Kukiya Plate-Application Restrictions uye Limitations

Kushandiswa kwe kuvhara mahwendefa kwakawedzera zvakanyanya kuwanda kwekushandiswa kweplate mukati mekugadzirisa kwekutsemuka. Nekudaro, kushandiswa kwavo kunofanirwa kuverengerwa uye kugadziridzwa nekuda kwezvingangove zvipinganidzo uye zvisingakwanisi. Muchinyorwa chino, isu tichatarisa kutarisisa kwekushandisa, matambudziko ekubvisa, uye zvisingakwanisi, 3 maficha ekuvhara plate application.

01.Ndezvipi Zvimiro Uye Zvinetso Zvinofanirwa Kucherechedzwa Mukushandisa Kukiya Plate?

Matanho uye Matambudziko ekudzikisa Mafracture neLocking Plates

Matanho ekugadzirisa zvakare fracture akagadziriswa. Kukiya mahwendefa haagadzirise zvakare mafractures. 

Kana yangoiswa muchikamu chepfupa, kuwedzera mamwe screws hakuzoifambisa. Kana ndiro yekukiya inongobvuma kukiya zvipikiri ikashandiswa, 

izvi zvinoreva kuti ndiro inogona kuvharwa chete mushure mokunge kuputsika kwaiswa.

Sezvo mahwendefa ekuvhara achibvumira kuporesa kwepfupa pasina kurasikirwa kwekutanga repositioning, 

chikonzero chikuru che malunion yekuvhara mahwendefa haina kururama kwekutanga repositioning. 

Uye, kugadzirisa kwakashata nekuda kwekusakwana ma mechanics kunogona kutungamirira kuhutano husina kunaka sezvo pfupa rebhoni rinoputika nekuda kwekunonoka kuporesa kana kusapora.

Repositioning pasina kushandiswa kwekuvhara mahwendefa zvakanyanya kuoma kana uchiita zvishoma zvishoma

 maitirwo nekuti kuratidzwa kwepfupa kwakanyanya kushoma. Inoda nzira dzakasiyana dzekukwevera (matafura ekudhonza, maretractor),

 zvakasiyana-siyana percutaneous repositioning forceps, uye Kirschner mapini ekugadzirisa mapfupa emapfupa uye kugadzirisa kwenguva pfupi. 

Usati waiswa mahwendefa ekuvhara uye zvipikiri zvekukiya, zvakakosha kuti utarise kugadziridzwa nefluoroscopy.

Sezvineiwo, kana uchishandisa ndiro yekukiya iyo inewo yakajairwa screw maburi, 

a standard traction screw inogona kuiswa mumakomba akajairika ekutanga repositioning pandiro.

 Zvimedu zvemapfupa zvinoiswa pakatarisana neplate. Kana ndiro yacho inoenderana neanatomy, inogona kushandiswa segwara rekugadzirisa. 

Kukiya zvipikiri kunovimbisa kugadzikana mhedzisiro pasina kushandura yekutanga reset. Iyi kurongeka kwekuisa (standard screws, ipapo kukiya screws) yakakosha (Mufananidzo 4).

Fig. 4 Tanga waisa ma screws uye woasimbisa.

Kushaikwa Kwetactile Feedback PaKusimbisa Kukiya Mapegi

Iko hakuna tactile mhinduro kana uchisimbisa kukiya musoro screws. Saizvozvo, 

kusungirirwa kwembambo yekuvhara kunoitika panguva imwe chete mu cortical kana cancellous bone uye musimbi yekuvhara ndiro. Nechikonzero ichi,

 zviri nyore kuti chiremba afungire zvisiri izvo kuti mbambo yekuvhara inobata zvakanaka mu cortical kana cancellous bone (Mufananidzo 3).

Fig. 3 Kushanda kureba kwekuvhara screws zvichienderana nemhando yemapfupa uye nhamba yekortices.

Self-Tapping Locking Screws

Iko kushandiswa kwe-self-tapping yekuvhara screws zvinoreva kuti hapana tactile mhinduro panguva yekuchera kana kuomesa sezvazvinoitika panguva imwe chete.

Zvimiro zvavo zvemagetsi zvakafanana neaya e single cortex yekuvhara screws panguva imwechete cortex application. Kana dzakareba, 

vanozobata cortex yechipiri isina kucheneswa, zvichikonzera kumira kusina kunaka kwembambo yekukiya mundiro yekukiya.

Munguva yebicortical application, inogona kunge yakapfupika, ichiita kuti ive yakaenzana neine-cortical yekukiya zvipikiri. 

Kana dzakanyanya kureba, dzinowedzera kupfuura cortex uye dzinogona kukuvadza zvimiro zvakakomba kune rumwe rutivi rweplate.

Kureba kwembambo yekukiya kwakaringana kunongowanikwa chete nekuyera hurefu hunodiwa mushure mekuboora kana kuuona nefluoroscopy.

Zvimiro zveUniaxial Locking Screws

Iko kusakosha kukuru kwe uniaxial kukiya zvipikiri ndeyekuti kutaridzika kwavo kwakafanotemerwa. 

Vanogona kunge vaine imwe implant kana prosthetic dzinde munzira yavo, zvichiita kuti kupinza kusagoneke kana kuvamisa kune unicortical fixation.

Kune anatomical yekuvhara mahwendefa anoshandiswa mumakumbo ane uniaxial kukiya zvipikiri zvine yakamisikidzwa yakatarisana, 

yakagadziridzwa nekuda kwezvikonzero zveanatomical uye biomechanical, kune njodzi yekuisa intra-articular yekuvhara mbambo. 

Muenzaniso wakajairika ndeye distal radius fracture. Ngozi iyi inotokura kana ndiro yekukiya iri padyo nejoinhi kana kuti anatomy iri understandard. 

Kusavapo kwe-intra-articular fracture kunofanira kusimbiswa ne fluoroscopy.

Nhoroondo ye MIPO Technologies

Iyo minimally invasive percutaneous osteosynthesis (MIPO) maitiro anosanganisira subcutaneous uye/kana submuscular. 

uye extraperiosteal kuiswa kwebhonzo ndiro kuburikidza nekaburi kadiki mubhonzo mushure mekutsvedza, pasina kuburitsa

 nzvimbo yakatsemuka. Izvi zvinobvumira kuchekwa kudiki, kushomeka kwenzvimbo yekuvhiya, uye kunoita kuti maitiro awedzere 'biologic'

 nokuti hapana chikonzero chekufumura chimedu chepfupa rega rega uye hapana kupindira kune zvinyoro zvinyoro, periosteal vascularization, kana fracture hematoma.

Inogona kuzadzikiswa nendiro yekuvhara uye chimbo chakanyatsogadzirwa chinobvumira ndiro 

kuti ishandiswe uye ipfuure nepaganda kuti iwane nyore maburi ekukiya zvipikiri mundiro. 

Fluoroscopic mifananidzo inofanira kutorwa padanho rega rega kuti uone kufambira mberi. Nhanho imwe neimwe yehunyanzvi uhu inonetsa. Dambudziko rekutanga nderekugadzirisa zvakare kuputsika kusati kwagadziriswa.

 Iyo yekuvhara ndiro inofanira kubva yanyatsoiswa pakati pehurefu hwebhonzo, zvikasadaro kurongeka kweplate yekuvhara kuchave asymmetric (Mufananidzo 5). Pamusoro pe, 

ndiro yekuvhara inofanira kunyatsoenderana necortex yebhonzo iyo yakagadzirirwa kutevera uye pedyo nebhonzo se 

zvinogoneka pasina kuderedza zvakanyanya kuoma kwechimiro. Munguva yekupedzisira yekuvhara danho, zvakaoma kuve nechokwadi kuti

 maconduits e-screw anonyatsoenderana pavhareti yekuvhara uye kuti zvipikiri zvekuvhara zvakanyatsobatanidzwa panguva yekusimbisa.

Mufananidzo 5 Eccentric positioning yekukiya ndiro uye kushaikwa kwehaptic mhinduro panguva yekusunga screw.

Kunogona Kukuvara Kweganda Paunenge Uchishandisa Outer Ankle Locking Plates

Kushandiswa kwekuvhara mahwendefa ekugadzirisa kunze kwekuputsika kwemakumbo kwave kwakabatanidzwa nemazinga akawandisa eganda necrosis. 

Ukobvu hweaya subcutaneous locking plates anoisa kudzvanya paganda uye anovhiringa kugovera kwayo vascular uye kuporesa. 

Chimwe chinhu chakafanana chinogona kuitika kana mahwendefa ekuvhara achishandiswa kune hawksbill fractures.

Njodzi YeOsteoporosis Uye Screw Extraction

Mune osteoporotic bone, kuvhara zvipikiri kunobatsira kuderedza njodzi yekudhonza screw kana kubvisa. 

Iyo inovaka haina kuoma zvakakwana nekuda kweiyo yakaonda pfupa cortex uye yakaderedzwa density yetrabeculae.

Muchiitiko ichi, kukiya ndiro kugadzirisa kunogara kwakasimba uye kwakabatikana zvirinani kana uchishandisa evanescent kana convergent monolithic kuvaka (Mufananidzo 3).

Pfupiso:

1. Locking screws haibvumiri kuputsika pabhonzo ndiro kuti igadziriswe zvakare.

2. Kutyoka kunofanirwa kugadzikiswa kusati kwawedzera siruu yekukiya.

3. percutaneous fixation yekuderedza kuputsika kunoda kuvhara ndiro instrumentation. iyo MIPO tekinoroji iri kudiwa zvakanyanya.

02. Matambudziko Ekubvisa Maplates ekukiya

Kubvisa ndiro yekukiya kana kuputsika kwapora kunonetsa uye hazvifungidzike, 

asi mamiriro acho ezvinhu anogona kugadziriswa. Dambudziko guru nderekusunungura siruu yekukiya.

Mune zvimwe zviitiko, tambo dziri pamusoro wembambo yekukiya dzinokuvadzwa panguva yekuiswa 

(kusimba kwakawanda uye kusunungura, screwdriver pateni yakakuvadzwa uye isina kunyatso hexagonal, kuisirwa sikuru kunoitwa nechibooreso chemagetsi), 

zvinoreva kuti haigoni kusunungurwa. Naizvozvo, zvakanakisa kudzivirira dambudziko iri nekukasira kutsiva chero screw ne 

yakakuvadzwa musoro pateni panguva yekusimwa, uchishandisa screwdriver yakazara uye kunyatsosimbisa screw neruoko (kwete nemagetsi drill).

 Kushandisa screws yakagadzirwa nezvinhu zvakasimba kunogona kubatsira kuderedza dambudziko iri.

Kazhinji, pane kukiya kwemuchina kana kudhumhana pakati petambo dzezvipikiri zvekukiya uye buri rine shinda mundiro yekukiya. 

Izvi zvinonyanya kuonekwa ne 3.5mm dhayamita titanium hex pateni imwe shaft yekukiya screws. Hapana nzira imwe chete

 zvekuvhiringidza. Zvikumbiro zvinowanzotanga kuomeswa zvakanyanya nekuda kwekutadza kushandisa torque wrench yakapihwa mumudziyo wechiridzwa, 

iyo inogona kushandura tambo pahoko yekukiya nendiro yekukiya. Mune zvimwe zviitiko, 

kutadza kushandisa kana kushandiswa kwegwara risiri iro rakakonzera kuti screws isaenderane kana yakasimbiswa, 

izvo zvakaita kuti screws zviite jam. Kuti uderedze njodzi yejamming panguva yekutanga kugadzirisa maitiro,

 zvakakosha kushandisa zvishandiso zvese zviripo: dhiraivha madhairekitori uye zvigadziko, torque wrenches mune yakazara kutendeseka modhi paunenge uchisimbisa kukiya zvipikiri.

Iyo MIPO tekinoroji inotakura njodzi yakanyanya yekuiswa zvisirizvo kwegwara rekugadzirisa, 

sezvo pasina kuona kwakananga kweplate yekuvhara. Kurongeka kusiri iko kwegwara rekubhora zvinoreva kuti gomba rakaboorwa 

chipikiri chekuvhara uye kuiswa kwechipikiri chekuvhara zvichave zvisina kururama. Panewo njodzi yekukuvadza musoro wepateni we

 kukiya mbambo kana sikurudhiraivha isina kunyatsobatanidzwa nescuru.

Nokuda kwezvikonzero izvi, vasati vabvisa ndiro yekuvhara, chiremba anovhiya anofanira kuziva kuti zvingasava 

zvinokwanisika kusunungura mbambo yekuvhara, nekudaro zvinoda kushandiswa kwepamusoro-soro hexagonal screwdriver uye kuwedzera chiridzwa.

Kana chipikiri chekuvhara chisingagoni kusunungurwa, kana kuti musoro wepamusoro wakakuvadzwa, 

danho rekutanga kuisa screw extractor (tapered screwdriver ine inverted threads) mumusoro wescrew;

 izvi zvinogona kukwana kusunungura sikuruu. Imwe sarudzo ndeyekucheka ndiro yekukiya kune rumwe rutivi rwechipikiri chekukiya uye kushandisa

 iyo se screwdriver kusunungura chimiro chose. Kana screw ichiri kusakwanisa kusunungurwa, ndiro yekukiya inogona kusunungurwa nayo 

Kuiboora nechibooreso, kuparadza musoro wembambo yekukiya, kana nekucheka kutenderedza ndiro kuti usunungure chipikiri chekukiya. Mushure maizvozvo, 

vhisi inogona kushandiswa kubvisa matanda emapegi ekukiya. Kana iyo ichiri kutadza kusunungurwa (nokuti yakabatanidzwa mufupa kana kuti haina kubuda zvakakwana), 

inogona kubviswa nemhete drill (Fig. 6).

Mufananidzo 6 Mazano uye matipi ekubvisa masiruu ekukiya akanamira mubhodhi.

Matambudziko ese aya anogona kurebesa kuvhiyiwa, anogona kukonzera nyoro matishu abrasion nekuda kwekuburitswa kwesimbi zvimedu, uye kutakura njodzi yekutapukirwa. 

Kushandiswa kwechibhorani chemhete kunowedzera njodzi yekuputsika kweperioperative.

Pfupiso:

1. Dambudziko rekubvisa zvipikiri zvekukiya rinoitika zvakanyanya ne 3.5mm hex musoro wekukiya titanium screws.

2.Nzira yakanakisa yekudzivisa dambudziko iri kushandisa zvese zvakapihwa zviridzwa paunenge uchiisa screw. Matambudziko aya anogona kugadziriswa nekushandisa maturusi akakodzera.

03. Ndeapi Mamiriro eKushandiswa kweiyo Locking Plate?

Clavicle plate fracture uye osseous nonunion

Nekuona kuti chimiro hachina kunyanya kuoma nekuda kwehurefu husina kukwana hwekushanda kweplate yekuvhara kana kuwandisa kwenhamba yezvipikiri zvekuvhara (Fig. 7), njodzi yekuputsika kweplate yekuvhara pasi pemaburi e screw kana pa screw / bone plate junction inogona kuderedzwa.

Mufananidzo 7 Kuporeswa kwebhonzo kwakawanikwa mushure memazuva makumi matanhatu nekusiyanisa nhamba uye chinzvimbo chekuvhara screws uye kuwedzera elasticity yezvimiro zvakaomarara zvakanyanya.

Kuongororwa kwemapfupa ekusabatanidzwa kunowanzosimbiswa nekuputsika kweplate. 

Kunonoka kuputsika kwendiro yekukiya kana mbambo yekukiya inguva yakakodzera sezvo micromotion inogona kuitika ichitungamira kupora kwemapfupa.

Mukutsemuka kuri nyore kunoda kudzvanywa, zvinoenderana nerudzi rwekutyoka kwete bhonzo rinobatanidzwa, 

chimiro chakasimba umo zvidimbu zviviri zvisingabatani zvinogona kutungamirira kune kusaporesa uye kuneta kukundikana kweplate. 

Iko kusanganiswa kweakaomesesa splint + kukiya mbambo + traction panzvimbo yekutyoka inoguma nefupa nonunion.

Kusiyana kweizvi ndiko kuputika panguva imwe chete kwechipikiri chekuvhara pasi pekubatanidza kwayo kune ndiro, 

iyo inokonzerwawo nekunyanya kuomarara chimiro. Izvi zvinoita kuti imwe mugumo wendiro uburitse 'muchidimbu chimwe' uye kuporeswa hakuna kuwanikwa (Mufananidzo 8).

Mufananidzo 8 Kutadza kwechipiri kwechimiro chakanyanya kuoma uye chisina kuenzana: masiruuru ekukiya akawandisa akashandiswa kure uye proximal splice ndiro yakanga isina kureba zvakakwana.

Naizvozvo, kugadziriswa kwe intracapsular fractures yehudyu ine mahwendefa ekuvhara kunogona kutungamirira kune pfupa risingaiti nokuti chimiro chakanyanya kuoma kuti chipinge panzvimbo yekuputsika. 

Pasina iyo micromotion inodiwa pakurapa, mutoro wese unotakurwa neiyo implant uye inopedzisira yakundikana.

asymmetric kuporesa tishu

Periosteal bone scabs inogona kunge isina asymmetric, 

kunyanya mukutyoka kweiyo distal 1/3 yefemur. Micromotion nekuda kwe elasticity inobvumira iyo 

yunifomu yekuvandudza kwekutyoka kuporesa tishu kunoitika chete panzvimbo dzinoenderana dzekuvhara ndiro / mbambo yezvipikiri.

 Kudzora njodzi iyi, kureba kwekushanda kwendiro yekukiya kunofanira kuwedzerwa, kungave nekushandisa mamwe mahwendefa etitanium anochinjika kana kushandisa dhizaini nyowani dzekukiya. 

Sezvineiwo, zvigadziriso zvinochinjika zvakanyanya zvinogona kutungamira kune hypertrophic bone nonunion.

Plastiki deformation yesimbi mahwendefa

Kuisa ndiro iri pedyo nekortex sezvinobvira kunoderedza dambudziko rekugadzirisa kwepurasitiki pakati peplate;

 apo chinhambwe pakati peplate uye cortex chinodarika 5 mm,

 simba rekugadzira rakaderedzwa zvakanyanya uye njodzi yepurasitiki deformation yeplate uye kukundikana kwetitanium plate yakakwirira.

Kunonoka kuputsika kweiyo diaphysis kana metaphysis pakupera kweplate yekuvhara

Ngozi yekunonoka kuputsika pakupera kwekuvhara ndiro diaphysis kana metaphysis, 

kunyanya mune osteoporotic bone, inogona kuderedzwa nekuisa imwe cortical locking nail kana standard bicortical screw pamagumo eplate kuderedza kushushikana munharaunda ino.

Mechanical Kukundikana

Mamiriro anotevera anowedzera njodzi yekutadza kwemuchina kweplate yekukiya:

1. Kugadziriswa kwehumeral diaphysis fractures kunoda kushandiswa kwezvipikiri zvina zvekukiya kumativi ese enzvimbo yekutsemuka kuti zvirambe torsion uye kuwedzera kutadza kwemagetsi; uye

2. Kugadzirisa epiphyseal fractures kwakaoma nokuti inowanzosagadzikana, 

kunyanya nokuti nzvimbo yekuputsika haigoni kuomeswa nezvipikiri zvekuvhara uye pfupa rine osteoporotic;

3. comminuted intra-articular and extra-articular comminuted fractures ye epiphysis haina kugadzikana.

 (semuenzaniso, distal femur fractures, bicondylar tibial plateau fractures, distal radius fractures);

4. medial comminution ye metaphyseal fractures inotarisa kuendesa kune inversion (semuenzaniso, proximal humerus, proximal femur, uye proximal tibia fractures).

 Kuvhara mahwendefa akasungirirwa kune lateral aspect yebhonzo inopa chimiro chakasimba chinowanzokwana 

kudzikamisa aya mafractures pasina chikonzero chekuwedzera console-type plates medially kana kuwedzera bhonzo uchichengetedza biologic fracture environment. 

Kugadzikana kunotsamira chete pane yekuvhara ndiro / yekuvhara mbambo interface, 

iyo inonyanya kusimbiswa mushure mekugadzirisa zvakare apo epiphysis inoramba yakasvibiswa kana kana iyo medial console isati yavakwazve. Iyo yekukiya ndiro inogona kuzotadza yechipiri kune kuneta.

Nokudaro, kugadziriswa kwebicondylar tibial plateau fractures uchishandisa mahwendefa ekuvhara chete padivi re lateral inofanira kutariswa zvichienderana nerudzi.

 Kune proximal humerus fractures, huwandu hwekutyoka zvidhinha, kurasikirwa kwekutsigirwa kwemukati,

 uye inversion of the epiphysis for fixation zvinozivikanwa ngozi zvinhu. Kuderedza njodzi yekukundikana kwekuvaka, 

zvimwe zvipikiri zvekukiya zvichange zvichitsigirwa nemuchina kubhadhara kusavapo kwerutsigiro rwemukati mukuderedza kutsemuka kwekunze kwakaturikirwa.

Biological Kukundikana Kukiya Plates

Iyo biological kutadza maitiro emarata ekukiya akachekwa ukuru nekutyoka kana kupinzwa kwembambo yekukiya. 

Njodzi idzi dzakakura kana bone osteoporosis iripo muskeleton, 

izvo zvinoreva kuti kugadziriswa kwepakutanga uye kudzokera kune uremu kunofanira kuitwa zvakanyatsonaka kusati kwaitwa kuporesa kwepfupa.

(1) Kubviswa Kwekukiya MaScrew

Screw extract inofambirana ne 'total' uye nekubviswa panguva imwe chete kwembambo yekukiya kubva pabhonzo kune imwe kana magumo eplate. Mune zvimwe zviitiko, 

chipikiri chinokiyiwa chinotorwa nechidimbu chebhonzo chakaipoteredza.

Mudunhu reepiphyseal, iyo imwe-chidimbu yekuvhara ndiro chimiro kazhinji inopa kugadzikana kwakakwana nekuda kwekupararira kana kuchinjika kukiya mbambo anchorage, 

uye chimiro chetatu-dimensional chinowedzera kupikisa kudonhedza screw kubva papfupa rinokanzura.

Munharaunda yediaphyseal, kuchinjika uye kupararira zvipikiri zvekukiya uye zvivakwa zvine marefu ekukiya mahwendefa ane nani ekudhonza simba. 

Mhando iyi yekuvaka inonyanya kukodzera kune periprosthetic fractures. Mune osteoporotic bone, 

bicortical stem screw fixation inopfuura monocortical screw fixation. Kune periprosthetic fractures, flat-head unicortical screws inobatsira kudzivirira kubata ne intramedullary implants.

Izvi zvinokanganisa kugadzirisa zvinosanganiswa nehurombo husina kunaka hwemafupa, kunyangwe chimiro chiri mushina.

(2) Kucheka-kunze kana kupinzwa kwemasikuru ekukiya

Kucheka-kunze kana kupinza kwezvipikiri zvekukiya zvine intra-articular kupinza kunogona kuitika munzvimbo inokanzura epiphyseal.

Uku kuchinjika kuchinjika kwe epiphyseal zvimedu zveakaderera-mass bhonzo akatamiswa akatenderedza fixation yekuvhara chipikiri.

 Izvi zvinokonzera kurasikirwa kwepiphyseal fracture kuderedza. Muchiitiko chakanakisa, iyo epiphyseal yekuvhara mbambo inopinza uye

 inopinda nekanzura bhonzo. Mumamiriro ezvinhu akaipisisa, epiphyseal locking nail inobuda mu epiphysis uye inofamba ichienda mujoini.

Aya matambudziko maviri anoitika kazhinji mune proximal humerus uye distal radius fractures. 

Nekuvhara ndiro kugadzirisa kweproximal humerus fractures, zvinokurudzirwa kuti kureba kwe 

epiphyseal locking mbambo inogumira kuderedza njodzi yeingrowth uye yechipiri majoini kupinda.

Kukundikana kwekugadzirisa uku kunokonzerwa nekusakwana kwehutano hwemapfupa uye hukuru hwekutanga kubviswa kwezvimedu zvekuputsika zvisati zvaderedzwa, 

kunyange kana chimiro chacho chiri mechanically intact.

Joint Rehabilitation uye Immediate Weight Bearing

Kudzoreredza uye kutakura uremu kunobvumidzwa chete mushure mekugadzirisa kwakakwana kwave kuwanikwa uye kusimbiswa pane postoperative X-rays.

Zvidzidzo zveBiomechanical zvakaratidza kuti mumapfupa akajairwa, kana mukaha pakati pezvimedu uri pasi pe1 mm, 

kutakura uremu kunogoneka pasina njodzi. mushure me 1 mamiriyoni ekutenderera, kuoma kwakafanana neiyo yemapfupa akajairika, iyo yakakwana kuti kuporesa kuitike.

Kana zvimiro zvinonzwika, mahwendefa ekuvhara uye zvipikiri zvekuvhara-kona zvinobvumira kukurumidza kudzoka kune 

kutakura uremu nekuti mutoro unotamiswa zvakananga kubva pachipikiri chekukiya kuenda kune yekukiya ndiro, pasina njodzi yekutadza kugadzirisa pane chipikiri-plate junction.

Zvisinei, kana axis ye-multiaxial locking peg isiri perpendicular kune yekuvhara ndiro, kutanga kwekutakura uremu hakubvumirwi.

Kune MIPO, kutakura uremu kwekutanga kunobvumirwa kuwedzera-articular, nyore uye / kana nyore comminuted fractures. 

Akareba chaizvo zvimiro zvinochinjika zvakakwana nealternating bicortical yekukiya zvipikiri uye kuvhurika kwekutakura mitoro uye kugovera.

Mhedziso:

1.Biomechanical zvidzidzo zvakaongorora marudzi akasiyana-siyana ezvivakwa uye maitiro avo emagetsi.

Mabhuku anobatsira kusimbisa tariro dzedzidziso dzakabatana nerudzi urwu rwekugadzirisa. 

Nekudaro, mabhuku achangoburwa anoratidzawo matambudziko ehunyanzvi uye kutadza kunoenderana nekukiya marata.

2.Chikonzero chikuru chekutadza kuronga kusakwana kwehunyanzvi hwekuvhiya, 

izvo zvinoda zvakanyanya, kunyanya kana uchiita maitiro mashoma ekupinda.

3.Kutyoka kunofanirwa kugadzikwa patsva, pasina kukiya ma screws mundiro,

sekugadzirisa zvisina kunanga kweplate nekuvhara ma screws hazvigoneke.

4.Chimiro chinofanira kuva chehurefu uye simba rakakodzera, 

izvo zvinoreva kuti chiremba anovhiya anofanira kunge akajairana nemitemo nemitemo inotungamirira kushandiswa kwemahwendefa aya. 

Saka chimiro chinofanira kunge chiri elastic, nenhamba shoma yenguva dzose yakaparadzana yekukiya screws inochinjana nemaburi asina chinhu.

5.Pasinei nekudzikama kuri nani kwekutanga kwekuvhara mahwendefa, 

kugadziriswa kwechimiro kunogumira nekuoma kwekuputsika, hutano hwekudzikisa, uye hutano hwehupenyu hwepfupa.

6.Kana iyo dhizaini iine mechanically intact, kunaka kwepfupa kwakanaka uye kuputsika kuri kuwedzera-articular, 

murwere ane kuzvimiririra kwakakwana anogona kubvumirwa kutakura uremu pagumbo rakatyoka. Muzviitiko zvakawanda, kukiya kweplate kugadzirisa kunobvumira kugadziridzwa kwekutanga.