RU2253395C1 - Method for operative treatment of fractures in proximal department of brachial bone - Google Patents

Abstract

FIELD: medicine, traumatology, orthopedics.

SUBSTANCE: one should fix fragments due to applying sharply curved needles from external surface of brachial caput into metadiaphysial part of distal fragment of brachial bone, moreover, needles should appear at internal surface of brachial bone followed by fixing curved ends of needles with "castellated" disk and cortical screw at distal fragment of brachial bone. In case of fragments being distally against surgical cervix, the ends of needles should be withdrawn into medullary canal of distal fragment at support into cortical part of distal fragment at opposite side against their insertion, and curved ends should be fixed with "castellated" disks both above the area of fragments and at cortical layer of distal fragment to provide rigid fixation.

EFFECT: higher efficiency of therapy.

1 cl, 3 dwg, 1 ex

Description

The invention relates to medicine, namely to traumatology and orthopedics, and can be used in the treatment of fractures of the proximal humerus.

There is a method of fixation in case of a fracture of a surgical neck of a shoulder with V-shaped knitting needles (A.F. Lazarev, E.I. Solod “Traumatology and Orthopedics Bulletin named after N.N. Priorov, No. 3, 2003, M., Medicine). However, this method, for its simplicity, does not have sufficient fixation strength and, in addition, cannot be used for fractures of the surgical neck of the shoulder with fragments in the metadiaphyseal zone.

The synthesis of fractures of the surgical neck of the shoulder according to Weber has sufficient strength for fixing fragments, is simple in its execution. But this method can not always be applied in the presence of fragments distal to the area of the surgical neck.

The closest is the method of "crown" osteosynthesis of fractures of the surgical neck of the humerus (Kobzev EV, patent No. 2133593, published July 27, 1999, bull. No. 21). The method is distinguished by low morbidity compared with bone osteosynthesis and more stable fixation compared to isolated spoke or helical osteosynthesis. In addition, the method is distinguished by simple technical execution, which significantly shortens the time of surgical intervention.

However, this method has a significant drawback in that when screws are screwed into the crown washers, the mutual compression of the fragments occurs on the implant installation side, which gives uneven compression in the fracture area, resulting in a wedge-shaped expansion of the gap on the opposite side (Fig. 1-a , Fig. 1-b). This phenomenon significantly reduces the quality of the synthesis.

Description of the invention is illustrated by drawings:

1) FIG. 1a and FIG. 1-b — displacement of the proximal fragment during unilateral compression with a “crowned” mini-fixator;

2) FIG. 2-a and FIG. 2-b - fixation of fragments according to the author's technique;

3) FIG. 3a and FIG. 3-b - fixation according to the author's technique of a multi-fragmented fracture.

The objective of the invention is to increase the efficiency of the synthesis of the surgical neck of the humerus by uniformly distributing the compressive effect along the plane of the fracture and enhancing the rigidity of fixation by the optimal arrangement of mini-fixators and knitting needles.

The task is achieved as follows:

Under general anesthesia under aseptic conditions, an incision is made in the skin and subcutaneous tissue along the anteroposterior surface of the deltoid region 7–9 cm long. The fracture site of the surgical neck of the humerus is exposed in layers. After reposition of the fragments, practically without periosteum detachment, the fragments are fixed by holding needles bent at an acute angle of 2.0 mm from the outer surface of the humerus head to the metadiaphyseal part of the distal fragment of the humerus, with the needles coming out on the inner surface of the humerus. With subsequent fixation of the bent ends of the spokes with a “crown” washer and a cortical screw on the distal fragment of the humerus (Fig. 2a, Fig. 2b).

In the presence of fragments distal to the surgical neck, the ends of the spokes, after passing through the head of the shoulder, are inserted into the medullary canal of the distal fragment with emphasis on the cortical part on the opposite side from the introduction of the spokes, and the curved ends are strengthened with “crown” washers both over the area of the fragments and on cortical layer of the distal fragment. In this case, the needles are fixed with a “crown” washer and a screw in the region of the humeral head (Fig. 3a, Fig. 3b). To achieve optimal stiffness of fixation of fragments during comminuted fractures, the number of spokes can be different, depending on the location and number of fragments. Next, the wound is sutured in layers. In the postoperative period, kerchief immobilization is used for 2 weeks for more optimal healing of the postoperative wound.

Clinical example

Patient Yu. Born in 1941, was admitted to the trauma unit of the 4th city hospital in Kursk on September 12, 03, case history No. 10631/1052. Diagnosis: closed comminuted fracture of the surgical neck and head of the left humerus with displacement. After a general clinical and radiological examination, September 18, 03, an open reposition of fragments was performed with fixation by a spoke-screw system using a “crown” washer according to the described method. In the postoperative period, kerchief immobilization was used for 2 weeks. After removing the stitches after 12 days, the patient began to gradually develop movements in the shoulder joint.

Thus, the task was achieved by holding the needles bent at an acute angle of 2.0 mm from the outer surface of the humeral head into the metadiaphyseal part of the distal fragment on the inner surface of the humerus, followed by fixing the bent ends of the spokes with a “crown” washer and a cortical screw on the distal fragment of the humerus and in case of multi-fragmented fractures of the surgical neck of the shoulder, the ends of the spokes are inserted into the medullary canal below the fracture area with emphasis on the cortical part of the distal fragment on the opposite side, then strengthen the spokes with mini implants depending on the location of the fragments.

Claims (2)

1. A method for surgical treatment of fractures of the proximal humerus, including osteosynthesis, characterized in that the needles bent at an acute angle are carried out from the outer surface of the humeral head to the metadiaphysial part of the distal fragment with the needles reaching the inner surface of the humerus, and the bent ends of the spokes are fixed along the outer the surface of the distal fragment with a crown washer, a screw. 2. The method according to claim 1, characterized in that in multi-fragmented fractures, the ends of the spokes after being inserted through the head are inserted into the medullary canal below the fracture area with emphasis on the cortical part of the distal fragment on the opposite side from the introduction of the spokes, the curved ends of the spokes are strengthened with castellated washers as above region of fragments, and on the cortical layer of the distal fragment.

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