RU2029518C1 - Guide for closed osteosynthesis of neck of femur - Google Patents

Abstract

FIELD: medical engineering. SUBSTANCE: this guide includes clamp with sleeve 1, calibrated pointed rod 21 together with supporting pad at pointed end and bushing 16 with through longitudinal passage 17 in its wall. Clamp is made detachable in its central portion for movement and fixation of its halves. Rod 21 is positioned on clamp half 5. Bushing 16 is coaxially disposed for rotary motion inside sleeve 1. EFFECT: simplified design. 2 cl, 7 dwg

Description

 The invention relates to medical equipment and is intended for use in traumatology in the treatment of femoral neck fractures.

 There are a number of devices designed for this purpose, the description of which is given in the literature on traumatology, for example: Petrov-Yasnov, N.P. Novachenko, A.V. Kaplan devices, stereoscopic director N.A. Gear (1987). As a prototype, a guide is chosen that is designed to solve the same problem as the proposed device: providing the possibility of targeted insertion of a fixative during closed osteosynthesis by fixing the guide on the femoral head [1].

 As a result of a comparative analysis of the proposed device with the prototype, the following general characteristics were established: a guide with a sleeve; a calibrated pointed rod mounted on the guide, as well as the following differences of the proposed device from the known one: the sleeve is coaxially mounted with the possibility of rotation in the sleeve; the sleeve is made with a through longitudinal channel in the wall; the guide is made in the form of a bracket; the bracket is detachable in the central part with the possibility of relative movement and fixation of its halves; the rod is made with a support platform at the pointed end.

 Thanks to the above distinguishing features, when using the device, the necessary correction of the targeted introduction of a special wedged fixator is achieved, with the help of which stable osteosynthesis of a femoral neck fracture is performed.

 The purpose of the invention is to increase the accuracy of the formation of the channel for the introduction of a special wedging retainer, optimally adapted for osteosynthesis of the femoral neck, reducing the morbidity of the operation, preventing complications and shortening the treatment time.

 This goal is achieved in that the guide for the closed osteosynthesis of femoral neck fractures is equipped with a pointed calibrated rod with a supporting platform at the pointed end, which contains a limiting flange, and the rod is movably fixed in a sleeve made at the end of the jaw of the connecting bracket; a sleeve is inserted into the receiving sleeve, in the wall of which a through longitudinal channel is selected containing a fixing rod, and the sleeve has axial rotation, while the bracket is detachable in the central part with the possibility of relative movement and fixing of its halves. All this ensures the installation and rigid fastening of the guide directly to the peripheral and central bone fragments, i.e. at two points: the initial - the subvertebral zone and the final - the femoral head with the possibility of correction to obtain the optimal location of the wedged retainer in the neck, due to which stable osteosynthesis is achieved, which is the main condition for the extraction of patients.

 In FIG. 1 shows a general view of the guide; FIG. 2 is a plan view of FIG. 3 - from the end; figure 4 is a section aa in figure 1; in Fig.5 is a section bB in Fig. 1; figure 6 is a section bb in figure 1; 7 is a pointed tared rod with a reference platform.

 The guide consists of three nodes: the receiving sleeve 1, the reference indicator unit 2 and the connecting bracket 3. The bracket is detachable. It contains two L-shaped jaws: the outer 4 and the central 5. On the horizontal branch of the jaw 4 there is a fixed fixing element 6, comprising a housing 7, a clamping bolt 8, a longitudinally oriented groove 9 with a side slot. The groove is made in a form that provides connection and axial mutual arrangement of jaw 4, 5, movably fastened by bolt 8. At the fastening end 10 of jaw 4, a thread is cut for connection with threaded holes 11 or 12 of the receiving sleeve 1, a locking bolt 25 is screwed into hole 12. Two threaded holes 11, 12 provides the ability to install a guide for use with both right-side and left-side femoral neck fractures. The base of the sleeve contains a shoulder 13 with an opening 14 for the mounting rod 15. A sleeve 16 is inserted into the sleeve, in the wall of which a through longitudinal channel 17 is drilled for the second mounting rod 18. At the working end of the jaw 5 there is a sleeve 19 with a screw lock 20 for a calibrated rod 21, the working end of which 22 is pointed and bounded by the supporting platform 23, and a depth gauge 24 is applied on the surface of the second end.

 The device operates as follows.

 On the orthopedic operating table under anesthesia, a fracture reduction was performed in a known manner. Under aseptic conditions, as injection marks, three injection needles were inserted into the bones all the way into the bone: one into the femoral head zone and two along the outer surface of the undervert region. Radiograph of the hip joint. Two points of the optimal direction of the tracheal canal, required for insertion of the intraosseous fixator, were determined: the peripheral point - on the outer surface of the undervert region, the central one - on the femoral head. The topical position of these points relative to the oriented needles is indicated by the brilliant green on the skin.

 The guide for closed osteosynthesis of femoral neck fractures is adjusted in accordance with the relative position of these points. The clamping bolt 8 of the mounting unit 6 is released and the tared rod 21 together with the central L-shaped jaw 5 is separated. The length of the working end of the rod 21 is set on a depth gauge 24 in accordance with the thickness of the layer of soft tissue above the femoral head. This thickness is determined by the immersion depth of the corresponding reference needle. Then, from a puncture of the skin with a scalpel, a calibrated rod 21 is inserted all the way into the head and the pointed end 22 is hammered into the bone to the supporting platform 23. Then, the outer surface of the trochanteric zone of the thigh is exposed in a 6-cm long layer. A receiving sleeve 1 assembled with a L-shaped jaw 4 is introduced into the section. The base of the sleeve is mounted on the bone at the corresponding point, which is defined on the reference needle.

 The next step, in the orientation groove 9 of the fastening element 6, the free end of the L-shaped jaw 4 is inserted through the lateral slot 4. Both jaws 4, 5 in the axial relative position are fastened together by a clamping bolt 8, and thus the connecting bracket 3 is restored. The guide is installed in right points. For rigid bone fixation of it in the trochanteric zone by means of the fasteners of the sleeve 1, a fastening rod 15 is drilled into the hole 14 of the shoulder 13 of this sleeve, and a second fastening rod 18 is drilled through the channel 17 of the sleeve 16.

 A second X-ray was taken in direct projection, on which it was found that the rod 18 located in the neck of the thigh was shifted 3-4 mm above the optimal fixation zone.

 In order to correct the fixing rod 15 is removed, the bolt 8 is released, the sleeve 1 has become mobile. It is rotated together with the sleeve 16 around the eccentrically located mounting rod 18 clockwise by the calculated value. In this position, the sleeve 1 is fixed by re-introducing the rod 15 into the bone at a new point. Then, a channel passing through the neck and femoral head is drilled by a drill of the corresponding diameter (8 mm) inserted into the sleeve 16. The proppant of our design (A.S. N 1066575), with which the hip fracture is stably fixed, is introduced into this channel to the entire depth.

 On the control x-ray in two projections found the optimal location of the latch. The guide has been deleted. A soft tissue wound along the outer surface of the thigh is stitched in layers. An aseptic dressing is applied.

 Clinical observations in patients operated using a guide for closed osteosynthesis of femoral neck fractures showed that its use has several advantages compared with other devices of this type. Due to the boning in the trochanteric zone and the femoral head, a sufficiently reliable fixation of the guide is achieved in the optimal position, which makes it possible to drill the neck channel and femoral head for the fixator and stable osteosynthesis of any types of these fractures. Due to this, the effectiveness of surgical treatment is increased, the length of hospital stay and recovery is reduced, and the number of complications and adverse outcomes is reduced.

 The technique of surgery is becoming simpler and more accessible for widespread use in traumatological practice.

Claims (2)

 1. GUIDE FOR CLOSED OSTEOSYNTHESIS OF THE HIP NECK, comprising a guide with a sleeve and a calibrated pointed rod mounted on the guide, characterized in that it is provided with a sleeve coaxially mounted for rotation in the sleeve and made with a through longitudinal channel in the wall, while the guide is made in in the form of a bracket, and the rod with a supporting platform at the pointed end.  2. The guide according to claim 1, characterized in that the bracket is detachable in the central part with the possibility of relative movement and fixation of its halves.

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