RU2332184C1 - Method of closed manual ankle dislocation reduction - Google Patents

Abstract

FIELD: medicine; traumatology.

SUBSTANCE: foot and ankle are gripped with both hands, reduction traction is applied along the ankle axis to its distal end with simultaneous countertraction at its proximal end. With the patient lying on the stomach, by flexion of the ankle at knee joint the distal ankle end and foot are positioned so, that the ankle axis is vertical against thigh axis. A medic performs hand grip by placing thumbs to the outer foot and ankle surface along the lateral calf, the other fingers placed to the inner foot and ankle surface along the internal calf. Countertraction is performed by the medic's knee support against the lower third of patient's hip.

EFFECT: momentary fragment resetting; elimination of dislocations in ankle-joint and foot with further fixation, and prevention of recurring dislocations.

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Description

The invention relates to medicine, namely to traumatology and orthopedics, and can be used for closed reposition of ankle fractures in the treatment of intraarticular injuries of the ankle joint, accompanied by subluxation of the foot.

The outcome of the treatment of ankle fractures to a large extent depends on how far the distance to reach the correct position of the fragments during reposition and retention to bone fusion. There is a method of closed manual reduction of ankle fractures with plantar or dorsal talus subluxation, in which, after fixing the distal tibia, the forefoot is bent respectively in the dorsal or plantar direction to its middle position. According to the authors, this allows for treatment taking into account the bias formation mechanism (patent RU 2202970, IPC АВВ 17/56). However, from the description of the patent it is not clear what actions are performed for this by the doctor.

There is a method of closed manual reposition of ankle fractures with displacements, in which the doctor grabs the foot so that one hand is located on the heel, and the other captures the forefoot. The assistant holds the leg by the thigh with a bent knee (traction). The reposition is performed in such a way that the foot is given the position of varus and dorsal inflection, the outer ankle is set with the fingers (in case of a fracture with external displacements) and traction along the longitudinal axis is simultaneously performed. ("Multivolume Guide to Surgery" ./ Edited by V.D. Chaklin, - M .: State Publishing House of Medical Literature, Volume XII, p. 444, Fig. 320). The disadvantages of this method is that to perform the reposition, the doctor needs an assistant to fix the damaged limb during the comparison of fragments: in addition, for various types of fractures, various grips of the ankle joint and foot, and in some cases additional devices are required; difficulties arise when applying a plaster cast, since after comparing fragments it is difficult to keep the fragments in the adjusted state, which leads to their repeated displacement and the need for repetition to be repeated.

There is a method of closed manual reposition of ankle fractures with displacements, in which the patient is placed in a sitting position, bending the leg in the knee joint, while the distal end of the leg with the foot is placed focusing on the doctor’s knee joint, which grab the ankle joint with both hands for reposition and reposition fractures by flexion of the foot and pressure down. Moreover, for each type of ankle fracture, a special grip on the ankle joint and foot is proposed (A.V. Kaplan. "Technique for the treatment of bone fractures." - Medgiz, 1948, p. 282-292) (prototype). The disadvantage of this method is that for each type of ankle fracture, it is necessary to apply various types of grip of the ankle joint and foot with the hands, the need for an assistant when comparing fragments and fixing them.

In addition, in all known methods of reposition, the relaxation of the leg muscles is determined, first of all, by performing local anesthesia, while one of the conditions for successfully achieving restoration of the impaired anatomical integrity of the damaged segment of the limb is to create maximum relaxation of the leg muscles.

The claimed invention solves the problem of developing a universal method of closed manual reduction of ankle fractures with the elimination of subluxations of the foot, which could be successfully performed by one doctor without an assistant.

The technical result is the development of a universal capture of the foot and ankle joint, which allows for simultaneous reposition of fragments and elimination of all types of displacements in the ankle joint and foot with subsequent fixation, as well as the creation of physiologically favorable conditions for this.

To this end, we propose a method of closed manual reposition of ankle fractures, including grabbing the foot and ankle joint with both hands and applying a repositional traction directed along the axis of the shin to its distal end while creating a traction in the proximal end, in which, after laying the patient on the abdomen by bending the shank in to the knee joint, the distal end of the lower leg with the foot is brought into a position where the axis of the lower leg is set vertically to the axis of the thigh, grabbing the hands of the foot and ankle joint displacements thumbs (doctor) on the outer surface of the foot and ankle along the lateral malleolus, and the rest of the fingers on the inner surface of the foot and ankle along the inside of the ankle and knee protivotyagu create emphasis physician joint in the lower third of the patient's thigh. In the claimed method for the reposition of ankle fractures, bending the lower leg in the knee joint at a right angle while the patient is in a position on the abdomen provides maximum relaxation of the lower leg muscles, grabbing the hands with the above-described method is universal for manipulating with any type of fracture with any displacements, since with this grasp it is possible various manipulations without interception of hands. Due to the fact that traction and the creation of a traction at its proximal end is performed by one doctor, the synchronization of the action of traction and traction forces at the time of reposition is created. The doctor performing the reposition is in a comfortable position for work. Associated fragments after reposition are held by hands, without interfering with the application of gypsum immobilization.

The claimed method is illustrated by drawings and photographs.

On figa shows the position of the patient laying on his stomach; on 1b - the position of the patient when bending the lower leg in the knee joint at an angle of 90 °, when the axis of the lower leg is installed vertically to the axis of the thigh; on figv and 1g arrows show the direction of forces at the time of reposition. The photographs clearly show the position of the limb during reposition, the position of the doctor’s hands with the grip described above (photo 1, photo 2), performing flexion of the foot at various displacements (photo 3-7).

To implement the claimed method after anesthesia, the fracture site of the patient is laid horizontally on a viewing couch (Fig. 1 a). The doctor becomes from the edge of the couch from the side of the damaged limb, bends the lower leg in the knee joint at a right angle (Fig. 1b), then sets his knee joint on the lower third of the thigh of the injured limb (patient), creating a counter-support (Fig. 1b), grabs with both hands patient's foot (outside). With this grip, the thumbs of the doctor rest on the outer surface of the foot and ankle joint along the lateral ankle, and all other fingers - on the inner surface of the foot and ankle joint, along the inner ankle. The heel and the anterior arch of the foot are in a fork between the first finger and the other fingers of the right and left hand. Photo 1 shows the position of the limb, the doctor’s knee counteract in n / a third of the patient’s thigh. Capture of the foot and the position of the doctor's hands during reposition - the location of the fingers on the inner surface of the foot and ankle joint (side view). Photo 2 shows the location of the doctor’s fingers on the outer surface of the foot and ankle joint (top view). Photo 3 shows the position of the hands during reposition (side view). Photo 4 shows the implementation of the back flexion of the foot. Photo 5 shows the position of the hands with plantar flexion of the foot. Photo 6 shows the position of the hands during supination of the foot. Photo 7 shows the position of the hands during the propanation of the foot. Doctor's actions: without changing the position of the hands and emphasizing the knee on the lower third of the patient's thigh, traction of the foot along the axis of the lower leg is performed. After that, without changing the grip, the foot is moved by the movement of the hand to the position or supination, and its front section to the position of adduction; or to the position of propanation, and the front to the abduction position. If necessary, working with the hands and not changing the grip of the feet, you can put the foot in the position of the back flexion or plantar extension.

Example 1

Patient I. 25 years old, husband., I.B. No. 326. DS. Closed fracture of the lateral ankle and medial ankle with subluxation of the foot outward (Dupintren fracture, injury mechanism - pronational-abduction). Treatment: a closed reduction was performed by the claimed method with the removal of the foot to the supination and adduction position. Result: the complete elimination of the displacement of fragments and subluxation of the foot. Plaster immobilization.

Example 2

Patient M. 53 years old, female, I. B. No. 615. DS. Closed fracture of the inner ankle, lateral ankle and subluxation of the foot outside. (The trauma mechanism is supination-adduction.) Treatment: a closed reposition by the claimed method was performed with the foot in the pronation and abduction position. Result: the complete elimination of the displacement of fragments and subluxation of the foot. Plaster immobilization.

The practice of treating ankle fractures with the claimed method has shown good results: a doctor alone without an assistant simultaneously performs a closed reposition of fractures, eliminating all types of displacements; when performing gypsum immobilization there are no repeated displacements, which significantly improves the quality of treatment; the versatility of the claimed method allows to increase the technical skills of a traumatologist.

Claims (1)

A method of closed manual reposition of ankle fractures, including gripping the foot and ankle joint with both hands and applying a repositional traction directed along the axis of the shin to its distal end while creating a traction in the proximal end thereof, characterized in that the lower leg is bent in the knee joint in the patient’s position in the abdomen, the distal end of the lower leg with the foot is brought into a position where the axis of the lower leg is set vertically to the axis of the thigh, while grabbing with your hands is performed by placing the thumbs of the doctor on aruzhnoy surface of the foot and ankle along the lateral malleolus, and the rest of the fingers on the inner surface of the foot and ankle along the inside of the ankle and knee protivotyagu create emphasis physician joint in the lower third of the patient's thigh.

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