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fixare interna de fractura de sold

intertrohanteriana reducere
deschisa
LESSER
TUBEROSITY
Pelvis AP i AP old de un pacient n vrst
cu o fractura de sold intertrohanteriana trei pri.
LATERAL RADIOGRAPH
nfiinat pe masa fractura nu are nevoie de piciorul lezat s fie plasate n
hyperflexion i rpire. Picioarele pot fi plasate ca foarfeci pentru a
permite bune radiografii laterale de partea afectat, fr a pune la old
opus la risc.
ISCHIUM
LESSER
TROCHANTER
FEMUR
This image demonstrates the position of the fracture
table with the patients affected arm over the chest
and well padded.
SCDs ON
DURING
PROCEDURE
Observai c dispozitive de compresie secventiale rmne
pe picioare n timpul procedurii.
Un punct de vedere de mai jos demonstreaz poziia braului.
C-braul este adus dintr-un unghi de aproximativ 30 de grade
distal de pacient. Radiografia AP este luat cu C-arm
uor peste rotit pentru a oferi o imagine mai perfect AP cu respect
la anatomia a femurului proximal i punctul de vedere lateral.
Incizia trebuie s nceap proximal la trohanteriana
creast i au nevoie de a extinde de aproximativ 10 de
centimetri n jos a coapsei.
ITB
Incizia adus pn la nivelul a
Iliotibial trupa i fascia lata.
ITB
Trupa iliotibial este incizat cu un cuit. A Metzenbaum
foarfece este folosit pentru a diseca dedesubtul benzii, care este mprit
n conformitate cu incizie.
Trupa iliotibial este incizat cu un cuit. A Metzenbaum
foarfece este folosit pentru a diseca dedesubtul benzii, care este mprit
n conformitate cu incizie.
Cu retragere a benzii iliotibial, vast
fascia lateralis este vizualizat.
VASTUS
LATERALIS
ITB
A sharp rake is introduced anteriorly and is used to retract the
vastus lateralis anteriorly. An incision is then made in the
fascia just anterior to the most posterior aspect of the femur.
A sharp rake is introduced anteriorly and is used to retract the
vastus lateralis anteriorly. An incision is then made in the
fascia just anterior to the most posterior aspect of the femur.
A periosteal elevator can be used to elevate the lateralis
off the femur with care taken to avoid perforating branches.
A Bennett retractor can be placed over the anterior
surface of the femur, exposing the lateral edge of
the femur.
AP x-ray demonstrating abduction of the proximal fragment
and displacement of the posteromedial fragment.
A bone hook can be used, as can a clamp or other
technique, to reduce the abduction in the proximal
fragment.
Once a reduction is obtained and confirmed on the AP and
lateral radiographs, the angle guide is placed against the
lateral surface of the femur in order to place the guidewire
for the lag screw.
The natural anteversion of the hip requires commensurate
external rotation of the jig in order to drive the wire into the
center of the head.
X-rays demonstrating the position of the guidewire
through the jig in the AP and lateral planes.
After the appropriate measurement for the lag screw is made,
the femur is prepared by reaming. In this case, a long barrel
was chosen and the appropriate reamer is selected.
If the bone is of good quality, a tap may be used.
AP radiograph of the lag screw being terminally seated.
When using a small incision, the side plate must be slid from proximal
to distal along the femoral shaft, then drawn back up proximally such
that it is within the wound.
In order to seat the side plate, its distal end must be held
gently off bone, such that the side plate is parallel with the
femur in order to engage the lag screw.
Once the plate is terminally seated and tapped in place,
it is affixed to the cortex using standard screw fixation.
AP radiograph of the lag screw and side plate in position.
In this particular situation, the posteromedial fragment was
rather large, thus it was elected to fix it with a lag screw.
This must be done from a position anterior to the side plate.
This is the case because the side plate must be slightly
posterior to the midline in order to direct the lag screw
into the center of the head, given the normal anteversion
of the neck.
The posteromedial fragment cannot be lagged through the
plate because the angle of the screw through the plate
would be too great. Thus, the screw is placed from anterior
to the plate as seen in this figure.
Lateral view of the posteromedial fragment
reduction with a clamp.
The image shows the drill that is placed into
the lesser trochanter.
Final AP radiograph demonstrating excellent fixation and
compression across the intertrochanteric fracture as well
as lag screw fixation of the lesser trochanter.
ITB
The closure is then performed with a running
stitch of the vastus lateralis.
ITB
The iliotibial band is repaired using interupted sutures;
the skin will then be closed in layers.