RU2325881C2 - Plaster fixation of shin fracture in case of slow consolidation - Google Patents

Abstract

FIELD: medicine; traumatology.

SUBSTANCE: vertical streak up to 20 mm of width of front surface is cut up in plaster boot, and knee and ankle joints are released. Plaster collar are laid over distal and proximal parts of bandage. Padding between plaster and shin is laid. By bending-unbending of knee joint with overcome of effort of biplicated rubber bandage, fixed at the table, exercise therapy is conducted. In the case of formation of 50%-sized callus it's allowed to stay on two legs during 10-15 minutes. In the case of formation of 70%-sized callus it's allowed to walk full-load. ¾ of length of padding are being removed between sessions of exercise therapy.

EFFECT: prevention of contracture joints and possibility of conduction of differentiated load.

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Description

The present invention relates to the field of bone traumatology and can be used in a method of conservative treatment of lower leg bones with delayed consolidation in order to reduce treatment time. According to the currently used conservative treatment method, after a month of skeletal traction, a circular gypsum boot is applied to the injured limb from the upper third of the thigh to the tips of the toes on the foot to ensure the immobilization of the fracture. The named “reliability” is that Trojan horse. This boot is modeled by three spindles, two of them along the lateral surfaces of the limb, and the third, the largest, along the back surface of the limb from the fingertips above the knee joint, after which the gypsum is strengthened with circular plaster bandages. In some cases, Volkovich’s “stirrup” dressing is used [2]. According to the method used, in the middle of the fixation process, a control radiography is performed, which, as a rule, reveals the absence of signs of consolidation or a sharp slowdown of the latter after 4 months of fixation, in connection with which attempts to stimulate the growth of / from taking "SA" preparations to the eggshell begin, physiotherapy/. All this without changing the functional situation does not give an effect, in contrast to the method used. A significant reduction in the fixation bandage changes the passive treatment tactics to active, and another method is created, characterized in that the functional component is implemented. The problem to which the invention is directed, gives such a result when releasing the knee and ankle joints. Normalization of joint function, “when it is impossible to restore shape” [1], as well as the possibility of early physiotherapy exercises / exercise therapy /, restoration of the axial load on the injured limb is based on the change of the previously applied boot on the gypsum clutch, from the upper third of the leg to the lower / including /. By releasing the joints and removing the destroyed at the same time, on the front surface of the coupling, without removing it, a vertical strip of gypsum is cut up to 20 mm wide [figure 1]. The next step is to model the dressing itself by applying lock rings. This is done by applying gypsum rings proximally and distally, each 60 mm wide [FIG. 2], after the edges of the coupling come closer together.

This one-stage simulation is associated with the following through the latch-retainer and its functional element. The following modeling - functional - the introduction of a retainer pad between the lower leg and gypsum - this fills the free space under the control of sensations: tight, comfortable. The named retainer is a narrow sheet-like cardboard with a thickness of 1-2 mm wedge-shaped from 20 to 10 mm, possibly more, is made ex tempera, tapers in the distal direction, 150 mm long [figure 3]. 2 identical fixators are used: on the back-outer and back-inner surfaces of the lower leg at the same time. In addition to the structural solutions listed above, with the introduction of fixatives, venous filling of the vessels of the lower leg is used depending on the position of the limb: raised - fixatives are introduced.

The introduction of the clamps is fully functional, working, modeling to perform a set of exercises. The third simulation is performed at rest when 3/4 fixers are removed from under the gypsum in between classes / exercise therapy /.

To enhance the effect of exercise therapy exercises, heating with an heating pad is added, followed by wrapping with a towel to maintain heat (for injured after metal osteosynthesis, heating is less intense).

The implementation of the described method is particularly effective in the named sequence:

A) functional modeling; B) thermal procedures - heating the lower leg and foot with a towel; C) massage and self-massage, accompanied by heating of the nearby parts of the leg and foot.

Particular attention should be paid to the small joints of the foot: fingers, metatarsus, tarsus.

During exercise therapy, after passive gymnastics, one should sequentially perform active / with reinforcement with a rubber bandage /; for the ankle joint, rolling a small cylinder / smaller diameter /, a cylinder of 10-15 cm, a large rubber ball with its foot in place.

The final exercises should be a simulation of axial load or different, its value depends on the x-ray picture. Exercises are performed as follows: a double-folded bandage is fixed in the middle of the foot by light tension in the form of a loop, while bending-unbending in the knee joint is carried out with resistance to bandage force. Upon reaching the callus, half of the required set of exercises ends with the following: the load on both n / limbs at rest for 10-15 minutes, standing upright. The implementation of the complex - a multiple increase in it serves to restore muscle tone and increase blood supply and the intensity of consolidation. With all variants of the proposed method, the determining factor is x-ray control. Upon reaching the periendostal bone callus 70% of the full allowed walking with a full load. Long terms of treatment for shin fractures lead to attempts to improve its results: reduce plaster dressings, shorten them below the knee joint [3], Delbe-type annular dressing [6], Sarmient dressing [4]. For a long time, the author independently engaged in such methods, made a report at the Institute of Traumatology and Orthopedics. Harmful in the 90s by the described method at the "bottom of the traumatologist": there were no comments on the author. Of the cases cited in the report, several groups of injured are united according to general laws: the largest group of cases of fractures in the lower third of the lower leg / including A / intra-articular - this group, when any reposition is problematic; B / after metal osteosynthesis with screws, plates: in 2 cases, when fixing with screws, the fracture occurred again and treatment by the method was repeated; during fixation with plates: in 1 case, incorrectly made fixation: 1 screw in soft tissues - adhesion occurred after the implementation of the described method. In / in three cases, external fixation devices were removed on an outpatient basis for various reasons. In 1 cl. spoke osteomyelitis is stopped; another case of osteomyelitis has been stopped during outpatient treatment. G / 2 cases - double fractures of the lower leg. The use of the method in the development of joint stiffness at 60% bone marrow by the described method is indicative, the use of long-term residual disability in the patient-driver is also interesting. D / in the group identified at the reception of bamber fractures [figure 4], the option of maintaining axial load [5] - 3 sl. the method was used as a stage after "stirrup" fixation and regression of phlebothrombosis, in one case with a treatment period of 3 months 2 days, the axial load in this group remained normal. Of the applied it is important to mention the possible change in the size of the gasket to more fill the free space under the gypsum and especially functional modeling should be supportive, comfortable, reliable. The problem to which the invention is directed is to create a method of conservative treatment with delayed consolidation, the treatment stage - the result of which is to normalize the functions of the knee and ankle joints by restoring muscle tone and axial load. The combination of the two stages of treatment: consolidation and rehabilitation with regular determining radiological examination.

The present invention allows, in comparison with the well-known method to implement:

1. An increase in the activity of the treatment itself / exercise therapy, a change in gypsum, imitation of axial load / immediately.

2. Stimulation of fusion - a real restoration of axial load.

3. Three methods of modeling gypsum: 1) one-time; 2) daily work; 3) rest.

4. Change the circular fixation dressing without disturbing the fixation process. The size of the plaster cast depends on the individual characteristics of the injured.

5. Ease of dressing replacement, variability: fenestrated reinforced, plastic.

6. Convenience in the treatment of complications of the main method: eczema, pyoderma, osteomyelitis.

7. The stage of fixation of the fracture is combined with the stage of rehabilitation.

8. The bandage does not fix either the knee or the ankle joints.

9. The ability to replace external fixation devices with a segmental dressing as a stage.

10. Visual control of the skin condition of the damaged segment 1.

11. Regular x-ray examination.

12. The possibility of active use of residual disability.

13. The method is adapted for domestic use after a single briefing.

14. In the process of modeling, elements of physiology are used.

15. Physical activation is clearly reflected in the level of consolidation.

Bibliography

1. KF Wegner, "Fractures and their treatment." A guide for doctors and students. "Moscow". 1926

2. N.M. Volkovich, "Damage to bones and joints." Publishing house of Kiev honey. Inst. 1928

3. V.P. Okhotsky, "Treatment of fractures of the lower leg with a plaster cast." Publishing House of the Sklifosovsky Research Institute "Orthopedics and Traumatology 1985 №12.

4. M. Zeeman, "Dressing technique." Publishing house "Peter". 1994

5 A.V. Kaplan, "Damage to bones and joints." Moscow Publishing House "Medicine". 1979 year

6. N. A. Shestakova A. I. Malkis, “Plaster technique”. Publishing House of Medicine. 1981

Brief description of the drawings:

Figure 1 - Plaster coupling.

Figure 2 - Clutch with lock rings.

Figure 3 - The liner-retainer.

Figure 4 - Xerox ergorenograms of the variant bamber fracture without displacement.

Claims (1)

A method of treating delayed consolidation of shin bone fractures, including applying a gypsum boot and physiotherapy exercises, characterized in that they excise a vertical strip up to 20 mm wide on the front surface in the gypsum boot, release the knee and ankle joints, apply gypsum rings to the distal and proximal parts of the dressing , insert gaskets between the gypsum and lower leg until the free space is filled, warm the lower leg and foot, conduct physical therapy by flexion-extension ia in the joints of the foot, rolling the cylinder with the foot, flexion-extension in the knee joint with overcoming the efforts of the double folded rubber bandage fixed on the foot, and the pads between the gypsum and lower leg are removed 3/4 of the length in the intervals between physical therapy, with the formation of 50% of the sizes bone marrow is allowed to stand on both legs for 10-15 minutes, with the formation of 70% bone marrow is allowed to walk at full load.

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