Tibial Intramedullary Nail Fixation hman dan tur a ni

Puitlingah chuan tibial stem fracture unstable leh displaced te tan chuan intramedullary nail fixation hi enkawlna duh ber a la ni reng a ni. Surgical treatment tum ber chu tibia sei zawng, alignment leh rotation siam that leh fracture healing neih a ni. Intramedullary nailing thatna chu surgical trauma tlem ber leh fracture-a thisen supply dik taka vawn that hi a ni. Chu bakah, tibia intramedullary nailing hian biomechanical fracture stability dik tak a pe a, load-sharing device angin hna a thawk a, postoperative mobilization hmasa ber a phalsak bawk. Intramedullary nail design leh reduction technique lama hmasawnna chuan intramedullary nail fixation atana indication te chu a tizau a, proximal tibia leh lower middle third fractures te pawh a huam tel a ni.

Vawiin thleng hian tibial fracture-a closed reduction intramedullary nail fixation hi trauma orthopedic surgeon-te tan chuan thil tih dan pangngai a ni tawh a ni. Displaced tibial stem fracture-a intramedullary nail fixation hman hi a lar hle chung pawhin, a la harsa reng a, harsatna tam tak a nei thei bawk. Surgery technique pawh a lo thang zel a. He thuziak hian a tum ber chu tibial stem fracture-a intramedullary nail fixation-a concept awm mekte sawifiah a, tun hnaia he field-a hmasawnna te khaikhawm a ni.

一 tih a ni. A tir lama endik leh enfiah

Damlo naupang zawkah chuan tibial stem fracture hi high-energy injuries avanga lo awm a ni fo a, Advanced Trauma Life Support (ATLS) guidelines angin damlote chu associated trauma an neih leh neih loh endik a ngai a ni. A chhehvel vun leh soft tissue hliam, fracture blisters, vun abrasion, kang, ecchymosis, emaw vun elevation te endik a ruh chu a inhawng em tih chiang taka sawi a, a inhawng a nih chuan tetanus leh antibiotics hmanga enkawl; leh neurovascular examination uluk tak neiin a chunga kan sawite hi document rawh. Osteofascial compartment syndrome awm leh awm loh endik la, heng damlote hi clinical examination hrang hrang neihpui rawh.

Tun hnaia zirchianna hrang hrangah chuan tibial tuberosity fracture hnua osteofascial compartment syndrome vei hi 11.5 % vel a ni thei tih hmuhchhuah a ni. A bik takin damlo pawl naupang zawkte chuan osteofascial compartment syndrome an nei tam zawk. Osteofascial compartment syndrome hi clinical findings atanga hmuhchhuah tur a ni a, chung zingah chuan natna nasa tak, neurovascular inthlak danglamna, myofascial compartment swelling, leh passive toe extension avanga natna tihpun te pawh a tel tur a ni. Chuvangin osteofascial compartment syndrome hi clinical diagnosis a la ni reng a, clinical examination uluk taka documentation neih a pawimawh hle. Myofascial compartment chhunga pressure chu pressure needle (Figure 1) hmangin specialty exam-a complementary examination method atan teh theih a ni.

Figure 1. Pressure needle hmanga interosseous septum-a pressure tehna

Data rintlak hmuh theih nan myofascial compartment paliah leh myofascial compartment tin chhunga hmun hrang hrangah intrafascial pressure teh tur a ni. Literature-a zirchianna hrang hrangah chuan pressure danglamna 30 mmHg aia tlem (diastolic pressure minus fascial compartment pressure) chuan fascial compartment syndrome a nih thu a tarlang. Surgery neih laiin diastolic pressure a tlahniam tlangpui a, differential pressure chhut hunah preoperative diastolic pressure ngaihtuah tur a ni.

Tun hnaia zirchianna hrang hrangah chuan intrafascial pressure monitoring hi acute fascial compartment syndrome hriat theihna atana hmanraw tangkai tak a ni tih hmuhchhuah a ni a, sensitivity 94 % leh specificity 98 % a ni. Mahse, compartment syndrome avanga chhiatna thlen thei tur ngaihtuah chuan compartment syndrome hi clinical findings atanga hmuhchhuah tur a ni a, interosseous compartment pressure measurement hi thil danglam bik, damlo hliam lai emaw, clinical data point chiang lo emaw-ah hman tur a ni.

Imaging evaluation-ah hian standard orthopantomograms leh tibia hliam lateral view leh a kianga khup leh ke ruh inzawmna radiograph te a tel tur a ni a, chu chu computed tomography (CT) hmangin endik belh a ni tur a ni. Chutiang bawkin, tibial plateau thlenga fracture line leh a kaihhnawih noncontiguous ankle injuries te hmuh theih nan ke ruh CT scan neih a ngai thei bawk

二 tih a ni. Clinical lama harsatna awm thei te

Tibia hnuai lam middle third-a fracture percentage sang tak, ankle fracture nei an awm tih hmuhchhuah a ni. CT scan pangngai hmangin tibia middle leh lower third fracture 43 % chu ankle fracture nen a awm a, a tam zawk chu surgery hmanga enkawl a ngai a ni. Fracture chi hrang hrang awm tam ber chu distal tibia hnuai lam middle third-a spiral fracture a ni a, chu chu posterior ankle fracture tlemte emaw, displaced lo emaw nena inzawm a ni (Figure 2). A kaihhnawih ankle fracture-a displacement tlemte avang hian plain ankle radiograph-ah hliam 45 % chauh hmuh theih a ni. Chuvangin, lower middle tibia fracture a awm chuan ke ruh CT scan routine hi ngaih pawimawh hle tur a ni (Fig. 3).

Figure 2.AF Dinglam tibia hnuai lam middle third-a spiral fracture (A, B) Operation hmaa ankle radiograph-ah chuan normal (C) a lang. Intraoperative C-arm fluoroscopy hmangin posterior ankle chu nondisplaced fracture a awm tih hmuhchhuah a ni (D) Surgical fixation (EF) hnua postoperative radiographs-ah chuan tibial leh ankle fracture te chu a dam tha hle tih hmuhchhuah a ni

Figure 3. AF Left tibia (AB) preoperative radiographs-a middle leh lower third-a spiral fracture; (CD) preoperative CT scan-ah chuan nodisplaced posterior malleolar fracture a awm tih hmuhchhuah a ni a; (EF) ah hian tibia leh malleolar fracture te chu thil thleng lo takin a dam tih hmuhchhuah a ni

三 tih a ni. Surgery tih dan tur

01. Tibial Needle luhna hmun

Entry point dik tak din hian hmun pawimawh tak a chang a, literature-a zirchianna tam tak chuan tibial fractures intramedullary nailing atana entry point tha ber anatomical location chungchangah thu pawimawh tak tak a pe a ni. Heng zirchiannate hian ideal pinning point chu tibial plateau hmalam margin-ah a awm tih a tarlang a, lateral tibial spur-ah medial-ah chauh a awm a ni. Safety zone, a zau zawng 22.9 mm ± 8.9 mm, a kianga joint structure-a chhiatna thlen lo pawh an report bawk. Tunhma atang tawhin tibial stem fractures intramedullary nail fixation atana bul tanna chu infrapatellar approach hmangin an siam thin a, chu chu patellar tendon inthen (transpatellar approach) emaw, patellar tendon stop thenkhat stripping (paratendinous approach) emaw hmangin a ni.

Tun hnaia orthopedic literature-ah semi-extension intramedullary nailing hian ngaihven a hlawh hle a, Tornetta leh Collins te chuan semi-extension position-a nail internal fixation atan medial parapatellar approach hman an rawt a, chu chuan intramedullary nail apex chu anterior tibial cortex-ah a rawn chhuah loh nan.3 The use of a medial parapatellar approach for semi-extension position-a intramedullary nailing pawh hman a tha. Tibial intramedullary nailing leh intramedullary nail chu patellofemoral joint kaltlangin semi-extended position-a dahna atan suprapatellar approach hman a tha.

Hetiang hian khup chu degree 15-20 vel a flex a, patella chungah kut zungtang pakhat atanga pahnih vel zeta zau longitudinal incision centimetre 3 vel siam a ni. Quadriceps tendon chu longitudinal fashion-in an inthen a, patellofemoral joint-ah blunt dissection an ti a. Patellofemoral joint kaltlangin blunt socket dahin proximal anterior tibial cortex leh articular surface inzawmna hmunah entry point siam a ni (Figure 4).

Figure 4. ab Intraoperative photographs of (a) quadriceps tendon inthen a, trocar chu patellofemoral joint kaltlangin tibial entry point thlenga dah a ni (b) a luhna hmun chu intraoperative lateral view a ni

C-arm kaihhruaina hnuaiah starting needle point hriat nan 3.2 mm drill bit hman a ni. Entry leh exit point te fine-tune turin perforated socket dah a ni bawk. Surgery dang zawng zawng chu reaming leh tibial nail insertion te pawh socket kaltlangin tih a ni.

POTENTIAL ADVANTAGES: Semi-extended leg position hian fracture repositioning-ah a pui thei a, a bik takin fracture-ah chuan typical proximal third of the tibia leh angled forward a awm chuan. , Semi-extended position hian quadriceps muscle-a tension a ti bo thei a, fracture repositioning-ah a pui thei bawk. , Semi-extended position suprapatellar approach hi traditional infrapatellar approach aiin a danglam thei bawk (Figure 5).

Figure 5. Intraoperative photograph-ah hian infrapatellar region-a soft tissue hliam chu semi-extended position-a suprapatellar approach neih theihna tur indication atan a lang.

Zirna hrang hrangah chuan semi-extended position-a tibial intramedullary nailing tihnaah suprapatellar approach hi surgical technique him leh tangkai tak a ni tih hmuhchhuah a ni. Nakin lawkah clinical trial neih a ngai a, hei hian suprapatellar approach intramedullary nailing a thatna leh a that lohna te zirchian belh a, he technique nena inzawm hun rei tak chhunga a chhuah dan tur te zirchian a ngai a ni.

02. Technology siam thar leh rawh

Tibial intramedullary nail dah ringawt hian fracture tihziaawmna a tling lo; reaming process leh intramedullary nail dah chhung zawng hian fracture reduction dik tak neih reng a ngai a ni. Manual traction hman chauh hian a mah chauhin fracture chu anatomic reduction a ti thei lo thei. He thuziak hian closed, minimally invasive, leh open reduction maneuver hrang hrang a sawi dawn a ni.

-Closed reset dan tur tips te

Closed reduction maneuver hi F-fracture reducer ang chi reduction tool hmangin tih theih a ni a, hei hi F-shaped radiographically transmissible reduction device a ni a, inversion/exversion angle bakah medial/lateral translation pawh a siam tha thei a ni (Fig. 6).

Fig. 6. Surgery-a F-shaped fracture reducer tarlan

Mahse, he device hian soft tissue-ah stress nasa tak a siam thei a, hei hi rei tak hman loh tur a ni. Reduction forceps pawh hi vun chhungah dah theih a ni a, spiral leh oblique fracture ang bawkin. Heng hmanrua te hi soft-tissue friendly takin incision te te hmangin hman theih a ni (Figure 7).

Figure 7. Tibial fracture reset nan percutaneous clamping hmanga tih a ni

Clamp chi leh surgical incision awmna tur chu clamp dah atanga hun rei tak chhunga soft tissue tihchhiat tlem theihna tur strategy hmanga thlan tur a ni (Figure 8).

Fig. 8. Tibial fracture reset turin pointed repositioning forceps a awm a

Retractor hi tibia sei zawng siam thatna atana hman tlanglawn tak pakhat a ni bawk. A tlangpuiin medial-ah leh intramedullary nail dahna hmun atanga hla takah dah an ni. Proximal traction pin te hi proximal blocking screw position ang deuha dah theih a ni a, hei hian intramedullary nail a luh veleh fracture chu awlsam zawkin a tihtlem theih phah a ni.

A then phei chuan closed leh minimally invasive reduction technique te hi anatomic reduction hmuh theih nan a la tawk lo. Chutiang hunah chuan a chhehvela soft tissue te uluk taka enkawl chungin incisional reduction technique ngaihtuah tur a ni. Open reduction technique hmanga chhiatna awm thei chu surgical trauma additional a ni a, hei hian surgical site infection a tipung thei a ni. Chu bakah, thisen tliakna hmuna thisen supply stripping additional hian postoperative fracture nonunion a thlen theihna a tipung thei bawk.

-Incision leh Repositioning atana Technical Skills neih a ni

Incisional reduction maneuver hian surgical reduction forceps hmun dik takah dah mai bakah, intramedullary nailing procedure-a fracture reduction vawng reng turin fracture site-ah splint te tak te emaw, te tak te emaw dah a phalsak bawk.

Plate te chu monocortical screw hmangin proximal leh distal fracture fragment ah te an secure thin. Splint hi reaming leh tibia chhunga intramedullary nail dah chhung zawngin a awm reng a ni. Intramedullary nail dah hnuah plate chu lakchhuah emaw, a hmunah dah emaw a ni a, chu chuan fixed structure stability a tichak zawk a ni (Figure 9). Plate chu a hmunah dahin single cortical screw chu double cortical screw nen inthlak danglam tur a ni. Tibial stem-a open surgery neih a ngaihna hmun thlan biktea hman tur ngaihtuah tur a ni a, chu chuan fracture tihziaawmna pawm theih a ni.

Figure 9. Open tibia fracture, comminution na tak leh ruh chhiatna, reduction hnua fracture tawp chhe laiah splint te tak te hmanga single cortical fixation leh intramedullary nail fixation hnua splint lakchhuah

Blocking nail hman chhan chu metaphyseal region-a medullary cavity tihtlem a ni. Blocking nails hi intramedullary nail dah hmain short articular fragment chhungah leh deformity concave side-ah dah a ni. Entirnan, tibia proximal third fracture-a typical deformity chu valgus leh forward angulation hmanga hriat theih a ni. Valgus deformity siamthat nan hian locking screw chu proximal fracture fragment (chu chu deformity concave side) lateral portion-ah anteroposterior lam hawiin dah theih a ni. Intramedullary nail hi medial lam atanga kaihhruai a ni a, chu chuan valgus a veng thei a ni. Chutiang bawkin, angulation deformity pawh hi locking screw medial to lateral to the posterior portion of proximal block (chu chu deformity concave side) dahin a hneh theih bawk (Figure 10).

Figure 10. tibial fracture chu blocking nail dahin assisted reset a ni

-Medullary tihzauh a ni

Fracture repositioning zawh hnuah medullary reaming thlan a ni a, chu chuan ruh chu intramedullary nail insertion atan a buatsaih a ni. Ball-ended guidewire chu tibial marrow cavity chhungah leh fracture site kaltlangin dahin, reaming drill chu ball-ended guidewire chungah an pass a ni. Ball-ended guidewire awmna chu C-arm fluoroscopy hmangin ankle joint level-ah a awm tih finfiah a ni a, guidewire chu anteroposterior leh lateral view-ah te a centered tha hle bawk (Figure 11).

Figure 11. ah hian C-arm fluoroscopy hmanga medullary cavity chhunga guidewire awmna chu frontal leh lateral position ah a lang

Expanded leh non-expanded medulla chungchang hi sawisel a hlawh hle. North America-a surgeon tam zawk chuan non-expanded ai chuan tibia-a expanded medullary intramedullary nailing hi an duh zawk niin kan ring. Mahse, expanded leh non-expanded intramedullary nailing te hi standard technique pawmtlak atan hman theih a ni a, method pahnih hmang hian result tha tak a awm thei bawk.

-Locking screw dahna tur

Tibial stem fracture-a interlocking screw hman hi shortening leh malrotation venna atan a ni a, tibia intramedullary nailing atana indication te chu metaphysis nena inzawm tibial stem fracture proximal leh distal zawkah a tizau a ni. Metaphyseal region nena inzawm fracture-ah chuan axial alignment vawn reng nan interlocking screw te chu a pawimawh zual ta hle a ni.

Proximal interlocking screw pathum hian stability nasa takin a tichangtlung a, angle-stabilized interlocking screw hian interlocking screw pangngai aiin stability nasa zawk a pe thei a, hei hian interlocking screw tlem zawk hmangin structural stability inang chiah a siam thei bawk. Tibia chhunga fixation atana interlocking screw mamawh zat leh configuration chungchanga clinical data chu a tlem hle.

Proximal interlocking screw dahna hi intramedullary nail spike-a scope dah hmanga tih a ni tlangpui. Distal interlocking screw te hi fluoroscopic kaihhruaina hnuaiah freehand in dah a ni. Distal tibial interlocking screw dahna atan electromagnetic computer-assisted guidance system hman a tha (Figure 12). He technique hian distal interlocking screw radiation-free insertion a phalsak a, a tih theih leh dik tak a nih thu hmuhchhuah a ni bawk.

Figure 12.AB C-arm perspective hmanga screw lock dan; CD Locking screw te chu electromagnetic computer hmanga locking hmanga tih a ni

Proximal leh distal interlocking screw dah hi surgical procedure him tak a ni a, interlocking screw te hi a dik leh soft tissue friendly taka dah a ngai a ni.

Anatomic study-ah chuan proximal medial to lateral oblique interlocking screw dah hian peroneal nerve palsy vei theihna a la awm tih hmuhchhuah a ni. Hetiang hlauhawmna tihtlem nan hian surgeon-te chuan C-arm kaihhruaina hnuaiah screw-te chu drilling an ngaihtuah tur a ni a, C-arm-a fluoroscopic angle chu drill bit plane-ah perpendicular-in a awm tur a ni. Distal tibia cortex chhunga drill luh chu tactile feedback hmangin hriat a harsa thei a, fibular head hnaih lutuk hian tactile impression chu a ti thim thei a, surgeon chu 'ruh chhungah' awm anga hriatna a pe thei a, a takah chuan fibular head chu a lut tawh a ni. Screw sei zawng hi graduated drill hmang chauh ni lovin depth gauge tehna dik tak hmanga hriat tur a ni. Drill emaw screw emaw sei zawng 60 mm aia tam tehna eng pawh hian posterolateral protrusion rinhlelhna a siam tur a ni a, hei hian common peroneal nerve chu hliam hlauhawm takah a dah thei a ni.

Distal anterior leh posterior interlocking screw te hi anterolateral neurovascular bundle, tibialis anterior tendon leh extensor digitorum longus te venhimna ngaihtuah chungin dah a ni. Percutaneous screw dah hi a him tlangpui a, mahse surgeon-te chuan a chhehvela soft tissue structure-te tana hlauhawmna an hriat a ngai a ni. Tibial stem fracture tam zawk tan chuan proximal interlocking screw pahnih leh distal interlocking screw pahnih hian stability tha tak a pe a ni. Proximal leh distal tibial fracture te hian he structure stability tihpun nan plane hrang hrangah interlocking screw dang dah belh a nih chuan hlawkna a awm thei (Figure 13).

Figure 13. Tibia-a ruh tliak tam tak, intramedullary nailing hmanga distal leh proximal interlocking screw pathum hmanga enkawl, a hnu lama x-ray-te chuan ruh tliak a dam tih a tilang.

-Fibular Fixation a ni

Tunlai intramedullary nail design, distal interlocking screw hmanga siam chuan tibia intramedullary nailing atana indications te chu metaphyseal region inrawlhna proximal leh distal fractures te pawh huamin an tizau a ni.

He zirchiannaah hian distal interlocking screw configuration hrang hrang hman a ni (medial atanga lateral thleng screw 2 leh screw 2 perpendicular-a dah leh a vaiin distal interlocking screw 3 leh distal interlocking screw 1 chauh hman a ni). Fibular fixation leh tibial intramedullary nail fixation hmanga enkawl damlote zingah chuan lost reset rate chu a tlahniam hle. Fibular fixation nei lo intramedullary nail fixation nei zinga 13 % chuan postoperative loss of reset an nei a, fibular fixation tel lo tibial nail fixation nei zinga 4 % chuan an hmu thung.

Trial dang pakhatah chuan tibial intramedullary nail fixation leh fibular fixation leh tibial intramedullary nail fixation leh no fibular fixation te a thatzia khaikhin a, fibular fixation leh tibial nailing hmanga enkawl damlote chuan rotational leh inversion/eversion alignment-ah hmasawnna an nei tih an hmuchhuak.

Kan thutlukna chu adjunctive fibular fixation hian intramedullary nail fixation hmanga distal tibia fracture hmun thuma ṭhena hmun khata tibial fracture tihtlem a tihlawhtling a, a vawng reng bawk. Mahse, traumatized tissue awmna hmuna incision dang tihpun avanga hliam harsatna awm thei buaina chu a la awm reng a ni. Chuvangin assisted fibular fixation hmannaah fimkhur turin kan rawt a ni.

03. Results a awm

Tibial stem fracture te hi intramedullary nailing fixation hmangin result tha tak a awm thei. Zirna hrang hrangah intramedullary nailing of the tibia tihdamna rates hmuhchhuah a ni. Tunlai implant leh surgical technique dik tak hman a nih chuan damna rate hi 90 % aia tam a nih beisei a ni. Intramedullary nail fixation hnua tibial stem fracture dam lote damna rate chu second expanded intramedullary nail hmanga internal fixation hnuah nasa takin a tha chho a ni.

Surgery hnu kum khata outcome assessment-ah chuan damlo 44 % thlengin hliam tuar lower extremity-ah functional limitation an nei chhunzawm zel a, 47 % thlengin operation-related disability an report chhunzawm zel a, operation an neih hnu kum khatah pawh an report chhunzawm zel bawk. He zirchianna hian tibia intramedullary nailing hmanga enkawl damlote chuan hun rei tak chhung chu hnathawh danah harsatna lian tak an nei chhunzawm zel tih a tarlang. Surgeon te hian heng thilte hi an hriat chian a ngai a, chutiang chuan damlote chu thurawn pe rawh se!

四 tih a ni. Operation hnua harsatna awm thei

01. Patellar hmaa natna

Anterior patellofemoral pain hi tibial stem fractures intramedullary nail fixation hnua harsatna awm fo a ni. Zirna hrang hrangah chuan intramedullary nailing hnua damlo 47 % velin prepatellar pain an nei thei tih hmuhchhuah a ni a, a chhan hi hriat chian a la ni lo. A nghawng thei thilte chu intra-articular structures-a traumatic leh medical injury, saphenous nerve infrapatellar branch-a hliam, natna nena inzawm neuromuscular reflexes tihtawp avanga secondary thigh muscles chak lohna, fat pad-a fibrosis avanga impingement, reactive patellar tendonitis, intramedullary atanga bending strain te a ni thei tibia proximal portion chungah nailing, leh nail proximal end protrusion te a awm bawk.

Intramedullary nailing hnua prepatellar pain awm chhan an zirchian khan transpatellar tendon approach chu parapatellar approach nen an khaikhin a. Transpatellar tendon approach hi postoperative knee pain tamna nen a inzawm thei a ni. Mahse, prospective randomized clinical data-ah chuan transpatellar tendon approach leh parapatellar approach inkarah hian danglamna lian tham a awm lo.

Tibial intramedullary nailing hnua prepatellar pain tihbo nan internal fixation selective removal hman tangkai dan hi hriat chian a la ni lo. Mechanical etiology hriat theih a nih chuan intramedullary tibial nail lakchhuah hi ngaihtuah a ngai a, chu chu nail protrusion emaw protruding interlocking screw emaw a ni. Mahse, symptomatic patient-te tibial intramedullary nail removal hmanga hlawkna chu zawhna awm thei a la ni.

Postoperative prepatellar pain chungchangah chuan, semi-extended position-a patella-a tibial nail intramedullary nail fixation clinical study hmasa berah khan natna thlentu hi chiang takin a lang thei lo. Chuvangin, suprapatellar approach-a intramedullary nail fixation-in postoperative prepatellar pain a nghawng dan finfiah nan hun rei tak chhunga enkawlna nei clinical study lian tak tak neih a ngai a ni.

02.Operation hnua alignment tha lo

Post-traumatic osteoarthritis hi tibial stem fracture intramedullary nailing hmanga enkawl hnuah pawh harsatna lian tak a la ni reng a ni. Biomechanical study-ah chuan tibial malalignment hian a kianga ankle leh knee joint-a contact pressure nasa takin a tidanglam thei tih hmuhchhuah a ni.

Tibial stem fracture hnua hun rei tak chhunga clinical leh imaging outcome endikna clinical study-ah chuan tibial malalignment sequelae chungchangah data inthlau tak tak a awm a, tun thlengin thutlukna chiang tak a la awm lo.

Tibia intramedullary nailing hnua postoperative malalignment report erawh a tlem hle a, case tlemte chauh report a ni. Postoperative malrotation hi tibial intramedullary nailing-ah hian harsatna awm fo a la ni reng a, tibial rotation intraoperative assessment pawh a harsa hle. Tun thleng hian clinical examination emaw imaging method emaw chu intraoperative determination of tibial rotation atana gold standard atan siam a la ni lo.CT examination evaluation-ah chuan tibia intramedullary nailing hnua malrotation rate hi 19 % atanga 41 % thleng a sang thei tih hmuhchhuah a ni. A bik takin, pawn lam rotation deformities hi internal rotation deformities aiin a tam zawk niin a lang. Postoperative malrotation tehna atana clinical examination neih chu a dik lo tih an sawi a, CT assessment nen pawh inzawmna a nei tlem hle.

Tibia intramedullary nailing hmanga enkawl tibial stem fracture-ah hian malalignment hi hun rei tak chhung harsatna a la ni reng niin kan ring. Malalignment leh clinical leh imaging outcome inzawmna chungchanga data inthlau tak awm mah se, he variable hi control theih nan leh result tha ber hmuh theih nan surgeon-te chuan fracture-te anatomic alignment neih tumin an bei tur a ni tih kan rawt a ni.

五 tih a ni. Tawpna

Static locking expanded medullary intramedullary nailing hi tibial stem fracture displaced te tan chuan standard treatment a la ni reng a ni. Entry point dik tak chu surgical procedure-a thil pawimawh tak a la ni reng a ni. Semi-extended position-a suprapatellar approach hi procedure him leh tangkai takah ngaih a ni a, nakin lawka zirchiannaah chuan he procedure hian a hlauhawmna leh a hlawkna te hi zirchian belh a ngai a ni. Surgeon enkawltu chuan tunlai repositioning technique a hriat chian a ngai a ni. Closed approach hmanga anatomic fracture alignment tih theih a nih loh chuan incisional reduction techniques ngaihtuah tur a ni. Expanded leh non-expanded intramedullary nailing hmang hian 90 % aia tam healing rates tha tak a awm thei. Damna rate tha tak awm mahse, damlote hian hun rei tak chhunga hnathawh theih lohna (long-term functional limitations) an la nei tho. A bik takin, tibial intramedullary nailing hnuah pawh prepatellar pain hi complaint awm fo a la ni reng. Tin, internal tibial fixation hnua malrotation hi harsatna awm fo a la ni reng bawk.

Thuhmahruai

1.Tibial Fractures Investigator-te zingah Reamed Intramedullary Nails Prospectively Evaluate tura zirchianna. A rilru a hah lutuk chuan a rilru a buai em em a, a rilru a hah lutuk chuan a rilru a buai em em bawk a. Bhandari M, Guyatt G, Tornetta P, III, Schemitsch EH, Swiontkowski M, et al. Tibial shaft fracture te chu reamed leh unreamed intramedullary nailing hmanga tih dan randomized trial neih a ni. J Ruh ruh Surg Am. 2008;90:2567-2578-ah a tarlang bawk. A rilru a hah lutuk chuan a rilru a buai em em a. 10.2106/JBJS.G.01694.

2.McQueen M. M., Duckworth A. D., Aitken S. A., Sharma R., Court-Brown CM te an ni. Tibial fracture hnua compartment syndrome awm theihna tur hriltu. J Orthop Trauma a ni. 2015. [Epub hmain print a ni].

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