RU2148966C1 - Method for treating fractured internal epycondyle of the humerus - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves making incision on the posteromedial surface of the elbow joint. A notch is made on the lower pole of the maternal humerus bed in perpendicular to the direction of muscles attached to the internal epicondyle. A step is created on the proximal fractured bone fragment. The distal fractured bone fragment is transferred to the produced step. In particular cases, the epicondyle is fixed with two wires crosswise coming through the center of the distal bone fragment. EFFECT: excluded skeletization of the distal bone fragment; retained blood supply sources. 2 cl

Description

 The invention relates to medicine, namely to traumatology and orthopedics, and can be used mainly for stale, old detached fractures of the internal epicondyle of the humerus.

 Known methods for holding the distal fragment in a repaired position by applying cotton-gauze, adhesive-stick pelots to the area of the internal epicondyle after a closed reposition of the fragment. There is also a known method of using a more advanced pelot - pneumopelot ("Surgery" N 10, 1968, p. 86-88).

 The disadvantage of these methods is that after the edema subsides, the pelots are not able to hold the fragment in the correct position, as a result of which secondary displacement of the internal epicondyle often occurs.

 A known method of treating a fracture of the internal epicondyle of the humerus ("Orthopedics and Traumatology" N 10, 1981, S. 53 - 54), including an incision along the posterior-medial surface of the elbow joint, reposition and fixation of the distal fragment.

 The disadvantage of the method selected as a prototype is that it has a rather complex structure, is difficult to use, in addition, when installing and removing the latch significant damage is caused to the soft tissues of the elbow joint area.

 The task set by the authors is to eliminate these shortcomings by sparing manipulations, excluding skeletonization of the distal fragment, preserving the main sources of blood circulation and preventing the development of the phenomena of secondary neuritis of the ulnar nerve.

 To this end, in the method of treating a fracture of the internal epicondyle of the humerus, including an incision along the posterior medial surface of the elbow joint, reposition and fixation of the distal fragment, it is proposed to additionally incise at the lower pole of the mother bed of the humerus perpendicular to the direction of the muscles attached to the internal epicondyle, form a step on proximal fragment, and then move the distal fragment into the formed step.

 In addition, it is proposed that the epicondyle be fixed with two spokes drawn across the center of the distal fragment.

 The proposed operation allows you to achieve 100% bone fusion of fragments.

 The method is as follows.

Under general anesthesia, a 4–5 cm long arcuate anterior incision is made along the posterior-medial surface of the joint, bypassing the damage zone on the humerus. The proximal cut point is the projection upper pole of the fracture plane. After careful removal of blood clots on the upper posterior edge of the surgical wound, the mother bed of the internal epicondyle opens. A notch is made at the lower pole of the mother bed using a straight bit corresponding to the width, perpendicular to the plane of fracture and the direction of the muscles attached to the internal epicondyle, 0.3 cm deep.Then, a step is formed on the proximal fragment of the same depth. They are repositioned by inserting a knitting needle under the base of the torn epicondyle at the muscle attachment site. A metal needle sharpened under a round awl is introduced by rotational movements. Its sharp end is led into the corner of the step and partially fixed in it. Then, while bending the forearm, but not less than 90 ^o in the elbow joint, the torn fragment is moved to the formed step as if on a lever. At the same time, in order to avoid separation of the fragment, a large force cannot be applied. The epicondyle in the correct position is fixed with the same and the second knitting needle with a similar sharpening drawn through the center of the fragment across the first.

 Example 1

 B. Ya., 1982 , (and / b 576/1283), received an injury to the elbow joint on 05.22.95, falling from a height of 2.0 meters. In the CRH at the place of residence, R-grams of the elbow joint were produced in two projections, the posterior plaster cast was applied. Upon admission to the clinic, on the 10th day after receiving the damage, the reproduction of the internal epicondyle was performed according to the described method. On the control R-gram, 4 weeks after the operation, bone consolidation of the fracture is determined. After removing the metal spokes, I received a month-long course of comprehensive rehabilitation treatment. On an outpatient examination, 3 months after the operation and in the long term, one year after discharge from the clinic, the full range of movements in the damaged joint is determined, there are no vascular and neurological disorders.

 Example 2

 Patient Yu., 9 years old, (and / b 284/96), went to the clinic 2.5 months after receiving an injury. At the place of residence, he received treatment with gypsum immobilization for three weeks, after the termination of which - rehabilitation treatment without effect. Clinical examination revealed: movements in the left elbow joint are sharply limited, painful; violation of tactile and pain sensitivity in the projection of the innervation of n.ulnaeis sin., the impossibility of active extension of the fourth and fifth fingers of the left hand. On a radiograph in two projections, a fracture of the internal epicondyle with impingement in the joint cavity is determined. In addition to confirming the x-ray picture, an infringement of the ulnar nerve in the joint cavity was revealed during the operation. Made neurolysis of the latter and reposition of the fragment according to the developed method. On the first day after surgery, the full range of movement of the IV-V fingers of the hand. After a course of cerebrolysin, intravenous neurological disorders in the innervation zone of n.ulnaris sin. not detected. On the control x-ray after 4 weeks - bone consolidation. On an outpatient examination after 6 months after surgery - the full range of movements in the elbow joint, no vascular and neurological disorders.

 The advantage of the proposed method is to avoid the invasiveness of the elbow joint, which contributes to strong consolidation and eliminates the secondary displacement of the fragment and the formation of pseudoarthrosis, and also does not lead to secondary complications from the ulnar nerve.

Claims (2)

 1. A method of treating a fracture of the internal epicondyle of the humerus, including an incision along the posterior medial surface of the elbow joint, reposition and fixation of the distal fragment, characterized in that at the lower pole of the mother bed of the humerus, a notch is made perpendicular to the direction of the muscles attached to the internal epicondyle, form a step on the proximal fragment, then the distal fragment is moved to the formed step.  2. The method according to claim 1, characterized in that the fixation of the epicondyle is carried out with two knitting needles drawn across the center of the distal fragment.