RU2356511C1 - Ankle fracture treatment method - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to traumatology and orthopaedics, and can be used in treatment of ankle fractures started with application of a hinged compression distraction apparatus comprising a locating pivot ring, a reposition and a fracture fixation. Two crossing pins are delivered through distal metaphysic of shin bone, or two Shanz bone screws are inserted thereto, or combined pin and Shanz screw are fixed on the locating pivot ring. Two pins are delivered through heel bone perpendicularly to a saggital plane. The pins are fixed on a back semi-ring of a closed hinged bearing comprising two semi-rings joint with threaded hinged bars mounted in arms on the ends of the semi-rings. Two crossing pins are delivered through midfoot bones and fixed on a front semi-ring of said closed hinged bearing thereafter attached to the locating pivot ring with paired threaded bars joint with ball couplings. The pins are delivered through ankle fragments and fixed on the arms mounted on said closed hinged bearing.

EFFECT: method ensures fracture union, involves multidimensional reduction and keeps foot shape and structure through stable fragment fixation.

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Description

The invention relates to medicine, namely to traumatology and orthopedics, and can be used in the treatment of talus fractures.

Known methods for the treatment of talus fractures, which include closed or open reposition of fractures, osteosynthesis with submersible structures [1], as well as osteosynthesis with the Ilizarov apparatus [2].

Closed reduction is possible only with talus fractures with slight displacements of fragments. In severe displaced fractures and fractures of the talus, open reduction with the use of extensive surgical approaches to the fracture site can lead to additional circulatory failure in the damaged area of the bone. In addition, submersible structures do not always provide adequate stable fixation of the talus fracture during the fusion period.

The use of transosseous osteosynthesis using the Ilizarov apparatus has improved the outcome of treatment. However, the known layouts of the apparatus do not always take into account the biomechanical features of the foot [2]. Firstly, holding just one spoke through the metatarsal bones promotes flattening of the foot, reducing its stress state, which is inadequate with the position of biomechanics. Secondly, the layout of the apparatus does not take into account the characteristic features of the displacement of talus fragments and, in particular, the rotational component of displacement.

Closest to the technical solution of the claimed method, is transosseous osteosynthesis by the Ilizarov apparatus for the treatment of fractures of the talus [3], providing for the crossing of knitting needles through the bones of the lower leg and calcaneus, as well as knitting needles through the bones of the forefoot and talus fragments, and fixing them in the supports of the Ilizarov apparatus. This method has several disadvantages. First, the hinge-free connection of the distal supports located on the bones of the foot prevents the formation of the arches of the foot during distraction along the rods between the supports, and the fastening of the spokes in the closed support of the arch, due to the characteristic anatomical and biomechanical features of the talus of the foot, is not always able to achieve repositions.

From biomechanics, it is known that the normal foot is in a twisted, stressed state. In this case, there is supination of the heel and reduction of the forefoot, which are provided by the tone of the muscles that are attached to the bones of the foot. The talus, being the key bone of the foot, is constantly in a state of tension - the talus block is twisted outwardly relative to the vertical axis by the size of the torsion of the distal legs; its head and neck are twisted towards pronation relative to the sagittal axis [4]. At the time of injury, during a fracture, the talus loses its stress state, while along with displacements along the length and width, the most characteristic is the displacement of fragments along the periphery (rotational). It is this type of displacement that determines the clinical picture of damage.

These methods [2, 3] do not provide for eliminating the rotational displacement of talus fragments and restoring the shape of the foot, and devices for their implementation are complex in their technical solution. Repositioned arc supports located on the fragments of the talus often close the fracture plane, which makes it difficult to evaluate radiographs.

The essence of the invention lies in the combination of distinctive features sufficient to achieve the desired technical result, and consists in reducing the time and improving treatment outcomes.

The essence of the invention lies in the fact that the method of treating talus fractures involves the application of a hinged compression-distraction apparatus containing a basic annular support, reposition and fixation of the fracture. Two crossed needles are passed through the distal metaphysis of the tibia, or two Shantz bone screws are inserted into it, or a combination of a knitting needle and Shants screw are used, which are fixed to the base ring support. Two spokes are carried through the calcaneus perpendicular to the sagittal plane, they are fixed on the rear half ring of a closed hinge support, consisting of two half rings connected by threaded rods with hinges installed in brackets at the ends of the half rings. Two intersecting needles are passed through the bones of the middle part of the foot and fixed on the front half ring of the said closed hinge support, while the closed hinge support is connected to the base ring support by means of threaded rods with successively mounted hinges. Through the fragments of the talus, conduct spokes and fix them on brackets mounted on the aforementioned closed hinged support.

Passing two crossing knitting needles through the distal metaphysis of the tibia, or introducing two Shantz bone screws into it, or using a combination of a knitting needle and Shantz screw with fastening on the base ring support increases the rigidity of the system and ensures its stability for the entire time of bone fusion.

Holding two spokes perpendicular to the sagittal plane through the calcaneus and crossing needles through the bones of the midfoot ensures the safety of the transverse arch of the foot.

Holding the spokes in isolation, through each fragment of the talus, and fixing them on the brackets of the closed hinged frame provides the possibility of replenishing the compression along the plane of the fracture during treatment with unloading of the subtalar joint.

The connection of the supports of the compression-distraction apparatus by means of threaded rods connected in series by hinges provides multi-plane reposition with the subsequent preservation of the shape and structure of the foot.

The layout of the compression-distraction apparatus of external fixation is shown in the drawing.

The device includes a support 1, connected by pairs of threaded rods 2 with hinges 3 connected in series between them, with a closed hinge support 4. A closed hinged support 4 consists of two half rings: a back 5 and a front 6, interconnected by threaded rods 7 with successively mounted hinges 8 installed in brackets 9.

The method is as follows.

Two crossed needles are passed through the distal metaphysis of the tibia, or two Shantz bone screws are inserted into it, or a combination of knitting needles 10 and Shants screw 11 takes place, which are fixed to the support 1 of the apparatus. Two spokes 12 and 13 are drawn through the calcaneus, perpendicular to the sagittal plane, and fixed in the posterior half of the ring 5 of the closed hinged support 4. Through the bones of the middle part of the foot, two crossed needles 14 are attached, which are fixed on the front of the ring 6 of the same support 4, while hinges 3 and 8 are relaxed. Dosed distraction is performed on threaded rods 2 and 7, containing successively mounted hinges 3, while turning the front half ring 6 of the closed support 4 in the direction of the forefoot along the hinges 3 and 8, they achieve reposition of the talus fragments and restoration of the anatomy of the foot. With significant, in magnitude, displacements of the talus, open reposition from small accesses with the elimination of all types of displacements under visual control is not excluded. At the end of the reposition, in isolation through each fragment, conduct spokes 15 and 16, which are fixed, respectively, in brackets 17 and 18 mounted on the ring support 1 and the front half ring of the closed frame 4.

The connection of all the supports of the apparatus by means of threaded rods with hinges ensures the restoration and preservation of the arches, shape and structure of the foot, and the isolated passing of the spokes through fragments of the talus bone makes it possible to replenish the compression during treatment.

Clinical example. Patient G., born in 1966, ist. disease number 2779, was admitted to the Department of Traumatology, NICT "WTO" July 16, 2000. Diagnosis: Closed neck fracture with transition to the block of the left talus with displacement of the fragment.

Operation: transosseous osteosynthesis with an external fixation device 07/21/2000. Under conduction anesthesia, through the distal metaphysis of the tibia, two crossed needles were held, which are fixed on an annular support. Spokes are drawn through the calcaneus and the bones of the middle part of the foot and mounted on the half rings of the closed hinged foot support connected to the ring support by threaded rods with hinges. After achieving reposition, with the elimination of all types of displacements, spokes are held through the fragments of the talus, which are fixed in brackets mounted on a closed hinged support. The patient was discharged from the hospital on 07.25.2000. Dismantling and removal of the external fixation device 10/15/2000. The course of rehabilitation treatment in the conditions of SRC "WTO". The patient was taken for follow-up. Disability restored completely.

Information sources

1. N.A. Koryshkov, O.V. Zaitsev, Features of the treatment of injuries of the talus; Bulletin of Traumatology and Orthopedics named after N.N. Priorov, 2003, No. 1, p.

2. S.I.Shved, Yu.M. Sysenko, L.V. Malysheva, V.G. Shilov. Transosseous osteosynthesis according to Ilizarov in the treatment of patients with talus fractures; The genius of orthopedics, 1997, No. 1, pp. 50-52.

3. V.M. Shigarev, S.Ya. Zyryanov. Our view of the current state of the treatment of talus fractures; The genius of orthopedics, 1998, No. 2, pp. 20-28.

4. I.A. Polievktov. Human foot is normal and pathological; Dzaudzhikau, 1949, p. 112.

Claims (1)

A method for treating talus fractures, comprising applying an articulated compression-distraction apparatus containing a base annular support, reposition and fixation of the fracture, characterized in that two intersecting spokes are inserted through the distal metaphysis of the tibia, or two Shantz bone screws are inserted into it, or a combination is used spokes and screws of the Shants, which are fixed on the base annular support, through the calcaneus carry two spokes perpendicular to the sagittal plane, fix them on the rear half ring a closed hinge support, consisting of two half rings interconnected by threaded rods with hinges installed in brackets at the ends of the half rings, two crossed needles are drawn through the bones of the middle part of the foot and fixed to the front half ring of the said closed hinge support, while a closed hinged support is connected with a basic ring support using pairs of threaded rods connected to each other by ball joints, spokes are passed through the fragments of the talus and fixed to the brackets, mouth updated on said closed articulated support.