RU2324445C2 - Method of osteosynthesis of distal fractures of humeral bone with supporting femoral condylar plate - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: plate is pre-modeled according to the posterior surface of the humeral bone taking in account the anatomic shapes in its distal part. The plate is placed along the posterior surface of the humeral bone so as the plate's incision corresponds to the circuit of antecubital fossa. The plate is fixed with 4-6 screws to the short distal fragment and with 4 screws to the proximal humeral bone fragment.

EFFECT: method provides repair of elbow joint and prevents post-surgery complications.

21 dwg, 2 exr

Description

The invention relates to medicine, in particular to traumatology and orthopedics, and is used in the treatment of fractures and false joints of the distal humerus.

Several methods are known for osteosynthesis of distal humerus fractures, the essence of which is the fixation of fragments by straight plates with a thickness of 4.5 mm along the posterior surface of the humerus or by plates ^of _1/2 tube along the lateral surfaces of the humerus (1).

There is also known a method of fixing fragments with a Y-shaped plate, while its branches are located on the lateral and medial columns of the humerus, which we selected as a prototype. After wound healing, plaster immobilization is carried out for 4-6 weeks (2).

This method of osteosynthesis is characterized by insufficient fixative strength and requires the use of external immobilization for 4-6 weeks, which leads to the development of contractures in the elbow joint. In addition, there were cases of fixative fracture and the formation of a false joint, which reduced the effectiveness of the method and increased the duration of treatment. The disadvantage of this method is the impossibility of active movements from the first day after the operation.

The technical result of the present invention is the fixation of fragments of the distal shoulder, the stability of fixation, the execution of movements from the first day after the operation, the full restoration of the function of the elbow joint, since external immobilization is not used.

The result of the invention is achieved in that the method of osteosynthesis of distal humerus fractures, including the use of a supporting condyle of the femur, is characterized in that the plate is pre-modeled on the posterior surface of the humerus taking into account its anatomical shape, in a short distal fragment, 4-6 cortical 4.5 mm screws and 4 screws in the proximal fragment, which ensures the stability of the fragments, which is the main condition for bone fusion and the possibility of early active movements in the elbow joint.

The compliance of the technical solution with the criterion of "novelty" is determined by the absence in the prior art of an identical technical solution to achieve the claimed result.

Compliance with the criterion of "inventive step" was determined by the fact that our solution does not follow explicitly from the prior art, and also by the fact that the effect achieved by the proposed solution was discovered by chance by the applicant himself. The use of a support condylar femoral plate for osteosynthesis of distal shoulder fractures solved several problems: a) stable fixation of the fracture, allowing 4-6 cortical screws in a short distal fragment, b) the possibility of early active movements in the elbow joint, which is the basis for the prevention of contractures, in ) the ability to refuse any external immobilization, which allows patients to return to work immediately after the removal of sutures, d) the possibility of using the technique for non-consolidated fractures and are false x joints of this localization.

Compliance with the criterion of "industrial applicability" is determined by the effectiveness of the treatment of fractures and pseudoarthrosis of the distal humerus, which supports the interest of public health in them, ready to move on to the widespread implementation of the proposed method, for which it is advisable to obtain patent protection of a new development.

The drawings show:

Figure 1. Support condyle femoral plate in direct projection.

Figure 2. Supporting condyle femoral plate in lateral projection.

Figure 3. Precurved support condyle femoral plate in direct projection.

Figure 4. Precurved support condyle femoral plate in lateral projection.

Figure 5. Precurved support condyle femoral plate in direct projection on the humerus.

6. Precurved support condyle femoral plate in lateral projection on the humerus.

7. Radiographs of patient Sh. In direct projection during hospitalization.

Fig. 8. Radiographs of patient Sh. In lateral projection during hospitalization.

Fig.9. Radiographs of patient Sh. In lateral projection during hospitalization.

Figure 10. Radiographs of patient Sh. In direct projection after surgery.

11. The functional result of patient C. after 3 weeks (complete flexion in the elbow joint).

Fig. 12. The functional result of patient C. after 3 weeks (complete extension in the elbow joint).

Fig.13. Radiographs of patient C. 3 months after surgery - consolidation of the fracture in the lateral projection.

Fig.14. Radiographs of patient C. 3 months after surgery - consolidation of the fracture in direct projection.

Fig.15. Radiographs of patient K. during hospitalization.

Fig.16. Radiographs of patient K. in lateral projection after surgery.

Fig.17. Radiographs of patient K. in direct projection after surgery.

Fig. 18. Radiographs of patient K. 3.5 months after the operation — consolidation of the fracture in the lateral projection.

Fig.19. Radiographs of patient K. 3.5 months after surgery — consolidation of the fracture in direct projection.

Fig.20. The functional result of patient K. after 3 weeks (complete extension in the elbow joint).

Fig.21. The functional result of patient K. after 3 weeks (complete flexion in the elbow joint).

The method of osteosynthesis of distal fractures of the humerus of the supporting condyle femoral plate is as follows. Soft tissue to the bone is cut through a straight cut along the posterior surface of the shoulder in the patient’s position on the abdomen, if necessary, the radial nerve is visualized, only the posterior surface of the humerus, the ulnar fossa and the medial and lateral columns of the humerus are exposed. After that, the fracture is repositioned and the plate is laid on the back surface of the shoulder so that the cutout of the plate matches the contour of the ulnar fossa, the plate is fixed with 4.5 mm cortical screws to the bone.

The wound is sutured in layers. Gypsum immobilization is not imposed, from the first day after the operation, active movements in the elbow joint are allowed. The fixators are usually removed 1 year after surgery.

The method of osteosynthesis by the supporting condyle femoral plate is more stable compared to the prototype, since it does not require immobilization, the period of incapacity for work is reduced, since the patient can begin to work without waiting for the fracture to heal. Complications in the postoperative period were not observed in any of the patients operated on by the proposed method.

Clinical example 1

Patient Sh. During arm wrestling received a fracture of the distal humerus with displacement of fragments. With a diagnosis of closed oblique fracture of the lower third of the right shoulder with the displacement of fragments hospitalized in the clinic of the institute. 3 days after the injury, the patient according to the proposed method underwent surgery of the osteosynthesis of the humerus of the supporting condyle femoral plate. After 3 weeks, the patient had completely restored the range of motion in the elbow joint and after 3 months there was consolidation, confirmed by control radiography.

Clinical example 2

Patient K., when falling from a motorcycle, received a fracture of the distal humerus with displacement of fragments. He was treated in a thoracobrachial plaster cast for 3 months in one of the hospitals in the city. After removing the bandage, refracture occurred during the development of movements in the elbow joint. With a diagnosis of an overgrown oblique fracture of the lower third of the left shoulder with displacement of fragments, he was hospitalized in the clinic of the institute. 3.5 months after the injury, the patient according to the proposed method underwent surgery of the osteosynthesis of the humerus with the support condyle femoral plate. After 4 weeks, the patient had completely restored the range of motion in the elbow joint and after 3.5 months there was consolidation, confirmed by control radiography.

List of used literature.

1. M.E. Muller, M.A. Allgover, R. Schneider, H. Willinger. Guide to internal osteosynthesis, translation into Russian - Ad.Marginem Publishing House, Moscow, 1996.

2. S.G. Girshin. Clinical lectures on emergency traumatology, Moscow, 2004.

Claims (1)

A method for osteosynthesis of distal humerus fractures, including the use of a support condyle of the femur plate, characterized in that the plate is pre-modeled on the posterior surface of the humerus taking into account its anatomical shape in the distal section and the plate is placed on the posterior surface of the shoulder so that the cutout of the plate matches the contour of the ulna the fossa and fix it with 4-6 screws to the short distal fragment and 4 screws to the proximal fragment of the humerus.

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