RU2402296C1 - Method of treating knee fractures and related apparatus for implementation thereof - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: group of inventions refers to medicine, namely to traumatology and orthopaedics and can be used in treating knee fractures. A compression-distraction apparatus is applied, fracture reduction and fixation follow. The apparatus consisting of one ring and two semiring bearings is mounted on rods with the semiring bearings being fixed on the rods arranged on the lower one-third of thigh and in the mid-third of shin bone. The central ring bearing is placed below the fracture level. Threaded nails fixed in movable reduction elements mounted on a ring bearing are inserted into each deviated condyle fragments with the reduction element comprising a hinge. An apparatus for treating knee fractures comprises upper and lower semiring location bearings, and a central ring bearing. Threaded rods joints the upper and lower semiring bearings and the central ring bearing. The apparatus is provided with the rods to be inserted below and above the fracture level, the threaded rods to be inserted in the condyle fragments, the rod retainers to be inserted in the condyle fragments, and the movable reduction elements. The rods to be inserted below and above the fracture level are mounted on the upper and lower semiring location bearings. The movable reduction elements are fixed on the central ring bearing and have a cylindrical body of two identical semi-bodies with their parting plane passing along the cylinder axis. The semi-bodies have eye ring located along a parting line on face surfaces of the semi-bodies on two sides of lateral surfaces. One of the semi-bodies is rigidly mounted on a threaded axis for screw nut fastening on the central ring bearing. The body has a symmetric cavity on the axis with its diametre matched with the diametre of the rod retainer whereon the threaded rod is nut up. Slots for the threaded rods to be introduced into the condyle fragments nut up in the slots are provided on the midline of the body. The semi-bodies are connected by threaded connection in eye rings.

EFFECT: inventions provide reduction of an intraarticular knee fracture, elimination of all types of displacement, restored congruence of articular surfaces, stable fixation for fusion.

2 cl, 2 dwg

Description

The invention relates to medicine, namely to traumatology and orthopedics, and can be used in the treatment of fractures in the knee joint.

Known methods of treating fractures in the knee joint, as well as devices for their implementation, which include reposition of the fracture, holding knitting needles with thrust pads through the fragments, while the free ends of the knitting needles are fixed in the distraction nodes of external fixation devices with the possibility of compression along the fracture plane [1 , 2].

However, these methods and devices are not always and not fully able to provide accurate reposition with restoration of congruence of articular surfaces and stable fixation for the period of fusion. If necessary, open reduction, in cases of multi-fragmented and impression-compression condyle fractures, the latter is carried out, as a rule, from extensive surgical approaches, which is always associated with additional circulatory disturbance in the fragments of a limb segment.

Closest to the claimed method, according to its technical solution, is a method for treating condyle fractures of the femur and tibia using transosseous osteosynthesis [3], which provides for the needles to be passed through the femur and tibia with their fastening in the supports of the Ilizarov apparatus connected by threaded rods. Spokes are also passed through each of the displaced fragments of the condyles and fixed on rods mounted on a U-shaped plate connected by a support rod to the apparatus. By moving along the spokes in the U-shaped plate, the fracture is repositioned. This device was also used for compression fractures of the tibial condyles, by gradual elevation of the condyle by 1/4 mm 4 times a day by the movement of the U-shaped plate with repairing knitting needles along the support rod to replace the defect formed as a result of crushing of the cancellous bone.

However, this method employs a device that has limited repositional and stabilization capabilities and can be used experimentally and even for fractures with insignificant displacements of the fragments, when it is necessary to co-opt the fragment along the fracture plane and make up for compression. With significant displacements, with comminuted and impression-compression fractures, the elimination of the tibial condyle defect, as well as the restoration of congruence of articular surfaces in this way is extremely difficult. In addition, the use of one supporting threaded rod for the purpose of reposition is not enough to ensure stable fixation of fragments.

Closest to the claimed device, in its technical solution, is the device considered in the method of treating patients with condyle fractures of the knee bones of the Ilizarov apparatus [4]. In this method, the apparatus is mounted from three or four annular supports on the needles, which are held through the lower third of the thigh and tuberosity of the tibia, and the middle annular support is installed at the level of the fracture. Reposition of the condyle is achieved here with the help of a repairing needle held at an angle of the sagittal plane, which is fixed on the middle ring. Depending on the nature of the fracture.

However, the described method of reposition is not always able to ensure the elimination of all types of displacements and restore congruency in the knee joint, which is especially important with significant displacements of fragments, as well as partial or complete damage to the ligaments of the knee joint. In addition, holding the spokes through the thigh and tibia does not exclude a “block” of muscles with the formation of so-called “fixed muscle points”, which may be an additional reason for joint contracture.

The invention consists in a combination of essential features sufficient to achieve the desired technical result, consisting in reposition of an intraarticular fracture in the knee joint, with the elimination of all types of displacements, restoration of congruence of the articular surfaces and stable fixation for the period of fusion.

The essence of the method of treating fractures in the knee joint includes the application of a compression-distraction apparatus, reposition and fixation of the fracture. The apparatus, consisting of one annular and two semicircular supports, is mounted on the rods, while the semicircular supports are fixed on the rods mounted on the lower third of the reed and in the middle third of the tibia. The middle annular support is placed below the level of the fracture, threaded rods are inserted into each of the displaced condyle fragments, mounted in movable repair nodes mounted on the annular support. The reponent assembly comprises a hinge.

The use of semi-ring supports as the base and the use of rods as fixing elements allowed to significantly reduce the weight of the structure and make it more convenient for patients.

Placing the middle annular support below the level of the fracture allows the installation of reponent nodes containing threaded rods for insertion into the displaced fragments of the condyles.

The use of repair nodes makes it possible to eliminate all types of displacements with restoration of congruence of articular surfaces and reliably fix fragments for the period of fusion.

The essence of the invention lies in the fact that the device for treating fractures in the knee joint region contains an upper and lower half-ring base support and a middle ring support, threaded rods for connecting the upper and lower semi-ring supports to the middle ring support. The device has rods for insertion below and above the fracture level, threaded rods for insertion into the condyle fragments, rod clamps for insertion into the condylar fragments, movable repair nodes. Rods for insertion below and above the fracture level are installed on the upper and lower semicircular base supports. The movable repair units are fixed on the middle annular support and have a cylindrical body of two identical half-bodies, the plane of the connector of which passes along the axis of the cylinder. The half-shells have ears located along the split line along the end surfaces of the half-shells, on two sides of the side surfaces, one of the half-shells is rigidly mounted on the threaded axis for mounting on the middle ring support with nuts. A symmetrical cavity is made along the axis in the housing, while the diameter of the cavity corresponds to the diameter of the rod retainer on which the threaded rod is fixed with nuts. Through the midline of the half-shells of the body, through-cuts are made under the threaded rods for insertion into the fragments of the condyles, fixed in the cuts by nuts, the half-shells are threaded to the ears.

Rigid fastening (installation) of one of the half-shells on the threaded axis allows you to change the position of the reponent assembly vertically, ensures its rotation around this axis and mounts it on the support with nuts.

Performing a symmetrical cavity along the axis of the housing allows you to install the rod retainer in the peripheral parts of the cavity. A cavity located in the middle part, with a diameter corresponding to the size of the rod retainer, with nuts installed on it, and the placement of the end sections of the rods in the through radial slots, on both sides of the side surfaces, along the midline of the housing half-shells, perpendicular to the connector line, ensures rotation of the retainer around the horizontal axis of the repository node and its fixation in this node.

The execution of a cylindrical body of a movable reponentive node of two identical half-shells and their connection with threaded joints behind the ears located on the end surfaces of the half-shells allows during the operation to establish (place) a rod inserted into the tibial condyle fragment in it.

The layout of the compression-distraction apparatus, providing the implementation of the proposed method, is shown in figure 1, figure 2 shows the design of a movable reparation unit.

The device consists of the basic supports of the compression and distraction apparatus: the upper - 1 and lower - 2, mounted respectively on the threaded rods 3 and 4, the basic supports are connected by threaded rods 5 to the annular support 6, on which the movable repair nodes are fixed 7. The cylindrical body of the repair nodes , in turn, consists of two identical half-shells 8 and 9, the plane of the connector of which passes along the axis of the cylinder. One of the half-shells - 9 is rigidly mounted on the threaded axis 10 for mounting on a support with nuts. A symmetrical cavity is made along the axis in the housing, while the diameter of the cavity in the peripheral sections 11 corresponds to the diameter of the rod retainer 12, on which the threaded rod 14 is fastened with nuts. and 9 are connected by a threaded connection 16 for the ears 17 located along the line of the connector along the end surfaces of the half-shells. On two sides of the side surfaces, on the midline of the half-shells 8 and 9 of the housing, perpendicular to the connector line, through-cuts 18 are made for threaded rods 14, fixed in the slots by nuts 19.

The method using the device is as follows.

Bone rods 3, 4 (or a combination of knitting needles and rods are used) are inserted into the bone fragments above and below the fracture site, which are fixed in the supports 1 and 2. By distraction along the threaded rods 5 between the supports, coarse displacements of the fragments are eliminated due to tension and capsular tension ligamentous apparatus of the knee joint and their orientation relative to the plane of the fracture. The final reduction with the restoration of congruency in the joint is achieved with the help of repair nodes 7. Threaded rods 14 with a threaded thread are inserted into each of the displaced large fragments, which are fixed on the rod retainer 12 with nuts 13. The half-body 9 of node 7 is set to the required height in the ring support 6. The position of the rod 14 in the latch 12 is adjusted by moving the nuts 13. The latch 12 with the rod 14 installed in it is placed in the cavity of the half-housing 9 of the reparation unit 7, with the threaded rods 14 being covered with slots 18. Set They create a half-shell 8 and connect it to the half-shell 9 by threaded connections 16. By angular movements of the rods 14 with the clips 12, in the cavity of the bodies of the nodes 7, a final reposition of the fracture is achieved with the elimination of all types of displacements and restoration of congruency in the knee joint. The rods 14 are fixed in the bodies of the reponentive nodes 7 using nuts 19. Moreover, in case of fractures of the tibial condyles, the intact condyle of the femur is a splint on which reposition is performed with restoration of congruence of the articular surfaces. With significant displacements, especially with multi-split and impression-compression fractures, an open reposition of the fracture with bone autoplasty of the condyle defect, which is performed from small operative approaches, is not excluded. Upon reaching reposition, through fragments of the condyles, in opposite directions, spokes 20, 21 are held with stops that are fixed on the support of the apparatus, which significantly increases the reliability and stability of fixation.

Information sources

1. K.K. Nigmatullin, V.I. Evseev. A method for the treatment of intraarticular impression fractures. A.S. No. 982662, BI No. 47, p. 1982

2. K.K. Nigmatullin, A.A. Kilkinov. A method for the treatment of intraarticular impression fractures. Patent No. 2023429, BI No. 22, p. 26.

3. S.I.Shved, G.E. Karagodin, V.K. Noskov. A method for the treatment of condyle fractures of the femur and tibia using transosseous osteosynthesis. Orthopedist. - injury. - 1986, No. 2, pp. 42-43.

4. V.K. Noskov. Treatment of patients with condyles fractures of the knee bones with Ilizarov apparatus. Orthopedist. - traumatol. - 1988, No. 9, p. 26-28.

Claims (2)

1. A method of treating fractures in the knee joint region, including applying a compression-distraction apparatus, reposition and fixation of the fracture, characterized in that the apparatus, consisting of one annular and two half-ring supports, is mounted on the rods, while the semi-ring supports are fixed on the rods installed on the lower third of the thigh and in the middle third of the tibia, the middle annular support is placed below the level of the fracture, threaded rods fixed in movable repons are introduced into each of the displaced condyle fragments The nodes mounted on the annular support, the reparation unit contains a hinge. 2. A device for treating fractures in the knee joint region, comprising an upper and lower semicircular base support and a middle ring support, threaded rods for connecting the upper and lower semicircular supports to the middle ring support, characterized in that it has rods for insertion of lower and higher levels fractures, threaded rods for insertion into the condyle fragments, rod clamps for insertion into the condylar fragments, movable repair nodes, rods for insertion below and above the fracture level are installed on the upper and lower half-ring base supports, movable reponent nodes are fixed on the middle ring support and have a cylindrical body of two identical half-shells, the plane of the connector of which runs along the axis of the cylinder, half-shells have ears located along the split line along the end surfaces of the half-shells, on two sides of the side surfaces, one of half-shells are rigidly mounted on the threaded axis for mounting on the middle annular support using nuts, in the housing, along the axis, a symmetrical cavity is made, while the diameter of the cavity is it corresponds to the diameter of the rod retainer, on which the threaded rod is fixed by nuts, through the middle line of the housing half-shells, through cuts are made under the threaded rods for insertion into the fragments of the condyles, fixed in the slots by nuts, the half-shells are connected by a threaded connection to the ears.

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