RU2330626C1 - Method of temporary fixation of cortical bone fragments - Google Patents

Abstract

FIELD: medicine; orthopaedics.

SUBSTANCE: fixation device is installed on cortical bone. Bone fragments are fixed by means of replaceable perforated surrounding cortical bone. After that tape is fixed in mobile clamp of fixation device. Tape is tightened by means of clamp prior to bone fragments approximation. Mobile clamp is stabilised in required position by means of rack holder. Fragments fixation is followed with osteosynthesis with lag screw or bone plate. Then, unfastening perforated tape from mobile clamp, device is demounted of the bone. Lag screw used for osteosynthesis is taken through aperture in perforated tape. Fixation device used for osteosynthesis procedure is installed on cortical bone which has bone plate preliminary applied. In case of long oblique fractures two and more fixation devices are used.

EFFECT: method provides reliable fixing of reduced bone fractures and simplification of following installation of permanent fixation device.

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Description

The invention relates to medicine, namely to traumatology and orthopedics, and can be used for temporary fixation of fragments of the tibia in oblique fractures, as well as temporary fixation of fragments of other long tubular bones.

A known method of temporary fixation of long tubular bones by forming a ligature of the bone with the Way-Param tape [B. Boychev, B. Konforti, K. Chokanov, “Surgical traumatology and orthopedics”. Medicine and physical education, Sofia, 1961, p.87].

The disadvantages of this method: it is used to fix bone fragments for the entire treatment period, the ligature is not a reliable method for such a long use, it is impossible to use this method for intraoperative fixation of fragments.

The closest way to temporarily fix fragments of tubular bones, including mounting a fixing device on a tubular bone, is to fix using a device made in the form of ticks, Lambbott fixation forceps [V. P. Voznesensky, V. A. Ivanov, “Surgery and topographic anatomy” ", Medgiz, Moscow, 1959, p.69].

The disadvantages of this method: the difficulty of installing a device that fixes bone fragments on the operated bone due to its bulkiness, the inability to implant a bone plate without removing this device from the bone.

The technical task and the positive effect of this proposal is a more reliable intraoperative fixation of repaired bone fragments and simplification of the subsequent installation of a permanent fixation device, such as a tightening screw or plate.

This is achieved due to the fact that the method of temporary fixation of fragments of tubular bones involves mounting a fixing device on a tubular bone containing a removable perforated tape that is circled around the damaged bone, fixed in a movable clamp, which is equipped with a fixing device, using a clamp, pull the perforated tape to comparison of bone fragments, then the movable clamp is stabilized in the required position with the help of a rack retainer, and then tightening wines are installed t, which, if necessary, is carried out through the hole in the perforated tape, and a bone plate, which, if necessary, is preliminarily applied to the bone before mounting the fixation device, which can be one or more depending on the length of the oblique fracture.

The method is illustrated by drawings, where:

figure 1 - oblique fracture of a long tubular bone,

figure 2 - temporary fixation of bone fragments in the required position using the device,

figure 3 - diagram of the device in the assembled state,

figure 4 - addition of fixation of fragments with a tightening screw,

figure 5 - dismantling of the device from the bone,

figure 6 - installation of the osseous plate and its fixation using the device,

Fig.7 - fixing the plate to the bone using screws,

Fig.8 is the result of osteosynthesis.

The device implementing the method comprises a base 1; a tape 2 made of metal or a polymer material with fullerite content to increase its elasticity, strength and resistance to high temperatures during sterilization, with holes 3; a latch 4 securing the tape 2 to the base of the device 1; the working part 5 of the base 1 with a slot 6 for tape 2; auxiliary part 7 of the base 1; clamp 8; the fixed part 9 of the clamp 8; the movable part 10 of the clamp 8; screw 11 clamps 8; slots 12 for sliding the movable part 10 of the clamp 8; rack lock 13 to stabilize the clamp 8, fixed to the base 1 of the device using hinges.

Temporary fixation of the tubular bone according to the method for simple oblique fracture is as follows.

They make access to the site of fracture of the tubular bone, expose the bone fragments to a sufficient extent to make it possible to fasten them to each other with tape 2 (Fig. 1). The tape 2 is fixed to the working part 5 of the device using the latch 4. The free part of the tape 2 is circled around the bone at the fracture site, after which it is inserted into the slot 6 of the working part of the device. Then the same free part of the tape 2 is preliminarily passed through the clamp 8. If the displacement of bone fragments is significant, then the assistant repositions and stabilizes them, while the surgeon fixes the free part of the tape 2 in the clamp at this time. This is done as follows: the clamp 8 is tilted forward, since it is fixed to the base 1 of the device using hinges, after which the tape 2 placed in the clamp 8 is clamped with a screw 11. The clamp 8 with the tape 2 fixed in it is tilted in the opposite direction (back ), thus the tape 2 is stretched and presses the bone fragments to each other (figure 2). For complete stabilization of the device and its autonomous operation, the clamp 8 is fixed motionless with a rack lock 13 (Fig.3). Then proceed to install the tightening screw 14 (figure 4). If necessary, the tightening screw 14 is carried out directly through the hole 3 in the belt 2. This should not subsequently prevent the removal of the device, since the diameter of the hole 3 is larger than the diameter of the screw head. The installation of a tightening screw provides primary stability at the fracture site, therefore, the device is removed from the bone (Fig. 5). Then, for more stable fixation of the fragments, a osseous plate 15 is installed and fixed using the device in the same way as the bone fragments were previously fixed for installing a tightening screw (Fig. 6). They begin to fix the plate 15 to the bone using screws 16 (Fig. 7) and, as it is fixed, dismantle the device from the bone (Fig. 8).

When carrying out osteosynthesis without the use of tightening screws, the osseous plate 15 is mounted on top of the tape 2, which, in turn, fixes bone fragments. However, it must be remembered that the screws securing the plate to the bone should not be carried out through the hole 3 in the tape 2, since it will not be possible to remove the device. With the correct installation of the osseous plate, the device for temporary fixation of fragments of tubular bones is removed by pulling the tape 2 from under the osseous plate, after which the plate is finally fixed to the bone by tightening the installed and installing the remaining screws. If the installed plate is a LCP (Locking Compression Plate) plate and does not require a tight fit to the bone, then final installation is made, and then the device is dismantled.

The implementation of this method with long oblique fractures to increase the stability of temporary fixation of fragments involves the use of two described devices.

Clinical example. Patient P., 36 years old, with a diagnosis of closed oblique fracture of the left tibia with displacement of fragments, was admitted to the hospital for surgical treatment. During the surgical examination, it was decided to make this patient metal osteosynthesis of the left tibia with an LCP plate using this method of temporary fixation of bone fragments. During the operation, access to the tibia, reposition of fragments and installation of the device used in this method were made by circling the perforated tape around the bone, tensioning and stabilizing it using a movable clamp of this fixing device. Then the surgeon without the help of an assistant implanted the LCP osseous plate. There is a gap between the plate and the bone, so nothing prevented the pulling of the perforated tape in this gap and the dismantling of the fixing device from the bone. The postoperative period was uneventful, and on the tenth day the patient was discharged from the hospital with recommendations.

Thus, the positive effect of this device is that it is possible to fix bone fragments with a tightening screw and / or bone plate during surgery without removing the device from the bone.

Claims (4)

1. A method for temporary fixation of fragments of tubular bones, including mounting a fixing device on a tubular bone, characterized in that the bone fragments are fixed using replaceable perforated tape by circling it around the tubular bone, after which the tape is fixed in a movable clamp of the fixing device, then the tape is tensioned using a clamp to compare bone fragments, the movable clamp is stabilized in the required position using a rack retainer, after fixing the fragments metalosteosynthesis extramedullary tightening screw or plate, and then, releasing the perforated web of the movable clamp, disassembled device with the bone. 2. The method according to claim 1, characterized in that when carrying out metal osteosynthesis, a tightening screw is carried out through an opening in a perforated tape. 3. The method according to claim 1, characterized in that when carrying out metal osteosynthesis, the mounting of the fixing device is carried out on a tubular bone with a bone plate preliminarily superimposed on it. 4. The method according to claim 1, characterized in that for long oblique fractures using two or more fixing devices.

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