RU2074669C1 - Apparatus for osteosynthesis of proximal end of femur - Google Patents

Abstract

FIELD: orthopedic traumatology, surgical treatment of fractures and pseudarthroses of femur neck. SUBSTANCE: apparatus comprises rod-screw, diaphysary plate provided with opening for passage of rod-screw and having cavity with cylindrical surface, axis of which is parallel to opening axis. Diaphysary plate carries replaceable jig having channels adapted to receive replaceable sleeves, axes of which are parallel and coaxial to axes of opening and of cylindrical cavity. Replaceable jig accommodates replaceable sleeves. Plate has cavity with cylindrical surface in form of semicylindrical trough adapted to receive replaceable sleeves. One of these sleeves is formed with one central opening and at least two side openings adapted to receive positioning pins. Other replaceable sleeve is formed with single opening adapted to receive cylindrical osseous transplant. EFFECT: effective aid for traumatologist and surgeon. 3 cl, 5 dwg

Description

 The invention relates to medicine of traumatology-orthopedics and is intended for osteosynthesis of fractures and false joints of the femoral neck.

 A known device for osteosynthesis of the femur (1), having a bar with holes in which a rod for fastening the neck of the thigh, retainers of the greater trochanter and diaphysis of the femur are installed.

 With the introduction of the rod into the head and neck of the thigh, rotation of the head is possible due to the fact that it is not fixed in the acetabulum and rotational-translational movements of the rod contribute to the rotation of the femoral head in the acetabulum.

 Closest to the claimed is a device for osteosynthesis of the proximal end of the femur (2), containing a screw rod, a diaphyseal pad with an opening for the screw rod and with a cavity having a cylindrical surface, the axis of which is parallel to the axis of the hole. A removable conductor is installed on the diaphysis pad, in the channels of which replaceable bushings are placed. The axis of the conductor channels is parallel and aligned with the axes of the hole and the cylindrical cavity.

 When holding the rod-screw into the head, its rotation and diametrical displacement are possible, moreover, the design does not provide compression and firm fixation in the fracture zone during treatment.

 The objective of the invention is the prevention of the rotation of fragments when holding the thigh screw in the femoral head and ensuring their stable fixation during treatment.

 The problem is solved in that in the device for osteosynthesis of the proximal end of the femur, containing a screw rod, a diaphyseal pad with an opening for the screw-rod and with a cavity having a cylindrical surface, the axis of which is parallel to the hole axis, a removable conductor with channels installed on the diaphyseal pad for removable bushings, the axes of which are parallel and coaxial to the axes of the hole and the cylindrical cavity, replaceable bushings located in the removable conductor, the cavity with a cylindrical surface is made in the form e of a semi-cylindrical groove for the replaceable sleeve, wherein one of the replaceable bushings is made with one central hole and at least two side holes for the spokes, and the other replaceable sleeve is made with a hole for a cylindrical bone graft.

 A cavity with a cylindrical surface is made in the form of a semi-cylindrical groove in the overlay, forming a guiding groove for replaceable sleeves with one of the cylindrical channels of the conductor, which allows the directional insertion of retaining spokes and a bone graft into the femoral head.

 The first interchangeable sleeve having one central hole and side holes is intended for insertion of locking knitting needles preventing rotation of the head when introducing a screw rod.

 Another interchangeable sleeve, having one central hole, is designed to drill holes in the neck and femoral head for a cylindrical bone graft (auto or hello), ensuring stability of fixation of fragments.

 The second channel of the conductor, due to alignment with the lining channel, allows the rod-screw to be carried into fragments parallel to the bone graft, which ensures uniform distribution of the load on the femoral head during treatment and maintains stable fixation of the fragments after removal of the screw-rod.

 Figure 1 shows a General view of the device with the installed guide and retaining spokes, and a screw rod; figure 2 view a in figure 1; figure 3 - sleeve 6 in isometry; in Fig.4 sleeve 7 in isometry; figure 5 General view of the device without a conductor after the final compression.

 The device (Fig. 1) contains a cover plate 1 with screws 2, a removable conductor 3 with a channel 4. The cover plate 1 has a cavity with a cylindrical surface in the form of a semi-cylindrical groove 5 (Fig. 2), forming a guide groove for interchangeable bushings 6 and 7 (Fig. 1, 3, 4). The second cylindrical channel 8 of the removable conductor 3 is parallel to the channel 4 and below it, coaxially with the lining channel 1, and is intended for the screw rod 9. The conductor 3 is mounted on the cover 1 with a screw 10. Holes 11 are made in the replaceable sleeve 6 (Fig. 3) , one of which is central, and the other side. The sleeve 7 has one Central hole 12 for a cylindrical bone graft. Locking spokes 13 pass through holes 11 of the replaceable sleeve 6 for fixing the femoral head (FIGS. 1, 2). The conductor 3 has two holes 14 (figure 2) for the guide spokes 15.

 The screw-rod 9 has a metric thread at one end, and a screw thread at the other end. In the patch 1, a square groove 16 is made under the washer 17 (Fig. 5).

 At the end of the rod-screw 9, a nut 18 is screwed, holding the spring 19.

 Replaceable bushings 6 and 7 are provided with stop flanges 20 (Figs. 3, 4).

 The device operates as follows.

 The operation is performed in the position of the patient on the back. Access is external lateral. After dissection of the skin and soft tissues, the lateral surface of the greater trochanter and the proximal end of the femur are exposed. Open or closed match the proximal end of the femur and the femoral head. A guide needle 15 is drawn along the front surface of the neck and head towards the center of the head 15. A conductor 3 is put on the spoke 15 with a conductor 3 fixed to the cover 1 by a screw 10. The cover 1 is attached with two screws 2 to the outer surface of the upper third of the femur. Insert the replaceable sleeve 6 into the channel 4 of the conductor 3 and carry it into the groove 5 of the lining 1 until it stops in the flange 20. Through the holes 11 of the replaceable sleeve 6, the locking spokes 13 are passed through the neck into the femoral head through the second cylindrical channel 8 of the conductor 3 and the lining 1 into screw the head-screw 9, screw the nut 18 on the outside and pre-compress the fragments. X-ray control of the position of the rod-screw and fragments. The sleeve 6 is removed along with the locking spokes 13. In the channel 4 of the conductor 3 insert a replaceable sleeve 7, hold it in the cavity 5 until it stops in the flange 20. Through the hole 12 of the sleeve 7, drill a channel under the bone graft 21 (Fig. 5). The nut 18 is screwed from the screw rod 9, the screw 10 is unscrewed, the jig 3 is removed. The washer 17 is put on the end of the screw rod 9, the spring 19, the nut 18 is screwed on and the final compression of the fragments is made by screwing it (Fig. 5).

 A cylindrical bone allo or autograft 21 is introduced into the prepared canal.

 After x-ray monitoring of the position of the fragments, layered wound closure is performed.

 Example No. 1. Patient S. 63 years old, and. N 1334, was admitted to the department with a diagnosis of "False joint of the neck of the left thigh with its complete defect." After preliminary skeletal traction for the femoral condyles, an operation was performed: an open reposition of the head and intertrochanteric region using the proposed device.

 An arched lateral incision along the outer surface of the thigh reveals a large trochanter and place of neck defect. A large skewer with muscles attached to it is brought down for a better approach to the neck defect site. The inter-fragment scar tissue was removed and the fragments were mapped. Toward the center of the front surface of the femoral head, a guide pin of 2.5 mm was drawn. A conductor is worn on the spoke, pre-connected to the pad. The pad is attached to the diaphysis of the thigh with two screws. A sleeve with an outer diameter of 10 mm to the stop is inserted into the upper channel of the conductor along a semi-cylindrical trough with a cylindrical surface; three spokes with a diameter of 1.5 mm are inserted through its openings into the femoral head. Then, through the lower conductor channel and the lining, a screw-rod with a diameter of 6 mm and a length of 110 mm is inserted into the femoral head through the neck. The nut precompressed fragments. Then the first interchangeable sleeve together with the locking spokes was removed, another interchangeable sleeve with one central hole of 8.2 mm in diameter was inserted into the upper conductor channel, through which a channel for a bone graft was drilled through a drill with a diameter of 8 mm. Then the nut is removed and the conductor is removed. A washer is put on the screw rod, laid in a rectangular groove of the lining, a spring is put on, then a nut is screwed on, which produced the final compression of the fragments. Radiography was made in two projections to control the location of the rod-screw and compression of fragments. The neck is formed from a spongy autobone taken from the base of the greater trochanter, which is correspondingly replaced by spongy allocost. A cylindrical bone allograft with a length of 80 mm and a diameter of 8 mm was introduced through a neck into the head into a previously drilled channel through a cavity with a cylindrical lining surface. A large skewer is fixed outwards from its bed with catgut seams. The wound is sutured in layers tightly.

 In the postoperative period, the limb was laid on the Beler splint for a period of 2 months with a cuff extension for the lower leg.

 5 months after the operation, consolidation of fragments in the area of the operation was noted, the condition of the fragments is satisfactory. The patient walks with two crutches without loading the operated limb.

 Example No. 2. Patient K., 36 years old, and. N 2409, was admitted to the department with a diagnosis of "Fracture of the neck of the left thigh." After preliminary skeletal traction for the condyles of the thigh, an operation was performed: closed osteosynthesis of fragments of the left thigh with fixation with a screw-rod and a bone allograft using the proposed device.

 An arched lateral incision along the outer surface of the thigh reveals a large trochanter and place of neck defect. Fragments are closed mapped. Toward the center of the front surface of the femoral head, a guide pin with a diameter of 2.5 mm was drawn. A conductor is worn on the spoke, pre-connected to the pad. The pad is attached to the diaphysis of the thigh with two screws. An interchangeable sleeve with a diameter of 10 mm and a length of 28 mm to the stop is inserted into the upper channel of the conductor through the gutter, three spokes with a diameter of 1.5 mm are inserted through its openings into the femoral head. Then, through the lower conductor channel and the lining, a screw-rod with a diameter of 6 mm and a length of 110 mm is inserted into the femoral head through the neck. The nut precompressed the fragments. Then the first interchangeable sleeve together with the locking knitting needles was removed, the second interchangeable sleeve with one central hole with a diameter of 8.2 mm was inserted into the upper channel of the conductor, through which a channel for a bone graft was drilled through a drill with a diameter of 8 mm. Then the nut is removed and the conductor is removed. A washer is put on the screw rod, laid in a rectangular groove of the lining, then a spring is put on, then a nut is screwed on, which produced the final compression of the fragments. Radiography was made in two projections to control the location of the rod-screw and compression of fragments. A cylindrical bone graft with a length of 80 mm and a diameter of 8 mm was introduced into the channel through the groove of the lining through the neck into the head. The wound is sutured in layers tightly.

 In the postoperative period, the limb was laid on the Beler splint for a period of 1 month with a cuff extension for the lower leg.

 After consolidation of the fracture, the structure was removed 1.5 years after the operation; instead of a screw-rod, a second bone cylindrical allograft was introduced. The patient freely controls the limb, walks with support on it, movements in the hip joint in full.

 The medical and clinical effectiveness of the device consists in preventing the rotation of the femoral head with the introduction of a screw-rod, in ensuring the normal anatomical position of the fragments and creating their stable fixation.

Claims (3)

 1. Device for osteosynthesis of the proximal end of the femur, comprising a screw shaft, a diaphyseal plate with an opening for the screw shaft and a cavity having a cylindrical surface, the axis of which is parallel to the axis of the hole, a removable conductor with channels for removable sleeves mounted on the diaphyseal plate, the axes of which parallel and coaxial to the axes of the hole and the cylindrical cavity, replaceable sleeves located in the removable conductor, characterized in that the cavity with a cylindrical surface is made in the form of half-cylindrical whom the gutters for the removable sleeve.  2. The device according to claim 1, characterized in that one of the replaceable bushings is made with one central hole and at least two side holes for the spokes.  3. The device according to p. 1, characterized in that the other removable sleeve is made with a hole for a cylindrical bone graft.

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