5 Intramedullary nail hman dan tur leh surgical technique!

Intramedullary nailing tih thupui bulpui ber .

1. Intramedullary nailing chanchin .

Kum 1910 khan Lilienthal aluminum intramedullary nails hmangin femoral shaft fractures an enkawl a.

Kum 1913 khan Schone hian kut hmawr ruh tliak enkawlna atan tangkarua intramedullary nail hmangin a hmang a. 

Kuntscher (1900-1972) chuan intramedullary nail fixation-ah nasa takin hma a la a. 

Kum 1960 leh 1970 chho vel khan intramedullary nails te chu a lo thang chak hle a. 

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

2. Open reduction leh closed reduction .

1. Limb fracture te chu direct vision hnuaiah surgery hmanga tihtlem emaw, X-ray monitoring hnuaiah pawh khar theih a ni.

2. Open reduction fracture healing time hi a rei hle a, intraoperative bleeding a tam zawk a, open reduction hian fracture tawp thlenga thisen supply a tichhia 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 siam theih a ni a, chu chuan pry leh reduce a ti thei a, chu chuan fracture tawp thlenga thisen supply-a inrawlhna a ti tlem thei a ni.

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

3. Intramedullary nail a fixation mechanism .

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

2. Intramedullary nail hmanga fracture fixation chu stress-distributing fixation a ni a, stress-shielding fixation a ni lo va, chu chu callus shaping atan a tha hle.

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

4. Intramedullary nail fixation hian closed reduction emaw limited open reduction emaw atana a bulpui a pe a.

4.Advantages intramedullary nails .

1. Complication tlem zawk .

2. Surgical indication hrang hrangte scope tihzauh .

3. Firm fixation .

4. Joint function training hmasa ber .

5. Early weight bearing .

6. Internal fixation dang nena hman theih a ni .

Basic chi hrang hrang leh technique hrang hrang .

1. Intramedullary nail lock leh non-locking .

2. Dynamic leh static locking intramedullary nails .

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

4. Fixation technique hawn leh khar .

Interlocking leh non-interlocking .

Ordinary intramedullary nails hian axial stability tha lo leh torsional strength hniam tak an nei a, mahse elasticity engemaw zat an nei a, deformation hnuah an dam leh thei a, chu chuan intrabone sliding tlemte chauh a thlen thei a ni.

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

Static fixation hmanga dynamization .

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

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

Dynamization hi ruh tliak damna tichaktu atan hman theih a ni. Limb shortening leh rotational deformity a thlen theih avangin routine takin a tha lo.

Marrow tihzauh leh marrow ni lo tihzauh a ni.

Marrow expansion hian intramedullary nails diameter lian zawk leh chakna sang zawk a dah thei a, hei hi early functional training atan a tha a, nail chhe rate a tihhniam bawk.

Marrow expansion hian ruhro tam tak a siam thei a, osteoinductive effect a nei a, hei hi fracture healing atan a tha hle.

Marrow tihzauh hian nutrient vessels leh endosteal membrane thisen supply a tichhia ang a, mahse thisen kalna kawngte chu intramedullary nails cavity-ah a insiam thar leh thei a ni. Marrow expansion hian a chhehvel soft tissue muscle-ah thisen kal a tipung thei bawk a, chu chuan fracture damna a tichak thei bawk.

Marrow expansion hian a tlem berah chuan infection leh embolism chance a tisang 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 sang a, hei hian fixation stability a ti tha hle. 

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

3 Medullary expansion hnua ruh bawlhhlawh hian ruh thar a siam thei a, hei hian ruh tliak damna a thlen thei a ni.

Medullary expansion intramedullary nails nen khaikhin chuan non-expanded intramedullary nails hian a hnuaia advantage te hi a nei a ni.

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

2 Soft tissue hliam na tak nei a nih chuan endosteal blood flow a tihbuai tlem.

Intramedullary nail hman dan tur .

Humeral interlocking intramedullary nail .

Humeral nails te tan indication a awm bawk.

Humeral shaft fracture enkawlna atana humeral interlocking intramedullary nails atana indication te chu: fractures with vascular and nerve damage, hliam tam tak, unstable fractures, pathological fractures, leh proximal humeral fractures te an ni.

Range fix theih chu humeral head atanga 2cm atanga olecranon fossa atanga 3cm thlenga sang a ni. Antegrade intramedullary nail hmangin emaw, retrograde nail hmanga elbow atang emaw chuan a kekawr ipte atanga siam that i thlang thei bawk.

Humeral Nails te mizia .

Humeral shaft fractures te 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 awm theihna a sang a, radial nerve pawh awlsam takin a tichhia thei bawk.

Tunlai humeral interlocking leh self-locking nails hian intramedullary nail pangngai, axial instability, poor rotation control, leh fixation dang mamawhna te tlakchhamna a hneh a, chutiang chuan fracture chu nghet taka siam that a ni a, thisen tlakchham chu a tlem a, soft tissue stripping chu a tlem a, medullary expansion chu load chu a bul tanna, leh a hnathawh dan tur ang chiah a ni.

Femoral interlocking intramedullary nail .

Femoral interlocking nails te tan indication a awm bawk.

Trochanteric vertebra atanga 2cm hnuai lam fracture chi hrang hrang leh khup ruh atanga 9cm aia tam.

Femoral shaft lai tak a fracture hlui te.

Plate chhunga fixation hlawhchham nei damlote.

Femoral interlocking nail a thil awm dan te .

Mechanical lama hmasawnna 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 a insem darh vek 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 chuan ruh chhunga intramedullary nail torque arm chu a ti tlem thei a, shortening leh rotation a veng thei a, fracture fixation atan stability leh firmness sang ber a nei thei bawk.

Gamma hian intramedullary nail a inzawm khawm a.

Gamma nail indication te pawh a awm bawk.

peritrochanteric fracture chi hrang hrangah hman theih a ni a, a bik takin subtrochanteric fractures-ah hman theih a ni.

A rilru a buai em em a, a rilru a hah em em bawk a.

Subtrochanteric fracture sang tak tak, trochanteric te chu femoral shaft fracture nen an inzawm a.

Gamma nail a thatna te .

Sliding hip screw leh intramedullary nail technology inzawmkhawm hmanga siam a ni a, main nail chu dynamic hip plate aiin medullary cavity chhung lam hnaih zawk a ni a, chuvangin gamma nail hian damlo rit zawng chu dynamic hip plate aiin femoral calcar hnaih zawkah a kalpui a, implant mechanical strength a tipung a ni. Medial cortical comminution hmanga subtrochanteric fractures te tan chuan gamma nail hian fracture anatomy reconstruction a mamawh loh avangin intertrochanteric fracture emaw subtrochanteric fracture emaw atan a hlawkpui hle.

Retrograde intramedullary femoral nailing .

Retrograde femoral nails a awm leh awm loh hriat theihna tur .

A bik takin supracondylar femoral fractures atan hman a ni a, chung zingah chuan supracondylar comminuted fractures leh intercondylar 't' leh 'y' comminute fractures te pawh a tel.

Femoral fractures te pawh femur isthmus hnuaiah hman theih a ni bawk.

Knee joint atanga 20cm chhunga femoral shaft, supracondylar femoral, leh intercondylar fracture te a awm bawk.

Plate fixation hlawhchham tawhte.

Retrograde femoral nailing ziarang .

Supracondylar femoral fracture hi a fracture na tak a ni a, pakhatnaah chuan harsatna a awm a, a tlahniam a, a pahnihnaah chuan internal fixation chak tak a awm bawk. Fracture non-union leh delayed healing te ang chi harsatna a tam hle.

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

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

Tibial interlocking intramedullary nails .

Tibial nailing hmanna tur indication te .

Tibia laihawl 1/3-a stable fractures: transverse fractures, oblique fracture tawi, pseudarthrosis.

Unstable fractures within 60% of the middle tibia: metaphysis bula fracture, spiral fracture sei tak tak, segmental fractures, comminuted fractures, ruh chhiatna nei fractures.

Tibial Nailing ziarang .

Interlocking intramedullary nailing of tibia hi mid tibia fracture atan hman a ni tlangpui.

Proximal leh distal tibia fracture-ah pawh hman theih ni mah se, complication rate a sang zawk a, malunion a awm tam zawk a, fracture end chu case 1/2-ah ≧1cm of movement a nei a, fixation 1/4 a fail bawk.

Literature chuan fibula routine fixation hnua proximal tibia fracture aiin distal tibia fracture outcome tha zawk an nei tih an sawi.

Surgical hmanrua te .

Thil hman tur bik buatsaih hmaa inbuatsaihna .

Orthopedic bed (traction khum) emaw, standard fluoroscopic surgical bed emaw; retractor a ni a; Hmanlai thlalak intensifier.

Preoperative endoprosthesis atan intramedullary nail length thlan dik tak a ni.

Radiograph 100 a ni.

Contralateral limb sei zawng tehna .

Intramedullary nail diameter .

X-ray isthmus zau zawng .

Intramedullary nail sei zawng tehna .

1.C-arm machine hnuaia translucent ruler tehna .

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

2.taksa chunglam chhinchhiahna ang zela teh .

femur: trochanter lian zawk tip → Lateral knee space emaw, patella pole sang zawk emaw; Tibia: Medial-lateral knee space → Ke dorsiflexion-a ankle joint hmalam lam hawi.

Intramedullary nail insertion technique - luh theihna kawng zawh dan tur .

Longitudinal axis chu medullary cavity chu line dik takah a awm a.

Entry point hnaih lutuk lo .

A sei zawng dik tak: dilated - a sei; undilated - tawi .

(Indirect confirmation of entry point; pulp dilation awm lo, soft tissue venhimna a ngai lo)

Parallel femoral intramedullary nail luhna hmun .

Parallel femoral intramedullary nail entry point buatsaih dan .

Hip flexion leh adduction te a awm bawk.

A rilru a buai em em a, a rilru a hah em em bawk a.

A hla lutuk lo .

Guide pin dahna tur hmun .

Soft tissue shield dahna tur hmun .

Retrograde femoral intramedullary nail luhna hmun .

30° a ni a, a khup a hup a ni.

guide pin axis sei tak chu distal femoral stem medullary cavity nen a kalna tur ang chiah a ni.

Kirschner pin chu patellar ligament kaltlangin distal femur-ah a invenna sleeve hmangin a thun lut a: orthogonal - a laiah chuan femur-a intercondylar fossa a awm a Lateral - Blumensaat-a line a awm a.

Hliam tuar lovin PCL bul tanna hmun .

Parallel tibial intramedullary nail luhna hmun .

Medullary Cavity-a centerline-ah chuan .

Tibial plateau hmalam margin a ni.

Plateau tichhe lovin a sang thei ang bera .

A khup flexion sang ber a ni.

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

Medullary cavity: guide pin chu 15°-ah guide pin chu tibial stem-a longitudinal axis-a sagittal plane-ah a awm a.

A thlalak intensifier .

Marrowing tih dan tur .

Electric hmanga tihtlem a ni.

Fresh fractures .

Kut hmanga tihtlem .

Hmanlai ruh tliak, pseudoarthrosis, sclerosis medullary cavity-a sclerosis .

Inflation hnuaiah tourniquet a awm lo.

Thisen circulation hi coolant tha ber a ni .

Repositioning tih dan tur .

Parallel femoral intramedullary nailing .

Femoral fractures siamthat harsatna chhan .

Thick soft tissue wrapping hmang hian ruh lam direct a lut thei lo .

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

A rilru a buai em em a, a rilru a hah em em bawk.

Tibial fracture tihziaawmna .

manipulation .

A tam zawk chu subcutaneous leh palpate awlsam tak a ni .

Stabilized fracture - Mid emaw distal emaw A leh B Type fracture .

Oblique fractures - overkill .

Intramedullary nailing→Displacement hmanrua te .

Ancillary tihtlem dan tur ruahmanna siam .

Point tihtlem Forceps .

Tibia tih a ni a; Percutaneous emaw hliam emaw hman .

Retractor lian tak tak (braces) .

tihtlem tihkhawtlai a ni a; Limb tih tawi .

Hun eng emaw chen atana Schanz screw te pawh a awm bawk.

1 Femur, Tibia 1000 a ni.

2 fracture line hnaih thei ang bera .

3 Proximal fracture Single cortical hmanna .

4 A universal chuck chu t-handle hmangin awlsam taka hman theih turin hmang rawh

Poller nail 100 a ni.

1Metaphyseal fracture (line of force siam that, siamthat lehna tur dinhmun nghet, operation siamthat) .

2 A chhuahna tur hmun leh a hmanna tur hmun chu a in ang lo hle.

3 Secondary surgery neih laiin medullary channel hluiah intramedullary nail awm tha lo tak tak a awm

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

Extra Wide Tourniquet a awm bawk.

1 Tibia 1000 a ni.

2 traction emaw retractor emaw hmanga tihpun a ni .

3 Soft tissue hliam na tak takah fimkhur taka hman .

4 A tawi zawngin sawi rawh .

5 Inflated state-a medullary expansion khap .

Nail locking sequence: distal a nih chuan proximal a ni.

A thatna te .

knockback awlsamna, fracture breaks compression; inthenna tihbo; tihtlem hnathawh dan tur.

Delayed & Nonunion Surgery atana tihtlem dan tur .

Surgery tihkhawtlai tawh avanga harsatna awm thei te .

Axial deformity (shortening, angulation leh or displacement) .

Granulation tissue atanga lo thang lian .

Early Bone Scabs .

Sclerosis of fracture breaks with closure of the medullary cavity .

Osteoporosis 1000 a ni.

Intraoperative lama harsatna awm thei te .

Expander leh intramedullary nail → Intramedullary nail a cortex a luh theihna tur deflection .

Angular deformity → Retractor .

A tawp ber atanga chhuak → Poller’s nail, plate fixation .

Force line dik lo awm lo tur venna hmanrua .

Proximal - A luhna hmun dik tak .

Distal - Medullary cavity lairil a intramedullary nail .

Intramedullary nailing avanga harsatna awm thei te .

★ hri kai theih a ni.

★Nerve damage .

★Fractures tihdamna danglam tak .

★Medical fractures .

Pawn lam atanga inher, torsion, valgus, chhung lam rotation, angulation .

★Adjacent joint pain .

★Fat embolism .

★Heterotopic ossification .

★Pulmonary embolism .

★Re-fracture 1000 a ni.

★Thrombosis .

★Joint a tichak .

★Non-Union A tlak loh, ruh Nonunion .

★Internal fixation a chhiat chuan .

★ Limb tih tawi .

★Midang .

Complication--Hrilhfiahna .

1.Early on, open fractures chu intramedullary nailing hman loh tur anga ngaih a ni.

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

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

3.Thisner intramedullary nails hian natna kai theihna a tipung a; Non-expanded locking intramedullary nails fixation hi a chhe hle a, ruh tawp pawh a chhe hle bawk.

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

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

A thau empolism syndrome .

1.Thawng sei tak tak, tubular ruh tliak te hi 0.5% atanga 2% vel an awm thin.

2. Medulla tihpun leh medulla tihpun loh hian pulmonary ventilation-ah nghawng lian tham a nei lo.

3.Medulla tihzauh hunah chuan technique chu zawi zawiin kneading a ni tur a ni a, force tam lutuk leh rough operation a awm loh nan.

4.Tun dinhmuna FES hmuhchhuah hian kum 1974-a Gurd-a’n a rawt criteria chu a la hmang reng a, a hriat hnua enkawlna chuan enkawlna hun tha ber a tikhawtlai ang a, a rah chhuah na tak a nei thei bawk.

Fracture damna tihkhawtlai leh ruh ni lo .

Thil hrang hrangin intramedullary nail fixation hnua fracture damna a nghawng a, a chhante chu hetiang hian an zirchiang thei ang.

1.Soft tissue chu fracture tawp lamah embedded a ni.

2. Transverse fracture tawp te inthen dan .

3. Damlo kum upa lam .

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

5. Intramedullary nail fixation tha lo .

6. Diabetes mellitus emaw, natna dang emaw, natna dang emaw a inzawm khawm.

Damdawi lam a hliam te .

Medical hmanga induced fractures hi intramedullary nail fixation laiin secondary fractures a awm a, chu chu a manipulation dik loh vang a ni.

Intraoperative attention pek a ngai a ni.

1. Nail entry point dik lo thlan hian proximal fracture a thlen thei.

2. Medulla tihzauh kawngah hian tharum hmanga nawr suh.

3. Pulp tihzauh luhna chu nail insertion lam hawi zawngin a kal tur a ni.

4. Distal end-a intramedullary nail dah luh dawnin force hmang suh.

A bul hnaia ruh inzawmnaah natna .

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

2. Tibial plateau chu medial meniscus hmalam kil nen transverse knee ligament hmangin a inzawm a, hetiang thleng hian tibial tuberosity chung lamah 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, chu chuan postoperative khup natna a thlen thei a ni.

3. Intramedullary nail leh heterotopic ossification te hi femoral intramedullary nail surgery hnua hip natna thlentu ber an ni.

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