RU211377U1 - DEVICE FOR INTRAOSSEOUS OSTEOSYNTHESIS IN FRACTURES OF THE ANKLES WITH A RUPTURE OF THE LINATIONS OF THE DISTAL INTERTITIBIAL SYNDESMOSIS - Google Patents

Abstract

The technical solution relates to medical equipment, to devices for internal osteosynthesis used in traumatology and orthopedics, and is intended for osteosynthesis in ankle fractures with torn ligaments of the distal tibiofibular syndesmosis.

The device contains a bone screw 1, equipped with a threaded shank 2, on which a cannulated screw 3 is installed. The screw 1 is made with a screw thread 4, with an outer diameter ranging from 4 to 5 mm. The screw 1 is equipped with a threaded shank 2, with an outer diameter ranging from 2 to 2.5 mm, containing a smooth section 10 and a threaded cut. The cannulated screw 3 is made with a screw thread 4, with an outer diameter of the screw thread 4 in the range from 4 to 5 mm, equipped with a turnkey hexagonal section 5, and a smooth through axial channel 6. The cannulated screw 3 is mounted on a threaded shank 2 with a smooth section 10. Moreover, the screw thread 4 of the screw 1 and the screw thread 4 of the cannulated screw 3 are made with identical geometric parameters. The cannulated screw 3 is blocked by the nut 7 mounted on the threaded shank 2.

The technical result consists in providing the possibility of stabilizing the bones in case of rupture of the distal tibiofibular syndesmosis. 3 w.p. f-ly, 8 ill.

Description

Technical field

The technical solution relates to medical equipment, to devices for internal osteosynthesis used in traumatology and orthopedics, and is intended for osteosynthesis in ankle fractures with torn ligaments of the distal tibiofibular syndesmosis.

State of the art

Intertibial syndesmosis is the connection of the tibia and fibula in the distal region of the ankle and ankle joint through connective tissue.

The main biomechanical function of syndesmosis is to resist the forces of axial load, rotation, and external translation of the talus. During the load on the lower limbs when walking, running, due to the elasticity of the connective tissue of the syndesmosis, the tibiofibular gap can expand and narrow depending on the magnitude of the load. The properties of syndesmosis provide the necessary range of motion and prevent the development of degenerative processes.

Rupture of the tibiofibular syndesmosis occurs with damage to the ankle joint and fractures of the ankles. As a result of damage to the ligaments of the distal tibiofibular syndesmosis, a complication is chronic instability of the ankle joint, the development of degenerative processes, post-traumatic deforming arthrosis of the ankle joint.

In the vast majority of cases, rupture requires surgical treatment. Ensuring the restoration of physiological function in the distal tibiofibular syndesmosis after its injury is the task of surgical treatment.

The classic method of treatment is the fixation of syndesmosis with bone screws (syndesmosis screw, position screw (source [1] patent RU 2682626)). As a rule, screws with an outer diameter of 3.5 or 4.5 mm are used, which are carried out 2-5 cm above the distal tibial plateau, rigidly connecting the tibia and fibula in the distal region. Bone screws rigidly fix the syndesmosis, however, in the long term, they create conditions for the development of synostosis and arthrosis of the ankle joint. In the distal tibiofibular articulation, under normal conditions, during walking, movements of the outer ankle in relation to the tibia occur, both of a rotational nature and in the frontal plane, as well as a slight divergence of the "fork" of the ankle joint. The screw serves as an obstacle to these physiological movements, limits the normal dorsal flexion of the foot and, as a result, can provoke persistent pain and extensor contracture of the ankle joint in the postoperative period. Moreover, the screws break quite often, even when installing several screws, it happens that they cannot withstand the load. One of the reasons is that the screw has a full length screw thread, at the point of transition from the fibula to the tibia screw, a local concentration of mechanical stress occurs on the threaded section, which, under cyclic loads, leads to the destruction of the screw.

A device for repositioning the distal tibiofibular syndesmosis and eliminating external subluxation of the foot is known (source [2]: patent No. RU 2164390, 2000). The device contains a metal rod with a screw thread (screw, screw) and a support pad, a handle-lock, a handle and a sleeve with an internal thread and a threaded hole for attaching the handle-lock. The rod is made with a threaded part for penetration into the bone and making up 2/3 of the entire rod, a threaded part for moving the bushing along the thread, and a support washer with a gasket is located between the threaded part for penetration into the bone and the bushing. EFFECT: provision of dosed elimination of diastasis in the distal tibiofibular syndesmosis, preservation of mobility in the joint and reduction of the operation time.

The disadvantage of this device is the limitation of the physiological range of motion in the distal tibiofibular syndesmosis. Compression of the tibiofibular syndesmosis is carried out for a fixed length of the rod (screw), which may limit the range of motion during static-dynamic loading in the distal tibiofibular syndesmosis.

A device for repositioning and fixing pelvic fractures is known (source [3]: patent No. RU 2545922, 2015). The device contains a rod with a screw thread (bone screw) and a spherical head, a sleeve with an external thread, a helical calibrated spring for installation on the rod, nuts for the rod, adaptive washers and a screw-in plug of the sleeve. Said spring rests with one of its ends against the head of the screw rod, and with the other end against the inner thrust pad of the bushing. EFFECT: invention ensures the preservation of the main physiological function in the distal tibiofibular syndesmosis after its injury.

The spring located in the sleeve does not perform its function during operation, since the free volume of the sleeve in which the spring is located is filled with organic materials, blood, bone chips, connective tissue, which prevent the displacement of the spring coils. The rod loses its ability to move relative to the sleeve, as a result, the mobility of the tibiofibular syndesmosis is limited.

In addition, since the nail is threaded at its distal end for substantially its entire length, bones can be unintentionally rigidly connected during nail insertion. Since when exiting from one bone to another, it is not possible to control the complete exit of the threaded thread of the nail from the tibia, the threaded thread does not allow the nail to move during movement. Moreover, in this case, the risk of a fracture of the rod increases, since it has a screw thread for the entire length, at the point of transition from the fibula to the tibia screw, a local concentration of mechanical stress occurs in the threaded section, which, under cyclic loads, leads to the destruction of the rod.

A rod with a screw thread (bone screw) and a spherical head, and a sleeve with an external thread are inserted separately, which complicates the operation technique. They require separate reaming of the channels and alternate insertion of device parts into the bones.

Thus, existing analogues have disadvantages, which complicates their use and limits the possibilities of application.

The essence of the technical solution

The present technical solution is aimed at providing the possibility of minimally invasive fixation of the position of the fibula and tibia in the distal section with the provision of physiological mobility. Ensuring the possibility of fixing the bones in an anatomically correct position with the possibility of postoperative mobility within acceptable limits.

EFFECT: stabilization of the position of the fibula and tibia in the distal section, providing mobility in a limited range, while reducing the risk of secondary instability. Ensuring the preservation of the main physiological function in the distal tibiofibular syndesmosis after its damage in ankle fractures.

Fixation of the tibiofibular syndesmosis allows early loading of the injured lower limb without means of external immobilization. The mobile nature of fixation reduces the risk of complications associated with static (rigid) fixation of bones. EFFECT: preservation of physiological function, anatomical relationships in the distal tibiofibular syndesmosis and improvement of the patient's quality of life is ensured.

The technical result is achieved by the fact that the device for intraosseous osteosynthesis in fractures of the ankles with ligament rupture of the distal tibiofibular syndesmosis, containing a bone screw for fixation in one bone, connected to a cannulated screw for fixation in another bone, characterized in that the bone screw is equipped with a threaded shank, on which the cannulated screw is installed, the bone screw is made with a screw thread with an outer diameter in the range from 4 to 5 mm, the cannulated screw is made with a screw thread with an outer diameter in the range from 4 to 5 mm, the screw thread of the screws is made with identical geometric parameters, the threaded shank made with an outer diameter in the range from 2 to 2.5 mm, contains a smooth section and a threaded thread, a cannulated screw is equipped with a turnkey hexagonal section and a smooth through axial channel, and the cannulated screw is locked by a nut mounted on a threaded shank.

Options for the implementation of the technical solution is illustrated by graphic materials:

Fig. 1 - General view of the device for intraosseous osteosynthesis for ankle fractures with torn ligaments of the distal tibiofibular syndesmosis, outer diameter - 5 mm;

Fig. 2 - view with spaced parts, in section, a device for intraosseous osteosynthesis for ankle fractures with torn ligaments of the distal tibiofibular syndesmosis, outer diameter - 5 mm;

Fig. 3 - side view, in section, a device for intraosseous osteosynthesis for ankle fractures with torn ligaments of the distal tibiofibular syndesmosis, outer diameter - 5 mm;

Fig. 4 - General view of the device for intraosseous osteosynthesis for ankle fractures with torn ligaments of the distal tibiofibular syndesmosis, outer diameter - 4 mm;

Fig. 5 - side view, in section, a device for intraosseous osteosynthesis for ankle fractures with torn ligaments of the distal tibiofibular syndesmosis, outer diameter - 4 mm.

Fig. 6 is a general view of the device for intraosseous osteosynthesis for fractures of the ankles with torn ligaments of the distal tibiofibular syndesmosis, outer diameter - 4.5 mm, with a tenon-groove connection, in the assembled state;

Fig. 7 - general view of the device for intraosseous osteosynthesis for fractures of the ankles with rupture of the ligaments of the distal tibiofibular syndesmosis, outer diameter - 4.5 mm, with a tenon-groove connection, in the extended state; the threaded shank is made of an elastic wire made of 12X18H10T stainless steel alloy, the bone screw is connected to the butt end with a cannulated screw by a tenon-groove connection;

Fig. 8 - view with spaced parts, in section, a device for intraosseous osteosynthesis for fractures of the ankles with a rupture of the ligaments of the distal tibiofibular syndesmosis, the outer diameter is 4.5 mm, with a tenon-groove connection.

Graphic materials indicate:

1 - screw;

2 - threaded shank;

3 - cannulated screw;

4 - screw thread;

5 - hexagonal section;

6 - channel;

7 - nut;

8 - distal end;

9 - cutting edge;

10 - smooth area;

11 - pin;

12 - spike;

13 - groove.

Device implementation

A device for intraosseous osteosynthesis in ankle fractures with torn ligaments of the distal tibiofibular syndesmosis contains a bone screw 1, equipped with a threaded shank 2, on which a cannulated screw 3 is installed. a larger diameter, in view of the size of the bones, can lead to splitting of the distal end of the bones; the execution of a screw of a smaller diameter, when made from iron alloys, steel, titanium alloys, does not provide sufficient strength necessary to achieve bone stability). The screw 1 is equipped with a threaded shank 2, with an outer diameter ranging from 2 to 2.5 mm, containing a smooth section 10 and a threaded cut. The cannulated screw 3 is made with a screw thread 4, with an outer diameter of the screw thread 4 in the range from 4 to 5 mm, equipped with a turnkey hexagonal section 5 and a smooth through axial channel 6. The cannulated screw 3 is mounted on a threaded shank 2 with a smooth section 10. Moreover, the screw thread 4 of the screw 1 and the screw thread 4 of the cannulated screw 3 are made with identical geometrical parameters. The cannulated screw 3 is blocked by the nut 7 mounted on the threaded shank 2.

Example 1 (Fig. 1; 2; 3).

The device for intraosseous osteosynthesis in ankle fractures with torn ligaments of the distal tibiofibular syndesmosis contains a bone screw 1, made with an outer diameter of the screw thread 4 equal to 5 mm, with a pitch of 2.7 mm, a height of coils of 0.75 mm, equipped with a threaded shank 2. Length screw 1 with a threaded shank 2 is 80 mm, and here the length of the threaded shank is 50 mm. The threaded shank 2 is made with a smooth section 10, with an outer diameter of 2.5 mm and a threaded cut with a metric thread M2.5. The device contains a cannulated screw 3, with an outer diameter of the screw part 4 equal to 5 mm, a screw thread 4 27.5 mm long, equipped with a hexagonal section 5, turnkey 5 mm, and a smooth through axial channel 6, with a diameter of 2.51 ... 2 .60 mm. The cannulated screw 3 is installed on the threaded shank 2, and the screw thread 4 of the screw 1 and the screw 3 is made with identical geometric parameters. The cannulated screw 3 is blocked by the nut 7 mounted on the threaded shank 2. The channel 6 of the cannulated screw 3 and/or the smooth section 10 of the threaded shank 2 have a fluoroplastic coating to reduce friction and increase the mating resource.

The device provides fixation and compression of the distal tibiofibular syndesmosis, maintaining the physiological necessary mobility in the joint in the range of 1.5±0.2 mm outwards, 2.0±0.2 mm posteriorly, replaces torn tibiofibular ligaments by the function of mobility limitation.

The bone screw 1 is made in the form of a steel rod of transitional diameter with a metric thread on the shank 2 and a screw thread 4 for screwing the screw 1 into the bone at the opposite end. The place of transition of the diameters of the screw 1 is made with a fillet with a radius of 0.5 mm (to reduce local mechanical stresses). The end 8 of the screw 1 is made pointed, with a cutting edge 9 for cutting into the bone. The cannulated screw 3 is mounted on the threaded shank 2 of the screw 1 with the possibility of adjusting its position along the threaded shank 2, limited by the nut 7. Moreover, to ensure the possibility of transmitting torque, the screw 3 is equipped with a turnkey hexagonal section 5. The nut 7 and the hexagon section 5 have the same outer geometric shape, the hexagon is 5 mm in size. The nut 7 adjoins the hexagonal section 5. The cannulated screw 3 is mounted on the threaded shank 2 of the screw 1, so that the hexagonal section 5 faces in the opposite direction from the end 8, and the screw 3 is able to move freely along the smooth section 10. The screw 3 is made with a screw thread, intended for screwing into the bone, at the end contains a cutting edge 9.

Example 2 (Fig. 4; 5).

A device for intraosseous osteosynthesis in ankle fractures with torn ligaments of the distal tibiofibular syndesmosis contains a bone screw 1 with an outer diameter of the screw thread 4 equal to 4 mm, with a pitch of 1.75 mm, a height of 0.5 mm, equipped with a threaded shank 2, made in the form elastic knitting needles made of steel 12X18H10T. The length of the screw 1 with the threaded shank 2 is 70 mm, and the length of the threaded shank 2 is 40 mm. The threaded shank 2 is made in the form of an elastic spoke with an outer diameter of 2 mm on a smooth section 10 and a metric thread M2.

The device contains a cannulated screw 3 with an outer diameter of the screw part 4 equal to 4 mm, a screw thread length 4 equal to 27.5 mm, equipped with a hexagonal section 5 and a smooth through axial channel 6 with a diameter of 2.1 mm. The cannulated screw 3 is installed on the threaded shank 2, and the screw thread 4 of the screw 1 and the screw 3 is made with identical geometric parameters. The cannulated screw 3 is blocked by a nut 7 mounted on the threaded shank 2. The channel 6 of the cannulated screw 3 and/or the smooth section 10 of the threaded shank 2 have a roughness of not more than 0.16 µm (laser metal processing or diamond burnishing is applicable), to reduce friction and increase pairing resource.

The device provides fixation and compression of the distal tibiofibular syndesmosis, maintaining the physiological necessary mobility in the joint in the range of 1.5±0.2 mm outwards, 2.0±0.2 mm posteriorly, replaces torn tibiofibular ligaments by the function of mobility limitation.

The bone screw 1 is made of a titanium alloy in the form of a rod of transitional diameter, with a metric M2 thread on the shank 2, and a screw thread 4 intended for screwing into the bone at the opposite end. Moreover, the diameter transition point is made as follows: the M2 spoke is inserted into the axial recess with a rounded edge and fixed with a pin 11. The end 8 of the screw 1 is made pointed, with a cutting edge 9. The cannulated screw 3 is mounted on the threaded shank 2 of the screw 1 with the possibility of adjusting its position along of the shank 2 is limited by the nut 7. Moreover, to ensure the possibility of transmitting torque, the screw 3 is equipped with a hexagonal section 5. The nut 7 and the hexagonal section 5 have the same outer geometric shape, the hexagon is 5 mm in size. The nut 7 is adjacent to the hexagonal section 5. The screw 3 is mounted on the shank 2 of the screw 1, so that the hexagonal section 5 is turned in the opposite direction from the end 8. The screw 3 is made with a screw thread 4, intended for screwing into the bone, at the end contains a cutting edge 9 .

The device (example 1, 2) is used as follows.

In the area of the ankle joint, an arcuate incision of the soft tissues is made, facing the base of the fibula, peeled off in layers and expose the distal fibula. The bed is drilled with a drill (a channel with a diameter of 3-4 mm is made, it is not necessary to make channels of different diameters) to introduce screw 1 into the tibia through the fibula. Screw 1 is installed with end 8 inside the tibia in the area of syndesmosis. Then, a cannulated screw 3 is installed on the threaded shank 2 of the screw 1, screwing it by the hexagonal section 5 into the metaphyseal section of the fibula on the projection of the syndesmosis, which ensures stabilization of the relative position of the bones. Then the self-locking nut 7 is put on the threaded shank 2 and the nut 7 is screwed, using a wrench, the bones are compressed to the required value. When screwing the nut 7, the bones approach each other, however, the screw 3 is left with the possibility of movement along the threaded shank 2 along the smooth section 10, which provides the necessary range of motion, so the tibiofibular syndesmosis is restored while maintaining mobility, which prevents the development of degenerative processes. To lock the position of nut 7, a second nut (lock nut, not shown) may be screwed in to compress the tibia. The wound is sutured in layers.

The device is used for intraosseous osteosynthesis in ankle fractures with torn ligaments of the distal tibiofibular syndesmosis with a minimally invasive surgical technique that allows for early activation and rehabilitation of patients.

Screws 1 and 3 stabilize the bones with a physiological degree of mobility, screw 3 is able to move along the smooth area 10, in the range limited by the nut 7, which reduces the risk of developing synostosis and arthrosis of the ankle joint, since movements occur in the frontal plane in the distal tibiofibular joint during walking , and rotational in nature, a slight divergence of the “fork” of the ankle joint is not limited. Moreover, the risk of fracture of the screw 1 is reduced, since in the area between the bones it is made without mechanical stress concentrators (smooth section 10), of sufficient diameter (2-2.5 mm). The execution of the threaded shank 2 of the spokes (needles for osteosynthesis, Kirschner's spokes), which has elastic properties, allows the shank to repeatedly deviate from the longitudinal axis of the screw 1, ensuring the mobility of the connection, without cracks in the material.

Example 3 (Fig. 6; 7; 8).

A device for intraosseous osteosynthesis in case of ankle fractures with torn ligaments of the distal tibiofibular syndesmosis contains a bone screw 1, with an outer diameter of a screw thread of 4.5 mm, a pitch of 2 mm, a coil height of 0.5 mm, equipped with a threaded shank 2 made in the form of an elastic-elastic needle . The length of the screw 1 with the threaded shank 2 is 80 mm, and the length of the threaded shank is 50 mm. The threaded shank 2 is made in the form of an elastic spoke with an outer diameter of 2 mm and a metric thread M2.

The device contains a cannulated screw 3, with an outer diameter of the screw part 4 equal to 4.5 mm, a length of the screw part 4 equal to 30 mm, equipped with a hexagonal section 5, and a smooth through axial channel 6 with a diameter of 2.1 mm. Cannulated screw 3 is mounted on a threaded shank 2, and the screw thread of the screw 1 and screw 3 is made with identical geometric parameters. The cannulated screw 3 is blocked by the nut 7 mounted on the threaded shank 2. The channel 6 of the cannulated screw 3 and/or the smooth section 10 of the threaded shank 2 have a roughness of not more than 0.16 µm to reduce friction and increase the mating resource.

The screw thread 4 of the screw 1 and the screw thread 4 of the cannulated screw 3 are continuations of each other, i.e. when screw 1 is connected to screw 3 end-to-end, a continuous screw thread 4 is formed. Screw 1 at the point of transition to threaded shank 2 is equipped with protrusions in the form of a spike 12, screw 3 is equipped with grooves 13 in the end part, thus forming a tongue-and-groove connection that provides docking screws 1 and 3 transmission of torque.

The device provides fixation and compression of the distal tibiofibular syndesmosis, maintaining the physiological necessary mobility in the joint in the range of 1.5±0.2 mm outwards, 2.0±0.2 mm posteriorly, replaces torn tibiofibular ligaments by the function of mobility limitation.

The bone screw 1 is made in the form of a metal rod of a transitional diameter, with a metric M2 thread on the shank 2, and a screw thread for screwing the screw into the bone at the opposite end. Moreover, the diameter transition point is made as follows: the M2 spoke is inserted into the axial recess with a rounded edge and pinned. The end 8 of the screw 1 is pointed, with a cutting edge 9. The cannulated screw 3 is mounted on the threaded shank 2 of the screw 1 with the possibility of adjusting its position along the shank 2, limited by the nut 7. Moreover, to ensure the transmission of torque, the screw 3 is equipped with a hexagonal section 5. The nut 7 and the hexagonal section have the same outer geometric shape, the hexagon is 5 mm in size. The nut 7 is adjacent to the hexagonal section 5. The screw 3 is mounted on the shank 2 of the screw 1, so that the hexagonal section 5 is turned in the opposite direction from the end 8. The screw 3 is made with a screw thread intended for screwing into the bone, at the end it contains a cutting edge 9.

The device (example 3) is used as follows.

In the area of the ankle joint, an arcuate incision of the soft tissues is made, facing the base of the fibula, peeled off in layers and expose the distal fibula. A bed is drilled with a drill (a channel with a diameter of 4 mm) to insert the screw 1 into the tibia, through the fibula (it is provided that the device can be inserted both from the side of the inner and from the side of the outer ankle, i.e. into the tibia, through the fibula or into the fibula, through the tibia). Screw 3 is connected to screw 1, inserting spike 12 into groove 13, pressing with nut 7. The tongue-and-groove connection makes it possible to transmit torque and insert the device in one pass, which simplifies the operation technique, since the device parts are not installed into the channel separately. The assembled device is installed with its end 8 inside the tibia in the area of syndesmosis, immersing the screw thread 4 of the screw 1 completely into the bone. The device is screwed by the hexagonal section 5 into the metaphyseal section of the fibula and the tibia on the projection of the syndesmosis, so that the screw 1 remains screwed into the tibia with a screw thread 4, the screw 3 is screwed into the fibula with a screw thread, which ensures stabilization of the relative position of the bones. Then the nut 7 is loosened, ensuring the mobility of the screw 3 on the threaded shank 2 in the region of the smooth section 10. The range in which the mobility of the bones is allowed is determined by the turns of the nut 7, taking into account the pitch of the metric threading of the shank 2. When screwing the nut 7, the bones approach each other. to each other, when unscrewing the nut 7, the range of mutual movement of the screws 1 and 3 expands. The screw 3 is left with the ability to move along the threaded shank 2 along the smooth section 10, which provides the desired required range of motion, so the tibiofibular syndesmosis is restored while maintaining mobility, which prevents the development of degenerative processes. Bone screws 1 and 3 movably fix the syndesmosis, screw 3 is able to move along the shank 2 under load, and the shank is able to elastically deviate from the longitudinal axis, which provides physiological mobility, reduces the risk of developing synostosis and arthrosis of the ankle joint. In the distal tibiofibular articulation, when walking, running, movements of the outer ankle in relation to the tibia occur, both of a rotational nature and in the frontal plane, as well as a slight divergence of the “fork” of the ankle joint.

The wound is sutured in layers.

The device is used for intraosseous osteosynthesis in ankle fractures with torn ligaments of the distal tibiofibular syndesmosis with a minimally invasive surgical technique that allows for early activation and rehabilitation of patients.

Claims (4)

1. A device for intraosseous osteosynthesis in ankle fractures with torn ligaments of the distal tibiofibular syndesmosis, containing a bone screw for fixation in one bone, connected to a cannulated screw for fixation in another bone, characterized in that the bone screw is equipped with a threaded shank on which the cannulated screw is installed , the bone screw is made with a screw thread with an outer diameter in the range of 4 to 5 mm, the cannulated screw is made with a screw thread with an outer diameter in the range of 4 to 5 mm, the screw thread of the screws is made with identical geometric parameters, the threaded shank is made with an outer diameter in the range from 2 to 2.5 mm, contains a smooth section and a threaded thread, the cannulated screw is equipped with a turnkey hexagonal section and a smooth through axial channel, and the cannulated screw is locked by a nut mounted on a threaded shank. 2. A device for intraosseous osteosynthesis for fractures of the ankles with ligament rupture of the distal tibiofibular syndesmosis according to claim 1, characterized in that the screws are made with a screw thread with an outer diameter of 5 mm, a threaded shank with an outer diameter of 2.5 mm. 3. A device for intraosseous osteosynthesis for fractures of the ankles with ligament rupture of the distal tibiofibular syndesmosis according to claim 1, characterized in that the screws are made with a screw thread with an outer diameter of 4 mm, a threaded shank with an outer diameter of 2 mm, and the threaded shank is made of elastic spokes from an alloy of stainless steel of brand 12X18H10T. 4. A device for intraosseous osteosynthesis for fractures of the ankles with rupture of the ligaments of the distal tibiofibular syndesmosis according to claim 1, characterized in that the screws are made with a screw thread with an outer diameter of 4.5 mm, a threaded shank with an outer diameter of 2 mm, and the threaded shank is made elastic needle made of stainless steel alloy grade 12X18H10T, the bone screw is connected to the butt end with a cannulated screw by a tenon-groove connection.

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