RU2387399C1 - Method of operational treatment of fractures of intercondylar eminence of tibia in children - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to children traumatology and orthopedics, and is intended for fixation of fragments in children in operational treatment of fractures of intercondylar eminence of tibia. By means of guide pin with a hole is passed into joint. "Ethicon" No 5 wire is passed through eye of said pin. Pin is removed and wire loop is brought onto anterior surface of upper third of tibia. Second pin and other is passed and other end of wire is introduced into the hole of said wire. Pin is removed and second end of wire is brought outside. After that in position of knee joint extension free ends of wire are fixed on anterior surface of bone by twisting.

EFFECT: method ensures stable osteosynthesis.

1 ex, 13 dwg

Description

The invention relates to medicine, namely to pediatric traumatology and orthopedics, and is intended for fixation of fragments in children during surgical treatment of fractures of the intercondylar elevation of the tibia.

A known method of intra-arthroscopic fixation of a fracture of the intercondylar elevation with a L-shaped metal retainer (patent RU 2168956 C1, 06/20/2001). It is the closest to the proposed method, we took it as a prototype.

Significant disadvantages of the above method for the surgical treatment of fractures of the intercondylar elevation of the tibia are:

1) the inability to use the retainer with the comminuted nature of the fracture of the intercondylar elevation of the tibia;

2) the selection of the fixative depends on the age and growth of the patient;

3) the bulkiness of the structure;

4) the technique is accompanied by arthrotomy and is traumatic for the joint;

5) the duration of the immobilization of the knee joint is about 6 weeks;

6) removal of the fixative requires repeated surgical intervention with arthrotomy.

This method of treating fractures of the intercondylar elevation of the tibia is taken as a prototype, the disadvantages of which are completely eliminated by our treatment method.

The aim of the proposed method is to eliminate the above disadvantages, which allows for small accesses to make stable osteosynthesis of fractures of the intercondylar elevation of the tibia.

To achieve a medical and technical result, the proposed method of osteosynthesis at the fracture site is performed using 2 arthroscopic approaches (antero-medial and antero-lateral). Fragments of the tibia are anatomically matched and fixed with a wire loop.

The inventive method is illustrated by drawings (1-13).

The method is as follows.

Under anesthesia, under aseptic conditions, after treating the surgical field with iodopyron and alcohol, osteosynthesis is performed from 2 standard approaches: antero-medial and antero-lateral. Perform arthroscopy of the knee joint. The joint is washed with physiological saline (0.9% NaCl). Using the guide (cruciate guide) produce a reposition of fragments of the intercondylar elevation of the tibia in the position of flexion of the knee joint at 45 ° (figure 2). Using the guide, a knitting needle with a hole is carried out (Fig. 3,4), then using a knitting needle, wire “Ethicon” No. 5 is drawn through the eye of the guide needle (Fig. 5). The needle is removed, and the wire loop is brought to the front surface in / 3 b / tibia (Fig.6). Next, a 2nd spoke is carried out, and the other end of the wire is inserted into the hole of this spoke, the needle is removed, and the second end of the wire is brought out onto the skin (Figs. 7, 8, 9). Then, in the extension position of the knee joint, the ends of the wire are tightened and twisted by a knot along the anteromedial surface of the in / 3 lower leg (Fig. 10). Then produce control radiography. The joint is washed. Sutures and an aseptic dressing are applied at the incision site. The joint is immobilized by the posterior plaster cast in the extension position.

Practical example

The patient A. Globenko, 13 years old, was admitted to the Department of Pediatric Traumatology at the Center for Pediatric Traumatology 08.21.2007 (and / b No. 3754) with a diagnosis of "comminuted fracture of the intercondylar elevation of the left tibia" (2nd degree according to the Meyers classification -McKeever). Injury from 08.16.2007, when falling from an ATV, turned up his left leg. First aid at the site of injury: examination, x-ray, puncture of the joint (60.0 ml of blood removed), the joint is fixed in brace. The patient was hospitalized in the Department of Pediatric Traumatology. On examination, severe swelling, limited movement in the left knee joint. According to the clinical and radiological examination, the diagnosis was made: "separation fracture of the intercondylar elevation of the left tibia with displacement" (Fig. 11, 11, 12). 08/23/07 performed arthroscopic debridement of the left knee joint, osteosynthesis of the intercondylar elevation of the left tibia with a wire loop (Fig. 13).

The early postoperative period was uneventful. Ligation, puncture of the knee joint were performed. The knee joint is fixed with a plaster cast for up to 4 weeks. In the future - a rehabilitation course. The patient was examined 3 months after surgery: no complaints. It goes without additional support. Movements in the left knee joint in full, painless. The symptoms of the “front drawer, Lachmann, pivot-shift” are negative.

3 months after the operation and complete restoration of the function of the knee joint through a mini-incision of the skin and subcutaneous tissue (7-8 mm), without opening the knee joint, the wire loop was removed. 1 stitch is applied to the skin.

The proposed method operated on 56 patients aged 2 to 43 years.

As a result, the advantages of the proposed method for arthroscopic osteosynthesis of the intercondylar elevation of the tibia are noted:

1) minimally invasive surgery technique;

2) stable fixation of the fracture;

3) the possibility of using this fixation method with the comminuted nature of the fracture of the intercondylar elevation of the tibia;

4) the possibility of using this method in patients with a functioning growth zone;

5) reduction of the rehabilitation period and the total duration of treatment;

6) good cosmetic effect;

7) removal of a wire loop through a mini-incision on the skin.

The list of drawings for the description of the invention:

Figure 1 - tear fracture of the intercondylar elevation b / tibia

displaced bones (3rd degree by Meyers-McKeever).

Figure 2 - arthroscopic reduction of the fragment of the intercondylar

elevations using the cruciate guide.

Figure 3 - conducting guide spokes with a hole.

Figure 4 - dismantling the guide (cruciate guide).

Figure 5 - holding a wire loop "Ethicon" No. 5 through the eye

guide knitting needles.

6 - wire removal to the front surface in / 3

b / tibia.

Fig.7 - holding the 2nd guide knitting needle with a hole.

Fig.8 - in a similar manner held the second end of the wire

loop "Ethicon" No. 5 through the eye of the second guide needle.

Fig.9 - wire removal to the front surface in / 3

b / tibia.

Figure 10 - the free ends of the wire are fixed on the front

surface in / 3 b / tibia by twisting.

11 - x-ray: tear-off intermuscular fracture

elevations of the left tibia with displacement (2nd degree in

Meyers-McKeever) before surgery.

12 is a computer tomogram: a tear fracture of the intercondylar elevation of the left tibia with displacement (2nd degree according to Meyers-McKeever).

Fig - x-ray: tear-off intermuscular fracture

elevations of the left tibia with displacement (2nd degree in

Meyers-McKeever) after surgery.

Claims (1)

A method for the surgical treatment of fractures of the intercondylar elevation of the tibia, including arthroscopic reposition and osteosynthesis of a fragment of the intercondylar elevation, characterized in that a guide with a hole is inserted into the joint using a guide, then Ethicon No. 5 wire is passed through the ear of the knitting needle, the needle is removed to bring one end wire to the front surface of the upper third of the tibia, hold the 2nd spoke, and the other end of the wire is introduced into the hole of this spoke, the needle is removed to output the second end of the wire ki, then in extension of the knee joint-free ends of the wire are fixed on the front surface of the upper third tibia twisting method.

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