RU2152183C1 - Surgical method for treating the cases of abnormally adhered fractures in posterior part of the tibia - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves performing external malleolus osteotomy at the level of talocrural articulation fissure. Malleolus splinters are brought aside. Posterior fragment osteotomy is carried out on the line of the abnormally adhered fracture. Reduction and fixation is carried out with screws and wires in correct position. EFFECT: unaffected exterolateral part of articulation capsule. 11 dwg

Description

 The invention relates to medicine, namely to traumatology and orthopedics, and is intended to restore the anatomical integrity of the distal end of the tibia in chronic fractures with the displacement of the posterior region operatively.

 The unresolved displacement of fragments in all cases leads to the development of deforming arthrosis with impaired joint function and reduced ability to work.

 A known method of surgical treatment of fractures of the distal end of the tibia with posterior-external access / in the book. "Operational access to the bones of the limbs", Leningrad, 1956, p. 32 /. However, it does not allow an overview of the ankle gap.

 Describes access to the ankle joint by posterior-external access, in which an osteotomy of the fibula in its lower third is carried out 5 cm above the ankle joint. / H. Bruckner, M. Hinz: in the book. Zugangswege in der Traimatologie ", 1980, Leiprig, S. 182, 183 /.

 He is also a prototype, which provides for the complete cutting off of the anterior and posterior tibial ligaments, the intersection of the fibula above the ankle joint and dislocation of its distal end outwards, with the opening of the joint capsule, which is very traumatic / cm. FIG. 1 and 2 /.

 In the proposed method, a skin incision is also performed along the posterior edge of the outer ankle / Fig. 3 /, and then follows the osteotomy of the external ankle at the level of the ankle gap. After partial dissection of the tibiofibular ligaments, ankle fragments are moved away from the side / Fig. 4/. In this case, the outer-lateral part of the capsule of the ankle joint is not dissected or injured. The latter is extremely important for healing without scars, which contributes to the full restoration of joint function.

 A skin incision is made along the posterior-outer surface in the area of the damaged ankle joint by Kocher access. Next, the fibula is exposed at the level of the ankle fissure and its osteotomy is performed. The front and rear portions of the tibia ligaments are partially dissected, which allows you to push the fragments of the fibula forward. At the same time, the crack of the ankle joint is visually determined, he reveals the line of fracture, the degree of displacement of a fragment of the posterior tibia. With a chisel (Fig. 5), an osteotomy of an incorrectly fused fragment along the fracture line is performed, its reposition into osteosynthesis with a screw (Fig. 6), screws, knitting needles in the correct position. Fragments of the fibula are connected by an intromedullary rod inserted through the tip of the ankle (Fig. 7). Dissected ligaments are sutured and the wound is sutured in layers (Fig. 8). Immobilization with a plaster cast to the knee joint. After removing the seams, the longet is transferred to a circular plaster cast. Two months later, the bandage is removed, X-ray control is carried out to determine the fusion of a fragment of the posterior tibia, after which the question of the appointment of physiotherapy exercises and physiotherapy procedures is decided. Axial load is allowed after three months. The proposed method is less traumatic, because complete dissection of the tibial ligaments and dislocation of the outside of the distal end of the fibula is not carried out. In addition, for reliability, fragments of the external ankle are connected by a rod.

 Clinical example (Fig. 9).

 Patient N., 41 years old, entered the institute on 09/01/93, Is. b. N 9490 after 5 months. after an injury.

 Diagnosis: fused fractures of the posterior part of the left tibia and both ankles of the left tibia with displacement of fragments.

 The operation was performed: osteotomy of the fibula at the level of the joint space, osteotomy of an incorrectly fused posterior part, its reposition and fixation with two screws. The outer ankle is fixed by the shaft, and the inner ankle by a screw. Fixation of a plaster cast for 2 months, followed by physiotherapy and physiotherapy. Load after 3 months. After 5 months, the patient returned to work.

Claims (1)

 A method for the surgical treatment of abnormally fractured posterior tibial fractures, characterized in that the ankle osteotomy is performed at the level of the ankle joint fissure, fragments of which are moved to the sides, and osteotomy of the posterior fracture is performed along the line of the abnormally fractured fracture with subsequent reposition and fixation with screws or knitting in the correct position.

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