Intramedullary nail hman dan tur principle leh surgical technique 5!

Intramedullary nailing chungchanga thu bulpui ber berte

1. Intramedullary nailing chanchin

Kum 1910 khan Lilienthal aluminum intramedullary nail hmangin femoral shaft fracture enkawl a ni a.

Kum 1913 khan Schone chuan silver intramedullary nail hmangin kut hmawr ruh tliak a enkawl a. 

Kuntscher (1900-1972) chuan intramedullary nail fixation-ah nasa takin a thawhhlawk hle. 

Kum 1960 leh 1970 chho vel khan intramedullary nails te chu a lo thang chak hle a, a hmaa a lo awm tawhna chu a lo thang chak hle a ni. 

ka ram hian kum 1990 chho atang khan nasa takin a hmang tan a.

2. Open reduction leh closed reduction

1. Limb fracture hi direct vision hnuaiah surgery hmangin tihtlem theih a ni a, X-ray monitoring hnuaiah pawh khar theih a ni bawk.

2. Open reduction fracture dam hun hi a rei deuh a, intraoperative bleeding a tam zawk a, open reduction hian fracture tawp thlenga thisen supply a tichhe zual bawk.

3. A theih ang anga closed reduction hman a tha. Traction reducer hman theih a ni a, a nih loh leh fracture plane-ah incision te tak te siamin pry leh tihtlem theih a ni a, chu chuan fracture tawp thlenga thisen kalna tibuaitu a ti tlem thei a ni.

4. Closed reduction failure, ruh fragment flipping emaw piercing surrounding tissue te, leh displaced fracture fragment lian tak tak te tan chuan surgical open reduction hman theih a ni.

3. Fixation mechanism hmanga thil tih dan tur intramedullary nail a awm

1. Intramedullary nail chhunga fixation hman dan chu symmetrical central internal splint fixation a ni.

2. Intramedullary nail hmanga fracture fixation hi stress-distributing fixation a ni a, stress-shielding fixation ni lovin, callus siamna atana tha a ni.

3. Central fixation hi theoretically chuan cortical external fixation aiin a tha zawk a, hei hian force arm a tihziaawm thei a, valgus angulation leh internal fixation failure a ti tlem thei bawk.

4. Intramedullary nail fixation hian closed reduction emaw limited open reduction emaw awm theihna tur a siam a ni.

4.Intramedullary nail hman thatna

1. Harsatna tlem zawk

2. Surgical indication hrang hrangte huam zau zawk

3. Fixation nghet tak neih a ni

4. Joint function training hmasa ber

5. A hmaa rit phurh

6. Internal fixation dang nen hman dun theih a ni

Basic Types leh Techniques te

1. Intramedullary nail lock leh lock loh

2. Dynamic leh static locking intramedullary nail te chu a chhuak thei lo

3. Medullary expansion leh non-medullary fixation hman dan tur

4. Open leh closed fixation technique hrang hrang

Interlocking leh inzawm lo

Intramedullary nail pangngai hian axial stability tha lo leh torsional strength a hniam hle a, mahse elasticity engemaw zat an nei a, deformation hnuah pawh an lo harh leh thei a, chu chuan intrabone sliding tlemte chauh a thlen thin.

Interlocking intramedullary nails hian anti-rotation leh anti-compression effects tha zawk a nei a, fixation stability tha zawk a nei a, biological fixation principle nen a inmil bawk. Ke ruh sei takah an hmang nasa hle. A bik takin multi-segment leh comminuted fracture tan chuan intramedullary nail pangngai aiin stability an nei tha zawk.

Static fixation tihchakna (dynamization) a ni

Static locking intramedullary nails hian stress masking a siam tlem hle a, tunah chuan non-routine action of dynamization atan an sawi tam ber.

Operation hnu thla 6 atanga thla 8 chhunga dam lo fracture tan chuan in situ bone grafting emaw expanded intramedullary nails te chu dynamization hmanga thlak emaw hman a ni tlangpui.

Dynamization hi fracture tihdamna atana hmanraw atan hman theih a ni. Routine taka hman loh tur a ni a, a chhan chu limb shortening leh rotational deformity a thlen thei a ni.

Marrow tihzauh leh non-marrow tihzauh

Marrow expansion hian intramedullary nail diameter lian zawk leh chak zawk a dah thei a, hei hian functional training hmasa atan a tha a, nail chhe rate a ti tlem bawk.

Marrow expansion hian ruh chhe tam tak a siam thei a, osteoinductive effect a nei a, hei hian ruh tliak damna atan a tha hle.

Marrow expansion hian nutrient vessels leh endosteal membrane thisen supply a tichhe dawn a, mahse thisen kalna kawngte chu intramedullary nails cavity-ah a siam thar thei thung. Marrow expansion hian a chhehvel soft tissue muscle-a thisen kal a tipung thei bawk a, chu chuan fracture healing a tichak thei bawk.

Marrow expansion hian infection leh embolism chance a tipung hle a, open fractures, multiple injuries, leh complex injuries te tan fimkhur taka hman tur a ni.

Medullary expansion a thatna te

1 Medullary expansion hnuah intramedullary nail leh ruh inkar contact area a pung a, chu chuan fixation stability a ti tha hle. 

2 Medullary expansion hnuah diameter lian zawk intramedullary nail hman theih a ni a, chu chuan intramedullary nail chakna a tipung a, nail chhe rate a ti tlem bawk. 

3 Medullary expansion hnua ruh chhe (bone debris) hian ruh thar a siam thei a, hei hian ruh tliak damna atan a tha hle.

Medullary expansion intramedullary nail nena khaikhin chuan non-expanded intramedullary nail hian a hnuaia mi ang hian a thatna a nei a ni

1 Operation hun rei lo zawk leh thisen chhuah tlem zawk. 

2 Soft tissue hliam na tak nei tan chuan endosteal blood flow a tibuai tlem zawk.

A hman dan tur intramedullary nail a awm

Humeral inzawmkhawm (intramedullary nail) a awm

Humeral nail hman dan tur hriattirna

Humeral shaft fracture enkawlna atana humeral interlocking intramedullary nail hman theihna tur indication te chu: vascular leh nerve chhiatna nei fracture, hliam tam tak, unstable fracture, pathological fracture, leh proximal humeral fracture te hi a ni.

Range fix theih chu humeral head hnuai lam 2cm atanga olecranon fossa chunglam 3cm thleng a ni. A kekawr bul atanga antegrade intramedullary nail hmanga siam that emaw, elbow atanga retrograde nail hmanga siam that emaw i thlang thei bawk.

Humeral nails te mizia

Humeral shaft fracture-a surgical fixation hman dan chu a bul berah chuan plate fixation leh intramedullary nail fixation a ni.

Plate fixation hian anti-rotation leh anti-bending property chak tak a nei a, nghet takin a fix a, mahse surgical trauma a lian a, infection a awm theihna a sang a, radial nerve pawh a chhe awlsam hle.

Tunlai humeral interlocking leh self-locking nails hian intramedullary nail pangngaia tlin lohna axial instability, rotation control tha lo, leh additional fixation mamawhna te chu a hneh a, chutiang chuan fracture chu nghet takin a fix a, thisen hloh chu a tlem a, soft tissue stripping a tlem a, medullary expansion chu local bone transplantation nen a inang a, load chu a inang tlang bawk distributed, callus chu a lo lang hma a, operational exercise chu operation hnuah pawh tan theih a ni.

Femoral inzawmkhawm intramedullary nail

Femoral interlocking nails awm theihna tur indication

Fracture chi hrang hrang trochanteric vertebra hnuai lam 2cm leh khup ruh atanga 9cm aia hlaa awm.

Femoral shaft lai tak a fracture hlui.

Plate chhunga fixation hlawhchham tawhte.

Femoral interlocking nail a awm dan

Mechanical lama a thatna te

Fracture siam thatna atana femoral interlocking intramedullary nail force arm chu steel plate aiin a sei zawk a, chu force chu ruh pum pui central axis-ah inang tlangin a insem a, chu chu bend leh deform awlsam a ni lo.

Intramedullary nail tawp pahniha locking nail te hian ruh chu a chung atanga a hnuai thlengin a pum puiin a siam a, distal end a locking nail te hian ruh chhunga intramedullary nail torque arm a tihziaawm thei a, shortening leh rotation a veng thei a, fracture fixation atan maximum stability leh firmness a nei thei bawk.

Gamma hmanga inzawmkhawmna Intramedullary Nail

Gamma nail tih a ni

Peritrochanteric fracture chi hrang hrang, a bik takin subtrochanteric fracture-ah hman theih a ni.

Gamma nail (reconstruction nail) tihzauh a nih thu a sawi

subtrochanteric fracture sang tak, trochanteric leh femoral shaft fracture inzawm.

Gamma nail hman thatna

Sliding hip screw leh intramedullary nail technology hmanga siam a ni a, main nail hi dynamic hip plate aiin medullary cavity chhung lam a hnaih zawk a, chuvangin Gamma nail hian damlo rit chu dynamic hip plate aiin femoral calcar hnaih zawkah a hruai a, hei hian implant mechanical strength a ti sang zawk a ni. Medial cortical comminution awmna subtrochanteric fracture tan chuan Gamma nail hian fracture anatomy reconstruction a ngai lo va, chuvangin intertrochanteric fracture emaw subtrochanteric fracture emaw tan a hlawkpui hle.

Retrograde intramedullary femoral nailing hmanga siam a ni

Retrograde femoral nails a awm tih hriattirna

Supracondylar femoral fracture atan hman a ni ber a, chung zingah chuan supracondylar comminuted fractures leh intercondylar 'T' leh 'Y' comminuted fractures te, articular surface inrawlhna te pawh a tel.

Femur isthmus hnuaia femoral fracture tan pawh hman theih a ni.

Khup ruh atanga 20CM chhunga femoral shaft, supracondylar femoral, leh intercondylar fractures te a awm thin.

Plate fixation hlawhchham tawhte.

Retrograde femoral nailing awm dan

Supracondylar femoral fracture hi ruh tliak na tak a ni a, a hmasa berah chuan tihtlem leh pahnihnaah chuan internal fixation chak tak a harsa hle. Fracture non-union leh delayed healing ang chi complication a tam hle.

Retrograde interlocking intramedullary nailing hi tun hnaia distal femur fracture enkawlna atana hman tlanglawn tak a ni a, mechanical stability tha tak a nei a, fracture distal end-a posterior displacement leh rotational displacement te chu tha takin a control thei a, joint movement hmasa berah pawh a pui thei bawk.

Supracondylar combined femoral stem fracture hi lengthened supracondylar intramedullary nailing hmanga fix a ni a, hei hian femur-a interlocking intramedullary nailing hmanga chinfel harsa tak buaina chu a chinfel sak a ni. He instrument hi hman a awlsam a, a positioning pawh a dik a, fixation-ah pawh rintlak a ni a, damlo chuan operation hnuah functional knee exercise hmasa ber a ti thei bawk.

Tibial interlocking intramedullary nail te chu a awm a

Tibial nailing hman dan tur hriattirna

Tibia laihawl 1/3-ah stable fractures: transverse fractures, short oblique fractures, pseudarthrosis.

Middle tibia sei zawng 60% chhunga unstable fracture: metaphysis bula fracture, spiral fracture sei, segmental fracture, comminuted fracture, ruh chhiatna nei fracture.

Tibial nailing awm dan

Tibia interlocking intramedullary nailing hi mid tibia fracture atan hman a ni ber.

Proximal leh distal tibia fracture tan pawh hman theih ni mahse, complication rate a sang zawk a, malunion a awm tam zawk a, fracture end hian 1/2 ah ≧1cm a movement a nei a, fixation 1/4 chu a hlawhchham bawk.

Literature-ah chuan fibula routine fixation hnua proximal tibia fracture aiin distal tibia fracture outcome tha zawk a awm tih an sawi.

Surgery hman dan tur

Operation hmaa hmanraw bik buatsaih

Orthopaedic bed (traction bed) emaw, standard fluoroscopic surgical bed emaw a ni a; retractor tih hi a ni a; image tihchakna a ni.

Preoperative endoprosthesis atana intramedullary nail sei zawng thlan dik

Radiograph atanga lak a ni

contralateral limb sei zawng tehna

Intramedullary nail diameter a ni

x-ray isthmus a zau zawng a ni

Intramedullary nail sei zawng tehna

1.C-arm machine hnuaia translucent ruler tihfelna

Ruh tawp distal leh proximal chu ray centerline-ah a awm a; ruler chu diaphysis nen a inmil hle.

2.Taksa chunglam chhinchhiahna angin a sei zawng tehna

Femur: trochanter lian zawk tip → lateral knee space emaw patella chunglam pole emaw; tibia: medial-lateral knee space → ke ruh dorsiflexion-a ankle joint hmalam hawi.

Intramedullary Nail Insertion Technique - Entry Point hmanga luh dan tur

Medullary cavity a longitudinal axis chu line dik takah a awm a

Entry point hnaih lutuk lo

A sei zawng dik tak: dilated - long; undilated - tawi

(Entry point indirect confirmation; pulp dilation a awm lo, soft tissue venhimna a ngai lo)

Parallel femoral intramedullary nail luhna hmun a ni

Parallel femoral intramedullary nail siamna tur entry point buatsaih

Hip flexion leh adduction te a awm bawk

Longitudinal incision chu trochanter lian zawk bulah a awm

Hnunglam hla lutuk lo

Guide pin dahna tur hmun

Soft tissue shield dahna tur hmun

Retrograde femoral intramedullary nail luhna hmun a ni

30° a khup a inher thei

Guide pin a long axis chu distal femoral stem a medullary cavity nen a kalna tur a ni

Kirschner pin chu distal femur-ah patellar ligament kaltlangin protective sleeve hmanga dah luh: orthogonal - femur-a intercondylar fossa lai tak lateral - Blumensaat-a line a ni

Hliam nei lo PCL tanna hmun

Parallel tibial intramedullary nail luhna hmun a ni

Medullary cavity centerline-ah chuan

Tibial plateau hmalam sir a awm

Plateau tichhe lovin a sang thei ang bera

Khup flexion tam ber

Incision tibial tuberosity-inferior pole of patella chu medullary cavity zawhin a awm a

Medullary cavity hawng la: tibial stem longitudinal axis-a sagittal plane-ah 15°-a guide pin chu hawng rawh

Image intensifier awmna hmun

Marrowing hman dan tur

Electric hmanga chakna hmanga tihtlem

fracture thar a awm

Manual tihtlem a ni

old fracture leh pseudoarthrosis, medullary cavity-a sclerosis awm

Inflation hnuaiah tourniquet a awm lo

thisen kal dan hi coolant tha ber a ni

Repositioning technique hrang hrang

A rilru a buai em em a, a rilru a hah em em bawk a. Parallel femoral intramedullary nailing

Femoral fractures siamthat harsatna chhan

Thick soft tissue wrapping hian ruh chhungah direct-in a lut thei lo

Needle entry point chu direct-a hmuh theih a ni lo

Hip joint adduction → iliac fascia tension → ruh tliak tawi

Tibial fracture tihziaawmna

Manipulation tih a ni

A tam zawk chu subcutaneous leh palpate awlsam tak a ni

Stabilized fracture - mid emaw distal emaw A leh B type fracture

Oblique fractures - a tihbuai lutuk

Intramedullary nailing→a chhuahna hmanrua

Ancillary tihtlem dan tur ruahmanna

Point tihtlem dan tur forceps

tibia (tibia) chu; percutaneous emaw hliam emaw hmanga hman

Retractor lian tak tak (braces) .

tihhniam tihkhawtlai; limb tih tawi

Hun eng emaw chen atan Schanz screw te

1 Femur, ke ruh (tibia) a ni

2 Fracture line hnaih thei ang berah

3 Proximal fracture pakhat chauh cortical hman

4Maneuvering awlsam zawk nan T-handle nei universal chuck hmang ang che

Poller nail a ni

1Metaphyseal fracture (line of force siamthat, restoration stabilize, operation siamthat)

2 distal tibia emaw femur emaw a oblique fracture (shear stress → pressure) tih a ni.

3 Secondary surgery neih laiin intramedullary nail position tha lo tak takte chu medullary channel hluiah an lut thin

4 Point of entry tha lo, proximal fracture alignment tha lo (endoplant displacement awm thei tur perpendicular-a screw dah)

Tourniquet zau zawk a awm bawk

1 tibia a ni

2 traction emaw retractor emaw hmanga tihpun a ni

3 Soft tissue hliam na tak takah fimkhur taka hman tur

4 A tawi zawngin dah rawh

5 Inflated state-a medullary expansion khap

Nail locking sequence: distal atanga proximal

A thatna te

knockback awlsamna, fracture break-a compression; inthenna tihbo; tihtlem hna thawh a ni.

Delayed & nonunion surgery neih theihna tur tihtlem dan tur

Surgery tihkhawtlai avanga harsatna awm thei

Axial deformity (a tawi, angulation leh emaw, a inthlak danglam) .

Granulation tissue a lo thang lian zel

Ruh hring hmasa ber

Sclerosis of fracture chu medullary cavity khar a nih chuan a chhe thin

Ruh natna (Osteoporosis) a awm

Intraoperative lama harsatna awm thei te

Expander leh intramedullary nail te deflection → intramedullary nail atanga cortex chhunga lut

Angular deformity → a hnunglam atanga lo chhuak

Severed ends atanga dislocation → Poller-a nail, plate fixation

Force line pangngai lo awm lo tura ven dan

Proximal - entry point dik tak

Distal - medullary cavity lai takah intramedullary nail a awm

Intramedullary Nailing avanga harsatna awm thei

★Infection a awm thei

★Nerve tihchhiatna

★Thil ruh tliak (fractures) tihdamna dik lo (distorted healing).

★Damdawi lam atanga ruh tliak

Pawn lam inher, torsion, valgus, chhung lam inher, angulation

★A kianga ruh natna

★Fat embolism a awm thei

★Heterotopic ruh siam chhuahna (ossification) a ni

★Pulmonary embolism a awm thei

★Re-fracture leh tur a ni

★Thrombosis a awm thei

★Joint a nghet lo

★Non-union of fracture, ruh inzawmna nei lo

★Internal fixation a hlawhchham

★Limb tih tawi

★Midang

Harsatna awm thei--Infection

1.A tir lamah chuan open fractures hi intramedullary nailing contraindication anga ngaih a ni.

2.Open fracture-a postoperative infection awm zat hi soft tissue hliam leh contamination dinhmun a zirin a innghat

Open fracture hnua infection awm zat hi soft tissue hliam leh contamination dinhmun bakah soft tissue enkawl danah a innghat a ni.

3.Intramedullary nail te tak te hian natna kai theihna a tipung a; non-expanded locking intramedullary nails fixation hi a tha lo hle a, ruh tawp pawhin a nei

Non-expanded locking intramedullary nail fixation hi a tha lo hle a, ruh tawp chhe tawh chu microscopic movement bakah residual cavity a awm bawk a, hei hi bacteria te tan a awlsam hle.

4. Expanded leh limited expanded medullary fixation hman hian fracture stability a tichak mai bakah dead space siam a veng bawk.

Fat Embolism Syndrome a awm a, a natna hi a thau hle

1.Long tubular bone fracture FES hi 0.5% atanga 2% vel a ni.

2. Medulla zau leh zau lo hian pulmonary ventilation-ah nghawng lian tham a nei lo.

3.Medulla tihzauh hian technique chu zawi zawiin kneading tur a ni a, force tam lutuk leh rough operation tih loh tur a ni.

4.tuna FES hmuhchhuah dan hian kum 1974-a Gurd-a’n a rawt dan chu a la hmang reng a, hmuhchhuah hnua enkawlna hian enkawlna hun tha ber a tikhawtlai ang a, a rah chhuah pawi tak a nei thei bawk.

Fracture dam rei leh ruh nonunion tihkhawtlai

Intramedullary nail fixation hnua fracture healing hi thil hrang hrangin a nghawng a, a chhan pawh a hnuaia mi ang hian kan zirchiang thei bawk.

1.fracture tawp lamah soft tissue embedded a awm

2. Transverse fracture tawp lam inthen darh

3. Damlo kum upa zawk

4. Open fracture, soft tissue hliam na tak, local hemodialysis na tak emaw infection emaw.

5. Intramedullary nail fixation tha lo

6. Diabetes mellitus emaw, ei leh in lama natna dang emaw inzawmkhawm.

Damdawi lam Fracture te

Medically induced fractures hi intramedullary nail fixation-a manipulation dik lo avanga secondary fracture a ni ber.

Intraoperative ngaihven tur a ni

1. Nail entry point thlan dik loh chuan proximal fracture a thlen thei.

2. Medulla zau zawng chu tharum hmangin nawr lut suh.

3. Pulp expansion luhna chu nail insertion lam hawiin a awm tur a ni.

4. Distal end-a intramedullary nail dah hian chakna hmang suh.

A kianga ruh (joint) a na

1. Intramedullary nail dahnaah hian soft tissue leh joint capsule thlengin joint 1 tal vel a awm a.

2. Tibial plateau hi medial meniscus hmalam kil nen transverse knee ligament hmangin a inzawm a, hetiang thleng hian tibial tuberosity chungah safe zone a siam a ni. Nailing point chu a chung lam hnaih lutuk emaw, intramedullary nail diameter a lian lutuk emaw chuan intra-articular structures a tichhia thei a, postoperative knee pain a thlen thei a ni.

3. Femoral intramedullary nail surgery hnua hip natna thlentu ber chu intramedullary nail protrusion leh heterotopic ossification a ni.

4. Intramedullary nails proximal protrusion, proximal locking nail irritation leh rotator cuff interference te hi humeral intramedullary nailing hnua shoulder natna thlentu ber a ni.