RU2394475C1 - Method of determination of start date of axial weight bearing in fractures and control of dynamics - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: to determine the start date of the axial weight bearing in fractures and to control its dynamics, X-ray examination is applied. Additionally, radiothermometry of bone and soft tissue structures are prescribed. If observing a temperature gradient of an injured segment and a symmetric healthy section decreasing to 1.0°, graduated axial weight bearing is recommended.

EFFECT: method allows determining the starting date of the axial weight bearing, controlling its dynamics, preventing complications associated with delayed administration of the axial weight bearing.

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Description

The present invention relates to medicine, in particular to methods for determining the timing of the onset of axial load on the lower limb during fractures and monitoring its dynamics.

As a prototype, the method of radiography was chosen, which consists in determining the contours of bone fragments and the fracture line, the presence of endosteal and periosteal callus (Shestakov D.Yu. Surgical treatment of intraarticular fractures of the condyles of the tibia with the ChKOS method: Abstract of dissertation of the Candidate of Medical Sciences / D. Y. Shestakov. - M., 2003. - P. 21).

However, the known method is associated with radiation exposure to the patient, depends on the quality of the x-ray image. The assessment of the radiograph is subjective and depends on the experience of the doctor. Another disadvantage limiting the use of the known method is the high cost of the equipment and the examination itself.

The task of the invention is to reduce radiation exposure to the patient.

The problem is solved due to the fact that in the method, including x-ray examination, radiothermometry of bone and soft tissue structures of the limbs is additionally prescribed.

The method for determining the timing of the onset of axial load on the lower limb during fractures and control of its dynamics is as follows. On average, eight weeks after surgery, radiothermometry is performed and a temperature gradient is measured in the damaged and symmetrical parts of the limb. In the presence of a temperature gradient of less than 1.0 °, a metered axial load is allowed. Then, temperature monitoring is performed every two weeks. When the temperature gradient rises above 1.0 °, the axial load is limited until the next control measurement. In the presence of a temperature gradient of more than 1.0 ° two months after the operation, the axial load is not allowed. With a control temperature measurement, a gradient decrease to 1.0 ° is expected every two weeks. After reaching this gradient, the axial load on the injured limb is resolved with temperature control every two weeks. The full axial load is allowed while maintaining the temperature gradient at the same level after the start of the axial load on the limb or its reduction, as well as on the basis of clinical examination and a single X-ray examination several months after the operation, thus determining the individually optimal start time of the axial load on the damaged limb and controlling its dynamics.

Clinical example

Patient F., 35 years old, and.b. No. 233374, 31.01.08 was admitted to the Nizhny Novgorod Research Institute of Traumatology and Orthopedics with a diagnosis of closed comminuted intraarticular fracture of the external condyle of the left tibia with displacement, rupture of the internal lateral ligament. Injury received on 01/26/08 as a result of a fall while skiing. 02/05/08 the operation was performed: open reduction, osteosynthesis of the external condyle of the left tibia with an LCP plate, bone grafting of a post-traumatic defect with an allograft. The postoperative wound healed by first intention, the patient was discharged 11 days after surgery. 8 weeks after surgery, the patient was in control. Comparative radiothermometry of both knee joints was performed before loading and after a standard functional test. Radiothermometric examination showed the presence of a temperature gradient from ΔТ = 1.8 ° to ΔТ = 2.6 °. In this case, a diagnostically significant temperature gradient before and after a standard functional test was not detected. The patient was recommended to temporarily refrain from axial load on the injured limb with continued development of movements in the joint and strengthening of the thigh muscles. 12 weeks after the operation, the patient reappeared for a consultation, where she underwent a radiothermometric examination. During the examination, it was found that the temperature gradient in both knee joints before and after the load does not exceed the technical measurement error and is equal to ΔТ = 0.8 °. The patient is allowed to begin axial load on the injured knee joint with its gradual increase and dynamic radiothermometric control. During the follow-up examination 16 weeks after surgery (full axial load was achieved), an increase in the temperature gradient between the knee joints was not detected. Control radiography and clinical examination showed consolidation of the fracture.

The method allows to determine the timing of the start of the axial load on the injured limb, to control its dynamics, to avoid complications associated with the delayed appointment of the axial load, such as angular deformation in the knee joint and the development of post-traumatic osteoarthritis. In addition, the method allows to reduce radiation exposure to the patient.

Claims (1)

A method for determining the timing of the onset of axial load on the lower limb during fractures and monitoring its dynamics, including x-ray examination, characterized in that radiothermometry of the bone and soft tissue structures of the limb is additionally prescribed, and with a decrease in the temperature gradient between the damaged segment of the limb and a symmetrical healthy area to 1.0 ° recommend dosed axial load on the limb.