RU2463984C1 - Method of radiocarpal joint arthrodesis in children with flaccid paralysis of upper extremity - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to traumatology and orthopedics. Resection of articular cartilage of navicular, lumate, triquetral, distal end of radial bone and cortical plate from head of ulnar bone is performed. Pisiform bone is mobilised together with attaching to it tendon of ulnar flexor of hand. Cortical plate of pisiform bone is resected from radial, proximal and distal surfaces with preservation of place of attachment of tendon of ulnar flexor of hand. Pisiform bone is introduced into formed space between ulnar and triquetral bones.

EFFECT: method ensures elimination of risk of radiocarpal joint instability with minimal trauma to anatomic structures by creation of favourable conditions for consolidation of bone fragments at the background of neurotrophic disorders.

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Description

The invention relates to medicine, namely to traumatology and orthopedics.

Known methods for arthrodesis of the wrist joint by means of the back arthrotomy using patch and plug-in autografts from the iliac crest, as well as sliding autografts from the radius, remove the articular cartilage between the bones of the wrist and from the articular surface of the radius, and put sponges into the formed lumen ( See source: A. Ashkenazi, “Surgery of the wrist joint” - M .: Medicine. - 1990. - P.86-87).

The disadvantage of these methods is significant trauma due to the collection of bone graft.

A known method of arthrodesis of the wrist joint without the use of autografts, for example, according to Brockman (see source: IA Movshovich, "Operational Orthopedics" - M .: Medicine. - 1983. - S.133-134). The essence of the method consists in resection of the distal radius and ulna with the formation of a pointed distal end of the radius, followed by its introduction into the cleft of the wrist.

The disadvantage of this method is the significant shortening of the limb, which makes it unacceptable for children (over 12 years old), preserving the potential for the formation of the skeleton.

There is also a method for arthrodesis of the wrist joint, for example, according to Smith-Peterson, taken by us as a prototype (See source: Ashkenazi A.I. "Surgery of the wrist joint" - M .: Medicine. - 1990. - P.87). A distinctive feature of the method is the resection of the distal end of the ulna, which is used as a plug-in autograft.

The disadvantage of the method taken as a prototype is the insignificant participation in the arthrodesis of the ulnar bone, since a full elbow-carpal fusion is not created.

The objective of the invention is to improve the functionality of the upper limb, eliminating the risk of instability of the wrist joint with minimal trauma to the anatomical structures by creating favorable conditions for the consolidation of bone fragments against the background of neurotrophic disorders.

The technical result of the task is achieved by the fact that in the method of arthrodesis of the wrist joint in children with flaccid paralysis of the upper extremity, it is proposed to resect the articular cartilage from the scaphoid, semilunar, trihedral, distal end of the radius and the cortical plate from the head of the ulna, mobilize the pea bones and resect it a plate with a radial, proximal and distal surfaces with preservation of the place of attachment of the tendon of the elbow flexor of the hand with the subsequent introduction m of pisiform bone between the ulnar and the trihedral bones.

The figure 1 presents the wrist joint (view from the palmar surface) and the diagram of the relative position of the anatomical structures, where:

- position 1 - third metacarpal bone;

- position 2 - fifth metacarpal bone;

- position 3 - scaphoid;

- position 4 - lunate bone;

- position 5 - trihedral bone;

- position 6 - pea-shaped bone;

- position 7 - the distal end of the radius;

- position 8 - the head of the ulna;

- position 9 - tendon of the elbow flexor of the hand.

The figure 2 presents the wrist joint (view from the palmar surface) and the operation diagram of the arthrodesis, where:

- position 1 - third metacarpal bone;

- position 2 - fifth metacarpal bone;

- position 3 - scaphoid;

- position 4 - lunate bone;

- position 5 - trihedral bone;

- position 6 - pea-shaped bone;

- position 7 - the distal end of the radius;

- position 8 - the head of the ulna;

- position 9 - tendon of the elbow flexor of the hand.

The figure 3 presents the x-ray of the left wrist joint of a patient with flaccid paralysis of the upper limb before surgery, where:

- position 1 - third metacarpal bone;

- position 2 - fifth metacarpal bone;

- position 3 - scaphoid;

- position 4 - lunate bone;

- position 5 - trihedral bone;

- position 6 - pea-shaped bone;

- position 7 - the distal end of the radius;

- position 8 - the head of the ulna.

The figure 4 presents the x-ray of the left wrist joint of a patient with flaccid paralysis of the upper limb after arthrodesis surgery, where:

- position 1 - third metacarpal bone;

- position 2 - fifth metacarpal bone;

- position 3 - scaphoid;

- position 4 - lunate bone;

- position 5 - trihedral bone;

- position 6 - pea-shaped bone;

- position 7 - the distal end of the radius;

- position 8 - the head of the ulna.

The method of arthrodesis of the wrist joint in children with flaccid paralysis of the upper limb is as follows.

On the rear of the wrist joint, a longitudinal skin incision is made from the base of the third metacarpal bone (1) to the distal end of the radius (7). Mobilize and part the tendons of the extensors of the hand and fingers. The capsule of the wrist joint is cut in the transverse direction and exposed. In the distal direction, articular cartilage with scaphoid (3), lunate (4) and trihedral (5) bones is removed with a sharp chisel. In the proximal direction, the articular disc between the distal sections of the ulnar and radial bones is removed. The chisel resect the articular surface of the radius and the cortical plate of the head of the ulna (8). An additional skin incision is made along the palmar surface of the wrist joint - projection from the base of the fifth metacarpal bone (2) to the head of the ulna. The pea-shaped bone (6) is mobilized together with the tendon of the elbow flexor of the hand (9) attached to it (m. Flexor carpi ulnaris). Economically resect the cortical plate of the pea bone from the radial, proximal and distal surfaces while maintaining the attachment point of the tendon of the ulnar flexor of the hand. A pea-shaped bone is introduced into the formed space between the ulnar and trihedral bones on the feeding tendon so that the sections of the pea-bone freed from the cortical plate are in contact with the decorted sections of the ulna, radius and trihedral bones. Brushes give a functionally advantageous position. Fixing with Kirschner spokes. Seams in layers. Plaster cast immobilization for 2 months.

The advantages of the method:

- Involvement in the arthrodesis of the elbow-carpal joint makes the wrist joint more stable;

- low injuries;

- the use of pea bones on the feeding tendon leg provides more favorable conditions for consolidation in patients with flaccid paralysis with neurotrophic disorders.

Claims (1)

Method of arthrodesis of the wrist joint in children with flaccid paralysis of the upper limb, characterized by resection of the articular cartilage from the scaphoid, lunate, trihedral, distal end of the radius and the cortical plate from the head of the ulna, mobilization of the pea bone and resection of its cortical plate from the radial, proximal surface with preservation of the place of attachment of the tendon of the ulnar flexor of the hand with the subsequent introduction of the pea between the ulna and the trihedral bones.

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