RU185903U1 - Device for optimizing open bone osteosynthesis - Google Patents

Abstract

The utility model relates to medical equipment, namely to devices used in surgical traumatology and orthopedics. The purpose of the utility model is to increase the effectiveness of the treatment of orthopedic and traumatic patients who undergo surgery for open bone osteosynthesis. The goal is realized using a device that is a tool for capturing and holding bone fragments and osseous metal structures and consisting of legs and a working part, characterized in that it is represented by elastic lips with a thickness and width of 3 mm, with two bends and T-shaped ends concave - angular in shape with corrugation on the concave side, and the legs include ring-shaped handles and racks with three and eight teeth for a wide variation in the distance between the T-shaped ends of the jaws and dosing capture strength of bone fragments and bone metal in the range from one to eight.

Description

The utility model relates to medical equipment, namely to devices used in surgical traumatology and orthopedics.

Treatment of fractures of long bones of the extremities is an urgent medical and social problem of traumatology and orthopedics. Providing the necessary conditions for the consolidation of fractures of long bones of the limbs, including anatomical reposition and stable fixation of bone fragments, maintaining adequate blood supply to the fracture zone and the possibility of early function of the damaged limb, as a rule, is achieved by using stable osteosynthesis. One of the most common types of stable osteosynthesis is open bone osteosynthesis, which consists in the operation of open reposition and stable fixation of bone fragments by various metal structures.

Analogs

During the operation of open bone marrow osteosynthesis, special tools are used to reposition and retain bone fragments and metal structures, the most famous of which are the bone holders Lambote, Boycheva and Lane (Fig. 1, a, b, c).

Criticism of analogues

For traditionally used bone holders, the following significant disadvantages are characteristic:

the massiveness and rigidity of their working parts with a rigid capture of bone fragments and an increase in the likelihood of damage (crushing or cracking) of bone fragments;

a significant thickness of the sponges, which, in addition to their rigidity, necessitates an increase in the volume of the wound and skeletonization of bone fragments over a greater length for their capture. This increases the invasiveness of the operation and, accordingly, the time of wound healing and the risk of intraoperative and postoperative complications;

the need for constant holding of the instrument by the surgeon or assistant, as well as the inconvenience of manipulating the limiter to maintain the correct position of bone fragments and metal structures.

Prototype

As a prototype of the proposed device selected bone holder Lane (Fig. 2) (Boychev B. Operative orthopedics and traumatology / B. Boychev, B. Conforti, K. Chokanov. - "Medicine and physical education", - 2nd ed., Rev. and additional - DI - Sofia, 1958, - 832. - P. 18-22), since it is distinguished by a smaller thickness of its working part and, accordingly, by the need for a shorter length of skeletonization of bone fragments for their capture and retention.

Prototype criticism

However, the prototype device has the following disadvantages:

rigidity of the sponges of the instrument with a rigid capture of bone fragments and an increase in the likelihood of damage to bone fragments;

excess thickness of the sponges (more than 10 mm), which necessitates an increase in the volume of the wound and skeletonization of bone fragments over a greater length for their capture;

to keep bone fragments in the reached position, at the ends of the instrument handles there is a special stopper consisting of a bar with recesses (teeth) on one handle, and a spike corresponding to the depth of these recesses on the other. The disadvantage of this limiter is, firstly, the unreliability of the tenon fixation in the notch with frequent loss of retention of the repositional position of the bone fragments, and, secondly, the inconvenience of manipulating this mechanism with delaying the operation time and the need for the surgeon or assistant to constantly hold the instrument;

insufficient stability of the capture of bone fragments and the metal structures laid on them, due, firstly, to the fact that the shape of the bone perimeter at the level of capture of bone fragments and metal structures varies widely, which can lead to a shift of the metal structure with increased compression between the working jaws of the tool, the shape the sponges of which are somewhat concave, but allowing bone fragments to slide off from them, and, secondly, the lack of elasticity of gripping the jaws of the instrument, which contributes to the stability of the position to ak bone fragments and the metalwork laid on them, as well as the instrument itself, with the need for its constant retention;

the inability to dose the rigidity of capture of bone fragments and the metal structures laid on them with rigid ridges of the instrument, which, on the one hand, does not exclude crushing or cracking of bone fragments (with excessive pressure with rigid ridges of the instrument), and on the other, it is accompanied by the loss of retention of the repositional position of bone fragments and the need repeated reduction and retention of bone fragments and metal structures (with insufficient pressure with the sponges of the instrument);

the ability to position the tool only transversely to the wound, which limits the review and access to bone fragments and metal structures when performing osteosynthesis (for example, when drilling holes and screwing in screws).

The purpose of the utility model is to increase the efficiency of treatment of patients with fractures of long tubular bones in need of open bone osteosynthesis.

Utility Model Essence

A device for optimizing open osseous osteosynthesis is proposed, which is a tool for capturing and holding bone fragments and osseous metal structures (Fig. 3, a, b) and consisting of legs (pos. 1) and a working part (pos. 2), characterized in that it is represented by elastic lips (pos. 3), 3 mm thick and wide, with two bends (pos. 4) and T-shaped ends (pos. 5) of a concave-angled shape with corrugation (pos. 6) on the concave side, and the legs (pos. 1) include ring-shaped handles (pos. 9) and cremaremals with three (pos. 7) and eight ью (pos. 8) with teeth for wide variation of the distance between the T-shaped ends (pos. 5) (Fig. 4, a, b, c) of the sponges and dosing of the grip strength of bone fragments (pos. 10) and bone metal construction (pos. 11) in the range of one to eight.

The T-shaped ends (pos. 5) of the working part (pos. 2) of the device with corrugation on its concave surface (pos. 6) is intended for more stable capture and retention of bone fragments (pos. 10) and bone metal structures (pos. 11 ) A stable grip is provided by the concavity of the T-shaped ends (pos. 5) and the corrugation (pos. 6) on their concave surface. Ring-shaped handles (pos. 9) are designed both for more convenient manipulation of the instrument, and for optimal and quick capture and retention of bone fragments and bone metal. Tool sponges (pos. 3), 3 mm thick and wide, contribute to the elasticity of capture and retention of bone fragments and metal tissue. The elasticity of the jaws of the device - both for a more firm grip and retention of bone fragments and osseous metal structures, as well as the possibility of dispensing this grip, which, on the one hand, excludes crushing or cracking of bone fragments, and, on the other, eliminates the loss of repositional position of bone fragments with the need for repeated reposition and retention of bone fragments and metal. A cremallera with three teeth (pos. 7) contributes to the reliability of fixing the capture and retention of bone fragments and osseous metalwork with the working part of the instrument, and a cremallera with eight teeth (pos. 8) - for dosing the gripping force of bone fragments of osseous metalwork in the range from one to eight. The presence of two bends (pos. 4) of the instrument jaws provides the opportunity to place most of the device on the side of the wound, which gives greater visibility and access to bone fragments and metal structures when performing osteosynthesis. The smaller volume and mass of the instrument with its more rational form determine the absence of the need for greater surgical access and skeletalization of bone fragments over a greater extent during the operation of bone osteosynthesis.

Device application example

As an example of the application of the proposed device, the following observation. Patient M., 79 years old, was admitted to the traumatology department of the RTC on 09/26/17 with a diagnosis of Closed comminuted fracture of the upper third of the left humerus. Concomitant coronary heart disease, hypertension, type II diabetes mellitus. 09/29/17, the operation was performed: Bone osteosynthesis of comminuted fracture of the upper third of the left humerus with a plate with angular stability. Under conduction anesthesia in the cervical and brachial plexus in the position of the patient on the back with a roller under the left shoulder blade, a longitudinal skin incision was made from the level of the head of the humerus downward 12-13 cm long. Subcutaneous tissue and fascia were dissected; at the top of the wound, the incision is deepened between the longitudinally split anterior portion of the deltoid and biceps, and distal - the abdomen of the brachial muscle is longitudinally split with subperiosteal abduction to the sides. The oblique-comminuted fracture zone with hematoma evacuation and elimination of soft tissue interposition is exposed. The pointed ends of both bone fragments and a sphenoid fragment are economically mobilized, their fracture lines are cleared and repaired by two devices for capturing and holding bone fragments. The device is represented by elastic jaws, 3 mm thick and wide, with two bends and concave-angled T-shaped ends with corrugation on the concave side, and the legs include ring-shaped handles and racks with three and eight teeth for varying the distance between the T-shaped ends of the sponges and dosing the capture strength of bone fragments and bone metal in the range from one to eight. On the front-outer surface of the repaired bone fragments, a modeled 15-cm plate with angular stability for 5 mm self-tapping blocking screws, which is held by a device for gripping and holding bone fragments and bone metal, is laid. Channels in the bone were drilled with a 4.5 mm drill with a nozzle and 5 mm screws were bi-cortical. All screws were blocked by screwing the threads of their caps into the threads of the plate holes. The ends of the screws protrude on the posteromedial surface of the humerus by no more than 0.5 cm. Osteosynthesis is stable. The wound cavity is washed with a solution of hydrogen peroxide and novocaine and sutured in layers, leaving active drainage. An aseptic sticker and a gypsum turner on the Turner are imposed. The postoperative period was uneventful. Drainage removed the next day. The Turner plaster cast was replaced by a band for fixing the shoulder girdle. The wound healed first. The patient was discharged on 10.10.17 with recommendations to engage in exercise therapy, the development of active movements in the joints of the upper limb. On a follow-up examination of the patient 15.10.17, it was noted that the function of the left upper limb is restored. X-ray signs of ongoing fracture consolidation were noted. The result of the treatment is regarded as good.

Features of utility model distinctive from prototype

Design features (distinguishing features from the prototype) of the device for optimizing open bone marrow osteosynthesis (Fig. 3 and 4) are:

T-shaped ends (pos. 5) of the working part of the device with corrugation on its concave surface (pos. 6);

the presence of ring-shaped handles (pos. 9);

thickness and width of tool jaws - 3 mm (item 3);

elasticity of tool jaws (pos. 3);

cremalleiers - with three (pos. 7) and eight (pos. 8) teeth;

two bends of the tool jaws (key 4).

The technical result (advantages over the prototype) of a device for optimizing open bone marrow osteosynthesis:

atraumatic application of this device;

more stable capture and retention of bone fragments and osseous metal structures due to the T-shaped ends (pos. 5) of the working part of the device with corrugation (pos. 6) on its concave surface;

more convenient manipulation of the instrument and optimal and quick capture and retention of bone fragments (pos. 10) and osseous metal structures (pos. 11), due to ring-shaped handles (pos. 9) and cremallera with three (pos. 7) and eight (pos. 8) with teeth;

a cremallera with three teeth (pos. 7) contributes to the reliability of fixation of the capture and retention of bone fragments (pos. 10) and bone tissue (pos. 11) by the working part of the instrument (pos. 2), and a cremallera with eight teeth (pos. 8) - for dosing the capture force of bone fragments of bone metal structures in the range from one to eight. At the same time, the simplicity and speed of the action of the cremallera mechanism when the device is snapped onto the bone surface and removed, significantly improves the handling properties of the device and minimizes the intraoperative time costs;

the possibility of wide variation of the working width with diluted working jaws of the instrument and their T-shaped ends (Fig. 4, a, b) makes it possible to use on bones of different diameters and cross-sectional shapes (Fig. 4, c) from the clavicle and bones of the forearm, to the tibia and femur;

the possibility of dosing capture and retention of bone fragments and bone metal, due to the elasticity of this capture;

the elasticity of this capture, due to the small thickness and width of the jaws of the instrument (3 mm), excludes crushing or cracking of bone fragments and loss of repositional position of bone fragments with the need for re-reduction and retention of bone fragments and metal structures;

the presence of two bends (pos. 4) of the jaws of the instrument provide the ability to position most of the device on the side of the wound, which gives greater visibility and access to bone fragments and metal structures when performing osteosynthesis;

the lack of need to retain repaired bone fragments during osteosynthesis and the ability to free the hands of the surgeon and assistant.

Thus, the proposed device can improve the quality of open osteosynthesis and create optimal conditions for increasing the effectiveness of treatment of patients with whom it is used.

Information taken into account:

1) Brown M.P. General principles of technology of surgical operations / M.P. Brown. - A guide for surgeons. - Rostov N / A: Publishing House "Phoenix", 1999. - 544 p .;

2) Pointed G.E. Operative surgery and topographic anatomy / G.E. Ostroverkhov, Yu.M. Bomash, D.N. Lubotsky - M: Medical Information Agency LLC, 2005. - 736 p .;

3) Traumatology: national leadership / ed. G.P. Kotelnikova, S.P. Mironova. - M.: GEOTAR-Media, 2008 .-- 808 p. - (Series "National Guides");

4) Boychev B. Operative orthopedics and traumatology / B. Boychev, B. Conforti, K. Chokanov. - “Medicine and physical education”, - 2nd ed., Revised. and add. - CI - Sofia, 1958, - 832. - S. 18-22. - prototype device.

Claims (1)

A device for open osseous osteosynthesis, which is a tool for capturing and holding bone fragments and osseous metal structures and consisting of legs and a working part, characterized in that the working part is represented by elastic sponges with a thickness and width of 3 mm, with two bends and T-shaped ends concave - angular in shape with corrugation on the concave side, and the legs include ring-shaped handles and racks with three and eight teeth for a wide variation in the distance between the T-shaped ends of the jaws and dosages the strength of the capture of bone fragments and bone metal in the range from one to eight.

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