Internal fixation

The operation of fixing the broken bone directly or in the broken bone with metal screws, steel plates, intramedullary nails, steel wires or bone plates is called internal fixation. This type of surgery is often used for fracture reduction and osteotomy to maintain the reduction of the fold end. The main advantage of internal fixation is that it can better maintain the anatomical reduction of the fracture, which is more effective than simple external fixation, especially in preventing the scissor or rotational activity of the fracture end. In addition, some internal fixation materials have strong supporting effect, and can be used less or without external fixation after operation, which can reduce the scope and time of external fixation. Strong internal fixation is beneficial to functional exercise and early waking of injured limbs, reducing long-term bed rest. And complications (such as hypostatic pneumonia, venous thrombosis, bladder stones, etc.). However, there should be sufficient understanding of the shortcomings of internal fixation. Regardless of the metal internal fixation, it is always a foreign body to the human body, and it is clinically common to have osteoporosis or absorption internal fixation loose under and around the internal fixation. Once an infection occurs, metallic foreign bodies will severely impede wound and fracture healing. At the same time, placement of internal fixation requires extensive exfoliation of soft tissue and periosteum, which inevitably affects blood supply and delays the healing of fractures. Due to the development of aseptic technique, the surgical technique is constantly proficient, the metal quality of the internal fixation is gradually improved, and the internal fixation is appropriately selected, and the treatment of certain fractures can improve the curative effect. However, it must be pointed out that the anatomical reduction of the one-sided pursuit of fracture, the abuse of internal fixation is extremely wrong, and the indications must be strictly controlled. At the same time, it should be recognized that the internal fixation is only a temporary measure to maintain the reduction. Although it has a certain supporting effect, it cannot replace the healing of the fracture. Different protective measures must be taken after the operation until the fracture is healed. Otherwise, internal fixation fatigue, bending or breakage will occur. According to the strong internal fixation with a certain pressure between the fracture ends, the concept of one-stage fracture healing (ie, the end of the fracture without the callus and the new bone directly connected to the bone end) is designed, and various pressurized internal fixations are designed (such as In addition to pressing steel plates, compression screws, etc., it can promote fracture healing, and it is not necessary or less to use external fixation, so that early activities and even weight bearing. Pressurized internal fixation also has the inherent disadvantages of general internal fixation. At the same time, strong internal fixation can cause bone atrophy in the fracture, and even fracture after internal fixation. Treatment of diseases: fracture of the humeral shaft fracture Indication 1. After fracture reduction, it is difficult to maintain the fracture end reduction by external fixation or traction, and should be fixed internally: 1 One end of the fracture has strong muscle contraction (such as ulnar olecranon fracture, tibial tuberosity fracture, humeral fracture, etc.); 2 intra-articular fractures, especially the weight-bearing joints of the lower extremities, requiring anatomic reduction; 3 multiple fractures of multiple bones or multiple fractures of the whole body, it is difficult to maintain the reduction by external fixation alone or prevent the care and complications; 4 spinal fracture combined with paraplegia, postoperative to maintain the stability of the spine. 2. Internal fixation can promote fracture healing. Such as femoral neck fractures, mostly in the elderly, poor external fixation, complications, internal fixation treatment can improve the healing rate and reduce mortality. 3. Non-healing due to improper treatment of fractures or other causes; congenital sacral pseudoarthrosis; bone defects caused by bone resection or severe injury. In the treatment, bone grafting is required at the same time, and there must be a firm internal fixation to ensure the healing of the bone graft. 4. After correcting the deformity according to the plan, internal fixation is needed to maintain a good position after correction (such as knee, elbow, valgus orthopedics, intertrochanteric, subtrochanteric osteotomy, spinal osteotomy, etc. ). Within 5.8 to 12 hours, the open fracture with light pollution, after thorough debridement and reduction, internal fixation is feasible. However, it is advisable to use a simple internal fixation (such as screws, steel needles, steel wires, small steel plates, etc.). Contraindications 1. For comminuted fractures, internal fixation can not effectively maintain the reduction, surgery can damage the blood flow of the fracture block, generally do not cut open, internal fixation. However, if the intra-articular comminuted fracture and the long bone butterfly fracture cannot be maintained after the reduction, internal fixation should be performed. 2. Open fractures for more than 12 hours, or within 12 hours, but the pollution is more serious. 3. There are acute infections in the fracture area. Preoperative preparation In addition to the preoperative preparation for fracture open reduction, the following preparations are required. 1. The metal quality of the internal fixation should be electroless, stainless, with appropriate hardness and appropriate specifications. It is not advisable to apply two different metal products at the same time to avoid electrolysis, resulting in bone absorption, loose internal fixation and affecting healing. The surface of the internal fixation should be smooth, and it should not be used if it is damaged or restored after bending. 2. Fully study the nature, shape, location and condition of the fracture, and then determine the variety of the internal fixation. And should fully estimate what may happen during the operation, and prepare the internal fixation of other varieties. Before the operation, the x-ray film should be selected to select the inner fixation with the thickness, length and width. It is better to prepare the internal fixation larger than the selected internal fixation and the smaller one for the intraoperative selection. 3. Intra-articular fractures and femoral neck fractures should be prepared with x-ray film in order to timely observe the situation of reduction and internal fixation, guide the operation and ensure the success of the operation. 4. For patients with poor blood supply and old fractures who have healed or not healed, bone grafting or periosteal grafting with blood vessels should be performed at the same time of open reduction and internal fixation. ready. Postoperative diet Suitable diet: 1, should eat fresh fruits and vegetables and other light diet. 2, do not eat spicy spicy food. 3, avoid drinking alcohol.