RU2302836C1 - Method for reducing and fixing posterior edge of distal tibial epiphysis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves setting reposition member to bracket. The bracket is placed at the level of posterior tibia fracture edge allowing movements in vertical direction. The reposition member is rotated to introduce its end into broken posterior edge of fragment on external Achilles tendon edge side with the Achilles tendon preliminarily replaced. The fragment is displaced backward from fracture line the largest protrusion size as far along the fracture line. Then the bracket is moved to arrange fragment and tibia fracture lines at the same level. The reposition member is moved forward as far as the fragment thrusts against the tibia.

EFFECT: high accuracy of broken fragment juxtaposition with tibial fracture line; reduced risk of traumatic complications.

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Description

The invention relates to medicine, namely to traumatology and orthopedics, and is intended for the treatment of patients with fractures of the posterior edge of the distal epiphysis of the tibia.

Damage to the posterior edge of the tibia occurs in 30% of the total structure of injuries of the ankle joint [1]. This type of damage is the most intractable component of such damage, which leads to unsatisfactory results.

In case of fractures of the posterior margin, surgical treatment is indicated [1]. It makes it possible to fully restore the congruency of the joint and is, therefore, the main condition for the subsequent fusion in the correct position and restoration of function. But such operations are technically difficult, since surgical access to the posterior edge of the tibia and ankle joint are extensive and traumatic [2]. This can lead to blood loss and increases the risk of purulent complications.

Known methods of closed reposition and fixation using special apparatuses [3, 4]. However, the constant wearing of the apparatus on the limbs leads to the risk of development of purulent-inflammatory complications around the spokes and rods of the apparatus [5].

Closest to the proposed method is the method described in the description of the copyright certificate of the USSR No. 1329777, 1986 [6]. The method includes closed transdermal insertion into a broken fragment of the posterior edge of the repairing element, subsequent reposition by lowering the broken fragment and its subsequent fixation to the tibia, then passing through the fragment to the tibia of the knitting needle and removing the reponent element, then removing the outer parts of the knitting needles by immersing the knitting needles into soft tissue under the skin.

However, reposition is difficult in this case, since the uneven surfaces of the fracture zone on the tibia and on the displaced posterior edge are in contact, interlock, and friction force occurs, because typical type of displacement is characteristic - up. This circumstance is aggravated by the fact that the Achilles tendon and soft tissues press the fragment to the edge of the tibia [7]. The known method also provides for the repair of the elements (threaded needles) on both sides of the Achilles tendon. However, this is traumatic, since large vessels and nerves, namely the posterior tibial artery and vein, the tibial nerve [8], which can be damaged, pass near the inner edge of the tendon.

The claimed invention solves the problem of creating a method of closed reposition and fixation of the distal epiphysis of the tibia, providing an unhindered comparison of the posterior edge of the distal epiphysis of the tibia and less traumatic.

The technical result when using the claimed invention is to facilitate the implementation of the method and reduce its morbidity due to a more accurate comparison of the broken fragment with the line of fracture of the tibia.

This technical result is achieved by the fact that with closed reposition and fixation of fractures of the posterior edge of the distal epiphysis of the tibia, which includes closed percutaneous insertion of the repairing element into the broken fragment of the posterior edge, subsequent reposition of the posterior edge by lowering it, followed by fixation to the tibia with threaded needles, the reponent element is inserted into the broken posterior edge from the side of the outer edge of the Achilles tendon, previously displacing the Achilles tendon, then, using a repo iruyuschego element tibia fragment is displaced posteriorly of the fracture line on the magnitude of the largest protrusion along the fracture line, and then degrade the fragment before placing fracture fragment lines and the tibia on one level, then displaced fragment forward and pressed against the tibia until recovery congruence joint.

The inventive method of closed reposition and fixation of a fragment of the posterior edge of the distal epiphysis of the tibia is illustrated in the drawing, where 1 is a reponent element located in the sleeve 2 and fixed by a bolt 3 to the bracket 4. The sleeve 2 has holes 5 for needles with a diameter of 2.5 mm. The bracket 4 is attached to the external support 6 and can be moved vertically by rotating the nuts 7. The external support 6 is fixed to the tibia 8 using arcs 9 with 10 needles.

To implement the method after general or local anesthesia on the middle and lower third of the lower leg, the external supports are fixed with 6 spokes 10 so that the bracket 4 is located at the level of the fracture of the posterior edge of the tibia. The Achilles tendon is shifted medially by finger pressing, through the puncture of the skin, the reponent element 1 is inserted all the way into the fragment of the posterior edge 11. After this, the sleeve 2 is fixed in the bracket by rotation of the bolt 3. Then, the reponent element 1 is rotated until the end having the corkscrew cut is inserted into the fragment 11 (position "a" in the drawing). Depth of penetration is determined by preoperative radiographs in the lateral projection. Then the bolt 3 is loosened, by pulling over the end of the reponent element 1, fragment 11 is displaced posteriorly by the size of the largest protrusion along the fracture line, after which the clutch 2 with the reponent element 1 is again fixed in the bracket 4 (position “b” in the drawing).). By rotating the nuts 7, the bracket is shifted down to the location of the fracture lines of the fragment 11 and the tibia 8 at the same level, which is confirmed by the control x-ray (position "in" in the drawing). Then, the bolt 3 is loosened, the reponent element 1 is shifted anteriorly until the fragment 11 stops in the tibia 8 (position “g” in the drawing).

After this, the fragment 11 is fixed transversely threaded needles 12 to the tibia. The reponent element 1 and the outer supports 6 together with the spokes 10 are removed (position “d” in the drawing). The threaded needles 12, after squeezing out the soft tissues, are bitten with nippers and immersed under the skin. A plaster cast is applied for 10-12 days before the swelling subsides, then they begin to develop movements in the ankle joint without resting on the limb. 6-8 weeks after surgery, the needles are removed and allowed to walk with a metered load. Full load is allowed from 2.5 months.

Example 1

Kochetova Valentina Petrovna, born 1940, trauma on the street on January 29, 2005, accidentally slipping, turned up her left foot, on January 29, 2005 she turned to a trauma center and was sent to the department, medical history No. 8332. Diagnosis: closed fracture of both ankles of the left tibia with a rupture of the tibiofibular syndesmosis and a detachment of 1/3 of the posterior edge of the tibia with displacement. On February 2, 2005, after examination and preliminary preparation, an open osteosynthesis of the inner ankle was performed, contraction of the tibia syndesmosis and posterior edge of the tibia of the left tibia according to the method described above. The operation lasted 40 minutes, with virtually no blood loss. After the operation, a plaster cast was applied. The postoperative course is smooth, the wound healed by primary intention. Antibiotic therapy has not been used. The plaster cast and sutures were removed on 02.10.2005, the patient began to develop movements in the left ankle joint without resting on the limb. Discharged for outpatient follow-up on February 11, 2005. March 30, 2005. The spokes were removed during repeated hospitalization in the hospital. The patient was allowed walking with a dosed load. 2.5 months after the operation, the full load on the left ankle joint was allowed. When viewed after 3.5 months from the day of surgery, the range of motion in the left ankle joint is complete, no complaints.

Example 2

Maykov Sergey Alexandrovich, born in 1970, an injury on the street March 22, 2005, turned up his left foot. 03/22/2005, he turned to the trauma center and was sent to the department, medical history No. 8952. Diagnosis: closed fracture of both ankles of the left lower leg with a margin of 2/5 of the posterior edge of the tibia, with subluxation of the foot outward and posteriorly. On March 24, 2005, after examination and preliminary preparation, an open osteosynthesis of the inner ankle, closed osteosynthesis of the outer ankle, and closed osteosynthesis of the posterior edge of the tibia of the left tibia were performed using the method described above. The operation lasted 35 minutes, intraoperative blood loss during osteosynthesis of the posterior margin was not observed. After the operation, a plaster cast was applied. The postoperative course is smooth, the wound healed by primary intention. Antibiotic therapy has not been used. The plaster cast and sutures were removed on April 2, 2005, the patient began to develop movements in the left ankle joint without resting on the limb. Discharged for outpatient aftercare on April 3, 2005. On May 29, 2005, the spokes were removed during re-hospitalization. The patient was allowed walking with a dosed load. 2.5 months after the operation, the full load on the left ankle joint was allowed. When viewed after 3 months from the day of surgery, the range of motion in the left ankle joint is complete, no complaints.

The method facilitates reposition by displacing a fragment of the posterior edge of the tibia posteriorly, due to which the fracture is wedged and then freely reduced. Since both the reponent element and the locking threaded spokes are held along the outer edge of the Achilles tendon, where there are no main vessels and nerves, the invasiveness of the intervention is reduced.

Information sources

1. Ankin L.N., Ankin N.L. Practical traumatology. European standards - M .: Book-plus, 2002, p. 365, 376-377.

2. Damage to the ankle joint // In the book. “Traumatology and orthopedics. A manual for doctors "in 3 volumes // ed. SOUTH. Shaposhnikova, vol. 2, p. 393.

3. A.S. No. 1371695 (1979). Device for reposition and fixation of fragments of tibia bones.

4. A.S. No. 1644637 (1979). Edinak device for osteosynthesis of fractures.

5. Shpilevsky I.E. et al. Prevention of soft tissue inflammation around the spokes of an external fixation device // Modern aspects of traumatology and orthopedics: Abstracts dokl. - T.XLII - Kazan: Medicine, 1994 .-- pp. 110-111.

6. A.S. No. 1329777 (1986). Device for reposition and fixation of the ankles.

7. Shabanov A.N., Kai I.Yu., Sartan V.A. Atlas of ankle fractures and their treatment - M .: Medicine, 1972, p. 47.

8. Sinelnikov R.D. Atlas of Human Anatomy - M .: Medicine, 1973, in 3 volumes, vol. 2, p. 356, 418; t.3, p.240.

Claims (1)

A method of closed reposition and fixation of fractures of the posterior edge of the distal epiphysis of the tibia, including closed transdermal insertion of a posterior element into a broken fragment of the posterior edge, subsequent reposition of the posterior edge by lowering it, and then fixing it to the tibia with threaded knitting needles, characterized in that the repair element is fixed to the bracket , the bracket is located at the level of the fracture of the posterior edge of the tibia, with the possibility of its vertical movement, rotate the reponent e an element until its end is inserted into the broken posterior edge of the fragment from the outer edge of the Achilles tendon, previously displacing the Achilles tendon, then, using the reponing element, the fragment is displaced posterior to the fracture line by the size of the largest protrusion along the fracture line, after which the bracket is moved down to placing the fracture line of the fragment and the tibia at the same level, then the reponent element is shifted anteriorly until the fragment stops in the tibia.