RU2284783C1 - Surgical method for treating medial fractures of femur neck - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves setting washer along guide wire in subtrochanteric region having threaded central hole for receiving screw. Four V-shaped curved wires are introduced through openings in peripheral washer zone along the femur neck. A washer having no thread is mounted on the washer with wires. Both washers are fixed with a screw unlocking V-shaped wire rays.

EFFECT: prevented wire migration and bone fragment displacement.

2 dwg

Description

The invention relates to medicine, namely to traumatology and orthopedics, and can be used in the treatment of medial fractures of the femoral neck.

There is a fixation method for a proximal femur fracture with V-shaped knitting needles (A.F. Lazarev, E.I. Solod, N.N. Priorov Bulletin of Traumatology and Orthopedics No. 12004, M .: Medicine). This method is less traumatic and technically it is simple, at the same time, in terms of the quality of fixation of fragments, it is not inferior to traditional methods of osteosynthesis, and even surpasses them in the quality of treatment.

However, this method, like all traditional ones (a three-blade nail, screws) does not have sufficient fixation strength and, in addition, the voltage of the spokes obtained immediately after synthesis decreases over time due to the development of osteoporosis, and as a result, migration of spokes and displacement of fragments are often observed .

The objective of the invention is to increase the efficiency of the synthesis of medial fractures of the femoral neck by enhancing the rigidity of fixation of the implant by fixing the V-shaped spokes in a double washer, both halves of which are connected by a screw.

The problem is achieved due to the fact that in the undertroke region, a round washer with a diameter of 19 mm is installed along the guide pin. In the center of the washer there is a round hole with a thread for a screw with a diameter of 5.0 mm. To strengthen the threaded part of the washer in the center, there is a round-shaped influx of 7 × 3 mm in size. Around the circumference in the periphery of the washer there are 8 holes with a diameter of 2.0 mm, which are located at a distance of 7 mm from the center of the washer. Through the holes in the periphery of the washer along the neck of the thigh, 4 V-shaped spokes with a diameter of 2.0 mm are inserted of the required length. After installing the knitting needles in the bone tissue of the femoral neck and impacting them, a washer with a diameter of 19 mm and a thickness of 2.0 mm with a hole in the center without a thread for a screw with a diameter of 5.0 mm is installed on top of the washer with knitting needles. Using a screw with a diameter of 5.0 mm and a length of 10.0 mm, both washers are fixed to each other, while unclenching the V-shaped spokes in the area of their bend. After this compression, an additional tension of the spokes is created, which increases the strength of fixation of fragments.

The description of the invention is illustrated by the figures:

figure 1 - locking washers with screw;

"A" - a washer with knitting needles;

"a" - a washer with knitting needles (rear view);

"B" - a clamping washer;

"B" - screw;

figure 2 - General view of the fixing implant.

The method is as follows.

Under general anesthesia under aseptic conditions, a closed reposition of fragments of the femoral neck is performed with prior fixation by their spokes under fluoroscopic control. An incision is made of the skin and subcutaneous tissue along the outer surface of the thigh in the undervert region of 5 cm in length (Fig. 2). Subtrochanteric region of the femur is exposed in layers. Under fluoroscopic control, the depth of insertion of the spoke implants into the neck and head of the proximal femur is determined using a guide needle. After that, a washer “a” with holes for the V-shaped curved spokes is installed on the guide needle. A drill with a diameter of 2.0 mm alternately perforates 8 channels through the holes of the washer in the cortical part of the undervert region of the thigh at the sites of the proposed introduction of spoke implants. Further along the neck of the thigh, V-shaped spokes are installed, they are impacted. Then, with the help of screw “c”, the clamping washer “b” is fixed to the washer “a” with knitting needles (Fig. 1) When the screw is screwed, mutual tension occurs in the “implant-bone” system due to the bursting of the “rays” of the V-shaped spokes, which significantly increases the rigidity of fixation. The total destructive effect of the implant on the bone tissue of the neck and femoral head is minimal.

Next, the wound is sutured in layers. In the postoperative period, active movements are made in the hip joint without load on the leg for 6-7 months. Additional immobilization of the damaged joint is not performed.

Clinical example.

Patient M., born in 1959, was admitted to the trauma department of the Kursk railway hospital 02/01/05. Case history No. 94-2. Diagnosis: Closed subcapital fracture of the neck of the left femur with displacement.

After a general clinical and radiological examination was performed on 02.02.05, a closed reposition of fragments was performed with fixation by a spoke-screw system according to the described method. In the postoperative period, immobilization was not used.

Thus, the task was achieved by passing through the fracture of the femoral neck four four V-shaped curved 2.0 mm spokes from the outer surface of the invert part, followed by fixing the spokes with two washers fixed to each other by a screw.

Claims (1)

A method for surgical treatment of medial fractures of the femoral neck, including the installation of a V-shaped bent knitting needle, characterized in that a washer is installed in the under the guide region of the throat with a threaded hole in the center, four are inserted through holes along the periphery of the washer along the thigh neck V-shaped curved knitting needles; a washer without thread is installed over a washer with knitting needles; both washers are fixed with a screw to each other, unclenching the "rays" of the V-shaped knitting needles.

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