Compression sliding goose head nail plate internal fixation

Intertrochanteric fracture is a common injury in the elderly. Because the intertrochanteric is a cancellous bone, the old bone is brittle and the tensile strength is weakened, which is easy to cause fracture. The age of onset was about 10 years higher than that of the femoral neck fracture. The injury is heavier, and the treatment seeks to prevent complications and reduce the mortality rate. In terms of treatment and prognosis, it is mainly suitable for stable classification. Stable patients can achieve good femoral moment and medial cortical alignment after rectification. Another type, such as femoral moment fracture and separation, small trochanteric fractures and comminuted fractures are displaced, it is unstable. There is no complete medial cortical and femoral moment after the restoration. The more vertical the fold line is, the more unstable it is, and the greater the endurance, the more likely it is to have hip varus, external rotation, and shortened deformity. There are many types of pressurized sliding goose nails, and their structures are similar. At present, the domestically produced pressurized sliding goose nail consists of four parts: a sleeve steel plate and a set screw. The angle between the steel plate and the sleeve is 135° and 150°. 2 tension screw: The rod is hexagonal and inserted into the sleeve, which can slide but cannot rotate. The head has a large thread and a threaded hole at the end that can be screwed into the compression screw. 3 Pressurized screw: After screwing the end of the compression screw, the screw is slipped and the bone end can be pressed and fixed. The advantage of the pressure-sliding goose nail is that the fracture is firmly fixed. Some patients can be abducted and moved to the ground early. For cases of severe osteoporosis, the rate of femoral head penetration is often lower than that of the goose head nail. Treatment of diseases: femoral neck fracture Indication Pressurized sliding goose nail plate fixation is suitable for: 1. Stable and unsteady intertrochanteric fractures. 2, under the trochanteric fracture. It is fixed by long sleeve steel plate and is relatively firm. 3, femoral neck fracture, short sleeve steel plate can be applied. Contraindications The old body is weak and has serious complications such as severe heart and lung, and cannot bear the operator. Preoperative preparation 1, the patient should be examined in detail before surgery, especially the cardiopulmonary condition. Determine whether you can undertake surgery. 2, with blood 400 ~ 600ml. Use a suitable length of pressurized sliding goose nail. 3, the limb should be fixed before surgery to relieve pain, which is conducive to fracture reduction. Surgical procedure 1, reset In order to achieve stability between the fractures, the femoral head neck bone piece must be in contact with or inserted into the broken end of the bone to achieve bone stability. The reduction can be divided into two cases: 1 there is no insertion between the fracture pieces, as long as the slight traction internal rotation and abduction can correct the hip varus and excessive forward tilt, and basically achieve anatomic reduction. 2 If the tip of the femoral head and neck bone piece has been inserted into the distal end of the fracture, accompanied by obvious hip varus and more fracture pieces, the fractured end has been inserted into each other, making the unstable fracture into a relatively stable fracture, anatomical reduction It is often difficult to reset the hip joint, correct the hip varus and make it valgus, and the fracture end remains inserted, and the internal displacement is achieved. In this case, the fracture ends are inserted into each other. The stress on the hip is transmitted from the bone end to the end of the bone, and the increased hip valgus angle compensates for the reduced limb length of the bone end. 2, cutting The trochanteric region and the upper end of the femur are exposed through the lateral incision of the upper femur. The upper half of the incision can be cut first to reduce bleeding. 3, enter the positioning guide pin 3cm below the attachment point of the large trochanter, corresponding to the small trochanter plane, a hole is drilled in the lateral femoral cortex, and the 135° guide guide is placed at the bone hole, and the femoral head and neck are oriented along the guide. Insert the guide pin and use the X-ray to view the positive position of the hip to determine the position of the guide pin. The guide needle should be located at the center of the femoral head, or below and behind, that is, within the dense pressure line of the femoral trabecular trabeculae. The needle end should be 1cm from the subchondral bone of the femoral head. 4, joint drilling and bone drilling The length of the guide needle outside the cortical bone was measured, and the length of the guide needle entering the bone was calculated. The guide pin is then drilled into the acetabular bone to prevent the guide pin from loosening out when the combined drill is applied. After determining the length of the joint drill according to the length of the inner guide pin, the joint drill card is locked to fix the length of the joint drill. Connect the combined drill and the electric drill, position the guide needle on the joint drill sleeve, drill the bone hole along the direction of the guide needle, and observe the depth and direction of the joint drill to the neck of the femoral head by X-ray fluoroscopy, when the joint drills to the determined depth Because the stalker encounters the cortical bone, it cannot advance. The positioning guide pin should not be taken out when exiting the joint drill. 5, bone tapping Position the guide pin on the tapping taper and slowly screw it in. When the screw is inserted, apply a certain pressure to make the tap screw out the thread in the neck of the femur. Exit the tapping cone. If the patient's bone is severely loose, the length of the combined drill can be adjusted to be shorter than the intra-bone guide needle by 3 to 4 cm. The depth of the tapping cone is also shortened accordingly, so that when the screw is screwed, the thread is screwed into the unbroken loose bone, so that the screw can hold more bone. 6, screw in the pull screw The tension screw is selected according to the length of the inner guide pin minus 1 and 5 cm. The length of the threaded portion of the screw should be able to rotate all the way through the fracture line into the neck of the femur. The selected tension screw is too short or too long to pressurize. Use a socket wrench to screw the tension screw into the bone. 7, nested into the sleeve steel Remove the positioning guide needle in the bone. Insert the sleeve guide rod into the tension screw and insert it into the bone hole. 8, the sleeve steel plate is attached to the femoral shaft If the sleeve part is put on the tension thread, and the angle formed by the bone cortex is wrong, the steel plate can not be attached to the femoral shaft, and the cortical bone part at the bone hole can be bitten off, so that the steel plate should not be strongly pressed, so as to avoid Caused a trochanteric fracture. The plate was fixed to the femoral shaft with a cortical bone screw. Then, screw the compression screw into the tail of the tension screw and gradually tighten the compression screw under X-ray. At this point, the fracture line can be observed to gradually close. The traction of the lower limbs should be relaxed before tightening the compression screws. In cases of osteoporosis, such as excessive compression, it can be seen that the tension thread exits outward and pulls the thread groove of the bone. complication 1. The fracture does not heal. 2, femoral head and neck cut through.

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