RU2408319C1 - Method of transosteal reposition of fracture of radial bone neck by means of pin in children - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to traumatology-orthopedics, and can be used for treatment of fractures of radial bone neck in children. Essence: one end of pin is introduced into central part of fracture zone with further movement of its free end in proximal direction in lever-type manner. Preliminarily pin is bent is arch-like way on 1/4 of circumference. Above fractures tension of soft tissues in distal direction is created. After introduction of pin in fracture zone, it is axially rotated by its free end, distally oriented, at 45° in both sides, until bone fragments are separated. Movement of free pin end in proximal direction is carried out until maximal tension of soft tissues above fracture zone is achieved, after which its 180° rotation around the end, introduced into fracture zone, is performed.

EFFECT: method allows to increase reposition accuracy.

1 ex, 11 dwg

Description

The invention relates to medicine, namely to traumatology orthopedics, and can be used to treat fractures of the radial neck in children.

From the literature it is known that fractures of the neck of the radial bone are often found in childhood and are characterized by angular displacement, as well as a displacement in width and the presence of knee-in of bone fragments. With an angular displacement of more than 30 °, fracture reposition is necessary. Closed manual reposition is the least traumatic treatment method and gives the best functional results, but its possibilities are limited with severe soft tissue swelling and angular displacement of more than 60 ° [1]. In these cases, percutaneous reposition with a knitting needle is preferable, allowing direct effect on the displaced head of the radius through a puncture skin puncture, with minimal additional trauma [2].

There is a method of percutaneous reposition with a spoke of a fracture of the radial neck in children by means of lever and axial action of one of its ends on the displaced edge of the radial head [3]. However, this method involves the impact on the head of the radial bone with the end surface of the end of the spoke connected to it. This can lead to perforation or rupture of the radial head with damage to its articular surface and growth area, an increase in the severity of the primary injury and deterioration of the treatment results. In addition, this method does not eliminate the incidence of bone fragments in the fracture zone, which makes it difficult to eliminate the shift in width.

Closest to the claimed method according to its technical solution is a method for percutaneous reposition of a spoke of a fracture of the radius of the radial bone in children by introducing the end of the spoke into the central part of the fracture zone with subsequent movement of its other (free) end in the proximal direction as a lever [2]. The lever action provided for in this method on the radial head is carried out by the lateral surface of the end of the spoke inserted into the fracture zone, which avoids the disadvantage of the previous method, such as perforation or splitting of the radial head. However, like the previous method, this method does not eliminate the incidence of bone fragments in the fracture zone. In addition, this method has a number of its own significant disadvantages. First, the lever action of the spoke does not eliminate the displacement of the radial head in width, and secondly, it leads to tension of the skin, which, against the background of soft tissue edema, significantly limits the movement of the free end of the spoke in the proximal direction and, accordingly, reduces the degree correction of angular displacement.

The essence of the invention lies in the combination of distinctive features, sufficient to achieve the desired technical result, and consists in increasing the effectiveness of percutaneous reposition with a spoke of fractures of the radial neck in children by improving the technique of reposition.

The essence of the invention lies in the fact that the end of the spoke is introduced into the central part of the fracture zone with the subsequent movement of its other (free) end in the proximal direction, like a lever. Previously, the needle is bent in an arcuate manner on ¼ of the circumference, over the fracture, tension the soft tissues in the distal direction. After introducing the knitting needle into the fracture zone, its axial rotation is performed beyond the free end oriented distally at 45 ° in both directions until the bone fragments are separated. The free end of the needle is moved in the proximal direction until the maximum tension of the soft tissues above the fracture zone is reached, after which it is rotated 180 ° around the end inserted into the fracture zone.

The arcuate bending of the knitting needle on ¼ part of the imaginary circle avoids the emphasis of its free end, oriented distally, on the outer surface of the forearm, and thus freely perform axial rotation of the knitting needle.

The axial rotation of the spoke, centrally located in the fracture zone, by 45 ° on both sides, until the bone fragments separate, eliminates the impact of bone fragments, which makes it easier to eliminate the shift in width.

The preliminary tension of soft tissues over the fracture zone in the distal direction provides a greater displacement of the free end of the spokes in the proximal direction, and, accordingly, a greater degree of correction of angular displacement.

A 180 ° rotation of the free end of the arcuately bent knitting needle around the end introduced into the fracture zone contributes to the continuation of the leverage on the radial head when maximum soft tissue tension is reached over the fracture zone, and also creates a lateral effect on the radial head, eliminating the shift in width.

The method is illustrated by drawings. Figure 1-4 presents a diagram of the main stages of the method in the frontal plane, where 1 is a repositional spoke, 2 is the head of the radius, 3 is the humerus, 4 is the ulna, 5 is the fracture zone, 6 is the neck of the radius - stock of soft tissues distal to the fracture zone. Figure 5 presents a diagram of the elimination of nesting of bone fragments in the axial plane of the section through the fracture zone, where 8 and 9 are the extreme positions of the replacing spoke, with its axial rotation. Figures 6 and 7 show radiographs of a clinical case before performing reposition and after reposition by the proposed method, respectively. On Fig-11 presents photographs of a clinical case illustrating the main stages of reposition by the proposed method.

The method is as follows.

Based on the data of x-ray and clinical studies of the injured limb, the forearm is set so that the displaced edge of the radial head is located subcutaneously in the outer part of the elbow joint. After that, the Kirschner needle used for reposition is bent in an arcuate manner on ¼ part of the circle (Fig. 8). Then, the soft tissues are tensioned over the fracture zone in the distal direction, and in the projection of the displaced edge of the radial head, through the skin puncture, one of the ends of the knitting needle is inserted into the fracture zone. In this case, the introduced end of the spoke is located in the central part of the fracture zone, and its free end is oriented in the distal direction parallel to the longitudinal axis of the forearm (Figs. 1 and 9). Perform axial rotation of the spoke beyond its free end by 45 ° in both directions until the separation of bone fragments in the fracture zone (figure 5). Make the movement of the free end of the spokes in the proximal direction (figure 2). Upon reaching maximum tension of the soft tissues above the fracture zone, which prevents further movement of the spokes, rotate its free end 180 ° around the end introduced into the fracture zone (Figs. 3 and 10). The movement of the free end of the spoke in the proximal direction continues until the end of the spoke comes out of the fracture zone (FIGS. 4 and 11).

Clinical example.

Patient E., 11 years old, source.ball. No. 5888. He entered the State Research Center "WTO" in November 2007 at the front desk. In the anamnesis - a fall in the street on the left forearm. On the primary radiographs - a fracture of the neck of the left radial bone with an angular displacement of 70 ° and a shift in width by 2/3 of the diameter of the bone (Fig.6). Clinically - marked swelling of the soft tissues in the area of injury, the head of the radius does not palpate.

Under anesthetic aid (general anesthesia), in the operating room, percutaneous reduction of a fracture with a spoke was performed using the proposed method. On the control radiographs - the complete elimination of all types of displacement of fragments of the radius (Fig.7).

Plaster immobilization - 6 weeks, then - the development of movements. When examined for a period of 2.5 months after the injury, the full range of movements in the elbow joint was obtained.

Information sources

1. Tibone J.E. et Stoltz M. Fractures of the radial head and neck in children. J Bone Joint Surg [Am]. 1981; 63-A: 100-106.

2. Steele J.A. et Kerr Graham H. Angulated radial neck fractures in children: a prospective study of percutaneouse reduction. J Bone Joint Surg [Br]. 1992; 74-B: 760-764.

3. Bairov G.A. Fractures in the elbow joint in children. Medgiz, 1962. S.144-146.

Claims (1)

A method for percutaneous reposition of a needle of a fracture of the neck of the radial bone in children, including the introduction of one end of the spoke into the central part of the fracture zone with subsequent movement of its free end in the proximal direction, like a lever, characterized in that the needle is bent arcuately 1/4 of the circumference above the fracture creates tension of the soft tissues in the distal direction, the spoke is inserted into the projection of the displaced edge of the radial head, after introducing the spoke into the fracture zone, its axial rotation is performed for free distally oriented, 45 ° to both sides until the bone fragments are separated, the free end of the needle is moved in the proximal direction until the soft tissue reaches maximum tension over the fracture zone, and then rotate it 180 ° around the end inserted into the fracture zone.

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