Imigomo engu-5 ye-Intramentuuntary Nail kanye namasu okuhlinza!

Izimiso eziyisisekelo zokungena emgqeni

1. Umlando Wokungena Ngezintambo

Ngo-1910, kwakusetshenziswa ama-lilienthal aluminium ama-intramenguntary nails asetshenziselwa ukwelapha ama-femove shaft fractures.

Ngo-1913, uSchone wasebenzisa izipikili zesiliva ezokwelapha ama-forearm fractures. 

I-Kuntscher (1900-1972) yenza iminikelo emikhulu ekuhlelweni kwezipikili ezihlangene. 

Iminyaka yo-1960 no-1970 yaba yinkathi yokuthuthuka okusheshayo kwezipikili ezihlanganayo. 

Izwe lami belisebenzisa ngobuningi kusukela ngo-1990s.

2. Ukuncishiswa okuvulekile nokuncishiswa okuvaliwe

1. I-LIMB Fractures ingancishiswa ngokuhlinzwa ngaphansi kombono oqondile noma ivaliwe ngaphansi kokuqapha i-X-ray.

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3. Kunconywa ukusebenzisa ukuncishiswa okuvaliwe ngangokunokwenzeka. Ukuncipha kwe-traction kungasetshenziswa, noma ukuvela okuncane kungenziwa ngendiza yokuqhekeka ku-PRY futhi kunciphise, ngaleyo ndlela kunciphise ukuphazanyiswa ngokunikezwa kwegazi ekupheleni kwegazi.

I-4. Ngokuhluleka ukuncipha okuvaliwe, i-bone Fluggn Flipping noma ukubhoboza izicubu ezizungezile, kanye nezingcezu ezinkulu zokuqhekeka ezisele, ukuncishiswa okuvuliwe okuhlile kungasetshenziswa.

I-3. Indlela yokulungisa yezipikili ye-intrametundary

1. Indlela yokulungiswa kwangaphakathi kwe-intrametundary kuyinto elula splint splint.

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I-3. Ukulungiswa okuphakathi kuphakeme ngokweqiniso ku-cortical yangaphandle yokulungiswa kwangaphandle, okunganciphisa ingalo yamandla, kunciphise izehlakalo ze-Valgus Mongatunation kanye nokwehluleka kwangaphakathi kokululeka.

4. Ukulungiswa kwezipikili kwe-intramenduvaty kunikeza isisekelo sokuncishiswa okuvaliwe noma ukuncishiswa okuphezulu okulinganiselwe.

4.Amage angenawo izipikili ezihlekisayo

1. Zimbalwa izinkinga

2. Ububanzi obunwetshiwe bezinkomba zokuhlinzwa

3. Ukulungiswa okuqinile

4. Ukuqeqeshwa kokusebenza kokuhlangana kusenesikhathi

5. Ukuthwala kwesisindo kusenesikhathi

I-6. Ingasetshenziswa ngokuhambisana nokunye ukulungiswa kwangaphakathi

Izinhlobo eziyisisekelo namasu

1. Ukukhiya kanye nokungakhiphi izipikili ezivalekile

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3. Ukunwetshwa kwama-medullary kanye namasu wokulungiswa okungahleliwe

4. Amasu wokulungiswa avulekile futhi avaliwe

Ukuhlangana nokungahlanganisi

Izipikili ezijwayelekile ze-intramenduvact zinokuqina okuxakile kwama-axial kanye namandla aphansi aphansi, kepha banokuqina okuthile futhi bangalulama ngemuva kokuphela, babangela kuphela inani elincane le-intrambone elingenayo.

Ukudlulisela izipikili ze-intramenduvationary izipikili zinokushisa okungcono nemiphumela yokulwa nokucindezela, ukuqina okuhle, nokuhambisana nomgomo wokulungiswa kwemvelo. Zisetshenziswa kabanzi emathanjeni amade ezilenzi. Ikakhulu ngesegcekeni ehlukahlukene kanye nokuqhekeka okususiwe, kunokuqina okungcono kunezinzipho ezijwayelekile ezijwayelekile.

Dynamization of fittation static

Izipikili ezikhiyiwe ze-Static ezivalekile zikhiqiza imaski encane kakhulu yokucindezela futhi okwamanje zigqugquzelwa kakhulu ngesenzo esingesihle sokushintshana.

Ukuqhekeka okungakaze kuphulukise ezinyangeni ezi-6 kuye kwezingu-8 ze-postoperatively, ekuxhumekeni kwamathambo e-SITU noma ukufakwa esikhundleni kwezipikili ezinwetshiwe ezinamandla ezisetshenziswayo zivame ukusetshenziswa.

Ama-Dynamization angasetshenziswa njengendlela yokukhuthaza ukuphulukiswa kwe-Fracture. Akunconywa njalo ngoba kungahle kuholele ekunciphiseni kwemilenze nokuguquguquka kokushintshana.

Ukunwetshwa komongo nokungenzi uhlangothi olungewona umshado

Ukunwetshwa koMarth kungafaka izinzipho zomculo ezinobubanzi obukhulu namandla amakhulu, okulungele ukuqeqeshwa kokusebenza kwangaphambi kwesikhathi futhi kunciphise izinga lezinzipho eziphukile.

Ukunwetshwa koMarth kungakhiqiza inani elikhulu lemfucumfucu yethambo ngomphumela we-osteondective, okulungele ukuphulukiswa kokuphulukisa.

Ukunwetshwa koMnyango kuzolimaza ukunikezwa kwegazi kwemikhumbi yezakhamzimba kanye nolwelwesi oluphelele, kepha imithambo yegazi ingavuselelwa kabusha emgodini wezipikili ezihlanganayo. Ukunwetshwa koMartor kungakhulisa ukujikeleza kwegazi emisipha yezicubu ezithambile ezungeze izicubu ezithambile zezicubu, ngaleyo ndlela kukhuthaza ukuphulukiswa kwe-fracture.

Ukunwetshwa koMarth Kukhulisa amathuba okutheleleka kanye nokuthembela, futhi kufanele kusetshenziswe ngokuqapha kokuhlubuka okuvulekile, ukulimala okuningi, kanye nokulimala okuyinkimbinkimbi.

Izinzuzo zokunwetshwa kwe-medullary

Ngemuva kokunwetshwa kwe-medullary, indawo yokuxhumana phakathi kwezipikili ezihlekisayo nethambo lenyuka, elithuthukisa ukuqina kokulungiswa. 

② Ngemuva kokunwetshwa kwe-medullary, ububanzi obukhulu be-intramenduvalundary nail bungasetshenziswa, obukhulisa amandla enkangala ye-intramedullary futhi yehlise izinga lezinzipho eziphukile. 

③ imfucumfucu yethambo ngemuva kokunwetshwa kwama-medullary kungakha amandla ukwakheka kwamathambo okusha, okulungele ukuphulukiswa kokuphulukisa.

Uma kuqhathaniswa nokwanda kwe-medullary ukunwebisa izipikili, izipikili ezinganwetshiwe ezinwetshiwe zinezinzuzo ezilandelayo

① isikhathi sokusebenza esifushane nokopha okuncane. 

Ukuphazanyiswa okungaphansi kokugeleza kwegazi okuphelele ezimweni ezinokulimala kwezicubu ezithambile ezithambile.

Ukusetshenziswa kwe-intrametullary nail

Ukuhlangana okuvumelanayo kwezipikili zomculo

Izinkomba zezipikili ezithobekile

Izinkomba zokuvumelanisa izipikili ezithobelayo ekwelapheni ama-shaft we-shaft anxusa yilezi: ukuqhekeka ngomonakalo we-vascular ne-nerve, ukulimala okuningi, ukuphazamiseka okungazinzile, nokuqhekeka kwe-pathological, kanye ne-proxilal fractures fractures.

Ibanga elingalungiswa lisuka ku-2cm ngezansi kwekhanda elithobekile kuya ku-3cm ngaphezulu kwe-Olecranon Fossa. Ungakhetha ukukulungisa kusuka ehlombe nge-Antgrade intramentary nail noma kusuka endolini nge-retrograde isipikili.

Izici zezinhlanzi ezithobekile

Izindlela zokulungiswa kokuhlinzwa ze-Humeral Shaft Fractures zingukulungiswa kwepuleti kanye nokulungiswa kwezipikili okuhlangene.

Ukulungiswa kwepuleti kunama-anti-rotation aqinile kanye nezakhiwo ezi-anti-ejensi futhi kugxile ngokuqinile, kepha ukuhlukunyezwa okuhlinzayo kukhulu, kungenzeka ukuthi amathuba okutheleleka aphezulu, futhi ama-radial nerve alimala kalula.

Izipikili zanamuhla zokuvumelanisa nokuzikhiya zinqoba ukushiyeka kwezinzipho ezijwayelekile ezifana nokuqina kwe-axilwary, ukukhishwa kwegazi kumiswe ngokuqinile, ukulahlwa kwegazi kuncane, umthwalo uyasatshalaliswa, i-callus iyasatshalaliswa ngokuqhubekayo, futhi umsebenzi osebenzayo angaqalwa ngemuva kokuhlinzwa.

I-Femoral interlocking i-intrametullary nail

Izinkomba zezinzipho zokuxhumana zabesifazane

Zonke izinhlobo zokuqhekeka kwe-2cm ngezansi kwe-vertebra ye-trochanterteric kanye ne-9cm ukusuka edolweni elihlanganisiwe.

Ukuphazamiseka okudala kwengxenye ephakathi ye-femolf shaft.

Iziguli ezine-Floud Plate zangaphakathi zokulungiswa.

Izici ze-Femoral interlocking nail

Izinzuzo Zomshini

Ingalo yamandla we-Feofleralting inteing intrametundary nail foting fractures isikhathi eside kunalena amapuleti ensimbi, futhi amandla asatshalaliswa ngokulinganayo eksishini ephakathi nendawo, okungekho lula ukugoba nokucima.

Izipikili ezivalekile emaphethelweni womabili ama-intramenduvaltary nail enza ithambo lonke lisuka phezulu liye phezulu, futhi izipikili ezikhiya endaweni ebhulazayo zinganciphisa ukuncipha nokujikeleza nokuqina, futhi kufinyelele ukuqina okuphezulu nokuqina kokulungiswa okuphezulu.

I-Gamma ihlangana nge-intrametullary nails

Izinkomba ze-Gamma Nail

Kusebenza ezinhlotsheni ezahlukahlukene zokuqhekeka kwePeritrochanterteric, ikakhulukazi ukuqhekeka okuphansi.

Kunwetshiwe i-GAMMA isipikili (kabusha izipikili)

Ukuqhekeka okuphezulu okuphansi, i-trochanteic kuhlanganiswe nemigodi yama-femoral shaft fractures.

Izinzuzo ze-Gamma Nail

Kuthuthukiswe ngokuhlanganisa isikulufa se-sliding hip nge-intrametundary Nail Technology, i-main nail isondele ngaphakathi kwepuleti ye-medullary kune-clip ye-hip eshukumisayo, ngakho-ke i-gamma nail yenza isisindo sesiguli eduze kwepuleti yesiguli, yandisa amandla omshini wokufakelwa. Ukuqhekeka okuphansi okubandakanya ukuqondiswa kwe-medical cortical, i-gamma nail ivimbela isidingo sokwakhiwa kabusha kwe-anatomy, ngakho-ke kuwusizo ekuqhekekeni kwe-intertrochantteric noma ukuqhekeka okuphansi.

Phinda ubuyekeze izikhala zowesifazane

Izinkomba zokubuyisa izipikili zabesifazane

Ngokuyinhloko esetshenziselwa ama-supracondylar Feofralylar Fractures, kufaka phakathi ama-fractures afakiwe ahlanganisiwe kanye ne-intercondylar 't ' kanye '

Ingasetshenziselwa futhi ama-floveral fractures ngaphansi kwe-isthmus ye-femur.

Shaft Feralyylar Femorylar Femorylar, kanye ne-Intercondylar fractures kungakapheli i-20cm ukusuka e-Knee Joint.

Labo abahlulekile ukulungiswa kwepuleti.

Izici ze-Retrograde Femoral Killing

I-Supracondylar Feamral Finalture ingukuqhekeka okukhulu ngobunzima okokuqala, ukuncishiswa nokwesibili, ukulungiswa okuqinile kwangaphakathi. Kunezigameko eziphezulu zezinkinga ezinjenge-fracture non-Union futhi zibambezele ukuphulukiswa.

I-Retrograde Ukuvuselela I-intrametullary Kingling kuyindlela esetshenziswa kakhulu yokwelapha ukuqhekeka kwe-femur edakayo eminyakeni yamuva, okunokuqina okuhle kwemishini, kungalawula ngokuphumelelayo ekuphangethweni kokuphela kokuphela kokuphela kokuqhekeka kwe-distral, futhi kusiza ekuhambeni okuhlangene okuhlangene.

I-Supracondylar ehlanganisiwe yesiqu sowesifazane i-Fracture ihlelwe nge-supracondyloarylar ye-intracondyloarn inciling, exazulula inkinga okunzima ukuxazululwa ngokuxhumanisa ukukha kwezintambo kwe-femur. Ithuluzi lilula ukusebenza, linembile ekumeni, elithembekile ekulungiseni, futhi isiguli singenza izivivinyo zokuqala zamadolo ngemuva kokuhlinzwa.

I-Tibial ihlangana ngokuxhunyaniswa kwezipikili zomculo

Izinkomba ze-tibial zikhala

Ama-Fractines aqinile maphakathi ne-1/3 yeTibia: Amahlaya aguqukayo, ama-fractures amafushane we-oblique, i-pseudarthrosis.

Ama-Fractures angazinzile ngaphakathi kwama-60% wobude be-Middle Tibia: Ama-fractures aseduze kwe-metaphysis, ukugcwala okuthe xaxa, ukuqhekeka kwezingxenye, ukuphazamiseka okubekiwe, ukuphazamiseka kwezimpawu zamathambo.

Izici ze-tibial zikhala

Ukuncenga ukuvela kwe-intramenduvary kwe-tibia kusetshenziselwa kakhulu ama-tibia fractures.

Yize futhi kungasetshenziselwa ukuqhekeka kwe-proximal kanye ne-distal tibia ukuphahlakala, i-maloumbang rate iphakeme kakhulu, i-malounion yenzeka kaningi, i-fracture end ine-≧ 1cm yokunyakaza ku-1/1 kwezingu-1

Izincwadi zibike imiphumela engcono yokuqhekeka kwe-tibia distal tracture kune-proximal tibia fracture ngemuva kokulungiswa kokulungiswa kwe-fibula.

Amasu okuhlinza

Ukulungiselela okusebenzayo kwemishini ekhethekile

Umbhede we-Orthopedic (umbhede we-traction) noma umbhede ojwayelekile wokuhlinza we-fluoroscopic; i-retractor; Ukuqina kwesithombe.

Ukukhetha okulungile kobude bezipikili be-intrametundary for prepoperative endoproprostheses

Iredijigraph

Isilinganiso sobude besikhashana sobumba

Ububanzi be-intramenduvary nail

I-X-ray usthmus ububanzi

I-intramenduvationary nail ubude isilinganiso

I-1.translucent mbusi ukuzimisela ngaphansi komshini we-C-ARM

Imikhawulo ye-distal kanye ne-proveximal yethambo ayesenkingeni ye-ray; UMbusi wayefana nedayidi.

2.Ukulinganisa okuthe ngokulandela imidwebo yomzimba

I-Femur: Ithiphu ye-trochanter enkulu → i-lateral knee space noma i-polo ephakeme ye-petella; I-Tibia: Isikhala se-Medial-Laede Space → Isici se-Anterior sokuhlanganiswa kwe-ankle ku-doriflexion of unyawo.

I-intramentundary Nail Incount Techtique - Indlela yokungena

I-eksisi ende ye-haditullary cavity emgqeni oqondile

Hhayi eduze kakhulu endaweni yokungena

Ubude obufanele: I-Dilated - Inde; kungafakwanga - kufushane

(Ukuqinisekiswa okuqondile kwephuzu lokungena; akukho pullep dilation, akukho ukuvikela izicubu ezithambile)

Parallel femoral izipikili iphuzu lokungena isipikili

Ukulungiselela iphuzu lokungena le-Flovel Femolvelvel Nail

I-HIP Flexion kanye nokwengeza

I-Longitudinal incision proximal ku-trochanter enkulu

Hhayi emuva kakhulu emuva

Ukubekwa kwe-PIN Yesiqondisi

Ukubekwa kwesihlangu esithambile sezicubu

Phinda ubuze isifayiso sowesifazane we-intraundary Nail Photo

30 ° Knee Flexion

I-Axis ende ye-PIN ye-Guide inkomo efanayo ne-medullary cavity yesiqu sosizi sangaphansi

Ukufakwa kwe-pin ye-kirschner ku-distal femur nge-patellar ligament ngokusebenzisa umkhono wokuvikela: Orthogonal - maphakathi ne-intercondylar fossa ye-femur; I-Lateral - Umugqa weBlumensaat

Ukuqala kwephuzu le-PCL ngaphandle kokulimala

Parallel tibial intramenduval nail Iphuzu

Ku-Centerline of the Medullary Cavity

Umugqa wangaphandle wethafa le-tibial

Phezulu ngangokunokwenzeka ngaphandle kokulimaza ithafa

Ubukhulu be-knee flexion

I-Incision Tuberoluty Tubethole e I-Pole ephansi ye-Patella eceleni komgodi we-medullary

Vula i-cavity ye-medullary: umhlahlandlela pin ku-15 ° kuya endizeni ye-sagittal ye-eksisi ende ye-tibial stem

Isikhundla sokuqina kwesithombe

Amasu wokubala

Ukwehliswa okunamandla kagesi

ama-fractures amasha

Ukuncishiswa okwenziwa ngesandla

Ukuqhekeka okudala nge-pseudoarthrosis, i-sclerosis emgodini we-medullary

Akukho msulwa ngaphansi kwe-inflation

ukujikeleza kwegazi kumnandi kakhulu

Amasu Okuphindisela

Parallel femoral inbalaing

Izizathu zobunzima ekubuyiselweni kokuhlaselwa kwabesifazane

Ukugoqwa kwezicubu ezithambile ezithambile akuvumeli ukufinyelela okuqondile kuthambo

Iphoyinti lokungena ngenaliti alikwazi ukubonwa ngokuqondile

Ukwengeza okuhlanganisiwe kwe-Hip → ILiac Fascia Tension → FRACTURE

Ukuncishiswa kwe-tibial kokuncipha

Amandla okukhohlisa

Iningi lihlehlise futhi kulula ukuhambisa i-palpate

I-Stacture Ezinzile - Maphakathi noma Distal A no-B Fluacture

I-Oblique Fractures - Obkique

I-intramenduvary liailing → Amathuluzi wokuthuthwa

Izindlela zokuncipha ezingezinyuka

Amaphoyinti wokunciphisa amaphoyinti

I-Tibia; ukusetshenziswa kwe-percutaneour noma ukulimala

Ama-retractors amakhulu (Braces)

ukuncishiswa okubambezelekile; Ukunciphisa umlenze

Izikulufo zesikhashana zeSchanz

① Femur, Tibia

② isondele kumugqa we-fracture ngangokunokwenzeka

③ Ukusetshenziswa kwe-Proximal single cortical ukusetshenziswa

Sucse i-chuck Universal enesibambo se-t ukuze uthole kalula

Poller nail

Ukuqhekeka kwe-Memetaphyseal (ukulungisa umugqa wamandla, kuqinisa ukubuyiselwa, ukubuyisela ukusebenza)

② ukuqhekeka oku-oblique kwe-distal tibia noma i-femur (ukucindezela kwe-shear → ingcindezi)

③ Izipikili ezingezinhle ezihleliwe zingena esiteshini esidala se-medullary ngesikhathi sokuhlinzwa kwesibili

④ Iphuzu elingezinhle lokungena, ukuvumelanisa okumpofu kwe-proximal fracture (isikulufa sibekwe nge-perpendicular ekudingisweni okungenzeka kwe-endoplant)

I-torniquet ebanzi eyengeziwe

① Tibia

② Ingezelelwa yi-traction noma i-retractor

③ Sebenzisa ngokuqapha ekulimaleni kanzima kwezicubu ezithambile

④ Yigcine iDemo

⑤ yenqabela ukunwetshwa kwe-medullary esimweni esisezingeni eliphezulu

Ukulandelana kokukhiya kwezipikili: distal ke proximal

Izinzuzo

Ukukhululeka kokucekela phansi, ukucindezela kwekhefu lokuphuka; ukuqedwa kokuhlukaniswa; imisebenzi yokunciphisa.

Amasu wokunciphisa ukuhlinza okubambezelekile nokungazinzi

Izinkinga ezingahle zihlangane nokuhlinza okubambezelekile

Ukukhubazeka kwe-Axial (ukufinyeza, ukunyathelana kanye nokufuduka)

Ukukhula kwezicubu zomzimba

Amathambo okuqala amathambo

Sclerosis yekhefu lokuphuka ngokuvalwa kwe-medullary cavity

I-Osteoporosis

Izinkinga ezingenhla ezingenzeka

Deflection of the reflender kanye ne-intrametuundary nail → ukungena kwezipikili okuhlangene kwe-cortex

Ukukhubazeka kwe-angular → retractor

Ukusatshalaliswa kweziphetho ezinqunyelwe → isipikili sempova, ukulungiswa kwepuleti

Izindlela zokuvimbela imigqa yamandla angajwayelekile

Proximal - iphuzu lokungena elilungile

Distal - isipikili esiphakathi nendawo enkabeni ye-medullary cavity

Izinkinga zokungena ngaphakathi

★ Ukutheleleka

★ ukulimala kwezinzwa

★ ukuphulukiswa okuhlanekezelwe kwama-fractures

★ Ama-Medical Fractures

Ukujikeleza kwangaphandle, i-torsion, i-Valgus, ukujikeleza kwangaphakathi, ukunyathelana

★ ubuhlungu obuhlangene obusondelene

★ ama-fat embolism

★ Hetetotopic Ossification

★ ama-pulmonary embolism

★ kabusha

★ i-thrombosis

★ ukuqina okuhlangene

★ okungeyona inyunyana ye-fracture, i-bone nonunion

★ Ukwehluleka kokulungiswa kwangaphakathi

★ umlenze ukunciphisa

★ Ezinye

Izinkinga - Ukutheleleka

Ngo-intanethi, ukuvula ama-fractures kwakubhekwa njengokuphambana nokukhahlela kwentambo.

2.I izehlakalo zokutheleleka nge-postoperative kuma-fractures avulekile kuya ngesimo sokulimala kwezicubu ezithambile nokungcola

Isigameko sokutheleleka ngemuva kokuphuka okuvulekile kuncike esimweni sokulimala kwezicubu ezithambile nokungcoliswa kanye nendlela izicubu ezithambile ezilawulwa ngayo.

3.Thinner intramentary izipikili zandisa amathuba okutheleleka; Ukulungiswa okunganwetshiwe kokukhiya okungenamkhawulo kokulungiswa kwezipikili kumpofu, futhi ama-bone amaphewo

Ukufakwa kwezipikili okungenakunqotshwa kwe-intrametullary kwe-intramengrary kumpofu, ngokuhamba kwemicroscopic kokuphela okuphukile kwethambo kanye nethambo elisele, okulula ekukhuleni kwamagciwane.

I-4. Ukusetshenziswa kokulungiswa okunwetshiwe okunwetshiwe nokunqunyelwe akunakuthuthukisa ukuqina kokuphuka, kodwa futhi kugwema ukwakhiwa kwesikhala esifile.

I-Fat Embolism Syndrome

1.Isigameko se-FES ye-Fractures ende ye-tubular fractures yi-0.5% kuya ku-2%.

2

3.Kwandisa iMedulla, inqubo kufanele ixoke ngobumnene, igweme amandla amaningi nokusebenza kanzima.

4.Ukuxilongwa kwamanje kwe-Fes kusamukele izindlela ezihlongozwe yi-GRD ngonyaka we-1974, futhi ukwelashwa ngemuva kokuxilongwa kuzoba nokuthola isikhathi esingcono kakhulu sokwelashwa futhi kungaba nemiphumela emibi.

Ukubambezeleka kokuphulukiswa kwe-fracture kanye nethambo

Izici ezahlukahlukene zithinta ukuphulukiswa kwe-fracture ngemuva kokulungiswa kwezipikili zomhlaba, futhi izimbangela zingahle zihlaziywe ngokulandelayo.

Izicubu ze-1.Soft zishumeke ekugcineni kokuphela

2. Ukwehlukaniswa kwe-transverse fracture kuyaphela

3. Iminyaka Edala Yesiguli

4. Vula i-Fracture, ukulimala kwezicubu ezithambile, i-hemodialysis yendawo engathi sína noma ukutheleleka.

I-5

I-6. Isifo sikashukela esihlangene mellitus noma ezinye izifo eziqoqiwe.

Ama-Medical Fractures

Ama-fracture angenziwayo ngokwelashwa ikakhulukazi ama-fractures asesebusuku abangelwa ukukhohlisa okungafanele ngesikhathi sokulungiswa kwezipikili ezihlangene.

Ukunakwa kwe-intraperaperative kufanele kukhokhwe

1. Ukukhethwa okungalungile kwephuzu lokungena kwezipikili kungaholela ekuqhekekeni kweProximal.

2. Ungacindezeli ngokucindezela ekwandeni kwe-medulla.

I-3. Ukungena kokunwetshwa kwe-pulp kufanele kube ngendlela efanayo nesiqondiso sokufakwa kwezipikili.

4. Musa ukusebenzisa amandla lapho ufaka izipikili ezihlekisayo ekugcineni.

Ubuhlungu ekuhlanganiseni okungomakhelwane

1. Ukubekwa kwesipikili esijwayelekile kufaka izicubu ezithambile ngisho ne-capsule ehlanganisiwe eduze okungenani okungu-1 ohlanganiswe.

2 Uma iphuzu lokukholiswa lisondele kakhulu phezulu noma ububanzi be-intramenduvaltary nail bukhulu kakhulu, kungadala ukulimala kwezakhiwo ze-intra-articular, okuholele ekubuhlungu kwedolo.

I-3. I-Proximal Promplion ye-intrametullary nail kanye ne-heterotopic ama-ossalification yizimbangela eziphambili zobuhlungu be-hip ngemuva kokuhlinzwa kwezipikili ze-feover.

I-4. I-Proximal Protorion ye-intrametullary nalists, ukuhanjiswa kwe-proximal yokuvala izipikili nokuphazanyiswa kwe-culf