RU2327427C1 - Method of enclosed osteosynthesis of cotyloid cavity fractures - Google Patents

Abstract

FIELD: medicine; traumatology.

SUBSTANCE: skin is punctured 1 cm deep in area of ischial tuberosity. Under X-ray image intensifier control, pin threaded 2 mm is closely installed through puncture in area of ischial tuberosity, through fracture line extraarticularly to iliac bone body. Canal is shaped along pin with cannulated drill, and osteosynthesis is performed with screw of proper length and diameter 7.3 mm. Within next stage under X-ray image intensifier control, threaded pin is closely installed through iliac bone body 2 cm higher of cotyloid cavity to pubic bone of fractured side. Screw of proper length and diameter 4.5 mm through puncture 1 cm to pubic bone of fractured side. Screws are fastened to bone fracture fragments.

EFFECT: reliable fixation; fracture consolidation; reduced trauma number; eliminated postoperative complications; reduced therapy time.

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Description

The invention relates to medicine, namely to traumatology and orthopedics.

A known method of performing osteosynthesis of an acetabulum using screws. (Guide to Internal Osteosynthesis. M.E. Muller, M. Algover Springer-Verlag. 1996 p. 517).

Significant disadvantages of the above method of surgical treatment of acetabular fractures are the following:

1. the operation is performed from large skin incisions;

2. accompanied by extensive soft tissue injury;

3. usually accompanied by large blood loss;

4. often accompanied by sciatic nerve neuropathy;

5. aseptic necrosis of the femoral head often develops;

6. high risk of inflammatory soft tissue complications.

This method of treating acetabular fractures is taken as a prototype, the disadvantages of which are completely eliminated by our new treatment method.

The purpose of this method is to eliminate the above disadvantages, which allows stable osteosynthesis of acetabular fractures from minimally invasive approaches.

To achieve a medical-technical result, we perform osteosynthesis from two minimal accesses.

The inventive method is illustrated in Fig.1-8.

The method is as follows. A 1 cm skin puncture is made in the region of the apex of the sciatic tubercle. A 2 mm needle is pierced through the skin puncture through the descending branch of the sciatic bone through the fracture line extra-articularly under the control of the tube in the ilium. Measure the required screw length. A canal is formed along the spoke with a cannulated drill. Osteosynthesis is carried out on a spoke with a screw with an incomplete thread with a diameter of 7.3 mm of the previously measured length. The screw is tightened until inter-fragment compression is achieved, which is determined radiologically by eliminating diastasis with the closure of bone fragments.

The next step is also closed under the control of the image intensifier through the body of the ilium 2 cm above the level of the acetabulum, the needle is closed, and the injured side is cut into the pubic body. Measure the required screw length. A screw with a diameter of 4.5 mm is passed through a puncture of the skin of 1 cm into the pubic body of the injured side. The screw is tightened until inter-fragment compression is achieved, which is determined radiologically by eliminating diastasis with the closure of bone fragments (Figure 1).

Practical Application Example:

Patient Avramenko A.V., 21 years old, and / b 4113, received an acetabular fracture as a result of an accident on August 25, 04 (Figure 2), on August 26, 2004 the patient underwent osteosynthesis of the acetabulum in the described manner (Fig. .3).

Since osteosynthesis is performed closed, without blood loss and damage to soft tissues, the patient is activated the next day after osteosynthesis with crutches without loading the left lower limb. The day after osteosynthesis, exercise therapy was started to develop movements in the left hip joint. 12 days after the operation, the wounds healed by first intention, the sutures were removed from the wounds, the patient was discharged for outpatient treatment with the possibility of self-care. After 1 year, during control radiography, the complete union of fractures (Figs. 4, 5, 6, 7).

The patient walks without means of support with a full load on the injured limb, the range of movements in the left hip joint is complete. Achieved complete medical and social rehabilitation of the patient (Fig.8).

We tracked the results of the treatment of 18 patients with acetabular fractures, operated on according to the presented method, in the period from 6 to 18 months. All patients achieved fracture fusion up to a year after surgery.

As a result, the advantages of the proposed method for closed osteosynthesis of the acetabulum are noted:

1. the absence of inflammatory complications;

2. the method is accompanied by minimal blood loss due to minimally invasive approaches;

3. there are no cases of the development of aseptic necrosis of the femoral head and false joints of fractures;

4. there is no development observed in the postoperative period of sciatic nerve neuropathy;

5. Patients can independently get up and walk without load on the damaged lower limb 2 days after the operation.

List of figures

Figure 1 Scheme of screws with closed osteosynthesis of the acetabulum.

Figure 2 Fracture of the left acetabulum.

Figure 3 After osteosynthesis.

Figure 4 Direct projection.

Figure 5 Caudal projection.

6 Obturator projection.

Fig. 7 Iliac projection.

Fig. 8 Patient 1 year after surgery - full load on the left lower limb.

Claims (1)

A method of closed osteosynthesis of acetabular fractures, including the introduction of screws with a diameter of 7.3 and 4.5 mm with an incomplete thread, characterized in that a 1 cm skin puncture is made in the area of the sciatic tubercle, under the X-ray control of the tube, a needle is closed through the skin puncture by cutting 2 mm through the branch of the sciatic bone, through the fracture line extra-articularly into the body of the ilium, then a canal is formed along the spoke with a cannulated drill and osteosynthesis is performed with a screw of the required length with a diameter of 7.3 mm, the next step is also closed under By controlling the image intensifier tube, a needle is inserted through the ilium body 2 cm above the level of the acetabulum with a cut into the pubic body of the injured side, a screw of the required length with a diameter of 4.5 mm is drawn through the puncture of the skin of the pubic bone of the injured side, the screws are tightened to achievement of inter-fragment compression.

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