RU192235U1 - Device for selecting screws and preventing complications during osteosynthesis of rib fractures with angularly stable plates - Google Patents

Abstract

The utility model relates to medicine, namely to traumatology, chest surgery and can be used for the prevention of interoperative complications, the selection of screws for surgical treatment of rib fractures in people with multiple and fragmentary rib fractures. The technical result of the claimed utility model is: reducing the risk of interoperative complications , the exclusion of possible damage to the pleura and lung tissue, with the exact selection of the length of the screws for fixing the plate to the bone, without additional measurements, with oste osynthesis of ribs in patients with multiple and fragmentary fractures of ribs. The technical result is achieved by the fact that the device abuts with one end on the fixing part of the drill in a medical drill, and the other - in the guide sleeve. These devices are made of stainless steel 12X18H10, have a cylindrical shape from 94 mm to 100 m long, the outer diameter is 8 mm, with a channel diameter of 2.9 mm. Each device is numbered and has a specific length in increments of 2 mm (4 pieces) (like 3.5 mm screws with angular stability), which easily allows you to select the required screw length from 12 mm to 18 mm without additional measurements. The device is used with a drill with a diameter of 2.8 mm, a length of 195 mm under the clamp, and 60 mm long guide sleeves for plates with angular stability with 3.5 mm blocking holes. The inventive device has shown high efficiency in osteosynthesis of rib fractures. It does not require expensive equipment, avoids severe complications, an exact selection of locking screws occurs, the surgeon’s work is simplified, and the duration of surgery is reduced.

Description

The utility model relates to medicine, namely to traumatology, chest surgery, and can be used for the prevention of interoperative complications, the selection of screws for surgical treatment of rib fractures in people with multiple and fragmented rib fractures.

Traumatic damage to the chest is one of the most serious types of injury, leading in the number of complications and deaths. The most common injuries due to chest injuries are rib fractures, which characterize the power and mechanism of injury on the chest wall. An increase in the number of rib fractures correlates directly with an increase in the number of complications and mortality. With fractures of six ribs and more, mortality reaches 15% of the developed complications. With multiple unilateral fractures of the ribs, the vital capacity of the lungs on the side of the lesion is reduced by 30%, while with a rib sash - by 50%. According to Davignon et. al., floating rib fractures occur in 10–20% of patients with a closed chest injury with a mortality rate of 10–35%.

Despite advances in helping patients with severe chest injuries, the problem of treating floating rib fractures remains relevant. Available methods of surgical treatment of this type of damage are sometimes opposite and have a limited number of publications on long-term outcomes. Conventional management consists in prolonged mechanical ventilation (mechanical ventilation) in order to achieve internal pneumatic stabilization of the chest due to positive end-expiratory pressure (PEEP). However, the results of this approach cannot be considered satisfactory due to the high risk of complications, the need for percutaneous tracheostomy, a long stay in the intensive care unit and intensive care, and dependence on the ventilator.

Despite the developed surgical methods of chest fixation, little is said in the studies on the prevention of interoperative complications associated with damage to the pleural cavity and lung during the formation of channels for screws.

Also, the issues of determining the required screw length in the most well-known MatrixRib rib osteosynthesis system, when using which it is necessary to measure the thickness of the rib, which leads to additional trauma to the soft tissues, with possible complications in the form of damage to the pleura and lung, have not been resolved.

The MatrixRib system is known in the art for rib osteosynthesis, which includes a standard drill sleeve and a 2.2 mm diameter drill bit of various sizes for clamping. Using a special meter, the thickness of the rib is measured and a certain length of the drill is selected, a channel for the screw is formed (www.depuysynthes.com/hcp/cmf/products/qs/Matrix_RIB_Fixation_System#tab3).

Disadvantages: this technical solution is not universal and is used only for osteosynthesis of ribs by plates of a certain company, it is expensive and requires a complete set of tools for this system and a line of implants. Also, when selecting the required length of the drill, before forming the holes, it is necessary to measure the thickness of the ribs, which leads to additional trauma.

Closest to the claimed technical solution is a universal sleeve 60 mm long for plates with angular stability using lockable screws 3.5 mm, using a drill to form a channel with a diameter of 2.8 mm, 195 mm long for clamping (http: // www. osteomed.ru/content.aspx?pri=2&sec=8).

This technical solution was developed for osteosynthesis of long tubular bones of the extremities, where there is no need to limit the length of the drill, since when the screw channel is formed after passing the second cortical bone layer, there is a minimal risk of complications in the case of a “failure” of the drill and there are no cavities that require tightness.

Thus, the disadvantages of this technical solution for osteosynthesis of ribs are an uncontrolled "failure" of a drill with a diameter of 2.8 mm, a length of 195 mm after passing the second cortical layer of the rib and a high probability of damage to the pleura and lung tissue, which can lead to serious complications. It is also necessary to additionally measure the thickness of the ribs, which can lead to complications.

The authors propose a device for selecting screws and preventing complications during osteosynthesis of rib fractures with angularly stable plates.

The technical result of the claimed utility model is: reducing the risk of interoperative complications, eliminating possible damage to the pleura and lung tissue, with the exact selection of the length of the screws for fixing the plate to the bone, without additional measurements, in the case of rib osteosynthesis in patients with multiple and fragmented rib fractures.

The technical result is achieved in that the device abuts against the fixing part of the drill in a medical drill with one end and the second into the guide sleeve. These devices are made of stainless steel 12X18H10, have a cylindrical shape from 94 mm to 100 m long, the outer diameter is 8 mm, with a channel diameter of 2.9 mm. Each device is numbered and has a specific length in increments of 2 mm (4 pieces) (like 3.5 mm screws with angular stability), which easily allows you to select the required screw length from 12 mm to 18 mm without additional measurements. The device is used with a drill with a diameter of 2.8 mm, a length of 195 mm under the clamp, and 60 mm long guide bushings for plates with angular stability with locking holes of 3.5 mm.

A device for the prevention of complications, the selection of screws for osteosynthesis of ribs with angularly stable plates with a 3.5 mm blocking hole in patients with multiple and fragmentary fractures of the ribs is shown in figures 1, 2.

The figure 1 shows a drawing of a device limiting drill during osteosynthesis of ribs with plates with angular stability with a blocking hole of 3.5 mm

The figure 2 presents the appearance of the devices.

Implementation of a utility model.

After installing a plate with angular stability for blocking holes of 3.5 mm on a broken rib in patients with multiple and fragmentary fractures of the ribs (patent No. 126260 dated 03/27/2013), installation of guide sleeves 60 mm long for 3.5 mm holes in the holes in plate. A drill is installed in a medical drill under a clamp with a diameter of 2.8 mm, a length of 195 mm, the proposed device of maximum length (100 mm for a screw 12 mm) is put on the drill (figure 3, 4), after passing the first cortical layer, provided that the device one end rests on the fixing part of the drill in a medical drill, and the other on the guide sleeve, the devices are replaced alternately in increments of 2 mm (up to a screw 18 mm long (if necessary)), without the risk of damage to the pleura and lung tissue until an opening is formed in the second cortical layer of the costal bone (this is felt by the "failure" of the drill). As soon as the second cortical layer of the rib is passed, the drill, guide sleeve are removed and a screw of a certain length corresponding to the selected device is installed, the screw is locked in the plate without risk of damage to the pleura and lung tissue. In this case, the mechanical effect on the repaired bone and the installed plate is minimal, because no change of the guide sleeve.

Clinical example.

The patient is 32 years old. He was admitted to the hospital on January 28, 2015, 1 hour after receiving an industrial injury (falling from a height) with complaints of sharp pains in the chest, shortness of breath at rest, sharp pain in both thighs. Upon admission, the condition is severe, blood pressure 100/60 mm. Hg. Art., pulse 130 beats per 1 minute, SpO2 79%, according to pulse oximetry, respiratory rate 30 in 1 minute. During examination and palpation of the chest, an extensive subcutaneous emphysema of the anterior chest and abdominal walls, pathological mobility, crepitation of bone fragments from II to VI ribs on the left along the anterior axillary line are determined, auscultatory breathing is heard on both sides, weakened on the left. When examining the upper limbs, puffiness, pathological mobility, crepitus in the region of the left elbow joint are determined. When examining and palpating the lower extremities, pathological deformation, mobility, crepitation of bone fragments of both thighs in the middle third are determined. Given the signs of acute respiratory failure, the patient was transferred to mechanical ventilation, puncture and catheterization of the subclavian vein on the right, anti-shock measures were started. The left pleural cavity was drained in the II and VII intercostal spaces along the midclavicular and posterior axillary lines, an intensive discharge of air, and hemorrhagic exudate was noted.

Radiography revealed: a fracture of the ulnar process, multi-fragmented fractures of both femurs in the middle and lower third with displacement of fragments, multiple fragmentary fractures of the ribs on the left from I to VI, contusion of the left lung, subcutaneous emphysema on the left. To clarify the diagnosis and further management tactics, the patient underwent multispiral computed tomography.

Based on clinical, laboratory and instrumental methods of research, the diagnosis was made: severe combined trauma: closed craniocerebral trauma: concussion, dull chest injury: multiple closed fragmentary fractures from I to VI ribs on the left along the shoulder blade and anterior axillary lines with chest flotation, contusion left lung, hemopneumothorax on the left. Closed fracture of the ulnar process on the left with the displacement of fragments. Closed fragmented comminuted pearl of the left femur in the middle third and lower third with displacement of fragments. Closed fragmented comminuted pearl of the right femur in the middle third and lower third with displacement of fragments. Traumatic shock 2 tbsp. Acute respiratory failure.

The patient's condition corresponds to 34 points on the ISS scale.

Under general anesthesia, the patient underwent open reduction, osteosynthesis of the left ulnar process according to Weber with fixation with a plaster cast. To stabilize bone fragments, both thighs were synthesized by the rod-shaped external fixation apparatus “AO”.

Due to the severity of the condition and acute respiratory failure, the patient was hospitalized in the intensive care unit for an extended mechanical ventilation. Continued antishock, infusion, hemostatic, antibacterial therapy.

After additional diagnostic measures and stabilization of the general condition of the patient, on the second day, taking into account the clinical data, computed tomography data to restore the chest frame, the patient underwent open reduction, osteosynthesis of the V rib along the anterior axillary line on the left with a rib plate with angular stability to fix the rib valve using the proposed device.

The next day, the patient's condition improved, breathing is heard from both sides, weakened on the left, the drainage is functioning, the patient is transferred to assisted ventilation, by the end of the day the patient is extubated.

On the sixth day, the patient was transferred to the department of severe combined trauma in the intensive care unit.

On day 15, the patient underwent closed reposition, osteosynthesis of a fracture of the right femur with a PFNL nail with blocking, the left thigh with a RAFN nail with blocking

The patient was discharged in satisfactory condition for outpatient treatment at the place of residence for 31 days in a hospital. Examined after three, six months and after one year, healthy.

The device showed high efficiency in osteosynthesis of rib fractures. It does not require expensive equipment, avoids severe complications, simplifies the work of the surgeon and can be used in trauma and surgical departments.

The inventive utility model was used when performing osteosynthesis of ribs in 27 patients with multiple and fragmentary fractures of the ribs against the background of polytrauma. Good clinical results were noted. There were no complications associated with osteosynthesis.

Thus, the claimed utility model is highly effective, since the use of this device when performing osteosynthesis of ribs in patients with multiple and fragmentary fractures of the ribs prevents interoperative complications that may occur due to additional trauma to the pleura and lung tissue, as well as select the most accurate screw length , which is also the prevention of complications. And in total, it simplifies the work of the surgeon, reduces the duration of surgery, which is not unimportant in this category of patients.

Claims (1)

A device for selecting screws and preventing complications during osteosynthesis of rib fractures with angularly stable plates, used with a 2.8 mm drill, 195 mm long under the clamp, and 60 mm long guide bushings for angularly stable plates with 3.5 mm locking holes, characterized in that it has a cylindrical shape from 94 mm to 100 mm long with a pitch of 2 mm with an outer diameter of 8 mm, with a channel of 2.9 mm in diameter, one end abuts against the fixing part of the drill of a medical drill, and the other into the guide sleeve.

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