Đang chuẩn bị nút TẢI XUỐNG, xin hãy chờ
Tải xuống
Trong những năm gần đây, điều trị gãy xương đã phát triển từ cố định, cứng nhắc giải phẫu nội bộ ủng hộ trong những năm 1960 và 1970 đối với ổn định, cố định "sinh học lành tính" nội bộ, sử dụng tối thiểu bóc tách mô mềm và co rút. | Indirect Fracture Reduction A Technique for Minimizing Surgical Trauma Lawrence B. Bone MD Abstract In recent years the treatment of fractures has evolved away from the rigid anatomic internal fixation advocated in the 1960s and 1970s toward stable biologically benign internal fixation utilizing minimal soft-tissue dissection and retraction. Application of this concept appears to avoid complications that can be produced by additional surgical soft-tissue trauma and bone devascularization. Achieving this goal requires the surgeon to assess the degree of soft-tissue injury so as to be able to optimally time the procedure and plan the surgical dissection. Preoperative planning of the location of the internal fixation enables precise placement of the incisions. The author describes techniques of indirect reduction that enable the surgeon to achieve an adequate reduction without the extensive additional soft-tissue dissection previously required to allow fragment manipulation. J Am Acad Orthop Surg 1994 2 247-254 The trauma of bone fracture often overshadows the concomitant injury to the surrounding soft tissue. Nevertheless it is imperative that the orthopaedic surgeon study not only the radiographs of the fracture but also the soft-tissue envelope that encloses the fracture for it is the soft-tissue envelope that provides vascularity and viability to the underlying bone and fracture fragments. Evaluation must also address the mechanism of injury including the magnitude and direction of the force. With careful soft-tissue examination and handling and appropriate fracture stabilization a satisfactory outcome can be achieved while avoiding potential complications such as skin sloughs wound infections and nonunions. In this article I will discuss assessment of the injury the concept of biologic fixation and the need for preoperative planning. Techniques of surgical exposure will be presented as well as the use of indirect reduction to limit the need for exposure. Finally