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Intramedullary bone plates for long bone fractures generally refer to intramedullary nails, which are widely used in the treatment of long bone fractures. The following is a detailed introduction to the key points of their use for you:
Indications
Long bone fractures: Applicable to fractures of long bones such as the femur, tibia, ulna, and radius. These fractures usually require strong stability. Intramedullary nails can provide good fixation and promote fracture healing.
Unstable fracture: When the fracture line is unstable and fracture displacement, rotation or shortening is prone to occur, intramedullary nail fixation surgery can provide strong stability and help fracture healing.
Multi-segment fractures: When multiple fracture segments occur on a long bone, intramedullary nails can provide continuous fixation, keeping the fracture segments in good alignment and stability.
Complex fractures: For cases of severe dislocation of fractures and complex fracture lines, intramedullary nail fixation surgery can effectively fix fractures and reduce the risk of nonunion.
Fractures in the elderly: For fractures in the elderly with osteoporosis, intramedullary nail fixation surgery can provide better stability and facilitate fracture healing.
Key points of surgical operation
Selection of intramedullary nails: Using a permeable X-ray ruler and under the control of the C-shaped arm, select intramedullary nails of appropriate length; Or by clinical means of marking on the skin and then measuring with a ruler to select the intramedullary nail of appropriate length; The head of the medullary cavity expander, as a probe, is a technical method for determining the diameter of the medullary cavity and can be used for the selection of the diameter of intramedullary nails.
Entry point position: In the femur and tibia, the entry point position must be on the same line as the medullary cavity, but not too close to the bone entry point. The correct intramedullary insertion point is of crucial importance. In the femur, hip flexion and adduction facilitate the entry of forward screws and also reduce the length of incisions, especially in obese patients. When using the femur to drive the intramedullary nail backward, the knee joint should be flexed at 30°, and the guide needle should be consistent with the midline of the distal femur cavity. A small incision should be made, and the guide needle should be inserted into the distal femur through the ligament under the protection of the sleeve. Check the position of the guide needle in the lateral position and be careful not to damage the anterior cruciate ligament. In the tibia, make a 15-20mm incision with a larger blade that is consistent with the longitudinal axis of the medullary cavity. This incision passes through the skin and the patellar ligament at the lower pole of the patella. Flex the knee joint as much as possible.
Insertion technique: Clinical observations have confirmed that the nearest end of the approach is the most useful. Draw a straight line at the proximal end of the femur consistent with the curvature of the femoral shaft. Make an incision of 2 to 5cm 10cm above the tip of the greater trochanter and insert it downward under the guidance of the hand. The incision should not be too far back; otherwise, it will cause changes in the abductor muscle strength line.
Postoperative precautions
Regular follow-up: Monitor the healing of fractures through X-ray films and adjust the treatment plan in a timely manner.
Functional exercise: Under the guidance of a doctor, perform functional exercises to promote blood circulation and accelerate recovery. If intramedullary nail fixation is performed, the affected limb should be elevated in the early stage to facilitate the reduction of swelling. After the swelling subsides, one can gradually get out of bed with crutches and move around. However, the affected limb should not bear weight within 6 weeks. After 6 weeks, if there is obvious callus on X-ray examination, partial weight-bearing activities of the lower limb can be gradually carried out. Generally, around 12 weeks after the operation, the callus is obvious and the fracture line is blurred, allowing for full weight-bearing activities without crutches.
Diet: Ensure a balanced diet and consume sufficient calcium and protein to support fracture healing.
Avoid excessive activity: In the early stage of recovery, avoid applying excessive pressure to the limb where the intramedullary nail has been implanted.
Complication prevention: It is necessary to pay attention to preventing the occurrence of complications such as fat embolism syndrome, deep vein thrombosis of the lower extremities, atelectatic pneumonia, and bedsores. Since intramedullary nail surgery involves intramedullary fixation, it can lead to an increase in intramedullary pressure. In adults, the intramedullary tissue is all yellow bone marrow, which is essentially fat. Once the pressure increases, the fat may enter the blood, causing fat embolism syndrome. Therefore, it is essential to closely monitor the blood oxygen concentration after the surgery.
Internal fixation removal: Generally, internal fixation should not be removed too early. If there is infection, loosening, breakage or other conditions that cause the fixation to lose its effect, the internal fixation should be removed promptly. To restore the normal structure and strength of the bone, the internal fixator should be removed after the fracture heals.
Advantages and disadvantages
Advantages:
Minimally invasive: Intramedullary nail fixation can perform closed reduction. Minimally invasive nail placement fixation causes less trauma and leads to relatively faster postoperative recovery. As it does not expose the fracture site through incision and does not require periosteum stripping, it has a smaller impact on blood supply at the fracture end and is conducive to fracture healing.
Good fixation effect: Intramedullary fixation belongs to central fixation, and its ability to resist axial loads is stronger than that of the traditional plate system.
Early activity is possible: Closed reduction is adopted, and the blood supply around the fracture site is not affected. It can better maintain the biological environment of the fracture site, which is conducive to fracture healing and conforms to the principle of minimally invasive. The intramedullary nail with a lock adopts closed reduction and closed threading, which does not expose the fracture end and enables early movement after the operation.
Disadvantage:
The fixation stability of fractures close to the articular surface decreases: Intramedullary nails are an effective method for treating long shaft fractures, but their fixation stability significantly decreases in fractures close to the articular surface and they are not suitable for use.
Possible complications: Intramedullary nail surgery is a commonly used treatment method in orthopedic trauma. Although it is widely applied, it has certain risks and sequelae, such as intramedullary nail incarceration, splitting point fractures, local infections, and limited movement. Most intramedullary nail incarceration is caused by the intramedullary nail being selected with an overly thick diameter, getting stuck at the narrow part of the medullary cavity during the operation, or being inserted into the normal cortical bone due to incorrect needle insertion direction. Split-point fractures occur when the bone at the needle insertion point is not chiseled out and the needle is forced in, or when the intramedullary nail is stuck in the bone and not corrected in time, but the needle is forced in instead. This situation can easily lead to local split-point fractures.