Locking Plate-Application khap leh tihkhawtlai

A hman dan tur locking plates hian plate internal fixation of fractures hmanna kawngah nasa takin a tizau a ni. Mahse, an hman dan tur chu rationalized leh optimized a ngai a, chu chu pitfalls leh limitation awm thei a nih vang a ni. He thuziak ah hian application ngaihtuah tur te, lak chhuah harsatna te, leh tihkhawtlai te, locking plate hman dan 3 aspects kan en dawn a ni.

01.Locking Plate hmannaah eng thil bik leh harsatna nge hriat tur?

Locking Plate hmanga Fracture tihtlem dan tur leh harsatna awm thei te

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

Bone segment-ah vawi khat dah a nih chuan screw tam zawk dah belh chuan a ti che lo ang. Locking nail chauh pawm thei locking plate hman a nih chuan, . 

hei hian plate chu fracture set hnuah chauh lock theih a ni tihna a ni.

Locking plate-te hian ruh a tihdam theih avangin a tir lama repositioning hloh lovin, 

locking plate malunion awm chhan ber chu initial repositioning dik lo a ni. 

Tin, mechanics tha tawk lo avanga repositioning tha lo chuan dam rei lo emaw, dam loh emaw avanga bone plate a rupture avangin damna tha lo a thlen thei bawk.

Locking plate hmang lovin repositioning hi minimally invasive tih hian a harsa hle

 procedures a nih avangin ruh exposure a tlem hle. Traction kalphung hrang hrang (traction table, retractor), .

 percutaneous repositioning forceps hrang hrang, leh Kirschner pin hmanga ruh chi hrang hrang manipulate leh temporary fixation te a awm bawk. 

Locking plate leh locking nail hman hmain fluoroscopy hmanga reset enfiah hmasak a pawimawh hle.

Chumi kalh zawng chuan, standard screw holes nei bawk locking plate hman hunah, . 

plate-a initial repositioning atan standard hole-ah standard traction screw dah theih a ni.

 Ruh chi hrang hrangte chu plate-ah an dah a. Plate hi anatomy nena inmil a nih chuan reset guide atan hman theih a ni. 

Locking nails hian initial reset tihdanglam ngai lovin result nghet tak a siam thei. Hetiang order of insertion (standard screws, chutah locking screws) hi a pawimawh hle (Figure 4).

Fig. 4 Standard screw te chu dah hmasa la, khauh takin khih rawh.

Locking Pegs Tightening-ah Tactile Feedback a awm loh

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

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

 doctor chuan locking nail chu cortical emaw cancellous bone-ah a chelh tha hle niin a ngai sual a awlsam hle (Figure 3).

Fig. 3 Ruh chi leh cortices awm zat a zirin locking screw hnathawh rei zawng.

Mahni in Tapping Locking Screws te chu a awm

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

An mechanical property hi single cortex application-a single cortex locking screw te nen a inang a ni. An sei lutuk chuan, . 

an drilled second cortex an tawk ang a, chu chuan locking plate-a locking nail dah dik lohna a thlen ang.

Bicortical application lai hian an tawi lutuk thei a, chu chuan mechanically chuan single-cortical locking nails nen a inang thei a ni. 

An sei lutuk chuan cortex pawn lamah an inzar pharh ang a, plate sir lehlama critical structure te pawh a tichhe thei bawk.

Locking nail sei dik tak chu drilling hnua a sei duh zawng teh emaw, fluoroscopy hmanga verify emaw chauhvin hmuh theih a ni.

Uniaxial Locking Screw hmanga thil tih dan

Uniaxial locking nails that lohna ber chu an orientation ruat lawk a nih vang a ni. 

An kawngah hian implant emaw prosthetic stem dang emaw an nei thei a, chu chuan insertion a ti thei lo a, unicortical fixation-ah a tikhawtlai thei bawk.

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

anatomical leh biomechanical reasons avanga optimized a nih avangin intra-articular locking nail placement a awm theihna a awm. 

Entirna tlangpui chu distal radius fracture hi a ni. He risk hi locking plate chu joint hnaih takah emaw, anatomy a substandard a nih chuan a nasa zawk a ni. 

Intra-articular fracture a awm loh leh nih loh chu fluoroscopy hmanga finfiah a ngai a ni.

MIPO Technology hrang hrangte

Minimally invasive percutaneous osteosynthesis (MIPO) technique hian vun hnuai leh/ emaw taksa hnuai lam a hmang thin 

leh ruh plate chu a tlan luh hnuah ruh chhunga kawngkhar te tak te hmanga extraperiosteal insertion, a lang chhuak lo

 a ruh tliakna hmun a ni. Hei hian incision tenau zawk a siamsak a, surgical site morbidity a ti tlem a, procedure chu 'biologic' zawkin a siam bawk.

 a chhan chu ruh chi hrang hrang pholan a ngai lo va, soft tissue, periosteal vascularization, fracture hematoma te pawh a tibuai lo.

Locking plate leh a bik taka siam instrument hmanga tih theih a ni a, chu chuan plate chu a phalsak thei a ni 

tihdanglam leh vun kaltlanga kalpui tur a ni a, chu chuan plate chhunga locking nail holes te chu awlsam takin a hmu thei ang. 

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

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

locking plate chu a zui tura siam ruh cortex nen a inmil tawk tur a ni a, ruh nen pawh a inhnaih ang 

a structure khauhzia nasa taka tihtlem lohvin a theih. Locking step hnuhnung ber chhung hian chutiang chu tih chian a harsa hle

 screw-te conduit-te chu locking plate-ah a inrem ṭhat a, tightening laiin locking nail-te chu uluk taka inzawm a nih thu a sawi bawk.

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

Outer Ankle Locking Plate hman hunah vun hliam awm thei

Pawn lam ke ruh tliak siamthatna atana locking plate hman hi vun necrosis rate danglam tak nen a inzawm tih an sawi. 

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

Hawksbill fracture atana locking plate hman a nih pawhin hetiang thil hi a thleng thei bawk.

Osteoporosis Leh Screw Extraction A Risk A Ni

Osteoporotic bone-ah chuan nail locking hian screw pullout emaw withdrawal emaw a ti tlem thei a ni. 

Construct hi a nghet tawk lo a, a chhan chu ruh cortex a thim zawk a, trabeculae density a tlahniam bawk.

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

Khaihtawi:

1. locking screw hmangin 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 atan hian locking plate instrumentation a ngai a. MIPO technique chu a mamawh zawk.

02. Locking Plate lakchhuahna kawnga harsatna awm thei

Fracture a dam hnua locking plate lakchhuah chu thil harsa tak 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 thin 

(multiple tightening leh loosening, screwdriver pattern a chhia a, perfectly hexagonal a ni lo, screw insertion hi power drill hmanga tih a ni), 

chu chu unscrew theih a ni lo tihna a ni. Chuvangin, he harsatna hi ven a tha ber a, screw eng pawh chu a 

implantation laiin lu pattern chhia, screwdriver kimchang hmanga screw chu kut hmanga tihkhauh kim vek (electric drill hmang ni lovin).

 Thil chak zawka siam screw hman hian he harsatna hi a tihziaawm 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 atan. Instrument kit, 

chu chuan locking peg leh locking plate-a thread awmte chu a tidanglam thei a ni. Thil dang dangah chuan . 

drill guide dik lo hman loh emaw hman loh emaw chuan screw-te chu tihkhauh a nih chuan a inmil lo va, 

chu chuan screw te chu a ti jam ta a ni. A tir lama fixing process chhunga jamming hlauhawmna tih tlem nan, .

 instrument awm zawng zawng hman a pawimawh hle: drill guide leh socket, locking nail tihkhauh hunah full integrity mode-a torque wrench.

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

locking plate chu direct view a awm loh avangin. Drill guide alignment dik lo chuan hole drilled for tihna a ni 

locking nail leh locking nail insertion pawh a dik lo ang. Tin, lu pattern tihchhiat theihna a awm bawk

 locking nail chu screwdriver chu screw nen a inzawm tha lo a nih chuan.

Heng avang hian locking plate a lakchhuah hmain surgeon chuan a ni lo mai thei tih a hriat a ngai a ni 

locking nail chu tihzauh theih a nih avangin hexagonal screwdriver quality sang tak leh instrumentation dang hman a ngai a ni.

Locking nail chu tihzauh theih a nih loh chuan, emaw, lu pattern a chhiat chuan, . 

a hmasa ber chu screw lu chhungah screw extractor (tapered screwdriver inverted thread nei) dah a ni a;

 hei hi screw tihzauh nan a tawk mai thei. Thil dang chu locking nail sir lehlamah locking plate chu cut la, hman a ni

 chu chu screwdriver angin a structure zawng zawng tihzauh nan. Screw chu a la thlah thei lo a nih chuan locking plate chu tihzauh theih a ni 

drill hmanga drilling emaw, locking nail lu tihchhiat emaw, locking nail tihzauh nan plate vel cut emaw hmangin. Chumi hnuah chuan . 

vise hmangin locking peg-te stake te chu lakchhuah theih a ni. A la thlah thei lo a nih chuan (ruh chhungah a inzawm tlat emaw, a chhuak tawk lo emaw a nih avangin), . 

ring drill hmangin lakchhuah theih a ni (Fig. 6).

Figure 6 Board chhunga locking screw tangte paih chhuahna tur hints leh tips.

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

Ring drill hman hian perioperative fracture a tipung a ni.

Khaihtawi:

1. Locking nail lakchhuah harsatna hi 3.5mm hex head locking titanium screw hmanga tihchhuah a ni ber.

2.He harsatna pumpelh dan tha ber chu screw dah dawnin instrument pek zawng zawng hman hi a ni. Heng harsatnate hi hmanraw ha tak hmanga chinfel theih a ni.

03. Locking Plate-a hman theih lohna tur chu engte nge ni?

Clavicle plate a tliak a, ruh inzawmna (osseous nonunion) a awm bawk

Locking plate hnathawh sei tawk lo emaw, locking nail tam lutuk emaw avanga structure chu a khauh lutuk loh nan (Fig. 7) screw holes hnuaiah emaw, screw/bone plate inzawmna hmunah emaw locking plate a chhe thei a ni.

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

Bone nonunion hmuhchhuah hi plate breakage atanga finfiah a ni tlangpui. 

Locking plate emaw locking nail emaw a tlai deuh chuan a hun takah a awm a, micromotion a awm avangin ruh a tidam thei a ni.

Compression mamawhna simple fracture-ah chuan, chu chu ruh inrawlh aiin fracture chi hrang hrangah a innghat a, 

a rigid structure-a fragment pahnih inhnaih lohna chuan plate chu non-healing leh fatigue failure a thlen thei a ni. 

Fracture site-a rigid splint + locking nail + traction te inzawmkhawm hian ruh nonunion a thlen thin.

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

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

Figure 8 Structure khauh lutuk leh inthlau lutuk secondary failure: locking screw tam lutuk chu distally-ah hman a ni a, proximal splice plate pawh a sei tawk lo.

Chuvangin, hip intracapsular fractures te chu locking plate hmanga fixation hian bone nonunion a thlen thei a, a chhan chu a structure hi a rigid lutuk a, fracture site a impinge thei lo. 

Damna atana micromotion mamawh awm lo chuan load zawng zawng chu implant hian 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 distal 1/3 fracture-ah chuan. Elasticity avanga micromotion chuan a phalsak a 

locking plate/nail construct-a a corresponding surface-a awm chauh, fracture healing tissue uniform development.

 Hetiang hlauhawmna hi control tur chuan locking plate hnathawhna sei zawng tihpun a ngai a, chu chu titanium plate flexible zawk hmangin emaw, locking nail design thar hmangin emaw a ni. 

A lehlamah chuan construct flexible lutuk hian hypertrophic bone nonunion a thlen thei a ni.

Steel plate te chu plastic hmanga tihdanglam a ni

Plate 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 mm 5 aia tam a nih chuan, .

 structural strength nasa takin a tlahniam a, plate plastic deformation leh titanium plate failure risk a sang hle.

Locking plate tawp lama diaphysis emaw metaphysis emaw a tlai lama fracture

Locking plate diaphysis emaw metaphysis emaw tawp lama late fracture hlauhawmna, . 

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

Mechanical lama chhiatna a awm

A hnuaia thil awmte hian locking plate mechanical failure a thlen theihna a tipung a ni:

1. Humeral diaphysis fractures fixation atan chuan fracture site sir lehlamah locking nail pali hman a ngai a, chu chuan torsion a do thei a, mechanical failure a tipung thei bawk ;leh

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

a bik takin, ruh tliakna hmun chu locking nail-in a compress theih loh avangin leh ruh chu osteoporotic a nih avangin;

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

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

4. metaphyseal fracture inversion-a inthlak duh (eg, proximal humerus, proximal femur, leh proximal tibia fracture) te medial comminution.

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

heng fracture te hi medial-a console-type plate dah ngai lovin stabilize emaw, biologic fracture environment vawng reng chungin ruh dah belh emaw a ngai lo. 

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

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

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

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

 leh fixation atana epiphysis inversion te hi risk factor hriat lar tak a ni. Construct failure hlauhawmna tih tlem nan, . 

locking nail thenkhat chu mechanically supported a ni ang a, chu chuan pawn lam atanga translated fractures tihziaawmna tura medial support awm lohna chu a khum ang

Locking Plate te hi Biological Failure a ni

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

Heng hlauhawmnate hi ruh ruh natna (bone osteoporosis) a awm chuan a nasa zawk a, . 

chu chu ruh damna a awm hmain rehabilitation hmasa leh weight bearing-a kir leh hi uluk taka tih a ngai tihna a ni.

(1) Locking Screw te lakchhuah

Screw extraction hi 'total' leh a ruala locking nail chu plate tawp pakhat emaw tawp pahnih emawa ruh atanga lakchhuahna nen a inmil a ni. A then phei chuan, . 

locking nail chu a chhehvel ruh chi khat hmanga lakchhuah a ni.

Epiphyseal region-ah chuan one-piece locking plate structure hian a tlangpuiin dispersed emaw convergent locking nail anchorage, 

leh three-dimensional structure hian cancellous bone atanga screw extraction laka invenna a tipung bawk.

Diaphyseal region-ah chuan converging leh dispersed locking nail leh construct locking plate sei zawk nei te hian pullout strength an nei tha zawk 

Hetiang construction hi periprosthetic fracture tan chuan a tha zawk. Osteoporotic bone-ah chuan, . 

bicortical stem screw fixation hi monocortical screw fixation aiin a tha zawk. Periprosthetic fracture tan chuan flat-head unicortical screws hian intramedullary implants nena inzawmna nei lo turin a pui thin.

Heng fixation failures te hi ruh quality tha lo nen a inzawm a, structure chu mechanically intact mahse.

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

Intra-articular penetration nei locking nail cut-out emaw impingement emaw chu cancellous epiphyseal region-ah a awm thei.

Heng displacement te hi fixation locking nail vel a ruh lian lo tak tak epiphyseal fragment displacement te an ni.

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

 cancellous bone chhungah a lut a. A pawi ber chu epiphyseal locking nail hi epiphysis atang hian a chhuak a, joint chhungah a kal ta a ni.

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

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

epiphyseal locking nail hi tihtlem a ni a, hei hian ingrowth leh secondary joint penetration hlauhawmna a ti tlem thei ang.

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

a structure chu mechanically intact mahse.

Joint Rehabilitation leh Weight Bearing nghal theih a ni

Rehabilitation leh weight bearing hi perfect fixation neih a nih hnuah leh postoperative X-ray-a verified hnuah chauh phal a ni.

Biomechanical study atanga a lan dan chuan ruh pangngaiah chuan a chi hrang hrang inkar gap chu mm 1 aia tlem a nih chuan . 

weight bearing hi risk awm lovin a awm thei. cycle maktaduai 1 hnuah chuan ruh pangngai nen a nghet a, chu chu damna a awm theih nan a tawk a ni.

Structurally sound a nih chuan locking plate leh fixed-angle locking nail te hian a hmain a rawn kir leh thei a ni 

weightbearing a nih chhan chu load chu locking nail atanga locking plate-ah direct-in a transfer a, nail-plate junction-ah fixation failure hlauhawmna a awm lo.

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

MIPO tan chuan extra-articular, simple leh/or simple comminuted fractures tan chuan weightbearing hmasa phal a ni. 

Specific structure sei tak takte chu a flexible tawk a, bicortical locking nail leh opening te chu load absorption leh distribution atan a inthlak danglam thei a ni.

Tawpna:

1.Biomechanical study-ah hian 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 dik tih finfiah nan a pui a ni. 

Mahse, tun hnaia literature-te pawhin locking plate-a technical harsatna leh hlawhchhamnate a tarlang bawk.

2.A hlawhchham chhan ber chu surgical technique ruahmanna fel tawk lo a ni a, . 

chu chu a harsa hle a, a bik takin minimally invasive procedure tih hunah chuan.

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

screw lock hmanga plate indirect reset theih a nih loh avangin.

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

chu chu surgeon chuan heng plate hman dan tur kaihruaitu thu bul leh dante a hriat chian a ngai tihna a ni. 

Chuvangin, structure chu elastic a ni tur a ni a, regular spaced locking screws tlemte chauh awmin, chu chu empty hole nen a inthlak a ni.

5.Locking plate te hi theoretical initial stability tha zawk ni mahse, . 

fixation of the structure chu a ruh tliak complexity, reduction quality leh ruh biological quality te vangin a tlem hle.

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

autonomy tling damlo chu a ke ruh tliak chungah rit phur turin phalsak theih a ni. Thil tam takah chuan locking plate fixation hian a hmain rehabilitation a phalsak thin.