ORIF Distal humerus

ORIF Distal humerus 

 

 

 

 

 

1.Set

OS Major set

OS Bone set

 

2.부속

OS Hand fracture set

OS Hand set

F자 Bender

pressure bender

synthes collibri drill

mixter (set내 rt-angle 도 가능)

*Olecranon fracture 할 경우

hoke osteotome

synthes micro saw + 045blade

wire set

tension band

 

3.준비물품

20,15mess

bovie

bipolar

spoid

gauze

stockinet

sling

suture material: 1/0 vicryl, 2/0 vicrly

no.2 black silk (7호 tie용)

JP 100M

 

4.회사기구

1)synthes DHP Set

2)준영 DHP Set

 

 

 

 

 

1.position

lateral decubitus position 

 

 

 

 

그림참고 Master techniques in orthopaedic surgery fractures (2012) 3.reduction

2.incision & approach

posterior midline incision used by #20mess

full-thickness medial, lateral fascio-cutaneous flap을 raised한다. 

(deep fascia를 elevate하면서 dissection 하는 이유는 ulnar, radial nerve 확인하기 위함)

metz (or tenotomy scs)로 triceps-sparing approach 

senn vein, army, cushing 으로 retraction

ulna nerve가 노출되면 sling 으로 protection 

vessel이 나오면 mixter*2로 clamping하고 black silk로 tie

 

*multiple intra-articular fragment, coronal shear fragments 일경우

approach: triceps-spraing approach

olecranon osteotomy 

micro saw, hoke osteotomy, tentsion band, 21g wire, vice grip

 

 

 

그림참고 Master techniques in orthopaedic surgery fractures (2012)

3.reduction

reduction clamp 중,대를 이용하여 humerus 전체를 reduction 한 후 

k-wire 로 temporary fixation

 

 

 

4.plate

1)plate

(1)medial

(2)lateral

(3)dorsolateral with support

2)screw

(1)Distal screw

VA Locking screw 2.7 (drill bit 2.0)

low profile metaphyseal compression screw 2.7

cotical screw 2.4

(2)Shaft screw

locking screw 3.5 (drill bit 2.8)

cortical screw 3.5 (drill bit 2.5)

 

 

 

 

5.close 

JP 100 M Drain

olecranona의 tip과 deep dermis suture: 1/0 PDS (직침 필요)

subcutaneous suture: 2/0 vicryl 

skin : 4/0 nylon