RU2229270C2 - Fixation method for treating the cases of hindfoot and crus injuries and deformities - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves introducing cantilever screw rod having self-tapping end in the direction from inside towards outside from front to back in horizontal and skew-sagittal planes at the point located over internal surface of the calcaneus on the boundary separating the middle and inferior one-third of the line connecting the inferior malleolus pole and maximum remote point on the calcanean tubercle to the rod exit point on the opposite surface of the calcaneus. The rod is fixed by means of strips with threaded end face fastening to external supporting members of apparatus. Foot position is controlled by dosed displacement of transcutaneous apparatus members. EFFECT: enhanced effectiveness of fixation; reduced risk of traumatic complications. 6 dwg

Description

The invention relates to medicine, in particular to orthopedics and traumatology, and is intended for the treatment of injuries and deformities of the bones of the foot and lower leg.

Known methods of treating injuries and deformities of the foot bones by external transosseous osteosynthesis [1], [2].

The common features of these methods of treating deformities and fractures of the foot bones, including the posterior tibia, are the installation of two or more cross knitting needles, one of which with emphasis, in the calcaneus is perpendicular to its longitudinal axis, medial or lateral to the Achilles tendon. With the help of these knitting needles, fixed in the external supports, they control the position of the calcaneus in the process of eliminating its deformation or reposition of its fracture.

The disadvantages of the above methods of fixation of the hindfoot are the lack of rigidity in the fixation of the calcaneus with knitting needles, as a result of which the needles cut through the skin and soft tissues around when performing movements, which, in turn, increases the risk of developing infectious complications. The use of three or more spokes is relatively traumatic and does not always provide sufficient fixation rigidity.

The use of a spoke with emphasis is insufficient and not always effective in eliminating the displacement of the calcaneus in width. During reposition, the needle must be pulled with a special tensioner in order to move the stop along with the calcaneus fragment in a given direction, taking into account the nature of the displacement and the type of deformation. This complicates the operation and does not allow to correct the deformation or reposition the fracture with the necessary accuracy.

To eliminate the above drawbacks, we proposed for the treatment of fractures and deformities of the hindfoot by external transosseous osteosynthesis using a through threaded screw-rod with a pointed self-tapping end in the calcaneus, in the direction of the inside-out, front-back, in the horizontal and oblique planes, through a point located on the inner surface of the calcaneus, on the border of the middle and lower third of the line connecting the lower pole of the inner ankle and the most distant point calcaneal tuber. This direction of installation of the retainer provides the maximum area of its contact with the bone due to the maximum number of turns of the rod located in the bone, and its passage through the safe anatomical and functional zones. The point of insertion of the rod is due to the anatomical and topographic features of this zone - the absence of vaginal bags of tendons.

Figure 1 shows the General layout of the external transosseous apparatus for eliminating deformations and for repositioning fractures of the calcaneus using the proposed method, where 1 is a through screw-rod with a self-cutting tip, a large pitch thread in the center and a metric thread along the edges; 2 - strips with threaded end fastening; 3 - external supports of the apparatus: 4 - the base of the apparatus on the lower leg.

The method is as follows.

Under general intravenous anesthesia, the skin is pierced on the inner surface of the calcaneus at a point located on the border of the middle and lower third of the line connecting the lower pole of the inner ankle and the most distant point of the calcaneal tubercle, and a through screw-rod with a self-cutting end is screwed with a handle.

1. The rod is installed in the horizontal and oblique planes in the direction from inside to outside, front to back through the puncture point. In this case, the maximum number of turns of the rod is located directly in the bone, thus ensuring the maximum contact area of the retainer with the bone, and therefore the maximum fixation stiffness. The rod is installed right through until it exits on the opposite side of the calcaneus. The rod with the help of strips with a threaded end mount 2 is attached to the external supports of the apparatus 3. The position of the foot is controlled by the dosed movement of the supports of the apparatus.

After the end of the reposition and elimination of the heel bone displacement, X-ray control is performed.

Using a through screw-rod in the calcaneus and introducing it in the direction we have proposed, through the point proposed above, allows you to precisely repair the fracture or eliminate the deformation of the foot and rigidly fix its position relative to other bones of the foot and lower leg, and therefore prevent the possibility of infection and inflammation, and also reduce the invasiveness of the intervention and simplify the installation of the device due to the smaller number of locks installed.

Example. Patient B. was admitted to the hospital with a diagnosis of “Closed calcaneus fracture with displacement of fragments”.

The patient underwent surgery: osteosynthesis of the lower leg and foot with a rod-type apparatus. In this case, a through screw-rod was inserted in the horizontal and oblique planes in the front-back direction, inside-outside through a point on the inner surface of the calcaneus, located on the border of the middle and lower third of the line connecting the lower pole of the inner ankle and the most distant point of the calcaneal angle. The device is removed from the foot after 3 months. The fracture is fused in the correct anatomical and functional positions. A good clinical result was obtained.

An example is illustrated by photographs of radiographs of the patient: figure 2 - before treatment, figure 3, figure 4 - during treatment, figure 5, figure 6 - after treatment.

Sources of information

1. A.S. 1047467 USSR, MKI ³ A 61 V 17/00 A way to eliminate deformation of the hindfoot (G.A. Ilizarov, A.V. Popkov, S.Ya. Zyryanov (USSR)), No. 3443679 / 28-13.

2. Elimination of multicomponent foot deformities in adults using the Ilizarov method / Educational and methodological developments /. Kurgan, 1992.

Claims (1)

The method of fixation in the treatment of injuries and deformities of the hindfoot and lower leg, including fixing the external transosseous apparatus on the bones of the foot and controlling the position of the foot with the metered movement of the supports of this apparatus, characterized in that a through cantilever screw-rod is inserted with a self-cutting end in the direction of the inside-outside, front-back in the horizontal and oblique-sagittal planes through a point located on the inner surface of the calcaneus at the border of the middle and lower third of the line connecting the lower field inner ankle with a most distant point the calcaneal tuberosity, to output shaft on the opposite side of the calcaneus, the rod is attached with brackets with threaded mechanical fastening the supports to the external apparatus.

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