RU2290105C2 - Method for surgical treatment of pendulous 1st metatarsal bone - Google Patents

Abstract

FIELD: medicine, orthopedics, traumatology.

SUBSTANCE: the present innovation deals with the ways of surgical treatment of diseases and aftereffects of motor system traumas, particularly, pendulous 1^st metatarsal bone. The innovation deals with wedge-shaped resection of the 1^st tarso-metatarsal joint, the transfer of great toe's long extensor tendon towards 1^st metatarsal caput. Moreover, additionally, it is necessary to transfer the tendon of the 2^nd toe's extensor towards 1^st metatarsal caput. Application of the present method enables to avoid the relapse of pendulous 1^st metatarsal bone.

EFFECT: higher efficiency of therapy.

1 cl, 2 dwg, 1 ex

Description

The invention relates to medicine and relates to methods for surgical treatment of diseases and consequences of injuries of the musculoskeletal system, in particular sagging of the first metatarsal bone.

Known methods for surgical treatment of sagging of the first metatarsal bone.

1. The method of I. A. Movshovich [2]. A feature of the method is an osteotomy of the base of the first metatarsal bone and a transplant of a tendon of the long extensor of the first finger to the head of the first metatarsal bone. The disadvantage of this method is the ability to displace fragments in the osteotomy area. In patients with looseness in the first tarso-metatarsal joint, osteotomy of the base of the first metatarsal bone is not effective enough.

2. The method of A. P. Chernov, I. I. Losev, G. G. Vorobyov [1]. The essence of the method is a wedge-shaped resection of the first tarso-metatarsal joint and transplantation of the tendon of the long extensor of the first finger to the head of the first metatarsal bone.

This method is taken as a prototype. The disadvantage of this method is that when the strength of the long extensor of the first finger is weakened, the effectiveness of the surgical intervention decreases.

The purpose of the invention is to increase the effectiveness of surgical intervention to correct sagging of the first metatarsal bone, reducing the number of complications.

The method is as follows: the first skin incision is performed along the front surface of the foot in the projection of the first tarso-metatarsal joint. The joint is opened, a wedge-shaped resection of the joint is performed. The base of the wedge is positioned anteriorly. Fragments are compared and fastened with bone sutures. The wound is sutured in layers.

The second skin incision is made on the front surface of the first toe. The tendon of the long and short extensors of the finger is isolated and stitched together. The tendon of the long extensor is dissected proximal to the staple site. In the head with an awl or drill, a tunnel is formed in a horizontal plane.

A third skin incision is made on the front surface of the second finger. The tendon of the short and long extensors of the second finger is isolated and stitched together. The long extensor tendon is dissected proximal to the sutures.

A fourth skin incision is made along the front surface of the foot in the projection of the second tarso-metatarsal joint. A tendon of the long extensor of the second finger is isolated and removed to the wound (Fig. 1). The fourth surgical wound is connected by a subcutaneous tunnel to the second surgical wound. A tendon of the long extensor of the second finger is passed through the tunnel. The ends of the tendon of the long extensor I and II of the fingers are fixed in the bone tunnel of the head of the first metatarsal bone (figure 2). Wounds are sutured in layers. Impose a plaster boot from the tips of the fingers to the middle third of the leg.

Figure 1 shows the removal of the tendon of the long extensor of the second finger into the fourth surgical wound. Figure 2 - fixation of the tendon of the long extensor of I and II fingers to the head of the first metatarsal bone.

The fundamental difference between the proposed method and the known one is the transplantation of the tendon of the long extensor of the second finger to the head of the first metatarsal bone simultaneously with the tendon of the long extensor of the first finger.

The advantage of the proposed method over the known ones is as follows: transplantation of the tendon of the long extensor of the second finger to the head of the first metatarsal bone enhances the effect of holding the metatarsal bone in a given position, especially when the strength of the long extensor of the first finger is weakened.

The proposed method with a positive effect was performed in a patient with the consequences of poliomyelitis.

1. Patient S.P.I. 21 years old entered the clinic of traumatology and orthopedics of the Samara Medical University on February 5, 2004. Case history No. 251/141. From the anamnesis it was found that at the age of one year he suffered polio.

Diagnosis: residual poliomyelitis, paresis of the muscles of the right lower leg, paralysis of the anterior tibial muscle, sagging of the first metatarsal bone.

February 7, 2004, the operation was performed according to the developed method. Inspected on May 11, 2004. The deformation is fixed, walks in ordinary shoes with arch support.

The technical result. Tendon transplantation of the long extensor of the II finger to the head of the I metatarsal bone improves the results of the operation and reduces the possibility of recurrence of deformation.

Bibliography

1. A.F. Krasnov, G.P. Kotelnikov, A.P. Chernov. Tendon-muscle plastic surgery in traumatology and orthopedics. Samara, 1999 .-- 287 p.

2. I.A. Movshovich. Operative orthopedics. M., 1983 .-- 278 p.

Claims (1)

A method for surgical treatment of sagging of the first metatarsal bone, including a wedge-shaped resection of the first tarso-metatarsal joint, transplantation of the tendon of the long extensor of the first finger to the head of the first metatarsal bone, characterized in that it also transplantes the tendon of the long extensor of the second finger to the head of the first metatarsal bone.

Images