MD1131Z - Method for preventing and treating the contracture of the elbow joint - Google Patents
Method for preventing and treating the contracture of the elbow joint Download PDFInfo
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- MD1131Z MD1131Z MDS20160089A MDS20160089A MD1131Z MD 1131 Z MD1131 Z MD 1131Z MD S20160089 A MDS20160089 A MD S20160089A MD S20160089 A MDS20160089 A MD S20160089A MD 1131 Z MD1131 Z MD 1131Z
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- olecranon
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Abstract
Description
Invenţia se referă la medicină, în special la traumatologie şi ortopedie şi poate fi utilizată pentru tratamentul pacienţilor cu contractură posttraumatică a articulaţiei cotului sau cu fracturi metaepifizare complicate de tip C a porţiunii distale a humerusului cu modificarea formei anatomice normale a fosei olecraniene. The invention relates to medicine, in particular to traumatology and orthopedics and can be used for the treatment of patients with post-traumatic contracture of the elbow joint or with complicated metaepiphyseal fractures of type C of the distal portion of the humerus with modification of the normal anatomical shape of the olecranon fossa.
Este cunoscută o metodă de osteotomie a olecranului, care include incizia pielii pe suprafaţa posterioară a humerusului, marginea radială a olecranului şi crista ulnei (abordul postero-lateral, transolecranian) şi osteotomia transversală sau în formă de V a olecranului cu fixare ulterioară, după reconstrucţia extremităţii distale a humerusului, cu broşe Kirschner sau şuruburi spongioase [1]. A method of olecranon osteotomy is known, which includes skin incision on the posterior surface of the humerus, the radial edge of the olecranon and the crista ulna (postero-lateral, transolecranon approach) and transverse or V-shaped osteotomy of the olecranon with subsequent fixation, after reconstruction of the distal extremity of the humerus, with Kirschner wires or cancellous screws [1].
Metoda cunoscută nu prevede posibilitatea rezolvării contracturilor postraumatice ale antebraţului, legate de schimbarea (micşorarea) razei de curbură a incizurii trohleare a olecranului. The known method does not provide for the possibility of resolving post-traumatic contractures of the forearm, related to the change (reduction) of the radius of curvature of the trochlear notch of the olecranon.
Este cunoscută, de asemenea, o metodă de lichidare a contracturii articulaţiei cotului folosind combinaţia osteotomiei parţiale a olecranului prin abordul posterior şi osteosinteza extrafocară cu aparat Ilizarov cu scopul modificării controlate a razei de curbură a incizurii trohleare a olecranului şi prelucrării precoce a mişcărilor în articulaţia cotului [2]. A method of eliminating elbow joint contracture is also known using the combination of partial olecranon osteotomy through the posterior approach and extrafocal osteosynthesis with the Ilizarov apparatus with the aim of controlled modification of the radius of curvature of the trochlear notch of the olecranon and early processing of movements in the elbow joint [2].
În pofida faptului că metoda descrisă are momente pozitive, există şi unele neajunsuri destul de serioase, cum ar fi riscul înalt de dezvoltare a complicaţiilor septice prin infectarea broşelor aparatului de fixare externă şi disconfortul pentru pacient, legat de pansamentele regulare şi necesitatea permanentă a deservirii aparatului Ilizarov. Despite the fact that the described method has positive moments, there are also some quite serious shortcomings, such as the high risk of developing septic complications through infection of the external fixation device pins and the discomfort for the patient, related to regular dressings and the permanent need to service the Ilizarov apparatus.
Mai este cunoscută o metodă de intervenţie chirurgicală bazată pe osteotomie incompletă în formă de L în plan sagital până la mijlocul olecranului şi frontal spre exterior cu refixare ulterioară cu şuruburi [3]. Another known surgical intervention method is based on incomplete L-shaped osteotomy in the sagittal plane to the middle of the olecranon and frontally outwards with subsequent refixation with screws [3].
Metoda descrisă nu prezintă posibilitatea pentru revizia chirurgicală adecvată a articulaţiei în cazul leziunilor intraarticulare grave ale extremităţii distale a braţului. The described method does not provide the possibility for adequate surgical revision of the joint in case of serious intra-articular injuries of the distal extremity of the arm.
În rezultatul analizei datelor din literatură şi în baza experienţei proprii propunem o metodă originală a osteotomiei şi refixării ulterioare a fragmentului olecranului cu schimbarea razei de curbură a incizurii trohleare, care a fost utilizată la 4 pacienţi cu rigiditate (contractură) posttraumatică a articulaţiei cotului şi fracturi complicate metaepifizare tip C (AO) ale extremităţii distale a humerusului. As a result of the analysis of data from the literature and based on our own experience, we propose an original method of osteotomy and subsequent refixation of the olecranon fragment with changing the radius of curvature of the trochlear notch, which was used in 4 patients with post-traumatic stiffness (contracture) of the elbow joint and complicated metaepiphyseal type C (AO) fractures of the distal extremity of the humerus.
Problema pe care o rezolvă metoda propusă constă în crearea condiţiilor pentru restabilirea mişcărilor active de flexie-extensie ale antebraţului în volum maximal posibil prin folosirea metodei de osteotomie a olecranului cu schimbarea razei de curbură a incizurii trohleare. The problem that the proposed method solves consists of creating conditions for restoring active flexion-extension movements of the forearm in the maximum possible volume by using the olecranon osteotomy method with changing the radius of curvature of the trochlear notch.
Esenţa metodei constă în aceea că se efectuează incizia pielii pe suprafaţa posterioară a humerusului, pe marginea radială a olecranului şi crista ulnei, apoi se efectuează osteotomia olecranului în formă de Z în plan sagital pe suprafaţa laterală, începând de la mijlocul olecranului la nivelul inserţiei porţiunii posterioare a ligamentului colateral ulnar cu prelungirea în partea anterioară în direcţia părţii proximale a incizurii trohleare, apoi se mobilizează fragmentul osos proximal al olecranului şi muşchiul triceps brahial, se restabileşte anatomia părţii distale a humerusului, se înlătură ţesuturile sau dereglările patologice ale fosei olecraniene, se efectuează adaptarea fragmentului olecranului, se verifică raza de curbură a incizurii trohleare, se efectuează osteosinteza cu ajutorul a 2 broşe Kirschner cu diametrul de 2 mm, introduse de-a lungul axei osului ulnar, şi cu un fir metalic şi se suturează plaga pe straturi. The essence of the method consists in performing a skin incision on the posterior surface of the humerus, on the radial edge of the olecranon and the crista ulna, then performing a Z-shaped osteotomy of the olecranon in the sagittal plane on the lateral surface, starting from the middle of the olecranon at the level of the insertion of the posterior portion of the ulnar collateral ligament with the extension in the anterior part in the direction of the proximal part of the trochlear notch, then mobilizing the proximal bone fragment of the olecranon and the triceps brachii muscle, restoring the anatomy of the distal part of the humerus, removing the pathological tissues or disorders of the olecranon fossa, adapting the olecranon fragment, checking the radius of curvature of the trochlear notch, osteosynthesis is performed using 2 Kirschner wires with a diameter of 2 mm, inserted along the axis of the ulnar bone, and a metal wire and suture the wound in layers.
Principalul avantaj al metodei propuse constă în restabilirea mişcărilor active de flexie-extensie în articulaţia cotului în volum maximal posibil cu îmbunătăţirea calităţii vieţii pacientului. The main advantage of the proposed method is the restoration of active flexion-extension movements in the elbow joint in the maximum possible volume, improving the patient's quality of life.
Cu scopul creării condiţiilor pentru restabilirea mişcărilor active de flexie-extensie în articulaţia cotului în volum maximal posibil în timpul resintezei olecranului a fost folosit principiul schimbării razei de curbură a incizurii trohleare cu majorarea ei şi păstrarea maximală a suprafeţei “de lucru” a cartilajului incizurii trohleare, graţie specificului liniei osteotomiei propuse. In order to create conditions for restoring active flexion-extension movements in the elbow joint in the maximum possible volume during olecranon resynthesis, the principle of changing the radius of curvature of the trochlear notch with its increase and maximal preservation of the “working” surface of the trochlear notch cartilage was used, thanks to the specifics of the proposed osteotomy line.
Metoda se realizează în modul următor. The method is carried out in the following way.
După examinarea clinico-radiologică şi stabilirea diagnosticului de rigiditate (contractură) posttraumatică a articulaţiei cotului sau fracturi complicate metaepifizare tip C (AO) a extremităţii distale a humerusului se efectuează intervenţia chirurgicală - osteotomia olecranului cu schimbarea razei de curbură a incizurii trohleare la pacienţii cu contractură posttraumatică a articulaţiei cotului şi cu fracturi complicate metaepifizare a extremităţii distale a humerusului, şi anume osteotomia olecranului în formă de Z în plan sagital a fost efectuată cu ferăstrăul oscilant sau cu o daltă subţire pe suprafaţa laterală, începând de la mijlocul olecranului la nivelul inserţiei porţiunii posterioare a ligamentului colateral ulnar, în plan frontal spre anterior în direcţia 1⁄4 proximale a incizurii trohleare. După mobilizarea fragmentului osos proximal şi a muşchiului triceps, au fost luate măsurile necesare de restabilire a anatomiei extremităţii distale a humerusului şi de lichidare a modificărilor patologice ale fosei olecraniene, cu scopul creării condiţiilor pentru restabilirea mişcărilor active de flexie-extensie în articulaţia cotului în volum maximal posibil. În timpul resintezei olecranului a fost folosit principiul schimbării razei de curbură a incizurii trohleare cu majorarea ei şi păstrarea maximală a suprafeţei “de lucru” a cartilajului incizurii trohleare, graţie osteotomiei propuse, după adaptarea fragmentului olecranului, majorarea şi verificarea razei de curbură a incizurii trohleare, se efectuează osteosinteza cu 2 broşe Kirschner cu diametrul de 2,0 mm, introduse strict de-a lungul axei osului ulnar, şi cu un fir metalic, care permite prelucrarea precoce a mişcărilor active de flexie-extensie ale antebraţului. After clinical and radiological examination and establishing the diagnosis of post-traumatic stiffness (contracture) of the elbow joint or complicated metaepiphyseal fractures type C (AO) of the distal extremity of the humerus, surgical intervention is performed - olecranon osteotomy with changing the radius of curvature of the trochlear notch in patients with post-traumatic contracture of the elbow joint and complicated metaepiphyseal fractures of the distal extremity of the humerus, namely the Z-shaped olecranon osteotomy in the sagittal plane was performed with an oscillating saw or a thin chisel on the lateral surface, starting from the middle of the olecranon at the level of the insertion of the posterior portion of the ulnar collateral ligament, in the frontal plane towards the anterior in the direction of the proximal 1⁄4 of the trochlear notch. After mobilizing the proximal bone fragment and the triceps muscle, the necessary measures were taken to restore the anatomy of the distal extremity of the humerus and to eliminate the pathological changes in the olecranon fossa, with the aim of creating conditions for restoring active flexion-extension movements in the elbow joint in the maximum possible volume. During the olecranon resynthesis, the principle of changing the radius of curvature of the trochlear notch with its increase and maximal preservation of the “working” surface of the trochlear notch cartilage was used, thanks to the proposed osteotomy, after adapting the olecranon fragment, increasing and checking the radius of curvature of the trochlear notch, osteosynthesis is performed with 2 Kirschner wires with a diameter of 2.0 mm, introduced strictly along the axis of the ulnar bone, and with a metal wire, which allows early processing of active flexion-extension movements of the forearm.
Exemplul 1 Example 1
Este descris un caz de aplicare a metodei de osteotomie a olecranului cu schimbarea razei de curbură a incizurii trohleare la un pacient cu pseudoartroză a humerusului distal pe fon de deteriorare a fixatoarelor după o osteosinteză imperfectă cu plăci cu stabilitate unghiulară (blocate) - complicaţie postoperatorie, legată de nerespectarea tehnicii corecte a folosirii LCP - ghidului şi osteosintezei în general. A case of application of the olecranon osteotomy method with changing the radius of curvature of the trochlear notch is described in a patient with pseudoarthrosis of the distal humerus due to damage to the fixators after an imperfect osteosynthesis with angularly stable (locked) plates - a postoperative complication related to failure to follow the correct technique of using the LCP - the guide and osteosynthesis in general.
Bolnavul B., 34 ani, s-a adresat cu acuze de dureri în regiunea 1/3 distale a braţului cu iradiere proximală şi distală. Din anamneză: intervenţie chirurgicală efectuată cu un an în urmă în legătură cu fractura metafizară distală a osului humeral drept, tip B (după AO). S-a efectuat osteosinteza humerusului cu plăci cu stabilitate unghiulară (blocate) - LCP reconstructive. Tratatament postoperator - fără imobilizare externă. Din spusele bolnavului, din prima zi după intervenţia chirurgicală s-au depistat limitări severe ale mişcărilor active şi pasive de flexie-extensie în articulaţia cotului. S-a aflat la evidenţa medicului timp de 2 luni. A avut loc încercarea forţată nereuşită a majorării volumului mişcărilor, după care bolnavul a fost îndreptat pentru tratament la locul de trai. Patient B., 34 years old, complained of pain in the distal 1/3 of the arm with proximal and distal irradiation. From the anamnesis: surgical intervention performed a year ago in connection with a distal metaphyseal fracture of the right humeral bone, type B (after AO). Osteosynthesis of the humerus with plates with angular stability (locked) was performed - reconstructive LCP. Postoperative treatment - without external immobilization. According to the patient, from the first day after the surgical intervention, severe limitations of active and passive flexion-extension movements in the elbow joint were detected. He was under the doctor's care for 2 months. An unsuccessful forced attempt to increase the volume of movements took place, after which the patient was sent for treatment at his place of residence.
Examinarea obiectivă: hipotrofia muşchilor biceps şi triceps brahii, dorsali ai antebraţului, volumul mişcărilor active şi pasive de flexie-extensie în articulaţia cotului (poziţionat în flexie 90°) în limitele 5° - rigiditatea articulaţiei, dureri moderate. Sensibilitatea membrului păstrată, mişcări active în articulaţia mâinii şi ale degetelor sunt prezente în volum complet. Objective examination: hypotrophy of the biceps and triceps brachii muscles, dorsalis of the forearm, the volume of active and passive flexion-extension movements in the elbow joint (positioned in 90° flexion) within 5° - stiffness of the joint, moderate pain. The sensitivity of the limb is preserved, active movements in the hand and finger joints are present in full volume.
După un examen imagistic a fost depistată pseudoartroza humerusului distal pe fon de deteriorare a fixatoarelor, după osteosinteza cu plăci cu stabilitate unghiulară (blocate), plasarea incorectă a plăcii laterale cu suprapunere parţială a fosei olecraniene. After an imaging examination, pseudoarthrosis of the distal humerus was detected due to damage to the fixators, after osteosynthesis with angular stability plates (locked), incorrect placement of the lateral plate with partial overlap of the olecranon fossa.
Bolnavul a fost supus intervenţiei chirurgicale în secţia 1 ortopedie şi traumatologie IMSP IMU. A fost ales abordul transolecranian, şi anume datorită tipului de osteotomie a olecranului - oblică în formă de Z în plan sagital, cu scopul majorării ulterioare a spaţiului între suprafeţele articulare ale trohleei şi olecranului. S-a efectuat extragerea materialelor de osteosinteză deteriorate. A fost marcată lipsa contactului sigur al şuruburilor cu osul humeral, absenţa fixării lor în fragmentele deteriorate ale ambelor plăci cu stabilitate unghiulară (blocate) şi localizarea extremităţii distale a plăcii laterale în regiunea fosei olecraniene. S-a stabilit prezenţa pseudoartrozei hipotrofice a osului humeral la nivelul metafizei pe fon de cicatrice paraarticulară severă. The patient underwent surgery in the 1st department of orthopedics and traumatology of the IMSP IMU. The transolecranon approach was chosen, namely due to the type of osteotomy of the olecranon - oblique Z-shaped in the sagittal plane, with the aim of further increasing the space between the articular surfaces of the trochlea and the olecranon. The damaged osteosynthesis materials were extracted. The lack of secure contact of the screws with the humeral bone was noted, the absence of their fixation in the damaged fragments of both plates with angular stability (locked) and the localization of the distal end of the lateral plate in the region of the olecranon fossa. The presence of hypotrophic pseudoarthrosis of the humeral bone at the level of the metaphysis was established against the background of severe paraarticular scarring.
S-a efectuat prelucrarea fragmentelor humerusului cu deschiderea canalului, osteosinteza autoosteoplastică cu transplant spongios din crista osului iliac, artroliza articulaţiei cotului, transpoziţia nervului ulnar. The humerus fragments were processed with canal opening, autoosteoplastic osteosynthesis with cancellous transplantation from the iliac crest, arthrolysis of the elbow joint, and ulnar nerve transposition were performed.
Pentru fixarea fragmentelor osului humeral au fost folosite 2 plăci reconstructive de rază 4,5 (lăţime - 10 mm, grosime - 2,4 mm) cu şuruburi de diametrul corespunzător, osteosinteza olecranului cu 2 broşe cu diametrul de 2,0 mm şi fir metalic. Drenarea activă postoperatorie a plăgii. Construcţiile metalice, destul de masive pentru nivelul dat, au permis prelucrarea precoce a mişcărilor de flexie-extensie în articulaţia cotului - practic din prima zi, volumul lor a constituit 0°-40°-130°. Dereglări neurovasculare periferice în dinamică nu s-au dezvoltat. Din primele zile au fost indicate antibiotice, preparate pentru îmbunătăţirea hemocirculaţiei segmentului operat, anticoagulante (2 săptămâni). Din proceduri fizioterapeutice - numai hipotermie locală periodică în primele 3 zile. Plaga postoperatorie s-a cicatrizat primar. For fixation of the humeral bone fragments, 2 reconstructive plates of radius 4.5 (width - 10 mm, thickness - 2.4 mm) with screws of the corresponding diameter were used, osteosynthesis of the olecranon with 2 pins with a diameter of 2.0 mm and metal wire. Active postoperative drainage of the wound. The metal constructions, quite massive for the given level, allowed early processing of flexion-extension movements in the elbow joint - practically from the first day, their volume constituted 0°-40°-130°. Peripheral neurovascular disorders in dynamics did not develop. From the first days, antibiotics, preparations for improving hemocirculation of the operated segment, anticoagulants (2 weeks) were indicated. From physiotherapeutic procedures - only periodic local hypothermia in the first 3 days. The postoperative wound healed primarily.
Rezultatul pozitiv al aplicării metodei propuse constă în faptul că pe parcursul perioadei de recuperare, bolnavul a prelucrat mişcări de flexie-extensie, a urmat un curs de masaj şi tratament medicamentos care a inclus preparate de calciu, antiinflamatoare, antiagregante. Peste 4 luni controlul imagistic a confirmat semne clare de consolidare a fragmentelor. Peste 6 luni după intervenţie chirurgicală pacientul s-a întors la activitatea sa profesională (constructor). Volumul mişcărilor active de flexie-extensie în articulaţia cotului a constituit 0°-45°-130°, de prono- supinaţie - în limitele normei. The positive result of applying the proposed method is that during the recovery period, the patient worked on flexion-extension movements, underwent a course of massage and drug treatment that included calcium preparations, anti-inflammatory, antiplatelet agents. After 4 months, the imaging control confirmed clear signs of consolidation of the fragments. After 6 months after surgery, the patient returned to his professional activity (builder). The volume of active flexion-extension movements in the elbow joint was 0°-45°-130°, pronation-supination - within the normal limits.
Exemplul 2 Example 2
Bolnava I., 73 ani, internată în mod urgent cu diagnosticul: fractura cominutivă a paletei humerale pe dreapta cu deplasare, tip IC 13C2 (AO). Patient I., 73 years old, urgently hospitalized with the diagnosis: comminuted fracture of the humeral blade on the right with displacement, type IC 13C2 (AO).
Intervenţie chirurgicală peste 3 zile după traumatism: reducerea deschisă a fragmentelor humerusului distal prin abordul transolecranian, osteosinteza paletei humerale cu 2 plăci reconstructive şi şuruburi. Cu scopul creării condiţiilor anatomice pentru restabilirea mişcărilor active de flexie-extensie în articulaţia cotului şi păstrarea maximă a suprafeţei “de lucru” a cartilajului incizurii trohleare a fost efectuată osteotomia olecranului cu schimbarea razei de curbură a incizurii trohleare după metoda descrisă şi restabilirea maximal posibilă a formei anatomice normale a fosei olecraniene. Surgical intervention 3 days after the trauma: open reduction of the distal humerus fragments through the transolecranon approach, osteosynthesis of the humeral blade with 2 reconstructive plates and screws. In order to create anatomical conditions for restoring active flexion-extension movements in the elbow joint and maximally preserving the “working” surface of the trochlear notch cartilage, an olecranon osteotomy was performed with a change in the radius of curvature of the trochlear notch according to the described method and the maximal possible restoration of the normal anatomical shape of the olecranon fossa.
După adaptarea fragmentului olecranului a fost efectuată osteosinteza cu 2 broşe Kirschner introduse strict de-a lungul axei osului ulnar şi cu un fir metalic. Drenarea activă postoperatorie a plăgii. After adaptation of the olecranon fragment, osteosynthesis was performed with 2 Kirschner wires inserted strictly along the axis of the ulnar bone and with a metal wire. Active postoperative drainage of the wound.
Dereglări neurovasculare periferice nu s-au dezvoltat. Din primele zile au fost indicate antibiotice, preparate pentru îmbunătăţirea hemocirculaţiei segmentului operat, anticoagulante (2 săptămâni). Proceduri fizioterapeutice: hipotermie locală în primele 3 zile. Plaga postoperatorie s-a cicatrizat primar. În perioada de recuperare a urmat tratament medicamentos, care a inclus: Clodifen 75 mg/zi pentru reducerea durerilor, D-calcin cu scop de profilaxie a osteoporozei postraumatice 200 UI/zi, Londromax - inhibitor specific non-hormonal al osteoclastelor, 70 mg/zi, nr.4, Aspirină - antiagregant plachetar 75 mg/zi, Ripronat - pentru ameliorarea circulaţiei regionale sangvine, 500 mg/2 ori pe zi, timp de 4 săptămâni. Peste 2 luni controlul imagistic a confirmat semne de consolidare a fragmentelor. Peripheral neurovascular disorders did not develop. From the first days, antibiotics, preparations for improving hemocirculation of the operated segment, anticoagulants (2 weeks) were indicated. Physiotherapeutic procedures: local hypothermia in the first 3 days. The postoperative wound healed primarily. During the recovery period, drug treatment followed, which included: Clodifen 75 mg/day for pain relief, D-calcin for the purpose of post-traumatic osteoporosis prophylaxis 200 IU/day, Londromax - specific non-hormonal inhibitor of osteoclasts, 70 mg/day, no. 4, Aspirin - antiplatelet agent 75 mg/day, Ripronat - for improving regional blood circulation, 500 mg/2 times a day, for 4 weeks. After 2 months, imaging control confirmed signs of consolidation of the fragments.
Volumul mişcărilor active de flexie-extensie în articulaţia cotului a constituit 0°-30°-160°, de prono-supinaţie - în limitele normei. The volume of active flexion-extension movements in the elbow joint was 0°-30°-160°, pronation-supination - within the normal limits.
1. Muller M., Allgower M., Schneider R., Willenegger H. Manual of Internal Fixation: Technigues Recommended by the Ao-Asif Group. 3-rd edition. Published by Springer, 1991, 750 p. 1. Muller M., Allgower M., Schneider R., Willenegger H. Manual of Internal Fixation: Techniques Recommended by the Ao-Asif Group. 3rd edition. Published by Springer, 1991, 750 p.
2. RU 2074666 C1 1997.03.10 2. RU 2074666 C1 1997.03.10
3. RU 2344779 C1 2009.01.27 3. RU 2344779 C1 2009.01.27
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| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| RU2074666C1 (en) * | 1994-04-13 | 1997-03-10 | Российский научный центр "Восстановительная травматология и ортопедия" им.акад.Г.А.Илизарова | Method to eliminate bending elbow joint contracture |
| MD1503G2 (en) * | 1999-05-05 | 2001-01-31 | Государственный Медицинский И Фармацевтический Университет "Nicolae Testemitanu" Республики Молдова | Method of surgical treatment of deformation in the congenital radioulnar synostosis to cildren |
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| MD2735G2 (en) * | 2004-07-30 | 2005-12-31 | Государственный Медицинский И Фармацевтический Университет "Nicolae Testemitanu" Республики Молдова | Method of secondary cataract treatment |
| RU2289338C2 (en) * | 2004-11-22 | 2006-12-20 | Федеральное государственное учреждение "Российский научно-исследовательский институт травматологии и ортопедии им.Р.Р. Вредена Федерального агентства по эдравоохранению и социальному развитию" (ФГУ "РНИИТО им.Р.Р.Вредена Росздрава") | Method for treating chronic fracture-luxation in elbow joint |
| RU2344779C1 (en) * | 2007-06-21 | 2009-01-27 | Федеральное государственное учреждение "Уральский научно-исследовательский институт травматологии и ортопедии имени В.Д. Чаклина Федерального агентства по высокотехнологичной медицинской помощи" | Method of olecranon osteotomy |
| RU2463981C1 (en) * | 2011-02-02 | 2012-10-20 | Александр Борисович Слободской | Method of treating severe intraarticular fractures of elbow joint in combination with fractures of ulnar bone diaphysis |
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| RU2074666C1 (en) * | 1994-04-13 | 1997-03-10 | Российский научный центр "Восстановительная травматология и ортопедия" им.акад.Г.А.Илизарова | Method to eliminate bending elbow joint contracture |
| RU2177753C2 (en) * | 1997-11-18 | 2002-01-10 | Российский научный центр "Восстановительная травматология и ортопедия" им. акад. Г.А.Илизарова | Method of treatment of patients with contractures of elbow joint |
| MD1503G2 (en) * | 1999-05-05 | 2001-01-31 | Государственный Медицинский И Фармацевтический Университет "Nicolae Testemitanu" Республики Молдова | Method of surgical treatment of deformation in the congenital radioulnar synostosis to cildren |
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| RU2289338C2 (en) * | 2004-11-22 | 2006-12-20 | Федеральное государственное учреждение "Российский научно-исследовательский институт травматологии и ортопедии им.Р.Р. Вредена Федерального агентства по эдравоохранению и социальному развитию" (ФГУ "РНИИТО им.Р.Р.Вредена Росздрава") | Method for treating chronic fracture-luxation in elbow joint |
| RU2344779C1 (en) * | 2007-06-21 | 2009-01-27 | Федеральное государственное учреждение "Уральский научно-исследовательский институт травматологии и ортопедии имени В.Д. Чаклина Федерального агентства по высокотехнологичной медицинской помощи" | Method of olecranon osteotomy |
| RU2463981C1 (en) * | 2011-02-02 | 2012-10-20 | Александр Борисович Слободской | Method of treating severe intraarticular fractures of elbow joint in combination with fractures of ulnar bone diaphysis |
| RU2521561C2 (en) * | 2012-06-14 | 2014-06-27 | Открытое акционерное общество "Чепецкий механический завод" | Extraction separation of zirconium and hafnium |
Non-Patent Citations (1)
| Title |
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| Muller M., Allgower M., Schneider R., Willenegger H. Manual of Internal Fixation: Technigues Recommended by the Ao-Asif Group. 3-rd edition. Published by Springer, 1991, 750 p. * |
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