RU205153U1 - DEVICE FOR OPTIMIZATION OF OPEN NAPOUS OSTEOSYNTHESIS - Google Patents

Abstract

The utility model relates to medical technology, namely to devices used in operative traumatology and orthopedics. The purpose of the utility model is a more stable grip and retention of bone fragments and extramedullary metal structures. This goal is realized with the help of a device for open bone osteosynthesis, which is a tool for capturing and holding bone fragments and bone metal structures and consisting of legs and a working part represented by sponges, characterized in that the sponges are made with T-shaped ends of a concave-angular shape with grooved on the concave side.

Description

The utility model relates to medical technology, namely to devices used in operative traumatology and orthopedics.

Treatment of fractures of the long bones of the extremities is an urgent medical and social problem of traumatology and orthopedics. Providing the conditions necessary for the consolidation of fractures of the long bones of the extremities, including anatomical reduction and stable fixation of bone fragments, maintaining an adequate blood supply to the fracture zone and the possibility of early function of the injured 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 reduction and stable fixation of bone fragments with various metal structures.

Analogs

During the operation of open osteosynthesis for the reduction and retention of bone fragments and metal structures, special instruments are used, the most famous of which are the Lambote, Boychev and Lane bone holders (Fig. 1, a, b, c).

Criticism of analogues

Traditionally used bone holders are characterized by the following significant disadvantages:

- the massiveness and rigidity of their working parts with a rigid grasp 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 operating wound and skeletonization of bone fragments over a greater extent for their capture. The increase in the trauma of the osteosynthesis operation, respectively, increases the wound healing time and the risk of intra- 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 hardware.

Prototype

As a prototype of the proposed device, Lane's bone holder was chosen (Fig. 2) (Boychee B. Operative orthopedics and traumatology / B. Boychev, B. Conforti, K. Chokanov. - "Medicine and physical education", - 2nd ed., Revised. and additional - CI - Sofia, 1958, -832. - S. 18-22), since it differs in the smaller thickness of its working part and, accordingly, the need for a smaller extent of skeletonization of bone fragments for their capture and retention.

Criticism of the prototype

However, the prototype device has the following disadvantages:

- rigidity of the jaws of the instrument with a rigid grip of bone fragments and an increase in the likelihood of damage to bone fragments;

- excessive 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 extent to capture them;

- to hold bone fragments in the achieved position, there is a special limiter at the ends of the instrument handles, consisting of a bar with grooves (teeth) on one handle and a spike corresponding to the depth of these grooves on the other. The disadvantage of this limiter, firstly, is the unreliability of fixing the thorn in the groove with frequent loss of retention of the repositional position of bone fragments, and, secondly, the inconvenience of manipulating this mechanism with a delay in the operation time and the need to constantly hold the instrument by the surgeon or assistant himself;

- 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 displacement of the metal structure when the compression between the working jaws of the instrument increases, the shape of the sponges of which is somewhat concave, but allowing the bone fragments to slide off them, and, secondly, the lack of elasticity of the grip of the instrument jaws, which contributes to the stability of the position of both bone fragments and the metal structure laid on them, and the instrument itself, with the need for its constant retention;

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

- the possibility of positioning the instrument only transversely to the wound, which limits the view 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.

The essence of the utility model

A device for optimizing open bone osteosynthesis is proposed, which is a tool for grasping and retaining bone fragments and extramedullary metal structures (Fig. 3, a, b) and consisting of legs (pos. 1) and a working part (pos. 2), differing in that that it is represented by elastic jaws (pos. 3), 3 mm thick and wide, with two bends (pos. 4) and T-shaped ends (pos. 5) of a concave-angle shape with grooves (pos. 6) on the concave side, and the legs (pos. 1) include ring-shaped handles (pos. 9) and clemaliers, one of which has three (pos. 7), and the other with eight (pos. 8) teeth for a wide variation of the distance between the T-shaped ends (pos. . 5) (Fig. 4, a, b, c) of the sponges and dispensing the strength of the grip of bone fragments (pos. 10) and extramedullary metal structures (pos. 11) in the range from one to eight.

The T-shape of the ends (pos. 5) of the working part (pos. 2) of the device with corrugation on its concave surface (pos. 6) is intended for a more stable grip and retention of bone fragments (pos. 10) and extra-bone metal structures (pos. 11 ). A stable grip is provided by the concavity of the T-shaped ends (pos. 5) and 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 grip and retention of bone fragments and extra-bone metal structures. The jaws of the instrument (pos. 3), 3 mm thick and wide, contribute to the elasticity of the capture and retention of bone fragments and extramedullary metal structures. The elasticity of the sponges of the device - both for a more firm grip and retention of bone fragments and extra-bone metal structures, and the possibility of dispensing this grip, which, on the one hand, excludes crushing or cracking of bone fragments, and, on the other hand, excludes the loss of the repositional position of bone fragments with the need for repeated reduction and retention of bone fragments and metal structures. A clemalier with three teeth (pos. 7) contributes to the reliability of fixation of the capture and retention of bone fragments and extra-bone metal structures by the working part of the instrument, and a clemalier with eight teeth (pos. 8) - for dosing the force of grasping bone fragments of extra-bone metal structures in the range from one to eight. The presence of two bends (pos. 4) of the jaws of the instrument provide the possibility of positioning most of the device to the side of the wound, which gives a greater view and access to bone fragments and metal structures when performing osteosynthesis. The smaller volume and mass of the instrument with its more rational form make it unnecessary for a large surgical access and skeletonization of bone fragments over a greater extent during the operation of extra-bone osteosynthesis.

Application example of the device

As an example of the application of the proposed device, we present the following observation. Patient M., 79 years old, was admitted to the traumatology department No. 4 of the Republican Center of Traumatology and Orthopedics (RCTO) on January 20, 2020 with a diagnosis of Closed comminuted fracture of the upper third of the left humerus. Concomitant ischemic heart disease, hypertension, type II diabetes mellitus. On 24.01.2020, the operation was performed: Outer osteosynthesis of a comminuted fracture of the upper third of the left humerus with a plate with angular stability. Under conduction anesthesia in the area of the cervical and brachial plexus in the position of the patient on the back with a roller under the left scapula, a longitudinal skin incision was made from the level of the head of the humerus downwards, 12-13 cm long. The 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 muscles, and distally, the abdomen of the shoulder muscle is split longitudinally with subperiosteal abduction to the sides. The area of oblique splinter fracture with evacuation of hematoma and elimination of interposition of soft tissues was exposed. The pointed ends of both bone fragments and the wedge-shaped fragment were economically mobilized, their fracture lines were cleaned and repositioned with two devices for capturing and holding the bone fragments. The device is represented by elastic jaws, 3 mm thick and wide, with two bends and T-shaped ends of a concave-angle shape with grooves on the concave side, and the legs include ring-shaped handles and clemaliers with three and eight teeth for varying the distance between the T-shaped ends of the jaws and dispensing the grasping strength of bone fragments and extra-bone hardware in the range of one to eight. A modeled 15-cm plate with angular stability for 5-mm self-tapping locking screws was placed on the antero-outer surface of the repositioned bone fragments, which was held by a device for capturing and holding bone fragments and extramedullary metal structures. The canals in the bone were drilled with a 4.5 mm drill with a nozzle and 5 mm screws were inserted bicortically. All screws were blocked by screwing the threads of their caps into the threads of the holes in the plate. 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 was washed with a solution of hydrogen peroxide and novocaine and sutured in layers, leaving active drainage. Applied aseptic sticker and plaster splint according to Tourner. The postoperative period was uneventful. The drain was removed the next day. The plaster splint according to the Tourner was replaced with a bandage for fixing the shoulder girdle. The wound healed primarily. The patient was discharged on 03.02.2020 with recommendations to engage in exercise therapy, the development of active movements in the joints of the upper limb. At the follow-up examination of the patient on 03/05/2020, it was noted that the function of the left upper limb was restored. X-ray showed signs of ongoing fracture consolidation. The result of the treatment was assessed as good.

Features of a utility model that differ from a prototype

The design features (distinctive features of the prototype) of the device for optimizing open 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 the tool jaws - 3 mm (pos. 3);

- elasticity of the tool jaws (pos. 3);

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

- two bends of the tool jaws (pos. 4).

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

- atraumatic use of this device;

- more stable grip and retention of bone fragments and extramedullary 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 extramedullary metal structures (pos. 11), due to the ring-shaped handles (pos. 9) and clemelier with three (pos. 7) and with eight (pos. 8) teeth;

- a clemalier with three teeth (pos. 7) contributes to the reliability of fixation of the grip and retention of bone fragments (pos. 10) and extramedullary metal structures (pos. 11) by the working part of the instrument (pos. 2), and a clemalier with eight teeth (pos. 8) - for dosing the force of gripping bone fragments of extra-bone metal structures in the range from one to eight. At the same time, the simplicity and speed of action of the clemalier mechanism when snapping the device on the bone surface and removing it significantly improves the manipulative properties of the device and minimizes intraoperative time consumption;

- the possibility of wide variation of the width of the grip when the working jaws of the tool and their T-shaped ends (Fig. 4, a, b) can be used on bones of different diameters and cross-sectional shapes (Fig. 4, c) - from the clavicle and the bones of the forearm , to the tibia and femur;

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

- the elasticity of this grip, 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 repeated reduction and retention of bone fragments and metal structures;

- the presence of two bends (pos. 4) of the jaws of the instrument make it possible to locate most of the device on the side of the wound, which gives a greater view and access to bone fragments and metal structures when performing osteosynthesis;

- no need to hold the repositioned bone fragments when performing osteosynthesis and the ability to free the hands of the surgeon and assistant.

Thus, the proposed device makes it possible to improve the quality of open osteosynthesis and create optimal conditions for increasing the efficiency of treatment of patients to whom it is applied.

Claims (1)

A device for open bone osteosynthesis, which is a tool for grasping and holding bone fragments and bone metal structures and consisting of legs and a working part represented by sponges, characterized in that the sponges are made with T-shaped ends of a concave-angular shape with corrugation on the concave side.

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