RU2465854C1 - Method of arthroplasty of interphalangeal joints of fingers - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely traumatology and orthopaedics, and may be used for treating consequences of severe long-standing juxta-articular hand fractures by arthroplasty of interphalangeal joints. A deviated bone fragment is separated. Cicatrical tissues are excised. A canal is created in the separated bone fragment. An end of the central fragment is modelled by the form of the canal in the form of a projection to form peripheral bone-periosteal blades. The fragment with the formed canal is set on the projection of the central fragment. A junction of the bone fragments is overlapped by the formed peripheral bone-periosteal blades.

EFFECT: method provides functional recovery of fingers, creation of the conditions for bone fragment regeneration, reduction of injures and length of treatment.

5 dwg

Description

The invention relates to medicine, namely to traumatology and orthopedics, and can be used in the treatment of the effects of severe chronic periarticular fractures of the bones of the hand.

One of the urgent problems of restoring the function of fingers is arthroplasty of interphalangeal and metacarpophalangeal joints.

There are various methods of arthroplasty of these joints with interposition of the resected ends of the phalanges after modeling them with a wide fascia of the thigh, autografts of the joint ends of other bones (usually toes), or even synthetic materials [1]. However, these methods allow to obtain positive results in only 50% of cases [2]. Methods for restoring joint function by silicone and metal endoprostheses are also known. However, not all patients agree to such operations.

The prototype is a method of arthroplasty of the metacarpophalangeal and interphalangeal joints of the fingers of the hand [3], which is carried out by resection of the articular ends, the formation of articular surfaces and filling the newly formed joint gap with an elastic foam polymer. The disadvantage of this method is the imposition of an external fixation apparatus on the damaged finger until the postoperative wound heals, with which the joint, paraarticular tissues are prepared and all stages of the operation are performed. In this case, additional trauma is caused when installing the device, there is a possibility of infection in the area of the needles, the periods of rehabilitation of the patients are extended.

From a biological point of view, the most valuable plastic material for arthroplasty is automaterials. So in the absence of articular ends of the phalanges of the fingers of the hand, it is possible to use autogaline cartilage in the form of a cap, or the articular end of other bones to form a joint. Technical difficulties arise here: poor congruency of the articular surfaces, a very laborious process of modeling the ends, and the patient is additionally injured while taking the automaterial.

The invention consists in the combination of essential features sufficient to achieve a technical result, which consists in the gentle restoration of the function of the fingers in the treatment of the consequences of severe chronic periarticular fractures of the bones of the hand, while reducing the treatment time and improving its outcome, due to the use of a damaged bone fragment as a graft phalanges of the finger.

The essence of the method of arthroplasty of the interphalangeal joints is that they allocate a displaced bone fragment, excise scar-changed tissues. A channel is made in the selected bone fragment. The end of the central fragment is modeled according to the shape of the canal in the form of a protrusion, with the formation of marginal bone-periosteal lobes. Insert the fragment in which the channel was made onto the protrusion of the central fragment. The junction of bone fragments overlap formed by the marginal bone-periosteal lobes.

Isolation of the displaced bone fragment provides the ability to restore congruence of the articular surfaces.

Excision of scarred tissue allows the regeneration of bone fragments.

The creation of a channel made in the selected bone fragment and a protrusion on the central fragment formed congruently to the channel in the said selected bone fragment, their tight connection and overlapping of the junction of the bone fragments with the formed marginal bone-periosteal lobes are necessary to create optimal conditions for co-optation and fusion of these fragments.

The method is illustrated by illustrations.

Figure 1-3 shows a diagram of the operation: figure 1 is the initial state of the damaged phalanx of the finger of the brush; figure 2 - shows the formed channel, the protrusion, with the formed marginal bone-periosteal lobes, on the surfaces of the phalanx fragments; figure 3 - connection of the processed ends of the phalanx with the overlap of the zone of connection of the marginal bone-periosteal lobes.

Figure 4-5 shows x-rays, which show, respectively, the brush before and after surgery.

The proposed method is as follows.

After processing the skin of the hand and anesthesia according to the well-known technique, soft tissues are dissected layer by layer with the back semi-oval incision above the interphalangeal or metacarpophalangeal joint. The displaced head of the metacarpal bone or phalanx 1 is isolated (see Fig. 1), after which the canal 2 is made in it by removing the cancellous bone, and the end of the central fragment 3 is modeled in the form of the canal 2 in the form of a protrusion 4 with the formation of marginal bone-supraspinal lobes of decortication 5. Then, the modeled head 1 is inserted by a channel 2 onto the protrusion 4 of the central fragment 3. The pressing is carried out with force until the bone fragments are tightly knocked together, then bone-superficial petals 5 are applied to the fragments, which are hemmed with overlapping zones s junction of bones. The wound is sutured in layers according to the generally accepted technique. The phalanx is fixed with a plaster cast for 2 weeks, after which passive and active development of movements in the joint begins.

Information sources

1. USSR author's certificate No. 439277, А61В 17/00, BI No. 30, 1974

2. Blokhin V.N. Orthopedics, traumatology and prosthetics. 1969, No. 7, p. 2.

3. RF patent No. 2082341, A61B 17/56, A61K 31/65, A61F 2/28, BI No. 18, 1997.

Claims (1)

The method of arthroplasty of the interphalangeal joints of the hand, characterized in that the displaced bone fragment is isolated, scarred tissues are excised, a channel is made in the selected bone fragment, and the end of the central fragment is modeled in the form of a channel in the form of a protrusion with the formation of marginal bone-periosteal lobes, a fragment is inserted, in which the channel was made, onto the protrusion of the central fragment, the junction of the bone fragments is covered by the formed marginal bone-periosteal lobes.

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