Open reduction and internal fixation of femoral shaft fractures

Most of the femoral shaft fractures can be treated with continuous traction reduction and small splint fixation, and satisfactory results are obtained. Only in the reduction of femoral shaft fractures, or late treatment, difficult to close the reduction; or fracture non-healing; or complicated by blood vessels, nerve damage, only need to open the reduction and internal fixation. Treatment of diseases: femoral shaft fractures Indication Most of the femoral shaft fractures can be treated with continuous traction reduction and small splint fixation, and satisfactory results are obtained. Only in the reduction of femoral shaft fractures, or late treatment, difficult to close the reduction; or fracture non-healing; or complicated by blood vessels, nerve damage, only need to open the reduction and internal fixation. Preoperative preparation 1. It is very important to routinely perform limb traction before surgery to return the femoral head from the posterior superior aspect of the acetabulum to the acetabular level. Traction can relax the contracted muscles, on the one hand, it can make the operation reset easily and prevent postoperative dislocation; on the other hand, it can reduce the cartilage surface necrosis and avascular necrosis of the femoral head after compression of the femoral head. opportunity. Older, dislocated children can be used for traction; older age should be treated with humeral traction. Generally, the femoral head can be lowered to the acetabular plane after 2 to 3 weeks of traction. After the X-ray film is confirmed, the weight can be appropriately reduced, and the femoral head can be maintained in the plane for 1 to 2 weeks. 2. If the traction of the femoral head is not obvious, it should be checked whether it is caused by the contraction of the femoral or gluteal muscles. In this case, the adductor muscle starting point should be cut or released, and then the limbs should be pulled to meet the traction requirements. Generally speaking, those who are more than 2 to 3 years old need to be cut off and can be released. 3. Preoperative cases were prepared for skin around the hip joint and lower limbs for 3 days. 4. Preoperatively, the anteversion angle, the hip valgus angle, the selected capping site, the hip osteotomy site, and then the surgical design of the femoral or hip bone osteotomy angle and the size of the bone graft should be determined. 5. Prepare blood 200 ~ 600ml. 6. The muscles around the femur are rich, the displacement after fracture is obvious, the bleeding is more, and it is easy to cause shock. Infusion, blood transfusion, or blood matching should be used before surgery to prevent shock. Surgical procedure 1. Position: supine position, the lower side of the injured side is 15°. 2. Incision, exposure: more choice of anterior or lateral femoral incision. 3. Repositioning: After exposing the fracture, remove the hematoma, granulation, or callus, check the fracture displacement, and determine the reset method. At the time of resetting, the assistant pulled the lower limb of the injured limb, and the other assistant pulled the pre-placed perineal traction belt on the head side of the injured person to resist traction. The surgeon used the periosteal stripper to open the fracture end and reset it. After the reduction, check whether a thick line (femoral condyle) on the posterior side of the femur is anatomicly reset to prevent rotational displacement. 4. Internal fixation: The femoral shaft is the longest tubular bone in the human body. The medullary cavity is round and the inner diameter is not much different. The backbone is only slightly curved forward and outward in the middle. Therefore, the middle and upper segment of the transverse and short oblique fractures should be the first choice for intramedullary nail fixation. The lower segment fracture should be treated with compression plate. Because of femoral fracture and femoral surgery, it is easy to cause quadriceps and femur adhesion, resulting in difficulty in bending the knee. . Intramedullary and compressional steel plates can be used without postoperative fixation, which can prevent early adhesion and prevent adhesion. complication infection.

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