RU2189194C2 - Method for treating inherent radial club hand - Google Patents

Abstract

FIELD: medicine, orthopedics, traumatology. SUBSTANCE: method deals with treating inherent radial club hand at the presence of hypoplastic radius in distal forearm department. The first stage deals with removing an axial forearm deformation by bringing down the wrist distally together with intact distal part of the radius to create superposition of forearm bones. The second stage deals with resection of forearm ends along with their synostosis. The method enables to restore movements in wrist joint. EFFECT: higher efficiency. 7 dwg, 1 ex

Description

 The invention relates to the field of medicine, namely orthopedics and traumatology.

 Known methods for the treatment of congenital radial squint are based on the centering of the hand on the ulna, resection of part of the bones of the wrist and the creation of arthritis in the elbow-carpal joint (Kessler J., 1989. Catagni M., Szabo R., Cattaneo R., 1993). These methods can be used for aplasia or pronounced radial hypoplasia in the proximal forearm, and although they eliminate oblique, but limit the functional activity of the hand, lead to stiffness in this joint.

 There is a method of treating ulnar squint with partial aplasia of the ulna, when they create a single bony forearm by radio-lunar synthesis (Paneva-Holevich E., Yankov E., 1984; Shvedovchenko I.V., Prokopovich V.S., 1997). We accept this proposal as a prototype.

 The objective of the invention is the preservation of the wrist joint in cases of the presence of a hypoplastic radius in the distal forearm, which allows to restore functional active movements in this joint after eliminating obliquity and radial deviation of the hand.

 The therapeutic effect of the task is achieved by the fact that in the method of treating congenital radial obliquity, the first step is to apply the distraction apparatus to the wrist and forearm, then the wrist is brought to the middle position by distraction, and the second result is achieved by transposition of the underdeveloped radius to the distal end of the ulna.

 From the analysis of the claimed and well-known solutions it follows that there are no identical in technical essence and the problem to be solved.

 In FIG. 1 shows a diagram of the reduction of the hand together with an underdeveloped radius and wrist joint using a distraction apparatus.

 In FIG. 2 presents a diagram of the planned resection of the bones of the forearm, where on pos. 1 - the distal end of the ulna to be removed, pos. 2 - the proximal part of the hypoplastic radial bone to be removed.

 In FIG. 3 presents a diagram of the final result of a superposition of the bones of the forearm, where pos. 3 - ulnar bone, pos. 4 - the distal part of the displaced radius, pos. 5 - fixing knitting needles.

 A method for the treatment of congenital radial rhizomes is as follows.

 The first step is the application of a distraction apparatus consisting of two half rings, which are interconnected by two sliding rods equipped with holes for Kirchner fixation spokes. One of the spokes is passed through the proximal or middle third of the ulna, the other through the middle third of the second or third metacarpal. After 3-4 days, 1 mm distraction begins, daily for 4-5 weeks. As a result of distraction, the hand is gradually removed from radiation deviation and, together with the hypoplastic radius, they are brought down in the distal direction.

 The second stage remove the distraction apparatus. Then, from the transverse incision along the dorsal surface of the forearm in the projection of the wrist joint, the distal end of the ulna and the proximal part of the hypoplastic radius are isolated. A partial resection of the selected ends of the bones of the forearm is made and compared with the brush. The achieved transposition is additionally fixed with two knitting needles drawn through the 1st and 5th metacarpals, the wrist and the formed single radial-ulnar bone.

 The operation is completed by stitching the wound. External immobilization is carried out by means of a plaster cast, imposed for a period of 5-6 weeks. After synostosis of the ends of the forearm, consolidation, confirmed by x-ray, the fixation is stopped, the spokes are removed. The plaster cast is removed and, as a preventive measure, is equipped with a removable plastic splint. A complex of rehabilitation treatment is carried out using physiotherapy and physiotherapy.

 Execution example. Patient S., 15 years old, with a diagnosis of congenital radial oblique. X-ray, in addition to the displacement of the hand to the radial side, the presence of a hypoplastic radius in the distal forearm was noted (Fig. 4).

 The first stage was superimposed distraction apparatus of our Institute. Turner design. On the 4th day, distraction began, which lasted 30 days. As a result, the hand is brought to the middle position, and the underdeveloped radius is displaced in the distal direction (Fig. 5).

 The second stage is removed distraction apparatus. From the incision on the back of the wrist joint, the distal head of the ulnar bone with which the cartilage is resected has been isolated. Then a hypoplastic radius was selected, where a resection of its proximal part by 2/3 was performed. The brush, along with the remainder of the radius, is moved to the ulna. The achieved transposition of the forearm bones is fixed by two knitting needles (Fig. 6). Seams were laid in layers, an alcohol dressing, a palmar plaster cast.

 35 days after the second stage of the operation, the spokes were removed. The plaster cast is replaced by a removable plastic splint. A course of rehabilitation treatment. A good result was obtained (Fig. 7).

 The effectiveness of the proposed method for the treatment of congenital radial obliquity is as follows: the radiation deviation of the hand is eliminated, the hand is centered in the middle position without intervention on the bones of the wrist, the wrist joint is preserved and functional active movements are restored in this joint.

Sources of information
1. Paneva-Holevich B., Yankov E. Lengthening of the forearm by superposition of both bones // Experimental-theoretical and clinical aspects of the method of transosseous osteosynthesis developed at KNIIEKOT. - Kurgan, 1983.P. 213-215.

 2. Kessler J. Centralization of the radial club hand by gradual distraction // J. Hand Surg. - 1989. - V.14-B, 1. - P. 37-42.

 3. Catagni M., Szabo R., Cattaneo R. Preliminary experience with Ilizarov method in late reconstruction of radial hemimelia // J. Hand Surg. - 1993. - V. 18-A, 2. - P. 316-321.

 4. Shvedovchenko I.V., Prokopovich V.S. Treatment of children with ulnar obliquity using the method of beam-elbow superposition // Treatment and rehabilitation of children with disabilities with orthopedic and orthopedic neurology at the stages of medical care. St. Petersburg, 1997 .-- S. 101-103.

Claims (1)

 A method for the treatment of congenital radial obliquity in the presence of a hypoplastic radial bone in the distal forearm, including the elimination of axial deformation of the forearm using a distraction apparatus in the first stage and the creation of the wrist joint in the second stage, characterized in that the removal of axial deformation is carried out by lowering the wrist in the distal direction with preserved distal part of the radius to create a superposition of the bones of the forearm, followed by the resection of the ends of the forearms in the second stage I and sinostozirovaniem.

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