Tibial ƒe gbagbã, suprapatellar intramedullary nail technique .

Intramedullary nailing technique for tibial fractures: to suprapatellar, transarticular approach kple klo ƒe ʋuʋu le 20-30° kple ametakpɔnu tɔxɛ aɖe me be woatsɔ akpɔ intra-articular structures ta.

01.Tibial Intramedullary Nailing .: mɔɖeɖe kple ɖoɖowɔwɔ ɖe ɖoɖo nu, klo ƒe vevesese si le ŋgɔgbe .

Amekoko ƒe mɔɖeɖe ɖe lãkusi ƒe gbagbã ƒe lãkusi ƒe ƒoƒo ŋu le vevie be woate ŋu ade lãkusi me ɖa to teƒe si sɔ, be woaɖe klo ƒe wɔwɔme siwo le ƒunukpeƒea me la dzi akpɔtɔ, eye be woakpɔ afisi wogbugbɔ ɖo ɖe teƒe si sɔ nyuie wu kple ɖa ƒe gege ɖe eme nyuie.

Mɔnu xoxo siwo wozãna na tibial stem fractures enye median infrapatellar alo parapatellar mɔnuwo. Togbɔ be woɖe mɔnu siawo fia na mid-portion fractures hã la, dɔwɔwɔ vɔ megbe valgus, anterior, alo syndesmotic deformities dzɔna enuenu le proximal fractures geɖe wu me.

Nusi koŋ gbɔ wòtsona be nu manyomanyo si le lãkusi ƒe gbagbã siwo te ɖe eŋu mee nye nɔnɔme madeamedzi si tsoa quadriceps ƒe lãkusi hehe le klo ƒe ƒoƒo me kple mɔ̃ɖaŋununya ƒe dzrewɔwɔ le ɖa ƒe nugbɔ kple megbeƒu ƒe lãkusi dome le nusi wotsɔ de eme la dede me. Afɔdzideƒea hã xea mɔ na axial entry of the nail in the sagittal plane (Fig. 1a, b). Eyata mɔnu bubu si bɔ si dzi woato age ɖe nyaa mee nye to medial parapatellar incision, si wɔnɛ be wotsɔa nail insertion si le titina vie la dea eme (Fig. 1C kple 2). Ne ɖa la le gegem ɖe ʋuka si le ʋukaa me la me le adzɔge tso gbagbãƒea gbɔ la, wotsɔa akpa si te ɖe eŋu la ƒoa ƒu ɖe exostosis me (Fig. 2). Mlɔeba la, ŋgɔgbexɔa ƒe lãkusiwo ƒe teteɖeanyi ƒe teteɖeanyi kpena ɖe ectropion ŋu vie (Fig. 3).

Figure 1 a,b Le infrapatellar mɔnu si wozãna ɖaa zazã me la, patella xea mɔ na axial entry of the nail, si wɔnɛ be anterior apical sagittal alignment kple ectropion coronal alignment.C intramedullary nail alignment si wowɔ to parapatellar mɔnu zazã me.

Figure 2 tete ɖe teƒe si woge ɖo ŋu to medial parapatellar incision dzi hea medial vie ɖe lateral nail insertion dzi. Ne ɖa la le gegem ɖe lãkusia me le afisi didi tso gbagbãƒe (A) gbɔ la, wotsɔa akpa si te ɖe eŋu la ƒua gbe ɖe dzo (b) me .

Fig. 3 Akɔta ƒe lãmeka ƒe akpa si le ŋgɔgbe ( A ) ƒe teteɖeanyi wɔa ectopic ɖoɖo si menya kpɔna dzea sii bɔbɔe o ( B ) .

Tibia ƒoƒo ɖe teƒe si keke wu kpena ɖe ame ŋu be woaƒo asa na kuxi siwo do ƒome kple klo ƒe ʋuʋu sesẽ le dɔwɔwɔ me.Gelbke, Jakma et al. Le ƒe 2010 me eye wòxɔ ŋkɔ le ƒe ʋɛ siwo va yi me elabena afɔtiwo tsɔtsɔ ƒo ati ɖe abɔ kple afɔ ƒe nɔnɔme si le dzɔdzɔe kloe me la naa gbagbã ƒe asitɔtrɔ kple eƒe nɔnɔme tɔtrɔ bɔbɔe. Fluoroscopy va le bɔbɔe be woawɔe le mɔ̃ɖaŋununya me. Woka nya ta be ɣeyiɣi si wotsɔ ƒoa fluoroscopy na suprapatellar nailing la le kpuie ŋutɔ wu infrapatellar nailing . Tsɔ kpe ɖe eŋu la, dzogoe si wotsɔ dea nu me (le sagittal plane me) sɔ kple afɔkpodzi ƒe didime ƒe axis kple mɔnu sia wu infrapatellar nailing; Esia xea mɔ na mɔ̃ɖaŋununya ƒe dzrewɔwɔ le ɖa ƒe nugbɔ kple megbeƒu dome, si wɔnɛ be ƒu ƒe gbagbã dzi ɖena kpɔtɔna.

Klo ƒe vevesese si le ŋgɔgbe le dɔwɔwɔ vɔ megbe nye kuxi si sɔ. Woka nya ta be klo ƒe vevesese le dɔnɔ siwo ƒe lãme gbã ƒe 50-70% ŋu, eye dɔnɔ 30% koe le vevesese dzi ɖem kpɔtɔ le eƒe nugbɔ ƒe akpa si woɖe la ɖeɖe ɖa vɔ megbe. Wobu akɔnta be abi ƒe wɔwɔme si do ƒome kple patellar tendon kple Hoffa ƒe ami ƒe akpa si nye fat pad nye nusi ate ŋu anye klo ƒe vevesese si tso dɔwɔwɔ vɔ megbe gbɔ. Tsɔ kpe ɖe eŋu la, suprapatellar ƒe mɔnu la ƒoa asa na ʋuʋudedi si nye saphenous nerve ƒe akpa si nye patellar la ƒe akpa si nye patellar, si ƒoa asa na klo ƒe ŋgɔgbe ʋuʋu kple seselelãme si me mekɔ o la ɖeɖe ɖa tsã (Nɔnɔmetata 4). Edze abe ne woto ɖa ŋu to lãkusia ƒe lãkusia me, si wɔnɛ be patellar ƒe lãkusia megagblẽna o la, eɖea klo ƒe vevesese le dɔwɔwɔ nɛ vɔ megbe dzi kpɔtɔna ŋutɔ ene.

Fig. 4 Ƒomedodo si le saphenous nerve kple mɔ vovovo siwo dzi woato akpɔ tibialis obliqua nail dome .

Le nusiwo do tso proximal fractures me nyuie ta la, wokeke nusiwo le dɔdamɔnu me ɖe enu va ɖo gbagbãƒewo katã.

Kuxi siwo ate ŋu anɔ intramedullary nailing le suprapatellar mɔnu me:

- Ate ŋu agblẽ reaming gbeɖuɖɔ ɖe klo ƒe ƒunukpeƒe. Gake atikewɔnyawo ŋuti nuteƒekpɔkpɔ le afɔdzidede si trɔna ɖe megbe meɖe nugbegblẽ le ame ŋu ɣeyiɣi kpui alo didi aɖeke fia o.

- Aleke woɖea nusi wotsɔ de lãme na ame la ɖa le gbagbãƒea ƒe dɔyɔyɔ megbe? Togbɔ be mɔ̃ɖaŋununya ate ŋu adzɔ be woaɖe lãkusi si le lãkusi me ɖa to mɔnu si nye suprapatellar dzi hã la, aɖaŋua bia nu geɖe eye amekola akpa gãtɔ lɔ̃na be yewoaɖe lãkusi si le lãkusi me la ɖa to mɔnu si me womedea amii o me.

02.Ɣekaɣie wòle be woazã ɖa si le suprapatellar intramedullary me?

Viɖewo .

- Klo ƒe nɔnɔme si keke afã kple afã naa gbagbã ƒe asitɔtrɔ kple edziɖeɖekpɔtɔ toa lãmeka ƒe ŋusẽwo ƒe ɖiɖiɖeme kple wo léle ɖe asi me le ɖadede me.

- Afɔku si le dɔwɔwɔ vɔ megbe ƒe vodada si nye proximal, segmental, kple distal fractures ƒe afɔku si le dɔwɔwɔ vɔ megbe ne wotsɔe sɔ kple mɔnu xoxowo .

- Nailing le bɔbɔe wu le mɔ̃ɖaŋununya gome .

- Nailing nye nusi woate ŋu awɔ abe 'amekola ɖeka ƒe ɖoɖo' ene.

- Fluoroscopy ɣeyiɣi dzi ɖe kpɔtɔ .

- Nu aɖeke megblẽ le patellar tendon ŋu o eye klo ƒe klo ƒe vevesese megbe ƒe dzɔdzɔ dzi ɖe kpɔtɔ .

- Ele bɔbɔe wu be woawɔ le ƒuƒoƒo geɖe ƒe dɔwɔwɔ me, abe alesi wòle le polytrauma gome ene.

Nusiwo gblẽ le eŋu .

- Afɔku si le klo ƒe ƒunukpeƒewo ƒe gbegblẽ kple ƒunukpeƒewo ƒe wɔwɔme bubuwo me .

- klo ƒe dɔléle ƒe afɔku si dzi ɖe edzi .

- Woate ŋu aɖe nusi wotsɔ de eme la ɖa ate ŋu abia mɔnu bubu .

Nusiwo fia .

- Afɔkpodzi ƒe akpa si le ƒunukpeƒea ƒe akpa si le ƒunukpeƒea ƒe akpa si le ƒunukpeƒea ŋu (AO 41A ƒomevi) .

- Tibia ƒe ʋuʋudedi ƒe gbagbã bɔbɔe siwo wotsɔ ƒo ƒu ɖekae (ƒomevi AO 42A-C) .

- Segmental tibial diaphysis ƒe gbagbã (ƒomevi AO 42C) .

- Extra-articular kple bɔbɔe intra-articular distal extension fractures of the distal tibia (ƒomevi AO 43A kple C1)

- Klo si le tsia dzi .

Nusiwo woawɔ atsɔ atsi tre ɖe nu ŋu .

- Gustilo Grade 3C ƒe afɔkpodzi ƒe gbagbã le ʋuʋu me le afɔku si le ƒunukpeƒetetedɔ ƒe afɔku me ta, togbɔ be womegblɔ afɔku si le ƒunukpeƒetetedɔ me ƒe dzidziɖedzi le ʋuʋu le ʋuʋu me o hã .

- Lãmetsi falɛfalɛwo ƒe vuvu sesẽ, ɖiƒoƒo alo dɔlékuiwo le suprapatellar nuto me .

- Ipsilateral klo ƒe ŋutilã ƒe akpa aɖe (si nye nusi ŋu woƒo nu tsoe le ƒomedodo me) .

- Klo ƒe ƒoƒo ɖekae .

- Klo ƒe kekeme si gbɔ eme >20°

- ipsilateral tibial plateau fracture si me ɖa ƒe gege ɖe teƒe si wogena ɖo la nye nusi tsi tre ɖe eŋu le ƒomedodo me .

- Implants xe mɔ na ɖa ƒe gege ɖe teƒe si wogena ɖo .

- ipsilateral patella ƒe gbagbã (si nye nusi ŋu woƒo nu tsoe le ƒomedodo me) .

03. Amekokomɔnu .

1 Ŋutilã ƒe nɔnɔme kple nukpɔsusu .

Fig. 5 Dɔnɔa mlɔa anyi ɖe kplɔ̃ si dzi keklẽŋusẽ le dzi si ɖea mɔ ɖe afɔ siwo me mama le ŋu. Wogblẽa abɔ si le gbagbãm la ɖe ati ŋu faa eye wotsɔa agbalẽ xatsaxatsa aɖe dana ɖe klo ƒe ƒunukpeƒe (A) te be wòaɖo klo 10-30° . 

(B). Wotsɔa C-abɔa dana ɖe akpa si tsi tre ɖe eŋu la dzi. Woɖea afɔ si ŋu womekpɔ ŋusẽ ɖo o la dzi kpɔtɔna 10-30° tso tsia dzi be woakpɔ egbɔ be woɖe nɔnɔmetatawo nyuie le axadzi ƒe nɔnɔme me.

2 Di nu si sɔ na aŋea ƒe gege ɖe eme .

Nutata 6 Wode dzesi mɔnu sia to patella, tibial tuberosity, kple anterior tibial cortex ƒe asike me. Wowɔa ŋutigbalẽ ƒe didime si didi sentimeta 2 la ƒe didime si nye 1-1.5 cm si te ɖe patella ƒe gɔme si le etame ŋu. Woɖea lãkusi eneawo ɖe go eye wowɔa titina ƒe didime ƒe ʋuʋudedi le lãkusi ƒe kaawo ƒe mɔ nu. Woʋua suprapatellar ƒe ɖiɖiɖemeɣi eye amekolaa ƒe asibidɛwo gena ɖe klonu ƒe ƒunukpeƒea tso patella la te be yeada alesi woate ŋu age ɖe eme bɔbɔe la kpɔ. Afɔkpodzi ƒe kekeme sue aɖe ate ŋu ana klonu la nate ŋu age ɖe eme bɔbɔe. Langenbeck retractor dede eme hena patella ƒe kɔkɔme sue hã ate ŋu ana mɔɖeɖe ɖe eŋu nanyo ɖe edzi. Ne ƒunukpeƒea ƒe teƒea le gbadzaa ŋutɔ eye haƒonuwo wɔwɔ sesẽ la, woate ŋu atso titina alo axadzi ƒe kpekpeɖeŋunamɔ̃a ɖe eŋu be wòate ŋu aʋuʋu patella la ɖe akpa ɖeka.

3 Cartilage takpɔkpɔ .

Figure 7 Patellofemoral cartilage takpɔkpɔ tso abi si woxɔ le amekoko me gbɔ nye amekokoa ƒe taɖodzinu vevitɔwo dometɔ ɖeka. Eyata ele be woazã ametakpɔnu ƒe abɔtawo le dɔwɔnu kple ɖa ƒe nudede me.A Dɔwɔnuwo na transarticular access dometɔ aɖewoe nye asiléƒewo, gotagome (fafɛ) kple ememe (ga) ametakpɔnu, trocar pins, kple porous wire guides.B la, woƒoa asiléƒe ƒe asiléƒewo nu ƒu kple trocar pin, kple gotagome (falɛfalɛ) kple gotagome (falɛfalɛ) kple gota gome. Wotsɔa ametakpɔnu ƒe abɔta kple asiléƒe si kpɔa ame ta la ƒoa trocar-aŋea nu ƒu.B ƒe asiléƒe si dzi woɖea ya le le axadzi. Asiléƒe si wotsɔ dea nu me la tame xea mɔ na asiléƒea ƒe ƒoƒo ƒu le vo me .

1 De mɔfianu la eme eye nàtrɔ asi le teƒea ŋu .

Figure 8a Wotsɔa asiléƒea ƒe ƒuƒoƒoa dea patella la te to patellofemoral joint la me ɖoa afisi wodi be wòage ɖo le tibia la gbɔ (Nɔnɔmetata 9). Zi geɖe la, patella la aʋuʋu vie le titina alo axadzi le dɔwɔnuwo dede eme me. Zi geɖe la, groove si le patellofemoral joint la me la fiaa mɔ trocar needle la yia teƒe nyuitɔ le eɖokui si.

Woɖo kpe nɔnɔmetata 8b ƒe nɔnɔme dzi le yameʋu eveawo me to fluoroscopy zazã me eye woɖɔe ɖo le afisi wòhiã le. Emegbe wotsɔa mɔfiaka si me ʋuʋudedi le, si nye mɔfiala si toa mɔfiaka ƒe titina do me eye wotsɔa eƒe nugbɔ dea tibial metaphysis si te ɖe eŋu me be woakpɔ egbɔ be wole teƒe si sɔ la ɖɔ li trocar-aŋea.

Figure 8c Ne mɔfiaka la le teƒe si mesɔ o la, woate ŋu azã mɔfiaka evelia atsɔ awɔ asitɔtrɔ sue aɖewo le nɔnɔme nyuitɔ me to mɔfiaka si me ʋuʋudedi le me, vaseɖe 4.3 mm si sɔ gbɔ wu abe mɔnu bubu ene la, ate ŋu anɔ bɔbɔe be woadze egɔme kple mɔfiaka la eye woatsɔe aɖo teƒe nyuitɔ kekeake si wòage ɖo. Emegbe wotsɔa dɔwɔnu si wotsɔ dea eme si ŋu mɔfianu le la ƒua gbe ɖe mɔfiaka la dzi.

6 Medulla Oblongata ƒe kekeɖenudɔwɔwɔ .

Fig. 9A medullary cavity la ʋuʋu tso teƒe si sɔ nyuie la nye afɔɖeɖe vevi aɖe le amekokoa me. Le ŋgɔgbe yameʋu me la, esiae nye titina ƒe akpa si le axadzi tibial spur. Le axadzi yameʋu me la, teƒe si sɔ la le tɔtrɔ si le articular ƒe anyime kple anterior cortex dome.

Fig. 9B Mɔfiaka ƒe nɔƒe nyuitɔ sɔ kple tibial axis le ŋgɔgbe yameʋu me eye wògogo anterior cortex la alesi wòanya wɔe le axadzi projection me. Guidewire la dina be yeaʋuʋu le megbe.

Figure 9C Le nɔnɔme siwo me womate ŋu atsɔ pin alo ɖa me nyuie o la, mɔxexe ɖe ɖa alo pin la nu kpena ɖe ame ŋu wòfiaa mɔ lãgbalẽa yia teƒe si sɔ. 

Wozãa ɖa siwo xea mɔ na nu le metaphyseal nuto si keke wu me ne womate ŋu atsɔ mɔfiaka alo ɖaƒoƒoa aɖo titina wòasɔ kple ƒu ƒe didime ƒe axis alo ne gbagbãƒe ƒe nɔnɔme si mesɔ o le yameʋu ɖeka alo evea siaa me gakpɔtɔ le ɖaƒoƒo me.

Figure 10 Le afɔɖeɖe sia me la, wokafui be woatsɔ 3.2 mm ƒe mɔfianu abla asiléƒea ƒe ƒuƒoƒoa ɖe afɔkpodzi ƒe lãkusi ŋu. Esia xea mɔ na kpekpea be wòagado le afɔkpodzia me o.

Figure 11 Wotsɔa 12.0 mm hollow drill bit la dana to ememe ametakpɔnu ƒe abɔta eye wòɖina to mɔfiala la me yia ƒu me. Woʋua medullary canal to tomekuku vaseɖe goglome si nye 8-10 cm eye wotsɔa mɔfianu si wotsɔa bɔl ƒoa nui dea afɔkpodzi si te ɖe eŋu la me.

6 fracture dzi ɖeɖe kpɔtɔ .

Nɔnɔmetata 12a Le afɔɖeɖe sia me la, míegbugbɔ ɖo gbagbãƒea.

Figure 12b Le afisi gbagbãƒea le kple eƒe nɔnɔme nu la, woate ŋu azã dɔwɔnu vovovo siwo dzi woɖe kpɔtɔ abe percutaneous clips, retractors, fragment plates suewo, kple blocking screws ene atsɔ aɖo wo nɔewo gbɔ nyuie. Le proximal tibial fracture reduction me la, ɣeaɖewoɣi la, ne wotsɔ nusiwo wotsɔ de eme bubuwo ƒe kpekpeɖeŋu gɔ̃ hã, hafi ʋu medullary canal to tomekuku me. Wodoa reaming rod la ɖe ŋgɔ le didiƒe eye wotsɔe dea distal tibial metaphysis ƒe titina. Ne wogbugbɔ ɖo wo ɖe teƒe bubu vɔ la, wokpɔa ɖa ƒe didime kple didime. Ne ehiã la, woadzi tibia ƒe mɔ̃a ɖe edzi va ɖo didime si nèdi la dzi to reaming le 0.5 mm increments me. Ʋuʋu le abɔta ƒe asiléƒe si kpɔa ame ta la wɔnɛ be woate ŋu akɔ gbeɖuɖɔ siwo le ƒunukpeƒea me kple wo ɖeɖe le wo ŋu le wo ƒoƒo me. Ne anya wɔ la, wokafui be woazã ɖa si ƒe didime le sue wu milimeta 10. 5.0 mm ƒe ʋuƒo si wotsɔna ƒoa ɖa sia ƒomevi la te ŋu nɔa te ɖe kpododonu nu wu 4.0 mm ƒe ʋuƒo si wozãna na ɖa siwo le nyuie wu. Zi geɖe la, wotsɔa fluoroscopic dziɖula dea dzesi lãkusi siwo le lãkusi me ƒe didime.

4 Tsɔ lãkusi si le lãkusi me la de eme .

Fig. 13a nail dede to reaming rod me le fluoroscopy me. De dzesii be asiléƒe si wotsɔ dea eme na suprapatellar nail la didi wu esi le infrapatellar nail la ŋu elabena didime si tso ŋutigbalẽa ƒe akpa si woɖe tso lãkusi me gbɔ hã didi wu.

Figure 13b Taflatse de dzesii be womate ŋu atsɔ ga si le lãkusia me ƒe nuwuwu si te ɖe eŋu la ade eme to ga si le eme si kpɔa ame ta la me o. Eyata ele be woaɖe ememe ametakpɔnu la ɖa le asiléƒea ƒe kpekpea me hafi woatsɔ ɖa la ade eme (b; kpɔ akpa 'errors, afɔkuwo kple kuxiwo'). Kpɔ teƒe mamlɛtɔ si lãkusia le le ŋgɔgbe-megbe kple axadzi ƒe nukpɔkpɔwo me. Ɖe reaming rod la ɖa. Ne ehiã be woaɖɔli ɖa la, gblẽ atikplɔa ɖe teƒea eye nàde lãgbalẽgolo yeyea atikplɔa me. 5 mm ƒe dzesiwo le nusi wotsɔ de eme ƒe asiléƒea dzi fiaa nusi wotsɔ de eme ƒe goglome le lãkusi si le ŋgɔgbe la me (Fig. 14). (Nɔnɔmetata 14)

1 Distal kple proximal locking .

Figure 14A proximal kple distal locking configurations nɔ te ɖe fracture ƒe nɔnɔme tɔxɛwo dzi. Woate ŋu atsɔ alɔ si le taɖodzinu ɖom ɖe eŋu awɔ nusi te ɖe eŋu. Distal locking nye freehand alo to radiopaque drill guide zazã me. Ne èdi la, woate ŋu azã nuwuƒe ƒe nutrenu, si wɔnɛ be ƒu megatsina ɖe lãkusia ƒe nugbɔ si te ɖe eŋu me o eye wònaa woɖea nusi wotsɔ de eme la ɖa emegbe bɔbɔe. Vevietɔ la, ɖa siwo wotsɔ de eme wògbɔ eme la ɖeɖe ɖa le bɔbɔe wu ne wozã nuwuƒe ƒe nutrenu siwo ƒe didime sɔ. Wodzidzea nuwuƒe ƒe nutrenu ƒe didime si wodi to dzesi aɖe dede asiléƒea me alo to mɔ̃a ƒe ka dede alɔnu si wotsɔna ɖoa taɖodzinua gbɔ me.

Figure 14B Mɔfiameka ƒe nugbɔ fia afisi lãkusia ƒe akpa si le ete la le. Ele be woaɖe gavi si doa ka kple taɖodzinu ƒe alɔnu ɖe ​​ɖa ŋu la ɖa be woatsɔ ade nuwuƒea ƒe nugbɔ la eme. Nuwuwu ƒe nutrenu la toa asiléƒe si wotsɔ de eme la ƒe ʋuƒoa me. Asiléƒea ƒe asiléƒea gakpɔtɔ le teƒea. Esia naa nuwuƒe ƒe nutrenu la sɔna kple lãkusi si le lãkusia me ƒe tame eye wòxea mɔ nɛ be wòagabu le klo me o. Mɔfiaka la dede ʋuƒoa ƒe nuwuƒe ƒe nugbɔ ɖe ɖaa ƒe nuwuwu si te ɖe eŋu hã kpena ɖe eŋu wòfiaa mɔ nuwuƒea yia eƒe teƒe si sɔ le lãkusia ƒe nugbɔ si te ɖe eŋu la me. Le dɔwɔwɔa ƒe nuwuwu la, ele be woaklɔ dzetsi si me dɔlékui mele o la me be woaklɔ gbeɖuɖɔ ɖesiaɖe si susɔ la ɖa.

04. Nuxlɔ̃amewo .

Afɔɖeɖe siwo woawɔ atsɔ awɔ amekokodɔwoe .

- Le ƒunukpeƒetetedɔ si nɔ anyi do ŋgɔ gome la, patellar motion si ŋu seɖoƒe le ate ŋu axe mɔ na ƒunukpeƒewo ƒe gege ɖe wo nɔewo me. Medial alo lateral support band ƒe akpa si te ɖe eŋu ƒe ƒoƒo tso titina ƒe akpa dzi naa trocar pin la dede eme nɔa bɔbɔe.

- A ipsilateral klo ƒe ŋutilã ƒe wɔwɔme menye nusi tsi tre ɖe suprapatellar pinning ŋu vevie o. Gake de dzesii be ɖewohĩ manya wɔ be woate ŋu age ɖe teƒe si wodzea tibial ƒoƒo ƒe ɖoɖoa gɔme le zi geɖe la me o.

- Le fractures kple articular extension me la, woate ŋu ade gavi bubuwo eme be woatsɔ axe mɔ na articular fracture component. Wokafui be woatsɔ gavi siawo ade eme hafi woatsɔ wo ade eme be woaƒo asa na articular fracture ƒe ʋuʋu evelia.

Proximal Tibia ƒe gbagbã ŋu bubu .

Proximal tibial fractures ye nye tibial fractures siwo sesẽ wu be woatsɔ aƒo eye wobia be woage ɖe eme pɛpɛpɛ (abe alesi míegblɔe ɖe etame ene). Ele be woaɖe gbagbã siawo dzi akpɔtɔ hafi woatsɔ ati aƒoe be woatsɔ atsi ŋusẽ ɖesiaɖe si gblẽa nu le ame ŋu nu eye woakpɔ dzidzedze geɖe wu. Le go aɖewo me la, ne woɖo abɔ si ŋu dɔlélea le la ɖe teƒe si keke afã kple afã nyuie eye woakpɔ teƒe si tututu wògena ɖo eye woatsɔ medullary canal aɖo kpea me le coronal kple sagittal axes me la, ana be tibia la nasɔ nyuie le ƒoƒoe megbe.

Gake le go geɖe me la, ehiãna be woawɔ afɔɖeɖe aɖewo siwo dzi woaɖe akpɔtɔ hafi woate ŋu atrɔ asi le wo nɔewo ŋu nyuie eye woalé wo ɖe teƒe bubu si woatsɔ wo aɖo teƒe bubuwo. Ne fracture line la le bɔbɔe eye wòle dzogoe ene me la, woate ŋu azã pointed resetting clamps alo coaptation clamps bɔbɔe siwo wotsɔ ɖo wo nɔewo ŋu, siwo woda ɖe wo nɔewo ŋu, atsɔ axɔ reset ahalé eme ɖe asi le atitsotso me. Ne clamp la mesɔ gbɔ o alo fracture plane medo eɖokui ɖe clamping me o la, pollen alo blocking screws ate ŋu akpe ɖe eŋu be woaxe mɔ ɖe ʋuʋu kple malposition nu (Nɔnɔmetata 15). Wotsɔa gavi siawo dana ɖe megbe na ɖa ƒe nɔnɔme si wodi le axadzi ƒe nukpɔkpɔa dzi kple axadzi la ɖe ɖa ƒe nɔnɔme si wodi la ŋu le ŋgɔgbe-megbe ƒe nukpɔkpɔa dzi. Screw siawo ɖoɖo nyuie hena reset nyui ate ŋu asesẽ.

Fig. 15 Gavi siwo wotsɔ xea mɔ na ʋuƒo ƒe mɔ si wodi la ƒe gota gome le ŋgɔgbe kple megbe ƒe nukpɔkpɔwo (A) me eye le ɖamɔ si wodi la megbe le axadzinɔnɔme (b) Tsitretsitsi ƒe ŋusẽwo dzi ɖuɖu me .

Mɔnu bubu si wɔa dɔ ŋutɔe nye ɣeyiɣi kpui aɖe ƒe fixing of the fracture in an anatomic position (Fig. 16). Zi geɖe la, kakɛ sue aɖe si ƒe ʋuƒo le abe ʋuƒo ene si me cortical locking screw eve alo etɔ̃ le la alé gbagbãƒe si dzi ɖe kpɔtɔ le ke ƒe mɔ̃ dzadzraɖo kple ɖa ƒe dodo me. Plɛti la akpɔ ʋuʋu eveawo siaa dzi. Ele be woagblẽ agbalẽvi la ɖe teƒea zi alesi dometsotso aɖeke meli si axe mɔ na edziɖeɖe si dzɔna zi geɖe le agbalẽvia ɖeɖe ɖa megbe o. Plɛti sia si ŋu cortical screw ɖeka le la mesẽ o eye makpɔ ŋusẽ ɖe ɖa ƒe liƒo si sɔ gbɔ o dzi o. Woate ŋu azã reset plate technique na gbagbãƒe siwo le ʋuʋu kple esiwo wotu siaa.

Figure 16 Woate ŋu akpɔ ʋuƒo sue aɖe si me wotsɔ cortical screw ɖeka ɖo eye woalé be nɛ le anatomic reposition me. Zi geɖe la, ele be woagblẽ agbaa ɖe teƒea le atitsotso vɔ megbe. Valgus ƒe nɔnɔme madeamedzi gbãtɔ si nye tibial ƒe gbagbã si te ɖe eŋu. B Wotsɔa fracture plate sue aɖe si me cortical screw ɖeka le la dana ɖe titina be woakpɔ fracture repositioning eye woalé eme ɖe asi le nailing me. c Womeɖea agbaa ɖa le ƒoƒo vɔ megbe o elabena enaa liƒo bubu .

Ðoɖomawɔmawɔ, afɔkuwo kple kuxiwo .

- Ametakpɔnu ƒe abɔta ƒe ʋuʋu le dɔwɔwɔ me ate ŋu agblẽ nu le ƒunukpeƒe kple klo ƒe xɔtunuwo ŋu (Nɔnɔmetata 17). Ele be woagbugbɔ aɖo abɔta si akpɔ ame ta la bliboe.

- Ametakpɔnu ƒe abɔta ƒe ʋuʋu vie ate ŋu ana Reamer ƒe ta ɖeɖe nadzi ɖe edzi. Fluoroscopy kpena ɖe ame ŋu be woade dzesi kuxia. Ametakpɔnu si wotsɔ kpɔa ame ta la ƒe asitɔtrɔ le eŋu akpɔ kuxia gbɔ (Fig. 18) .

- Nail lock-up: nusi wotsɔ de eme ate ŋu azu nusi tsi ga ƒe abɔta le proximal bend (Herzog curve) la me. Le ɖaƒoƒo mamlɛtɔ gome la, ele be woaɖe gamɔ̃a ɖa, eye gota gome falɛfalɛ si wotsɔ plastik wɔe la koe susɔ. Ne ɖa la tsi la, ehiã be woagaɖee ɖa keŋkeŋ eye woagade nusi wotsɔ de eme la me ne woɖe ga si wotsɔ ƒoe la to plastik-mɔ̃a me ko vɔ megbe.

Figure 17 Ametakpɔnu ƒe asibide ƒe asiɖeɖe le eŋu Fluoroscopic ŋkuléleɖenuŋu manɔmee ate ŋu ana klo naxɔ abi .

Figure 18 Ametakpɔnu ƒe ʋuƒoa ƒe ʋuʋu alo eƒe ʋuʋu le vo me ate ŋu ado kplamatse reamer ɖeɖeɖa, elabena reamer ƒe ta ate ŋu axe. B A fluoroscopic inspection with alignment correction na be woate ŋu aɖe reamer ta la ɖa. C Woate ŋu aɖe reamer ƒe ta la ɖa ne reamer ƒe ta la mele teƒea o. D Woate ŋu aɖe reamer ƒe ta la ɖa ne reamer ƒe ta la mele teƒea o.

Nusiwo woŋlɔ ɖe eme .

Hessmann MH, Buhl M, Finkemeier C, Khoury A, Mosheiff R, Blauth M. Suprapatellar na afɔkpodzi ƒe gbagbãwo ƒe ƒoƒo. Oper orthop traumatol. 2020 Oct;32 (5): 440-454.