RU2168317C1 - Method for treating trans-syndesmosis fractures of fibula by applying dynamic intramedullary osteosynthesis approach - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves introducing intramedullary rod in the direction corresponding to longitudinal axis of healthy fibula for fixing the fractured bone fragments. The intramedullary rod is introduced into the distal fragment in direct way with maximum displacement backwards and outwards from the fibula cross-section center in asymmetrical position relative to medullary canal cross-section center of the central fragment. EFFECT: permanent head-on and lateral compression caused by lateral malleolus upon the talus; repaired malleolar fork of the talocrural articulation; accelerated treatment course. 6 dwg

Description

 The invention relates to medicine, namely to traumatology and orthopedics, and can be used in the treatment of transgressive fractures of the fibula.

 A known method of intramedullary osteosynthesis of fractures of the distal fibula, which consists in the fact that after mobilization of the distal fragment, the fracture is repaired, the intramedullary rod is inserted retrograde or directly through the distal fragment into the central one. For intramedullary fixation of fractures of the fibula, rods with a square, round and other cross-sectional shape of the pin are used. With this method of osteosynthesis, the intramedullary shaft is in a neutral position with respect to fragments of the fibula (see, for example, “Closed fractures of the lower leg”, N. Ya. Prokopyev, Tyumen, 1991, p. 106).

 This method is accepted by us as a prototype.

 This method of intramedullary osteosynthesis ensures the integrity of only the fibula and does not affect the restoration of the width of the ankle fork. This requires the operating surgeon to additionally restore the distal tibiofibular syndesmosis with structures that tighten the tibia between them, which often leads to an ankle clenching. This lengthens the time for surgery, increases the number of implants used for osteosynthesis, increases the risk of infectious complications, and prolongs the treatment time.

 The purpose of the invention is to increase the stability of fragments during intramedullary osteosynthesis of cressindesmosis fractures of the fibula.

 Achieving this goal is ensured by the fact that the intramedullary rod is inserted into the distal fragment directly, maximally displaced posteriorly and outward from the center of the cross section of the fibula, asymmetrically relative to the center of the section of the bone marrow canal of the central fragment. In addition to restoring the integrity of the cressindesmosis fracture of the fibula, the conditions of dynamic osteosynthesis are created due to the constantly acting lateral directional compression of the fragments, the width of the ankle fork of the damaged ankle joint is restored by the pressure of the external ankle on the talus.

 In FIG. 1 shows the implementation of the method of intramedullary osteosynthesis according to the prototype.

 In FIG. 1a, shows the ratio of the cross section of the intramedullary nail to the cross section of the fibula at the level of the central and distal fragments when implementing the prototype osteosynthesis method.

 In FIG. 2 shows the first step in the implementation of the method of dynamic intramedullary osteosynthesis of cressindesmosis fractures of the fibula according to the proposed method.

 In FIG. 3 shows the second stage of the method of dynamic intramedullary osteosynthesis of cressindesmosis fractures of the fibula according to the proposed method.

 In FIG. 4 shows the third stage of the implementation of the method of dynamic intramedullary osteosynthesis of cressindesmosis fractures of the fibula according to the proposed method.

 In FIG. 5 shows the ratio of the cross section of the intramedullary nail to the cross section of the fibula at the level of the central and distal fragments when implementing the method of osteosynthesis according to the proposed method.

 The method is as follows.

 After mobilization of the distal fragment, without preliminary reposition, through the apex of the external ankle, after the preliminary formation of a channel in it, going subcortically along its posterior-outer wall, a rod is inserted through the formed channel in a direct way that is maximally displaced posteriorly and outward relative to the transverse section of the fibula at the level of the distal fragment (Fig. 2). Then, having displaced the external ankle at an angle open posteriorly, the nail is inserted intramedullary into the central fragment (Fig. 3). In the process of introducing a nail under the influence of its elastic elastic deformation, the fracture of the fibula is repositioned, the outer ankle is displaced inwards, the ankle fork of the damaged ankle joint is restored (Fig. 4). Moreover, the length of the inserted intramedullary rod, which is carried out in the medullary canal of the central fragment, must correspond to at least 5: 1 to the length of the distal fragment of the fibula. Due to the elastic-elastic deformation of the "tail" of the intramedullary shaft, a constantly acting laterally directed compression of the fragments along the fracture line of the fibula and outer ankle on the talus is created (Fig. 5). If surgery is not required on the inside of the damaged ankle joint, the operation ends. Hemostasis. Layer wound closure. Gypsum bandage.

 The proposed method of intramedullary osteosynthesis is intended for use in traumatology with cressindesmosis fractures of the fibula, especially with chronic injuries in the ankle joint.

 Its use allows for minimal intraoperative destruction of the periosteal tissue of the fibula to accurately correlate fragments of the fibula, firmly fix them, while restoring the ankle fork of the damaged ankle joint, reduce treatment time.

Claims (1)

 The method of intramedullary osteosynthesis of cressindesmosis fractures of the fibula, consisting in the fact that the intramedullary rod that fixes the fragments is carried out in the direction corresponding to the longitudinal axis of the intact fibula, characterized in that the said intramedullary rod is inserted into the distal fragment directly to the back, to the maximum the center of the cross section of the fibula, asymmetrically relative to the center of the section of the bone marrow canal of the central fragment.

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