alo ƒu ƒe tsɔtsɔ.

Akpa ɖeka ƒe gotagome fixation system na ƒuwo tsɔtsɔ yi teƒe bubuwo .

4.3 gotagome fixation ƒokpli .

Wozãa gotagome fixation si wotsɔ ƒo ƒui na gbagbã siwo te ɖe ƒunukpeƒea ŋu eye wòbiaa Kirschner pin si wotsɔ blae hena asigɛ ƒe ƒoƒo kple scanz screw si wozãna ɖaa na diaphysis la. Zi geɖe la, wozãa 3/4 ƒokpli ƒe asigɛ. Wozãa ring fixators siwo wotsɔ ƒo ƒui koŋ na afɔkpodzi si te ɖe eŋu kple didiƒe.

Wotsɔ gotagome fixation brace ƒo ƒui na tibial plateau fractures. Woate ŋu azãe hã na afɔkpodzi ƒe akpa si le didiƒe ʋĩ ƒe ƒunukpeƒewo ƒe gbagbã. V-nɔnɔme ƒe xɔtuɖoɖoa naa liƒo nyui EDIC .

4.4 Kplɔ̃ɖoɖo gotagome fixation brace .

Viɖe si le gotagome fixation system si ƒo xlã wo bliboe ŋue nye be agbatsɔtsɔ ƒe axis kple ropedic axis toa nutome ƒe gotagome fixation system ƒe titina kpakple ƒu ƒe didime ƒe axis. Woate ŋu azã gotagome fixator system si ƒo xlã wo nɔewo hena ƒu didi, ƒuwo ŋudɔwɔwɔ, kple ƒu ƒe gbagbã bɔbɔe siwo sesẽ la gbɔ kpɔkpɔ.

Tibial ring gotagome fixation brace .

Tibial ring ƒe gotagome fixation system ƒe foto si wokpɔna le atikewɔƒe .

Mɔnu sia zazã ɖea mɔ be woatsɔ kpekpeme si woatsɔ awɔ dɔe kaba. Le gbagbã yeyewo gome la, míelɔ̃a akpa ɖeka ƒe gotagome fixation frame bɔbɔe aɖe si woatsɔ awɔ dɔe. Woate ŋu atsɔ akpa ɖeka ƒe gotagome fixation system awɔ atike na ƒuwo ŋudɔwɔwɔ kple wo didi nenema ke, gake ate ŋu asesẽ be woawɔ ɖɔɖɔɖo siwo sesẽ, siwo nɔa anyi ɖaa, siwo ƒe nɔnɔme le vovovo, siwo ŋu wokafu gotagome fixator si ƒo xlã wo ɖo. Ne wozãe abe gotagome fixation ene la, gotagome fixator si le gota la naa liƒo si sɔ. Ne wotsɔ aŋea to yameʋu vovovowo me hena multiplanar fixation la, xɔtuɖoɖo sia naa liƒo deŋgɔ aɖe. Alesi xɔa ƒe ŋusẽ le la toa vovo le alesi woɖoa nu ɖe nu ŋu, asigɛ siwo wozã, kple pin ƒomevi si wozãna, abe Kirschner pins alo schanz screws ene, ƒe ɖoɖo nu. Le kpekpea nu la, woate ŋu agbugbɔ gbagbãƒea aɖo alo aƒoe ɖe enu, eye woate ŋu aɖɔ nɔnɔme madeamedzia hã ɖo. Zi geɖe la, wozãa ring external fixators hena osteogenesis ƒe susuhenuwo be woatsɔ aɖɔ ƒu ƒe gbagbã, kpuie kple nɔnɔme madeamedziwo ɖo.

4.5 hinged gotagome fixation brace .

Wozãnɛ tsɔ léa ƒunukpeƒe siwo woɖe ɖe vovo alo gbagbãƒewo ƒe ʋuʋu ɖe teƒe bubuwo me ɖe asi eye woɖea mɔ ɖe ƒunukpeƒe aɖewo (siwo dzi wokpɔna) ŋu be woatsɔ axe mɔ ɖe ƒunukpeƒewo ƒe sesẽ nu. Wozãnɛ wu na abɔta ƒe ƒunukpeƒe.

5 frame wɔwɔ gotagome fixation braces .

5.1 Ŋkɔnyawo tso xɔtunuwo ƒe xɔtuɖoɖowo ŋu .

Mɔ vovovowo li siwo dzi woato aɖo xɔtunuwo ƒe wɔwɔmewo ɖe hatsotsowo me, vevietɔ le:

- Wᴐ dᴐ.

- Frame ƒe nɔnɔmetata.

- yameʋu ƒe dɔwɔwɔ.

- Dzesiwo.

5.1.1 Akpa ɖeka ƒe nɔnɔmetatawo .

Unilateral frame nye gotagome fixator frame modality si wozãna wu hena diaphyseal fractures yeyewo dada. Wotsɔa xɔtunua dea yameʋu ɖeka me, le kpɔɖeŋu me, eƒe ŋgɔgbe alo titina alo titina alo axadzi alo axadzi na afɔkpodzia. Wotsɔa fixation pin la dea ŋutigbalẽa me le akpa ɖeka eye wogena ɖe lãkusi eveawo me. Ele be woatsɔ pin la aɖo adzɔge tso ƒunukpeƒea gbɔ, le ƒunukpeƒea ƒe akpa si ŋu wobu nyuie la godo, be ƒunukpeƒea nagage ɖe ƒunukpeƒea o. Wotsɔa atikplɔ eveawo ɖoa yameʋu ɖeka me alo le yameʋu vovovo eve me eye emegbe wotsɔa wo ƒoa ƒui.

5.1.2 Akpa eve ƒe nɔnɔmetatawo .

Wotoa szczecin pin la me toa ŋutigbalẽ si le akpa ɖeka la me, egena ɖe bilaminar cortex la me, eye emegbe wotoa ŋutigbalẽ si le akpa si tsi tre ɖe eŋu la me. Womekafu akpa eve ƒe xɔtunuwo na ƒu gbagbãwo ƒe atikewɔwɔ si ŋu kakaɖedzi le o, gake woate ŋu azãe hena ɣeyiɣi kpui aɖe ƒe nuléle.

5.1.3 External fixation frames siwo wotso .

Wozãnɛ le nusiwo gblẽ le nusiwo gblẽ ŋu be woatsɔ akeke teƒe siwo lãkusi falɛfalɛwo xɔ abi vevie alo ƒunukpeƒetetedɔ sesẽ siwo le ƒunukpeƒea me kple gbagbãƒewo ƒe ʋuʋu.

▲Pelvic fractures, proximal femur fractures, kple proximal tibia fractures Wozã ɣeyiɣi kpui aɖe ƒe gotagome fixation braces to klo kple afɔkpodzi ƒe ƒunukpeƒewo dzi.

Lili si gotagome fixation frame la naa la ɖea mɔ na lãkusi falɛfalɛwo gbugbɔgaxɔ kpakple CT scanning kple ɖoɖowɔwɔ do ŋgɔ na dɔwɔwɔ. Wozãa akpa ɖeka ƒe xɔtunuwo wu, eye ele be woatsɔ fixation pins ade abixɔƒe kple amekoko si ŋu kakaɖedzi le ƒe dɔwɔwɔ le etsɔme me.

5.1.4 Kekeɖenu ƒe nɔnɔmetatawo .

Ilizarov to mɔnu sia vɛ kple gotagome ƒe gotagome fixation frame. Woate ŋu azã tubular gotagome fixation frames kple akpa ɖeka ƒe gotagome fixation frames atsɔ awɔ gɔmeɖose sia ŋudɔ blewuu, kple kuxi si nye be womate ŋu awɔ ɖɔɖɔɖo le dzogoe kple tɔtrɔ ƒe nɔnɔme madeamedziwo siaa ŋu le ɣeyiɣi ɖeka me o negbe ɖe wowɔ didi to intramedullary nailing me hafi.

5.2 Nɔnɔmewo Gbugbɔgaɖoanyi ƒe Mɔnuwo .

Viɖe si le gotagome fixation frame si wotsɔ ƒo ƒui ŋue nye be eɖea mɔ be woaɖe ƒu didiwo katã dzi akpɔtɔ, axe mɔ ɖe wo nu, eye woatsɔ wo aɖo wo nɔewo ŋu, teƒe siwo te ɖe ƒunukpeƒea ŋu, kple ƒunukpeƒea ŋutɔ (transarticular).

Schanz-gaviawo ɖoɖo ate ŋu anye ablɔɖe, si ana woatia ŋutilã ƒe wɔwɔme ƒe teƒe nyuitɔ kekeake ƒe nɔƒe na Schanz-gaviawo alo teƒe nyuitɔ kekeake si woatsɔ aɖo wo nɔewo ŋu le afisi wogbã ƒomevi si nye gbagbã kple lãkusi falɛfalɛwo ƒe abixɔxɔ nu. Woate ŋu awɔ gbagbãƒe kakɛ gãwo dzi ɖeɖe kpɔtɔ to leverage kple indirect reduction techniques me, esime wole ʋu ƒe sisi yi ƒu kple soft tissuewo me ta kpɔm. Mɔnu sia zazã ɖea mɔ be woatrɔ asi le gbagbãƒea dzi ɖeɖe kpɔtɔ ŋu ɣesiaɣi.

Mɔnu si wotsɔ ɖea edzi kpɔtɔna ƒe mɔnu.

A ƒomevi B tibial stem fracture.

B Le gbagbãƒe gã ɖesiaɖe gome la, wotsɔa gavi ƒoa fixation pin 2 le abixɔame ƒe akpaa godo.

C fixation pins le dedie na connecting rods kple universal clamps, si wɔe be wonye 2 handles na indirect fracture reduction.

d Ne wogbugbɔ ɖo gbagbãƒea ɖe teƒe bubu vɔ la, wotsɔa 3rd connecting rod la blaa 2 gbãtɔ siwo doa ka kple wo nɔewo kple tube-tube clamp.

▲ gotagome fixation brace si wotsɔ ƒo ƒui ƒe wɔwɔfia. Afɔkpodzi aɖe. B Aɖuɖɔtoe. C Trans-Knee.

6 Dɔdamɔnu Tɔxɛwo .

6.1 Joint Fusion .

Nu tɔxɛ aɖe si wozãna le gotagome fixators mee nye ƒunukpeƒewo ƒe ƒoƒo ɖekae to nutete kple akpa eve ƒe gotagome fixators me. Wozãa gɔmeɖose sia ɣeaɖewoɣi hena afɔkpodzi, klo, kple abɔta ƒe ƒunukpeƒewo ƒe ƒoƒo ɖekae, vevietɔ ne dɔlékuiwo le wo ŋu .

6.2 Dɔlékuiwo .

External fixation nye atikewɔwɔ mamlɛtɔ na dɔléle sesẽ alo dɔlékui ƒe nonunion of a fracture, elabena zi geɖe la, woate ŋu atsɔ fixation pins ade teƒe si dɔlélea le.

6.3 Ðɔɖɔɖo si wotsɔ ɖɔa ƒu ɖo .

Ƒumeŋusẽwo hena ɖɔɖɔɖo le nɔnɔme madeamedziwo ŋu ne lãkusi falɛfalɛwo ƒe nɔnɔmewo mede ame dzi alo gblẽ o eye afɔku si le ememe fixation zazã me sɔ gbɔ, le nɔnɔme sia me la, woate ŋu azã gotagome fixation brackets hena fixation. Nu bubu si ɖenɛ fianae nye ƒumeŋuɖui si me ƒuwo le le ɣeyiɣi ɖeka me. Zi geɖe la, esia bia be woatsɔ gotagome fixation frame aƒo xlã wo nɔewo.

6.4 Ƒu ƒe dɔwɔwɔ - Susuhenuwo ƒe ƒu ƒe dzɔdzɔ .

Wotu ƒu ƒe susuhenuwo ɖe Ilizarov ƒe gɔmeɖose si nye be woakpɔ ƒunukpeƒea ta dzi ale be ƒu si wotso nyuie la nate ŋu ahe eƒe susu ɖa vivivi (0.5-1 mm/d), eye ƒu yeye va do le dometsotso sia me. Nusiwo hea susu ɖa le ame ŋu blewuu nana ƒuwo daa dɔ, gake susuhenuwo ƒe agbɔsɔsɔ kabakaba si wua lãkusia ƒe tete ɖe ame ŋu ya menaa ƒuwo dzɔna o. Ƒumeŋuɖui siwo wotsɔna ɖe asi alo esiwo hea susu ɖa, abe esiwo le ƒu gbagbãwo ŋu ene hã toa lãkusi ƒe tsitsi ƒe akpawo katã me vaseɖe esime ƒu ƒe dɔyɔyɔ nadzɔ. Nu 3 ye fia be woazã mɔnu sia, eye ɣeaɖewoɣi la, dzesi siawo ate ŋu anɔ anyi ɖekae:

- Abɔ kple afɔ didi.

- Segmental ƒu ƒe dɔwɔwɔ be woatsɔ ada ƒu ƒe gbagbãƒewo.

- Ðɔɖɔɖo ƒe ƒugɔmeɖeɖe.

Fixation frames siwo sɔ wu na esiae nye gotagome gotagome fixation frame (si me gotagome fixation frame si ƒo xlã afã kple afã le alo esi mele eme o) kple akpa ɖeka ƒe gotagome fixation frame.

6.5 ƒunukpeƒewo gbugbɔgaɖɔɖo kple ʋuʋu si nɔa anyi ɖaa .

A hinged external fixator nye nu vevi aɖe si wotsɔ kpe ɖe abi gbogbo aɖewo siwo me li ke o siwo me li ke o, siwo dometɔ aɖewoe nye abɔta ƒe ʋuʋu si nɔa anyi didi alo esi womekpɔ ta na o le incisional repositioning kple ligament repair megbe. A hinged external fixator léa abɔta gbugbɔgaɖoɖo me ɖe asi kple dziɖuɖu si dzi wokpɔna. Ðoɖowɔwɔ ɖe teƒe bubuwo ŋu me léle ɖe asi nye nu gbãtɔ si woatsɔ aɖo nɔƒe gbãtɔ. Malikenyenye dzi kpɔkpɔ sesẽ wu ʋuʋu ƒe bu. Ele be woaɖo axis la ɖe teƒe ɖeka pɛpɛpɛ le fluoroscopy te. Vovototo sue aɖewo le afisi hinge le ate ŋu akpɔ ŋusẽ ɖe eƒe dɔwɔwɔ dzi vevie.

▲ External fixator si wotsɔ hinged wɔe la ɖoɖo ɖe abɔta.

7 Atikewɔwɔ le dɔwɔwɔ vɔ megbe .

7.1 PIN tract dzikpɔkpɔ .

Pin tract reaction nɔ te ɖe fixation pin ƒe nɔƒe kple eƒe liƒo dzi, dɔnɔdzikpɔkpɔ ƒe ƒuƒoƒoa kple dɔnɔa ƒe dɔwɔwɔ vɔ megbe. Mɔnu si wotsɔ ɖea edzi kpɔtɔnae la ɖea vi wu elabena enaa woate ŋu atia ŋutilã ƒe nɔnɔme nyuitɔ kekeake na fixation pin la le fracture ƒomevi la nu. Ele be kɔdzia ƒe pin tract care ƒe ɖoɖo si me kɔ nanɔ kɔdzia si, eye ele be dɔnɔdzikpɔla bibiwo nafia dɔnɔwo be woawo ŋutɔwo nawɔ pin tract care. To asaƒoƒo na dzoxɔxɔ ƒe abixɔxɔ kple nutoa me ƒe ʋu ƒe ʋuʋu le pin dodo me, kple aha ƒe dɔlékuiwutikewo zazã atsɔ akɔ pin teƒea ŋu le beléle na wo yometiti me, eye woazã nyaƒoɖeamenu ƒe nutrenu siwo wotu la, woate ŋu aɖe pin la ƒe dɔlékui kple eƒe ʋuʋu dzi akpɔtɔ ŋutɔ.

7.2 Pin tract dɔlékui . 

Ele be pin ƒe beléle na pin nyuie nanɔ pin care dzi gbã. Le Schanz-gavi siwo wozãna ɖaa gome la, zi geɖe la, wobiaa be woatsɔ aƒoe do ŋgɔ eye wotsɔa asi ƒoa pin la be wòaɖe dzoxɔxɔ ƒe necrosis dzi akpɔtɔ. Ele be woaɖe asi le lãkusi falɛfalɛ siwo mesɔ o siwo ƒo xlã pin la ŋu le amekokoa me. PIN-mɔ̃a dzi kpɔkpɔ nyuie le vevie be woaɖe pin tract ƒe kuxiwo ƒe dzɔdzɔ dzi akpɔtɔ. Woate ŋu akpɔ pin tract infection kple screw shoosening gbɔ to pin si le gbadzaa la ɖeɖe ɖa me eye woagbugbɔ aƒo pin le teƒe bubu.

7.3 Amewo ƒe ƒuƒoƒo .

Negbe nu tɔxɛ ʋɛ aɖewo koe (woatsɔ nuawo aɖo wo nɔewo ŋu, wo zazã kpata, asitɔtrɔ le wo ŋu ƒe asitɔtrɔ), woɖe mɔ ɖe kpekpeme ƒe akpa aɖe ƒe kpekpeme tsɔtsɔ ŋu le gotagome fixator ƒe gɔmedzedze. Ne dɔyɔyɔ le yiyim la, woate ŋu adzi kpekpeme blibo ƒe tsɔtsɔ ɖe edzi vivivi. Mehiã be woatsɔ dynamization mɔ̃ bubuwo akpe ɖe gotagome fixator ŋu o. Kpekpeme ƒe akpa aɖe alo blibodede nye mɔnu nyuitɔ kekeake si wɔa dɔ wu le dynamization me.

8 Ɣeyiɣi Didime Si Woatsɔ Aɖo Nu Gɔmesese .

8.1 Atikewɔwɔ ƒe tɔtrɔ .

Dɔdamɔnu vevi 3 ye li:

• Zã gotagome fixator abe atikewɔwɔ si ŋu kakaɖedzi le ene vaseɖe esime gbagbãƒea nahaya.

• Trɔtrɔ kaba ɖe ememe fixation ŋu.

• Trɔ ɖe atikewɔwɔ si menye amekoko o ŋu, abe aŋɔ, orthosis, kple bubuawo ene.

Ne wole mɔ kpɔm na tɔtrɔ ɖe ememe ƒe fixation ŋu la, ele be woawɔe kaba ale si woate ŋui (le kwasiɖa 2 me) elabena kuxi ƒe agbɔsɔsɔme le ʋɛ ŋutɔ wu tɔtrɔ megbe tɔtrɔ tɔ.

Ele be woawɔ ɖe se siwo gbɔna dzi ne wole ɖoɖo wɔm ɖe amekoko ɖesiaɖe ŋu do ŋgɔ na ɣeyiɣi kpui aɖe ƒe ɖoɖowɔwɔ, alo le ɣeyiɣi kpui aɖe megbe:

• Ne wotsɔ nusi wotsɔ de eme yeyee la ƒo xlã gotagome fixation teƒe gbãtɔa la, ele be pin tracts katã nanɔ dzadzɛ. Ɣeaɖewoɣi la, wowɔa dɔa le akpa eve me, eye wowɔa akpa ɖeka tsɔ kɔa pin tract gbãtɔa kple akpa evelia ŋu tsɔ wɔa fixation si ŋu kakaɖedzi le.

• Wobua pin tract teƒe ɖesiaɖe si xɔ wu ŋkeke 10 va ɖo 14 be woxɔe eye ele be woakɔ wo ŋu ahatsɔ wo aƒu gbe le wo ŋu hafi woatsɔ wo aɖo wo teƒe godoo.

• Ne ɖikeke aɖe le pin tract nyatakakadzraɖoƒe siawo ƒe vidzidzi ŋu alo pin tract la xɔ dɔlékui xoxo la, 'pin gbɔɖeme ƒe ɣeyiɣi' si nye ŋkeke 10 ya teti la hiã le pin tract ɖeɖeɖa megbe hafi woatsɔ nusi wotsɔ de eme yeyee.

• Ele be woazã dɔlékuiwutikewo atsɔ axe mɔ ɖe dɔlékuiwutikewo nu kple dɔlékuiwutikewo ƒe ɣeyiɣi si woatsɔ axe mɔ ɖe dɔlékuiwo nu tso dɔlékui siwo tso pin tract dɔlékui siwo nɔ anyi va yi me.

• Klo kplɔkplɔ ɖo le kwasiɖa 6 gbãtɔawo me le esi woɖɔli ememe fixator la megbe.

Ne kpeɖodzi li be kuxi aɖe le pin tract la ŋu la, anyo wu be woade dzesi dɔlékui ƒomeviawo, atsɔ dɔlékuiwutikewo, atrɔ pin la eye woagbugbɔ aɖoe ɖe teƒe bubu, eye woayi edzi awɔ atike na wo kple gotagome fixator. Ele be PIN tract beléle na dɔnɔa nalɔ̃ ɖe edzi be woakpɔ egbɔ be nu nyuitɔ kekeake do tso eme. Ne ele be woatsɔ ememe fixation aɖɔli gotagome fixator la le nuwuwu ƒe akpaa me la, wokafui be 'pin gbɔɖeme ƒe ɣeyiɣi' si nye ŋkeke 10 ya teti nanɔ esi, si nye be ne woɖe gotagome fixator la ɖa vɔ la, ele be woakɔ pin tract la ŋu eye woatsɔe agbãe gbã, eye emegbe woatsɔ aŋe si wotsɔ blaa nu la aɖo eŋu hafi woakpɔ pin tract kuxia gbɔ. Woate ŋu azã dɔlékuiwutikewo nyuie le ɣeyiɣi sia me.

8.2 Nu mamlɛtɔ si woatsɔ aɖo nuwoe .

External fixation ate ŋu ana abɔa ƒe akpa aɖe nali ke hena ɣeyiɣi aɖe eye wòana lãmeka falɛfalɛwo nate ŋu ahaya. Zi alesi lãkusi falɛfalɛwo ƒe nɔnɔmewo li ke ko la, woate ŋu atsɔ ememe nutrenu mamlɛtɔ aɖɔli gotagome fixator la. Le mɔ nyuitɔ nu la, ele be woatsɔ ememe ƒe fixation aɖɔlii le ŋkeke 10 me.

Ne gotagome fixation la gakpɔtɔ li ke eye dzesi aɖeke mele kuxiwo ŋu o la, mehiã be woatsɔ ɖɔliɖɔli ƒe fixation mehiã o. Ne ŋutigbalẽa ƒe xɔxlɔ̃ mede ame dzi o, alo wotsia dzi ɖe ŋutilã falɛfalɛ ƒe nugbegblẽ sesẽ ŋu eye afɔku si le dɔlékuiwo xɔxɔ me le ʋuʋu ɖi le ʋuʋu me la sɔ gbɔ la, woate ŋu alé gotagome fixator la me ɖe asi abe atike mamlɛtɔ si woatsɔ awɔ gbagbãƒeae ene.

Ele be woalé ŋku ɖe ŋgɔyiyi si wowɔ le ƒu gbagbã ƒe dɔyɔyɔ me ŋu nyuie, eye ne ŋgɔyiyi aɖeke meli o la, ele be woabu atikewɔmɔnu bubuwo ŋu.