Kugwiritsa Ntchito Moyenera Plate Locking!

A Locking mbale ndi chipangizo chokhazikika chophwanyika chokhala ndi dzenje la ulusi. Pamene wononga ndi mutu wa ulusi ikulungidwa mu dzenje, mbaleyo imakhala (screw) angle fixation device. Mbale yokhoma (yokhazikika) imatha kukhala ndi mabowo otsekera komanso osatseka kuti zomangira zosiyanasiyana zikhomedwemo (zomwe zimatchedwanso mbale yophatikiza). Popeza kuti lingaliro la mbale zotsekera linaperekedwa ndikugwiritsidwa ntchito pa chithandizo cha fracture, lakhala likugwiritsidwa ntchito kwambiri pakukonzekera kwa fractures ya periarticular, comminuted ndi osteoporotic fractures chifukwa cha ubwino wake wopereka chithandizo chokhazikika ndi kukonzanso kwa fractures, mlingo wapamwamba wa machiritso a fracture, kuchepa kwa minofu yofewa komanso kusokonezeka kwa magazi. Kuwerenga kwa m'mawa kwa lero kukupatsani chidziwitso chatsatanetsatane cha mbale zokhoma, zomwe ndi zofunika kuphunzirapo!

(A) Chidule Chachidule

1.Kodi mbale yotsekera ndi chiyani?

Chitsulo chilichonse chomwe chitha kukulungidwa kukhala zomangira zokhazikika kapena zomangira zokhazikika zimakhaladi mbale yokhoma.

2. Ubwino ndi kuipa kwa mbale zokhoma

Ubwino wake

■ Kukhazikika kwa angular, kukana kupindika ndi kugwedezeka

■ Mawonekedwe owoneka bwino a wononga mutu amathandizira kagawidwe ka makina

■ Perekani ma radial preload, kupewa fupa resorption ndi kumasula zomangira

■ Zowoneka bwino kuti zigwirizane ndi mawonekedwe a anatomical omwe ali mdera lanu

■ Kufananiza ma templates kuti alole kukhazikika kwa percutaneous mu diaphysis (kortical imodzi, kudzibowolera, zomangira zokhoma)

■ Zomangira zokhoma zimapereka zozikika bwino kwambiri pazingwe zosinthika komanso kukhazikika kokhazikika.

■ Palibe chifukwa chokhudzana kwambiri ndi fupa, kuteteza magazi

■ Kuwongolera ma micromotion, kumathandizira kuchira kwa fracture

■Nthawi zambiri palibe kulumikiza mafupa kumafunika

Ndiwothandiza makamaka kwa osteoporotic fractures kapena fractures iliyonse yosakhazikika.

Zoipa

■ Zomangira zotsekera sizikhala ndi kuchepetsa komanso kukanikizana, makamaka pakuthyoka kwa intra-articular kapena fractures yosavuta.

■Mbale siingagwiritsidwe ntchito ngati chida chochepetsera kuthandizira kuchepetsa.

■ Zomangira sizimveka bwino ngati zomangira wamba zikaikidwa.

■Malo a zomangira sizingasinthidwe (kupatula zomangira zotsekera zambiri).

■ Zomangira zimayikidwa mothina kwambiri, zomwe zimatha kuyambitsa 'kuwotcherera kozizira'.

■ Kupatuka kwa ngodya > 5 °, kutaya mphamvu; > 10 °, kutsekera sikuthandiza

■ Kuthekera kwa subcutaneous protrusion ngati mbaleyo sinapindikidwe

Kuuma nkhani

Popanda kukhudzana kwabwino kwa cortical kapena kupanikizana kwa mapeto a fracture, kugwiritsa ntchito zingwe zotsekera, makamaka zitsulo zosapanga dzimbiri, zidzateteza gawo lachiwiri la machiritso a fracture chifukwa cha kuuma kwakukulu ndi kuchotsedwa kwa micromotion yabwino pa malo ophwanyika;

Ngati intraoperative traction ikugwiritsidwa ntchito ndiyeno kutsekedwa kwachitsulo kumagwiritsidwa ntchito, kusiyana kwa fracture kumasungidwa, zomwe zimapangitsa kuti kuchedwe kapena kusachiritsika;

Ngati kupasuka kosavuta sikunakhazikitsidwenso ndi kupanikizika, katunduyo amafalitsidwa kudzera mu mbale, zomwe zimapangitsa kuti pakhale kupsinjika maganizo komwe kungayambitse kusweka kwa mbale.

3. Kusiyana kwakukulu kwa biomechanical pakati pa mbale zokhoma ndi mbale wamba

Ma plates ochiritsira amadalira kugundana kwa fupa-plate mawonekedwe kuti akwaniritse kupanikizana kwa mbale.

4. Kufananiza ubwino wokhoma mbale ndi mbale wamba zitsulo

1.Kukaniza kukoka zomangira zokhoma ndizokwera kwambiri kuposa zomangira wamba.

2. Zomangira zotsekera za epiphyseal zimamangirirana wina ndi mzake, zomwe zimawonjezera kukana kwa wononga kutulutsa poyerekeza ndi zomangira zofanana.

(B) Mfundo zogwiritsira ntchito

1. Mfundo zolepheretsa kuyenda:

● Mfundo yapakatikati: kuthyoka kwa osteoporotic diaphysis

● Neutralization mfundo: osteoporotic diaphysis fracture

● Mfundo yolumikizira: diaphysis yowonjezera kapena kuwonongeka kwa metaphyseal

Mfundo ya mgwirizano: comminuted intra-articular metaphyseal fracture

2. Mfundo yolumikizira:

●Njira yodziwika bwino: kukonza mbale zocheperako pang'ono (MIPO kapena njira ya MIPPO)

●Njira yochepetsera mwachisawawa

●Pakuti mbale zomangira zikhazikike bwino, mabowo 3-4 azisiyidwa otsegula pafupi ndi mapeto othyoka.

3. Mfundo za mgwirizano:

● Kuphatikizika kwa mfundo ziwiri za biomechanical za kupanikizana ndi kumangirira mu mbale imodzi - locking compression plate (LCP)

● Kuthyoka kophweka mu gawo limodzi la fracture ndi fractures comminuted mu ina (mwachitsanzo, fractures comminuted ya metaphysis, diaphysis)

● Mfundo ya mgwirizano iyenera kugwiritsidwa ntchito pa mbale zomwe zimalola kuyika zomangira zonse ziwiri zotsekera komanso zomangira wamba.

Kutseka mbale sadalira kukangana pakati pa mawonekedwe a fupa-mbale ndi kudalira makamaka mawonekedwe pakati pa wononga ndi mbale ndi kukhazikika kwa angular kuti akhalebe okhazikika.

Chifukwa cha mgwirizano wawo wokhazikika, mphamvu yochotsa zomangira zokhala ndi mitu yotsekera ndizokwera kwambiri kuposa zomangira wamba, pokhapokha ngati zomangira zonse zozungulira zimachotsedwa kapena kusweka. Nthawi zambiri, zimakhala zovuta kuti screw imodzi ichotsedwe kapena kusweka yokha. Zomangira zotsekera zamutu sizipereka kukakamiza kwapakati. Pressurization ingapezeke pogwiritsa ntchito chipangizo chosindikizira kapena kuyendetsa zomangira nthawi zonse mu 'mixing holes' (zomangira zomangika poyamba, kenako misomali yotseka).

1.Ngati zomangira zakhala zikugwiritsidwa ntchito kutchingira cholumikizira (monga 1), kukoka zomangirazo kumakhala kosavuta (monga 2).

2.Ngati zomangira zotsekera zakhala zikugwiritsidwa ntchito kuteteza splint ndi fupa la fupa (mwachitsanzo, 1), sikoyenera kuti zomangira zokhazikika zizikulungidwa pafupa lomwelo (mwachitsanzo, 2) pokhapokha ngati zomangirazo zimasulidwa ndikuwonjezeredwa (LHS).

3.Pamene metaphyseal fracture block yakhala yotetezedwa ndi screw yokhala ndi mutu wotseka (LHS), compression fixation pakati pa fracture blocks imapezeka mwa kupukuta screw standard mu dzenje lopondereza mphamvu la Locking Compression Plate LCP kuphatikiza.

(C) Zizindikiro ndi contraindications

1. Zizindikiro

Ma fractures ambiri omwe amachitidwa opaleshoni safuna kukonza mbale zokhoma. Malingana ngati mfundo za opaleshoni ya mafupa zikutsatiridwa, ming'alu yambiri imatha kuchiritsidwa ndi mbale wamba kapena misomali ya intramedullary.

Komabe, pali mitundu yeniyeni ya fractures yomwe imatha kutayika, kuchepetsa mbale kapena kusweka, ndi kusagwirizana kotsatira, zomwe nthawi zambiri zimatchedwa 'zosasinthika' kapena 'zovuta' zowonongeka, kuphatikizapo fractures intra-articular comminuted fractures, fractures ya periarticular ndi fractures yaing'ono ya mafupa, mafupa ang'onoang'ono, ndi mafupa ang'onoang'ono. Mitundu iyi ya fractures nthawi zambiri imatchedwa 'zosasinthika' kapena 'vuto' zosweka ndipo zimaphatikizapo fractures ya intra-articular comminuted, periarticular short tuberosity fractures ndi osteoporotic fractures. Zothyoka zonsezi ndizizindikiro zokhoma mbale.

Zizindikiro zapamwamba komanso zoyenera zotsekera mbale zosweka ndi mfundo yolumikizirana ndi mfundo ya mgwirizano wa ma fractures ochulukirapo - kusweka kwamphamvu kwa odwala achichepere kapena osteoporotic fractures mwa odwala okalamba.

2. Contraindications

Ngakhale mbale zokhoma zakhala zikugwiritsidwa ntchito kwambiri ndipo zisonyezo zake ndizambiri, tiyenera kuzindikira ndikupewa zotsutsana zingapo zokhoma mbale. Ngati mbale zokhoma zimagwiritsidwa ntchito mosasamala, kulephera kwa kukonza ndi kusagwirizana kwa fracture kumatha kuchitika.

Ma fractures osavuta omwe amafunikira kupanikizana kwa interbody, monga ma fractures osavuta a mkono omwe amathandizidwa ndi kutsekeka kwamkati, amakhala osagwirizana.

Momwemonso, kuyika kwapang'onopang'ono kwa mbale zokhoma zothyoka zosavuta kugwiritsa ntchito njira zochepetsera pang'ono ndikotsutsananso.

Kuchepetsa kwachindunji ndi kutsekera kwa mbale sikulinso koyenera kuti pakhale fractures ya intra-articular, yomwe imafunikira kutsika kwapang'onopang'ono kwa ma anatomical ndi kupanikizana pakati pa zidutswa zosweka ndi kukhazikika kolimba.

Kutsutsana kwapang'onopang'ono kwa mbale zokhoma, chifukwa cha mtengo wawo wokwera, ndi fractures zomwe zingathe kukhazikitsidwa mokhutiritsa ndi mbale wamba. Mwachitsanzo, fractures of the forearm symphysis imakhala ndi machiritso oposa 90% pamene amachiritsidwa ndi mbale wamba.

(D) Kuyika mbale zotsekera

1. Chotsani chobowola m'mabowo omangira mbale. Kupatuka kwa> 5 ° pakati pa screw ndi screw hole kungayambitse kulephera kwa zotsekera, ndipo tikulimbikitsidwa kugwiritsa ntchito kubowola mabowowo makamaka.

2. Ikani mbale yachitsulo pamwamba pa fupa ndikubowola mabowo kupyolera mu kubowola manja.

3. Yezerani kuya ndi mawu akuya, samalani kuti mutu wa chowuliracho ulowetsedwe mu dzenje la screw.

4. Sankhani kutalika koyenera kwa screw screw.

5. Kuyika zomangira zopanikizidwa ndizofanana ndi mbale zachitsulo wamba.

6. Pomaliza limbitsani zomangira zotsekera ndi torque wrench, zikamangika, padzakhala kumverera kowoneka bwino komanso kumveka bwino, kuti mupewe kusokoneza mothina kwambiri, zomwe zimabweretsa zovuta zochotsa.

(E) Kutsekera mbale kuchotsa

Zomangira zomangira zachipatala zimagwiritsidwa ntchito kwambiri, koma kukumana ndi zovuta zochotsa mosavuta, zomwe zimawonekera mu wononga waya wotsetsereka ndi kapu ya msomali ndi ulusi wa dzenje la misomali pakati pa chomangira cholakwika.

1. Screw cap groove kuwonongeka

Nthawi zonse, wononga kapu kapu groove ndi screwdriver yofananira imagwirizana. screwdriver iyenera kulumikizidwa ndi screw cap groove isanalowe kapena kuchotsedwa, apo ayi screw cap groove ikhoza kukhala yopunduka panthawi yobowola kapena pobowola, zomwe zimapangitsa kuti pakhale kutsetsereka.

Kuonjezera apo, pambuyo pochiritsa fracture, screw cap notch nthawi zambiri imakulungidwa ndi fupa la fupa kapena minofu ya fibrous, yomwe iyenera kutsukidwa musanachotse wononga, koma ngati palibe chisamaliro chomwe chaperekedwa, wononga kapu ndi mawonekedwe a angular akhoza kuonongeka mwachinyengo.

Chifukwa kuzungulira kwa mkono wa woyendetsa sikugwirizana ndi utali wautali wa screwdriver, nthawi zambiri pamakhala ngodya inayake, pamene wogwiritsa ntchitoyo adawombera wononga, ndizosapeweka kuti screwdriver imagwedezeka, zomwe zimapangitsa kuwonongeka kwa kapu ya screw chifukwa cha mphamvu yosagwirizana. Chifukwa chake, kuwonongeka kwa screw groove kumatha kuyambitsa kutsetsereka.

2. Chipewa cha msomali kapena kusintha kwa dzenje la msomali

Pogwiritsira ntchito intraoperative ntchito ya anatomical locking zitsulo mbale, nthawi zina malinga ndi kufunikira kopinda koyenera kapena kuumba mbale yachitsulo, Raja et al. kukhulupirira kuti ngati kupinda mbali chikuchitika mu zokhoma wononga wononga mabowo, pamene screwing mu zomangira zokhoma adzakhala wononga kapu ndi msomali dzenje kusagwirizana, zomwe ndi zotheka kuti zimachitika pakati pa kapu ya msomali ndi mbale zitsulo mbale msomali mabowo ulusi wolakwika buckle, kapena zomangira pafupi ndi mbale zitsulo pamene mchira wa misomali deformation chifukwa cha amphamvu screwing, etc., amene angatsogolere kuchotsa zovuta pambuyo pake.

3. Kugwiritsa ntchito misomali yodzikhomera yokha ya cortical

Chifukwa fupa la kortical limakula mkati motsatira dzenje la misomali ndipo limagwira wononga, zomwe zimapangitsa kuti pakhale zovuta pakuchotsa zomangira, makamaka kugwiritsa ntchito zomangira zomangira pawokha, Suzuki et al. musamalimbikitse kugwiritsa ntchito zomangira zodziwombera zokha kuti zikhazikike pawiri cortical. Hou Yunfei et al. adanenanso kuti kukhazikika kosafunikira kwa bicortical ndi zomangira kuyenera kupewedwa chifukwa chosweka kumtunda, ndipo Maehara et al. ananenanso kuti kugwiritsa ntchito zomangira zokhoma pafupipafupi kuyenera kupewedwa mukamagwiritsa ntchito mbale zokhoma, komanso kuti pakufunika kukhazikitsa muyezo wapadziko lonse wosankha ndikugwiritsa ntchito zomangira zokhoma.

4. Mapangidwe ndi malo a zomangira

Kukula, malo, ndi malo a screw screw kungakhudze kuchotsedwa kwa screw. Akatswiri ena apeza kuti ngati wononga wononga ali pakati pa dzenje lokhoma, kamodzi msomali dzenje eccentricity oposa 5 ° pakhoza kukhala lotayirira wononga fixation, ulusi cholakwika buckle kapena msomali mapindikidwe mchira munakhala ndi kuchititsa kulephera fixation kapena gawo lachiwiri la kuchotsa mavuto.

5.Kuwotcherera kozizira

Normal titaniyamu mkati fixation pamwamba ali wosanjikiza wa passivated wosanjikiza zoteteza, m`kati opaleshoni makhazikitsidwe makhazikitsidwe fixation mkati, chifukwa cha zida kugwira ndi kuumba, kapena mutu wa wononga ndi kukangana pakati pa mbale zitsulo, etc., kungachititse kuti passivated zoteteza wosanjikiza dera kuvala. 2 zitsulo kukhudzana pamwamba pakati substantive kukhudzana mfundo adzatsatiridwa, ndiko, mapangidwe ozizira kuwotcherera.

Komanso, galvanic lumikiza pakati zitsulo ayoni, zochita yotupa, etc. akhoza kulimbikitsa mapangidwe welds ozizira. Ambiri opanga zipangizo mkati fixation akudziwanso za vutoli, choncho wosagwiritsidwa ntchito zokhoma mbale zitsulo yokutidwa ndi okusayidi filimu luso pakati pa mabowo msomali ndi wononga kukhudzana pamwamba, amenenso cholinga ziletsa ionization ndi adsorption wa mapuloteni mu thupi ndi kuchepetsa kuchitika kwa welds ozizira.

(F) Njira zochotsera

Kuchotsa njira zomwe zafotokozedwa m'mabuku a dziko lonse ndi apadziko lonse zingagawidwe m'magulu a 2, omwe ndi osavuta komanso othandiza komanso ovuta, omwe amadziwika ndi kupezeka kosavuta, zothandiza, kuwonongeka kwa minofu yofewa yochepa, luso lochepa komanso kusowa kwa zida zapadera, ndipo zotsirizirazi zimafuna zida zapadera ndi zida.

Maehara et al. apangitseni kugwiritsa ntchito ma screwdrivers ochepetsa ma torque okhala ndi ziboda zazikulu ngati kuli kotheka. Mukakumana ndi zomangira zotsetsereka, Pattison et al. lipoti losavuta njira kuchotsa zomangira kuterera ndi kukulunga mutu wa screwdriver ndi platinamu zitsulo ndi kuika mu poyambira wa wononga kapu. Njira imeneyi ndi wochenjera kudzaza wononga kapu poyambira ndi zitsulo zojambulazo ndi kuonjezera kukhudzana m'dera ndi kukangana pakati pa screwdriver ndi poyambira, amene facilitates kuchotsa zomangira ndi kuterera ulusi. Mu njira imeneyi akadali zovuta kuchotsa mlanduwo, ngati wononga kapu ndi zitsulo mbale msomali dzenje ulusi akadali bwino, mungayesere kugwiritsa ntchito conical n'zosiyana pogogoda wononga chochotsa, ndiye kuti, kuchokera wononga kapu poyambira anaikapo m'mbuyo pogogoda ndi kudzaza poyambira, m'kati mozungulira ndi pressurizing wononga kunja.

Kumbali yakumunsi, zomangira zina zokhoma zimakhala zovuta kukhala zogwira ntchito pogwiritsa ntchito conical reverse tapping screw extractor, monga Ehlinger et al. ndi Bae et al. amene anapeza kuti njira imeneyi nthawi zambiri zothandiza 3.5 mamilimita wononga slippage, koma nthawi zambiri osathandiza 4.5 mm wononga slippage. Pamenepa, si magulu onse achipatala omwe ali ndi zida zapadera zopera zitsulo monga zobowolera za carbide, zobowola diamondi, kapena mawilo opera kwambiri.

Gopinathan et al. fotokozani njira yomwe sikutanthauza zida zapaderazi pofotokoza vuto la zovuta zochotsa wononga kuchokera ku mbale yomanganso ya clavicular, mwachitsanzo, pogwiritsa ntchito kadulidwe kakang'ono ka mbale yomanganso, chodulira waya chachikulu chimagwiritsidwa ntchito kumeta gawo locheperako la mbale pakati pa mabowo a misomali, kotero kuti zomangira ndi dzenje la msomali gawo la mbaleyo lipanga kagawo kakang'ono, ndikuchotsa mosavuta. Njirayi imangogwira ntchito pama mbale otsekera a titaniyamu, mbale zokhoma zam'manja zokhala ndi notche zocheperako, ndi mbale 1/3 zamtundu wa chubu, ndipo sizingagwiritsidwe ntchito ngati mbale zokulirapo kapena zokulirapo m'munsi.

Njira yosavuta yafotokozedwanso momwe kubowola kokulirapo kumagwiritsidwa ntchito pobowola bowo pafupi ndi phula lotsekera lotsekera, ndiyeno mbale ndi zomangira zimakhomeredwa molunjika kumene bowo wamba wabowoledwa kumene, ndiyeno mbale ndi zomangira zimachotsedwa pogwiritsa ntchito chodulira mafupa chomwe chimayikidwa pansi pa mbale ndikuchichotsa ndi mfundo yoboola.

Zoonadi, pali kuthekera kwa kuwonongeka kwa mafupa ndi njirayi, choncho chitetezo cholemera pambuyo pa opaleshoni chikulimbikitsidwa. Kuphatikiza apo, ndikofunikira kukonzekera zida zaukadaulo zomwe zimagwiritsidwa ntchito nthawi zambiri musanachite opaleshoni yochotsa mkati, monga bolt extractor, hole reamer, screw extraction pliers, T-type pressurized socket ndi zina zotero.

Pamaso pa zokhoma wononga wononga poterera mavuto kuchotsa waya, akatswiri ena zoweta akufuna kusintha poyambira njira, ndiko kuti, ntchito mano yaying'ono akupera makina zitsulo chidutswa cha mchenga kusintha wononga kapu poyambira hexagonal kapena quadrangular poyambira 'mmodzi' kapena 'khumi' poyambira, kapena kuzama choyambirira.

Ehlinger ndi al. linanena kuti pamene conical reverse tapping screw extractor akadali ndi vuto kuchotsa wononga, anaganiza kuti mbale zitsulo akhoza kuchotsedwa powononga mutu wa wononga ndi tungsten kubowola ndi kukulitsa mabowo a misomali mu mbale zitsulo, ndiyeno thupi la wonongayo akhoza kuchotsedwa pogwiritsa ntchito ring saw.

Georgiadis et al. ndi Raia et al. akufuna mu wononga ndi zitsulo mbale kuphatikiza ndi zothina kwambiri ndi zovuta kuchotsa, zida zapadera (monga pneumatic mkulu-liwiro kudula kubowola, carbide kubowola, mawilo diamondi, etc.) pa dzenje msomali kuzungulira zitsulo mbale kudula njira, mu mbale zitsulo kudula kumasula wononga wononga, wononga ndi mwachibadwa zosavuta kuchotsa.

Kumar ndi Dunlopl inanena mu distal femur kutseka zitsulo mbale wononga dongosolo mkati fixation kuchotsa ndondomeko, mu ntchito muyezo kudziletsa malire makokedwe screwdriver, conical wononga Sola alephera, komanso anayambitsa njira yatsopano, ndiko kuti, ntchito mkulu-liwiro woonda-flake mawilo abrasive m'mphepete mwa mbale zitsulo m'mphepete mwa wononga wononga wononga, knifedge mu bowo ndi radial. musatsegule bowo la misomali yachitsulo kuti mupumule kapu, kuti muchotse bwino zomangira zotsekera.

Ndikofunika kuzindikira kuti njira zomwe zili pamwambazi ziyenera kupita patsogolo pang'onopang'ono momwe zingathere panthawi yodula kapena kugaya mbale pogwiritsa ntchito diski yothamanga kwambiri kuti mupewe kudula pamutu wa screw ndi kuwononga fupa ndi zofewa. Kuonjezera apo, njirazi zingapangitse kutentha kwakukulu ndi zinyalala zazitsulo, zomwe zingapangitse chiopsezo chowonjezereka cha kuswekanso kwamankhwala, minofu thermal necrosis, ndi matenda.

(G) Mwachidule

■ Lolani kuti mbale isagwirizane ndi periosteum

■ Mbale iyenera kukhazikitsidwa isanayambe kutseka, chifukwa chophwanyika sichingakhazikitsidwenso pambuyo potseka.

■ Locking mbale sangakhoze kupsinjidwa, ayenera kugwiritsa ntchito pressurizer kapena centrifugal screwing mu dzenje mgwirizano mu wononga wamba, prepressurized, kenako kutseka.

■ Kuthyola malo 3 ~ 4 wononga mabowo opanda zomangira kufalitsa nkhawa; ■ Kuthyola malo 3 ~ 4 wononga mabowo opanda zomangira kufalitsa nkhawa; ndi

■ kukhazikika kwa fupa la diaphysis kapena kotekisi ya fupa, ndi pamene fupa lili bwino; ndi

■Ikatsekedwa, siingathe kutulutsidwa, pomwe zomangira wamba zimatha kutulutsidwa

■ Kukhazikika kwamphamvu ndi zomangira zambiri kungayambitse kusalumikizana; mfundo ndi yakuti mbale ziyenera kukhala zazitali ndipo zomangira zochepa ziyenera kugwiritsidwa ntchito; pochiza fractures za periarticular, zomangira zochepa ziyenera kuikidwa pa tsinde ndipo zomangira zambiri ziyenera kugwiritsidwa ntchito pokonza pamwamba pa articular.

■ kutalika kwa mbale yolumikizira kuyenera kukhala kuwirikiza kawiri kutalika kwa malo ophwanyika, zomangira ziyenera kugawidwa mofanana, ndipo kukonza koyenera kuyenera kukhala kudzera pa kabowo.

■ Mphamvu imagawidwa mofanana pa mbale yaitali, ndipo kuika ndi zomangira zochepa kungathandize kupanga nkhanambo ndikulimbikitsa kuchira kwa mafupa.