RU2363407C1 - Method of repositioning and osteosynthesis of segmental fracture of humerus using rod-shaped device for transosseous osteosynthesis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: in the proximal and distal fragments of the humerus two channels are drilled in each fragment, and two transosseous rods are inserted in each channel. Transosseous rods passing near the fracture line of proximal and distal fragments of the humerus are fixed in fastening units and reposition fixing units and are attached to the inner surface of an arc by supporting arms. A rod-shaped device is mounted, consisting of three arcs with openings and provided with four repositioning units. The arcs are joined together by threaded bars. In the intermediate fragment, two channels are drilled and two transosseous rods are inserted and are fixed in two fastening units and reposition fixing units, which are held on both sides of the middle arc by supporting arms. The proximal, intermediate and distal fragments are repositioned in a single step by moving the middle arc using threaded bars, elements of the repositioning units using nuts in perpendicular directions, directly manipulating fastening units and fixing units using nuts, moving them on threaded rods, as well as transosseous rods. The proximal, intermediate and distal fragments of the humerus are then fixed by a locking bolt with precise repositioning, and to stabilise the achieved repositioning, transosseous rods are one in each proximal and distal fragment. Transosseous osteosynthesis is done using the rod-shaped device.

EFFECT: reduced injury from the operation, more effective repositioning and extrafocal osteosynthesis due to rational linking of the device.

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Description

The invention relates to medicine, is used in traumatology and orthopedics for reposition and osteosynthesis of segmental fracture of the humerus with a rod apparatus for transosseous osteosynthesis.

The results of the treatment of fractures largely depend on the biomechanical conditions created for the fusion of fragments and the restoration of musculoskeletal function. In providing such conditions for transosseous osteosynthesis, the primary task is to perform a closed reposition. Its quality depends not only on the qualifications of the traumatologist, but also on the design features of the compression-distraction apparatus. In our country, the most widely used is the Ilizarov multipurpose apparatus, in which fragments can be moved in any plane. The practice of using the apparatus showed that the elimination of gross displacements of fragments does not present serious difficulties. However, to achieve high accuracy in matching fragments, comparable to open reposition, is a rather complicated matter, requiring repeated manipulation of the spokes and remounting of the structure. Recently, domestic traumatologists began to attract external fixation devices on the rods, which are already widely used abroad. To facilitate reposition, improve its quality, we proposed a rod apparatus for transosseous osteosynthesis with reposition units (decision to grant a patent dated August 30, 07 for application No. 2006115808/14 (017163). In patients with fresh fractures, reposition was usually achieved on the operating table All patients practically eliminated the displacement along the length, at an angle and along the periphery. We have developed a method for reposition and osteosynthesis of a segmental fracture of the humerus, which allows for simultaneous closed controlled reposition of fragments of the humerus using a rod apparatus for transosseous osteosynthesis, which contains arches with holes, threaded rods connecting arcs and reponing elements in the form of brackets fixed on arcs and equipped with transosseous rods. Various devices are known for this purpose, in particular the most widely a device for transosseous osteosynthesis used abroad [1]. However, it has the following disadvantages: when inserting support pins into bone fragments, the pins must be installed strictly parallel to each other with certain, by the size of the clamps, distances between themselves. In this case, technical difficulties arise associated with the installation of the apparatus, and the duration of the operation is extended.

The rod analogue of transosseous osteosynthesis of VVFurdyuk can serve as another analogue [2]. The disadvantage of this apparatus is the design complexity, as a result of which there are difficulties in combining the threaded bushings of the fixation and reposition units located on the same axis on opposite sides of the apparatus. The apparatus of V.V. Furdyuk [3] is known for transosseous osteosynthesis of long tubular bones, which includes an elongated frame with slots, on the parallel walls of which there are reposition and fixation nodes. In this case, the reposition units are made in the form of sliders with spacer threaded bushings and displacement nuts on the bodies of the sliders. Another disadvantage of this apparatus is the technical complexity of the design that occurs when installing the apparatus.

The closest in technical solution to the claimed one is the apparatus adopted by us for the prototype [4] for osteosynthesis of long tubular bones (AS No. 457470). The apparatus includes staples with tabs, in the slots of which movable carriages with spoke holders are installed, distractors with nuts, a closed traction system that covers the nuts of the distractors and the rollers located on the bracket. The brackets are mounted at the top of the brackets and have movable stops. However, despite the advantage of this device compared to the above counterparts, it, in turn, also has a number of disadvantages, the operation is rather time-consuming. The invention consists in a combination of essential features sufficient to achieve the desired technical result, namely, to reduce the invasiveness of the operation, its simplification, improvement of repositional and fixative qualities of the apparatus and its rational layout, providing increased efficiency of reposition and extra focal osteosy thesis segmental fracture of the humerus. This essence lies in the fact that the rod apparatus for transosseous osteosynthesis, containing arcs with holes, threaded rods connecting arcs, reponing elements made in the form of brackets equipped with transosseous rods and fixed on arcs, is characterized in that it is equipped with reponent nodes each made in the form of a threaded rod with a universal hinge that forms a mounting unit and a block for fixing the transosseous rod, and a locking bolt to stabilize the said blocks, transosse s rods have the possibility of rotational and axial displacement and fixation nuts, fastening unit is arranged with the possibility of moving and fixing nuts and threaded ends repositioned in units installed in the bracket holes, placed on the inner surfaces of the apparatus arcs. The adjustable arrangement of the threaded rods with the attachment unit and the fixation unit in the form of a universal joint passing through their holes of transosseous rods ensures, after preliminary elimination of rotational displacements, absolutely accurate closed reposition of bone fragments in these planes. The drawing shows a rod apparatus for reposition and transosseous osteosynthesis of a segmental fracture of the humerus. This essence lies in the fact that the method of reposition and osteosynthesis of a segmental fracture of the humerus with a rod apparatus for transosseous osteosynthesis differs in that two channels are drilled in the proximal and distal fragments of the humerus and two transosseous rods are inserted, transosseous rods drawn closer to the proximal fracture line and distal fragments of the humerus, are fixed in attachment units and fixation units of reposition units and are attached to the inner surface of the arches using brackets, mounted the rifle apparatus, consisting of three arches with holes and equipped with four repair nodes, the arcs are connected by threaded rods, two channels are drilled in the intermediate fragment and two transosseous rods are inserted, and they are fixed in two attachment blocks and fixation units of the reposition units, which are mounted on on both sides of the middle arc using brackets, simultaneously reposition the proximal, intermediate and distal fragments by moving the middle arc using threaded rods, elements their nodes with nuts in perpendicular directions, manipulating directly the attachment blocks and fixing blocks with the help of nuts, moving them along the threaded rods, as well as transosseous rods, then fix with a locking bolt for absolutely accurate reposition of the proximal, intermediate and distal fragments of the humerus and to stabilize the achieved reduction one transosseous rod is inserted into the proximal and distal fragments; transosseous osteosynthesis is performed by the rod apparatus.

The drawing shows an apparatus for reposition and transosseous osteosynthesis of a segmental fracture of the humerus.

The core apparatus for reposition and transosseous osteosynthesis with reposition units of this arrangement allows precise reposition of fragments of the humerus and stably synthesizes.

For reposition and transosseous osteosynthesis of a segmental fracture of the humerus, the rod apparatus contains three arcs with holes 1, interconnected by threaded rods 2. On the brackets 3 mounted on the outer surfaces of the arches 1, transosseous rods are placed 4. On the inner surfaces of the arches 1 on the brackets 5 are installed reponny nodes 6. Reponny elements made in the form of brackets fixed on arcs and equipped with transosseous rods are installed with the possibility of movement of fixations by nuts. The threaded ends of the reponentation nodes 6 are placed in the holes of the brackets 5 and are fixed by nuts 7. On the threaded rods 14, mounting blocks 8 and fixation 9 of transosseous rods 10 are installed in the form of a universal joint fixing the proximal fragment of the humerus. The fastening unit and the fixing unit are stabilized by the locking bolt 11. In the fixing blocks in the holes, transverse rods are installed with the possibility of movement and fixing 10. On the central arc 1, on both sides, using two brackets 5, two reponent assemblies 6 are installed, in the fastening and fixing blocks 9 transosseous the rods 12 and 13, fixing the intermediate fragment. Two transosseous rods were also made in the distal fragment, the transosseous rod, drawn closer to the fracture line, is installed in the attachment units and fixation units. The arcs 1 are interconnected by means of threaded rods 2. Under the image intensifier, the fragments of the humerus are repositioned simultaneously by moving the elements of the repair nodes with nuts in perpendicular directions, i.e. directly manipulating the attachment blocks and the fixing unit, moving them along the threaded rods 14 with the help of nuts 7, and transosseous rods 10, 12, 13. If the bone fragments are correctly positioned, they come closer to the compression by means of threaded rods 2 connecting the arcs 1. To stabilize the achieved repositions introduce one transosseous rod into the central and peripheral fragments at an angle of 60 degrees to its axis, and transosseous rods are fixed to arcs using brackets 3 on the outer surface of arcs 1. Adjustable the positioning of the threaded rods with attachment blocks and a fixation unit in the form of a universal joint passing through their holes of transosseous rods ensures, after preliminary rotation displacement is eliminated, absolutely accurate reposition of bone fragments in these planes and are fixed by a locking bolt 11. The drawing shows a rod apparatus for reposition and osteosynthesis of a segmental fracture of the humerus with reposition nodes, the working parts of the transosseous rods in the drawing are immersed in bone models.

1. Swiss patent No. 0684928, cl. A61B 17/60, 1995

2. Furdyuk V.V. A.S. No. 1766390, class A61B 17/60, 1993

3. Furdyuk VV RU 2152190 C1, cl. A61B 17/66, 1998

4. Faletov A.P., Glebov Yu.I., Glebova E.P. A.S. No. 457470, BI No. 3 dated 01.25.75.

5. BI No. 3 dated 01.25.75.

Claims (1)

The method of reposition and osteosynthesis of segmental fracture of the humerus with a rod apparatus for transosseous osteosynthesis, characterized in that in the proximal and distal fragments of the humerus, two channels are drilled and two transosseous rods are inserted, transosseous rods drawn closer to the fracture line of the proximal and distal bone from , fix in the mounting blocks and fixing blocks of the reposition units and fasten to the inner surface of the arcs using brackets, mount the rod apparatus, consisting of of three arcs with holes and equipped with four repair nodes, the arcs are connected by threaded rods, two channels are drilled in the intermediate fragment and two transosseous rods are inserted and they are fixed in two attachment blocks and fixation blocks of reposition units, which are installed on both sides of the middle arc using brackets, simultaneously reposition the proximal, intermediate and distal fragments by moving the middle arc with the help of threaded rods, elements of the repair nodes with nuts in a perpendicular ular directions, manipulating directly the attachment blocks and fixing blocks with nuts, moving them along the threaded rods, as well as transosseous rods, then fix with a locking bolt at absolutely accurate reposition of the proximal, intermediate and distal fragments of the humerus and introduce one transosseous to stabilize the achieved reposition. rod into the proximal and distal fragments, transosseous osteosynthesis is performed by the rod apparatus.

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