RU2326615C1 - Method of distal radioulnar joint ligamentous reconstruction - Google Patents

Abstract

FIELD: medicine; traumatology.

SUBSTANCE: joint is accessed by two sections of radial and ulnar ends of lower one-third of forearm. Tunnel is formed by back and volar surfaces over forearm bones. Autograft is led through tunnel around forearm bones. Then head of ulna is set in neutral position of forearm bones. Forearm bones are transosseous fixed with two Kirschner's wires more proximally of ulnar bone. By radial end above radial bone ends of tendinous autograft are sutured followed with forearm immobilisation.

EFFECT: provides reconstruction of proper relation of forearm bones, reliable fixation, and reduced trauma number.

4 dwg, 1 ex

Description

The invention relates to medicine, namely to traumatology and orthopedics, and is used in the restoration of ligaments of the distal radiolbow joint.

With persistent (fixed) chronic dislocations of the ulnar head with a pronounced restriction of movement, resection of the distal end of the ulnar bone 2-2.5 cm long is appropriate. However, this operation, which was considered almost universal, has several disadvantages due to the loss of support for the ulnar half of the wrist joint - instability with possible elbow movement of the hand, weakness of coverage [1].

Known methods of surgical treatment aimed at restoring the stability of the elbow joint with the creation of new ligaments from tendons, fascia, etc. One of these methods — the H. Milcha method [2] —is taken by us as a prototype. The operation is performed using four incisions: ulnar, radial, volar and dorsal. A drill with a diameter of 0.5 cm draw up two tunnels in the radius. From the wide fascia of the thigh, sewn in the form of a tube, the ligament is restored, which is carried out through the made bone channels. The lower end of the ulna is pressed against the plane of the joint of the radius bone, the free ends of the tube are pulled from the fascia and sutured together.

The method is traumatic, technically very complicated. In addition, over time, the tube from the wide fascia of the thigh atrophies (thins), stretches and does not withstand the functional load, which leads to joint instability.

The invention is expressed in the aggregate of essential features sufficient to achieve the desired technical result, consisting in improving treatment outcomes by reducing the invasiveness of the operation and increasing the physiological capabilities of the operated joint.

Keeping in mind that with an isolated displacement of the head of the ulnar bone, the palmar and dorsal radicular ulnar ligaments, the ulnar collateral ligament of the wrist are damaged, we perform a reconstructive operation with the creation of new ligaments from the tendon.

The essence of the invention lies in the fact that the method of restoring the ligaments of the distal radicular ulnar joint includes access to the joint, forming channels under the tendons of the flexors and extensors, conducting an autograft through them, rounding the bones of the forearm, restoring the normal relationship between the radius and ulna, subsequent fixation and immobilization of the limb of the gypsum bandage. Access to the joint is provided from two cuts along the radial and ulnar edges of the lower third of the forearm. The tunnel is formed along the dorsal and voluntary surfaces above the bones of the forearm, after which, in the neutral position of the bones of the forearm, the head of the ulnar bone is set in its place. In this case, the bones of the forearm are transdermally fixed by two Kirschner spokes proximal to the head of the ulnar bone. On the radial edge, above the radius, the ends of the tendon autograft are stitched side by side in the wound with the subsequent immobilization of the forearm.

The proposed method is performed from two sections instead of those proposed in the prototype four. It is also less traumatic because the radial bone is not injured during the operation. Compared with the prototype, the method is technically easy to perform.

The tendon autograft used to pass through the channels around the bones of the forearm is mechanically more durable, does not atrophy and does not stretch, which makes it possible to carry large physical loads.

Less traumatic fixation with two knitting needles for a period of 6 weeks allows you to maintain the correct relationship of the bones of the forearm in the distal radiolar joint.

The proposed method is illustrated by the radiographs shown, where in Fig. 1 is a view of a joint before surgery, in Fig. 2 is a view of a joint in two projections after surgery, in Fig. 3 and Fig. 4 both elbow joints of the patient are shown one year after the operation.

The method is as follows.

From sections along the radial and ulnar edges of the lower third of the forearm, proximal to the head of the ulna, along the dorsal and voluntary surfaces above the bones of the forearm, a forceps form a tunnel. A tendon autograft is passed through this channel around the bones of the forearm. After that, in the neutral position of the bones of the forearm, between supination and pronation, the head of the ulnar bone is pressed (set) into place, the bones of the forearm are transversely fixed with two Kirschner spokes 5-6 cm proximal to the head of the ulnar bone. In a wound along the radial edge of the forearm, above the radius, the ends of the tendon autograft are stitched together side by side. Immobilization of the forearm and fixation with needles for a period of 6 weeks, followed by physiotherapy in an outpatient setting.

Clinical example

Patient Mur-va O.YU., born in 1983, medical history No. 2146, was admitted to the Department of Hand Surgery 06/01/2001 with a diagnosis of chronic rupture of ligaments of the distal radiolar joint (see figure 1). Two years before treatment, she fell with emphasis on her right hand, was treated with a plaster cast.

06/07/01 an operation was performed - plastic ligaments of the distal radiolar joint of the right forearm. From two cuts along the ulnar and radial edges of the lower third of the forearm, through the tunnel formed around both bones (directly above them), a tendon graft was made from a long palmar muscle and a superficial flexor of the fourth finger. The head of the ulna is set and fixed with two knitting needles for 6 weeks (see figure 2). In the wound, along the radial edge of the forearm, above the radial bone, the ends of the tendon autografts are sewn together side by side. Stitches for wounds. Immobilization with a plaster cast for 6 weeks. After removing the spider and removing the patient's needles on an outpatient basis, physiomechanotherapy was performed. The patient was examined after a year: no complaints, satisfied with the result of the operation. A comparative picture of both joints is presented in figures 3 and 4.

Information sources

1. A.I. Ashkenazi. Hand surgery Moscow, Medicine, 1990, p. 215-216.

2. B. Boychev et al. Surgical orthopedics and traumatology. Sofia, 1961, p. 311-312.

Claims (1)

A method for restoring ligaments of the distal radiolbow joint, including access to the joint, forming channels under the tendons of the flexors and extensors, conducting an autograft through them around the bones of the forearm, restoring the normal relationship between the radius and ulna with subsequent fixation, immobilizing the limb with a plaster cast, characterized in that access to the joint is provided from two cuts along the radial and ulnar edges of the lower third of the forearm, a tunnel is formed along the dorsal and voluntary surfaces m above the bones of the forearm, after which, in the neutral position of the bones of the forearm, the ulnar head is adjusted in its place, the bones of the forearm are transversely fixed with two Kirschner spokes proximal to the ulnar head, along the radial edge, above the radial bone, the ends of the tendon autograft are sewn side-by-side side with subsequent immobilization of the forearm.

Images