Plate-application khapna leh tihkhawtlai theihna locking .

A hman dan . Locking plate hian a tam zawk chuan plate internal fixation of fractures hmanna tur a tizau hle a ni. Mahse, an hman dan tur chu rationalized leh optimised a nih avangin harsatna awm thei leh limitation te avang a ni. He thuziak ah hian application ngaihtuah dan tur ngaihtuah te, lakchhuah chungchanga harsatna te, leh limitation te, locking plate application aspect 3 te kan en dawn a ni.

01.Locking plate hman danah hian eng special feature leh harsatna nge hriat tur?

Locking plate hmanga fracture tihtlem dan tur step leh harsatna .

Fracture reset dan tur step te chu standardized a ni. Locking plate hian fracture a reset lo. 

Bone segment-a dah a nih chuan screw tam zawk dah belh chuan a che thei dawn lo. Locking nail locking chauh pawm thei locking plate hman a nih chuan, . 

Hei hian a awmzia chu plate chu fracture set a nih hnuah chauh lock theih a ni tihna a ni.

Plate locking hian a tir lama repositioning hloh lovin ruh dam theihna a siam avangin, . 

Locking plate-a malunion awm chhan ber chu a tir lama repositioning dik lo a ni. 

Tin, mechanics tling lo avanga repositioning tha lo chuan damna tha lo a thlen thei a, chu chu damna tlai emaw, dam lohna emaw avanga bone plate ruptures te a ni.

Locking plate hman loha repositioning hi minimally invasive tih laiin a harsa hle a ni .

 Procedures Bone exposure a tlem hle avangin. Traction procedure hrang hrang (traction table, retractor) a ngai a, .

 Percutaneous repositioning forceps hrang hrang, leh Kirschner chuan ruh fragment leh temporary fixation te chu a manipulation theih nan a pin a. 

Locking plate leh locking nail hman hma hian fluoroscopy hmanga reset hi enfiah hmasak a pawimawh hle.

A lehlamah chuan, standard screw holes nei bawk locking plate hman hunah, . 

Plate-a dah hmasakna tur standard holes-ah standard traction screw dah theih a ni.

 Bone fragment te chu plate-ah an dah a. Plate chu anatomy nen a inmil chuan reset guide atan hman theih a ni. 

Nail locking hian a tir lama reset thlak danglam lovin result nghet tak a nei thei. He insertion order (standard screws, chutah chuan locking screws) hi a pawimawh hle (Figure 4).

Fig. 4 Standard screw te chu dah hmasa la, tight rawh.

Locking pegs tihkhauh huna tactile feedback awm lohna .

Locking head screw te tihkhauh hian tactile feedback a awm lo. Anihna takah chuan, 

Locking nail tightening hi cortical emaw cancellous bone-ah leh locking plate-a metal-ah a rualin a thleng a ni. Hemi avang hian, .

 Damdawi thiam tan chuan locking nail hian cortical emaw cancellous bone-ah a chelh tha hle tih ngaihtuah sual a awlsam (Figure 3).

Fig. 3 Locking screw hnathawh sei zawng chu ruh chi leh cortices awm zat a zirin a ni.

Self-tapping locking screw te pawh a awm bawk.

Self-tapping locking screw hman hian drilling emaw, tightening emaw laiin a ruala a thlen angin tactile feedback a awm lo tihna a ni.

An mechanical property te hi single cortex hman laiin single cortex locking screw te nen a inang tlangpui. An rei lutuk a nih chuan, . 

Undrilled second cortex chu an biak ang a, chu chuan locking nail chu locking plate-ah a position dik lo ang.

Bicortical application an tih lai hian an tawi lutuk thei a, chu chuan single-cortical locking nail nen mechanically equivalent a siam thei a ni. 

An rei lutuk chuan cortex atanga chhuakin an inzar pharh ang a, plate sir lehlamah critical structure an tichhia thei bawk ang.

Locking nail sei dik tak chu fluoroscopy hmanga drilling emaw verify emaw hnua a sei duh zawng tehna hmang chauhin kan hmu thei.

Uniaxial locking screw-a thil langsar tak takte

Uniaxial locking nail-te chhiatna ber chu an orientation chu ruat lawk a nih vang a ni. 

An kalna kawngah implant emaw prosthetic stem dang an nei thei a, chu chuan insertion chu a theih loh emaw, unicortical fixation-ah a tihtlem emaw thei a ni.

Uniaxial locking nail nei limb-a hman tur anatomical locking plate-te tan chuan orientation fixed nei, . 

Anatomical leh biomechanical lam hawia optimized a nih avangin intra-articular locking nail placement a awm theihna a awm bawk. 

Entirna tlangpui chu distal radius fracture a ni. He risk hi locking plate chu joint hnaih taka a awm emaw, anatomy a tlem lai emaw a nih chuan a sang zawk a ni. 

Intra-articular fracture awm lohna chu fluoroscopy hmanga finfiah a ngai a ni.

Mipo Technologies 1000 a ni.

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

leh extraperiosteal-a ruh plate-a inslide hnua ruh chhunga kawngkhar te tak te chhunga dah luh, a chhuah loha, a chhuahna tur a ni.

 a hliam na hmun a ni. Hei hian incisions te zawk, surgical site morbidity tlem zawk a siam thei a, procedure chu 'biologic' a ti tam zawk bawk.

 A chhan chu ruh fragment tinte pholan a ngai lo va, soft tissue, periosteal vascularization, fracture hematoma te pawh a inrawlh lo.

Locking plate leh a bik taka siam instrument hmanga tihhlawhtlin theih a ni a, chu chuan plate chu a phalsak a ni . 

Plate chhunga nail holes locking awlsam taka hmuh theih nan vun chhungah manipulated leh paltlang tur a ni. 

Hmasawnna finfiah nan step tinah fluoroscopic image lak a ngai a ni. He technique step tin hi a harsa hle. Challenge hmasa ber chu fixation hmaa fracture reset a ni.

 Chumi hnuah chuan locking plate chu ruh sei zawng zawngah uluk taka centered a ngai a, chuti lo chuan locking plate alignment chu asymmetric a ni ang (Figure 5). Chubakah chuan, 

Locking plate chu a hnung zui tura siam leh ruh hnaih tak ang maia hnaih tawh ruh cortex nen a inmil tawk tur a ni. 

a awm thei chu a structure-a a nghetna nasa taka tihtlem loh chuan a awm thei. Final locking step chhung hian 1000 a nih theih nan a harsa hle.

 Screw-a conduit te chu locking plate-ah a inmil tha hle a, locking nail te chu tightening laiin a engage tha hle a ni.

Figure 5 Locking plate-a eccentric positioning leh screw tightening laiin haptic feedback awm lohna.

Outer ankle locking plate hman hunah vun hliam thei tur .

External ankle fractures siamthat nan locking plate hman hi vun necrosis rates sang tak tak nen a inzawm tlat a ni. 

Heng subcutaneous locking plate thickness hian vunah pressure a siam a, a vascular distribution leh healing a tibuai bawk. 

Hawksbill fracture-a plate lock-a hman a nih pawhin chutiang bawk chu a thleng thei.

Osteoporosis leh screw lakchhuah theihna risk .

Osteoporotic bone-ah chuan locking nails hian screw pullout emaw withdrawal emaw a awm theihna a ti tlem a ni. 

Construct hi a chhe tawk lo a, a chhan chu bone cortex a thinner zawk a, trabeculae density a tlahniam bawk.

Chutiang a nih chuan locking plate fixation chu evanescent emaw convergent monolithic construct emaw hman hian a chak zawk a, anchor tha zawk a ni fo bawk (Figure 3).

Khaihtawi:

1. Locking screw-ah chuan ruh plate-a fracture chu reset theih a ni lo.

2. Locking screw dah hmain fracture chu reset hmasa phawt tur a ni.

3. Fracture tihtlem nan percutaneous fixation a ngai a, chu chu plate instrumentation lock a ngai a ni. Mipo technique hi a mamawh zawk a ni.

02. Locking plate tihbo chungchanga harsatna .

Fracture a dam tawh hnua locking plate lakchhuah chu thil harsa leh sawi lawk theih loh a ni a, 

Mahse dinhmun chu chinfel theih a ni. Harsatna lian ber chu locking screw tihzauh hi a ni.

A then phei chuan locking nail lu chunga thread te chu insertion laiin a chhe vek a ni . 

(Multiple tightening leh loosening, screwdriver pattern a chhia a, a hexagonal tha tawk lo, power drill hmanga screw insertion tih a ni), 

chu chu unscrewed theih a ni lo tihna a ni. Chuvangin, he harsatna hi screw eng pawh chu a thlak nghal a, a . 

Implantation laiin lu pattern chhia, screwdriver kimchang tak hmangin screw chu kut hmangin a tight vek (electric drill nen ni lovin).

 Thil chak zawk hmanga siam screw hman hian he harsatna hi a ti tlem thei a ni.

A tam zawkah chuan locking nail thread leh locking plate-a threaded hole inkarah hian mechanical locking emaw jamming emaw a awm thin. 

Hei hi 3.5mm diameter titanium hex pattern single shaft locking screw hmanga hmuh tam ber a ni. Mechanism pakhat chauh a awm lo .

 inrawlhna tur a ni. Screw te hi a tir lamah chuan instrument kit-a torque wrench pek an hman loh avangin an over-tighten fo thin a, 

chu chuan locking peg leh locking plate-a thread awmte chu a tidanglam thei a ni. A dang erawh chuan, . 

Drill guide dik lo hman loh emaw, hman loh emaw chuan screw te chu tight a nih chuan alignment a nei lo a, . 

chu chuan screw te chu a ti jam ta a ni. Initial fixing process chhunga jamming awm theihna tur tihtlem nan, .

 Instrument awm zawng zawng hman a pawimawh hle: drill guide leh socket, torque wrench te chu locking nails tihkhauh hunah full integrity mode-ah a awm.

MIPO technique hian alignment guide dah dik loh theihna risk sang tak a keng tel a, 

locking plate direct view a awm loh avangin. Drill guide alignment dik lo tihna a ni a, chu chu 10.1. 

Locking nail leh locking nail dahna pawh a dik lo ang. Head pattern tihchhiat theihna a awm bawk a, a .

 Screwdriver chu screw nen a inzawm tha lo laiin nail lock.

Heng avang hian locking plate a lak chhuah hmain surgeon chuan a hriat a ngai a ni. 

A theih chuan locking nail chu a tizau thei a, chutiang chuan hexagonal screwdriver quality sang tak leh instrumentation dang hman a ngai a ni.

Locking nail chu a lo chhuah theih loh a, a lu pattern a chhiat loh chuan, . 

A hmasa ber atan chuan screw extractor (tapered screwdriver with inverted threads) chu screw lu chhungah dah a ni a;

 Hei hian screw chu a tihzauh theih nan a tawk mai thei. Thil dang dang chu locking nail sir lehlamah locking plate chu cut a, hman a ni .

 a structure zawng zawng tihzauh nan screwdriver angin a awm. Screw chu a la tihzauh theih loh chuan locking plate chu 1000 hmangin a lo chhuak thei a ni. 

Drill hmanga drill emaw, locking nail lu tihchhiat emaw, locking nail tihzauh nan plate vel a tan emaw a ni. Chumi hnuah chuan, . 

Vise hmang hian locking pegs stakes te chu lakchhuah theih a ni. a la chhuah theih loh chuan (a chhan chu ruhah a inzawm tlat emaw, a chhuak tawk lo emaw a nih chuan), 

Ring drill hmangin a chhuak thei (Fig. 6).

Figure 6 Board-a locking screw lo lutte paih chhuah dan tur leh tips.

Heng harsatna zawng zawng hian operation hi a ti rei thei a, metal fragment chhuak avanga soft tissue abrasion a thlen thei a, natna kai theihna a nei thei bawk. 

Ring drill hman hian perioperative fractures a thlen theihna a tipung a ni.

Khaihtawi:

1. Locking nail lakchhuahna kawnga harsatna chu a bul berah chuan 3.5mm Hex head locking titanium screws nen a thleng thin.

2.He harsatna laka invenna tha ber chu screw inthun hunah instrument pek zawng zawng hman a ni. Heng harsatnate hi hmanraw ha tak tak hmangin chinfel theih a ni.

03. Locking plate-a hman theih lohnate chu engte nge ni?

Clavicle Plate a tichhia a, osseous nonunion a ni.

Locking plate hnathawh rei tawk loh vang emaw, locking nail tam lutuk emaw avanga structure a nghet lutuk loh nan (Fig. 7), screw holes hnuai emaw, screw/bone plate junction-a emaw locking plate a tlak theihna tur chu tihtlem theih a ni.

Figure 7 Ni 60 hnuah ruh damna chu locking screw awm zat leh a awmna hmun danglam leh structure stiff lutuk elasticity tihpun hmangin an ti thei a ni.

Bone nonunion tih hriat a nih chuan plate breakage hmangin an finfiah tlangpui. 

Locking plate emaw locking nail emaw a tlak hnuhnun ber chu a hun takah a ni a, micromotion a awm theih avangin ruh damna a thlen thei a ni.

compression mamawh fracture awlsam tak takah chuan, chu chu ruh inzawm aiin ruh tliak chi hrang hrangah a innghat a, chu chu . 

Rigid structure-ah chuan fragment pahnih hian an khawih loh chuan non-healing leh fatigue failure of the plate a thlen thei a ni. 

Fracture site-a rigid splint + locking nail + traction te inzawmkhawm chuan bone nonunion a thlen a ni.

Chumi danglamna chu locking nail chu plate-a a innghahna hnuaiah a ruala rupture a ni a, 

chu pawh chu a rigid lutuk structure vang a ni. Hei hian plate tawp khat chu a chhuah tir 'in one piece' a ti chhuak a, damna a thleng thei lo (Figure 8).

Figure 8 Secondary failure of an overly stiff and unbalanced structure: Locking screw tam lutuk chu distal-ah hman a ni a, proximal splice plate pawh a sei tawk lo.

Chuvangin, hip-a intracapsular fracture-te locking plate-a fixation chuan bone nonunion a thlen thei a, a chhan chu structure chu a rigid lutuk a, fracture site-a impinge theih a ni lo. 

Damna atana micromotion mamawh awm lovin, load zawng zawng chu implant-in a phur vek a, a tawpah chuan a hlawhchham ta a ni.

Asymmetric tihdamna tissue .

Periosteal bone scabs hi asymmetric a ni thei a, . 

a bik takin femur-a distal 1/3-a fracture-ah te. elasticity avanga micromotion awm chuan a phal a ni. 

Fracture healing tissue chu a locking plate/nail construct a inmilna hmunah chauh a lo awm thin fracture healing tissue chu a lo thang lian zel a.

 Hetiang hlauhawmna hi thunun theih nan locking plate hnathawh rei zawng chu tihpun a ngai a, chu chu titanium plate flexible zawk hmangin emaw, locking nail design thar hmangin emaw a ni thei. 

Chumi kalh zawng chuan, overly flexible constructs chuan hypertrophic bone nonunion a thlen thei a ni.

Steel plate a plastic a deformation a awm chuan a .

Place chu cortex hnaih thei ang bera dah chuan plate lai takah plastic deformation awm theihna a ti tlem a;

 Plate leh cortex inkar hlat zawng chu 5 mm aia tam a nih chuan, .

 Structural strength nasa takin a tlahniam a, plate a plastic deformation leh titanium plate a chhiat theihna a sang hle bawk.

Locking plate tawp lama diaphysis emaw metaphysis emaw a tlakhniam hnuhnung ber .

locking plate tawp lama late fracture hlauhawmna chu diaphysis emaw metaphysis emaw a ni a, . 

A bik takin osteoporotic bone-ah chuan, he biala stress awmte tihziaawmna turin plate tawp lama cortical locking nail pakhat emaw, standard bicortical screw emaw dahin tihtlem theih a ni.

mechanical a chhiat chuan .

A hnuaia condition te hian locking plate-a mechanical failure a thlen theihna a tipung a ni:

1. Humeral diaphysis fractures fixation chuan fracture site sir lehlama locking nail pali hman a ngai a, chu chuan torsion a do a, mechanical failure a tipung a ni ;leh mechanical failure tihpun a ngai a ni ;

2. Epiphyseal fractures fixation hi a harsa a, a chhan chu a nghet lo fo thin a, . 

A bik takin fracture site chu locking nails hmanga compress theih a nih loh avangin ruh chu osteoporotic a nih avangin;

3. Epiphysis-a intra-articular leh extra-articular comminuted fractures te chu a nghet lo

 (eg, distal femur fractures, bicondylar tibial plateau fractures, distal radius ruh tliak te);

4. Inversion-a inthlak danglam duhtu metaphyseal fracture-te medial comminution (eg, proximal humerus, proximal femur, leh proximal tibia fractures).

 Locking plates anchored to the lateral aspect of the bone chuan robust structure a pe a, chu chu a tawk fo thin . 

Heng fracture te hi console-type plate medially add ngai lovin emaw, biologic fracture environment vawng reng chungin bone add emaw a ngai lo. 

Stability chu locking plate/locking nail interface-ah chauh a innghat a, . 

chu chu epiphysis inverted a awm reng emaw, medial console siam thar loh emaw a nih chuan reset hnua stress nasa ber a ni. Chumi hnuah chuan locking plate chu a fatigue vangin secondary a fail thei.

Chuvangin, bicondylar tibial plateau fractures fixation chu lateral side-ah chauh locking plate hmanga fixation chu type a zirin ngaihtuah a ngai a ni.

 Proximal humerus fractures tan chuan fracture block awm zat, medial support hloh, .

 leh fixation atana epiphysis inversion te hi risk factors hriat lar tak a ni. Construct failure hlauhawmna tihtlem nan, . 

Locking nail thenkhat chu pawn lam atanga lehlin fractures tihtlem nan medial support a awm loh avangin mechanically supported a ni ang.

Locking plate te biological failure .

Locking plate-a biological failure mode-te chu screw cut out leh fracture emaw, locking nail impingement emaw a ni. 

Heng hlauhawmna te hi ruh ruh ruh (bone osteoporosis) a awm chuan ruhroah a awm a, . 

chu chu ruh damna a thlen hmain a hmaa rehabilitation leh return to weight bearing tih a ngai tihna a ni.

(1) Locking screw lakchhuah .

Screw extraction chu 'total' nen a inmil a, a ruala locking nail chu ruh atanga plate tawp khat emaw, a tawp ber emawa lakchhuah a ni. A then phei chuan, . 

Locking nail chu a chhehvel ruh pakhat hmangin an la chhuak thin.

Epiphyseal region-ah chuan one-piece locking plate structure hian a tlangpuiin stability tling tak a pe a, chu chu dispersed emaw convergent emaw locking nail anchorage a nih vang a ni a, 

Tin, three-dimensional structure hian cancellous bone atanga screw lakchhuah theihna a tipung bawk.

Diaphyseal region-ah chuan converging leh dispersed locking nails leh constructs locking plate sei zawk nei te hian pullout strength an nei tha zawk . 

Hetiang chi hi periprosthetic fracture atan a tha zawk. Osteoporotic ruhah chuan, . 

Bicortical stem screw fixation hi monocortical screw fixation aiin a tha zawk. Periprosthetic fractures atan chuan flat-head unicortical screws hian intramedullary implant nena inzawmna a awm loh nan a pui a ni.

Heng fixation failure te hi ruh quality tha lo nen a inzawm a, structure chu mechanically intact a nih pawhin a inzawm tlat a ni.

(2) Locking screw te cut-out emaw impingement emaw .

Cancellous epiphyseal region-ah hian intra-articular penetration hmanga locking nail cut-out emaw impingement emaw a awm thei.

Heng displacement te hi fixation locking nail vel a low-mass bone displaced epiphyseal fragments te displacement a ni.

 Hei hian epiphyseal fracture tihtlem a hloh phah a ni. A tha berah chuan epiphyseal locking nail impinges leh .

 Cancellous bone chu a rawn luhchilh a. A chhe ber lai chuan epiphyseal locking nail chu epiphysis atang chuan a chhuak a, joint chhungah a lut a.

Heng harsatna pahnih hi proximal humerus leh distal radius fracture-ah a thleng tam ber a ni. 

Proximal humerus fractures locking plate fixation atan chuan a sei zawng hi a sei zawng 

Epiphyseal locking nail chu introwth leh secondary joint penetration hlauhawmna tihtlem nan tihtlem a ni.

Heng fixation failure te hi ruh quality tha tawk lo leh fracture fragments tihtlem hmaa initial displacement lian tak a nih vang a ni a, 

structure chu mechanically intact a nih pawhin.

Joint rehabilitation leh weight bearing nghal mai tur a ni.

Rehabilitation leh weight bearing hi perfect fixation a awm hnuah chauh phal a ni a, postoperative x-ray-ah pawh finfiah a ni.

Biomechanical study-ah chuan ruh pangngaiah chuan fragment inkar gap chu 1 mm aia tlem a nih chuan, 

Risk awm lovin weight bearing a awm thei. Cycle maktaduai 1 hnuah chuan ruh pangngai ang chiah kha a ni a, chu chu damna tur atan a tawk a ni.

Structural sound a nih chuan locking plate leh fixed-angle locking nail te chuan a hmaa kir leh theihna a siam a ni. 

Weightbearing hi load chu locking nail atanga locking plate-a direct-a transfer a nih avangin, nail-plate junction-ah fixation failure hlauhawmna a awm lo.

Mahse, multiaxial locking peg axis chu locking plate-a perpendicular a nih loh chuan early weight bearing a phal lo.

MIPO tan chuan early weightbearing hi extra-articular, simple leh/or simple comminted fractures te tan phal a ni. 

Specific structure rei tak tak te chu a flexible tawk a, alternating bicortical locking nails leh load absorption leh distribution atan openings te pawh a awm bawk.

Tawpna:

1.biomechanical study-ah chuan construct chi hrang hrang leh an mechanical property te an zirchiang a.

Literature hian he fixation chi hrang hrang nena inzawm theoretical hopes te hi a nemnghet thei a ni. 

Mahse, tun hnaia literature-ah chuan locking plate-a technical harsatna leh hlawhchhamnate pawh a tarlang bawk.

2.A hlawhchham chhan ber chu surgical technique ruahmanna felfai tak a ni a, 

Chu chu a phurawm hle a, a bik takin minimally invasive procedures tih hunah.

3.Fracture chu reset hmasa tur a ni a, screw te chu plate-ah lock lovin, .

Screw te lock hmanga plate indirect reset theih a nih avangin.

4.A structure chu a sei leh a chakna dik tak a ni tur a ni, . 

Chu chu surgeon chuan heng plate hman dan tur kaihruaitu principle leh dan te a hriat chian a ngai tihna a ni. 

Chuvangin, a structure chu elastic a ni tur a ni a, regular taka spaced locking screw awm zat tlemte chauh a awm a, chu chu khur hrui hring nen a inthlak a ni.

5.Plate locking-a theoretical initial stability tha zawk awm mahse, . 

Structure fixation hi a fracture complexity, reduction quality leh ruh biological quality te hian a tikhawtlai a ni.

6.Structure chu mechanically intact a nih chuan ruh quality a tha a, fracture pawh extra-articular a ni a, 

Damlo autonomy tling tak nei chuan a ke ruh tliak chu a phur thei ang. Thil tam takah chuan locking plate fixation hian a hmaa rehabilitation a phalsak thin.