RU2308911C2 - Method for removing rotation shift of osseous fragments at radius fracture - Google Patents

Abstract

FIELD: medicine, traumatology, orthopedics.

SUBSTANCE: the present innovation deals with treating patients at radius fractures in typical site. Along with the traction along the axis one should fulfill relaxing stretching of forearm's muscles, in case of muscular relaxation one should constantly conduct the traction by the first finger. It is important to remove the shift with the effort of the first finger, press the fragment towards radius caput, shift the fragment with the first finger dorsally towards volar side, proximal fragment should be kept with the effort of fingers due to counterpressure, carry out stimulation of supinator muscle, keep the fragments in such position to carry out immobilization that enables to avoid rotation shifts completely.

EFFECT: higher efficiency of therapy.

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Description

The invention relates to medicine, namely to traumatology and orthopedics, and can be used to treat patients with fractures of the radial bone in a typical place: in the wrist joint - the radius.

Currently, several developed methods for treating patients with radial fractures in a typical location with displacement are known; of these methods, the most characteristic is the method that includes the process of closed manual reduction of bone fragments with subsequent immobilization of a plaster cast from the heads of the metacarpal bones to the middle third of the shoulder (Babich B.K. Outpatient treatment of fractures. M: Medgiz, 1952; Smetanin B.F. Rational methods of reposition of the beam fracture in a typical place. Kazan, Medical journal, No. 2, 1965, p.65).

The essential and obvious drawbacks of this method of treatment for a fracture of the radius with a displacement in a typical place is the incomplete list and scope of the actions performed with the damaged bone and its fragments, which leads to a defect in the fusion site and a disruption in the physiological functions of the arm due to significant restrictions on rotational movements in the forearm, wrist and wrist joints, dramatically reducing the quality of human life.

A known method of eliminating the rotational displacement of bone fragments during a fracture of the radius in a typical place, including anesthesia of the damaged organ, closed manual reposition of bone fragments of the radius, followed by immobilization with a plaster cast with overlays and rounds from the head of the metacarpal bones to the middle third of the shoulder of the damaged arm (Degen .L. To the technique of reposition of fragments in case of fracture of the radius in a typical place. Orthopedics, traumatology, prosthetics, 1962, p. 74-75). The method, without eliminating the rotational displacements, leads to the restriction of rotational movements.

The closest is the method of the same purpose, described in the Guide to traumatology, orthopedics, ed. Yu.G. Shaposhnikova vol. 2, 1977, Medicine, 215-218. Having certain advantages over analogues, this method has significant drawbacks: the method is carried out without the necessary instrumentation and analytical support for the elements of operations that allow the participation of insufficiently qualified medical personnel to eliminate the rotational displacement of bone fragments when they are displaced simultaneously in several projections: fracture of the Wheel type and Smith type , which leads to an unrepaired rotational displacement, to a restriction of the rotational movements of pronation and supination, and is the cause of the decline in the quality of life of the victim.

The technical result of this method is the implementation of the most accurate comparison of bone fragments during a fracture of the radial bone in a typical place with the complete elimination of displacements: angular, in width, and rotational in a limited compressed time (about 20 min), leading to the most rapid healing of the fracture, reducing the number days of labor without the activities of the victim.

This in the invention is achieved through the implementation of a method for eliminating the rotational displacement of bone fragments during a fracture of the radius, including anesthesia of the damaged organ, closed manual reposition of bone fragments of the radius, followed by immobilization with a plaster cast with the application of splints and rounds from the head of the metacarpal bones to the middle third of the shoulder of the damaged arm , while successively produce traction along the axis of the forearm due to the application of force with one hand of the surgeon to the first finger of the injured hand, one using massage operations performed by the surgeon’s other hand, they perform a relaxing kneading of the tense muscles of the injured arm and, at the same time, stretch the second to fourth fingers of the injured arm, and when the massed muscles of the forearm relax, they constantly traction for the first finger of the injured arm with ulnar deviation of the hand, physical effort of the first finger of the second hand of the surgeon eliminates the displacement of the peripheral fragment along the axis and the lateral displacement to the radial side, pressing the fragment towards the head of the ulna, after the transfer of the first finger of the surgeon, the dorsal fragment is pressed onto the peripheral fragment and displaced to the velar side, and the proximal fragment is held back by the pressure imposed by the surgeon’s fingers, then the suparnus muscle is stimulated in the injured arm, and the injured arm is held in position pronation and flexion of the hand - this achieves retention of the distal fragment and crepitation of the proximal fragment, indicating the completion of reposition and elimination of p otational displacement of bone fragments of the radius, fixation of the radius by applying a plaster cast (bandet and rounds) to consolidate the damaged bone and heal the damage.

The described method of eliminating the rotational displacement of bone fragments of the radius is illustrated by drawings, where:

figure 1 shows a hand with a broken radius and a fracture of two types: type of Wheel and type of Smith;

on figa shows a diagram of the implementation of the method of the known method;

on figv and 2c shows the process of implementing the proposed method;

figure 3, figure 4 and figure 5 shows the x-ray of the fracture of the radial bone of the type of Koles (figure 3) and the x-ray of the rehabilitated arm with this type of fracture (figure 4, 5);

6 shows a Smith type fracture;

in Fig.7 and Fig.8 shows a rehabilitated arm with this type of fracture.

Figure 1 shows the arm 1 of the patient, in which the radius bone 2 is broken (injured); typical fractures are: a Koles-type fracture - 3 and a Smith-type fracture - 4. When implementing the method, interact with the first finger of the injured hand in the direction of line 5 and interact with the second - fifth fingers of the same hand in the direction of the arc 6 (Fig. 1 and Fig. .2c) or line 6 depending on the type of fracture. Pressure is also applied to the injured arm and hand in the direction of line 78 (solid arrow) during a fracture of the Koles type; in case of Smith type fracture - in the direction of the dashed arrow 8. Also, in case of a Kolles type fracture, supination is performed in the direction of arrow 9; and with a Smith type fracture, pronation is made in the direction of the dashed arrow 10.

The described method of eliminating the rotational displacement of bone fragments during a fracture of the radial bone is further disclosed with specific examples of its implementation.

Clinical example 1. Patient K.Z., born in 1961, b / l 0127 - t, and / b 4268 was admitted to the traumatology department of the State Pediatric Hospital No. 96 of St. Petersburg, 04/07/05, with a preliminary diagnosis - a fracture of the radius left hand. During examination and radiography, the diagnosis was made: a closed comminuted fracture of the left radial bone in a typical place with a separation of the styloid process (fracture of the Collesla type (Fig. 2c, Fig. 3, Fig. 4). Elimination of the displacement of bone fragments and their combination was carried out by the proposed method, with which anesthetized the injured organ, then successively produced traction along the axis of the forearm due to the application of the surgeon's one-handed effort to the first finger along line 5 (Figs. 1, 2c), while performing massage manipulations of the forearm muscles, - this was done with the fingers of the other hand of the surgeon, while relaxing the muscles, stretching was performed for the second and fourth fingers of the injured hand (Fig.2c), the onset of muscle relaxation allowed constant traction for the first finger along line 5 and the ulnar deviation of the hand along line 6, with physical effort the first finger of the second hand of the surgeon eliminated the displacement of the peripheral fragment along the axis and eliminated the lateral displacement to the radial side, making an effort along line 7 and curve 9 (Fig. 1, 2c), pressing the fragment towards the head of the elbows bone and pressure on the peripheral fragment of the mixer in the voluntary direction, holding the proximal fragment by counter-pressure (by the fingers of the surgeon's hands), stimulated the suparnus muscle of the damaged arm, holding it in the position of pronation and flexion of the hand, which led to the complete combination and crepitation of fragments of the radius indicating the completion of the reposition and the elimination of the rotational displacement of the bone fragments of the radial bone, which is fixed by the application of plaster casts and rounds (plaster cast) during consolidation of damage awaited bone. After rehabilitation and rehabilitation treatment, the patient was discharged with recovery and disability.

Clinical example 2. Patient S.N., 1941 year of birth, and / b-8362, 02/18/05, turned to RNIITO St. Petersburg about a right arm injury. During examination and radiography, the diagnosis was made: a closed fracture of the radius with displacement of fragments in a typical place (Smith type fracture, Fig. 1 pos. 4, Fig. 2c pos. 4, Fig. 6). In this case, the method was carried out as shown in Clinical Example 1, with the difference that during Smith type fracture reposition is carried out by applying guiding forces along line 5, as well as along line 8 and curve 10 (dashed lines shown in FIGS. 1 and 2c). After reposition (Figs. 5, 6, 7, and 8), the displacement of the fragments of the radius bone was eliminated, a plaster cast and rounds were applied to consolidate the fracture, and rehabilitation and rehabilitation treatment was performed, after which the patient was discharged with recovery and disability.

Thus, the developed orthopedic method of eliminating the rotational displacement of bone fragments of the radius, as shown by experiments, can be successfully and effectively used to treat patients with these typical fractures of the radius.

Claims (1)

A method for eliminating rotational displacement of bone fragments during a fracture of the radial bone, including anesthesia of the damaged organ, closed manual reposition of bone fragments of the radial bone by stretching along the length of the first finger with one hand and the fourth finger with the other hand, orient the fragments with subsequent immobilization of gypsum a splint from the elbow joint to the head of the metacarpal bones with the application of splints and rounds, characterized in that at the same time as the axial traction, a relaxing kneading of tensed muscles is performed pre shoulders, with the onset of relaxation of the muscles of the forearm, they constantly traction behind the first finger, eliminate the displacement of the fragment by the force of the first finger, press the fragment to the head of the ulnar bone, transfer the fragment dorsally to move the fragment to the velar side, and the proximal fragment is held back by pressure of the fingers, muscle stimulation is performed - instep support, hold the damage in this position and immobilize the patient’s rehabilitated arm.

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