Judul : Teknik Operasi Fraktur Humerus Dan Radius-Ulna pada Hewan (Bedah Fraktur) bag. 2
link : Teknik Operasi Fraktur Humerus Dan Radius-Ulna pada Hewan (Bedah Fraktur) bag. 2
Teknik Operasi Fraktur Humerus Dan Radius-Ulna pada Hewan (Bedah Fraktur) bag. 2
definite
A fracture is a break in the continuity of a bone, with or without a change in the location of bone fragments, resulting in a loss of integrity or balance. Fractures are often accompanied by soft tissue injury of varying degrees, involving vessels, muscles, and nerves.
Cause of fracture
In general, the causes of fractures can be divided into two types:
- extractive reasons. Direct violations such as those caused by injury such as hitting, beating or falling from a height, indirect violations such as spinning.
- internal causes Muscle contraction leading to avulsion fractures, which is common in immature animals. Fracture pathology caused by systemic diseases such as neoplasms, bone cysts, rickettsiae, osteoporosis, hyperparathyroidism, osteomalacia.
therapy
Fractures are treated with the following methods:
1. Recovery operation
- Limestone installation (Gibson)
- talk (ma'am)
- Tommaso Stecca
2. Operation call
- Kirchner wire
- bone plate
- Bone fixation (medullary nail)
- Dental inserts (stainless steel screws)
- bone thread
- Combination with method 1-5
3. Final decision
- amputate
The technique used for treatment is very dependent on the degree of damage to the bone by the method. The biological approach is to align the proximal and distal bone fragments with minimal formation of fracture hematomas and attachment of soft tissues to the bone fragments.
In tree fractures, complete reduction is not the highest priority, but the main priority is to optimize bone union by providing the same soft tissue conditions around the stabilizing bone d. Examples of biological approaches to fractures include plate fixation, nail blocking, external fixation, and plate twisting.
While there are many techniques that can be used in the treatment of humerus fractures, the radius and ulna are the most commonly used treatments for bone attachment (interosseous nail).
principle of operation
In the management of orthopedic fracture surgery, the concept of 4 Rs is known, namely recognition, reduction, retention and rehabilitation.
- Recognition or recognition is the performance of various diagnostics by Jan Benard, which will help in the treatment of fractures, because the therapy plan can be prepared more perfectly.
- Repositioning is the act of restoring a disturbed state as close as possible to the original state or condition.
- Retention or immobilization is the act of preserving bone fragments so that the healing process takes place for optimal drying.
- Rehabilitation is the act of allowing the affected part to return to its normal state.
The surgical operations performed will give optimal results if they are performed on the basis of the correct work and technique of the therapist and always adhere to the basic principles of orthopedic surgery.
The operation is also carried out with relatively short healing and the highest possible frequency of injuries due to the operation. Some of the principles to be followed when restoring bone include the following:
- The blood supply to bone and bone fragments must always be considered and protected from surgical damage.
- Precise restoration of the shape of bones, especially in the area of the joints.
- Mechanical reduction should be stable fixation.
- The technique used tries to cause as little injury as possible.
- Rehabilitation is absolutely necessary and necessary. Rehabilitation begins as soon as possible after the last therapy. The aim is to preserve the fracture survivor's function while healing and restore function to normal and as quickly as possible before healing.
The location and type of fracture, which affects the surgical technique and the fixation devices used, is presented as follows:
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| Homero's Fracture Doctor Schematic |
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| The scheme of treatment of fractures of the radius |
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| The scheme of treatment of a fracture of the ulna |
technical operator
The surgical technique for fractures varies depending on the type and location of the fracture. Different types of fractures also require different ways of fixing fragments. Threads, bone marrow pins, bones and bone plates are used as fixation tools.
The surgical technique begins with preparing the patient under anesthesia and then shaving off the hair around the operating area. perform incisions with different accesses depending on the type of fracture and perform different methods of fixation for different types of fractures.
Longitudinal skin incisions were made along the distal half of the dressing gown from the fracture site. The skin and fat under the skin are prepared and then removed.
Efforts to separate the muscles, especially in cases of radial and ulnar fractures, the extensor wrist muscles and the flexor wrist muscles must be done carefully because they are full of blood and the surface of the muscle is blackish red.
The muscle is then stretched so that the area of the fracture can be seen. They try to raise the fragment of the fracture to the surface by bending the joint in the direction of flight.
The pins, the length of which is adjusted to the length of the bone, are inserted into the medullary cavity distal to the proximal one and continue to penetrate until they penetrate the bones of the dorsal row joints in a state of flexion.
Then the proximal fracture is pressed together with the distal fragments to the place where the ends of the bones do not fit together. Ping, which is located in the distal cavity of the marrow, then evaluates the proximal direction, so that it enters the proximal cavity of the marrow and fixes two fractures in a state similar to a whole bone.
The nail is cut at the distal end of the nail, which is still outside the joint, so that after cutting the distal end of the nail can be correctly inserted into the joint.
Naked muscles and stratified fasciae were sewn together with chromic intestinal paint, previously cleaned of residual blood clots from the hematoma and instilled with a solution of Gentamicin 50.
Then they give santican and antiseptic antibiotics. The radiologist was carried out to make sure that the various therapeutic devices were correctly placed and continued to ensure that the fixation devices were on average one year after the operation.
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| so is the plate |
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| intramedullary nail |
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| Kirchner wire |
Yang's healing factor affects
Fracture healing is influenced by several factors, namely:
- Age, in Sueya Mud fractures are easier to treat than in old Padusiya.
- General health.
- The nature of the fracture, if the fracture is accompanied by a large network, then healing will be long, comminuted fractures will require a longer time.
- local fracture. In areas with poor vascularity, healing will take longer and be more difficult. For example, a fracture of the femoral head.
- There is an infection or tyracnia.
- Janice Fracture.
The technique of fracture surgery begins with preparation for surgery, surgery and postoperative measures. In general, preoperative and postoperative measures are the same for fractures of the humerus and fractures of the ulna. The difference lies in the different surgical procedures for each type of fracture.
initial operation
hevan
The diagnosis of a fracture is based on the history, physical examination, movement, measurement, palpation, and x-ray. The history is taken to determine the fracture, its cause, when it occurred, so that it can help in the diagnosis.
Examination is carried out carefully on the limbs, whether there is lameness, swelling, stiffness of movements, discoloration, cyanosis, pallor, etc.
Measurements are made by comparing the healthy part of the foot with the patient, whether it looks symmetrical. Palpation is performed with caution for the presence of crepitus, edema, soreness, lines-lines.
Diagnosis fades in and out. Pictures of the fracture should be taken from 2 sides, perpendicular to each other, to get a clear image of the broken bone, which will help therapy.
This is followed by an examination of the general condition of the animal's body, including: pulse rate, respiration, body temperature, posture and routine blood tests. This is done in order to find out if it meets the operational requirements or not.
Dogs must fast for 12 hours and not drink for 2 hours before surgery to keep the bowels empty so that the dog does not vomit under anesthesia.
The part of the body to be incised, namely the craniolateral region of the humerus, is wetted with soapy water to facilitate shaving. The dog's coat was shaved with a sharp razor, cleaned with air, then smeared with tincture of iodine.
After MOT, weigh the dog to determine the total volume of the drug to be used.
Preparatory Statements and Auxiliary Statements
Veterinarians as operators and operators' assistants must perform a number of operating procedures under sterile conditions before and during surgery.
The operator was given an operator's assistant to prepare for washing hands from the tip of the hand to the elbow before surgery using soap under clean running water, followed by disinfection with a 4% PC solution.
Operators providing assistance must also wear masks, sterile gloves and surgical gowns.
Persian medicine
Atropine sulfate 0.025% at a dose of 0.04 mg/kg BW dry subcutaneously was used as premedication. For intramuscular anesthesia, a mixture of 2% xylazine at a dose of 2 mg/kg of body weight with 10% ketamine hydrochloride at a dose of 15 mg/kg of body weight was used. It is also necessary to prepare ampicillin 10% at a dose of 10 mg/kg of body weight.
In large animals, especially in horses, there are two stages of anesthesia, the first stage - before anesthesia comes 1% acepromazine at a dose of 5 mg / 50 kg of body weight, then they are allowed to calm down and relax. The second stage is general anesthesia by overcoming 10% Hydras Chlorali at a dose of 100 mg/kg of body weight.
instruments in Persian
The operating table must be cleaned and sterilized. Surgical instruments are prepared in a sterile state and sequentially and carefully placed on a table adjacent to the operating table.
Prepared instruments: stethoscope, thermometer, shaver, hoist (processing), standard surgical instruments, periosteal elevator, 2-3 bone-holding forceps, fixation instruments (plates and screws or wire pin), nippers, skewers (for callus removal). , yarum, sewing thread, tampon and plaster.
operation
Complete surgery for proximal humerus fracture
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| Examples of fractures of the proximal humerus |
- Animals are under anesthesia
- Shaving job nearby
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| The incision reaches the proximal humerus |
- Cut the skin until superficial muscles appear.
- Tighten your acromion deltoid and brachiocephalic muscles.
- make a periosteal incision so that the broken bone is visible.
- perform fixation by inserting an intramedullary nail from the greater tubercle to the medial part of the condyle
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| Insertion of an intramedullary nail (nail IM) |
- After that, stitch between the muscles with the muscles with a 2/0 chrome-plated cat's intestine thread in a simple single stitch pattern.
- perform subcutaneous closure with a simple continuous suture with a simple 3/0 cat gut suture.
- make leather stitching with cotton thread in a single simple pattern.
- Apply tincture of iodine to the seam area.
- Give Secar antibiotics intramuscularly.
Surgery for a diaphyseal fracture of the humerus
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| Examples of diaphyseal fractures of the femur |
- Animals are under anesthesia
- Shaving job nearby
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| Incisional approach reaches the medial part of the humerus |
- Cut the skin and superficial parts of the muscle and deploy the biceps and brachiocephalic muscles.
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| Installation and dish |
- section de section middle fracture
- Place the plate proximal to the humerus and support the plate.
- After that, stitch between the muscles with the muscles with a 2/0 chrome-plated cat's intestine thread in a simple single stitch pattern.
- perform subcutaneous closure with a simple continuous suture with a simple 3/0 cat gut suture.
- make leather stitching with cotton thread in a single simple pattern.
- Apply tincture of iodine to the seam area.
- Give Secar antibiotics intramuscularly.
Fracture of the medial condyle of the humerus
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| Fracture of the condyle |
- Animals are under anesthesia
- Haircut around the opera site
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| Access to the medial condylar incision reaches the part |
- Skin incision to locate the superficial muscle in the region of the medial condyle.
- Incise several superficial muscles and stretch the muscles in this area, paying attention to the medial and ulnar nerves.
- attachment of bone to condyle
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| bone bed placement |
- After that, stitch between the muscles with the muscles with a 2/0 chrome-plated cat's intestine thread in a simple single stitch pattern.
- perform subcutaneous closure with a simple continuous suture with a simple 3/0 cat gut suture.
- make leather stitching with cotton thread in a single simple pattern.
- Apply tincture of iodine to the seam area.
- Give Secar antibiotics intramuscularly.
Fractures proximal to the radius and/or ulna
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| Appearance of the fracture |
- Animals are under anesthesia
- Hair shaving at the opera site
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