RU2265412C1 - Device for osteosynthesis of supracondylar and transcondylar fractures of thighbone - Google Patents

Abstract

FIELD: medicine; traumatology; orthopedics.

SUBSTANCE: Device has rods for introducing them into proximal part of thigh, needles for introducing through condyles of thigh-bone, universal clamps for rods, clamps for needles and rod as well as Ilizarov' ring for mounting onto needles to introduce them through condyles of thigh-bone. Rods are made of graphite. Scantz rods are used as for introducing into proximal section of thigh. The pins are connected by means of two rods with ring of Ilazarovs' apparatus. One rod is fixed at slanting direction at angle of 30-45 degrees. Supracondylar and transcondular fractures can be fixed for the whole period of treatment to provide minimal traumatism of soft tissues. Active movements of extremity operated at early stage of treatment can be developed.

EFFECT: improved efficiency; higher quality.

11 dwg, 3 ex

Description

The present invention relates to external fixation devices for osteosynthesis of supracondylar and supracondylar femoral fractures (type A and C according to AO classification [M.E. Muller et al. 1996]).

The variety of such fractures causes difficulties in choosing the optimal method of treatment, as a rule, most traumatologists, seeking accurate reposition, prefer to use advanced surgical access, thereby producing additional trauma to the surrounding soft tissues. Even with closed fractures, this tactic often leads to the development of various complications (inflammation of the soft tissues, osteomyelitis, the development of cicatricial contractures, aseptic necrosis of bone tissue, etc.) For open fractures, when the installation of a massive metal fixator is impossible before the wound heals, external fixation is the method of choice. Therefore, all over the world, and especially in our country, there are more and more supporters of the use of external fixation devices (Ilizarov G.A. 1954, 1976; Volkov M.V., Oganesyan O.V. 1986).

Currently, from the external fixation devices for the treatment of intra and periarticular fractures of the distal end of the thigh, the apparatuses of G.A. Ilizarov (copyright certificate 538710, 1977), I.M. Pichkhadze (copyright certificate No. 534231, 1977) are used .F. Khabirova, S.G. Tinchurina (copyright certificate No. 599800, 1978), V.A. Korkhina (copyright certificate No. 1175461, 1985).

A common drawback of the above methods is the difficulty in applying the apparatus, the bulky design of the apparatus, the passage of the spokes and rods of the apparatus through the quadriceps muscle, a long operation time.

The closest device for osteosynthesis, which we adopted as a prototype, is the apparatus of G.A. Ilizarov (O.A. Kaplunov 2002), containing supports in the form of openable rings and arcs, knitting needles, telescopic and screw rods, knots for adjusting and fixing the supports , knitting needles and rods.

However, the described external fixation apparatus has the following disadvantages. The spokes in the proximal and middle part of the thigh are passed through the entire thickness of the soft tissues of the thigh, which inevitably leads to the immobility of the thigh muscles and the formation of contracture of the knee joint. Another significant drawback is the location of the rings or half rings in the proximal and middle thigh. This leads to the fact that patients cannot sit and lie in an ordinary bed, and are forced to sacrifice comfort during the entire period of treatment.

The aim of the proposed invention is the following: stable fixation of supracondylar and supracondylar femoral fractures for the entire duration of treatment with minimal trauma to soft tissues, the possibility of developing early active movements in the operated limb, maintaining patient mobility, creating maximum comfort for the patient for the entire treatment period.

This goal is achieved by the fact that the Shants rods are used in the proximal part of the thigh, connecting them by means of two graphite rods with the Ilizarov apparatus ring mounted in the distal part of the thigh, one of the rods being attached obliquely at an angle of 30-45 degrees.

Figure 1 shows a General view of a spoke-rod device. Figure 2 shows adapters consisting of a combination of a universal clamp for rods and flags from the Ilizarov apparatus. Figure 3 shows the supracondylar fracture in the patient from Example No. 1. Figure 4 shows the fracture in the patient of Example No. 1 after osteosynthesis (direct and lateral projection). In Fig. 5, the fracture in a patient from clinical example No. 1 (direct and lateral projection) after disassembling the device is fused. In Fig.6 supracondylar multi-fragmented fracture in a patient from Example No. 2. In Fig.6, a fracture in a patient from Example No. 2 after osteosynthesis with an external fixation device (direct and lateral projection). On Fig fused supracondylar fracture in a patient from example No. 2 (direct projection). In Fig.9 supracondylar multi-fragmented fracture in a patient from Example No. 3. In Fig. 10, a fracture in a patient from Example No. 3 after osteosynthesis with an external fixation device (direct projection). In Fig.11, the fracture in the patient from example No. 3 after osteosynthesis with an external fixation device (lateral projection).

We explain the essence of the device we have proposed using specific clinical examples.

Example No. 1. Patient M., 16 years old, was admitted to the hospital 1 hour after an injury (hit by a car) with a diagnosis of Combined injury. Mixed epiphysiolysis of the distal end of the right thigh. Brain concussion. Injuries to the abrasion of the head. The fracture was oblique-transverse (type A1) (figure 3). Upon admission, anesthesia of the fracture site was performed sol. Novocaini 0.25% - 80.0; skeletal traction for the proximal metaphysis of the left tibia is established. 7 days after the injury, after preoperative preparation, due to the continued displacement of the fragments, the need for early activation of the patient, osteosynthesis of the right thigh was performed using a device of the original design:

Under endotracheal anesthesia, in the position of the patient on the back on the orthopedic table. Under the control of the tube, three 2.0 mm intersecting needles were drawn through the condyles of the femur perpendicular to the axis of the femur. On the spokes is mounted a ring from the Ilizarov apparatus, consisting of two half rings (ring diameter 220 mm). Four Shantz rods with a diameter of 3.5 mm were drawn through the upper - middle third of the femoral diaphysis, on which a graphite rod of the same apparatus was mounted using universal rod clamps of the external fixation device. Further under the control of the image intensifier after reposition with the elimination of the main types of bias. Using special adapters, consisting of a combination of a universal rod clamp and remote “flags” of the Ilizarov apparatus, a ring of the Ilizarov apparatus was mounted on the rod of the AO apparatus. To give additional rigidity to the external fixation apparatus, an additional rod is mounted to the graphite rod of the external fixation apparatus and the Ilizarov apparatus ring at an angle of 35 degrees. Final fracture stabilization was performed. Aseptic dressings with alcohol on the mouth of the spokes. X-ray control (figure 4).

The patient was activated three days after the operation, walked on crutches without loading the right leg. Walking with a dosed load on the right leg two months after the operation. Three months later, walking with a full load on the right leg. Four months later, the fracture healed, the device was dismantled. After 5 months from the moment of injury, the limb function is complete (figure 5).

Example No. 2. Patient A., aged 19, was taken from the accident site directly to the intensive care unit in an extremely serious condition. Diagnosed: Severe concomitant injury. Severe open traumatic brain injury. A severe brain contusion. Fracture of the base of the skull in the anterior cranial fossa. Pearl of the upper jaw according to FOR III. Open (type II according to the Gustillo classification) comminuted supracondylar fracture of the right thigh with displacement (Fig.6). Bruises of the abrasion of the head, face of the trunk of the limbs. SHOCK II. Upon admission, massive anti-shock, symptomatic therapy has been started. Given the open nature of the fracture, the presence of severe traumatic brain injury, psychomotor agitation, to facilitate patient care, it was decided, after preoperative preparation of the patient, stabilization of his condition, to perform osteosynthesis of an open comminuted fracture of the distal end of the right thigh with an external fixation device of the original design:

Under endotracheal anesthesia, in the position of the patient on the back on the orthopedic table. Under the control of the image intensifier, fragments of the distal femur were repaired through the condyles of the femur perpendicular to the axis of the femur three 2.0 mm intersecting spokes were made. On the spokes is mounted a ring from the Ilizarov apparatus, consisting of two half rings (ring diameter 240 mm). Three Shantz rods with a diameter of 3.5 mm were drawn through the upper - middle third of the femoral diaphysis, on which a graphite rod of the same apparatus was mounted using universal rod clamps of the external fixation device. Further under the control of the image intensifier after reposition with the elimination of the main types of bias. Using special adapters consisting of a combination of a universal rod clamp and remote “flags” of the Ilizarov apparatus, a ring of the Ilizarov apparatus was mounted on a rod of an external fixation apparatus. To give additional rigidity to the external fixation apparatus, an additional rod is mounted to the graphite rod of the apparatus and the Ilizarov apparatus ring at an angle of 30 degrees. Final fracture stabilization was performed. After the initial surgical treatment of the wound of the lower third of the right thigh, the edges of the wound were economically excised, obviously unviable, crushed subcutaneous fatty tissue and quadriceps muscle fibers were removed. Toilet wounds with a large number of antiseptics. Wound closure was not performed. Aseptic dressings with alcohol on the mouth of the spokes. Dressing with a water-soluble ointment on the wound. X-ray control (Fig.7).

After the operation, the patient was transferred to the intensive care unit. Wound dressings were performed. Received infusion, antibacterial, noo-vasotropic therapy. Activation within the bed 10 days after the operation. Repeated surgical treatment of the wound, suturing 15 days after injury. After 16 days, transferred to the department. Physical therapy classes have begun. The range of motion in the right knee joint is 110-180 degrees. Walking on crutches on the 20th day after the injury. The total period of inpatient treatment is 32 days. Walking with a dosed load on the right leg after 2 months from the moment of injury. After 4 months from the moment of injury, the fracture fused and the device was dismantled (Fig. 8). The range of motion in the knee joint is 100-180 degrees.

Example No. 3. A 58-year-old patient was taken to the clinic from a suburban hospital where first aid was provided, with a diagnosis of: Severe combined injury. Closed head injury. Bruise of the brain. Closed intraarticular multi-fragmented fracture of the distal metaepiphysis of the right thigh with displacement (Fig.9). Fracture of the cells of the ethmoid labyrinth on the right. Fracture of the zygomatic bones on both sides without displacement, paraorbital hematomas on both sides. Upon receipt, continued antishock, symptomatic therapy. Was in the intensive care unit for 6 days. 11 days after admission, after preparation, examination of the patient, the operation was performed: Closed reposition of an supracondylar fracture of the right thigh, fixation with an original design spoke-rod device. The method of operation did not differ from that given in examples No. 1 and No. 2. X-ray control (Fig. 10, Fig. 11).

The next postoperative period was uneventful. On the 4-5th day after the operation, physiotherapy exercises have been started. The range of motion in the right knee joint is 120-180 degrees. Walking on crutches on the 12th day after the operation. The total period of inpatient treatment is 53 days. Walking with a dosed load on the right after 2.5 months from the moment of injury. After 5 months from the moment of injury, the fracture healed, the device was dismantled. The range of motion in the knee joint is 100-180 degrees.

In total, in the clinic, with the help of a spoke-rod device of external fixation of our design, 8 patients are currently treated. Of these, 3 patients with supracondylar and 5 patients with trans supracondylar intraarticular hip fractures. All patients had consolidation of fractures, two developed inflammation in the area of the mouth of the spokes, which led to the dismantling of the device in one case. The range of motion in the knee joint of the injured limb ranged from 65 to 110 degrees (an average of more than 90 degrees). In one case, the formation of persistent extensor contracture of the knee joint was observed.

The claimed invention is not obvious to specialists working in this field. The device we proposed for osteosynthesis of supracondylar and supracondylar fractures was developed by us for the first time, as a result of a long search specifically for the treatment of patients with fractures of very complex localizations, the treatment of fractures of such localizations was not previously achieved by any of the external fixation methods.

Despite the presence of a large arsenal of retainers (rings, knitting needles, rods, various types of clamps for rods and knitting needles, etc.), as well as a variety of fixation techniques, no one has managed to develop at the same time a reliable and at the same time comfortable stabilization system for the patient supracondylar and supracondylar femoral fractures.

Claims (1)

A device for osteosynthesis of supracondylar and supracondylar femoral fractures, comprising rods for conducting into the proximal femur, knitting needles for conducting through the condyles of the femur, universal clamps for rods, clamps for spokes and rods, characterized in that it is provided with an Ilizarov ring for mounting on knitting needles for conducting through the condyle of the femur, the rods are made of graphite, as the rods for conducting into the proximal femur using Shants rods, which are connected by two rods with the Ilizarov apparatus ring, one of the rods being attached obliquely at an angle of 30-45 °.

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