RU2211000C1 - Method for performing reposition and fixation of calcaneus fractures - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves introducing wires with supporting platform one after another through proximal and peripheral fractured bone fragment in meeting each other and in perpendicular to calcaneus axis. The wires are stretched arc-like in separated wire fastener members in Ilizarov apparatus half-ring making splitter wedging. Single stage reposition is carried out by descending the half-ring and using the arc as lever. The fracture is set by bringing the members for fastening wire, close and conducting two overhanging fixed wires through calcaneal tuber. EFFECT: enhanced effectiveness of treatment; reduced risk of traumatic complications; excluded blockage of adjacent articulations. 9 dwg

Description

 The invention relates to medicine, in particular to traumatology and orthopedics.

 There is a method of closed reposition of the calcaneus followed by the application of a plaster cast (G.S. Yumashev. Traumatology and orthopedics, p. 370).

 The method is ineffective in most fractures of the calcaneus and cannot be used for tear-off fractures.

 There is a method of reposition of calcaneus fractures using a Steiman nail (A. V. Kaplan. Damage to bones and joints, p. 545). Under local anesthesia, the nail is inserted perpendicular to the plane of the calcaneus fracture into the peripheral fragment and, using the nail as a lever, reposition is performed. Then the nail is introduced 3-4 cm deeper and a plaster cast is applied.

 The method is traumatic, it is not always possible to reposition fragments, because the method does not involve wedging of fragments, it cannot be used for comminuted fractures of the calcaneus. Often there are cases of secondary displacement of fragments after removal of the retainers, flattening of the longitudinal arch of the foot, and calcaneal calcaneal arthrosis.

 Closest to the proposed method is the treatment of comminuted intraarticular fractures of the calcaneus, which consists in the needles that are mounted on the distal support of the distraction apparatus through the tuber and the body of the calcaneus perpendicular to the sagittal plane, and no less than 5 two spokes with emphasis, the ends of which are fixed on brackets in the distal sections of threaded rods mounted with the possibility of axial movements in the holes of the base second unit support and after elimination of all kinds of displacements carried out stabilization (Application RF 2000105852/14, Bull. 33 (Part 1), 2001).

 The disadvantages of the method are the relatively high morbidity and the impossibility of its implementation to exclude the blocking of adjacent joints.

 The objective of the invention is to reduce the morbidity, the creation of a method of simultaneous reposition and fixation of calcaneus fractures, which allows to exclude blocking (immobilization) of adjacent joints.

 The task is achieved in that the fragments are wedged by passing one spoke with a thrust pad through the proximal and peripheral fragments towards each other perpendicular to the axis of the calcaneus and the arcuate tension of the spokes in the dilated spoke fixators in the half ring of the Ilizarov apparatus, then they are repositioned simultaneously using the half ring the lever, and fix the fracture by mixing the fixators and holding two cantilevered spokes held through the calcaneal tubercle .

In practice, the method is as follows:
After anesthesia, a spoke is held with a persistent pad into the proximal fragment, perpendicular to the axis of the calcaneus from the inside outward (Fig. 1). The second spoke with a persistent pad is also held perpendicular to the axis of the calcaneus in the peripheral fragment, from the outside to the inside (Fig. 2). The knitting needles are pulled in the semicircle of the Ilizarov apparatus in previously diluted special fixators in the shape of the letter "X". In this case, wedging of fragments occurs. Then, using the arc as a lever, reposition of fragments is carried out by lowering the distal part of the apparatus. Spice fixators bring together in the shape of the letter "O" and pull again in the arc, bringing together fragments (figure 3). The method ends with two cantilevered spokes on opposite sides of the plane 3 of the half ring, which creates a rigid closed structure or internal splinting inside the calcaneus (Fig. 4).

 Example. I.B. 14389-tr. Patient - B.N.I. - born in 1960

 He was admitted to the hospital after injury on 09/18/01. A clinical and radiological examination made the diagnosis: closed transverse calcaneus fracture with displacement of fragments.

 Under local anesthesia with a solution of novocaine - 0.5% - 50.0, a spoke was made with a persistent pad into the proximal fragment, perpendicular to the axis of the calcaneus from the inside out. The second spoke with a persistent pad was also held perpendicular to the axis of the calcaneus into a peripheral fragment from the outside to the inside. The spokes are strung in the semicircle of the Ilizarov apparatus in previously divorced special fixators in the shape of the letter "X". In this case, wedging of fragments occurred. Using the arc as a lever, they brought it down. At the same time, the alignment of the fragments was restored. The fixators brought together, deforming the spokes in the shape of the letter "O" and pulled the latter, creating a compression between the fragments. Then, two knitting needles were cantilevered on opposite sides of the half-ring plane. The patient was allowed to walk with full support on the operated limb immediately after the operation. In fact, the full load on the limb to patients was carried out the next day. The device is removed 5.5 weeks after application. Subsequent immobilization of the limb and rehabilitation measures were not required. After 6 weeks, the patient returned to his normal lifestyle.

 In the event that a duck-beak-type fracture occurs, they do not resort to wedging manipulations, hold the knitting needle into the body of the calcaneus, hold the second knitting needle in the fragment (Fig. (figa), thereby producing internal splinting.

 Example 2. Patient M., 42 years old. He enrolled in City Clinical Hospital 67 with a diagnosis of a closed heel bone tubercle fracture of the duck beak type.

 A needle was inserted into the body of the calcaneus under conduction anesthesia; a second spoke was inserted into a fragment of the calcaneus. Reposition was achieved simultaneously by reducing the half-ring. The fracture was fixed by holding two cantilevered spokes through the calcaneal tubercle.

 The patient was allowed to walk with full support on the operated limb immediately after the operation. In fact, the full load on the limb was carried out the next day. The device is removed 5 weeks after application. Subsequent immobilization of the limb and rehabilitation measures were not required. After 6 weeks, the patient returned to his normal lifestyle.

 In the case of a calcaneus fracture with impression of the posterior articular facet, the spoke is inserted into the calcaneus body and into the fragment of the posterior articular facet (Fig. 1b). By lowering the half-ring, the fracture is repositioned (Fig. 2b). Fixation of the fracture is carried out by holding two cantilevered spokes through the calcaneal tubercle (figa).

 Example 3. Patient C., 23 years old. He entered GKB 67 with a diagnosis of closed intraarticular fracture of the right calcaneus with impression of the posterior articular facet.

 Under conduction anesthesia, a needle was made perpendicular to the axis of the calcaneus through its body, the second needle was drawn through a fragment of the posterior articular facet. A simultaneous reduction was achieved by reducing the semicircle of the apparatus. The fracture was fixed by holding two cantilevered spokes through the calcaneal tubercle.

 The patient was allowed to walk with full support on the operated limb immediately after the operation. In fact, the full load on the limb was carried out the next day. The device is removed after 6.5 weeks after application. Subsequent immobilization of the limb and rehabilitation measures were not required. After 7.5 weeks, the patient returned to his normal lifestyle.

 The advantages of the method are that the method makes it possible to produce simultaneous reposition of fragments and create internal splinting of calcaneus fractures without immobilizing adjacent joints with minimal use of parts of the Ilizarov apparatus using two spokes and a half ring without remounting the apparatus. Basing the apparatus solely on the calcaneus avoids the subsequent immobilization of the limb and rehabilitation measures.

 The proposed method operated on 38 patients with HCG 67 with good and satisfactory results.

Claims (1)

 The method of reposition and fixation of calcaneus fractures, which includes passing the spokes through the calcaneus and securing them in the semicircle of the Ilizarov apparatus, characterized in that the fragments are wedged by conducting one spoke with a persistent pad through the proximal and peripheral fragment towards each other perpendicular to the axis of the calcaneus and the arch the tension of the spokes in the divorced special fixators in the semicircle of the Ilizarov apparatus, then they are repositioned simultaneously by lowering the semicircle, using the arc as a lever, and fix the fracture by mixing the fixators and holding two cantilever-fixed knitting needles through the calcaneal tubercle.

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