RU198593U1 - Device for temporary intraoperative fixation of bone fragments - Google Patents

Abstract

The useful model relates to surgical instruments and relates to the field of medicine, in particular to traumatology, and can be used during osteosynthesis for the purpose of reposition of bone fragments and temporary intraoperative fixation. The technical result of the proposed useful model for reduction and osteosynthesis is to simplify the implementation of open reduction and fixation of fractures, increase the efficiency of osteosynthesis of skeletal fractures, the ability to determine the size of implants, reduce the trauma of surgical intervention, and reduce the frequency of postoperative complications. The device contains handles with a screw compression clamp and a working part, consisting of two jaws and jaws, on the supporting surface of which there are teeth that prevent sliding from the bone surface. One of the jaws of the working part has a support surface that contains a blind hole 2 mm deep. The second sponge contains a guide tube - a protector with a through hole that allows drilling the bone to form a channel for installing a fixing screw, the channel is directed from the center of the guide hole to the center of the blind hole of the second jaw. The walls of the tube protect the surrounding soft tissue from damage from the sharp edges of the drill. The diameter of the through hole allows the screw to be passed directly through the hole in the targeting tube without removing the device and losing reduction. The wall of the sponge in the area of the blind hole prevents excessive penetration of the drill into the soft tissue. On the lateral surface of the screw clamp in the area of the handles, there is a measuring scale corresponding to the distance between the jaws of the working part, with which the required length of the fixing screw is determined.

Description

The useful model relates to surgical instruments and belongs to the field of medicine, in particular to traumatology, and can be used in the course of performing osteosynthesis for the purpose of temporary intraoperative fixation of bone fragments.

In the course of performing osteosynthesis operations, it is often required to perform open reduction, especially in fractures that do not have additional intermediate fragments. A large number of different bone holders and devices have been proposed to perform reduction. After reaching the exact position of the bone fragments, the fragments are fixed with lag screws, the repositioning device is removed, and if necessary, additional fixation with bone implants is performed.

Stable accurate osteosynthesis provides the possibility of early functional recovery, helps to reduce the intensity of pain, creates conditions for the healing of fractures [Ruedi T, Buckley R, Moran CAO Principles of fracture management. - Stuttgart; New York: Thieme-Verlag, 2007. - 948 p.].

Open reduction and stable fixation of bone fragments allows the most accurate restoration of anatomical relationships when performing osteosynthesis operations. It should not be forgotten that one of the main requirements for surgical intervention is to reduce the volume of iatrogenic trauma associated with the use of instrumentation and medical implants. Prolonged reduction, extensive surgical approaches increase the invasiveness of the intervention, disrupt microcirculation, increase the incidence of infectious complications, nonunions and delayed consolidation [Leunig M, Hertel R, Siebenrock LA, et al. The evolution of indirect reduction techniques for the treatment of fractures. Clin Orthop 2000. - 375. - P.7-14.].

Thus, the reposition of bone fragments should take minimal time, be carried out with little trauma, and be simple to perform, which is impossible without the use of special medical instruments.

It is known "Device for the reduction and retention of bone fragments" [RU 107 930 U1 publ. 01/27/2011], in which the device is a bone holder and consists of a working part, jaws and ratchet. The working part is made in the form of elastic curved fenestrated jaws 2 mm thick and 30 mm wide. The lips have a crescent shape with two diverging spines, mutual concavity, smooth bend and denticles on the concave side. A cremalier with five teeth allows you to vary the distance between the jaws and to dose the strength of the grip of bone fragments in the range from one to five. The proposed device assumes a reduction in trauma, the ability to monitor the state of bone fragments, the ability to fix the fragments without removing the repositioning device.

Also known "Forceps for the reduction and retention of bone fragments" [RU 182 790 U1 publ. 09/03/2018], in which forceps for the reduction and retention of bone fragments, including crossing rod parts with handles and a fixing element, brushes, a working part in the form of jaws with teeth, characterized in that each jaw has a flat supporting surface with through parallel slots for holding temporary fixing needles, commensurate with their diameter, which is deflected at an obtuse angle from the longitudinal axis of the rod part, as well as the upper and lower teeth, which, in the middle of their length, are bent perpendicular to the supporting surface of the sponge towards the similar teeth of the second jaw. The technical result of the claimed utility model is to provide the necessary conditions for the most complete reconstruction of normal anatomy with open reduction in patients with intra-articular comminuted fractures of the distal humerus.

The disadvantages of the known devices are:

1) lack of protection of soft tissues when drilling a hole;

2) impossibility of using forceps [RU 182 790 U1] for osteosynthesis of fractures of long bones;

3) lack of guides for precise drilling;

4) forceps [RU 182 790 U1] are intended only for fractures of the distal humerus;

The bone holder Verbrugge was taken as the prototype of the utility model. The advantages of this medical instrument are the presence of a self-centering fixator, which provides fixation of a tubular bone of any anatomical shape. The reposition is carried out by means of a screw clamp.

The disadvantages of this device are:

1) lack of protection of the soft tissues of the fracture area when drilling a hole for the screw;

2) the applied bone holder reduces the area of the bone surface, into which the fixing screw can be passed;

The task of the proposed utility model is to improve the bone holder in order to eliminate the identified shortcomings.

The technical result of the proposed useful model for reduction and osteosynthesis is a decrease in the trauma of surgical intervention, a decrease in the frequency of postoperative complications, an increase in the efficiency of osteosynthesis of skeletal fractures.

The essence of the proposed utility model is illustrated by drawings, where Fig. 1 is a side view, FIG. 2 is a top view.

The stated technical result is achieved by the fact that the claimed device for temporary intraoperative fixation of bone fragments, which is a bone holder, contains the following elements: rod parts of the device (12) connected by a single-axis hinge (7), rod parts consist of handles (13, 14) with a screw clamp (8), simplifying the compression of the fragments, the lock nut (9), the clamp is connected to one of the handles by means of a single-axis hinge (11), passes through the oval hole (10) in the opposite handle, the working part of the device, consisting of two jaws (1) with saddle-shaped jaws with teeth on the supporting surface (5), one of the jaws has a through hole (2) and a guide tube - protector (3), connected to the sponge by a reinforced base (4), the second jaw has a supporting surface, with a blind hole 2 deep mm (b).

New in the proposed device is that it consists of two crossing rod parts, connected at the point of their intersection by a single-axis hinge, rod parts contain handles with a screw compression clamp with a lock nut and a working part consisting of two jaws and jaws on the supporting surface of which there are teeth that prevent slipping from the surface of the bone. One of the jaws of the working part has a supporting surface that contains a blind hole 2 mm deep. The second sponge contains a guide tube - a protector with a through hole that allows drilling the bone to form a channel for installing a fixing screw, the channel is directed from the center of the guide hole to the center of the blind hole of the second jaw. The walls of the tube protect the surrounding soft tissue from damage from the sharp edges of the drill. The diameter of the through hole allows the screw to be passed directly through the hole in the targeting tube, without removing the device and losing reduction. The wall of the sponge in the area of the blind hole prevents excessive penetration of the drill into the soft tissue.

During the operation of osteosynthesis, open reduction using the proposed device is carried out as follows:

An incision is made in the skin and underlying tissues in the area of the fracture, and access to the bone fragments is made. The ends of the device are placed on the cortical bone in the area of the fracture. With the help of handles, a screw clamp and convergence of the jaws, the bone fragments are repositioned and compressed, if necessary, X-ray control is performed. Through the guide tube located on the foot of the repositioning device, the bone is drilled in a predetermined direction; the second repositioning foot of the device prevents excessive penetration of the drill beyond the cortical layer, which protects the soft tissues inaccessible to direct visualization. The drill is removed, a screw of the required length and diameter is taken, which is inserted with a screwdriver and the created bone canal, the screw is tightened until the required compression of the fracture line. After fixation with a screw, the repositioning device is removed, X-ray control is performed, the accuracy and stability of reduction is monitored, and osteosynthesis of the fracture is performed according to the standard technique. This method of temporary reduction makes it possible to reduce iatrogenic trauma to soft tissues in the fracture area, control reduction, fix bone fragments with screws without removing the repositioning device and losing the achieved reduction.

Clinical example.

Patient P., born in 1979, was admitted to the hospital with a diagnosis of a closed two-malleolar fracture of the bones of the right leg with displacement, subluxation of the right foot outward. Street trauma, during a fall I felt a sharp pain in the right ankle joint. Delivered by ambulance, X-ray was performed on admission, skeletal traction system was applied. In the area of the right ankle, moderate swelling, movement, sensitivity of the toes of the right foot are preserved, the toes of the right foot are warm, the pulsation of the vessels is clear. After 6 days from the moment of injury, the operation was performed: open reduction, extra-bone osteosynthesis of the fracture of the right fibula with a lag screw, plate, osteosynthesis of the fracture of the medial malleolus with screws. During the operation, when performing open reduction of a fibular fracture, a device was used for reposition and fixation of bone fragments. With the help of which the reduction was performed, the fracture was fixed with a lag screw. On control radiographs, the position of the metal structures, bone fragments is correct, the congruence of the right ankle joint is restored. The postoperative wound healed by primary intention, necrosis, infectious complications were not revealed.

Claims (1)

A device for temporary intraoperative fixation of bone fragments, made of medical steel of two intersecting rod parts, connected at the point of their intersection by a single-axis hinge, the rod parts consist of two handles and a working part, in the area of the handles there is a screw compression clamp with a lock nut, the working part consists of two jaws and jaws, on the supporting surface of which there are teeth that prevent slipping from the bone, one of the jaws has a supporting surface with a blind hole 2 mm deep, the second jaw contains a guide tube - a protector with a through hole that allows drilling the bone in the direction from the center holes of the guide tube to the center of the blind hole of the opposite jaw, to form a channel for the installation of the fixing screw.

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