RU2357695C1 - Instrument for osteosynthesis of fractures of intercontyloid eminence of shin bone - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention pertains to medicine, namely, to traumatology - orthopedics and may be used in surgical treatment of dislocated fractures of intercontyloid eminence of shin bone under arthroscopic control. Instrument is made as a metal rod, diametre whereof is comparable with the size of the minimal arthroscopic portal. A handle is fixed in the T-form on the basement, and on its working end there is a co-axial to the rod cutting, width whereof meets diametres of the pin and depth whereof is not less than its two diametres.

EFFECT: reducing intraoperative trauma and improving cosmetic effect preserving minimal sizes of arthroscopic surgical portals.

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Description

The invention relates to medicine, namely to traumatology-orthopedics, and can be used in the surgical treatment of displaced fractures of the intercondylar elevation of the tibia under arthroscopic control.

In the surgical treatment of fractures of the intercondylar elevation of the tibia, metal structures are usually used as fixatives. So, when carrying out an operation according to the method of Bonin et al. [1], the osteochondral fragment of the intercondylar elevation, repaired under arthroscopic control, is drilled through with a spoke held from the side of the medial condyle of the tibia from front to back and from bottom to top, and the end of the spoke protruding into the joint cavity is bent in shape hook with a powerful surgical needle holder. The needle at the distal end is pulled caudally until the fracture is completely repositioned. Since the formation of a hook at the end of the spoke cannot be carried out with another tool, when using a needle holder, it is necessary to expand the arthroscopic access (portal), which leads to additional trauma to the knee joint.

The essence of the invention lies in the combination of distinctive features sufficient to achieve the desired technical result, consisting in reducing intraoperative trauma and improving the cosmetic effect, while maintaining the minimum size of arthroscopic surgical approaches (portals).

The essence of the invention lies in the fact that the tool for bending the intraarticular end of the knitting needle is made in the form of a metal rod, the diameter of which is commensurate with the size of the minimum arthroscopic portal. A handle is T-shaped on the base of the rod, and a slot is made coaxial to the rod at its working end with a slot corresponding to the diameter of the spoke and a depth of at least two of its diameters.

The use of a special tool in the form of a rod, the diameter of which is commensurate with the size of the minimum arthroscopic portal, eliminates the need to expand this portal. The use of this tool reduces intraoperative trauma and improves the cosmetic effect of surgical intervention.

Performing a straight cut at the working end of the tool, coaxial to the rod, the width of which corresponds to the diameter of the spokes, and a depth of at least two diameters, provides a reliable grip of the end of this spoke at different angles during operation.

The intraarticular end of the spoke, which has considerable rigidity, can be bent effortlessly thanks to a handle fixed T-shaped on the base of the metal bar of the instrument, because in this design, the applied force increases in proportion to the length of the arm shoulder.

Figure 1 shows the appearance of the tool, where 1 is the rod, 2 is the handle, 3 is a slot at the working end of the rod.

The layout of the anatomical formations of the knee joint after osteosynthesis of a fracture of the intercondylar elevation of the tibia is shown in Fig. 2 (front and side views from the inside), which shows the inner condyle of the tibia 4, the intercondylar elevation of the tibia 5, fixing the spoke 6.

A tool for osteosynthesis of a fracture of the intercondylar elevation of the tibia is used as follows.

From the antero-lateral and antero-medial standard portals, arthroscopy of the knee joint is performed. The repositioning of the intercondylar tibial elevation fracture is carried out by an arthroscopic probe. From an additional incision on the medial condyle of the tibia 4 through the osteochondral fragment of the intercondylar eminence 5, a knitting needle 6 is passed through 6. Through the medial arthroscopic portal, the working end of the knitting tool is inserted into the joint. The slot on the working end of the tool captures the protruding end of the spoke and form a hook by the rotational movement of the handle of the tool. The knitting needle is pulled at the distal end until the final reposition of the fracture with immersion of the formed hook in the cartilaginous tissue of the intercondylar eminence. The distal end of the knitting needle is bitten off, leaving a short section of it, which is bent with a needle holder or tool directly at the bone tissue.

Clinical example.

Patient N-ev (IB No. 1832), 14 years old, was admitted to the Scientific and Technical Center "WTO" on October 14, 2005 with a diagnosis of a closed fracture of the intercondylar elevation of the tibia of the right knee joint with a displacement of type 2. On October 17, 2005, surgery was performed. With a bent knee joint, with bleeding of the n / limb of the femoral pneumocuff, arthroscopy of the knee joint in a liquid medium was carried out through standard antero-medial and anterolateral portals. An arthroscopic debridement of the fracture zone was performed with repositioning of the intercondylar elevation with the probe. Through the anterior-medial portal, the tibial drill guide was inserted for the plastic surgery of the anterior cruciate ligament and was installed above the osteochondral fragment of the intercondylar eminence. Using a guide through the osteochondral fragment of the intercondylar elevation, a spoke was drawn. Tibial drill guide removed. Through the freed arthroscopic portal, a needle-bending tool was introduced. The end of the spoke protruding into the cavity of the joint is captured by the slot of the tool rod, its bending with the formation of a hook is made by the rotational movement of the handle. The needle is pulled up at the distal end by immersing the formed hook in the cartilaginous tissue of the intercondylar eminence. The distal end of the spoke is shortened and bent directly at the bone tissue with a needle holder. The postoperative course is smooth. 3 days after surgery, the patient was discharged for outpatient treatment in a plaster cast in the position of slight flexion of the lower leg. 2 weeks after the operation, the gypsum was removed and a course of physiomechanotherapy was prescribed. When examining the patient 3 months after the operation, the full range of movements in the joint was recorded with no symptoms of instability. Anatomical contours of the knee joint without cosmetic defects.

The source of information

1. Bonin N. et al. Adult tibial eminence fracture fixation: arthroscopic procedure using K-wire folded fixation // Knee Surg. Sports Traumatol. Arthrosc. - 2007 .-- Vol.15. - P.857-862.

Claims (1)

The tool for bending the intraarticular end of the spoke is made in the form of a rod, the diameter of which is commensurate with the size of the minimum arthroscopic portal, a handle is fixed on the base of the rod, and a straight cut is made on the working end, coaxial to the rod, with a width corresponding to the diameter of the spoke and a depth of at least its two diameters.

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