Plate and screw internal fixation

Plate and screw internal fixation for the treatment of fractures. The types of steel plates are divided into the following types: 1. Lane and Sherman steel plates are long and narrow with 8, 6, 4 round holes, as well as T-shaped, Y-shaped, etc., fixed with self-tapping screws. The length of the steel plate depends on the different parts. Generally, the length of the steel plate is 4 to 5 times the diameter of the fixed backbone. 8 holes in the femur, 6 holes in the tibia and fibula, and 4 holes in the ulna. Due to insufficient strength, such a steel plate must be externally fixed by plaster. Some use overlapping two steel plates of the same type, called "double steel plate" or trapezoidal steel plate, which cuts a steel plate above. According to reports, this usage is similar to car springs and has the effect of reducing stress shielding. Due to the promotion of compression plate, the application of such steel plate has been greatly reduced, but it is easy to shape, and it still has certain use value in the small bone or the part where the steel plate needs to be modified. AO/ASIF compression steel plates are used more. 2. Angle-shaped steel plate Yang Limin et al. (1987) developed an angled steel plate with an angular cross-section. The area of the curved plate is smaller than that of the curved plate. The clinical application results show that the long bone fracture can be reliably fixed due to the two plates. The end has a certain elasticity, and the osteoporosis caused by the fixed segment of the bone is mild. There are authors in China who design an angular plate according to the mechanical characteristics of the moment of inertia of the material area. Compared with the rectangular bone plate with the same cross section, the bending strength of the angled bone plate is increased by 33.45%~44.44%, the rigidity is increased by 49.94%~51.90%, the central impact toughness is increased by 36.8%, and the deformation is reduced by 11.2%. More than 1.62 million trials were conducted. The angled bone plate meets the physiological requirements of the human body and is used in clinical practice. The average follow-up period is 15 months. There is no abnormality, fracture of the steel plate, obvious osteoporosis or re-fracture. The shape of the steel plate is angular, similar to the angle of construction materials. The blocks on both sides are outwardly opened by 10°, which is 100°, and the height of the side blocks gradually decreases from the central portion to the both ends. There are three models: large, medium and small. Take the femur plate as an example, the length is 160mm, the width is 22mm, the thickness is 2.5mm, the middle cross-sectional area is 70mm2, 8 holes, of which 4 holes are oval pressing holes. The steel plate was slightly pre-bent, and the middle of the steel plate was 3 mm from the horizontal line. The angle plate and the matching rough compression screw are used for the operation, and the diameter is 4.5mm. The operation is basically carried out according to the AO technique, and the periosteum is removed as little as possible, and the large bone piece is pre-reset or fixed. After the upper and lower fracture ends are reset, the plate is placed on the side of the tension band. The angled plate and the backbone can be generally matched. If there is a slight disapproval, the bone can be slightly trimmed to fit, and then drilled with a 3.5mm drill bit. Attack the road, pressurize and fix with a suitable length of screw after sounding. Old fractures and poor blood supply were treated with cancellous bone grafting, and those with large trauma were placed under negative pressure drainage. Postoperative general fixation is not required, and patients are encouraged to move their limbs as early as possible. After 3 weeks of lower extremity fracture, he was abducted to the ground, gradually abandoned, and reviewed regularly. Severe comminuted fractures and internal fixation are not ideal, and they are protected by plaster support after operation. The plate screws were removed 8 to 12 months after the bone healing. 3.Richard sleeve nail plate is also called sliding nail plate or dynamic hip screw. It is suitable for femoral neck fractures and intertrochanteric fractures with higher position. The nail plate can keep the fracture end in close contact. When the fracture end absorbs, the sliding nail can slide in the sleeve, and the effect is excellent, and the application trend is expanded. The inner plant consists of a steel plate with a sleeve, a threaded sliding nail on the head and a compression screw. It is equipped with several AO cortical screws and a set of special installation tools. The inner plants are available in various sizes, and the nail plate angles are 130°, 135°, 140°, 145°, and 150°; the length of the sliding screw is 50 to 150 mm. The inner plants of suitable size should be selected according to the X-ray film before surgery. Treatment of diseases: acetabular fractures Indication Plate and screw internal fixation is applicable to: 1. Manipulative reset The external fixation cannot maintain the function reset and the traction cannot achieve the intended purpose. 2. Avulsion fracture near the joint. Such as displaced humeral fractures, olecranon fractures and so on. 3. There are displaced internal fixations. Such as femoral condyle, tibial plateau and acetabular fractures. 4. It is difficult to respond to the soft tissue embedded in the fracture end. 5. There are displaced fractures of the epiphysis. 6. Replantation of the broken limb and associated with large vascular nerve injury in the repair of the vascular nerve while performing the necessary internal fixation. 7. Old fractures with dislocation and malunion need to be cut orthopedic. 8. Bone defects, bones are not connected to the bone graft while internal fixation. 9. Not suitable for long-term external fixation and long-term bed traction, such as the elderly femoral neck fracture, intertrochanteric fracture and multiple fractures. 10. Open fractures with short time after injury and good soft tissue conditions. Contraindications 1. The general condition cannot tolerate anesthesia and surgical trauma. 2. Those with severe heart and cerebrovascular diseases. 3. Severe osteoporosis, the internal plants can not reach the purpose of internal fixation. 4. Osteomyelitis and active infections. 5. Soft tissue or large skin defects have not been repaired. 6. In some cases, the embedded fracture is good. After the fracture is healed, it does not affect the function, and there is no sequelae. Generally, internal fixation is not necessary. 7. Fractures with hemophilia, severe diabetes, internal fixation surgery should be particularly careful. Preoperative preparation After the preoperative preparation is determined, preoperative preparation must be done, including countermeasures that may occur during the operation. Special equipment, the operator should personally choose. Surgical procedure 1. Positioning After the satisfaction is satisfied, a 8~10cm straight incision is made on the outer side of the upper end of the femur, and the upper end of the femur is exposed. The selected T-shaped positioner is used to locate a Kirschner needle from the positioning hole on the T-shaped positioner. The perspective position is satisfactory. After that, the T-shaped positioner is removed. 2. Staple The reaming drill is placed on the Kirschner wire to open the hole, and then the tap is opened, and then the nail can be applied. Note that the thread must not exceed the fracture line when selecting the nail. 3. Upper board Insert the preselected slide plate. The angle of the sleeve of the selected sleeve nail plate must not exceed the fracture line, otherwise it will affect the sliding. Then tighten the compression screws at the end of the nail and tighten the screws of the nail plate one by one. complication Hematoma compression Excessive hematoma after surgery not only creates growth conditions for the bacteria, but also may induce ischemic necrosis of the muscles and even form the compartmental syndrome. In this case, puncture and suction can not be resolved; can be entered by the original incision, clear blood clots and all necrotic tissue, or fasciotomy and decompression. 2. Infection Selective surgery, the infection rate is 2% in foreign statistics. The key is strict aseptic technique and non-invasive operation. Preventive antibiotics are not required. If you are not sure, add antibiotics for 3 to 5 days during the operation until the operation. Open fractures, antibiotics are necessary during and after surgery. Topical application of degradable sustained-release microsphere antibiotics is valuable for preventing infection. 3 to 5 days after surgery, local redness, swelling, heat, and pain should be considered as infection. It is necessary to open the wound in time, remove the necrotic tissue, and wash it repeatedly. The internal fixation stable plant does not have to be removed, taking antibiotic saline drip irrigation, recording the amount of wound in and out, bacterial culture, drug sensitivity test, timely replacement of effective antibiotics, lavage for 4 to 5 days, often can control the development of infection. 3. Internal plant break The majority of internal plant fractures are fatigue fractures, and the third bone mass often appears to be not fixed and fixed on the fracture pressure side. During the movement, the internal plants, including the steel plate and the intramedullary nail, undergo fatigue fracture under repeated alternating bending. Once the inner plant breaks, it needs to be removed in time. The distal segment of the intramedullary nail can be removed by hooking the distal end of the medullary needle with a hooked needle. The broken portion of the screw can be removed by a nail remover. 4. Fracture According to AO statistics, the incidence of re-fracture is between 1% and 1.5%. The main reason is that the internal plant is removed too early, or the weight is removed without protection. Generally, cancellous bone can be removed after 3 to 6 months of internal fixation, bone plate fixation and intramedullary nail fixation. The postoperative removal time of the plant is 2 years for the femur, 1.5 to 2 years for the forearm and tibia, and 1 year for the tibia. . After the removal of the internal plants, animal experiments have shown that the bone torsion resistance is reduced by 50%, which lasts for 1 to 2 months. Therefore, the human body should be properly protected within 3 months after the removal of the internal plants, and it is forbidden to participate in sports and heavy physical labor.

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