fixare interna de fractura de sold intertrohanteriana reducere deschisa

LESSERTUBEROSITYPelvis AP i AP old de un pacient n vrstcu o fractura de sold intertrohanteriana trei pri.

LATERAL RADIOGRAPHnfiinat 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.ISCHIUMLESSERTROCHANTERFEMUR

This image demonstrates the position of the fracturetable with the patients affected arm over the chestand well padded.

SCDs ONDURINGPROCEDUREObservai c dispozitive de compresie secventiale rmnepe 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 gradedistal de pacient. Radiografia AP este luat cu C-armuor peste rotit pentru a oferi o imagine mai perfect AP cu respectla anatomia a femurului proximal i punctul de vedere lateral.

Incizia trebuie s nceap proximal la trohanterianacreast i au nevoie de a extinde de aproximativ 10 de centimetri n jos a coapsei.

ITBIncizia adus pn la nivelul aIliotibial trupa i fascia lata.

ITBTrupa iliotibial este incizat cu un cuit. A Metzenbaumfoarfece este folosit pentru a diseca dedesubtul benzii, care este mpritn conformitate cu incizie.

Trupa iliotibial este incizat cu un cuit. A Metzenbaumfoarfece este folosit pentru a diseca dedesubtul benzii, care este mpritn conformitate cu incizie.

Cu retragere a benzii iliotibial, vastfascia lateralis este vizualizat.VASTUSLATERALISITB

A sharp rake is introduced anteriorly and is used to retract thevastus lateralis anteriorly. An incision is then made in thefascia just anterior to the most posterior aspect of the femur.

A sharp rake is introduced anteriorly and is used to retract thevastus lateralis anteriorly. An incision is then made in thefascia just anterior to the most posterior aspect of the femur.

A periosteal elevator can be used to elevate the lateralisoff 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 fragmentand displacement of the posteromedial fragment.

A bone hook can be used, as can a clamp or othertechnique, to reduce the abduction in the proximalfragment.

Once a reduction is obtained and confirmed on the AP and lateral radiographs, the angle guide is placed against thelateral surface of the femur in order to place the guidewirefor 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 barrelwas 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 heldgently 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 wasrather 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 slightlyposterior to the midline in order to direct the lag screwinto the center of the head, given the normal anteversionof the neck.

The posteromedial fragment cannot be lagged through theplate because the angle of the screw through the plate would be too great. Thus, the screw is placed from anteriorto 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 intothe lesser trochanter.

Final AP radiograph demonstrating excellent fixation andcompression across the intertrochanteric fracture as wellas lag screw fixation of the lesser trochanter.

ITBVASTUS LATERALISThe closure is then performed with a running stitch of the vastus lateralis.

ITBThe iliotibial band is repaired using interupted sutures;the skin will then be closed in layers.