RU163654U1 - CONDITIONAL TIBERA PLATE - Google Patents

Abstract

The condylar tibial plate, containing the metaphysical and epiphyseal parts with angle-stable openings, as well as the diaphyseal part with angle-stable and oval compression holes for cortical screws, characterized in that the epiphyseal part is elongated, equipped with a module with an additional blocking cavity, which is oriented toward the posterior bone, , a groove for the possibility of intraoperative modeling and horizontal slots for multidirectional insertion of spokes into the subhon the deep layer of impression fragments, and at the border of the metaphysical and diaphyseal parts of the plate there are two angled stable beveled openings oriented proximally anteriorly and proximal posteriorly for medial stabilization of the proximal tibia.

Description

The utility model relates to medicine and medical equipment, in particular to traumatology and orthopedics, and can be used for osteosynthesis of fractures, false joints and corrective osteotomies of the proximal tibia.

A device for osteosynthesis of fractures of the proximal tibia is known - a dynamic compression plate DCP (1). The device is an L-shaped or T-shaped plate with conventional holes for cortical or spongy screws.

This device allows for the fixation of fractures with large bone fragments with good quality bone tissue, as well as with elastic osteotomies, in which the bone does not intersect completely, but with the preservation of part of the opposite cortical layer.

The disadvantages of the device is the lack of stability in the fixation of bone fragments in osteoporosis and in multi-fragmented impression fractures.

A device is known, the LCP plate is L-shaped for the tibia with angular stability (lockable compression plate), also serving as an analogue (2). This design is a combination plate in which the fixation of fragments by both conventional and angular stability screws is possible. The plate has anatomical bends, which takes into account the surface shape of the lateral condyle of the tibia and the hole for the spokes on the proximal edge of the epiphyseal branch.

The disadvantages of this device are the insufficient length of the epiphyseal part with holes for screws with angular stability, which does not allow the screws to capture the front and rear edges of the epiphysis at the same time, as well as the fact that the holes for the spokes allow them to be inserted in only one direction (technological temporary fixation of the plate level) and does not allow them to be widely used for additional subchondral fixation of multi-fragmented impressions.

The proximal tibia has a rather complex geometric shape, including a three-fold increase in the tagittal size and five-fold expansion compared with the diaphysis, as well as high individual variability of the curvature of its outer surface. Therefore, traditional osseous plates placed in the center of the outer surface often cannot correspond to it. They usually have to be additionally modeled (bent according to the shape of the pineal gland) during the operation or during its planning. When bending, the thread of the angle-stable holes is deformed, which leads to a loss of rigidity of fixation of the screw heads and their deviation from the optimal direction occurs.

Closest to the claimed device is the osseous plate "Zimmer" (3). The plate consists of two parts: diaphyseal and condylar. This plate has an anatomical bend along the averaged outer surface of the proximal tibia. The axis of insertion of the condylar screws of the plate is parallel to the axes of the introduction of screws of the diaphyseal part.

The disadvantages of this device are the insufficient stabilization of the medial condyle, the inability to fix the posterior sections of the articular surface of the tibia, the inability to introduce spokes and screws at the subchondral level to create support like a tier or "raft" under a multi-fragmented impression intraarticular fracture.

The technical result of the claimed utility model is to increase the reliability of fixation of bone fragments due to the simultaneous use of several fixing effects.

This is achieved by the fact that the inventive plate contains a metaphysical and epiphyseal part with angle-stable holes, as well as a diaphyseal part with angle-stable and oval compression holes for cortical screws. In this case, the epiphyseal part is made elongated: it is equipped with a module with an additional blocking hole oriented to the posterior tibial condyles, a groove for intraoperative modeling and horizontal slots for multidirectional insertion of spokes into the subchondral layer of impression fragments. On the border of the metaphyseal and diaphyseal parts of the plate, there are two angled stable beveled openings oriented proximally anteriorly and proximal posteriorly for medial stabilization of the proximal tibia ..

The osseous plate is provided with AO-ASIF holes for cortical screws with a diameter of 4.5 mm. and angle stable with a diameter of 3.5 mm ..

The inventive plate is anatomically precurved as its shape approaches the averaged outer surface of the proximal tibia. This allows you to better adapt the device to the bone, to eliminate or minimize the modeling of the plate during surgery and thereby reduce the total duration of the intervention.

The high congruence of the “plate-tibia” complex minimizes the likelihood of displacement of fragments when they are fixed with screws through the holes of the plate, and allows to maintain the accuracy of reposition of fragments with less bone skeletonization.

The beveled angle-stable holes allow the insertion of two locking screws into the front and rear edges of the medial condyle fragment during its concomitant fracture. In case of false joints of the proximal metaphysis or high corrective osteotomies, these locking screws provide additional medial stabilization of the short proximal fragment.

The introduction of knitting needles through horizontal knitting needles into the subchondral layer of the condyles provides mutual fixation of impression fragments of the articular surface. The horizontal and width of the spoke slots allows you to insert the spokes in different directions, get into all the impression fragments, “sew” them together and ensure the stability of the restored articular surface to secondary impression, and the support of the spokes on the metal slots reduces the risk of them erupting into the bones.

The illustrations show:

FIG. 1. The device on the bone, front view, where: 1 - the diaphyseal part, 2 - the metaphyseal part, 3 - the epiphyseal part, 4 - the module for fixing the posterior tibial condyles, 5 - the posterior tibial condyles, 6 - the tibia, 7 - oval holes, 8 - holes with angular stability, 9 - anatomical bending of the osseous plate, 10 - proximal tibia, 11 - beveled angle-stable holes and screw insertion directions, 12 - screw with angular stability with a diameter of 3.5 mm., 13 - axis of the diaphyseal part of the reservoir nines, 14 - a cortical screw without angular stability of 4.5 mm., 15 - horizontal spoke fissures, 16 - the spoke, 17 - the subchondral layer of the condyle of the tibia, 18 - groove for modeling the epiphyseal part of the plate, 20 - the articular surface of the tibia.

FIG. 2. The device on the bone, top view from the outside by 2/3, from the fixing elements the spokes and the direction of insertion of the beveled screws are shown, where: 1 - diaphyseal part, 2 - metaphyseal part, 3 - epiphyseal part, 4 - module for fixing the posterior condyles tibia, 5 - posterior tibial condyles, 6 - tibia, 7 - oval openings, 8 - openings with angular stability, 9 - anatomical bending of the bone plate, 10 - proximal tibia, 11 - beveled angle-stable openings and direction denia of screws, 12 - a screw with angular stability with a diameter of 3.5 mm., 13 - the axis of the diaphyseal part of the plate, 14 - a cortical screw with a diameter of 4.5 mm., 15 - horizontal spoke spaces, 16 - a spoke, 17 - a subchondral layer of the tibial condyle bones, 18 - groove for modeling the epiphyseal part of the plate, 19 - impression fragment, 20 - articular surface.

FIG. 3. The device on the bone, side view, where: 1 - the diaphyseal part, 2 - the metaphyseal part, 3 - the epiphyseal part, 4 - the module for fixing the posterior tibial condyles, 5 - the posterior tibial condyles, 6 - tibia, 7 - oval holes, 8 - holes with angular stability, 9 - anatomical bending, 11 - beveled angle-stable holes, 15 - horizontal spoke slots, 16 - spoke, 18 - groove for modeling the epiphyseal part of the plate,

FIG. 4. The device on the bone, a partial frontal section at the level of the first angle-stable screw of the epiphyseal part with a horizontal section 3 cm from the articular surface, front view, where: 1 - diaphyseal part, 2 - metaphyseal part, 3 - epiphyseal part, 4 - module for fixing the posterior tibial condyles, 5 - the posterior tibial condyles, 6 - tibia, 7 - oval holes, 8 - holes with angular stability, 9 - anatomical bending of the plate, 11 - beveled angle-stable holes with installed screws, 12 - a screw with angular stability with a diameter of 3.5 mm., 14 - a cortical screw without angular stability of 4.5 mm., 15 - horizontal spoke slots, 16 - a spoke, 17 - a subchondral layer of the tibial condyle, 18 - groove for modeling of the epiphyseal part of the plate, 19 - impression fragments, 20 - articular surface, 21 - transplant.

FIG. 5. A device that fixes a false joint or osteotomy, front view, frontal partial incision at the level of 2 screws of the epiphyseal part of the plate, where: 1 - the diaphyseal part, 2 - the metaphyseal part, 3 - the epiphyseal part, 4 - the module for fixing the posterior tibial condyles bones, 6 - tibia, 7 - oval holes, 8 - holes with angular stability, 11 - beveled angle-stable holes with screws, 12 - screw with angular stability with a diameter of 3.5 mm., 13 - axis of the diaphyseal part of the plate, 14 - cortical screw without angular stability and 4.5 mm., 15 - horizontal spoke fissures, 16 - spoke, 17 - subchondral layer of the condyle of the tibia, 20 - articular surface, 22 - zone of osteotomy or false joint.

The device consists of a diaphyseal part 1, a metaphyseal part 2 and an epiphyseal part 3 with a module 4 for fixing the posterior condyles of the tibia 5 of the tibia 6. In the diaphyseal part 1 there are compression (oval) openings 7 and openings with angular stability 8. The plate has an anatomical bend 9 (Fig. 2 and 3) corresponding to the normal shape of the surface of the proximal tibia 10. The metaphysical part of the plate 2 contains holes with angular stability 11, which sets the locking screws 12 inserted into it, a direction of 45 ° axis 13 of the diaphyseal part of the plate 1. In the diaphyseal part there are holes with angular stability 8 for angle-stabilizing screws 12 with a diameter of 3.5 mm, and compression (oval) holes 7 for cortical screws 14 with a diameter of 4.5 mm In the epiphyseal part there are angle-stable holes 8, above which there are horizontal spoke slots 15 for introducing the spokes 16 into the subchondral layer 17 of the condyles 5. The epiphyseal part 3 is delimited from module 4 by a vertical groove 18, along which module 4 can be bent according to the individual shape of the posterior section or kusit clippers, or break off, if the lock rear sections of the condyles do not need.

This device is used as follows.

After performing surgical anterolateral access to the proximal tibia, the fracture is repositioned. In the presence of impression of fragments of the articular surface 19, reposition is performed by raising them 19 sequentially to a normal level with comparison with the bone-cartilaginous edges of the proximal tibia 10 6, restore the normal shape of the articular surface 20 and fix them with subchondral spokes 16. The bone defect is compensated by the introduction of an autograft 21 under fragments 19 of the articular surface 20. Next, on the lateral surface of the proximal tibia, the claimed plate is laid, which put on the knitting needles 15 on the knitting needles 16, after which they are fixed to the tibia with cortical screws 14 through the oval holes 7, after which the angle-stable screws 14 are inserted into the holes 8 at the beginning of the epiphyseal 3 and metaphysical 2 parts and the angle-stable screws 12 are inserted into the beveled holes 11, fixing the medial condyle. After that reinforce the fixation of the entire system to the diaphysis by introducing screws 12 into the angle-stable holes 8 on the diaphysis. If necessary, reinforce the fixation of the impression fragments 19 by introducing the spokes 15 through the spoke slots 15. After that, the wound is drained and sutured. The stability of fixation allows you to do without immobilization in the early postoperative period.

With osteotomies and false joints, spoke slots 15 are used as technological ones for temporarily fixing the position of the plate. After resection of the false joint and bone grafting or osteotomy in zone 21 with correction, the claimed device is placed on the outer surface and temporarily fixed with a spoke 16 through the slot 15. The screws 14 are inserted into the angle-stable holes 8 of the epiphyseal and metaphysical parts, after which dynamic compression is performed using eccentric the introduction of cortical screws 12 into the oval compression holes 7 achieving absolute stability. The screws 14 are inserted through the beveled holes, achieving medial stabilization. With severe osteoporosis, angle-stable screws 14 are inserted into the holes 8 in the diaphyseal part of the plate. Suture the wound with drainage.

The proposed device allows you to:

- to produce a stable functional osteosynthesis in case of intraarticular fractures, false joints and corrective periarticular osteotomies of the proximal tibia;

- eliminate or minimize plate bending;

- increase the stability of osteosynthesis due to the simultaneous use of several fixing effects;

- fix both the front and rear sections of the tibial plateau.

BIBLIOGRAPHY

1. Muller M.E. Allgover M., Schneider R, Willenegger X. Guidance on internal osteosynthesis (technique recommended by the group of joint-stock companies Switzerland). - Springer-Verlag. - Berlin-Moscow. - s442-443.

2. McRae, R. Practical fracture treatment / R. McRae, M. Esser. - Edinburg. etc: Churchill Livingstone Fifth edition, 2008. - 447 r

3. United States Patent 7846179 B2 Winquist R.A. et al. Orthopedic bone plate Assignee: Zimmer, Inc. (Warsaw, IN) Family ID: Appl. No .: 10 / 738,786 Filed: December 17, 2003

Claims (1)

The condylar tibial plate, containing the metaphysical and epiphyseal parts with angle-stable openings, as well as the diaphyseal part with angle-stable and oval compression holes for cortical screws, characterized in that the epiphyseal part is elongated, equipped with a module with an additional blocking cavity, which is oriented toward the posterior bone, , a groove for the possibility of intraoperative modeling and horizontal slots for multidirectional insertion of spokes into the subhon the deep layer of impression fragments, and at the border of the metaphysical and diaphyseal parts of the plate there are two beveled angle-stable holes oriented proximally anteriorly and proximal posteriorly for medial stabilization of the proximal tibia.

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