Open reduction and internal fixation of tibial shaft fractures

One third of the humerus is thin, and the fracture often occurs in this part. The blood supply outside the junction of the middle and lower part of the humerus is poor, and delayed healing or non-healing may occur after surgery. The position of the humerus is superficial, and most of the fractures are suitable for manual reduction and external fixation. There are only a few fractures that fail to be reset or can not be repositioned, or fractures that are displaced after reduction (such as late fractures, spiral fractures or long bevel fractures) and nerves. Surgical treatment is required for fractures with damaged blood vessels. Treatment of diseases: humeral stress fractures and tibial plateau fractures Indication One third of the humerus is thin, and the fracture often occurs in this part. The blood supply outside the junction of the middle and lower part of the humerus is poor, and delayed healing or non-healing may occur after surgery. The position of the humerus is superficial, and most of the fractures are suitable for manual reduction and external fixation. There are only a few fractures that fail to be reset or can not be repositioned, or fractures that are displaced after reduction (such as late fractures, spiral fractures or long bevel fractures) and nerves. Surgical treatment is required for fractures with damaged blood vessels. Contraindications 1. The general situation of the wounded is not good, or the concomitant shock, must first rescue, until the shock is stable, the general situation can be improved before surgery. 2. If there is a life-threatening head, chest or abdominal cavity and other important organ damage, it must be treated first. The treatment of the fracture should be relegated to the secondary position. Temporary external fixation can be performed first, and the fracture should be treated after the condition is stable, or non-surgical treatment can be used. Try to get a better reset as much as possible. 3. There are more than 8 to 12 hours of open wounds in the fracture. 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: Use the anterior side incision of the calf. Do not subcutaneously separate when exposed, pay attention to the relationship between the soft tissue and the periosteum, and the less periosteal peeling, in order to maintain the blood supply to the calf skin and fracture end. 3. The first step is to reverse the limbs of the fractures by the assistant. The surgeon uses the periosteal stripper to open the fracture end and reset. Pay attention to the angle of the bone when resetting to avoid rotational displacement. 4. Internal fixation: The spiral fold and the oblique fold should be fixed by 1~2 screws or compression screws as much as possible, so that the damage is small and the healing is faster. For the treatment of late and old sacral fractures, the intramedullary or compression plate can be used for fixation. The surgical procedure is detailed in internal fixation. Fractures at the junction of the middle and lower humerus should be performed at the same time as open reduction and internal fixation to promote healing. complication fracture.