RU2120246C1 - Method for stretching short stump of metacarpal bone - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves performing osteotomy, bringing fractured bone fragments apart, moving the metacarpal bone stump and carrying out plastic bone defect repair. Feeding limbs having skin ribbon, subcutaneous veins and arterial vessels going from carpal blood vessel network on palm and rear hand surface in the projection of the metacarpal bone stump are formed. Stump separation being accomplished, its axial distraction at the extent of required value of elongation and plastic repair with bone graft are carried out by fixing attachment of its proximal end to the metacarpal bone stump to be stretched and the distal end to the metacarpal bone stump moved on the feeding limbs. EFFECT: prevented deforming arthrosis of radio-carpal articulation. 10 dwg

Description

 The invention relates to medicine, namely to reconstructive surgery of the hand.

 There are various methods for lengthening the stumps of the hand, for example, the method for lengthening the metacarpal bones, described in the dissertation abstract for the study Art. doctor of medical sciences "Treatment of patients with abruptions and amputation stumps of fingers" N.M. Vodianova, 1979, p. 35, "The method of restoring the gripping function in the absence of 2-5 rays of the brush" according to A.S. N 1175454 G.S. Godunova, I.V.Shvedovchenko and others. However, these methods cannot be used to lengthen the short stump of the metacarpal bone, and the treatment time when using these methods is long.

 Closest to the proposed technical solution is the method of transposition of the metacarpal bones, described by A. A. Koryukov in f. "Orthopedics, traumatology and prosthetics", 1993 N 3, p. 29. This method consists in the fact that they perform the movement of the second metacarpal bone on the third metacarpal bone, cross the head bone. A polygonal bone is placed in the diastasis between its fragments, due to which it provides an additional elongation of the "elbow" finger and the resorption of the autograft is prevented.

 However, this method is not without disadvantages of the above methods. It is applicable only to lengthen the third metacarpal bone and naturally, it cannot be used to remove the first metacarpal bone. In addition, the method does not provide the necessary lengthening of the stump. In this case, the anatomical relationship of the bones of the wrist is violated, which leads to pain, deforming arthrosis of the wrist joint, impaired function of the first carpal joint.

 The objective of the proposed technical solution is to lengthen the short stump of the metacarpal bone, including the first finger, by the required size and to prevent the development of deforming arthrosis of the wrist joint.

 This problem is solved due to the fact that feeding legs are formed in the projection of the transferred stump, after isolating the stump, axial distraction is performed by the required elongation and a bone graft is placed, fixing its proximal end to the elongated metacarpal stump, and the distal end to the displaced stump nourishing legs of the metacarpal stump.

 The invention is illustrated by drawings, where in FIG. 1 shows the initial state of the stump of the hand, in FIG. 2 - palmar feeding leg, axial distracting spoke, FIG. 3 - complete distraction of the stump of the metacarpal bone exarticulated in the wrist-metacarpal joint, in FIG. 4 - osteosynthesis of the proximal end of a bone autograft with an extension stump and a metacarpal stump moved onto it.

 The method is as follows.

 Choose a stump of the metacarpal bone, which must be lengthened. The palmar and dorsal feeding legs are formed in the projection of the displaced metacarpal stump. Next, isolate this stump in the wrist-metacarpal joint after resection of the articular surfaces of it, conduct axial distracting needle (Fig. 1, 2). An external fixation device is applied and the distal end of the spoke is fixed to the screw rod. Wounds are sutured in layers. After 5 days, gradual axial distraction of the stump begins. After stretching the stump of the metacarpal bone and the feeding legs by the required amount (Fig. 3), the second stage of the operation is performed.

 In this case, the repetition is mobilized by the stump on the distracted feeding legs. Bone autotransilantate is taken from the wing of the adductor bone and treated so that its length is equal to the magnitude of the extension of the metacarpal stump. Next, the proximal end of the graft is fixed to an elongated metacarpal stump by the implantation method. The metacarpal stump is moved to its distal end on the distracted feeding legs, and osteosynthesis is also performed by the method of introducing bone fragments of FIG. 4. The areas of osteosynthesis are additionally fixed with Kirschner spokes. Wounds are sutured in layers. Immobilization of the stump of the hand with a plaster cast for the period of consolidation of the graft.

 Clinical example.

 B-th M-ev A.V., born in 1974, source bol. N 157179, was in the Nizhny Novgorod Research Institute from September 6, 1993 to December 21, 1983, with a diagnosis of Stump of the metacarpal bones of both hands. Upon admission to the left hand, the stump of the first metacarpal bone 6 cm long is determined at the level of the head of the metacarpal bone. On the bone there are also stumps of 2-5 metacarpal bones at the level of the proximal third. Movement of the stump of the first metacarpal bone in the carpal-metacarpal joint in full. Bilateral grip of the hand is absent (Fig. 5, 6, 7). On the first hand there are stumps of 1-5 metacarpal bones at the level of the distal third. Bilateral grip of the hand is also completely absent.

 The patient refused the proposed reconstruction of the hand by means of finger transplants into the feet. 09.21.93, the first stage of the operation was completed according to the developed methodology. Formed feeding legs, including a skin tape 1.5 cm wide, saphenous veins and arterial vessels extending from the carpal vasculature, on the palmar and dorsal surfaces of the hand in the projection of the stump of the 3 metacarpal bone. The stump of the 3 metacarpal bone is isolated in the carpal-metacarpal joint. An axial distracting spoke was drawn through the stump. Protection wounds in layers tightly. On September 26, 1993, the distraction of the stump of the third metacarpal bone was started at 1 mm per day. After lengthening the stump along with the feeding legs by 5 cm. 2.12.93, the second stage of the operation.

 In this case, incisions were made in the projection of postoperative scars after the first stage. Re-mobilized feeding legs. Refreshed end of the stump of the second metacarpal bone. A 5 by 2 cm graft was taken from the iliac wing. The ends of the graft were treated with cylindrical phrases. Next, the proximal end of the graft is embedded in the stump of the second metacarpal bone. The stump of the third metacarpal bone was moved to the distal end of the graft on the distracted feeding legs of the stump of the third metacarpal bone. Osteosynthesis was performed by the method of introducing the distal end of the graft into the stump of the metacarpal bone with additional fixation with Kirschner spokes. Protection wounds in layers tightly. The plaster cast was immobilized for 2 months. The patient was examined after 4 months. The length of the second metacarpal bone is 6 cm. The linear opening of the stump of the first metacarpal bone is 5 cm. The reduction of the stump of the first metacarpal bone to the stump of the second metacarpal bone is complete. Movement in the wrist and first wrist joint is not impaired. Restored bilateral grip of the brush. The radiograph determines the complete consolidation of the transplant with the stump of the second metacarpal bone and the placed stump of the third metacarpal bone (Fig. 8, 9, 10). 04/30/94, the formation of the first interdigital gap was completed with a depth of 2 cm. The patient is fully self-serving. I am satisfied with the result of the treatment.

 Thus, the method allows to lengthen the short stump of the metacarpal bone (0.5-1 cm). In addition, the proposed method allows to reduce the lengthening of the stump, since the duration of treatment is determined only by the lengthening of the feeding legs of the moved stump and the consolidation of the bone graft.

 The method is not based on the formation of bone regenerate, and therefore can be implemented in a patient of all age categories.

 When implementing the method, the anatomical relationship of the bones of the wrist is not violated, which allows you to save the full range of movements in the wrist-metacarpal joint of the first metacarpal bone and in the wrist joint.

 The method allows to lengthen the stump of the metacarpal bone, including the first, by the required amount, depending on the length of the resistant stump.

 The formation of the feeding legs and their subsequent distraction provide adequate blood supply to the moved stump of the metacarpal bone. The location of the avascular bone graft between the blood-supplying bone fragments with fixation by the implantation method improves the conditions for its consolidation and restructuring, and prevents the resorption of avascular bone tissue.

 The method is simple, effective, does not require the use of special tools and can be implemented by specialists involved in hand surgery. The method has been successfully applied in one patient.

Claims (1)

 A method for lengthening a short stump of the metacarpal bone by osteotomy, diluting bone fragments, moving the stump of the metacarpal bone and bone grafting of a defect, characterized in that in the projection of the displaced stump, feeding legs are formed, including skin tape, saphenous veins and arterial vessels extending from the carpal vasculature to the palmar and dorsal surfaces of the hand in the projection of the stump of the metacarpal bone, after isolating the stump, carry out its axial distraction by the amount of necessary elongation and plastic bone graft, fixing its proximal end to the elongated metacarpal stump, and the distal end to the metacarpal stump moved on the feeding legs.

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