RU2200514C2 - General-purpose splint for treating injured hand - Google Patents

Abstract

FIELD: medical equipment, in particular, traumatology and orthopedics. SUBSTANCE: splint has aluminum members joined into single construction by means of rods and nuts. One of aluminum members is adapted for supporting hand in position functionally suitable for fingers. Said member has window arranged at its central portion and pivot hinge on axial bolt arranged at its distal end. Other aluminum member is adapted to support forearm and is joined thereto by means of wide adhesive tapes at two levels. Traction process is effected by delta-curved traction wires passed through ungual or main phalanxes by means of silk threads thrown over through pivot hinges to springs fixed at ends of rods. Longitudinal displacement of rods causes adjustable traction allowing bone fractured fragments or individual bone segments to be held in predetermined position. Splint is used for treating fractures and dislocations of metacarpal bones, as well as fingers under stationary, ambulant and military field conditions, and also for eliminating finger rigidity caused by prolonged immobility. EFFECT: increased efficiency by preventing from wrong knitting consolidation and wider operational capabilities. 1 dwg, 2 ex

Description

 The invention relates to medicine, namely to traumatology and orthopedics, and can be used for fractures and dislocations of the metacarpal bones, as well as phalanges of the fingers in both inpatient and outpatient settings, as a method of choice.

 Currently, there is a promising alternative to the compression-distraction method using external fixation devices.

 One of these methods is skeletal traction, used for more than a hundred years.

 The analogues of our tire are the designs of Eward, Vallet, Robertson and Sokolovsky.

 Unfortunately, these inventions do not fully comply with the principles of skeletal traction.

 In view of this, the treatment method on the Behler tire (Bohler) with constant extension by the finger was used as a prototype (Usoltseva EV "Closed fractures of the phalanges and metacarpal bones". - L., 1939).

 In this case, the brush occupies a functional position, i.e. back fixation in the wrist joint at an angle of 60 degrees, metacarpophalangeal - 45 degrees, proximal 90 degrees and distal interphalangeal joint - 45 degrees, and are fixed with a plaster cast.

 In addition, reposition and retention of the fragments by constant extension in the correct position for the steel wire drawn through the nail phalanx and fixing the traction thread on the gypsum bed before healing the fracture is required.

 This method is simple and allows to repair and treat various injuries of the hand in an outpatient setting, but it does not allow you to adjust the traction force and requires a lot of time to apply the tire, because there will be a manufacture and simulation of tires in each case.

 The invention is aimed at preventing abnormal healing of fractures, treating dislocations and finger stiffness during prolonged immobilization, as well as reducing the time required to apply skeletal traction in case of damage to the hand.

 This is achieved by fast and complete reposition in the proposed tire, followed by controlled skeletal traction, taking into account the biomechanical features of the hand (Obukhov I.A., 1995), the laws of Weber-Fechner, Dubois-Raymond, the principles and phases of treatment (according to N. Mityunin, 1974, mnemonic rules "5P" and "3P").

 The tire consists of two aluminum elements (A) and (B) (see drawing).

 On the element (A) there are hinges (1) for stretching the fingers. At a distance of 8 cm from the hinges there is a “window” (2) 25 • 65 mm. Element (A) is curved in a circle with a diameter of 150 mm in such a way that it is a bed for the hand and fingers. On the edges of the element (A) there are special cutouts, which allows you to use it for both the left and the right brush.

 Element (B) is the forearm bed. It has two eyes (3) for adhesive tapes.

 The opposite ends of the elements (A) and (B) are mounted together with the help of rods (4) passing through the holes of parallel platforms. The rods are fixed with nuts. At the distal ends of the rods there are holes for threading the spring (5).

 The minimum number of rods used is 2, the maximum is 4. The number of nuts is 8 and 16, respectively. Elements (A) and (B) are fixed on the forearm using wide adhesive tapes (6).

 Traction is carried out in the following way.

 Under local anesthesia, thin (from 1.1 to 2 mm in diameter) Kirschner spokes are passed through the nail or main phalanges, depending on the nature of the damage. The spokes held deltoid bend for ease of traction.

 The forearm and hand are laid on a tire pre-mounted in accordance with the anatomical dimensions of the upper limb.

 In the event that the traction is carried out behind the main phalanges, the deltoid-curved spokes drawn through them are displayed in the window of the element (A) on the outer surface of the tire. If the tension is done by the nail phalanges, the spokes are on the inner surface of the element (A). Silk threads are passed through deltoid-curved knitting needles, which are thrown through hinges and fixed at the distal ends of the spring, fixed to the rods.

 Extraction is carried out to eliminate bias by changing the position of the rods. Stabilize the tire optimally.

 The proposed method provides the treatment of damage to the hand in the functionally correct position of the fingers, which with prolonged (4 or more weeks) immobilization can significantly avoid violations of the ligamentous-articular apparatus and limitation of function in the fingers.

 This position is functionally active, and fingers that are free from traction (intact) have an almost full range of motion.

 The design is easy to use and can be quickly and successfully applied on an outpatient basis.

 The ability to change the length of the tire by means of the movable connection of two aluminum elements on the rods makes it universal, quickly adapted to the individual anatomical dimensions of the limb. The reposition is carried out gently by gradual stretching on the tire. The traction force during treatment can vary, which will allow to avoid necrotic changes in the distal phalanx and will allow to begin active load as early as possible.

 We give typical clinical examples.

 1. Patient I., born in 1948, and / b 7121.

 Diagnosis: closed fracture of the III metacarpal bone of the right hand with an offset of 10.05.99

 05.10.99, after a new anesthesia in the II and III intercarpal spaces according to E.V. Usoltseva with an exposure of 7 minutes was applied to our tire with skeletal traction for the main phalanx of the III metacarpal bone of the right hand. Produced a soft reposition in the tire by gradually increasing traction. After Rg-control, stabilization of the traction was carried out. Finger movements are allowed on the very first day. Immobilization in a stable mode is 3 weeks, at the beginning of the 4th week the traction force was reduced, and at the end it was stopped.

 The tire is removed. After the Rg control, the spoke was removed.

 On June 15, 1999, she was discharged for her work with full function and a consolidated fracture of the III metacarpal bone of the right hand.

 After 6 months: no complaints, brush function in full, place of work the same.

 2. Patient N., born in 1956, and / b 9213.

 Diagnosis: open fracture of the middle phalanx of the fourth finger of the left hand from 06/10/99

 On June 10, 1999, after PHO, wounds of the fourth finger under the conditions of the trauma department of the polyclinic under local anesthesia with a 1% solution of novocaine (5 ml), a needle was inserted through the nail phalanx of the same finger.

 Traction with reposition was carried out until the displacement in the tire of our design with the subsequent Rg control was completely eliminated.

 Further treatment consisted of regular wound dressings, FTL and exercise therapy on the splint. The wound healed on the 10th day.

 Traction in a stabilized mode was carried out for 2 weeks, followed by a decrease in traction within 3 weeks.

 06/30/99, the tire is removed. Rg control: fracture of the middle phalanx of the fourth finger of the left hand in the consolidation stage.

 07/03/99, the patient was discharged to his work with full function in the left hand.

 The long-term result after 6 months is excellent.

Claims (1)

 A universal tire for treating injuries of the hand, consisting of two aluminum elements mounted together supporting the forearm and the hand, characterized in that on one of the elements there are hinges for extending the fingers of the hand and a window located at a distance from the hinges, and there are cutouts at the edges, the counter ends of the elements are mounted together with the help of rods passing through the holes of the parallel platforms, the rods being fixed with nuts, and at the distal ends of the rods there are holes for threading the spring.