Open reduction and internal fixation of patella fractures

Tibial fractures are more common, more common in young adults, often caused by violent contraction or direct impact of the quadriceps muscles, humeral fractures involving the articular surface, often accompanied by quadriceps dilatation tears and intra-articular hematoma, prone to knee joints Dysfunction and arthritis of the tibia, the treatment of the tibial fracture requires anatomical reduction, firm fixation and early functional exercise, and repair of the quadriceps expansion. In addition to non-surgical treatment of non-surgical fractures of the humerus, most of the humeral fractures must be treated surgically. The young and middle-aged humerus is transversely folded and displaced. The size of the two fracture blocks is similar. It is feasible to perform open reduction and internal fixation. Blocks larger and smaller can be repaired after resection of small bones; the remaining humeral fractures, such as displaced comminuted fractures, displaced tibiofibular fractures, and displaced old fractures are feasible for humeral resection. Treatment of diseases: comminuted fractures and tibia fractures Indication Tibial fractures are more common, more common in young adults, often caused by violent contraction or direct impact of the quadriceps muscles, humeral fractures involving the articular surface, often accompanied by quadriceps dilatation tears and intra-articular hematoma, prone to knee joints Dysfunction and arthritis of the tibia, the treatment of the tibial fracture requires anatomical reduction, firm fixation and early functional exercise, and repair of the quadriceps expansion. In addition to non-surgical treatment of non-surgical fractures of the humerus, most of the humeral fractures must be treated surgically. The young and middle-aged humerus is transversely folded and displaced. The size of the two fracture blocks is similar. It is feasible to perform open reduction and internal fixation. Blocks larger and smaller can be repaired after resection of small bones; the remaining humeral fractures, such as displaced comminuted fractures, displaced tibiofibular fractures, and displaced old fractures are feasible for humeral resection. Preoperative preparation 1. The fracture is caused by severe trauma. The patient has severe pain and blood loss. Analgesic and blood matching should be given before surgery. For patients with poor general condition or existing shock, anti-shock treatment such as infusion and blood transfusion should be given, and the operation should be performed after the condition is stable. 2. Preoperative fracture site should be taken with positive lateral x-ray film to determine the location, shape and displacement of the fracture, which is convenient for determining the surgical procedure and internal fixation. For those who need to take x-rays during surgery, they should inform the radiology department and the operating room in advance to prepare. 3. The surgeon should propose the special equipment to be used and check whether the preparation of the equipment is complete, so as to avoid temporary preparation and prolong the operation time. 4. Open fractures should be treated with antibiotics and tetanus antitoxins; or if the original open fractures were delayed for more than 2 weeks, antibiotics and repeated injections of tetanus antitoxin should be used. 5. After the reduction and reduction, the internal fixation or bone graft should be used. The antibiotic should be intravenously administered immediately after anesthesia, and once every 6 hours, share 4 times. 6. The fracture site should have sufficient range of cleaning and disinfection preparations. The surgeon should avoid contact with the suppurative wound on the same day, and strictly follow the hand washing procedure to prevent the wound infection. 7. Patients who need to delay surgery for the first time should be towed first, can be reset, temporarily fixed, and can overcome soft tissue contracture, reducing the difficulty of resetting during surgery. 8. Need to simultaneously bone fractures, such as delayed bone fractures, slow healing fractures, etc., should be prepared for the bone area after surgery. Surgical procedure 1. Position: supine position. 2. Incision and exposure: The anterior u-shaped incision is more suitable, and the transverse incision is sufficient. The incision and the fracture part are not easy to adhere and affect the flexion function. 3. Exploring and cleaning the joint cavity: After cutting the skin and subcutaneous tissue, open the flap upwards to see the fracture of the tibia. In severe cases, the separation of the fracture block is large, and the tears of the joint capsule and quadriceps expansion on both sides are also large. The proximal and distal fracture blocks can be opened to enter the joint cavity, and the front of the femur can be exposed and explored, and the blood in the joint, bone debris and the soft tissue sandwiched between the fracture blocks can be completely removed. 4. Reset: first straighten the knee joint to relax the quadriceps muscle, use the towel clamp to clamp the fracture block and pull it close, so that it is reset and temporarily positioned by the assistant. 5. Internal fixation: The larger humerus transverse fracture of the two fracture blocks, commonly used stainless steel wire as an internal fixation. There are three commonly used fixing methods: (1) cerclage fixation method: using 18-28 stainless steel wire, guided by thick round needle, close to the iliac bone edge and suture a circle in the surrounding soft tissue, then reduce the iliac fracture, and gradually tighten and tighten the steel wire. This method is relatively simple, and the fixation is also perfect, but it is easy to produce an angular deformity, which is generally suitable for a fracture that is not displaced too much or a comminuted fracture that can still be restored. (2) Through-fixation method: use a 2mm drill bit on the inner and outer side of the proximal fracture block 1cm, perpendicular to the longitudinal axis of the humerus, drill a tunnel; in the same way, drill a tunnel in the corresponding part of the distal fracture block, 8 shape wear Over the wire. However, it should be noted that the tunnel should be located behind the midpoint of the full thickness of the humerus. Use a towel clamp to reset and tighten the wire to fix it. This fixation is direct, powerful, and relatively robust, and is suitable for fractures with large displacements. Since the wire crosses in front of the tibia, it can prevent the forward angle caused by knee flexion. (3) Tension band fixation method: using a Kirschner wire with a diameter of 1.5 mm, drilling from the inner and outer sides of the proximal fracture surface, drilling along the longitudinal axis of the humerus, drilling the tip of the fracture block, and adjusting the Kirschner wire by hand The needle just exposed the fold. After resetting, the same K-wire is used to drill from the near fold to the corresponding point of the far-folded fold, and the lower end of the distal fold is drilled along the longitudinal axis of the tibia. Adjust the Kirschner wire with a hand drill so that both ends are exposed to the outside of the sarcolemma by about 3 to 5 mm, and the needle tail is bent into a hook shape. Then, the 18 to 28 wire wire is used to bypass the back of the two K-wires, and the tightening is gradually tightened. prison. When tightening, be careful that the wire should pass through the back side of the Kirschner wire and tighten. In this way, after the steel wire is tightened, the Kirschner wire will be subjected to a certain pressure, which will cause the fracture blocks to close together and accelerate the healing; it should also be noted that the steel wire that has traversed the fracture line must not be excessively biased to the side, thereby losing the tension band fixation. effect. 6. Repair the quadriceps dilatation and joint capsule: check the tibial articular surface completely opposite, no joints and bones in the joint cavity, the quadriceps expansion of the bilateral torso, joint capsule and anterior iliac crest The membrane was sutured intermittently with silk. The wound is then rinsed and sutured layer by layer.

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