Mɔxexe ɖe plate-application kple seɖoƒewo nu.

alesi wozãa . Locking plates keke akpa gãtɔ ɖe enu le plate ememe fixation ƒe fractures zazã me. Gake ele be woawɔ wo zazã ŋudɔ nyuie eye woawɔ wo ŋudɔ nyuie wu le mɔ̃ siwo ate ŋu adze wo dzi kple seɖoƒe siwo woate ŋu azã ta. Le nyati sia me la, míalé ŋku ɖe dɔbiagbalẽviwo ŋu bubu, kuxi siwo le eɖeɖeɖa me, kple seɖoƒewo ŋu, 3 ƒe akpa siwo nye locking plate application.

01.Nu tɔxɛ kawo kple kuxi kawoe wòle be woade dzesii le ʋuƒo siwo wotsɔ xea mɔ na nuawo zazã me?

Afɔɖeɖewo kple kuxi siwo le gbagbãƒewo dzi ɖeɖe kpɔtɔ me kple nutrenu siwo wotsɔ xea mɔ na nu .

Woɖoa afɔɖeɖe siwo woawɔ atsɔ agbugbɔ aɖo gbagbãƒe aɖe la ɖe ɖoɖo nu. Locking plates megbugbɔa ƒu ƒe gbagbãwo ɖo o. 

Ne wonya tsɔe de ƒu ƒe akpaa me ko la, gavi bubuwo tsɔtsɔ kpe ɖe eŋu maʋãe o. Ne wozã ʋuƒo si wotsɔ xea mɔ na nu siwo xɔa gaviwo ko la, ke . 

Esia fia be ne woɖo gbagbãƒea vɔ ko hafi woate ŋu atɔ agbaa.

Esi wònye be agba siwo wotsɔna xea mɔ na ƒuwo nana ƒuwo daa gbe le wo ŋu evɔ womegagbugbɔa wo ɖoɖo ɖe teƒe gbãtɔ o ta la, . 

Nusi gbɔ nu vevitɔ si hea malunion vɛ le plating platewo ŋue nye be woagbugbɔ aɖo wo ɖe teƒe bubu si mesɔ o. 

Eye, tɔtrɔ ɖe nɔnɔme nyui me le mɔ̃ɖaŋununya si mesɔ o ta ate ŋu ahe dɔyɔyɔ nyui aɖeke vɛ o elabena ƒu ƒe gbadzɛa ƒe gbagbã le dɔyɔyɔ si tsi megbe alo esi me dɔyɔyɔ mele o ta.

Gbugbɔɖoɖo ɖe teƒe bubu si womezãa ga le o ŋu sesẽ ŋutɔ ne wole dɔ wɔm le mɔ sue aɖe ko nu .

 Dɔwɔwɔwo elabena ƒu ƒe ƒoƒo ɖe lãme na ame le sue ŋutɔ. Ebia be woawɔ hehemɔnu vovovowo (traction tables, retractors), .

 Percutaneous repositioning forceps vovovowo, kple kirschner pins be woatsɔ atrɔ asi le ƒu kakɛwo kple ɣeyiɣi kpui aɖe ƒe fixation ŋu. 

Hafi woatsɔ ʋuƒo siwo wotsɔ xea mɔe kple ɖaƒoƒo siwo wotsɔna xea mɔe la ade eme la, ele vevie ŋutɔ be woalé ŋku ɖe alesi wogbugbɔa ʋuae ŋu to fluoroscopy dzi.

Le go bubu me la, ne èle ʋuƒo si me woɖea gaviwo ƒe do siwo wozãna ɖaa le la zãm la, . 

Woate ŋu atsɔ traction screw si wozãna ɖaa la ade do siwo wozãna ɖaa me hena tɔtrɔ ɖe teƒe gbãtɔ le agbaa dzi.

 Wotsɔa ƒu kakɛwo dana ɖe agbaa dzi. Ne agbalẽa sɔ kple ŋutilã ƒe wɔwɔme la, woate ŋu azãe abe mɔfiame si wogbugbɔ ɖo ene. 

Kpe siwo wotsɔna ƒoa nui nana wokpɔa egbɔ be nusiwo li ke la li ke evɔ wometrɔa asi le gbãtɔa ŋu o. Ðoɖo sia si nye be woatsɔe ade eme (gavi siwo woɖo ɖe ɖoɖo nu, emegbe gavi siwo wotsɔna ƒoa gae) le vevie (Nɔnɔmetata 4).

Fig. 4 Gbã la, tsɔ gavi siwo wozãna ɖaa la de eme eye nàbla wo sesĩe.

Nyaŋuɖoɖo si wotsɔna ƒoa nu le ame ŋu ƒe anyimanɔmanɔ ne wole gavi siwo wotsɔna ƒoa gae la me kum sesĩe .

Nyaŋuɖoɖo aɖeke meli si woate ŋu atsɔ asi awɔ dɔe ne wole ta ƒe gavi siwo le ʋuʋu me la me kum sesĩe o. Le nyateƒe me, 

Kpe si wotsɔ xea mɔ na nu la ƒe sesẽ dzɔna le ɣeyiɣi ɖeka me le ƒu si le lãkusia me alo esi te fli ɖe eme kple ga si le ga si wotsɔ blaa nu la me. Le susu sia ta la, .

 Ele bɔbɔe be atikewɔla natsɔ vodada asusui be ɖa si wotsɔ xea mɔ na nu la le nyuie le ƒu si le lãkusia me alo esi te fli ɖe eme la me (Nɔnɔmetata 3).

Fig. 3 Dɔwɔwɔ ƒe didime ƒe ʋuƒo siwo wotu ɖe ƒu ƒe ƒomevi kple cortices ƒe xexlẽme dzi.

Self-tapping ʋuƒo gaviwo .

Self-tapping locking screws zazã fia be asikaka ame ŋu ƒe nyaŋuɖoɖo aɖeke meli le tomekuku alo etutu me esime wole dzɔdzɔm le ɣeyiɣi ɖeka me o.

Woƒe mɔ̃ɖaŋununya ƒe nɔnɔmewo sɔ kple esiwo le cortex ɖeka ƒe ʋuƒo siwo wotsɔna ƒoa gaviwoe me le cortex ɖeka ƒe dɔwɔwɔ me. Ne wodidi akpa la, . 

Woaƒo ka na lãkusi evelia si me mekɔ o la, si ana be woatsɔ ʋuƒo si wotsɔ xea mɔe la aɖo teƒe si mesɔ o le ʋuƒoa me.

Le bicortical zazã me la, woate ŋu anɔ kpuie akpa, si ana woasɔ kple mɔ̃ si sɔ kple ɖaƒoƒo ɖeka ƒe ʋuƒo siwo wotsɔna xea mɔ na nu. 

Ne wodidi akpa la, woakeke ta wu lãkusia eye woate ŋu agblẽ nu le xɔtunu vevi siwo le agbaa ƒe akpa kemɛ ŋu.

Ne wotsɔ fluoroscopy ɖo eƒe didime si wodi vɔ megbe ko hafi woate ŋu akpɔ ɖa ƒe didime si sɔ la to eƒe didime si wodi alo eƒe kpeɖodzi nana to fluoroscopy dzi me.

Uniaxial locking screws ƒe nɔnɔmewo .

Nusi koŋ gblẽ le uniaxial locking nails ŋue nye be woɖo woƒe nɔnɔme ɖi do ŋgɔ. 

Woate ŋu atsɔ nusi wotsɔ dea lãme na ame alo ametia ƒe ke bubu aɖe le woƒe mɔ dzi, si ana be womate ŋu ade wo me o alo be woaxe mɔ na wo be woatsɔ wo ɖokuiwo aɖo wo nɔewo ŋu.

na ŋutilã ƒe wɔwɔme ƒe ʋuƒo siwo wozãna le abɔwo kple afɔwo me kple uniaxial locking nails siwo ƒe mɔfiame le ɖoɖo nu la, . 

Ne wowɔe wònyo wu le ŋutilã ƒe wɔwɔme kple biomechanical susuwo ta la, afɔku li be woawɔ ƒunukpeƒewo ƒe ʋuƒo si wotsɔna ƒoa ɖae. 

Kpɔɖeŋu si bɔ enye didiƒe ƒe didime ƒe gbagbã. Afɔku sia lolo wu gɔ̃ hã ne ʋuƒoa te ɖe ƒunukpeƒea ŋu tututu alo ne ŋutilã ƒe wɔwɔme mede ŋgɔ o. 

Ele be woatsɔ fluoroscopy aɖo kpe ƒunukpeƒea ƒe gbagbã ƒe anyimanɔmanɔ dzi.

MIPO mɔ̃ɖaŋunuwo .

Aɖuɖɔtoemedɔléle si nye percutaneous osteosynthesis (MIPO) ƒe mɔnu si me womezãa nu boo aɖeke le o la lɔ ŋutigbalẽ te kple/alo lãkusi te ɖe eme . 

kple ƒu ƒe agba ƒe tsɔtsɔ de ƒu me to ʋuƒo sue aɖe me ɖe ƒu me le ʋuʋu vɔ megbe, evɔ womeɖee ɖe go o .

 Teƒe si wogbãe le. Esia ɖea mɔ ɖe nutsotso suewo ŋu, amekoko teƒe ƒe dɔléle dzi ɖena kpɔtɔna, eye wònana dɔwɔwɔa wu 'biologic'.

 Esi wònye be mehiã be woaɖe ƒu kakɛ ɖesiaɖe ɖe go o ta la, medoa kplamatse lãkusi falɛfalɛwo, ʋukawo ƒe ʋukawo ƒe ʋuʋu, alo ʋuka ƒe ʋuʋu o.

Woate ŋu atsɔ nutrenu kple dɔwɔnu si ŋu wotrɔ asi le etɔxɛe si ana agbaa nate ŋu awɔe la awɔe wòawu enu . 

be woatrɔ asi le eŋu eye woato ŋutigbalẽa me be woate ŋu akpɔ ɖa ƒe do siwo le agbaa me la bɔbɔe. 

Ele be woaɖe fluoroscopic nɔnɔmetatawo le afɔɖeɖe ɖesiaɖe me atsɔ aɖo kpe ŋgɔyiyi dzi. Aɖaŋu sia ƒe afɔɖeɖe ɖesiaɖe nye kuxi. Kuxi gbãtɔe nye be woagbugbɔ aɖo gbagbãƒea hafi woatsɔ aɖo wo teƒe.

 Emegbe ele be woatsɔ nutrenua aɖo titina nyuie le ƒua ƒe didime nu, ne menye nenema o la, ne wotsɔ gavi la ɖo afisi wòle be wòanɔ la, anye nusi mesɔ o (Nɔnɔmetata 5). Kpeɖe eŋu la, 

Ele be nutrenu si wotsɔ xea nu la nasɔ kple ƒu si wowɔ be wòakplɔe ɖo eye wòate ɖe ƒua ŋu abe . 

Ate ŋu adzɔ be womaɖe xɔa ƒe sesẽ dzi akpɔtɔ ŋutɔ o. Le afɔɖeɖe mamlɛtɔ si woawɔ me la, asesẽ be woakpɔ egbɔ be .

 Wotsɔa gaviawo ƒe mɔ̃wo ɖoa wo nɔewo dzi nyuie ɖe gavi si wotsɔ xea mɔ̃a ƒe ʋuƒoa dzi eye wotsɔa gavi siwo wotsɔ xea mɔ̃a ƒe ʋuƒoawo la wɔa dɔ nyuie ne wole wo ƒom.

Figure 5 Eccentric positioning of the locking plate kple haptic feedback ƒe anyimanɔmanɔ le screw tightening me.

Nuveviwɔame siwo ate ŋu axɔ ŋutigbalẽ ne wole gota gome ƒe afɔkpodzi ƒe ʋuƒo siwo wotsɔna ƒoa afɔkpodzii zãm .

Wogblɔ be ʋuƒo siwo wotsɔna xea mɔ na afɔkpodzi ƒe gbagbã le gota la zazã do ƒome kple ŋutigbalẽ ƒe kuku ƒe agbɔsɔsɔ si sɔ gbɔ le mɔ si mesɔ o nu. 

Alesi nulénu siawo siwo le lãkusi te ƒe titrime dea ŋutigbalẽa dzi eye wòxea mɔ na eƒe ʋukawo ƒe mama kple eƒe dɔyɔyɔ. 

Nane si sɔ kple esia ate ŋu adzɔ ne wozã LOCKING PLATES na Hawksbill ƒe gbagbã.

Afɔku si le ƒumeŋuɖui kple ʋuʋudedi me .

Le ƒumeŋuɖui ƒe ƒu me la, ɖaƒoƒo kpena ɖe ame ŋu wòɖea afɔku si le ʋuʋu alo eɖeɖe le lãme na ame me dzi kpɔtɔna. 

Nusi wowɔ la mesẽna o le ƒu ƒe lãkusi si le tsɛ wu kple trabeculae ƒe kpekpeme dzi ɖeɖe kpɔtɔ ta.

Le nɔnɔme sia me la, ʋuƒo si wotsɔna ƒoa nu ɖe nu ŋu la nu sẽna wu ɣesiaɣi eye wotsɔa seke ƒoa sena nyuie wu ne wozã evanescent alo convergent monolithic construct (Nɔnɔmetata 3).

Totoɖeme:

1. Gavi siwo wotsɔna ƒoa ƒu ɖe wo nɔewo ŋu meɖea mɔ be woagbugbɔ aɖo ƒu ƒe gbagbãƒe si le ƒu ƒe akpaa dzi la o.

2. Ele be woagbugbɔ aɖo gbagbãƒea hafi atsɔ gavi si wotsɔna xea mɔe akpe ɖe eŋu.

3. Percutaneous fixation na fracture reduction bia be woaxe mɔ ɖe plate instrumentation nu. MIPO ƒe aɖaŋua bia nu geɖe wu.

02. Kuxi siwo le ʋuƒo siwo wotsɔ xea mɔ̃wo ɖeɖeɖa me .

Ne woɖe gavi la ɖa ne gbagbãƒea nya da gbe le eŋu ko la, enyea kuxi eye womate ŋu agblɔe ɖi o, . 

Gake woate ŋu akpɔ nɔnɔmea gbɔ. Kuxi gãtɔ kekeakee nye be woaɖe asi le gavi si wotsɔna xea mɔe la ŋu.

Le go aɖewo me la, ka siwo le ɖa si wotsɔ xea mɔ na nu ƒe ta la gblẽna le wo dede eme . 

(Zi geɖe la, woblaa nu eye woɖea asi le eŋu, screwdriver ƒe nɔnɔme gblẽ eye menye dzogoe ade bliboe o, wowɔa screw insertion kple power drill), 

si fia be womate ŋu anye esi woɖe le eme o. Eyata anyo wu be woaxe mɔ ɖe kuxi sia nu to gavi ɖesiaɖe ɖɔliɖɔli enumake kple a . 

Ta ƒe nɔnɔme si gblẽ le edodo me, zã screwdriver blibo eye nàtsɔ asi abla gavi la bliboe (menye kple elektrik-ku o).

 Screw siwo wotsɔ nusiwo sesẽ wu wɔe zazã ate ŋu akpe ɖe ŋuwò nàɖe kuxi sia dzi akpɔtɔ.

Le go geɖe me la, mɔ̃wo ƒe ʋuʋu alo jamming nɔa ɖaƒoƒo ƒe ka siwo wotsɔ xea mɔe kple do si wotsɔ ka bla ɖe ʋuƒoa me la dome. 

Esia nye nusi wokpɔna wu kple 3.5mm ƒe didime titanium hex kpɔɖeŋu ɖeka shaft ʋuʋu screws. Mɔ̃ ɖeka aɖeke meli o .

 hena nudede nyawo me. Zi geɖe la, wotsɔa gavi siwo wotsɔna ƒoa gaviwoe la sesẽna le gɔmedzedzea me le esi womewɔa torque wrench si wona le instrument kit la me o ta, . 

si ate ŋu atrɔ ka siwo le gavi si wotsɔ xea mɔe kple gavi si wotsɔna ƒoa gae la dzi. Le go bubuwo me la, . 

Drill guide si mesɔ o zazã alo ezazã alo eŋudɔwɔwɔ na be gaviawo meva nɔ ɖoɖo nu ne wobla wo o, . 

si na gaviawo ƒo ƒu. be woaɖe afɔku si le jamming me le gbãtɔ ɖɔɖɔɖo ƒe ɖoɖoa me dzi akpɔtɔ la, .

 Ele vevie be woazã dɔwɔnu siwo katã li: drill guides kple sockets, torque wrenches le integrity mode blibo me ne wole ɖa siwo wotsɔ xea mɔ na wo la me kum.

MIPO ƒe mɔnu la tsɔa afɔku gã aɖe si nye be woatsɔ mɔfianu si wotsɔna ɖoa nuwo ɖe ɖoɖo nu la ade eme nyuie o, . 

Esi wònye be womekpɔa nu si wotsɔ xea mɔ na nu la tẽ o ta la. Drill guide la ƒe ɖoɖo si mesɔ o fia be do si woɖe na . 

Afɔ si wotsɔ xea mɔe kple ɖa si wotsɔ blaa nu la dede eme hã masɔ o. Afɔku hã li be woagblẽ nu le ta ƒe nɔnɔme si le .

 Kloe ne wometsɔ gavi la ƒo gavi la nyuie o.

Le susu siawo ta la, hafi amekolaa naɖe gavi si wotsɔ xea mɔ̃a ƒe ʋuƒoa ɖa la, ele be wòanya be ɖewohĩ menye . 

Ate ŋu adzɔ be woaɖe asi le ʋuƒoa ŋu, si ana be woazã dzogoe ade ƒe ʋuƒo si le ɖoɖo nyui nu kple dɔwɔnu bubuwo.

Ne womate ŋu aɖe asi le ɖa si wotsɔ blaa nu ŋu o, alo ta ƒe nɔnɔme gblẽ la, . 

Afɔɖeɖe gbãtɔe nye be woatsɔ gavi si wotsɔna ɖea gavi (si nye gavi si wotsɔna ƒoa gavi si ŋu ka siwo wogbugbɔ trɔ) la ade gavi la ƒe ta me;

 Esia ate ŋu asu be wòaɖe gavi la ɖa. Mɔnu bubue nye be nàtso gavi si wotsɔ xea mɔ na nu la ƒe akpa eveawo eye nàzã .

 Eye wònye nusi wotsɔna ƒoa ʋuƒoe be wòaɖe xɔa ƒe akpa bliboa ɖa. Ne womate ŋu aɖe gavi la ɖa kokoko o la, woate ŋu aɖe asi le gavi si wotsɔ xea mɔ̃a ƒe gavi la ŋu to . 

Kuku ɖe eŋu kple drill, si agbã ɖa si wotsɔ blaa nu la ƒe ta, alo to lãɖeɖe ɖe agbaa ŋu be wòaɖe asi le ʋuƒoa ŋu. Le ema megbe la, . 

Woate ŋu azã vise atsɔ aɖe gavi siwo le gavi siwo wotsɔ xea mɔe la ƒe atiwo ɖa. Ne womate ŋu aɖe asi le eŋu kokoko o (elabena wotsɔe de ƒu me alo medona ɖe gota nyuie o), . 

Woate ŋu atsɔ ring drill ɖae (Fig. 6).

Figure 6 ƒe aɖaŋuɖoɖowo kple aɖaŋuɖoɖowo hena ʋuƒo siwo wotsɔ xea mɔ̃a ƒe ʋuƒo siwo wotsɔ ƒo ɖe ʋuƒoa me la ɖeɖeɖa.

Kuxi siawo katã ate ŋu ana amekokoa nadidi ɖe edzi, ate ŋu ana lãkusi falɛfalɛwo naʋuʋu le ga kakɛ siwo woɖe ɖe go ta, eye woatsɔ dɔlékuiwo ƒe afɔku ɖe asi. 

Ring drill zazã dzia afɔku si le dɔwɔwɔ le dɔwɔwɔ nɛ me ɖe edzi.

Totoɖeme:

1. Kuxi si nye be woaɖe ɖawo ɖa la dzɔna koŋ kple 3.5mm hex ta ʋuʋu titanium screws.

2.Mɔ nyuitɔ si dzi nàto aƒo asa na kuxi siae nye be nàzã dɔwɔnu siwo katã wona la ne wole gavi la dem eme. Woate ŋu akpɔ kuxi siawo gbɔ to dɔwɔnu siwo sɔ zazã me.

03. Nukae nye dɔwɔwɔ ƒe seɖoƒe siwo le ʋuƒo si wotsɔna ʋua nu ŋu?

Clavicle Plate Fracture kple Ƒumelãwo ƒe Nonunion .

To egbɔkpɔkpɔ be xɔa mesẽ akpa le dɔwɔwɔ ƒe didime si mesɔ gbɔ le gavi si wotsɔ xea mɔe ƒe dɔwɔwɔ ƒe didime alo ɖa siwo wotsɔ xea mɔe ƒe xexlẽme si gbɔ eme o ta (Fig. 7) la, woate ŋu aɖe afɔku si le ʋuƒoa ƒe gbagbãƒe si gbã le gaviawo ƒe dowo te alo le gavi/ƒu ƒe ʋuƒoa ƒe ƒoƒo te la dzi akpɔtɔ.

Figure 7 Wokpɔ ƒu ƒe dɔyɔyɔ le ŋkeke 60 megbe to asitɔtrɔ le gavi siwo wotsɔna xea mɔe ƒe xexlẽme kple afisi wole ŋu eye wodzi xɔtuɖoɖo siwo sesẽ akpa ƒe elasticity ɖe edzi.

Zi geɖe la, woɖoa kpe ƒu ƒe no ƒe ƒuƒoƒo ƒe dzesi dzi to plate ƒe gbagbã me. 

Ne wogbã gbadzɛ alo ɖaƒoƒo ƒe ɖa ƒe gbagbã megbe la, esɔ ɖe ɣeyiɣia nu elabena micromotion ate ŋu adzɔ si ana ƒu nahaya.

le ƒu gbagbã bɔbɔe siwo hiã be woazi wo dzi me, si nɔ te ɖe ƒu ƒe gbagbã ƒomevi dzi tsɔ wu be wòanye ƒu si ŋu nya ku ɖo, . 

wɔwɔme sesẽ aɖe si me kakɛ eveawo meka asi o ate ŋu ana agbaa nado kpo dɔwɔwɔ eye ɖeɖi ate eŋu. 

Afɔkpodzi sesẽ + ɖaƒoƒo + ƒe ʋuʋu le afisi ƒu kplakplakpla le la ƒo ƒu naa ƒu megawɔa dɔ o.

Esia ƒe tɔtrɔ aɖee nye ɖa si wotsɔ xea mɔ na nu la ƒe gbagbã le ɣeyiɣi ɖeka me le eƒe kuku ɖe agbaa ŋu, . 

si hã tso xɔtuɖoɖo si me kɔ akpa gbɔ. Esia nana be agbaa ƒe nugbɔ ɖeka hea 'le akpa ɖeka me' eye womete ŋu daa gbe le ame ŋu o (Nɔnɔmetata 8).

Nutata 8 Xɔ si sesẽ akpa eye meda sɔ o ƒe kpododonu evelia: Wozã ʋuƒo siwo wotsɔ xea mɔ na nu geɖe akpa le didiƒe eye splice plate si le proximal la medidi o.

Eyata akɔta ƒe ƒuƒu siwo le intracapsular me ƒe ƒuƒoƒo kple ʋuƒo siwo wotsɔ xea mɔ na ƒu ƒe ƒuƒoƒo ate ŋu ana ƒu nagaƒo ƒu o elabena xɔa ƒe wɔwɔme sesẽ akpa be wòate ŋu agbã le teƒe si ƒu kplakplakpla la. 

Ne micromotion si hiã hena dɔyɔyɔ meli o la, agbaawo katã tsɔa nusi wotsɔ dea eme la ɖe asi eye wòdoa kpo nu mlɔeba.

Asymmetric gbedada ƒe lãkusi .

ƒumeŋuɖui ƒe ƒuƒoƒo ate ŋu anye esi mesɔ o, . 

vevietɔ le akɔta ƒe akpa si le didiƒe ʋĩ ƒe gbagbãƒewo me. Micromotion le elasticity ta ɖe mɔ ɖe . 

fracture healing tissue ƒe ŋgɔyiyi ɖekae si dzɔna ɖe locking plate/nail construct la ƒe anyigba siwo sɔ dzi ko.

 Be woakpɔ afɔku sia dzi la, ele be woadzi ga si wotsɔ xea mɔ na nu ƒe dɔwɔwɔ ƒe didime ɖe edzi, to titanium-gbadzɛ siwo te ŋu trɔna bɔbɔe wu zazã me alo to ɖaƒoƒo ƒe nɔnɔme yeyewo zazã me. 

Le go bubu me la, wɔwɔme siwo te ŋu trɔna fũ akpa ate ŋu ana ƒu naganye hypertrophic bone nonunion o.

Plastik ƒe deformation si nye gakpo gbadzɛwo .

Agbalẽa dada ɖe lãkusia gbɔ alesi woate ŋui ɖea afɔku si le plastik ƒe nɔnɔme ƒe tɔtrɔ le agbaa titina me dzi kpɔtɔna;

 Ne didime si le agbaa kple lãkusia dome wu milimeta 5 la, .

 Woɖea xɔtuɖoɖo ƒe ŋusẽ dzi kpɔtɔna ŋutɔ eye afɔku si le plastik ƒe nɔnɔme ƒe tɔtrɔ me le agbaa me eye titanium gbadzɛa ƒe kpododonu sɔ gbɔ ŋutɔ.

Diaphysis alo metaphysis ƒe gbagbã siwo tsi megbe le nutrenu ƒe nuwuwu .

Afɔku si le gbagbã megbe le locking plate diaphysis alo metaphysis ƒe nuwuwu, . 

Vevietɔ le ƒumeŋuɖui ƒe ƒu me la, woate ŋu aɖe edzi akpɔtɔ ne wotsɔ cortical locking nail ɖeka alo bicortical screw si wozãna ɖaa de agbalẽa ƒe nuwuwu be wòaɖe nuteɖeamedzi siwo le nuto sia me dzi akpɔtɔ.

Mɔ̃ɖaŋununya ƒe kpododonu .

Nɔnɔme siwo gbɔna dzia afɔku si le mɔ̃a ƒe dɔmawɔmawɔ nyuie me ɖe edzi:

1. Humeral diaphysis fractures ƒe fixation bia be woazã ɖa ene siwo wotsɔ xea mɔ na wo le akpa eveawo ƒe akpa eveawo be woatsi tre ɖe torsion ŋu eye woadzi mɔ̃wo ƒe dɔmawɔmawɔ nyuie ɖe edzi ;and

2. Epiphyseal ƒe gbagbã ƒe fixation sesẽ elabena zi geɖe la, womeli ke o, . 

Vevietɔ le esi womate ŋu aƒo ƒu ƒe gbagbãƒea nu to ɖa siwo wotsɔ xea mɔe dzi o eye ƒu nye ƒumeŋuɖui ta;

3. Commimed intra-articular kple extra-articular commimed fractures of the epiphysis are instable .

 (le kpɔɖeŋu me, akɔta ƒe akpa si le didiƒe, afɔti siwo le lãkusi me ƒe akpa eve ƒe gbagbã, didime si le didiƒe ʋĩ ƒe gbagbã);

4. Metaphyseal fractures ƒe titina ƒe comminution si te ŋu trɔna yia megbedede me (le kpɔɖeŋu me, proximal humerus, proximal femur, kple proximal tibia fractures).

 Kpe gbadzɛ siwo wotsɔ bla ɖe ƒu ƒe akpa si le axadzi la naa xɔtunu sesẽ aɖe si sɔ gbɔ zi geɖe . 

Be woali ke ƒuƒu siawo evɔ mahiã be woatsɔ console-ƒomevi ƒe agbalẽviwo akpe ɖe eŋu le titina alo atsɔ ƒu ade eme esime wole biologic fracture nɔnɔme me o. 

Stability nɔ te ɖe locking plate/locking nail interface dzi ko, . 

Nusi tea ɖeɖi ame ŋu wu le egbugbɔgaɖoɖo vɔ megbe ne epiphysis la gakpɔtɔ nye inverted alo ne womegbugbɔ medial console la wɔ o. Emegbe nutrenu si wotsɔ xea mɔ na nu la ate ŋu ado kpo nu le ɖeɖiteameŋu ƒe evelia me.

Eyata ele be woabu bicondylar tibial plateau fractures ƒe fixation zazã ŋu to locking plates zazã me le axadzi ƒe akpa dzi ko le eƒe ƒomevi nu.

 Le proximal humerus fractures, fracture blocks ƒe xexlẽme, medial support ƒe bublu, .

 kple epiphysis ƒe tɔtrɔ ɖe nɔnɔme ŋu hena fixation nye afɔku siwo wonya. Be woaɖe afɔku si le xɔtuɖoɖo ƒe kpododonu me dzi akpɔtɔ la, . 

Woatsɔ mɔ̃ akpe ɖe ʋuƒo aɖewo siwo wotsɔ xea mɔe ŋu be woatsɔ axe fe ɖe titina ƒe kpekpeɖeŋu ƒe anyimanɔmanɔ le ƒu gbagbã siwo gɔme woɖe le gota dzi ɖeɖe kpɔtɔ me ta .

Nu gbagbewo ƒe kpododonu le ʋuƒo siwo wotsɔ xea mɔ na nu ŋu .

Nu gbagbewo ƒe kpododonu ƒe mɔnuwo nyea gavi siwo wotso kple gavi si wotsɔ ƒoa gae la ƒe gbagbã alo eƒe ʋuʋu. 

afɔku siawo lolona ne ƒumeŋuɖui le ƒunukpeƒea, . 

Nusi fia be ele be woawɔ ɖɔɖɔɖo kaba eye woatrɔ ayi kpekpeme tsɔtsɔ me nyuie hafi woawɔ ƒu ƒe dɔyɔyɔ.

(1) Gavi siwo wotsɔna xea mɔ̃a ƒe gaviwo ɖeɖeɖa .

Screw extraction sɔ kple 'total' kple ɖaƒoƒo ƒe ɖa ɖeɖe ɖa le ƒu me le ɣeyiɣi ɖeka me le agbalẽa ƒe nugbɔ ɖeka alo evea siaa me. Le go aɖewo me la, . 

Wotsɔa ƒu kakɛ aɖe si ƒo xlãe la ɖea ɖa si wotu la ɖa.

Le epiphyseal nutoa me la, zi geɖe la, akpa ɖeka ƒe ʋuƒo ƒe xɔtunua naa liƒo si sɔ le esi wòkaka alo esi le ƒoƒom ɖe ɖa ƒe seke si wotsɔ ƒoa ʋuƒoe ta, . 

eye akpa etɔ̃ ƒe wɔwɔme dzia tsitretsitsi ɖe screw ɖeɖe ŋu ɖe edzi tso ƒu si me woate fli ɖe eme la me.

Le diaphyseal nutoa me la, ƒoƒoe siwo le ƒoƒom kple esiwo kaka ɖe wo nɔewo ŋu kple xɔtunu siwo ƒe ʋuƒo didi wu la ƒe ŋusẽ nyo wu . 

Xɔtutu sia ƒomevi sɔ wu na periprosthetic fractures. le ƒumeŋuɖui ƒe ƒu me, . 

Bicortical stem screw fixation nyo wu monocortical screw fixation. Le periprosthetic fractures gome la, flat-head unicortical screws kpena ɖe ame ŋu be woaƒo asa na kadodo kple intramedullary implants.

Fixation ƒe kpododonu siawo do ƒome kple ƒu ƒe nyonyome madeamedzi, ne mɔ̃a ƒe wɔwɔme me gblẽ o gɔ̃ hã.

(2) ʋuƒo siwo wotsɔna ƒoa gaviwoe alo woƒe ʋuʋu .

Cut-out alo imlingement of locking nails with intra-articular penetration ate ŋu adzɔ le cancellous epiphyseal nuto me.

Ʋuʋu siawo nye ƒu si ƒe lolome le sue si woɖe ƒo xlã fixation locking nail la ƒe epiphyseal fragments ƒe ʋuʋu.

 Esia wɔnɛ be epiphyseal fracture dzi ɖena kpɔtɔna. Le nɔnɔme nyuitɔ kekeake me la, epiphyseal locking nail la imlinges kple .

 Egena ɖe ƒu si tea fli ɖe eme la me. Le nɔnɔme si vɔ̃ɖi wu me la, epiphyseal locking nail dona le epiphysis la me eye wòzɔa mɔ yia ƒunukpeƒea.

Kuxi eve siawo dzɔna zi geɖe le proximal humerus kple distal radius fractures me. 

Le ʋuƒo si wotsɔ xea mɔ na humerus ƒe gbagbã siwo le ŋgɔgbe gome la, wokafui be . 

Epiphyseal locking nail be se ɖe edzi be woaɖe afɔku si le ingrowth kple evelia ƒe ƒunukpeƒe ƒe gege ɖe eme dzi akpɔtɔ.

Fixation ƒe kpododonu siawo tso ƒu ƒe nyonyome si mesɔ gbɔ o kple ƒu gbagbã ƒe kakɛawo ƒe ʋuʋu le gɔmedzedzea me gbɔ hafi woɖe wo dzi kpɔtɔ, . 

Ne mɔ̃a le xɔa me gɔ̃ hã.

ƒunukpeƒewo gbugbɔgaɖɔɖo kple kpekpeme tsɔtsɔ enumake .

Woɖe mɔ ɖe gbugbɔgaɖɔɖo kple kpekpeme ƒe tsɔtsɔ ŋu ne wowɔ ɖoɖo ɖe nu ŋu bliboe eye woɖo kpe edzi le X-ray siwo wowɔ le dɔwɔwɔ vɔ megbe ŋu ko.

Biomechanical numekukuwo ɖee fia be le ƒu si sɔ me la, ne dometsotso si le kakɛawo dome mede 1 mm o la, . 

Kpekpeme ƒe kpekpeme ate ŋu adzɔ afɔku manɔmee. Le tsatsam miliɔn 1 megbe la, sesẽa sɔ kple ƒu si sɔ la tɔ, si sɔ gbɔ be woada gbe le eŋu.

Ne gbeɖiɖi le ɖoɖo nu la, plate siwo wotu kple ɖa siwo wotu ɖe dzogoe ene me la ɖea mɔ be woatrɔ ayi . 

Weightbearing elabena wotsɔa agbaa tsoa ʋuƒo si wotsɔ xea nu la gbɔ tẽ yia ʋuƒoa me, eye afɔku aɖeke mele eme be woatsɔe aɖo ɖaƒoƒo ƒe mɔ̃a ƒe ʋuƒoa dzi o.

Gake ne axis si le multiaxial locking peg la mele tsiatre ɖe nutrenu la ŋu o la, womeɖea mɔ ɖe kpekpeme tsɔtsɔ kaba ŋu o.

Le MIPO gome la, woɖe mɔ ɖe kpekpeme tsɔtsɔ na ame kaba ŋu hena ƒunukpeƒetetedɔ siwo le ƒunukpeƒea godo, siwo le bɔbɔe kple/alo esiwo wotsɔ ƒo ƒu bɔbɔe. 

Xɔtuɖaŋu tɔxɛ siwo didi ŋutɔ la te ŋu trɔna ɖe nɔnɔmewo ŋu nyuie kple bicortical locking nails siwo trɔna kple ʋuƒo siwo wotsɔna ƒoa agbae hena agbawo ƒe xɔxlɔ̃ kple wo mama.

Nyanuwuwuw:

1.Biomechanical numekukuwo da wɔwɔme ƒomevi vovovowo kple woƒe mɔ̃ɖaŋununya ƒe nɔnɔmewo kpɔ.

Agbalẽawo kpena ɖe ame ŋu be woaɖo kpe nukpɔsusu ƒe mɔkpɔkpɔ siwo do ƒome kple fixation sia ƒomevi dzi. 

Gake agbalẽ siwo woŋlɔ nyitsɔ laa hã te gbe ɖe mɔ̃ɖaŋununya ƒe kuxi kple kpododonu siwo do ƒome kple agba siwo wotsɔ xea mɔe dzi.

2.Nusi koŋ gbɔ wòtso be wodo kpo nu enye ɖoɖowɔwɔ ɖe amekokomɔnu ŋu nyuie o, . 

Nusi bia nu geɖe ŋutɔ, vevietɔ ne wole dɔ siwo me womezãa nu boo aɖeke le o wɔm.

3.Ele be woagbugbɔ aɖo gbagbãƒea gbã, evɔ womatu gaviawo ɖe agbaa ŋu o, .

Abe alesi plate la gbugbɔɖoɖo tẽ to gaviawo tutu me manya wɔ o ene.

4.Ele be xɔtuɖoɖoa nanye didime kple ŋusẽ si sɔ, . 

si fia be ele be amekolaa nanya gɔmeɖose kple se siwo fiaa mɔ agbalẽvi siawo zazã nyuie. 

Eyata ele be xɔa nate ŋu atrɔ, eye woatsɔ gavi siwo wotsɔna xea mɔe edziedzi ƒe xexlẽme aɖe ko aɖo wo nɔewo ŋu siwo trɔna kple do ƒuƒluwo.

5.Togbɔ be nukpɔsusu gbãtɔ si nyo wu le gɔmedzedzea me ƒe liƒo si le ʋuƒo siwo wotsɔ xea nu me hã la, . 

Alesi xɔa ƒe akpa si le xɔa me la léle ɖe te la nana be ƒu ƒe gbagbã, alesi woɖea edzii ƒe nyonyome, kple ƒu ƒe nugbagbeviwo ƒe nyonyome dzi ɖena kpɔtɔnae.

6.Ne mɔ̃a me gblẽ le mɔ̃ me la, ƒu ƒe nyonyome nyo eye ƒu ƒe gbagbã nye extra-articular, . 

Woate ŋu aɖe mɔ na dɔnɔ si si ɖokuisinɔnɔ sɔ gbɔ ɖo la be wòatsɔ eƒe kpekpeme aɖo abɔ si gbã la dzi. Le go geɖe me la, plating plate fixation ɖea mɔ be woagbugbɔ aɖɔe ɖo kaba.