RU2228155C2 - Device for making medial malleolus osteosynthesis in the cases of vertical fracture - Google Patents

Abstract

FIELD: medical engineering. SUBSTANCE: device has plate having a part fixed on bone surface with a hole for receiving screws and intraosseous part bent at an angle of 90 deg relative to the part fixed on bone surface. The plate part fixed on bone surface has vertical part and a part congruent with medial malleolus surface in its apex area and in vertical part of the plate for carrying out additional fixation of the medial malleolus of the leg. Screws are arranged within fracture zone in the plate part congruent with medial malleolus surface. EFFECT: enhanced effectiveness in creating fracture zone compression; prevented secondary displacement. 1 dwg

Description

The invention relates to medicine, namely to traumatology and orthopedics.

One of the mechanisms of ankle injury is the supi-national adduction mechanism, in which the line of fracture of the inner ankle is vertical or approaches it. The relevance of functionally stable osteosynthesis of the inner ankle of the lower leg is determined by the high frequency of nonunion fracture, the formation of a false joint of the inner ankle of the lower leg, the preservation of internal subluxation of the foot, and the development of deforming arthrosis of the ankle joint.

Functionally stable osteosynthesis of the inner ankle of the lower leg should meet the principles of treatment of intraarticular fractures, namely

- the accuracy of the anatomical reposition of the fracture;

- strong fixation;

- early restoration of joint function.

The most common method for fixing the fracture of the inner ankle is with two screws perpendicular to the plane of the fracture (Müller M.E., Allgover M., Schneider R., Willenger X. “Guide to Internal Osteosynthesis.” 1996, pp. 604-610) .

The disadvantages of this method:

- fixation with screws does not interfere with the internal displacement of the foot;

- requires external immobilization, which leads to the need for treatment of post-immobilization ankle contractures;

- early axial load on the foot is not possible.

A known method of fixing the inner ankle of the lower leg with a two-bladed nail held along the axis of the inner ankle of the lower leg (Krupko I.L., Glebov Yu.I. “Fractures of the ankle joint region and their treatment.” M.: “Medicine”, 1972, p. 101-102).

The disadvantages of this fixation method are:

- the possibility of secondary displacement of a fragment of the inner ankle of the leg;

- lack of compression at the fracture site.

A known method of using a surgical compression plate for the treatment of fractures of tubular bones (A.S. No. 1502019, M. C. A 61 B 17/58, Bull. No. 31, 1989), selected as a prototype, in which metered compression at the fracture site by holding the fixing screws through the holes of the plate, inclined at an angle of 45 degrees to the longitudinal axis.

The disadvantages of the prototype:

- the shape of the plate requires additional thorough modeling according to the contour of the inner ankle;

- the introduction of fixing screws through holes inclined at an angle of 45 degrees with respect to the longitudinal axis of the plate in the case of vertical fractures of the inner ankle of the lower leg, does not create the necessary compression at the fracture site;

- the massiveness of the plate leads to technical difficulties in suturing the wound (closing the wound) and, as a result, can lead to necrotic changes in the edges of the wound.

The objective of the invention is to create compression at the fracture site with vertical fractures of the inner ankle and prevent its secondary displacements.

The task is achieved in that for the osteosynthesis of the inner ankle with its vertical fractures, a device is used that contains a plate having a osseous part with screw holes and an intraosseous part bent at 90 degrees with respect to the osseous part of the plate, and screws. The osseous part of the plate consists of a vertical part and a part congruent to the contour of the inner ankle. Mounting screws are installed at the end of the plate for additional fixation of the inner ankle in the region of its apex and in the vertical part of the plate. Compression screws are positioned in a portion of the plate congruent to the contour of the inner ankle of the lower leg within the fracture.

The novelty of the device:

1. The configuration of the osseous part of the plate having a vertical part and part congruent to the contour of the ankle of the lower leg.

2. The presence and location of screws for fastening at the end of the plate for additional fixation of the inner ankle and in the vertical part of the plate.

3. The presence of compression screws located in the part of the plate congruent to the contour of the inner ankle of the lower leg within the fracture.

The device we use is shown in the drawing, which shows a general view of the installation of the device. A device for osteosynthesis in vertical fractures of the inner ankle of the lower leg consists of a plate having an intraosseous part 1, bent at an angle of 90 degrees relative to the osseous part of the plate. The extension part of the plate consists of the vertical part 2 and the part congruent to the contour of the inner ankle 3. The screw for fastening 4 is installed in the vertical part of the plate, and the screw 6 is installed at the end of the plate for additional fixation of the inner ankle in the region of its apex. Screws for compression 5 are located in the part of the plate, congruent to the contour of the inner ankle of the lower leg within the fracture. The device is made of stainless steel 2 mm thick, the length of the immersion part is 12 mm. The device has round holes with a diameter of 6 mm, spaced from each other at a distance of 15 mm for installing screws.

The fixing screws are inserted:

- 4 - in the vertical part for fixing the plate;

- 6 - at the end of the plate for additional fixation of the inner ankle in the region of its apex.

The screws 5 are inserted in the part congruent to the contour of the inner ankle to create compression at the fracture site (the screws are held in a plane perpendicular to the plane of the fracture).

The execution of the osseous part of two parts, the vertical part and the part congruent to the contour of the inner ankle, prevents secondary displacement of the inner ankle. The introduction of screw 6 closer to the axis of the inner ankle prevents secondary displacements and fixes the plate more stable. The separation of screws into fixing and compressing screws provides the creation of better compression at the fracture site.

Osteosynthesis is carried out as follows: with an antero-internal incision up to 10 cm long with an bypass of the inner ankle, the fracture of the inner ankle with cutting out of the skin-subcutaneous-periosteal flap is exposed in layers, and the capsule of the ankle joint is dissected.

The surgeon removes blood clots (with fresh fractures), in old cases - scars of the ankle joint cavity, interponing tissues of the fracture site are excised (in fresh cases), in old cases - rough scars of the fracture site are excised. The reposition of the fragment of the inner ankle is carried out with preliminary fixation with two knitting needles (reposition is controlled by the joint space). The template corresponding to part 1 is superimposed on the fracture site, focusing on the top of the inner ankle and the fracture site. An osteotome 8 mm wide forms a channel for the intraosseous part of the plate. The intraosseous part 1 of the plate is inserted until it touches the cortical plate of the tibia. Drills with a diameter of 3.2 mm form channels in the horizontal plane for the compression screws 5. Used malleolar screws 5, the length of which is greater than the distance to the fracture line of the inner ankle. Screwdriver screws are inserted into the formed channels. Additional fixation is carried out by screws for fastening at the ends of the osseous part of the plate: screw 4 is inserted into the vertical part of the osseous part of the plate, and screw 6 in the region of the apex of the inner ankle in the part of the plate congruent to the contour of the inner ankle of the lower leg. The screw 4 in the vertical part 1 is held perpendicular to this part of the plate, and the screw 6 is inserted closer to the axis of the inner ankle. Hemostasis is carried out during the operation using a thermocoagulator. The wound is closed in layers by the imposition of nodal sutures. Aseptic dressing.

Clinical example. Patient L., 33 years old, was admitted to the traumatology department of the Ministry of Emergencies (GNSC OZSh) of the city of Leninsk-Kuznetsky on August 9, 2000 for: a closed supination adduction fracture of both ankles of the right lower leg, extensive conflicts of the right ankle joint. In the department of traumatology, antibiotic therapy, infusion therapy, antispasmodics, vitamin therapy, and local treatment of conflicts were carried out.

The right lower limb is immobilized on the Beller bus with adhesive tape traction. As a result of conservative treatment, the conflicts of the right ankle joint healed a second time. On September 12, 2000, the patient underwent surgery - open reduction, osteosynthesis of the inner ankle of the right lower leg with the proposed device, the external ankle of the right lower leg with Bogdanov's nail. Postoperative wounds of the right ankle joint healed primarily, the sutures were removed on the 10th day. The patient underwent a course of rehabilitation and outpatient treatment. He took up his duties 2.5 months after the operation. The result of treatment was evaluated after 1 year: pain in the right ankle joint does not bother, edema, there is no restriction of movement in the right ankle joint.

Conclusion. The use of a device for osteosynthesis of the inner ankle in case of a long-standing supination-adduction fracture of the inner ankle of the right lower leg in patient L., 33 years old, made it possible to create compression at the fracture site at the time of surgery, to begin early movements in the right ankle joint, and reduce the period of temporary disability. Osteosynthesis of the inner ankle of the lower leg with vertical fractures by the compression plate was performed in the traumatology department of the State Scientific and Clinical Center for Miners' Health Protection in Leninsk-Kuznetskiy in 14 patients. Good results were obtained in 93% of cases.

Claims (1)

A device for osteosynthesis of the inner ankle during its vertical fractures, containing a plate having a osseous part with holes for screws and an intraosseous part bent at 90 ° with respect to the osseous part of the plate, and screws, characterized in that the osseous part consists of a vertical part and a part , congruent to the contour of the inner ankle, the screws for fastening are installed at the end of the plate for additional fixation of the inner ankle in the region of its apex and in the vertical part of the plate, and I have screws for compression a plate portion, the inner contour congruent ankle tibia within the fracture.