RU2456948C1 - Method of supratalar joint arthrodesis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to traumatology and orthopedics. Fibula is exposed from two cuts - on the boundary of its meddle and lower third and in the area of external ankle. Osteotomy is performed on the boundary of meddle and lower third. Within the limits of said two cuts subperiosteal extirpation is performed. After removal of cartilaginous cover from talus end of tibia is introduced into talus. Gypsum bandage is applied.

EFFECT: method ensures recovery of support ability of lower extremity, reduction of post-operation complications.

4 dwg

Description

The invention relates to medicine, namely to traumatology and orthopedics, and can be used in the treatment of the effects of severe open injuries of the ankle joint.

One of the urgent problems of restoring lower limb support ability is ankle joint arthrodesis surgery. However, the existing methods of arthrodesis of the ankle joint, in the presence of extensive scars that occur after open fractures, dislocations in the ankle joint, is almost impossible to apply. Scars in this area are usually tightly welded with the bones of the lower leg, mainly with the fibula, which is explained by the anatomical features of the lower third of the lower leg (lack of muscle, an insignificant layer of subcutaneous fat). Therefore, to correct the vicious position of the foot, scars tightly welded with the fibula are the first to prevent, for the elimination of which the first stage shows various options for non-free skin grafting.

A known method of arthrodesis of the ankle joint, taken as a prototype, in which an osteotomy of the fibula is performed 6-7 cm above the tip of the ankle, the graft is temporarily removed, cartilage is removed from the articular surfaces of the tibia and talus, a groove is made on the outer surface of these bones, where they are inserted fragment of the fibula. The graft is fixed with screws to the tibia and talus.

The disadvantage of this method is the inability to use it due to the presence of extensive scars fused with the fibula, which interfere with the correction of the vicious position of the foot. The application of this method is possible only with a full skin cover of the ankle joint and with the correct axis of the lower leg and foot.

The essence of the invention consists in the combination of essential features sufficient to achieve a technical result, which consists in restoring the supportability of the lower limb after severe open injuries of the ankle joint, in the presence of extensive scar tissues fused to the fibula.

The essence of the method of arthrodesis of the supragranular joint includes external lateral access, osteotomy of the fibula and removal of cartilage of the affected joint. The fibula is distinguished from two sections - at the border of the middle and lower third and in the region of the external ankle. An osteotomy is performed at the border of its middle and lower third, subperiosteal is husked within these two sections. After removing the cartilage from the talus, the end of the tibia is inserted into the talus. Apply a plaster cast.

Isolation of the fibula from two cuts - on the border of the middle and lower third and in the region of the outer ankle, reduces the invasiveness of the operation, prevents complications from the skin in the ankle joint due to the presence of coarse scar adhesions with the fibula, allows you to restore the axis of the lower leg and foot .

Osteotomy and subperiosteal hulling of the fibula within these two sections is a less traumatic technique that can prevent complications from scarred skin of the ankle joint.

Removal of the cartilage from the talus promotes fusion (bone ankylosis) of the end of the tibia embedded in the talus.

The application of a plaster cast on the shin and foot provides immobilization of the ankle joint for the period of bone ankylosis.

The method is illustrated by photographs.

Figure 1 shows the x-ray of the lower leg and foot before surgery;

figure 2 - x-ray of the lower leg and foot after osteotomy and husking of the fibula in the anteroposterior projection;

figure 3 - x-ray of the lower leg and foot after osteotomy and husking of the fibula in a lateral projection;

figure 4 is an x-ray of the leg and foot one year after the operation.

The proposed method is as follows.

After processing the skin of the lower leg and foot and anesthesia according to the generally accepted method, soft tissues are longitudinally dissected over the fibula at the border of the middle and lower third of 3 cm long. The second incision is made in the region of the external ankle up to 3 cm long. The fibula is subperiostally within these two sections. osteotominate at the border of the middle and lower third and husk. After removing the cartilage of the talus, the end of the tibia is inserted into the talus. Wounds are sutured in layers. Apply a plaster cast.

Information sources

1. Movshovich I.A. Operative orthopedics. M .: Medicine, 1994, p. 313-332.

Claims (1)

The method of arthrodesis of the bulged joint, including external lateral access, osteotomy of the fibula, and removal of the cartilage of the affected joint, characterized in that the fibula is distinguished from two sections - at the border of the middle and lower third and in the region of the external ankle, osteotomy is performed at the border of the middle and its lower third, subperiosteally, is husked within these two cuts, after removing the cartilage from the talus, the end of the tibia is inserted into the talus, a plaster bandage is applied.

Images