RU200275U1 - Device for reduction and temporary 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 in the course of performing osteosynthesis for the purpose of reduction and temporary intraoperative fixation. The technical result of the proposed useful model is the ability to determine the size of fixing screws, simplify the implementation of open reduction and fixation of fractures, increase the efficiency of osteosynthesis of skeletal fractures. 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 slipping from the bone surface. 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 relates to the field of medicine, in particular to traumatology, and can be used in the course of performing osteosynthesis for the purpose of reduction and 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 extra-bone implants is performed.

Stable accurate osteosynthesis provides the possibility of early functional recovery, helps to reduce the intensity of pain, creates conditions for fracture healing [Ruedi T, Buckley R, Moran C. 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 instruments 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 KA, 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, 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 107930 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 sponges are crescent-shaped 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 gripping bone fragments in the range from one to five. The proposed device assumes a reduction in trauma, the ability to control 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 182790 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, jaws, 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:

inability to determine the size of the bone and the optimal length of the fixing screw;

the impossibility of using forceps [RU 182790 U1] for osteosynthesis of fractures of long tubular bones;

forceps [RU 182790 U1] are intended only for fractures of the distal humerus.

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

The disadvantages of this device include:

the tool does not provide the ability to determine the size of the fixing screw;

the imposed bone holder reduces the area of the bone surface into which the fixing screw can be inserted.

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 the reduction and temporary fixation of bone fragments is the ability to determine the size of fixing screws, simplify the implementation of open reduction and fixation of fractures, increase 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 reduction and temporary intraoperative fixation of bone fragments, which is a bone holder, contains the following elements: rod parts of the device (13) connected by a single-axis hinge (7), rod parts consist of handles (14, 15) with screw clamp (8), which simplifies the compression of fragments, lock nut (9), measuring scale (11) applied to the surface of the screw clamp, the clamp is connected to one of the handles by means of a single-axis hinge (12), passes through the oval hole (10) in the opposite the 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 protective guide tube (3), connected to the sponge by a reinforced base ( 4), the second jaw has a supporting surface with a blind hole 2 mm deep (6).

New in the proposed device is that it consists of two intersecting 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 sliding from the surface of the bone. One of the jaws of the working part has a support surface, which contains a blind hole 2 mm deep. The second jaw contains a guide-protector tube 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 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. On the 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.

During the osteosynthesis operation, open reduction and temporary fixation of bone fragments, 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 repositioning device are placed on the cortical bone in the fracture area. With the help of handles, a screw clamp and the convergence of the jaws, the bone fragments are repositioned and compressed, if necessary, X-ray control is performed. The length of the required fixing screw is determined using the measuring scale in the area of the screw clamp. 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, the length of the screw is determined according to the measuring scale applied to the surface of the screw clamp, the screw of the required diameter is taken, which is inserted into the created bone canal with a screwdriver, 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 right shin bones with displacement, subluxation of the right foot outward. Street trauma, during the fall I felt a sharp pain in the right ankle joint. Delivered by ambulance, X-ray was performed on admission, a system of skeletal traction 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, extraosseous 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 an open reduction of a fibular fracture, a device was used for the reduction and fixation of bone fragments, with the help of which the reduction was performed, the fracture was fixed with a lag screw. Control radiographs showed that the position of the metal structures, bone fragments was correct, the congruence of the right ankle joint was restored. The postoperative wound healed by primary intention, necrosis, infectious complications were not revealed.

Claims (1)

A device for reposition and temporary intraoperative fixation of bone fragments, made of medical steel of two crossing rod parts connected at their intersection by a single-axis hinge, 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, a working part consists of two jaws and jaws with supporting surfaces, on which there are teeth that prevent slipping from the bone, on the lateral surface of the screw clamp located in the area of the handles, a measuring scale is applied corresponding to the distance between the jaws of the working part, with which the required length of the fixing screw is determined ...

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