RU2218890C1 - Method for carrying out osteosynthesis of fractures and injuries of bone connections with wires - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves setting fractured bone fragments. Wires are introduced under acute angle through the splitters. Wire ends are bent near bone towards obtuse angle at an angle greater than the wire introduction angle. The ends are bitten off at a distance of 1-1.5 cm from bone surface. The wire is rotated by 180 deg about its axis. The bent ends are laid on the bone surface under the skin. One of bent wire ends is provided in particular case with protrusion; the wire is rotated by 150 deg; recess is prepared in bone for receiving the protrusion. The wire is rotated by 180 deg and the protrusion is arranged in the recess. EFFECT: prevented displacements; provided elastic fixation conditions. 2 cl, 9 dwg

Description

 The invention relates to medicine (traumatology) and is used to treat bone fractures.

 The main goal of treating fractures of AO is the complete restoration of function due to stable fixation, anatomical reposition and early active painless movements in the joints of the limb. But reposition and fixation is recommended taking into account the viability of the tissues, therefore, priority is now given to maintaining blood supply in the fracture zone due to atraumatic technique and the use of new implants that have less contact with the bone (Ankin L.N., Ankin H.L. Practice of osteosynthesis and endoprosthetics. Kiev, 1994, pp. 3-4).

 Osteosynthesis, the main purpose of which is to maintain tissue viability in the fracture zone, is called biological. Biological osteosynthesis is especially important in the elderly, where blood supply to the bones deteriorates, and in childhood, where the use of massive metal structures that damage growing children's bones is unacceptable.

 Spine fracture fixation is a less traumatic method. Moreover, after reposition of bone fragments, through their ends and the line of fracture is carried out at an angle of the spoke. The ends of the needles bite and leave subcutaneously. "In oblique and helical fractures, osteosynthesis can be done ... with knitting needles. The last type of transossal diafixation (Papar and others) is less stable. However, in some cases it is necessary to resort to it, for example, in old people with osteoporosis of bones ..." (A. V. Kaplan. Closed injuries of bones and joints. Moscow, 1967, p. 54).

 Modern low-traumatic fracture treatment methods, such as osteosynthesis with needles with an emphasis, the Ilizarov apparatus are difficult interventions. After their implementation, there is the possibility of infection of the spoke wounds, inconvenience to the patient when worn.

The proposed method of osteosynthesis of fractures with needles is explained on the model of the tibia. Through the oblique line of fracture of fragments of the tibia after matching, a spoke is drawn at an angle α = 45 ^o . The spoke passes through the fragments, forming obtuse β (135 ^o ) and acute α (45 ^o ) angles with the bone (on both sides). If both ends of the spokes are bent to the side with an acute angle = 45 ^o (the angle of introduction of the spokes), then they fit on the surface of the fragments. At what angle the needle is inserted into the fragments - it is necessary to bend the ends of the spoke at such an angle so that they fit on the bones. But it’s technically difficult to bend and lay the ends of the knitting needles to the bone even on the tibia model due to the elasticity of the knitting needles, etc. A special technique is used to achieve this. The ends of the knitting needles at the bone are initially bent towards an obtuse angle, so it is easier and more able to bend the knitting needle. A metal tube with a 2 mm channel or pliers bend the needle at the bone at an angle α = 45 ^o . The ends of the needles bite at a distance of 1-1.5 cm from the bone. When you rotate the Z-shaped curved knitting needle around its axis through 180 ^o , the ends of the needles will turn to the side with an acute angle and, in view of the equality of angles, will be laid on the surface of the fragments and fix them (Fig. 1).

If the ends of the needles are bent at an angle greater than (α + 15 ^o ), then when turning the Z-shaped curved knitting needles, an additional angle will be unnecessary, so they can be laid on the fragments, overcoming the elastic resistance of the ends of the knitting needles. At the same time, the ends of the spokes squeeze the fragments, bringing them together and creating an elastic interaction of the fragments (Fig. 3). The greater the angle (from the angle of introduction) the ends of the spokes bend, the more their ends approach the longitudinal axis of the bone and squeeze it AB> A ₁ B ₁ (figure 2).

 In FIG. 1 and 3 depict on the model sequentially the steps of working with a spoke.

 In FIG. 2 shows the convergence of the ends of a Z-shaped bent needle with an increase in the angle of their bending. In FIG. 3 shows a protrusion in the caudal region of the knitting needles and arrows indicate the direction of action of the forces.

In osteosynthesis, we use a standard spoke with a diameter of 1.5 and 2 mm made of steel grade 1X18H9T. The spoke has sufficient strength and elasticity. In practice, the angles of introduction of the spokes, the angle and length of the bent ends of the spokes depends on the conditions of their use. The longer the end of the spoke is bent, the greater the elasticity, the shorter, the more resistant to extension. The smaller the angle of introduction of the knitting needle, the greater the angle we can bend the knitting needle, more often the ends of the knitting needle are bent at an angle of 90 ^o .

 The mechanical properties of a Z-curved standard load spoke were tested.

The test was performed on the apparatus of Ivanovo city R-5 stepwise bent at an angle of 90 ^o two mm spokes. The needle is stepwise 1 cm bent in the middle and resembles a Z-shaped curved spoke with elongated ends. Stretching was performed over the end sections of the knitting needle. A Z-shaped curved spoke with 90 ^° bent ends experiences the same extension load as a step-like spoke. During the test, the mechanical elasticity of the spoke is maintained up to a load of 40 kgf, with a greater load, the spoke begins to unbend. These mechanical properties of the spokes are sufficient to fix fractures and damage to bone joints. Fixation of fragments with two Z-shaped curved spokes is sufficient to hold bone fragments even without a plaster cast.

 The inventive method is used for osteosynthesis of oblique and helical fractures and damage to bone joints, when the area of damage and fixation are located subcutaneously or lie close to the skin.

Close to the claimed is a method for osteosynthesis of a femoral neck fracture (the decision to grant a patent for an invention according to application 98110943/14 (012362) dated 05/28/2001). When osteosynthesis of a femoral neck fracture with knitting needles, the tail section of the knitting needles are bent up after being inserted into the bone, bite and rotate 180 ^o . When turning the L-shaped knitting needle 180 ^o achieved a snug fit of the bent end of the spoke to the surface of the bone. In contrast to the L-shaped knitting needle, the Z-shaped curved knitting needle has new properties and qualities and pursues other goals and objectives. A Z-shaped curved spoke with an angle of the bent ends is more than the angle of introduction of the spoke, when turned through 180 ^{°, it is} laid on the surface of bone fragments due to the elasticity of the ends of the spoke, creating a rapprochement and elastic interaction of bone fragments.

This problem is solved in a way in which through the bone fragments after their reposition one or more spokes are carried out at an acute angle, then the ends of the needles are bent at the bone in the direction of an obtuse angle at an angle greater than the angle of introduction of the knitting needles, bite the ends at a distance of 1-1, 5 cm from the bone surface, a Z-shaped or U-shaped curved spoke is rotated 180 ^° along the axis and placed subcutaneously on the surface of bone fragments. For the stability of the knitting needles, one of the bent ends of the knitting needles is performed with a protrusion, the knitting needle is turned 150 ^° , a depression is prepared on the bones for the protrusion, then the knitting needle is turned 180 ^° and the protrusion is inserted into the depression.

Distinctive features of the proposed method is a needle drawn through fragments at an acute angle, the ends of which are bent at the bone to an obtuse angle by an angle greater than the angle of introduction of the spoke, then rotate along the axis of the curved spoke by 150 ^o , preparing a place on the bone for a protrusion on one from the ends of the knitting needle, turn the knitting needle to 180 ^o with the institution of the protrusion in the recess of the bone.

 The introduction of new distinguishing features in combination with the achieved effect (promotes the convergence and elastic pressure between bone fragments, the protrusion keeps the bent knitting from possible displacement) are not described during osteosynthesis with knitting needles, indicate the "novelty" and "inventive step" of the proposed method. "Industrial applicability" is confirmed by the description and application of the method for osteosynthesis of damage to the tibiofibular syndesmosis of the lower leg.

 Designated in the drawings.

 BBK - tibia, MBK - fibula, MBSG - tibiofibular syndesmosis, NL - external ankle, VNL - fracture of the external ankle, VL - internal ankle, DS - deltoid ligament, MBS - fibular ligament, T - C - ram , OVS - formation of a protrusion of a spoke, BC - a protrusion of a spoke, ZC - a Z-shaped bent spoke, SSG - a flexor. The arrows indicate the direction of action of the force.

When the external ankle fracture with damage to the deltoid ligament and tibiofibular syndesmosis with subluxation of the foot (figure 4) under local anesthesia produce a simultaneous reposition of fragments with the elimination of subluxation of the foot. Impose a U-shaped plaster cast, an X-ray control is performed. The operation of osteosynthesis with a spoke to treat damage to the tibiofibular syndesmosis is performed on the second or fourth days (as edema subsides in the ankle joint). After removing the gypsum, the surgical field is processed. Under local anesthesia (a 0.5% solution of novocaine), a 1.5 cm long incision is made on the outer surface of the lower third of the lower leg (at the level of the tibia syndesmosis), 3-4 cm from the end of the external ankle. At the upper corner of the wound in m / tibia at an angle of 30-60 ^o enter a two-millimeter standard needle (Fig. 5). The needle is passed through the fibula and tibia. The tail section of the knitting needle is bent upward twice in the direction of an obtuse angle of 90 ^o , at a distance of 1.5 cm from each other (Fig.6). Biting the end of the needle 2 mm from the last bend, form a protrusion.

The needle behind the end section is pulled towards the tibia until the bend of the needle in the tail section. From the place of exit of the knitting needles, a skin incision is made 1 cm down. A bending needle is put on the end section of the knitting needle. The pliers produce a pull for the spoke, bringing together the bones in the area of the damaged syndesmosis (Fig. 7). Use a bending needle to bend the needle downward by 90 ^o . The tool is removed and bite the end of the spoke 1 cm from the bone (Fig. 8). The Z-shaped curved spoke is rotated around the axis by about 150 ^° , while the spoke brings the bones closer to each other and eliminates diastasis in the tibiofibular syndesmosis. An indentation of 2-3 mm is planned in the area of the external ankle with a thin awl on the bone, the knitting is completed to 170-180 ^° , the protrusion is placed in the recess on the bone (Fig. 9). Sometimes an institution of a protrusion of the knitting needle behind the outer crest of the fibula is enough. Then they are convinced of the stability of fixation. When indicated, osteosynthesis of the inner ankle is performed with a screw or spoke. Sutures, a bandage, a plaster cast are placed on the wound.

 The patient is discharged home 3-5 days after surgery. Plaster cast is applied for 3-5 weeks (depending on the duration of the operation after the injury). Partial load on the leg begins after 1.5 months, the Z-shaped needle is removed after 4 months.

 Example. Patient D., 41, medical history 3954, was admitted to the traumatology department of Nizhnekamsk City Hospital 2 04/04/01 with a diagnosis of a fracture of the external ankle of the right lower leg with damage to the deltoid ligament and tibiofibular syndesmosis, an operation of osteosynthesis of the tibiofibular syndesmosis of the tibia with a knitting needle was performed. Plaster was removed after 1 month, the patient was discharged to work on 07.20.01. Inspection after 5 months: no complaints. 01/12/02 spoke removed.

 The method is simple to execute, atraumatic, elastic fixation of syndesmosis is achieved, the time of disability and stay of patients in the department is reduced.

Claims (2)

1. A method for osteosynthesis of fractures and damage to bone joints, including reposition of fragments, insertion of a needle at an acute angle through the fragments, characterized in that the ends of the needles are bent at the side of the bone at an angle greater than the angle of introduction of the needles, bite the ends at a distance of 1- 1.5 cm from the surface of the bone, turn the spoke axis 180 °, and the bent ends are placed subcutaneously on the surface of the bone. 2. The method according to claim 1, characterized in that one of the bent ends of the knitting needles is performed with a protrusion, the knitting needle is turned 150 °, a recess is prepared on the bones for the protrusion, then the knitting needle is turned 180 ° and the protrusion is inserted into the recess.

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