5 Melao ya motheo ya tirišo ya manala a ka gare ga medulla le dithekniki tša go bua!

Melao ya motheo ya go kokotela ka gare ga medula.

1. Histori ya go kokotela ka gare ga medulla .

Ka 1910, manala a aluminiamo a aluminiamo a lilienthal a ile a dirišetšwa go alafa go robega ga shaft ya letheka.

Ka 1913, Schone o ile a diriša manala a silifera a intramedullary go alafa go robega ga letsogo la pele. 

Kuntscher (1900-1972) o bile le meneelo e megolo go fixation ya manala a ka gare ga medulla. 

Bo-1960 le bo-1970 e bile nako ya go gola ka lebelo ga manala a ka gare ga medula. 

Naga ya gešo e be e dutše e di šomiša ka bontši go tloga ka bo-1990.

2. Phokotšo ye e bulegilego le phokotšo ye e tswaletšwego .

1. Go robega ga ditho go ka fokotšwa ka go buiwa ka fase ga pono ya thwii goba gwa tswalelwa ka fase ga tlhokomelo ya X-ray.

2. Open phokotšo fracture phodišo nako ke e telele, intraoperative tsoa mali ke ho feta, 'me bulehileng phokotso ho feta senya phepelo mali ho fracture qetellong.

3. Go kgothaletšwa go šomiša phokotšo ye e tswaletšwego ka mo go kgonegago. Sefokodi sa go goga se ka šomišwa, goba go segwa mo go nnyane go ka dirwa ka sefofaneng sa go robega go pry le go fokotša, ka go realo go fokotša tšhitišo ya kabo ya madi go fihla mafelelong a go robega.

4. Bakeng sa go palelwa ga phokotšo ye e tswaletšwego, go phetla karolwana ya marapo goba go phunya ditlhalenama tše di dikologilego, le dikarolwana tše kgolo tša go robega tšeo di šuthišitšwego, go ka šomišwa phokotšo ya go buoa ye e bulegilego.

3. Fixation mochine oa intramedullary Nail .

1. Mokgwa wa intramedullary Nail ka hare fixation ke symmetrical bohareng ka hare splint fixation.

2. The fixation ya fracture ke intramedullary Nail ke kgateletšego-aba fixation, eseng kgateletšego-thehile fixation, e leng loketseng ho bopa callus.

3. Central fixation ke teori e phahametse cortical ka ntle fixation, e leng ka fokotsa matla letsoho, fokotsa ketsahalo ya Valgus angulation le ka hare fixation hloleha.

4. Intramedullary Nail Fixation e fana ka motheo wa phokotšo ye e tswaletšwego goba phokotšo ye e lekanyeditšwego ye e bulegilego.

4.Mehola ya intramedullary manala .

1. Mathata a mmalwa .

2. Expanded sebaka sa ditshupetso tsa ho buoa .

3. Firm Fixation Feme .

4. Tlwaetšo ya Mošomo wa Mohlakanelwa wa Pele .

5. Go rwala boima bja mmele ka pela .

6. e ka šomišwa ka kopanyo le go tsepama ga ka gare ga tše dingwe .

Mehuta ya Motheo le Dithekniki .

1. Go notlela le go se notlele manala a intramedullary .

2. Dynamic le static notlela intramedullary manala .

3. Medullary katoloso le bao e seng medullary fixation dithekeniki .

4. Dithekniki tša go tiiša tše di bulegilego le tše di tswaletšwego .

Go kgokagana le go se kgokaganye .

Manala a tlwaelegilego a ka gare ga medulla a na le go tsepama mo go fokolago ga axial le matla a tlase a go kgokologa, eupša a na le elasticity e itšego gomme a ka fola ka morago ga go senyegelwa, a baka feela tekanyo e nyenyane ya go thelela ka gare ga lesapo.

Interlocking intramedullary manala a na le molemo-ba khahlanong le mekoloto le khahlanong le khatello ea liphello, molemo fixation botsitso, le lumellana le molao-motheo oa fixation likokoana-hloko. Di dirišwa kudu marapong a matelele a ditho. Kudu-kudu bakeng sa dikarolo tše dintši le go robega mo go comminute, di na le go tsepama mo go kaone go feta manala a tlwaelegilego a ka gare ga medulla.

Dynamization ya fixation static .

Dipekere tša go notlela tša go notlela ka gare ga medulla di tšweletša go šira kgateletšego ye nnyane kudu gomme ga bjale di bueletša kudu tiro yeo e sego ya ka mehla ya go dira gore dilo di be le mafolofolo.

Bakeng sa go robega mo go sa fodilego ka dikgwedi tše 6 go ya go tše 8 ka morago ga go buiwa, go hlomesetšwa ga marapo ka lefelong goba go tšeelwa legato ga manala a ka gare ga medula a go katološwa ka dynamization go šomišwa ka tlwaelo.

Dynamization e ka šomišwa bjalo ka mokgwa wa go tšwetša pele phodišo ya go robega. Ga e kgothaletšwe ka mehla ka gobane e ka lebiša go khutsufatšwa ga ditho le go golofala ga go dikološa.

Katološo ya moko le katološo yeo e sego ya moko .

Katološo ya moko e ka tsenya manala a ka gare ga medulla ao a nago le bophara bjo bogolo le matla a magolo, ao a loketšego tlwaetšo ya mathomo ya mošomo le go fokotša seelo sa manala ao a robegilego.

Katološo ya moko e ka tšweletša palo e kgolo ya ditlakala tša marapo tšeo di nago le mafelelo a osteoinductive, e lego seo se loketšego phodišo ya go robega.

Katološo ya moko e tla senya kabo ya madi ya ditšhika tša phepo le lera la endosteal, eupša ditšhika tša madi di ka tsošološa go bapa le lešoba la manala a ka gare ga medula. Katološo ya moko e ka oketša gape le go elela ga madi mešifeng ya ditlhalenama tše boleta tše di dikologilego, ka go rialo ya kgothaletša phodišo ya go robega.

Katološo ya moko e oketša kgonagalo ya tshwaetšo le embolism, gomme e swanetše go šomišwa ka kelohloko bakeng sa go robega mo go bulegilego, dikgobalo tše dintši le dikgobalo tše di raraganego.

Melemo ya katološo ya medullary .

1 Ka morago ga katološo ya medullary, lefelo la kgokagano magareng ga lenala la ka gare ga medulla le lerapo le a oketšega, e lego seo se kaonafatšago go tsepama ga go tsepama. 

2 Ka morago ga go katološwa ga medullary, go ka dirišwa sepekere sa bophara bjo bogolo sa ka gare ga medulla, seo se oketšago matla a sepekere sa ka gare ga medula gomme se fokotša tekanyo ya manala ao a robegilego. 

3 Matlakala a marapo ka morago ga katološo ya medullary a ka hlohleletša go bopega ga marapo a mafsa, e lego seo se loketšego phodišo ya go robega.

Ge go bapetšwa le medullary katoloso intramedullary manala, bao e seng expanded intramedullary manala a na le melemo e latelang .

1 Nako e kopana ya go šoma le go tšwa madi a manyenyane. 

2 Ka tlase tšitiso le endosteal mali phallo maemong a le matla a matla dinama tse nyenyane tse dikgobalo.

Kopo ya intramedullary Nail .

Humeral interlocking intramedullary sepekere .

Ditšhupetšo tša manala a humeral .

Ditšhupetšo tša manala a ka gare ga medula a humeral a go kgokagana kalafong ya go robega ga shaft ya humeral ke: go robega ka tshenyo ya methapo le methapo, dikgobalo tše dintši, go robega mo go sa tsepamago, go robega ga bolwetši le go robega ga humeral ya kgauswi.

Lenaneo leo le ka lokišwago ke go tšwa go 2cm ka fase ga hlogo ya humeral go ya go 3cm ka godimo ga olecranon fossa. O ka kgetha go e lokiša go tšwa legetleng ka sepekere sa antegrade intramedullary goba go tšwa go elbow ka sepekere sa go boela morago.

Dika tša manala a humeral .

Mekgwa ya go tiiša ya go bua bakeng sa go robega ga shaft ya humeral ge e le gabotse ke go tsepama ga poleiti le go tsepama ga manala ka gare ga medulla.

Plate fixation e na le dithoto tše maatla tša go lwantšha go dikologa le tša go lwantšha go koba gomme e tiile ka go tia, eupša kgateletšego ya go bua ke ye kgolo, kgonagalo ya tshwaetšo e godimo, gomme methapo ya radial e senyega gabonolo.

Sebjalebjale humeral interlocking le go itšhupa manala a fenya mafokodi a tlwaelegilego intramedullary manala a bjalo ka axial go se tsepame, go se be le taolo e fokolago ya go dikološa, le go nyakega ga go tiiša tlaleletšo, e le gore go robega go tiile go lokišwa, tahlegelo ya madi ke e nyenyane, boleta dinama tse nyenyane tse hlobola ke ka tlase, gomme katološo ya medullary ka morago ga moo e ka sepetsa, le mojaro e lekane.

Femoral interlocking intramedullary sepekere .

Ditšhupetšo tša manala a go kgokagana a femoral .

Mehuta ka moka ya diphapano tša 2cm ka fase ga trochanteric vertebra le go feta 9cm go tšwa go lelokololo la lengwele.

Diphapano tša kgale tša karolo ya bogareng ya shaft ya letheka.

Balwetši bao ba nago le go tsepama ga ka gare ga poleiti ye e paletšwego.

Features ya femoral interlocking Nail .

Melemo ya Mechine .

Letsogo la matla la sepekere sa intramedullary seo se kgokaganego le femoral bakeng sa go lokiša diphapano ke le letelele go feta la dipoleiti tša tšhipi, gomme matla a phatlalatšwa ka go lekana godimo ga sele ya bogareng bja lerapo ka moka, yeo e sego bonolo go e koba le go e senya.

Manala a go notlela mafelelong ka bobedi a lenala la ka gare ga medulari a dira gore lerapo le bope ka moka go tloga godimo go ya fase, gomme manala a go notlela mafelelong a kgole a ka fokotša letsogo la torque la sepekere sa ka gare ga medulla ka lerapong, a thibela go khutsofatšwa le go dikološa, gomme a fihlelela go tsepama mo gogolo le go tia bakeng sa go tsepama ga go robega.

Gamma e kgokaganego ka gare ga medulla ya ka gare ga medulla .

Gamma ditshupo tsa manala .

E šoma go mehuta ye e fapanego ya go robega ga peritrochanteric, kudukudu go robega ga subtrochanteric.

Ditšhupetšo tše di atološitšwego tša Gamma Nail (Reconstruction Nail) .

High subtrochanteric fractures, trochanteric kopantswe le femoral shaft fractures.

Melemo ya Gamma Nail .

E hlamilwe ka go kopanya sekurufu sa letheka seo se thelelago le theknolotši ya manala a ka gare ga medulla, sepekere se segolo se kgauswi le ka gare ga lešoba la medullary go feta poleiti ya letheka ye e fetogago, ka fao lenala la gamma le swara boima bja molwetši kgauswi le calcar ya femoral go feta poleiti ya letheka ye e fetogago, go oketša maatla a motšhene a go tsenywa. Bakeng sa go robega ga subtrochanteric yeo e akaretšago comminution ya cortical ya magareng, sepekere sa gamma se efoga go nyakega ga go aga lefsa ga thulaganyo ya mmele ya go robega, ka fao e hola go robega ga magareng ga ditrokale goba go robega ga subtrochanteric.

Retrograde intramedullary femoral nailing .

Ditšhupetšo tša manala a femoral a go boela morago .

Kudu-kudu e dirišwa bakeng sa supracondylar femoral fractures, go akaretša supracondylar comminuted fractures le intercondylar 't ' le 'y ' comminute fractures akaretša bokagodimo articular.

E ka šomišwa gape go robega ga femoral ka fase ga isthmus ya femur.

Shaft ya femoral, supracondylar femoral, le intercondylar fractures ka hare ho 20cm ho tloha lelokololo la lengole.

Bao ba paletšwego go tsepama ga poleiti.

Litšobotsi tsa retrograde femoral nail .

supracondylar femoral fracture ke go robega mo gogolo ka bothata go pele, phokotšo le sa bobedi, go tsepama mo go tiilego ga ka gare. Go na le ditiragalo tše di phagamego tša mathata a go swana le go robega ga go se kopane le go diega ga phodišo.

Retrograde interlocking intramedullary nailing ke mokgwa o sebediswang ka tloaelo ho tšoara distal femur fracture lilemong tsa morao tjena, e leng o na le botsitso bo botle ba mochine, ka ka katleho laola posterior displacement le potoloho displacement ya distal qetellong ya fracture, le thusa ka pele motsamao kopanetsoeng.

supracondylar kopantswe femoral kutu fracture e tsitsitseng le lelefale supracondylar intramedullary nailing, e leng rarolla bothata bo thata ho rarolloa ka interlocking intramedullary nailing ya femur. Sedirišwa se bonolo go šoma, se se nepagetšego ka go beakanya maemo, se ka botwa ka go tsepama, gomme molwetši a ka dira ditlwaetšo tša lengole tše di šomago ka pela ka morago ga go buiwa.

Tibial interlocking intramedullary manala a .

Ditšhupetšo tša go kokotela tibia .

Diphapano tše di tsepamego bogareng bja 1/3 ya tibia: go robega ga go sepela ka go selaganya, go robega mo go kopana ga go sekama, pseudarthrosis.

Diphapano tše di sa tsepamago ka gare ga 60% ya botelele bja tibia ya bogareng: go robega kgauswi le metaphysis, go robega ga spiral ye telele, go robega ga dikarolo, go robega ga comminuted, go robega ka diphošo tša marapo.

Dika tša go kokotela tibia .

Interlocking intramedullary nailing ya tibia e sebediswa haholo bakeng sa mid tibia fractures.

Le ge e ka šomišwa gape go robega ga tibia ya kgauswi le ya kgole, seelo sa go raragana se godimo, malunion e direga gantši, mafelelo a go robega a na le ≧1cm ya motšhene go 1/2 ya melato, gomme 1/4 ya go tsepama e a palelwa.

Dingwalwa di begile sephetho se sekaone sa go robega ga tibia ya kgole go feta go robega ga tibia ya kgauswi ka morago ga go tsepama ga ka mehla ga fibula.

Dithekniki tša go bua .

Preoperative Go lokišetša didirišwa tše di kgethegilego .

Bethe ya marapo (bethe ya go goga) goba mpete wa go bua wa fluoroscopic wa maemo; sephedi sa go gogela morago; Seswantšho se matlafatšago.

Kgetho e nepahetseng ya bolelele ba nail intramedullary bakeng sa endoprostheses preoperative .

Radiograph .

Tekanyo ya botelele bja setho sa contralateral .

Bophara bja Sepekere bja ka gare ga medulla .

Bophara bja Isthmus bja X-ray .

Intramedullary Nail bolelele tekanyo .

1.Translucent mmuso boikemisetso tlas'a C-letsoho mochine .

Mafelelo a kgole le a kgaufsi a lerapo a be a le mothalong wa bogareng bja mahlasedi; Mmuši o be a le parallel le diaphysis.

2.Bolelele tekanyo ho ea ka 'mele holim'a matšoao .

femur: ntlha ya trochanter e kgolo → sebaka sa lengole la ka mahlakoreng kapa pole e phahameng ea patella; Tibia: Sebaka sa lengole sa magareng-ka mahlakoreng → Karolo ya pele ya lelokololo la leqaqailaneng ka dorsiflexion ya leoto.

Intramedullary Nail go tsenya thekniki ya go tsenya - go tsena ntlha ya go tsena .

Longitudinal axis ya medullary cavity ka mola o otlolohileng .

E sego kgauswi kudu le ntlha ya go tsena .

Bolelele ba maleba: dilated - telele; E sa hlwa e le e inehetseng - e khutšoanyane .

(Netiso e sa tobang ya ntlha ya ho kena; ha ho na dilation ya pulp, ha ho hlokahala dinama tse nyenyane tse e hlokahalang)

Parallel femoral intramedullary lenala la ho kena ntlha .

Go lokišetša ntlha ya go tsena bakeng sa sepekere sa ka gare ga medulla sa go bapelana .

Hip flexion le adduction .

Longitudinal incision proximal go ya go trochanter e kgolo .

e sego kgole kudu morago .

Go bewa ga phini ya tlhahlo .

Go bewa ga kotse ya dinama tše boleta .

Retrograde femoral intramedullary lenala la ho kena ntlha .

30° go koba lengwele .

Long axis ya tataiso Pin ka tsela e tšoanang le medullary cavity ya distal femoral kutu .

go tsenywa ga phini ya Kirschner ka gare ga femur ya kgole ka ligament ya patellar ka sleeve sa tšhireletšo: orthogonal - bogareng bja intercondylar fossa ya femur; Lateral - mola wa Blumensaat .

Ntlha ya go thoma ya PCL ntle le kgobalo .

Parallel tibial intramedullary lenala la ho kena ntlha .

Mothalong wa bogareng wa lešoba la medullary .

Moedi wa pele wa Tibial Plateau .

e phagamego ka mo go kgonegago ntle le go senya sethala .

Palo e kahodimodimo Knee Flexion .

Incision tibial tuberosity-ka tlase ga kota ya patella go bapa le lešoba la medullary .

Bula medullary cavity: tataiso Pin ka 15 ° ho sagittal sefofane sa longitudinal selekane sa kutu ea tibial .

Boemo ba setšoantšo se matlafatsang .

Dithekniki tša Moko .

Phokotšo yeo e nago le mohlagase wa mohlagase .

Go robega mo go foreše .

Phokotšo ya ka seatla .

Go robega ga kgale ka pseudoarthrosis, sclerosis ka gare ga lešoba la medullary .

Ga go na tourniquet ka tlase ga infleišene .

Go elela ga madi ke setšidifatši se sebotse kudu .

Dithekniki tša go beakanya gape .

Parallel femoral intramedullary nailing .

Mabaka a go ba le bothata bja go tsošološa go robega ga letheka .

Go phuthela dinama tše boleta tše koto ga go dumelele phihlelelo e lebanyago go lerapo .

Ntlha ya go tsena ya nalete e ka se bonwe ka leihlo la kgopolo ka go lebanya .

Hip kopanetsoeng adduction → iliac fascia tension → ho kgutsufatsa ho robeha .

Phokotšo ya go robega ga tibia .

Go diriša dilo ka tsela e fošagetšego .

Boholo subcutaneous le bonolo ho palpate .

Go robega ga go tsepama - go robega ga mohuta wa A le B wa bogareng goba distal .

Oblique Fractures - Overkill .

intramedullary nailing→didirišwa tša go šitišwa .

Ditekanyetšo tša phokotšo ya tlaleletšo .

Di- forceps tša go fokotša dintlha .

Tibia; Tšhomišo ya letlalo goba ya dintho .

Di-retractor tše dikgolo (di-brace) .

phokotšo ya go diega; Go khutsufatša setho .

Dikurufu tša nakwana tša Schanz .

1 Femur, Tibia .

2 kgauswi le mola wa go robega ka mo go kgonegago .

3 Proximal fracture tshebediso ya cortical e le 'ngoe .

4Use a chuck ya bokahohleng ka t-handle bakeng sa maneuvering bonolo .

Sepekere sa Poller .

1Metaphyseal fracture (go phošolla mola wa matla, go tsepamiša tsošološo, go tsošološa tshepedišo) .

2 Oblique fracture ya distal tibia kapa femur (Shear khatello ea kelello → khatello) .

3 Manala a intramedullary ao a sa bewago gabotse a tsena mokerong wa kgale wa medullary nakong ya go buiwa ga bobedi .

4 Ntlha e fokolago ya go tsena, go se loke mo go fokolago ga go robega ga kgauswi (sekurufu se beilwe thwii go go šuthišwa mo go kgonegago ga endoplant)

Tourniquet ya ka bophara e oketšegilego .

1 Tibia .

2 E tlaleleditšwe ka go goga goba go goga retractor .

3 Diriša ka kelohloko dikgobalong tše šoro tša ditlhalenama tše boleta .

4 Ke e boloka e le e kopana .

5 thibana medullary katoloso ka mmuso inflated .

Nail notlela tatelano: distal ebe proximal .

Melemo .

bonolo ba knockback, compression ya fracture breaks; go fedišwa ga karogano; Ditiro tša phokotšo.

Dithekniki tša Phokotšo tša go Bua ka go Diega & Nonunion .

Mathata ao a ka kopanago le go buiwa mo go diegilego .

Go golofala ga axial (go khutsofatša, go ba le angulation le goba go šuthišwa) .

Kgolo ka ya ya granulation dinama tse nyenyane tse .

Makwapi a marapo a pele .

Sclerosis ya go robega e thubega ka go tswalelwa ga lešoba la medullary .

Go ba le bolwetši bja marapo .

Mathata ao a ka bago gona a ka gare ga go buiwa .

Deflection ya expander le intramedullary Nail → Intramedullary Nail Penetration ya Cortex .

Go golofala ga sekhutlong → Retractor .

Dislocation ya mafelelo a kgaotšwego → Poller's nail, go tsepama ga poleiti .

Mekgwa ya go thibela mela ya maatla ye e sa tlwaelegago .

Proximal - Ntlha ya go tsena ye e nepagetšego .

distal - intramedullary Nail ka bohareng ba medullary cavity .

Mathata a go kokotela ka gare ga medulla .

★Tšheko ya tshwaetso .

★nerve tshenyo .

★Kgopamiso pholiso ya fractures .

★Diphapano tša bongaka .

Go dikološa ka ntle, go kgokologa, valgus, go dikološa ka gare, angulation .

★Lebitla le le haufi le manonyeletšo bohloko .

★ Embolism ya mafura .

★Heterotopic ossification .

★Tlhamo ya bobe

★Re-go kgaoga gape .

★Thrombosis .

★go thata go thatafala .

★Non-kopano ya go robega, marapo nonunion .

★Ka hare fixation hloleha .

★Go khutsufatsa ga setho .

★Tše dingwe .

Mathata--Tswamo .

1.Early ka, bulehileng fractures ba ne ba nkoa e le contraindication ho intramedullary nailing.

2.Tiragalo ya tshwaetšo ya ka morago ga go buiwa ka go robega mo go bulegilego e ithekgile ka maemo a kgobalo ya dinama tše boleta le tšhilafalo .

Tiragalo ya tshwaetšo ka morago ga go robega mo go bulegilego e ithekgile ka boemo bja kgobalo ya dinama tše boleta le tšhilafalo gammogo le mokgwa wo ditlhalenama tše boleta di laolwago ka wona.

3.Thinner intramedullary manala a eketsa monyetla oa tshwaetso; Non-expanded notlela intramedullary manala fixation ke batlang e mpe, 'me marapo mafelelo a na le .

The bao e seng expanded notlela intramedullary manala fixation ke batlang e fokola, le motsamao microscopic ya e robehileng qetellong ya lesapo hammoho le masala cavity, e leng bonolo bakeng sa kgolo ya baktheria.

4. Tšhomišo ya go tsepama ga medullary ye e katološitšwego le ye e lekanyeditšwego ye e katološitšwego ga e kaonafatše fela go tsepama ga go robega, eupša gape e efoga go hlolwa ga sebaka se se hwilego.

Sehlare sa Embulism sa Mafura .

1.The ketsahalo ya Fes ya telele tubular masapo a fractures ke 0.5% ho 2%.

2. Katološo ya medulla le go se atološwe ga medulla ga e na mafelelo a magolo go go tsenya moya ga maswafo.

3.Ge go katološwa medulla, thekniki e swanetše go ba e duba ka bonolo, e efoga matla a mantši kudu le go šoma ka makgwakgwa.

4.The jwale tlhahlobo ya FES ntse amohela ditekanyetos sisintsweng ke Gurd ka 1974, le kalafo ka mor'a hore tlhahlobo tla lieha nako e ntle bakeng sa kalafo le ka 'na ba le liphello tse tebileng.

Phodišo ya go robega ya go diega le go se šome ga marapo .

Mabaka a fapa-fapanego a kgoma phodišo ya go robega ka morago ga go tsepama ga manala ka gare ga medula, gomme dibaki di ka seka-sekwa ka tsela e latelago.

1.Soft dinama tse nyenyane tse embedded ka fracture qetellong .

2. Karoganyo ya mafelelo a go robega a go selaganya .

3. Mengwaga ya go feta ya molwetši .

4. Open fracture, tebileng bonolo dinama tse nyenyane tse gobala, tebileng sebakeng seo hemodialysis kapa tshwaetso.

5. Poor intramedullary manala fixation .

6. Bolwetši bja swikiri bjo bo kopantšwego goba malwetši a mangwe a go khutša.

Go robega ga tša kalafo .

Go robega mo go hlotšwego ke kalafo kudu ke go robega ga bobedi mo go hlolwago ke go dirišwa gampe mo go sa swanelago nakong ya go tsepama ga manala ka gare ga medulla.

Tlhokomelo ya ka gare ga go buiwa e swanetše go lefša go .

1. Kgetho e sa nepagalago ya ntlha ya go tsenya manala e ka lebiša go robegeleng ga kgauswi.

2. O se ke wa kgorometša ka kgapeletšo katološong ya medulla.

3. Mojako wa katoloso ya makhura o swanetše go ba ka tsela ye e swanago le tlhahlo ya go tsenywa ga manala.

4. O se ke wa diriša matla ge o tsenya manala a ka gare ga medulla ka mafelelong a kgole.

Bohloko manonyeletšong a baagišani .

1. Go bewa ga sepekere sa ka gare ga medulla go akaretša dinama tše boleta gaešita le capsule ya manonyeletšo tikologong ya bonyenyane 1 joint.

2. Tibial plateau e kgokagantšwe le mošito wa pele wa meniscus ya magareng ka ligament ya lengwele ya go sepela ka go selaganya gomme e bopa lefelo le le bolokegilego ka godimo ga tuberosity ya tibial go fihla ntlheng ye. Ge e ba ntlha ya go kokotela e le kgaufsi kudu le godimo goba bophara bja sepekere sa ka gare ga medulla se segolo kudu, se ka baka tshenyo dibopegong tša ka gare ga ditho, go feleletša ka bohloko bja lengwele bja ka morago ga go buiwa.

3. Protximal protrusion ya intramedullary lenala le heterotopic ossification ke dibaki tše kgolo tša bohloko bja letheka ka morago ga femoral intramedullary nail buiweng.

4. Protximal protrusion ya intramedullary manala, proximal notlela nail teneha le rotator cuff tšitiso ke dibaki ka sehloohong sa bohloko magetla ka mor'a humeral intramedullary nailing.