RU175914U1 - DEVICE FOR A CLOSED REPOSITION OF FRACTURES OF TUBULAR BONES DURING INTRAMEDULLARY OSTEOSYNTHESIS - Google Patents

Abstract

The utility model relates to medicine, namely to traumatology and orthopedics, and is intended for conducting a closed reposition of tubular bone fractures when performing intramedullary osteosynthesis. The essence of the proposed device is to increase the accuracy of closed reposition of fragments of tubular bones during intramedullary osteosynthesis under the control of an X-ray electronic optical transducer, due to the fact that the guide bar is fixed on the proximal bone fragment and does not connect to the distal fragment, the threaded screw is connected to the intramedullary shaft osteosynthesis, the guide bar is movably through the base connected to a threaded screw, distal twisting and second proximal fixing nuts threaded screw moves distally or proximally.

Description

The utility model relates to medicine, namely to traumatology and orthopedics, and is intended for conducting a closed reposition of tubular bone fractures when performing intramedullary osteosynthesis.

Various device configurations are known for the reduction of tubular bone fractures during intramedullary osteosynthesis.

A device for closed intramedullary osteosynthesis of long tubular bones is known, which consists in creating traction for the foot of a damaged limb on a traction table with a crotch stop (Campbells Operative Orthopedics, edited by A. N. Crenshaw, md; volume two, 1998, Mosby Year Book, s . 871).

Known devices for closed reposition and fixation of fragments of long tubular bones during surgery for intramedullary osteosynthesis, including knitting needles for conducting through the distal and proximal bone metaphyses, which are fixed in the supports of the external fixation apparatus. The spokes are located relative to each other so that when they are inserted into the bone, they do not affect the bone marrow canal and leave it free for insertion of the intramedullary shaft (RU 2562678 dated 03.25.2014, RU 75299 dated 11.03.2008, RU 2499571 dated 15.10.2012, RU 2250758 dated 08/22/2003, RU 51860 dated 06/15/2004).

However, the design features of these devices reduce the accuracy of the reposition when using them. The implementation of the reponing elements in the form of thin spokes leads to their deflection and poor fixation, which worsens the results and increases the time of surgery.

A device "AO / ASIF Distractor" is known, consisting of a threaded rod and two associated Shants screws having a diameter of 5 mm. To apply it in the proximal and distal metaphyses of bones, holes with a diameter of 4.5 mm are formed into which the above screws are screwed, then a connecting rod is attached to them, allowing fracture to be distracted (Müller M.E. et al. “Guide to Internal Osteosynthesis”. Third edition, expanded, translation into Russian, ed. Ad Marginem, Moscow, 1996, p. 322-330). The use of this device has the following disadvantages: significant tissue damage with screws with a diameter of 5 mm, is installed on the peripheral part of the damaged limb segment, which limits the movement of the peripheral fragment in various planes during reposition, the prototype requires complex adjustment, is fixed to the bone eccentrically, not along the axis of the segment, which leads to an uneven distribution of tensile forces and, as a consequence, the appearance of angular deformation, structural elements make it difficult to zhnya into the medullary canal and block, it is impossible to eliminate rotational displacement, without creating an offset width, since the device rotation axis does not coincide with the axis of the segment.

The technical result of the proposed device is to reduce the morbidity and increase the accuracy of the closed reposition of fragments of tubular bones during intramedullary osteosynthesis by eliminating the displacement along the length, rotational and angular.

The utility model is illustrated in Fig. 1 and fig. 2, where:

1 - a directing lath;

2 - the base of the guide bar;

3 - threaded screw;

4 - coupling;

5 - proximal fixing nut;

6 - distal locking nut;

7 - peripheral bone fragment;

8 - proximal bone fragment;

9 - cortical screws;

10 - intramedullary rod.

In fig. 3 presents the radiographs of the patient before treatment.

In fig. 4 presents the time of reposition using the proposed device for the reposition of fractures of tubular bones during intramedullary osteosynthesis.

In fig. 5 presents x-rays, which depict the osteosynthesis of a fracture of the tibia with a rod with blocking using the proposed device.

 A device for closed reposition of fractures of tubular bones during intramedullary osteosynthesis is practically used as follows. Under the control of an electronic optical transducer, an intramedullary rod - 10 is introduced antegrade into the proximal and distal fragments of the tubular bone (Fig. 2). Then, on the proximal bone fragment - 8 (Fig. 1), two 4.5 mm - 9 cortical screws (Fig. 1, 2) fix the guide bar - 1 (Fig. 1, 2). At the base of the guide bar - 2 (Fig. 1, 2) there is a threaded screw - 3 (Fig. 1, 2), which moves in it proximally and distally by means of tightening two fixing nuts - 5, 6 (Fig. 1, 2) located on both sides of the base of the guide bar - 2 (Fig. 1, 2) on the threaded screw - 3 (Fig. 1, 2). The threaded screw - 3 (Fig. 1, 2) is connected to the intramedullary shaft - 10 through the connector - 4 (Fig. 1, 2) - 10 (Fig. 2). Using the open-end wrench, the distal locking nut - 6 (Fig. 1, 2) is twisted counterclockwise until it stops at the base of the guide bar - 2 (Fig. 1, 2). With further tightening of the distal locking nut - 6 (Fig. 1, 2), the threaded screw - 3 (Fig. 1, 2) moves with the intramedullary shaft - 10 fixed to it (Fig. 2), which abuts the peripheral bone fragment - 7 (Fig. 1) and displaces it distally, thereby eliminating the displacement in the fracture zone along the length. This stage is controlled by an electronic optical converter. The achieved repositional position is fixed by the proximal fixing nut - 5 (Fig. 1, 2) by tightening it clockwise until it stops at the base of the guide bar - 2 (Fig. 1, 2). Then the rotational and angular displacement in the fracture zone is eliminated. A peripheral bone fragment - 7 (Fig. 1), under the control of an electronic optical transducer, rotates outside or inside the peripheral segment of the limb, moves up or down in the sagittal plane to the angle necessary for reposition. After reposition is achieved, the intramedullary rod - 10 (Fig. 2) is blocked in the medullary canal.

The distal fragment during reposition of the fracture is not fixed to the elements of the proposed device and the intramedullary shaft, which allows it to move freely in all planes and achieve the desired fracture reposition. Distraction using the device developed by us is carried out along the axis of the damaged segment of the limb. The axis of rotation of the segment coincides with the axis of rotation of the device.

Clinical example 1

Patient K., taken by ambulance from the street where she fell, turned up her right lower leg. On admission, radiographs of the right lower leg were performed (Fig. 3). The diagnosis was established - a closed comminuted fracture of both bones of the right tibia in the middle lower third with the displacement of fragments. A closed intramedullary blocked osteosynthesis of the right tibia was performed using the proposed utility model (Fig. 4), and the planned reduction and fixation were achieved (Fig. 5). On the 2nd day, the patient was placed on crutches, a week later she was discharged from the hospital. She started working after 2.5 months. No complaints.

Clinical example 2

Patient A., was admitted with a diagnosis of closed comminuted fracture of the left thigh in the middle third with displacement of fragments. Injury on the day of admission. A closed intramedullary blocked osteosynthesis of the left femur was performed using the developed device, and the planned reduction and fixation were achieved. On the 2nd day, the patient was placed on crutches, and was discharged from the hospital a week later. He started working after 4 months. No complaints.

Clinical example 3

Patient V. was admitted with a diagnosis of a closed screw-shaped fracture of the right shoulder in the middle third with displacement of fragments. Injury the day before admission. Closed intramedullary osteosynthesis of the right humerus was performed using a device for fracture reposition, and the planned reposition and fixation were achieved. Discharged from the hospital after 7 days. He started working after 2 months. No complaints.

Thus, the proposed device for reposition of a fracture of tubular bones during intramedullary osteosynthesis greatly simplifies the reposition, allows you to move the distal fragment in all planes during reposition, allows you to create large, controlled tensile forces, allows you to displace fragments by a certain amount, increases the possibility of using closed intramedullary osteosynthesis in various locations of fractures of the tubular bones and treatment results are improved .

Claims (1)

A device for closed reposition of tubular bone fractures during intramedullary osteosynthesis, consisting of a guide bar, the base of the guide bar, a threaded screw, a distal and proximal locking nuts, a coupling, characterized in that the guide bar is fixed to the proximal bone fragment and does not connect to the distal fragment , the threaded screw is connected to the rod for intramedullary osteosynthesis, the guide bar is movably connected through the base to the threaded screw, behind twisting the distal and proximal retaining nuts moves the threaded screw distally or proximal.

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