First, fracture of the tibia

1. supine position

2. Conventional disinfection drape.

3. Make a transverse arc incision in the right knee joint, cut the fascia layer, expose the fracture end of the humerus, and the patellofemoral ligament expansion of the fracture, flush the knee joint cavity, remove the hematoma, see the fracture crushing, shifting, and reset the fracture. Maintain with a towel clamp, drill two Kirschner wires in the longitudinal direction of the tibia, and then tie the wire with the line "8", take 1— 0Dexon line is sewn around the tibia for two weeks to fix.

4. Flush the field, completely stop bleeding, suture layer by layer.

 

Second, open reduction and internal fixation for humeral fracture

1. After the anesthesia is stable, the patient is supine, routinely sterilized, and a longitudinal incision of about 8 cm in the middle of the right knee is taken. The shallow deep fascia of the skin is cut and the fracture is separated.

2. The fracture of the tibia can be seen in the operation, which is comminuted. There are a lot of clots in the joint cavity, and the aponeurosis is broken at the fracture.

3. Surgical removal of the clot at the fracture end, after the fracture is reset, temporarily fixed with a towel clamp. The sacral sac was cut longitudinally along the humerus, and the patellofemoral articular surface was well-repaired. The tibia memory alloy tension hook was used to fix the joint cavity and incision with saline, and the aponeurosis and joint capsule were repaired with thick silk suture.

4. After the device is inspected, the subcutaneous tissue and skin are sutured. The operation was smooth, and there was not much bleeding during the operation. The patient returned to the ward after the operation.

 

Three, fracture of the tibia

Surgical procedure:

1. After successful brachial plexus anesthesia, the patient is placed in a supine position, the left upper arm is placed on the chest, the tourniquet is tied to the root of the left upper arm, and the skin of the conventional surgical field is disinfected.

2. Blood transfusion to 300mmHg, upper tourniquet, cut from the ulnar olecranon to the lower part of the lower part of the humerus about 10cm, cut the skin and subcutaneous tissue, reveal the triceps and diaphragm, reveal the ulnar nerve, pull the ulnar nerve In order to avoid injury, from the midline of the triceps to the periosteum of the humerus, the triceps muscles are pulled to the sides to reveal the fracture end of the humerus, see the distal end of the angular displacement, the hematoma of the fracture end is removed, traction reduction fracture And maintain, take the 5-hole tibia reconstruction plate pre-bend and place it on the posterior side of the humerus, drill, tap the thread, screw in the screw, and press the fracture end to check the fracture fixation stability, elbow joint activity is not affected.

3. Rinse the wound, completely stop bleeding, leave a hose to drain, and suture layer by layer.

4. Anesthesia is satisfactory, the procedure is smooth, and the left upper extremity plaster is externally fixed after operation.
 

Four, fracture of the left tibia fracture after internal fixation

1. After the anesthesia is stable, the patient takes the supine position and routinely disinfects the single sheet.

2. Cut along the original surgical incision, cut the skin and subcutaneous tissue layer by layer, separate the phrenic nerve, free the phrenic nerve and retract the protection, fully reveal the fracture end, visible left tibia fracture, internal fixation loose, fracture There is a large amount of granulation tissue formed at the end, there are broken bones, the fracture ends are misplaced into horns, the fracture end is osteolytic, and the medullary cavity is closed.

3. Surgical removal of the internal fixation, clear the granulation tissue at the fracture end, bite the fractured end and harden the bone, open the medullary cavity, remove part of the humerus at the right tibia, open above the humeral nodule and pith The iliac crest was reamed in turn, and 8× was entered; the main needle of the intramedullary nail with a locking of 220 mm was inserted into the level of the flat humerus nodules. Install the sight and pressure positioning rod, and then insert the distal locking nail by the incision, drilling, sounding and tapping, and then lock the proximal locking nail into the same position. After flushing the incision with a large amount of normal saline, The iliac bone was implanted at the fracture end.

4. During the operation, the fracture alignment was good and the fracture was firmly fixed. The incision was washed with a large amount of physiological saline and sutured layer by layer.

5. Under the C-arm machine, observe the fracture alignment and the alignment is good. The operation was smooth, and there was not much bleeding during the operation. The patient returned to the ward and returned to the room with a blood pressure of 130/70 mmHg.

 

5, external fractures

Surgical procedure:

1. After successful anesthesia, the patient takes a supine position and routinely disinfects the towel.

2. Blood transfusion to 600mmHg, upper tourniquet, centered on the fracture end, vertical incision on the lateral side of the lower left leg, 9cm long, incision until the periosteum of the tibia, revealing the fracture end, subperiosteal dissection at the fracture end, see the fracture is long Oblique, displace, remove the hematoma at the fracture end, reset the fracture traction, maintain the resetting state with the towel clamp, drill a screw hole perpendicular to the fracture line, screw in a lag screw, remove the towel clamp, take 8 The 1/3 tubular steel plate of the hole is placed on the outer side of the external malleolus and shaped according to the shape of the bone. The screw holes are drilled one by one and screwed into the screw.

3. In the next joint cooperation "claw test", put a small hook on the lower jaw joint, pull the outer malleolus, see the lower jaw joint loosening, through the lower jaw joint from the outer malleolus to the tibia, A cortical bone screw was screwed through the 3 layers of cortical bone to fix the lower jaw joint. Go again "claw test", see that the jaw joint is no longer loose.

4. Check that the fracture is firmly fixed, the restoration is good, the field is flushed, and the incisions are sutured layer by layer.

 

Six, total hip replacement for femoral neck fracture

Surgical procedure:

1. Left lateral position

2. Conventional disinfection drape.

3. Using a modified lateral approach, starting from the front of the upper iliac crest 6-7cm, extending forward and downward around the large trochanteric leading edge along the femur, 15cm long, in turn cut the skin, subcutaneous tissue and deep fascia, electricity Stop bleeding. Open the fascia and fascia lata muscle from the bottom up, bluntly separate the posterior edge of the gluteus medius and gluteus brevis, retract forward, and cut the attachment point of the external rotator muscles such as the piriformis at the rotor socket. Cut off part of the square muscles, expose and remove the joint capsule.

4. The joint capsule is not thick; the old blood is visible in the joint cavity; the synovial membrane has no obvious hyperplasia.

5. The femoral head was removed and the diameter was 46 mm. The fracture was subtotal and the articular cartilage was not degenerated. No obvious lesions were seen in the acetabulum.

6. 15 mm osteotomy on the small trochanter, remove residual and tight joint capsule, remove the joint gingival margin, remove the round ligament, remove the acetabular cartilage from the acetabular 46 to 50 mm to the subchondral bone, try Measured to a size of 50 mm, Striker's 52mm compression-fit acetabular prosthesis was used with an abduction angle of 45 degrees and a forward rake angle of 10 degrees. It was stable and placed in a high molecular polyethylene liner. The medullary cavity was opened in the proximal end of the femur with a box opening. The medullary cavity expander enlarged the medullary cavity to 8 mm, and then the medullary cavity was used to enlarge the medullary cavity to No. 8, with a anteversion angle of 15 degrees. In the mid-neck test, the soft tissue was moderately elastic, the activity was good and stable, and the medullary cavity of the femoral tract was flushed. The pressure-matched No. 8 femoral prosthesis was used, and the medullary cavity was slowly inserted into the femoral head and the joint was repositioned. Rinse the incision, completely stop the bleeding, place the hose to drain another opening, and close the incision in turn.

 

VII. Clavicle fracture

Surgical procedure:

1. After the cervical plexus anesthesia is successful, the patient takes a supine position, the right shoulder and back are raised, and the conventional surgical field skin is disinfected.

2. Take a transverse incision with the right clavicular fracture end as the center, about 8cm long, cut the fascia layer, reveal the clavicular fracture end, make subperiosteal dissection, remove the hematoma at the fracture end, see the fracture smash, shift, reduce the fracture traction The clamp is maintained. The 6-hole reconstruction plate is placed on the upper side of the collarbone, drilled, tapped, screwed into the screw, and the fracture end is pressurized to check that the fracture is stable.

3. Flush the field, completely stop bleeding, suture layer by layer.
 

eight, clavicular fracture open reduction and clavicular hook internal fixation

1. After the anesthesia is stable, the patient is supine and the left shoulder pad is high, and the patient is routinely disinfected.

2. Take the left acromioclavicular joint as the center and take a 10 cm incision along the clavicle. The incision is made layer by layer. The left acromioclavicular joint is revealed. The left lateral clavicle fracture, left acromioclavicular joint dislocation, acromioclavicular ligament and joint capsule injury are seen. Tearing. After removing the proliferative granulation tissue in the joint, the 6-hole clavicular hook plate was placed and fixed. The steel plate was attached well and the acromioclavicular joint dislocation recovered. Repair the acromioclavicular ligament.

3. The operation is smooth, the intraoperative blood is not much, the gauze equipment is counted correctly, a large amount of saline is washed and the incision is sutured layer by layer, and the patient returns to the ward after surgery, and the blood pressure of the returning room is 132/69 mmHg

 

Nine, metacarpal fractures

1. After the brachial plexus anesthesia is successful, the patient takes the supine position, the left upper extremity outer booth, and the conventional surgical field skin disinfection and drape.

2. Centered on the comminuted fracture end of the first metacarpal base of the left hand, incision on the medial side of the short extensor tendon of the left hand, curved to the medial side of the proximal thumb, about 6 cm long, showing the extensor tendon and tendon of the thumb. The superficial branch of the nerve, avoiding, incision between the thumb and the short extensor tendon, revealing the fracture, see the comminuted fracture of the base of the first metacarpal, shortening the displacement, the fracture involves the articular surface, and the proximal fracture is first reset, one A compression screw is fixed to completely reset the fracture, and a 7-hole AO"T" shaped steel plate is placed on the back side, drilled one by one, and screwed into the screw. Check that the fracture is well reset and reliable. Flush the field, completely stop bleeding, suture layer by layer.
 

10, Monteggia fractures

The main cause of the right Monteggia fracture was the open reduction plate screw, Kirschner wire internal fixation, gypsum external fixation after brachial plexus anesthesia, and the brachial plexus anesthesia was effective. The patient was placed in a supine position. The affected limb is placed on the chest. Conventional disinfection shop. After the right elbow, the median longitudinal incision is made, and the skin, subcutaneous tissue, and myofascial fascia are cut in turn, and the subcutaneous congestion is heavier. The ulnar callus is exposed to the proximal end from the ulnar flexor carpi muscle and the extensor muscle group. See fracture fracture, part of the bone is free. The ulnar nerve is found at the proximal end of the elbow and separated to the ulnar nerve canal. The ulnar nerve can be opened. The ulnar nerve was pulled and protected with a rubber band to further expose the fracture end. The ulnar olecranon fractured fracture, the articular surface of the ulnar joint was not completely integrated, the olecranon tip, the ulnar coronoid process and the upper ulnar ulnar joint surface were independent fracture blocks. , and many small fracture blocks with articular surface can be seen. There is no alignment mark, the posterior side of the ankle joint capsule is damaged, the ankle joint dislocation is unstable, the ankle joint is restored, and the Kirschner wire is temporarily fixed at the elbow 90 degrees. Position, with the tibial block as the alignment mark, the fracture of the ulnar olecranon with articular surface is restored, and the fracture of the ulna is used to mark the fracture. The Kirschner wire temporarily fixes the olecranon tip to the ulnar shaft, and then the ulnar coronoid process After the reduction of the ulnar and articular surface, the Kirschner wire was temporarily fixed, and the olecranon contour was restored. The proximal side of the ulna was placed on the posterior side of the ulna. The 6-hole anatomical locking plate was fixed with 3 locking screws at the distal end, and the proximal 3 self-attacking cortical screws. Fixed, intraoperative See distal humerus can be reset, the appropriate fixed position. The Kirschner wire of the fixed ankle joint was removed, and the reduction was satisfactory under direct vision. The flexion and extension activities were good, and the Kirschner wire of the fixed ulnar coronoid process, the upper ulnar ulnar joint surface and the olecranon lateral bone block were retained, a total of 4 pieces, and the bend was placed under the skin and washed. Check the equipment, after the dressing is correct. Once again, confirm that the ulnar nerve is intact. Close the wound in turn. After the operation, the operation was smooth and the intraoperative blood loss was about 400 ml. After the operation, the plaster was placed on the elbow flexion at 45 degrees. After the operation, the anti-inflammatory and swelling were treated to observe the changes in the affected limbs.

 

Eleventh, ulnar olecranon fracture surgery record

After successful anesthesia, routine disinfection of the towel, blood-sucking tourniquet pressure 300mmHg.

The right elbow and the longitudinal arc-shaped incision, about 8 cm long, were cut layer by layer to expose the olecranon and the fracture. The local hematoma was removed. The fracture of the olecranon was found in the operation. The main fracture line was serrated, the proximal olecranon was about 2.5 cm long, the fracture was separated by 3 cm, and the periorbital tear was broken. Strive to meet the anatomical reduction requirements of the articular surface. Conventional line tension band fixation, 2 diameter 2mm Kirschner wire vertical fracture surface direction from the olecranon tip fracture line to the anterior and posterior cortex of the coronoid process, 1mm wire "8" word winding, fracture compression fixation, satisfactory inspection, fixed fixation , suture repair the torn aponeurosis, NS irrigation field, suture the incision layer by layer.

At the end of the operation, the incision dressing was wrapped, and the right upper limb was post-gypsum to fix the elbow joint of the affected limb in the semi-flexion position.

 

12. Dorsal surgery for distal radius fracture

Open right humerus open reduction and plate screw internal fixation

1. Take the longitudinal incision of the distal part of the humerus, which is about 6cm long. Cut the skin and subcutaneously in turn, free and retract the protective cephalic vein, cut the deep fascia, and exfoliate the extensor muscle and the short extensor of the wrist. Entering, revealing a fracture.

2. The fracture was located in the distal part of the humerus, about 4 cm away from the wrist surface, the fracture end was cleaned, and the subperiosteal peeling was performed properly. The trial was performed with satisfactory reduction. The 4 hole 1/3 tubular steel plate was pre-bent and placed on the dorsal side. , drilling, tapping, and sounding in turn, screwing into the 3.5mm cortical bone screw to fix the fracture and the plate. Check the fracture near anatomical reduction and fix it firmly.

3. Rinse the wound, suture the incision and suture in turn.

 

Thirteen, supracondylar fracture of the humerus

Right humerus supracondylar fracture open reduction and Kirschner wire internal fixation