RU2309689C1 - Method for osteosynthesis of comminuted fractures of elbow bone - Google Patents

Abstract

FIELD: medicine, traumatology, orthopedics.

SUBSTANCE: the present innovation deals with treating comminuted fractures of elbow bone with the help of a plate and screws. One should drill osseous canal for a screw in proximal and distal fragments; fix distal and proximal fragments with a long compressing screw, curve the plate according to the shape of elbow bone's proximal part to apply it along posterior surface of elbow bone so, that plate's curved end should be under the screw's head, and peripheral - along distal fragment, fix the fragments towards the plate with the help of fixing elements successively in distal direction, create compression with a long screw, finally fix distal fragment towards the plate with several screws. The innovation provides stable fixation of fragments, reconstructs anatomic length of the bone and shortens terms of therapy.

EFFECT: higher efficiency.

5 dwg, 1 ex

Description

The invention relates to the treatment of comminuted ulnar fractures.

A known method of osteosynthesis of such fractures (Müller M., 1996) by open reduction using clamps or Kirschner spokes for preliminary fixation, then the fragments are fixed with screws to the compression plate, which is pre-bent along the contours of the bone. The disadvantage of this method is that it is difficult to adapt the plate of a given length to the main and intermediate fragments in such a way as to restore the normal anatomical length of the bone and to create stable compression between its fragments, since the possibilities of the compression plate are limited.

The technical result of the proposed method is to simplify the process of comparing fragments and adapting them to the plate, as well as achieving stable osteosynthesis, which involves early movements in the operated and adjacent joints, which helps to restore their function in the optimal time.

The result is achieved in that the distal and proximal fragments are first fixed with a long compression screw, the plate is bent in the shape of the proximal part of the ulna and placed under the head of the screw and along the cortical part of the fragments, the fragments are fixed to the plate using fasteners sequentially in the distal direction, the compression is long screw and finally fix the distal fragment to the plate with several screws.

The sequence of implementation of this method is illustrated by the example of comminuted intraarticular fracture of the proximal end of the ulna. A posterior incision in the region of the upper third of the forearm identifies the fracture region of the proximal end of the ulna (Fig. 1). Drill a bone channel under the screw in the proximal (3) and distal (4) fragments of the ulna. Screw the compression screw (1) into both fragments after maximum stretching along the length (figure 2). A compressing 3 mm plate (2) is laid on the back surface of the ulna, forming it so that the curved central end lies under the screw head, and the peripheral end along the distal fragment. This end of the plate is temporarily fixed to the fragment by the bone holder (Fig. 3). Then, intermediate fragments (5) are repaired sequentially from the center to the periphery and fixed to the plate by fasteners (6) (for example, screws and wire loops). In this case, the screws and loops are not tightened to the very end (Fig. 4). The bone holder is removed and the fragments are compressed along the length of the screw until they are in complete contact with each other. Pull the screws and wire loops and fix the distal fragment to the plate with 3 screws (7) (Fig. 5). A layered suture is applied to the wound.

The proposed method, due to the sequence of actions using a screw and a plate, allows to simplify the process of comparing fragments during a comminuted fracture of the proximal ulna, to achieve stable osteosynthesis due to compression of the fragments, which contributes to the early onset of movements in the operated and adjacent joints and a favorable outcome for the treatment of the fracture.

Clinical example: Patient M., 43 years old. I.B. No. 24356/05, was admitted to the hospital with a diagnosis of Closed comminuted intraarticular fracture of the proximal end of the right ulnar bone with displacement of fragments. 2 days after receipt of the operation.

A posterior incision in the region of the upper third of the forearm soft tissue to the bone is dissected in layers. The area of fracture of the ulna was highlighted. An audit of the wound revealed a comminuted fracture of the ulnar bone, which included proximal, distal and 5 intermediate intraarticular and periarticular fragments. The reposition and fixation of the fragments by wines and a plate was carried out according to the described method. By complete bending - extension and rotation in the elbow joint, as well as stretching along the length, the stability of fixation of fragments was checked. Layered stitches on the wound and an aseptic dressing.

Literature

1. Müller M. et al .; Guide to internal osteosynthesis. Springer-Verlag; 1996, S. 462-463.

Claims (1)

A method for osteosynthesis of comminuted ulnar fractures using a plate and screws, including fixation of the distal, proximal and intermediate fragments, characterized in that the bone channel under the screw is drilled in the proximal and distal fragments, the distal and proximal fragments are fixed with a long compression screw, the plate is bent according to the shape of the proximal parts of the ulna and lay on the back surface of the ulna, so that the curved end of the plate lies under the head of the screw, and the peripheral lengthwise distal fragment, the fragments are fixed to the plate by means of fixing elements sequentially in the distal direction, create long compression screw and finally fixed distal fragment to the plate by several screws.

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