RU2260394C1 - Method for elongating metacarpal bone by means of distraction with its stump or short stump being available - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves carrying out transverse subperiosteal middle metacarpal bone osteotomy in middle one-third portion. Gradual fragment distraction is carried out to required value. Osteotomy zone is exposed after having finished distraction stage without bone regenerate integrity being violated. Circular cross-section pin of 0.3-0.4 cm large diameter and length equal to sum of stump under distraction and bone fragment separation value is formed from cortical layer. The regenerate is laminated along its length. The pin is intramedullary introduced into peripheral bone fragment. The pin is retrogradely taken off via a separate incision on stump end face. The pin is hammered and intramedullary introduced into the central metacarpal bone fragment without bone regenerate integrity being violated. Maximum acute bone fragments traction is carried out on the pin, leaving its peripheral end at the same level with metacarpal bone base stump. The metacarpal bone fragments are attached to allotransplant with wires in maximum separation position. The wires are conducted in perpendicular to its longitudinal axis through both cortical layers. Basic phalanx stump being available, the stump is fixed with wires in extension position. The wires are removed after having finished distraction. A pin of total length equal to sum of metacarpal bone length, basic phalanx length and distraction value. A wire is intramedullarily and retrogradely introduced into the peripheral fragment of the metacarpal bone and into basic phalanx stump in transarticular way in the state of its maximum extension. The pin is hammered and intramedullary introduced into the central metacarpal bone fragment without bone regenerate integrity being violated. Maximum acute bone fragments traction is carried out on the pin, leaving its peripheral end at the same level with basic phalanx bone base stump. The metacarpal bone fragments are attached to allotransplant with wires drawn in perpendicular to its longitudinal axis through both cortical layers in maximum separation position.

EFFECT: enhanced effectiveness of treatment; accelerated treatment course; prevented regenerate distortion.

7 dwg

Description

The present invention relates to medicine, and specifically to traumatology and orthopedics, and for lengthening the metacarpal bone in the presence of its stump or short stump of the main phalanx.

Closest to the proposed technical solution is the method of distraction lengthening of the stump of the finger or metacarpal bone, described by Kuzmenko V.V., Korshunov V.F., Magdiev D.A., and others in the textbook for students, interns, graduate students, doctors " New solutions to current problems in traumatology and orthopedics ”, selected for the 70th anniversary of the founding of the department, Moscow, 2001, pp. 27-28.

величину, чем необходимо. Далее берут кортикальный аутотрансплантат, рассверливают костно-мозговой канал, причем повреждается эндост и регенерат. Трансплантат плотно внедряют в костномозговой канал обоих фрагментов через регенерат. Однако этот способ имеет существенные недостатки: перерастягиваются костные отломки, рассверливается костно-мозговой канал, плотно внедренный трансплантат вызывает резорбцию кости, в результате чего происходит оседание пальца, повреждаются регенерат и эндост.In accordance with this method, an osteotomy of the metacarpal bone is performed, a distraction apparatus is applied, fragments are stretched to

value than necessary. Next, they take a cortical autograft, drill the marrow canal, and the endost and regenerate are damaged. The graft is tightly inserted into the medullary canal of both fragments through the regenerate. However, this method has significant drawbacks: bone fragments are overstretched, the bone marrow canal is expanded, a tightly implanted graft causes bone resorption, resulting in subsidence of the finger, regenerate and endostomy are damaged.

The objective of the proposed technical solution is the preservation of the achieved lengthening of the stump, prevention of curvature of the regenerate, and in the presence of a short stump of the main phalanx of the finger, the prevention of the formation of its flexion contracture and the formation of a vicious stump, reduction of the time for distraction of bone fragments and the wearing time of the external fixation apparatus.

This problem is solved due to the fact that, in the presence of the metacarpal stump, transverse subperiosteal metacarpal bone osteotomy is performed in the middle third, the fragments are gradually distracted to the required size, after completion of the distraction, the osteotomy zone is isolated without violating the integrity of the bone regenerate, a bone pin is formed from the cortical allograft rounded section with a diameter of 0.3-0.4 cm and a length equal to the sum of the length of the distracted stump and the dilution of the bone fragments, layered along the regene atm, followed by introduction of the pin into the intramedullary peripheral otlomok and retrograde excretion through a separate incision in the stump end, and further pin inciting intramedullary administered to the central moiety metacarpal bone. Without violating the integrity of the regenerate, maximum sharp traction of the bone fragments on the pin is carried out, leaving the peripheral end of it at the same level as the stump of the metacarpal bony skeleton, in the position of maximum dilution, the metacarpal fragments are fixed to the allograft with spokes made perpendicular to its longitudinal axis through both cortical layers with subsequent layer-by-layer suturing of wounds, performing immobilization of the hand to consolidate bone fragments and removing needles, and in the presence of a stump of the main phalanx before distraction, the stump is fixed in the extension position, a pin is formed with its introduction intramedullary retrograde into the peripheral fragment of the metacarpal bone and transarticularly into the stump of the main phalanx in the position of its maximum extension, then the pin is hammered and inserted intramedullary into the central fragment of the metacarpal bone, maximize acute traction on the pin, leaving its peripheral end flush with the stump of the bony skeleton of the phalanx, in the position of maximum After dilution, bone fragments of the metacarpal bone are fixed to the allograft with spokes drawn perpendicular to its longitudinal axis through both cortical layers.

The essence of the invention is illustrated by drawings, where Fig. 1 shows a brush before distraction of the metacarpal bone, Fig. 2 shows fixation of the stump of the main phalanx, osteotomized first metacarpal bone and external fixation apparatus mounted on it, Fig. 3 - fragments of the metacarpal bone after completion their distraction, figure 4 - held intramedullary through fragments of the metacarpal bones and transarticularly through the stump of the main phalanx pin from the cortical allograft with fixing bone fragments and allograft sleep tsami.

The method is as follows.

In the presence of a stump of the finger at the level of the proximal third of the main phalanx, the phalanx 1 is fixed with spokes 2 held through the metacarpophalangeal joint in the extension position (Figs. 1, 2). A layer-by-layer incision is made of the skin and underlying tissues on the back surface of the metacarpal bone with the transverse subperiosteal osteotomy in the middle third. Through the peripheral and central fragments 3 of the metacarpal bone, the spokes of the external fisia apparatus 4 are passed and the fragments are gradually distracted by the required amount (Figs. 2, 3). After distraction is completed, the external fixation apparatus is removed and the spokes 2 are removed from the stump of the main phalanx 1. An incision is made along the scar after the previous operation. Allocate a zone of osteotomy without violating the integrity of the bone regenerate. A round pin 5 with a diameter of 0.3-0.4 cm and a length equal to the sum of the length of the distracted stump and the dilution of bone fragments 3 is formed from a cortical allograft. Next, the regenerate is stratified along without excising and without violating its integrity. Pin 5 is inserted intramedullary into the peripheral fragment with retrograde excretion through a separate incision at the end of the stump. In the presence of a stump of the main phalanx 1, before the distraction, the stump is fixed in the extension position with the needles 2. After the completion of the distraction, the spokes are removed, a pin 5 is formed with a length equal to the sum of the metacarpal bones, the stump of the main phalanx and the size of the distraction, it is inserted intramedullary and retrograde into the peripheral fragment of the metacarpal bone and transarticular to the stump of the main phalanx in the position of its maximum extension. Next, the pin 5 is knocked out and inserted intramedullary into the central fragment of the metacarpal bone 3, without violating the integrity of the regenerate. The maximum acute traction of the bone fragments 3 is carried out on the pin 5. At the same time, the peripheral end of the pin is left at the same level with the stump of the bone skeleton. In the position of maximum dilution of bone fragments 3, they are fixed to the allograft 5 with 2 needles, held perpendicular to its longitudinal axis and through both cortical layers (Figs. 3, 4). Next, the wounds are sutured in layers, the hand is immobilized with a plaster cast until the bone fragments are consolidated, after which the spokes 2 are removed.

Clinical example. B-th D-s V.E., 13 years old, was admitted to the Nizhny Novgorod NIITO on January 20, 2003, regarding the stump of the first finger of the right hand at the base level of the main phalanx. (Photo 1). From the anamnesis it is known that 1.5 years ago the patient received a traumatic detachment of the first finger. Upon admission, the stump of the base of the main phalanx of the first finger with a good condition of the soft tissues of the stump is determined. Bilateral grip of the brush is absent. On January 24, 2003, a transverse osteotomy of the first metacarpal bone of the right hand was performed and a distraction apparatus was applied after fixing the stump of the main phalanx in the position of extension by knitting needles. 04/10/03, a plastic distraction defect was performed, fixation of bone fragments with an allograft (Photo 2) and knitting needles according to the developed technique. The postoperative course is smooth. The wounds healed by primary intention. Knitting needles removed 2 months after surgery. The wearing time of the external fixation apparatus was 2.5 months. The magnitude of the achieved lengthening of the metacarpal bone is 2.5 cm. The patient was examined on December 10, 2003 (Photo 3). The achieved elongation of the metacarpal bone is preserved. The stump of the main phalanx is in the extension position. There is no curvature of the first ray. Restored bilateral grip of the brush. The butt of the stump is painless. The patient actively uses an elongated stump in his studies and everyday life.

The method has been successfully implemented in 3 patients.

The proposed method ensures the preservation of the achieved magnitude of lengthening of the stump, prevention of curvature of the regenerate. In the presence of a short stump of the main phalanx of the finger, the formation of its flexion contracture and the formation of a vicious stump are prevented.

Compared with the prototype, the periods of bone fragments distraction and the time of wearing the external fixation apparatus are reduced due to the dilution of bone fragments only by an amount sufficient to form a finger of a given length and their acute traction at the same time.

When implementing the method, regenerate, endost, and therefore periosteal and endosteal bone formation, are preserved, since the bone marrow canal is not drilled, the distraction defect is not completely filled with the graft, and when it is fixed, the spokes are not drawn through the regenerate zone. In addition, the allograft itself stimulates bone formation. The use of an allograft eliminates the need for additional trauma to the patient.

The method is simple, effective and can be implemented in any trauma hospital.

Claims (1)

The method of distraction lengthening of the metacarpal bone in the presence of its stump or short stump of the main phalanx by performing an osteotomy of the metacarpal bone, applying a distraction apparatus followed by stretching of the bone fragments and using a cortical graft, characterized in that in the presence of the stump of the metacarpal bone, transverse subperiosteal middle metacarpal osteotomy is performed. thirds, carry out the gradual distraction of fragments by the required amount; after completion of the distraction, an osteotomy zone is allocated b Without violating the integrity of the bone regenerate, a rounded cross-sectional pin with a diameter of 0.3-0.4 cm and a length equal to the sum of the length of the distracted stump and the dilution of bone fragments is formed from the cortical allograft, the regenerate is stratified along with the subsequent intramedullary insertion of the pin into the peripheral the fragment and retrograde excretion through a separate incision at the end of the stump, then the pin is knocked out and inserted intramedullary into the central fragment of the metacarpal bone, without violating the integrity of the regenerate, maximum acute traction of bone fragments on the pin, leaving its peripheral end level with the stump of the bone skeleton of the metacarpal bone, in the position of maximum dilution, the metacarpal bone fragments are fixed to the allograft with spokes held perpendicular to its longitudinal axis through both cortical layers with subsequent immobilization of the hand until bone consolidation fragments and removal of the needles, and in the presence of a stump of the main phalanx before distraction, the stump is fixed in the position of extension by the needles, after completion of the needles are removed, the pin is formed with a length equal to the sum of the lengths of the metacarpal bone, the stump of the main phalanx and the size of the distraction, followed by its introduction intramedullary and retrograde into the peripheral fragment of the metacarpal bone and transarticularly into the stump of the main phalanx in the position of its maximum extension, then the pin is inserted into the central fragment of the metacarpal bone, without violating the integrity of the regenerate, maximize acute traction on the pin, leaving its peripheral end at the same level with osseous bone of the skeleton of the main phalanx, fixing in the maximum dilution position the bone fragments of the metacarpal bone to the allograft with knitting needles drawn perpendicular to its longitudinal axis through both cortical layers.

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