RU2349278C1 - Method of broken intramedullar metal rod removal from long bone - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention concerns medicine, particularly traumatology and orthopedics, and is intended for broken intramedullar metal rod removal from long bone. In cortical layer of bone fragment above intramedullar metal rod and artificial joint fracture a wedge-shaped cortical transplant is formed with basement width equal to medullar canal width. First a shorter metal rod fragment and then the remaining part is removed through obtained 'hole'. Further the transplant is inserted into medullar canal of upper bone fragment and brought down into lower fragment canal till complete impaction overlapping artificial joint zone.

EFFECT: recovery of extremity functioning, limited operation zone, provision of conditions for bone consolidation in defect zone, elimination of the need for additional rod fracture removal devices, reduced post-operation complication and trauma rate, reduced term of treatment.

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Description

The invention relates to medicine, namely to traumatology and orthopedics, and can be used to remove a broken intramedullary metal rod from the tubular bone in the conditions of the formed false joint or diastasis between bone fragments at the level of the fracture of the rod.

Known methods and devices for removing a broken intramedullary structure in case of fracture of the leg of the hip joint endoprosthesis:

1. The method of removing a broken leg of an endoprosthesis, which consists in trepanation of the diaphysis of the femur along the entire length of the leg of the endoprosthesis and knocking it with an impact hammer in the direction of the upper pineal gland (Zubek K., Koch P., Lustcnberg A., Ganz R. .. Femoral fractures h following total hip prothesis. Untellchirurg. - 1990. - Bd. 93. - No. 10. - St.467-472).

The disadvantage of this method is the high morbidity, the risk of fracture of the bone, especially the tubular bones of the leg or shoulder.

2. Device for removing a hollow implant from the bone marrow space (Device for removing a hollow implant from the bone marrow space / Popkov V.M., Linnik S.A., Cancer A.V., Neverov V.A., Maltsev A.A., Saplae Raed, Mahamed Abu Khodra, Ermakov EA Application for invention No. 2005121325/14 (024046) dated 07.07.05. Decision to grant a patent for the invention dated 11.29.06.).

The disadvantage of this device is its use only for removal of hollow rods along the length much shorter than the length of the medullary canal, the complexity of the application while maintaining the upper epiphysis of the tubular bone, because this can cause damage to the adjacent joint.

As a prototype for the closest technical nature, we have chosen a method for removing an intramedullary body in a retrograde manner (Neverov V.A., Zakari S.M. Revision hip replacement. St. Petersburg, 1997, p. 57).

Its essence consists in opening the knee joint, trepanation of the bone marrow canal of the femur through the intercondylar space and knocking out the femoral component of the endoprosthesis from below using an intramedullary shaft inserted through the formed window. The cavity of the knee joint is then isolated from the bone marrow cavity and femur with a filling in the form of a piece of autobone taken during the formation of the window. The capsule of the knee joint is sutured, the wound is closed in layers. A pressure bandage is applied (Neverov V.A. and Zakari S.M. Revision prosthetics of the hip joint. St. Petersburg, 1997, p. 57).

The disadvantages of the method, according to the authors of the application, are: high invasiveness, because in fact, both adjacent joints of the tubular bone are damaged, resulting in the development of deforming arthrosis, and purulent arthritis in the early postoperative period. The disadvantages of the method can also include the complexity of the operation, as well as its duration - up to 2.5 hours.

The objective of the invention is the removal of the intramedullary metal rod from the bone marrow canal of the tubular bone in the conditions of its fracture and concomitant false joint or diastasis between bone fragments at the level of the fracture of the rod, as well as reducing the morbidity of the operation and the risk of possible complications, simplifying the operation and shortening its duration, as well as terms of treatment.

The technical result of the invention is to limit the operation to the fracture zone of the intramedullary metal rod and the false joint and create conditions for consolidation of the bone in the zone of the false joint or diastasis of the bone, as well as eliminating the need for additional devices to remove fragments of the metal structure.

The technical result is achieved by forming in the cortical layer of the upper intramedullary metal rod and the false joint a bone fragment from the fracture line of the bone fragment, a wedge-shaped cortical graft with a length of 7-10 cm and a width of a larger base equal to the width of the medullary canal. Then, through the resulting “window”, a shorter fragment of the metal rod is first removed, and then the rest of it. After this, the graft is immersed in the medullary canal of the upper bone fragment and reduced to the canal of the lower to a tight wedge, blocking the area of the false joint.

The method is as follows.

A linear incision up to 10 cm upward from the line of fracture of the rod and the false joint layer by layer reach the site of bone mobility. Thoroughly peel the periosteum and scar tissue along the front surface of the bone from the area of the false joint up. Using an ultrasonic saw, a cuneal wedge-shaped cortical graft of 7-10 cm length with a large base equal to the width of the bone marrow canal is formed in the cortical layer of the upper intramedullary metal rod and the false joint of the bone fragment in the upper fracture line. Through the resulting “window” it is quite easy to use a bone tongs and a hammer to first remove a shorter fragment of a metal rod, and then the rest of it. Scars are excised in the area of the pseudoarthrosis, after which the graft is immersed in the medullary canal of the upper fragment and reduced to the channel of the lower to tight wedging, overlapping the zone of the pseudoarthrosis. After washing the wound, the periosteum is restored. The wound is sutured tightly. After healing and removal of sutures, a circular gypsum dressing is applied with immobilization of adjacent joints for a period of 8 to 16 weeks, depending on the location of the fracture and the type of bone.

Distinctive essential features of the proposed method are:

- the formation in the cortical layer of the upper from the fracture line of the intramedullary metal rod and the false joint bone fragment of the cortical graft;

- the shape of the graft and its size is a wedge-shaped shape 7-10 cm long and a larger base width equal to the width of the medullary canal;

- removal through the resulting “window” of the first shorter fragment of the metal rod, and then the remaining part.

- immersion of the graft in the medullary canal of the upper bone fragment and its reduction into the canal of the lower to a tight wedge, blocking the area of the false joint.

A causal relationship between the salient features and the result achieved

The formation of a cortical graft in the cortical layer of the upper bone fracture from the fracture line of the intramedullary metal rod and the false joint allows the formation of a full graft of the desired shape.

The wedge-shaped form of the graft, as well as its length of 7-10 cm and the width of the larger base, equal to the width of the bone marrow canal, allows the graft to be tightly fixed in the pseudoarthrosis after immersion of the graft in the medullary canal of the upper bone fragment and its reduction into the lower canal, blocking the area of the false joint. A graft length of 7-10 cm is sufficient for osteoplastic stabilization of the pseudoarthrosis. The tight fixation of the graft optimally stimulates its consolidation, as the transplant, being a plastic material, stimulates the development of the vascular network.

Removing fragments of an intramedullary metal rod through one “window”, in contrast to the prototype method, according to which two are formed, is significantly less traumatic. The formation of one "window" is enough to remove fragments of the intramedullary metal rod.

Removing through the resulting “window” first a shorter fragment of the intramedullary metal rod, and then the remaining part of it — is technically convenient to perform.

The set of distinctive essential features is new and allows you to:

- remove the intramedullary metal rod from the medullary canal of the tubular bone in the conditions of its fracture and concomitant false joint or diastasis between bone fragments at the level of the fracture of the rod;

- to exclude trauma to adjacent joints, which contributes to the early restoration of limb function, reduce treatment time and reduce possible complications;

- simplify the operation and eliminate the need for additional devices for removing fragments of a metal structure, which reduces the duration of the operation.

Examples of clinical performance of the method

Example No. 1. Medical history No. 2273. Patient T., 76 years old.

Was admitted to the clinic of traumatology and orthopedics of the hospital. Emperor Peter the Great with complaints of pain in the upper third of the left leg. From the anamnesis it is known that a year ago she was operated on in one of the city hospitals for an oblique-transverse fracture of the upper third of the tibia diaphysis. Produced intramedullary osteosynthesis by a blocking rod.

When viewed in the upper third of the leg, mobility is determined with lateral and vertical loads on the leg. On radiographs, the false joint of the tibia and a fracture of the metal rod at the same level. 01/14/07 operation: removal of metal, bone autoplasty of the false joint. Under spinal anesthesia, a linear incision along the outer edge of the tibial crest in the upper third of the tibia reveals an anteroposterior surface of the bone in the area of the pseudoarthrosis. With the help of an ultrasonic saw from the line of the pseudoarthrosis, a wedge-shaped cortical autograft of up to 10 cm is formed, its larger base is 5 cm wide. Fragments of a metal rod are easily removed through the received “window” using bone tongs and a hammer after preliminary removal of the blocking screws. The bone graft is immersed in the medullary canal of the upper fragment of the bone and reduced to the lower fragment to firmly penetrate. The wound is washed and carefully layered in layers tightly. The duration of the operation is 45 minutes. After removing the stitches, on the 10th day after the operation, a circular plaster cast was applied to the upper third of the thigh. The load on the leg is allowed from the end of 6 weeks after surgery. On the control radiograph after 8 weeks (without plaster) - bone callus in the area of the pseudoarthrosis. The patient walks with a cane.

Example No. 2 (by the prototype method). Case history No. 1175. Patient A., 58 years old.

He entered the clinic of traumatology and orthopedics of the hospital. Emperor Peter the Great with complaints of pain in the middle third of the right lower leg. From the anamnesis it is known that 1.5 years ago, as a result of a household injury, he received a closed oblique fracture in the middle third of the diaphysis of both bones of the right lower leg. In one of the city hospitals, intramedullary hollow-rod intramedullary metalosthesis was performed. 6 months after surgery, repeated trauma, after which pain and bone mobility appeared in the area of the old fracture. On examination, the clinic revealed a fracture of the metal rod, and in the area of the fracture of the tibia and x-ray formed a rigid false joint. The clinic performed an operation - the removal of both fragments of a metal rod. False joint bone grafting.

The first stage of the operation. A linear incision in the area of the upper slope of the tibial tuberosity at the site of the overgrown defect after direct insertion of the hollow rod reached the bone surface. A round hole was formed in the cortical layer through which an unsuccessful attempt was made to remove the upper fragment of the broken structure. Through a small incision along the anteroposterior surface of the lower leg, a second “window” with a diameter of 1.5 cm was formed in the supradermal part. The lower edge of the rod was discovered, into which a slightly curved titanium rectangular rod was placed through the window. By hammer blows at its distal end, the hollow shaft is knocked out through the upper “window” in the tibial tuberosity region. In this case, the upper fragment of the hollow rod was infringed in the upper fragment of the bone. In this regard, in the area of the pseudoarthrosis, a groove is formed in the cortical layer of the upper and lower bone fragments 10 × 1 cm through an additional incision. Through the resulting “window”, the remaining fragment of the hollow shaft is relatively easily knocked out through the defect of the upper bone fragment. The wound is washed. Bone grafts are placed in place, but with a change of place. Layered blind seams. The duration of the operation is 2.5 hours. Further treatment was carried out in the Ilizarov apparatus. The consolidation of the false joint took place 16 weeks after its application.

According to the claimed method, 3 patients were operated on. Age 28, 52 and 76 years. There were no problems with the removal of metal rods, there were no complications in the postoperative period.

The duration of the operation according to the claimed method is 45 minutes, the treatment time is 8 weeks. According to the prototype method, respectively - 2.5 hours and 16 weeks.

The inventive method allows you to remove the intramedullary metal rod from the bone marrow canal of the tubular bone in the conditions of its fracture and concomitant false joint or diastasis between bone fragments at the level of the fracture of the rod. The exclusion of trauma to adjacent joints in the claimed method, in contrast to the prototype method, promotes early restoration of limb function, 2 times reduction in treatment time, as well as a reduced risk of possible purulent complications in the postoperative period and the development of deforming arthrosis in adjacent joints in the long term. Simplification of the operation and eliminating the need for additional devices for removing fragments of a metal structure reduces the duration of the operation by more than 2 times.

Claims (1)

A method of removing a broken intramedullary metal rod from the tubular bone, which consists in forming a cortical graft of a wedge-shaped base equal to the width of the bone marrow canal in the cortical layer of the upper intramedullary metal rod and the false joint of the bone fragment, and then through the resulting “window” "First remove the shorter fragment of the metal rod, and then the remaining part, after which the graft is immersed in the bone marrow channel of the upper th bone fragment and lower it into the canal of the lower to dense wedging, blocking the area of the false joint.