RU2076647C1 - Method and device for carrying out osteosynthesis of femoral neck fractures - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves carrying out reposition and fixation of the head and neck of the femur, introducing dough-like biologically active substance like crushed brephoosteomatrix filling the space between the fractured femur fragments through penetrating holes manufactured on all of three faces of the pin between its blades. The device has three-bladed pin with axial canal for guiding member, the penetrating holes are placed at a distance of r=20 ± mm from the pin end (its beginning portion) occupying L=50 mm in the pin between the blades communicating with the axial canal for guiding member so that axes of the holes on one face of the pin are at offset relative to hole axes on the neighboring faces by δ=1 ± 0.3 mm. EFFECT: reduced risk of traumatic complication development. 2 cl, 5 dwg

Description

 The invention relates to medicine, namely to traumatology and orthopedics.

A known method of surgical treatment, with intraarticular adduction fractures of the femoral neck [1]
In the known method of treatment, after reposition of fragments of the femoral neck and fixing them with a three-lobed nail Smit-Peterson, a Henderson-type conductor, through the formed window from the side of the bone marrow cavity in the direction of the damage zone of the femoral neck through the metaphysis create a tunnel with a diameter of 0.9 cm and into it before contact of the fragments, a prepared autograft is introduced through the fracture cavity.

 The disadvantage of this method is excessive injuries of the femoral neck and surrounding tissues, high technical complexity and the complexity of the manipulations that complicate the course of operations.

There is also a method of surgical treatment for medial fractures of the femoral neck in elderly patients [2]
Osteosynthesis of this group of fractures is carried out with a three-blade rod in the lateral plate fixed with screws to the femoral diaphysis in combination with fibular allografts introduced parallel to the metal retainer.

 The disadvantage of this method of treatment is the high technical complexity and the complexity of the manipulations that complicate the course of operations, as well as the inability to ensure accurate and uniform supply of biologically active material between the fragments of the femur.

The closest in technical essence and the achieved result is a method of canned treatment of false joints of long tubular bones [3]
A known method for the treatment of fractures and false joints of the femoral neck is based on the method of stimulating bone regeneration by introducing embryonic chicken bone cells into the inter-fragment tissue of the false joints using a Dufo needle.

 A disadvantage of the known method of treatment is that the introduction of biologically active materials by closed methods through needles such as Dufo does not provide an accurate and uniform flow of material between fragments.

 A known pin for osteosynthesis [4] containing a hollow organic body with split ends and a rod placed therein with the possibility of removal, as well as proppants. In order to increase the stability of osteosynthesis by ensuring reliable fixation of the pin along the entire bone marrow canal, the body has two cuts at the ends, the shaft and the channel of the body have a rectangular section, and the body channel is made with uniform narrowing to one of the ends with a corresponding increase in the thickness of the body wall to ensure wedging when moving the rod, at the same time, a protrusion is made at the other end of the housing channel, in the place of which symmetrical threaded holes are made in the housing wall which are perpendicular to the axis of the housing, under the proppant elements in the form of screws.

 The disadvantage of this device is the complexity of the structural implementation.

 The closest in technical essence and the achieved result is a three-blade pin (nail) [5] made of stainless steel, intended for osteosynthesis and made with an axial channel for the guide.

 A disadvantage of the known device is the inability to simultaneously use it as a fixative of bone fragments and a tool that serves to fill the inter-fragment space.

 The technical result of the invention is to simplify the treatment method, improve the outcomes of surgical treatment of femoral neck fractures, without increasing the time of operations and trauma, expanding the functionality of the device for osteosynthesis, namely combining the functions of the fixative of bone fragments and a tool to fill the inter-fragment space.

 The technical result is achieved by the fact that in the method of osteosynthesis of the femoral neck by reposition and fixation of fragments by a pin, after it is inserted into the neck and femoral head under pressure through its axial channel, a paste-like biologically active substance is introduced during the operation, for example, crushed brefostoomatrix filling the area between fragments of the femur through the through holes made on the faces of the pin between its three blades.

 In the device for osteosynthesis of the femur, containing a three-bladed body with an axial channel for the guide, at a distance of r 20 ± 0.1 mm from the inlet of the pin and for Z 50 mm between the blades with a pitch of h 5 ± 0.1 mm from each other through holes with a diameter of d 2.5 mm, connected to the axial channel, while the axes of one row of holes of one face of the pin body are offset relative to the axes of the holes on the adjacent face by δ = 1 ± 0.3 mm.

 The method of osteosynthesis of the femoral neck is as follows.

 Osteosynthesis of fragments of the femoral neck is performed by the extra-articular method.

 Pasty biologically active substance (for example, crushed brefosteomatrix) is collected in a metal syringe with a screw adapter and a rubber seal, which allows to achieve a tight connection between the syringe and the pin. After inserting the pin into the neck and femoral head, a syringe is screwed into it. The biologically active substance under pressure passes through the axial channel of the pin and through additional holes made on all three faces of the pin between the blades, it flows exactly between the fragments of the femur, filling all the voids in the fracture line. The axial channel of the pin is closed, for example, with a screw screwed into it, then the pin is fixed to the thigh with a small diaphyseal pad and a screw.

 In FIG. 1 shows a pin for osteosynthesis of the femur (side view); in FIG. 2 pin (side view); FIG. 3 pin (left view); FIG. 4, section A - A in FIG. one; FIG. 5, section B B in FIG. 2.

 The device for osteosynthesis of the femur contains a three-blade pin 1 with an axial channel 2 (Fig. 4) on the guide. At a distance of r 20 ± 0.1 mm from the end of the pin and over L 50 mm on all three of its faces (Fig. 2) between the blades 3 at a distance of h 5 ± 0.1 mm (Fig. 2 from each other, through with a diameter of d 2.5 mm, holes 4 connected to the axial channel of the guide 2. The centers of the holes 4 of one face of the pin are offset from the centers of the holes on the adjacent side by δ = 1 ± 0.3 mm (Fig. 2).

 A pin for osteosynthesis is used as follows.

 Osteosynthesis of fragments of the femoral neck is performed by the extra-articular method.

 First step.

 A pin 1 (Fig. 1) is inserted into the neck and femoral head by its lead-in. The depth of insertion of the pin 1 is such that its proximal end with a threaded hole remains immersed in the bone.

 Second phase.

 A paste-like biologically active substance (for example, crushed brefoostatrix) is collected in a metal syringe. A metal syringe with a screw adapter and a rubber seal is introduced into the housing 1 of the pin and screwed. The paste-like biologically active substance in the syringe, under pressure, passes through the axial channel 2 of the pin and through the additional holes 4 made on all three of its faces between the blades 3, it flows exactly between the fragments of the femur, filling all the voids in the fracture line. The axial channel 2 of the pin is closed, for example, by screwing a bolt into it. The pin is fixed to the thigh with a small diaphyseal pad. The accuracy and uniformity of the flow of biologically active substances between fragments is ensured by the presence of a large number of through holes on the side faces of the pin between its blades. For any transcervical or subcapital fracture of the femoral neck, the fracture line corresponds to two or three holes in the axial channel of the pin. With the introduction of a paste-like biologically active substance, the strength of the environmental resistance between the fragments is much less than in intact bone tissue and the femoral head.

 According to the laws of hydrodynamics, a pasty biologically active substance enters the zone with the least resistance, i.e., exactly between the fragments.

 Example 1

 On the hip joint of a corpse. Performed osteosynthesis of the proposed pin. Through the axial channel, 10 ml of Acrylaxide liquid plastic with zirconium was introduced. Result. Visual observation of the filling of inter-fragment diastasis.

 Example 2

 Patient A. 64 years old, medical history 4820 was in the clinic with a diagnosis of closed fracture of the neck of the right thigh with displacement of fragments.

 Operation N 201: closed all-articular osteosynthesis of the neck of the right thigh by the proposed method and device. During the operation, 10 ml of crushed brefosteomatrix was introduced into the fracture site through the axial channel of the pin. The postoperative period of complications. Discharged for outpatient treatment on the 12th day after surgery. Fusion after 4 months, walks with a stick. After 6 months, full restoration of functions, walks without crutches.

 Using the method of osteosynthesis of the femoral neck and a device for its implementation allows, without increasing the morbidity and time of the operation, to optimize the processes of reparative regeneration of bone tissue directly at the fracture site by using the proposed three-blade pin as a conductor for passing biologically active substances to the fracture line of the femoral neck .

Claims (2)

 1. The method of osteosynthesis of the femoral neck by reposition, fixation of fragments by a three-lobed pin with the introduction of a biologically active substance that stimulates bone regeneration between the fragments, characterized in that pasty brefostoomatrix is used as the biologically active substance, which is introduced through the axial channel of the pin and then through holes made on all faces of the pin between its blades.  2. A device for osteosynthesis of the femoral neck, made in the form of a three-blade pin with an axial channel under the guide, characterized in that in the pin between the three blades there are rows of holes with a diameter of 2.5 mm communicating with the axial channel at a distance of 20 ± 0.1 mm from the working end of the rod over 50 mm in increments of 5 ± 0.1 mm, and the axes of one row of holes are offset from the axes of the other row by 1 ± 0.3 mm.

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