RU2413474C2 - Method for eliminating posttraumatic platypodia - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to orthopaedics. It involves angular osteotomy of a body of a heel bone one plane of which passes alongside and backwards from a plantar exostosis. By counter multidirectional traction, a longitudinal arch is formed gradually by turning a heel in a plantar direction and thereby displacing an intermediate fragment of the body of the heel bone into a diastasis created by turning the heel.

EFFECT: method enables repairing the longitudinal arch with simultaneously forming a footplate of a hindfoot, preventing recurrent deformation and reducing length of treatment.

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Description

The invention relates to medicine, in particular to orthopedics and traumatology, in particular, is intended for the treatment of patients with post-traumatic flatfoot.

There is a method of eliminating deformities of the hindfoot, in which, after removal of the cartilage from the articular surfaces of the subtalar joint and osteotomy of the anterior calcaneus anterior to the calcaneal sulcus, the calcaneus is simultaneously moved in two planes of deformations by an external fixation apparatus (AS 1047467, application No. 3443679 / 28-13, RF. Publ. 1983. 10/15/83, Bull. No. 38).

However, the known method for post-traumatic flatfoot does not allow to eliminate bone spikes and growths on the plantar surface of the calcaneus, as well as to shorten the treatment time, since it is often necessary to turn the peripheral part of the heel by 90 ° or more.

A known method of reconstructive arthrodesis of the subtalar joint in case of post-traumatic flatfoot, which involves removing the cartilage from the articular surfaces of the subtalar joint, also removes bone spikes and growths along the plantar surface of the calcaneus, and to restore the calcaneal angle and arch of the foot between the calcaneus and talus, they introduce sphenoid or an allograft (p. 548. Kaplan A.V. Damage to bones and joints / A.V. Kaplan. - M .: Medicine, 1979. - 567 p.).

However, the known method for arthrodesis of the subtalar joint is traumatic, since in addition to a large incision, additional surgical intervention is required to take a bone autograft. In addition, the usual excision of bone spikes and growths does not exclude their recurrence, and simultaneous reversal of the heel is often impossible, for example, if the calcaneus is parallel to the tibia.

The objective of the present invention is to develop a method for restoring the longitudinal arch and forming the supporting surface of the hindfoot, which can reduce treatment time and prevent recurrence of deformity, as well as equalize the foot length.

The problem is solved in that in the method of eliminating post-traumatic flatfoot, angular osteotomy of the calcaneal body of the form is performed at the level of the plantar exostosis with the inclusion of the latter in this intermediate fragment and, using counter-directed traction of the calcaneal body and the intermediate fragment, the longitudinal arch is dosed, shifting the intermediate fragment body of the calcaneus in the diastasis formed when the heel turns.

The present invention is illustrated by a detailed description and copies of x-rays, in which:

Figure 1 - copy of the x-ray of the left foot with post-traumatic flatfoot before surgery with the scheme of osteotomy (lateral projection).

Figure 2 - copy of the x-ray of the left foot with post-traumatic flatfoot after surgery in the traction apparatus Ilizarov.

Figure 3 is a copy of the x-ray of the left foot with post-traumatic flatfoot after removing the Ilizarov apparatus.

The method is as follows.

In the operating room under epidural anesthesia, after processing the surgical field with an antiseptic, a linear incision of soft tissues is performed along the outer surface of the hindfoot. The incision is located at the level of the most protruding part of the exostosis, but does not extend to the supporting surface of the foot.

Then the osteotome performs a dissection of the body of the calcaneus of a triangular shape in the region of the exostosis protruding onto the plantar surface, including the latter in the intermediate triangular bone fragment formed, one of the vertices of which it is (Figure 1).

In the presence of cartilage residues in the subtalar joint, the latter are removed, and in the absence of mobility, a transarticular ostomy is performed in it. The wound is sutured in layers.

Then four crossed needles are drawn through the tibia, one of them through the fibula. Spokes held in pairs are fixed in two rings of the Ilizarov apparatus, which are connected together by rods.

Two spokes with thrust pads are passed through the talus and, in a taut state, fix them to the half-ring of the Ilizarov apparatus.

This support is connected to the rings on the shins with the help of rods and hinges, which are mounted from brackets. A needle drawn through a triangular intermediate fragment is attached to the same support with distraction rods, its ends bend in the proximal direction.

Two spokes with thrust pads, which are fixed in the second half-ring of the Ilizarov apparatus, are passed through the calcaneal bone in the calcaneal tuber. This external support is connected to the rings on the lower legs using rods and hinges.

Through the metatarsal bones, a spoke is held, which is fixed in a semicircle. The latter is connected to the rings on the lower leg using rods.

Five days after the operation, distraction begins, moving the peripheral fragment of the calcaneus in the plantar direction (Figure 2, the white arrow is the heel moving vector), and the intermediate triangular fragment is up and back (Figure 2, the black arrow is the movement of the triangular bone fragment) filling it with the formed space between the talus and calcaneus.

Clinical observation.

Patient K., a resident of the south of the Tyumen region, as a result of catatrauma, received an open comminuted intraarticular fracture of the calcaneus with displacement of fragments. Treatment after injury was carried out at the place of residence. The outcome is a malformed fracture with an almost vertical position of the calcaneus and a pronounced pain syndrome in the subtalar joint (Figure 1).

We performed an operation under epidural anesthesia. A linear incision of soft tissues 3 cm long was made on the outer surface of the posterior section. Skeletonation of the bone was not performed. After access to the subtalar joint, fragments of cartilage were found in it, which we removed. Then performed calcaneus osteotomy in the exostosis with the formation of a triangular fragment.

Then they placed the Ilizarov apparatus of two external supports on the shin. The talus and the triangular fragment were fixed using knitting needles in a half ring. Two spokes with thrust pads were passed through the calcaneus, and one spoke through the metatarsal bones, which were fixed in tension in two half rings of the Ilizarov apparatus.

In the postoperative period, distraction was carried out daily, moving the calcaneus in the plantar direction of 1-2 mm (Figure 2, the white arrow is the heel displacement vector), and the triangular fragment in the proximal direction and posteriorly, straightening the pre-bent needle, which is drawn through it, using distraction rods (Figure 2, black arrow - moving a triangular bone fragment).

The period of distraction was 46 days, and the fixation lasted 35 days. Additional immobilization, after removal of the Ilizarov apparatus, was not carried out (Figure 3).

1.5 months after removal of the Ilizarov apparatus, the patient switched to a full load on the operated limb using ordinary shoes.

There was no pain in the projection of the subtalar joint and along the plantar surface.

The proposed method allows to obtain the following positive effects.

Firstly, it provides a reduction in treatment time, since a triangular bone fragment, which is essentially a blood-supplied autograft, is introduced into the resulting interfragmental diastasis. The relocated autobone replaces the formation of bone regenerate.

Secondly, this method allows to prevent recurrence of deformation, since the blood-supplying movable bone fragment is fused with neighboring sections of the calcaneus, blood-supplying to the same vessels. Unlike distraction regenerate, it will not change its shape under load.

Thirdly, the proposed method not only does not shorten the foot, but, on the contrary, makes it possible to equalize the length of the feet, both by turning the heel into the position of normal correction and by moving it backward. In addition, this method allows you to restore the height of the hindfoot, which is reduced due to the impression and displacement of bone fragments in the vertical direction.

Fourth, this method allows, in the presence of concomitant deforming arthrosis of the subtalar joint, to obtain bone ankylosis of the latter and eliminate pain.

Fifthly, with this method, the supporting surface of the hindfoot is formed, while the protruding bone fragments, the resulting exostoses do not resect, which is often fraught with relapse, but are displaced in the proximal direction and used to restore the height of the foot, and hence the length of the lower limb.

In addition, the proposed method is used in the Tyumen regional trauma and orthopedic center.

Claims (1)

A method for eliminating post-traumatic flatfoot, including removing cartilage from the subtalar joint, moving the calcaneus, characterized in that an angular osteotomy of the calcaneus body is performed in the region of the exostosis protruding onto the plantar surface, including the latter in the formed bone fragment of a triangular shape, one of the vertices of which it makes , the peripheral part of the calcaneus is metered in the plantar direction, and the bone fragment formed of a triangular shape is moved, Full them form a space between the talus and the calcaneus for the formation of the longitudinal arch.

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