RU2360633C1 - Method of operative treatment of fractures of capitate ball of humerus - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention concerns medicine, in particular to traumatology. The way includes an open reposition and bracing of distal and proximal fragments by Kirschner wire. The new thing is that three Kirschner wires are pulled in parallel each other and axes of rotation of a joint outside inside through a distal fragment to a proximal fragment before their penetration into the cortical layer on a medial surface of the proximal fragment. Then two Kirschner wires are pulled in parallel each other and axes of rotation of a joint through a naruzhno-lateral surface of a proximal fragment before their penetration into a cortical layer on its medial surface. The wires acting from lateral aspect of fragments are bent radially. Immediately at a bone roundwires the wire in the form of an 8-shaped loop is spent in such a manner that the loop covers the wires, the loop is braided with tension, and superfluous extremities of the spokes are cut.

EFFECT: way warns development of a nonvascular necrosis of a distal fragment.

1 ex, 2 dwg

Description

The invention relates to medicine, in particular to traumatology.

A known method of surgical treatment of fractures of the capitate elevation of the humerus by osteosynthesis with spongy or cortical tightening screws (see Guide to internal osteosynthesis: methodology, recommended by the AO group (Switzerland) / M.E. Muller, M. Allgover, R. Schneider, X .Villinegger; translated by A.V. Korolev. - M.: Ad. Marginem, 1996.- P.448-449).

The disadvantage of this method is the instability of the fixation of the distal fragment due to its small size and spongy structure. In addition, this method is traumatic, requires special tools and prolonged immobilization of the limb.

Closest to the proposed invention is a method consisting in an open reposition of bone fragments and subsequent fixation of the capitate elevation with two crossed Kirschner spokes inserted through the outer-lateral surface of the distal fragment into the proximal (see Kazarezov M.V., Bauer I.V., Koroleva AM Traumatology, orthopedics and reconstructive surgery. - Novosibirsk, 2004. - Part 2, Ch. 2. - P.136).

However, the known method does not provide stable fixation of the fragments necessary for the processes of revascularization, rearrangement of the avascular fragment and consolidation of the fracture. In addition, it requires the immobilization of the joint for 2-4 months, which leads to the development of persistent contracture of the elbow joint.

The objective of the proposed invention is the provision of stable fixation of bone fragments with their mutual compression to reduce the risk of developing avascular necrosis of the distal fragment with its deformation or fragmentation, prevention of persistent elbow joint contracture.

The problem is solved due to the fact that in a method that includes open reposition and fixation of the distal and proximal fragments with Kirschner spokes, three Kirschner spokes parallel to each other and the axis of rotation of the joint are introduced through the distal fragment into the proximal fragments before they penetrate the cortical layer along the medial surface of the proximal fragment, through the outer-lateral surface of the proximal fragment parallel to each other and to the axis of rotation of the joint, two Kirschner spokes are held until they penetrate the cortical the middle layer on its medial surface, protruding from the outside of the fragments of the knitting needles are bent radially in the direction from the axis of rotation of the joint directly at the bone, around the knitting needles a wire is made in the form of an 8-shaped loop so that the loop covers the needles drawn through the distal and proximal fragments, the loop is twisted with tension, and the excess ends of the spokes bite.

The essence of the invention is illustrated by drawings, where in Fig.1 shows a diagram of the method (top view), Fig.2 is a diagram of the method in orthogonal projection.

A method for the surgical treatment of fractures of the capitate elevation of the humerus is as follows. Perform access to fragments, make an open reposition. Through the outer-lateral surface of the distal fragment 1, three Kirschner spokes 2 are passed from outside to inside parallel to each other and the axis of rotation of the joint into the proximal fragment 3 until they penetrate the cortical layer along its medial surface. Then, through the outer-lateral surface of the proximal fragment 3 parallel to each other and the axis of rotation of the joint, two Kirschner spokes 4 are passed until they penetrate the cortical layer along its medial surface. The free ends of the spokes 2 and 4, protruding from the outside, bend radially in the direction from the axis of rotation of the joint. Around the knitting needles, directly at the bone, is wire 5 in the form of an 8-shaped loop, which is then twisted with tension. The loop encompasses the needles drawn through the distal fragment 1 and the proximal fragment 3. The excess ends of the spokes 2 and 4 are bite and immersed in the fragments. The wound is sutured. A posterior plaster cast is applied from the upper third of the shoulder to the base of the fingers in the position of forearm flexion at an angle of 90 ° for 2-3 days. Movement in the elbow joint begins one day after the operation.

Clinical example:

Patient B., 55 years old, medical history 223268, was admitted to the NIIITO on May 15, 2006 with a diagnosis of an abnormally fused fracture of the capitate elevation of the right humerus with displacement of fragments, flexion-extensor and rotational contracture of the right elbow joint. She was injured on April 1, 2006 as a result of a fall on the region of the right elbow joint. It was treated conservatively outpatiently with immobilization of the right upper extremity by the posterior plaster cast for 3 weeks. Despite the subsequent rehabilitation treatment, a persistent restriction of movements in the right elbow joint was formed: amplitude of flexion-extensor movements = 0/70/95 °, rotational movements = 70/0/75 °. 05/19/2006, the operation was performed according to the proposed method. On the 3rd day after the operation, the immobilization was stopped, rehabilitation treatment was started, including active-passive movements in the right elbow joint. 3 weeks after the operation, she was discharged for outpatient treatment at the place of residence. After 1 year (February 26, 2007), the patient was admitted to the NIIITO with a diagnosis of an overgrown fracture of the capitate elevation of the right humerus. X-ray: the consolidation of the fracture of the capitate elevation of the right humerus is complete, the congruence of the articular surfaces is not broken. Amplitude of active flexion-extensor movements in the elbow joint = 0/20/130 °, rotational movements = 80/0/80 °. There are no complaints. Works in the same specialty. The removal of metal structures. The result of the treatment is rated as good.

A method for the surgical treatment of fractures of the capitate elevation of the humerus ensures stable fixation of bone fragments, prevents the risk of avascular necrosis, allows early functional treatment to be started, and prevents the development of elbow joint contracture.

Claims (1)

A method for the surgical treatment of fractures of the capitate elevation of the humerus by open reposition and fixation of the distal and proximal fragments by Kirschner spokes, characterized in that three Kirschner spokes are parallel to each other and the axis of rotation of the joint through the distal fragment into the proximal fragments before they penetrate the cortical layer along the medial the surface of the proximal fragment, through the outer-lateral surface of the proximal fragment parallel to each other and the axis of rotation of the joint, two spokes Cyrus until they penetrate into the cortical layer on its medial surface, the protruding from the outside of the fragments of the spokes bend radially in the direction from the axis of rotation of the joint, directly at the bone around the spokes, draw a wire in the form of an 8-shaped loop so that the loop covers the spokes held through the distal and proximal fragments, the loop is twisted with tension, and the excess ends of the spokes bite.

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