RU127612U1 - DEVICE FOR FIXING THE ELBOW JOINT AT ITS ARTHROSCOPY - Google Patents

Abstract

1. Device for fixing the elbow joint during arthroscopy, characterized in that it consists of two rods interconnected by a hinge unit with the possibility of rigid fixation by a screw, one of which is made telescopic, there are clamps at the ends of each rod, to which half rings are rigidly fixed with screws fixing the shoulder and forearm, and the outer half-ring for the forearm along its inner surface is equipped with fixed guide rails for the directional displacement of the inner half-ring on the circumference, with rigid fixing clamp placed through holes that are arranged at equal intervals from each other with the outer edge of the periphery toward the center midline of half rings with the aim of immobilizing the forearms in a position in which it is supposed to perform issledovanie.2. The device according to claim 1, characterized in that the half ring for fixing the shoulder and the inner half ring for fixing the forearm in the central part perpendicular to the midline at equal distance from its middle have slots for belts.

Description

The utility model relates to medicine, namely to traumatology and orthopedics, and can be used to fix the elbow joint during its arthroscopy.

Arthroscopy of the elbow joint is possible with two options for laying the patient: on the back or abdomen.

The disadvantages of arthroscopy when the patient is on the back are: difficulties with stretching, since the assistant must stretch the joint manually; difficulties with changing tensile strength; difficulties with changing the angle of bending; risk of damage to the hand and fingers when stretched; unstable fixation of the elbow joint.

The disadvantages of arthroscopy with the patient on the abdomen are: the need to turn the patient over; from the blood circulation - pressure on the internal organs is transmitted to the mesenteric and paravertebral vessels, leading to increased venous bleeding; from the side of breathing - squeezed internal organs limit the movement of the diaphragm; difficulty reaching the anterior elbow joint.

There are devices for fixing fractures of the forearm bones, for example, “Device for fixing fractures of the forearm bones” (1), based on transosseous (that is, invasive) fixation of bones of the forearm. The disadvantages of this device for performing arthroscopy of the elbow joint may be: the inability to fix the forearm without damaging the integrity of the anatomical structures 1 (skin, bones of the forearm); the impossibility of correcting the desired position of pronation and supination of the forearm, which limits the possibility of surgical manipulation, as well as the bulkiness of the device and the limitation of the surgical field when it is applied.

The prototype of the utility model is a device for stretching the arm up in the patient’s position on the back, consisting of a holder for fingers or an elastic bandage (2). The disadvantages of arthroscopy of the elbow joint when using this device are: difficulties in reaching the rear sections; difficulties with changing tensile strength; difficulties with changing the angle of bending; risk of damage to the hand and fingers when stretched; unstable fixation of the elbow joint, as a result of which it can deviate forward and backward.

The technical result of the utility model is to optimize the conditions for performing arthroscopy of the elbow joint by providing a predetermined angle of installation in it, including with the possibility of rotation, as well as the dosage of distraction, providing the necessary and sufficient stretching of the elbow joint, for better visualization of intraarticular structures and ease of use arthroscopic instruments in it.

The result is achieved due to the fact that the device consists of two rods interconnected by a hinge unit with the possibility of rigid fixation by a screw, one of which is made telescopic, clamps are located at the ends of each rod, to which half rings are rigidly fixed with screws to fix the shoulder and forearm, the latter equipped with through holes located at regular intervals from the outer edge from the periphery to the center and fixed guide rails for directional displacement of the inner ukoltsa in a circle, with the possibility of rigid fixation in a position in which is expected to produce research.

Figure 1. Schematic illustration of a device for fixing the elbow joint during arthroscopy, where:

1 - a rod, 2 - a telescopic rod, 3 - a clamp for attaching half rings, 4 - a hinge screw, 5 - a clamp for attaching a hinge assembly, 6 - a hinge assembly, 7 - a half ring for fixing the shoulder, 8 - an outer half ring for the forearm, 10 - guide rails for the inner half ring, 11 - retainer, 12 - belts, 13 - midline, 14 - slots for belts, 15 - screw, 16 - through holes.

Figure 2. The expanded position of the device for fixing the elbow joint during arthroscopy, where:

2 - telescopic rod, 4 - swivel screw, 8 - outer half ring for the forearm, 9 - inner half ring for fixing the forearm, 11 - retainer, 13 - midline, 14 - slots for belts, 16 - through holes.

Figure 3. The cross section of the node for fixing the forearm AA, where:

8 - outer half ring for the forearm, 9 - inner half ring, 10 - guide rails for the inner half ring, 11 - retainer.

Figure 4. The initial position of the device for fixing the elbow joint during its arthroscopy.

Figure 5. Distraction of the elbow joint in the device for fixing the elbow joint during arthroscopy ..

Figure 6. Rotation of the elbow joint in the device for fixing the elbow joint during arthroscopy.

The proposed device is made of inert metal and consists of two rods 1 and 2, one of which is telescopic, and half rings for fixing the shoulder 7 and forearm 8. Belts 12 are made in the form of tapes of elastic inextensible material.

The telescopic rod for the forearm 2 has a clamp 3 at its end part, to which the outer half for the forearm 8 is firmly fixed with a screw 15 through the middle of the middle line 13.

On the inner surface of the outer semicircle 8, over its entire length parallel to the middle line 13 at the same distance above and below the latter, the guide rails 10 are rigidly fixed by welding. Figure 3 in section AA shows that the guide rails 10 are U-shaped and grooves look at each other. Along the guide runners 10 there is a directed displacement around the circumference of the inner half ring to fix the forearm 9.

On the midline 13 of the half rings for the forearm 8 and 9 from the outer edge from the periphery to the center, five through holes are located at regular intervals from each other. The latch 11, in the form of a cylindrical threadless bolt, through the above holes 16 from the inside outwards, the semirings 8 and 9 are fixed in the position of supination or pronation necessary for examining the elbow joint.

The rod for the shoulder 1 at its end part has a clamp 3, to which a screw 15, through the middle of the middle line 13, is firmly fixed to a half ring for fixing the shoulder 7.

In the central part of the inner half ring for the forearm 9, perpendicular to the midline 13, two slots 14 are located at equal distance from its middle, through which straps 12 are inserted to fix the forearm. In the central part of the half-ring for fixing the shoulder 7 similarly there are two slots 14 through which the straps 12 for fixing the shoulder are inserted.

The rods 1 and 2 are interconnected by a hinge assembly 6 of the end-to-end type, the amplitude of motion of which is 120 ° (from 60 ° to 180 °). The screw of the hinge assembly 4 fixes the hinge assembly 6 in the desired position.

A device for fixing the elbow joint during its arthroscopy is used as follows:

When the patient is on the back, the hand is laid on a side table. The elbow joint is fixed with the proposed device: in the semicircle for fixing the shoulder 7 straps 12 fix the shoulder. In the inner semicircle for fixing the forearm 9, straps 12 fix the forearm. Moving the inner half ring to fix the forearm 9 along the guide rails 10 of the outer half ring for the forearm 8, the forearm sets the required degree of supination or pronation, after which this position is fixed with the latch 11. By extending the telescopic rod 2, the bones forming the elbow joint are distracted, and the hinge assembly 6 connecting the two rods 1 and 2 allows you to simulate the angle of flexion and extension in the elbow joint, which is necessary to examine a specific department and simplify arthroscopic manipulations in the joint. Fixing the required position is carried out by the screw of the hinge assembly 4.

Examples of application of the device.

1. Patient A, 20 years old, with combined contracture, Panner disease of the left elbow joint. Range of motion (flexion 80 °, extension 130 °, pronation 90 °, supination 90 °).

The use of the device allowed the distraction of the bones forming the ulnar joint (Fig. 5) and the forearm to be installed at an optimal angle of rotation (Fig. 6), which allowed the removal of the intraarticular body. Sequential supination of the forearm at different angles by moving the inner half ring 9 with its fixation in successively replaced positions by the latch 11 through the holes 16, made it possible to perform arthrolysis in the anterior part of the left elbow joint. As a result, it was possible to achieve an increase in range of motion: flexion of 45 °, extension of 180 °, pronation of 90 °, supination of 90 °.

2. Patient B, 35 years old, with an incorrectly fused marginal fracture of the capitate elevation of the left humerus. Range of motion (flexion 60 °, extension 170 °, pronation 90 °, supination 90 °).

The use of the device allowed distraction of the bones forming the ulnar joint (Fig. 5), and in the supination position (Fig. 6), to remove a fragment of the capitate head elevation of the humerus in a position in which optimal conditions were created for resection, local synovectomy and arthrolysis of the left elbow joint. This allowed to increase the range of motion: flexion of 50 °, extension of 180 °, pronation of 90 °, supination of 90 °.

Thus, the proposed device allows you to:

To optimize the conditions for performing arthroscopy of the elbow joint, which ultimately helps to eliminate complications, as well as minimize trauma; carry out arthroscopy of the elbow joint in the supine position, to avoid complications possible when the patient is on his stomach; stably fix the operated limb, which reduces the risk of complications associated with damage to the neurovascular bundles; to model the angle of flexion-extension, supination-pronation of the elbow joint, to distract the bones that form the elbow joint, which improves and simplifies the visualization of intraarticular structures and ultimately increases the effectiveness of the arthroscopy of the elbow joint.

Bibliography:

1) “Device for fixing fractures of the forearm bones”, authors: Bushmanov A.V., Nazarenko N.V., Groholsky V.N. RU 2268018. dated 10.06.2004

2) Strobel M. Guide to arthroscopic surgery. T.2. - Moscow., 2011 .-- p.140-141.

Claims (2)

1. Device for fixing the elbow joint during arthroscopy, characterized in that it consists of two rods interconnected by a hinge unit with the possibility of rigid fixation by a screw, one of which is made telescopic, there are clamps at the ends of each rod, to which half rings are rigidly fixed with screws fixing the shoulder and forearm, and the outer half-ring for the forearm along its inner surface is equipped with fixed guide rails for the directional displacement of the inner half-ring on the circumference, with rigid fixing clamp placed through holes that are arranged at equal intervals from each other with the outer edge of the periphery toward the center midline of half rings with the aim of immobilizing the forearms in a position in which it is supposed to perform the study. 2. The device according to claim 1, characterized in that the half ring for fixing the shoulder and the inner half ring for fixing the forearm in the central part perpendicular to the midline at an equal distance from its middle have slots for belts.

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