RU2457804C1 - Method of reconstructing posterior part of foot in case of absence of calcaneus - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to traumatology and orthopedics. Resection of medial malleolus and lateral malleolus, processing of joint surfaces of tibia, talus and navicular bones, as well as internal-posterior surface of cuboid bone is performed. Foot is displaced backwards to contact of cuboid bone with tibia and covering with posterior edge of the latter talus-navicular joint. Between joining surfaces of bones conditions of mutual compression are supported until stable adhesion is obtained.

EFFECT: method ensures reconstruction of foot loading axis, its workability and contours of posterior part.

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Description

The invention relates to medicine, in particular to orthopedics, and can be used in the treatment of patients in the absence of calcaneus.

There is a method of reconstruction of the hindfoot in the absence of the calcaneus, providing for the L-shaped osteotomy of the talus and dosed movement of the selected fragment from the bottom to the back to restore the anatomical contours of the calcaneus of the foot (V.I.Shevtsov, G.R. Ismaylov. Transosseous osteosynthesis in foot surgery. - M .: "Medicine", 2008. - P.360).

However, this method is only feasible provided that the talus is completely intact. Under conditions of a postosteomyelitis defect of the calcaneus, the formation of a sufficient volume of the talus fragment, its directed movement in the defect is difficult and does not exclude the development of recurrence of osteomyelitis.

There is a method of reconstruction of the hindfoot in conditions of chronic osteomyelitis, including arthrodesis of the ankle and talon-scaphoid joints, osteotomy of the tibia, dosed movement and reversal of the selected fragments in the defect from the bottom to the back, until restoration of the contours of the hindfoot (Patent No. 2381760; publ. 02.20.10, bull. No. 5).

However, this method does not provide restoration of the axis of the load of the foot due to the discrepancy between the size of the formed posterior section and the size of the front, which contributes to the development of pain syndrome in patients, requires orthopedic shoes.

The objective of the invention is to develop a method for the reconstruction of the hindfoot in the absence of the calcaneus, providing increased functional results of treatment due to the normalization of the axis of the foot load.

This problem is solved by the fact that in the method of reconstruction of the hindfoot in the absence of the calcaneus, including the processing and subsequent arthrodesis of the ankle and talar-navicular joints, when processing the bones, the inner and outer ankles are additionally resected, the inner-posterior surface of the cuboid bone is earned, and then they are displaced the foot posterior to the contact of the cuboid bone with the tibia and overlapping with the posterior edge of the last talon-navicular joint.

The method is illustrated by a description of examples of practical use and illustrative material, which shows:

Figure 1 - radiograph of the foot of patient K., before treatment;

Figure 2 - radiograph of the foot of patient K., during osteosynthesis;

Figure 3 - x-ray of the foot of the patient K., after dismantling the apparatus;

Figure 4 - view of the foot before (a) and after (b) treatment.

The method is as follows.

After anesthesia and treatment of the operative field, external ankle and talne navicular joints are exposed through external access. Cartilage is removed from the articular surfaces of the bones and moonlighted until congruent. At the same time, the outer and inner ankles are resected and the inner-posterior surface of the cuboid bone is treated. After this, the foot in a single block, is immediately displaced posteriorly until the cuboid bone comes in contact with the tibia and the posterior edge of the last talon-navicular joint overlaps with the posterior edge. Thereby, they normalize the load axis of the foot and recreate the likeness of the calcaneal tuber. In the attached position, the bones of the foot and lower leg are stabilized with diafixing needles, hemostasis of the wound is performed, which is sutured with the installation of a drainage system. Following these well-known techniques, an external fixation apparatus is mounted with holding knitting needles through the bones of the foot and tibia at the level of their middle and distal third. In the tensioned state, the spokes are mounted on the supports installed in their projection, which are interconnected by threaded rods, after which the diafixing spokes are removed. The operation is completed by performing control radiography and the application of aseptic dressings.

In the postoperative period, until a reliable clinical and radiological picture of the fusion is obtained, they perform intercompression of the treated surfaces of the articulating bones. After dismantling the device, the patient, if necessary, is recommended to use a removable span for 1.5-2 months.

The practical use of the method is illustrated by the following clinical observation.

Patient K., 50 years old, was admitted to the clinic of the RTC "WTO" named after Acad. G.A. Ilizarova with a diagnosis of chronic post-traumatic osteomyelitis of the left calcaneus, fistulous form. Condition after removal of a herniated disc L3-L4. Neurotrophic syndrome.

To eliminate the osteomyelitis process, the patient underwent radical sequestrnecrectomy with removal of the calcaneus; osteosynthesis with an external fixation apparatus.

After this, during the repeated surgical intervention, the affected foot was reconstructed. When it was carried out, the mating surfaces of the ankle and talar-scaphoid joints, the inner-posterior surface of the cuboid bone were treated, and the inner and outer ankles were resected. After that, in a single block, the foot was displaced posteriorly until the cuboid bone comes into contact with the tibia and the posterior edge of the last talon-navicular joint overlaps with the posterior edge. In the attached position, the bones of the foot and lower leg were stabilized and osteosynthesis was performed using an external fixation apparatus.

In the postoperative period, for 89 days, until a clinical-radiological picture of stable synostosis was obtained, the conditions for the mutual compression of the treated surfaces of the jointed bones were maintained. After dismantling the device, the patient used a removable span for a month, underwent a course of exercise therapy to develop a new stereotype of gait.

As a result of treatment, the total duration of which was 130 days, the support ability was restored and the shape of the hindfoot, close to natural, was recreated. The patient walks with a cane, fully loading the operated limb. Uses regular shoes.

At the follow-up examination, the achieved result is saved after a year, the patient does not complain, fistulas, no wounds, movement in the hip and knee joints within normal limits, the length of the limbs is the same.

Using the proposed method in the clinic of the RTC "WTO" showed that its use improves the functional result of treatment by restoring the load axis of the foot, its support ability and the anatomically correct contours of the back section.

Claims (1)

A method for reconstruction of the hindfoot in the absence of the calcaneus, including processing, bone displacement, and subsequent arthrodesis of the ankle and talar-navicular joints, characterized in that, when processing the bones, the inner and outer ankles are additionally resected, the inner-posterior surface of the cuboid bone is earned, and then the the foot posterior to the contact of the cuboid bone with the tibia and overlapping with the posterior edge of the last talon-navicular joint.

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