RU158571U1 - DEVICE FOR OSTEOSYNTHESIS OF FRACTURES OF THE PROXIMAL FEM DIVISION - Google Patents

Abstract

A device for osteosynthesis of fractures of the proximal femur, containing an extended cylindrical body with a central through channel having an inlet and an outlet; made by a proximal end bent at an angle of about 20-30 ° to the longitudinal axis of the device and beveled at an angle of about 45 ° by a distal end half of the case diameter; located on the side of the proximal end at an angle of 40-45 ° to the longitudinal axis of the body through the oblique channel, through which the fastener is held to ensure its passage through the inlet of the Central channel of the body and exit through the through oblique channel, and the body is made to gradually increase to 1, 5-2 times in diameter towards the proximal end for 1/3 of the length of the device, and the fastener is an awl rod, containing, on the one hand, a section tapered to the cone, on the other the second side is a section with an external thread corresponding to an internal thread deposited on the inner surface of the central channel from the side of its inlet, characterized in that on the section of the fastening element pointed to the cone, there is a self-cutting part in the form of an external thread with a length of 0.5-0 , 7 cm along the fastener and in increments of 0.1-0.2 cm.

Description

The utility model relates to medical equipment and medicine, namely traumatology, and is intended for the treatment of trochanteric and subtrochanteric fractures of the femur by means of intramedullary osteosynthesis.

There are various designs of intramedullary blocking devices for osteosynthesis of the upper third of the femur [copyright certificate SU for inventions No. 662082, No. 405543, 1595494, patent RU for invention No. 2289351]. All of them have an extended cylindrical body and fixing elements.

Also known fixative for osteosynthesis of long tubular bones [copyright certificate SU for the invention No. 1000027]. The latch contains a curved rod, a thrust screw, elastic elements made in the form of paired brackets, a nut. In the middle part of the rod, a slot is made, as well as a series of pair of holes for the locking screws. At the distal end of the rod, a threaded oblique channel is made for the thrust screw, and screw cutting under the nut is made at the proximal end of the rod.

However, this fixative is intended to be inserted retrograde into the femur, i.e. the blocking of the rod by means of a thrust screw is carried out through an oblique channel in the distal portion of the rod. When using the inventive device for introducing the housing is carried out antegrade, i.e. blocking of the device by means of the awl-rod is performed in the proximal femur. At the same time, the design of the above-described lock due to the presence of elastic elements in the form of paired staples along the longitudinal part of the device and the execution of the thrust screw with slots to ensure its swelling is less stable and difficult to manufacture. When installing this clamp, an additional incision is required to provide access to the pear-shaped fossa of the thigh with the aim of screwing the nut on the proximal end of the shaft for swelling and dynamic self-sealing of the clamp in the lower metaepiphysis of the femur.

Also known is a rod for osteosynthesis of the upper third of the femur [Catalog of instruments for performing intraosseous osteosynthesis by Synthes Inc. "PFNA. Proximal Femoral Nail Antirotation. " 12/2011]. The rod is made in the form of an extended body with a central through channel, a proximal and distal pointed ends and a through oblique channel located on the side of the proximal end, through which a screw is passed in the direction of the femoral head. To close the inlet of the Central channel from the side of the proximal end of the housing, a dummy screw is provided. Through holes are provided in the housing from the distal end side to provide lateral blocking of the rod.

However, the use of this rod is accompanied by the need to perform two surgical approaches for insertion of the rod and its proximal blocking: the first from the apex of the greater trochanter of the femur for insertion of the rod body, followed by the installation of the stub screw, the second from the undervert region for the insertion of the screw in the direction of the femoral head, which significantly increases the invasiveness of the surgical intervention.

The closest analogue to the claimed utility model is "Intramedullary device for osteosynthesis of fractures of the upper third of the femur" [RU patent for utility model 146659, the main authors of which are the authors of the claimed technical solution]. The device comprises an extended cylindrical body with a proximal and beveled at an angle of about 45 ° to half the diameter of the body with distal ends and a central through channel having an inlet and an outlet. An internal thread is applied to the inner surface of the central channel from the side of its inlet. The proximal end of the body is made curved at an angle of about 20-30 ° to the longitudinal axis of the device. The body is made with a diameter gradually increasing to 1.5-2 times towards the proximal end over 1/3 of the length of the device. From the side of the proximal end there is a through oblique channel through which the fastener is held. The latter is an awl rod, containing, on the one hand, a section tapered to the cone, and on the other hand, a section with an external thread corresponding to the internal thread of the central channel. The through skew channel is located at an angle of 40-45 ° to the longitudinal axis of the housing and is connected to its central channel with the possibility of passage of the fastener through the inlet of the central channel of the housing and exit through the through skew channel. At least one through transverse channel is made in the housing from the side of the distal end to ensure blocking of the device.

However, the absence of some design features in this device, namely, fixation nodes in the bone of the pointed portion of the fastener, can lead to its micro-mobility, which will reduce the quality of the treatment.

The objective of the claimed utility model is to increase the rigidity of fixation of fragments of the femur.

The essence of the claimed utility model lies in the fact that in the device for osteosynthesis of fractures of the proximal femur containing an extended cylindrical body with a central through channel having an inlet and an outlet; made by a proximal end bent at an angle of about 20-30 ° to the longitudinal axis of the device and beveled at an angle of about 45 ° by a distal end half of the case diameter; located on the side of the proximal end at an angle of 40-45 ° to the longitudinal axis of the body through the oblique channel, through which the fastener is held to ensure its passage through the inlet of the Central channel of the body and exit through the through oblique channel, and the body is made to gradually increase to 1, 5-2 times in diameter towards the proximal end for 1/3 of the length of the device, and the fastener is an awl rod, containing, on the one hand, a section tapered to the cone, on the other side - a section with an external thread corresponding to an internal thread deposited on the inner surface of the central channel from the side of its inlet, in the section of the fastening element pointed to the cone, there is a self-cutting part in the form of an external thread 0.5-0.7 cm long along fastener and increments of 0.1-0.2 cm.

The technical result of the claimed utility model.

Such a technique as performing a self-tapping part at one of the ends of the fastening element, namely, pointed to the cone, allows to increase the stiffness of fixation of the proximal fragment in the fracture zone by ensuring that the above end of the fastening element is screwed into the cortical layer of the bone in the region of the Adams arch, creating a strong adhesion devices with bone. The implementation of this technical solution in the form of an external thread in the type of self-tapping screws with certain geometric dimensions and performing it co-directed with a thread placed on the other end of the fastener allows to simplify the process of installing the latter, more rigid fixation of the proximal end of the device in the bone without using any or additional blocking elements.

The inventive utility model is illustrated using FIG. 1-3. In FIG. 1 is a perspective view; FIG. 2 is a view of the inventive device installed in the femur. In figure 1, the positions 1-13 are indicated:

1 - housing;

2 - the proximal end of the body;

3 - distal end of the housing;

4 - the central channel;

5 - inlet of the Central channel;

6 - the outlet of the Central channel;

7 - internal thread of the central channel;

8 - through oblique channel;

9 - fastener;

10 - tapered section of the fastener;

11 - self-tapping part in the form of an external thread;

12 - section with an external thread of the fastener;

13 - through channels to provide lateral blocking of the device.

A device for osteosynthesis of fractures of the proximal femur contains an extended cylindrical body 1 with a proximal 2 and distal 3 ends, as well as a central through channel 4, which has an inlet 5 and an outlet 6 hole. An internal thread 7 is applied to the inner surface of the central channel 4 from the side of its inlet 5. The proximal end 2 of the housing 1 is made curved at an angle of about 20-30 ° to the longitudinal axis of the device. Case 1 is made with a diameter gradually increasing to 1.5-2 times towards the proximal end 2 over 1/3 of the length of the device. On the side of the proximal end 2 there is a through oblique channel 8 through which the fastening element 9 is passed. The latter is an awl rod, containing, on the one hand, a section 10 pointed to the cone, on which there is a self-cutting part 11 in the form of an external thread of length 0, 5-0.7 cm along the fastener 9 and a step of 0.1-0.2 cm. On the other side of the fastener 9, a section is made with an external thread 12 corresponding to the internal thread 7 of the central channel 4. External threads 11, 12, applied with both sides of the mounting of the element 9 are made co-directional. The through skew-cross channel 8 is located at an angle of 40-45 ° to the longitudinal axis of the housing 1 and is connected to its central channel 4 with the possibility of the fastener 9 passing through the inlet 5 of the central channel 4 of the housing 1 and exit through the through skew-cross channel 8. The housing 1 side of the distal end 3 is made of at least one through transverse channel 13 to ensure blocking of the device. In some cases, in order to increase the stability of fixation of the device in the distal femur from the side of the distal end 3 of the housing 1, at least two through transverse channels 13 are made to ensure blocking of the device located in mutually crossed planes. To facilitate the insertion of the device into the medullary canal of the femur, the distal end 3 is made beveled at an angle of about 45 ° to half the diameter of the body 1.

Device for osteosynthesis of fractures of the proximal femur. An x-ray study is performed to evaluate the location of the fracture, the size and shape of the femur. According to the data obtained from a set of types of sizes, a device with the necessary length and diameter is selected. The patient is placed on an operating table equipped with a device for traction, on the back or in a side position. Under the control of the electron-optical transducer, the fracture is repositioned and the position of the fracture fragments, as well as the direction of introduction of the guide, the inventive device and the locking screws, are intraoperatively monitored. After processing the surgical field, surgical access is performed. A longitudinal skin incision is performed, about 5 cm long, passing near the top of the greater trochanter along the long axis of the thigh. Reaching the fascia, cut it along the cut line of the skin. Stupidly dividing the muscle fibers, they access the greater trochanter. After this, the localization of the point of introduction of the device is determined 5-10 mm lateral to the apex of the greater trochanter. Using a drill, a guide pin is inserted into the medullary canal through a previously defined device insertion point at an angle corresponding to the bending angle of the proximal end of the body. An opening and processing of the medullary canal is performed using a guided spoke using a cannulated drill with a diameter of 17.0 or a curved femoral awl of 8.0. To the inventive device, a guide body is mounted. The device body is introduced along the guide needle into the medullary canal of the femur. Then the guide needle is removed. A distal guide is attached to the guide body and the distal end of the housing is blocked in the transverse direction by introducing locking screws into the through channels to provide lateral blocking. The correctness of the introduction is controlled using an x-ray machine or an electron-optical converter. Remove the guide from the existing section. After that, the body is blocked from the side of its proximal end with the help of an awl rod, which is inserted through the inlet of the central channel with the exit through the cross-channel channel of the body. The introduction of the awl rod is carried out in the direction of the Adams arc along the internal thread deposited on the inner surface of the central channel and corresponding to the external thread on the awl rod, ensuring its simultaneous screwing into the cortical layer of the bone by means of a self-cutting part made on the section of the fastener attached to the cone item. When screwing the awl rod into the cortical bone layer in the area of the Adams arch, additional compression conditions are created along the fracture line. Carry out x-ray control. Wounds are sutured in layers and are treated with antiseptic solutions. Stick aseptic dressings.

Example.

The inventive utility model is implemented in an experimental sample. The product is being prepared for practical testing in a medical institution. Found constructive improvements are practically justified and justified constructive expediency.

Claims (1)

A device for osteosynthesis of fractures of the proximal femur, containing an extended cylindrical body with a central through channel having an inlet and an outlet; made by a proximal end bent at an angle of about 20-30 ° to the longitudinal axis of the device and beveled at an angle of about 45 ° by a distal end half of the case diameter; located on the side of the proximal end at an angle of 40-45 ° to the longitudinal axis of the body through the oblique channel, through which the fastener is held to ensure its passage through the inlet of the Central channel of the body and exit through the through oblique channel, and the body is made to gradually increase to 1, 5-2 times in diameter towards the proximal end for 1/3 of the length of the device, and the fastener is an awl rod, containing, on the one hand, a section tapered to the cone, on the other the ith side - a section with an external thread corresponding to an internal thread deposited on the inner surface of the central channel from the side of its inlet, characterized in that on the section of the fastening element tapered onto the cone, there is a self-cutting part in the form of an external thread with a length of 0.5-0 , 7 cm along the fastener and in increments of 0.1-0.2 cm.

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