RU2385680C1 - Method of treating tibial fractures - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention concerns medicine, namely to traumatology and orthopaedics. Bony reduction is carried out. It is followed with pin retention of fractured fragments. The pin is blocked through skin incisions to the openings drilled in the bone in a projection of proximal and distal openings with using an allogenic graft from cortical bone.

EFFECT: method eliminates the necessity to perform the dynamisation operation, reduces injuries and postoperative complications.

2 ex

Description

The invention relates to medicine, more specifically to traumatology and orthopedics, and can be used to treat fractures of the tibia.

A known method of closed intramedullary osteosynthesis of the tibia, in which its proximal and distal fragments are interconnected by a metal pin, which is inserted into the medullary canal and then blocked by screws. The screws are inserted through additional skin incisions into the holes drilled into the bones in the area of the projections of the distal and proximal pin holes (Guidelines for emergency traumatology: guidelines. Moscow, N.V. Sklifosovsky Research Institute of Emergency Medicine, 2000, pp. 166-175 )

With delayed fracture consolidation, a dynamization operation is performed. It consists in the removal of static locking screws, which creates a dynamic compression of bone fragments under the action of a metered load on the limb when walking, which contributes to the consolidation of the fracture.

After clinical and radiological healing of the fracture, the fixation removal operation is performed. It consists in sequentially removing the locking screws and the pin.

In the event of a fracture of the locking screws, they are either limited to removing their heads or the broken shanks of the screws are removed by drilling them from the bone.

However, the existing method has some disadvantages:

- in the case of delayed fracture consolidation, to create a more tight contact between bone fragments, it is necessary to perform a dynamization operation;

- in some cases, a breakage of the locking screws occurs, which can lead to an increase in the morbidity of the operation to remove the retainer;

- when removing the locking screws in the bone tissue, holes remain that weaken the bone, which can lead to its repeated fracture in the area of the screw holes. This danger increases when drilling broken locking screws.

The objectives of this invention are:

1) elimination of the need to perform the operation of dynamization;

2) reducing the morbidity of the operation of removing the retainer by eliminating the need to remove blocking structural elements for osteosynthesis.

The problem is solved in that in the method of treating tibial fractures, including reposition of bone fragments, fixing the fragments with a pin and blocking the pin using devices made through skin incisions into the holes drilled in the bones in the area of the projections of the distal and proximal holes of the pin, as blocking devices use an allograft from the cortical bone layer.

The method is as follows.

The patient is placed on an orthopedic table on his back, while the operated leg is bent at 90 ° in the hip and knee joints. By traction and rotation through a spoke, drawn through the calcaneus and fixed in a bracket, an indirect closed reposition of fragments is carried out. Proximal to the tibial tuberosity, a longitudinal incision is made in the skin, and the own patellar ligament is dissected or delayed. Through the metaphysis of the tibia, the bone marrow canal is opened.

Under the control of an electron-optical transducer (EOP), a metal pin is inserted into the medullary canal, which is then driven with a hammer to the level of the distal metaphysis.

Under the control of the image intensifier, proximal and distal pin blocking is performed. To do this, a bone is drilled through separate sections in the projection of the distal and proximal pin holes and the allografts from the cortical bone are inserted into the holes obtained, two or three in the proximal and distal holes. The grafts have a circular cross section, their diameter corresponds to the diameter of the holes in the used pins, the length corresponds to the thickness of the bone at the place of their introduction.

Thus, stable fixation of the main bone fragments is achieved.

The postoperative wound is sutured tightly.

In the case of delayed consolidation of the fracture, the dynamization of the pin is performed by a metered increase in the load on the limb when walking. Under load, a fracture of the locking devices occurs, leading to a “self-dynamization" of the pin.

After clinical and radiological healing of the fracture, the fixation removal operation is performed. It consists in removing the pin. In this case, the remaining locking devices fracture along the line of contact with the pin (cutting off). By the term of removal of the retainer, the locking devices with the tibia are consolidated in the area of the holes in the latter. Thus, only the central part of the locking devices is destroyed.

Clinical example 1

Patient P., 35 years old. Diagnosis: closed transverse fracture of the bones of the left tibia in the upper third with the displacement of fragments. Trauma as a result of an accident.

On admission, a skeletal traction for the calcaneus was applied at the NIISP.

9 days after the injury, an operation was performed: closed intramedullary osteosynthesis of the left tibia with a pin with proximal and distal blocking with allografts. The postoperative period was uneventful, the wounds healed by first intention, the sutures were removed on time. The patient was activated, trained to walk with crutches with a metered load on the operated leg. Discharged from the hospital on day 19.

11 weeks after surgery, clinical and radiological signs of fracture fusion were observed.

Clinical example 2

Patient M., 28 years old. Diagnosis: closed helical comminuted fracture of the bones of the right tibia in the middle third with the displacement of fragments. Injury from falling while snowboarding.

Upon admission, the patient in the NIISP imposed skeletal traction over the calcaneus.

8 days after the injury, the operation was performed: closed intramedullary osteosynthesis of the left tibia with a pin with proximal and distal blocking of allografts. The postoperative period was uneventful, the wounds healed by first intention, the sutures were removed on time.

7 weeks after surgery, radiological signs of delayed fracture consolidation were noted. To create additional compression of fragments, the metered load on the leg was increased. "Self-dynamization" occurred with the destruction of distal blocking grafts. 6 weeks after dynamization, clinical and radiological signs of fracture fusion were observed.

The positive effect of using this method is to eliminate the need for hospitalization of the patient to perform the dynamization operation in case of delayed fracture consolidation. The trauma of the latch removal operation is also reduced by eliminating the need to remove the locking screws. Blocking devices from the allocost are not removed, therefore, after removing the retainer in the bone there are no transverse holes.

Claims (1)

A method for treating tibial fractures, including reposition of bone fragments, fixation of fragments by a pin and blocking of a pin using devices made through skin incisions into holes drilled into the bones in the projection of the proximal and distal holes of the pin, characterized in that cortical homograft is used as blocking devices bone layer.