RU2354315C1 - Method of treating open fracture of shin bones - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method can be used in traumatology in treating patients with open fractures of shin bones. Injured limb segment is fixed by means of external fixation apparatus. Shinbone fragments are reset, preserving their contact with ends of fibula bone fragments in fracture region, and kept in such position until stable tibiofibular synostosis is formed. Wound edges are brought together and wound is sewn layer-by-layer.

EFFECT: single-stage removal of soft tissue defect and reduction of traumaticity, stabilisation of bone fragments, reduction of treatment terms.

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Description

The invention relates to medicine, in particular to traumatology, and can be used in the treatment of patients with soft tissue defects of the extremities.

A known method of treating open fractures of the lower leg bones, in which, in order to close the soft tissue defect, the diaphysis of the fibula is moved to the tibia to join the edges of the wound, followed by the healing of the defect by moving the fibula to its original position (A.S. 1367955, USSR, publ. 23.01.88., Bull. No. 3).

The proposed method does not increase the stability of fragments in the fracture zone and does not reduce the risk of secondary deformation of the segment.

There is a method of treating extensive damage to the soft tissues of the limbs, which involves fixing the damaged segment of the limb using a compression-distraction apparatus, after which an osteotomy is performed at the level of the proximal wound pole, soft tissues and related bone fragments located distal to the upper wound pole are rotated until approach its edges throughout and after suturing are fixed in the attached position until the latter heals, and then dosed to return to its original position (Application RF 2001107334, IPC ⁷ A61V 17/56 A method of treating limb extensive soft tissue damage / Martel II, Swede SI, RISC "RTO", Academy Ilizarov (RF) -..... Appl . March 19, 2001; Publish. February 20, 2003).

However, this method is traumatic, because they produce additional osteotomy, which leads to increased pain in the patient. After healing of the damaged segments, the bone fragments are returned to their original position, which slows down the process of consolidation of fragments in the fracture zone.

The objective of the present invention is to develop a method for the treatment of open fracture of the lower leg bones, providing stabilization of bone fragments, reducing trauma and eliminating the soft tissue defect in the fracture zone.

The problem is solved in that in the method of treating an open fracture of the lower leg bones, including reposition of bone fragments and subsequent fixation of the damaged segment of the limb to restore its supportability using the external fixation apparatus, as well as rapprochement of the edges and layered suturing of the wound, reposition of fragments of the tibia, while maintaining their contact with the ends of fragments of the fibula in the fracture zone, and in the dowry position is held until a stable tibiofibular synostosis is formed.

The invention is illustrated by the description, photographs and radiographs, which depict:

Figure 1 - radiograph of the leg of the patient before treatment;

Figure 2 (a, b, c) - a - created a soft tissue defect of 18 × 6 cm; b - the defect is eliminated without tension of soft tissues; in - radiograph of the patient in the process of fixation by the apparatus;

Figure 3 (a, 6, c) - a, b - radiograph and photo of the patient after treatment; c - functional result.

The method is as follows.

In the operating room, under anesthesia, primary surgical treatment of the wound is performed to obtain a soft tissue defect along the inner surface of the lower leg in the middle third. When applying an external fixation apparatus of four annular supports, two spokes are inserted through the proximal and distal metaphyses of the tibia. Following this, above and below the fracture region, reponing spokes are carried out, one of the spokes passing through both bones below the fracture region of the lower leg bones. Without changing the position of the fragments of the fibula, reposition of the tibia is carried out. The formed anatomical shape of the fibula allows you to reduce the tension of the interosseous membrane and eliminate the soft tissue defect without tension. Repositioning knitting needles are fixed in the middle supports of the apparatus. The dowry is held until a stable tibiofibular synostosis is formed.

The practical use of the method is illustrated by the following clinical example.

Patient E., 25 years old, medical history No. 23270, was admitted with a diagnosis of open comminuted fracture of both bones of the right lower leg in the middle third with complete displacement of fragments; soft tissue defect in the middle third of the leg (Figure 1).

During the operation, after treating the skin with an antiseptic solution and delimiting the area of operation with sterile material, the primary surgical treatment of the wound was performed by excision of non-viable soft tissues, resulting in a soft tissue defect of 18 × 6 cm (Fig. 2a). Next, they held two knitting needles through the proximal and distal metaphyses of the tibia and imposed an external fixation apparatus of four ring supports. Above and below the fracture region, reponing spokes were used, one of the spokes passing through both bones below the fracture line. Without changing the position of the fibula, they repositioned the tibia and restored the integrity of the skin without tension (Fig.2b). Repositioning knitting needles were fixed in the middle supports of the apparatus. Then the wound was sutured in layers with the application of aseptic dressings and performing control radiography (Figv).

In the postoperative period, supportive compression was performed at the junction of the fragments and in the area of creating the tibiofibular synostosis.

After 3 months, the apparatus was dismantled, the support ability of the limb was fully restored (Fig. 3a, b, c). Additional limb immobilization was not required.

Practical use of the proposed method in the Federal State Institution Scientific and Research Center “WTO” named after Acad. G.A. Ilizarova allows you to simultaneously eliminate the soft tissue defect, reduce trauma, and also reduce the duration of treatment of patients with open fractures of the leg bones.

Claims (1)

A method of treating an open fracture of the leg bones, including reposition of bone fragments and subsequent fixation of the damaged segment of the limb to restore its supportability using an external fixation apparatus, as well as rapprochement of the edges and layer-by-layer suturing of the wound, characterized in that they reposition fragments of the tibia, maintaining their contact with the ends of fragments of the fibula in the fracture zone, and in the dowry position are held until a stable tibiofibular synostosis is formed.

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