RU2465858C2 - Method of conservative treatment of shin bone fractures - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to orthopaedics and traumatology. A wire is delivered through a heel bone. It is used for skeletal traction to remove lengthwise bone fragment dislocation. Then two supplementary wires are delivered in a frontal plane: in a distal tibial epimetaphys and in a proximal tibial epimetaphys. The supplementary wires are fixed in supports of a derotation device from two rings of a standard Ilizarov's osteosynthesis kit. The rings are coupled by three telescopic rods. The fracture is reduced. Edgewise dislocation of the bone fragments is removed, and the bone fragments are rotationally dislocated. The telescopic rods are fixed in the achieved position. The skeletal traction wire is removed from the heel bone. The X-ray control follows. A plaster bandage is applied on a shin with covering knee and ankle joints. After the plaster bandage is dried, the derotation device is removed.

EFFECT: method provides tibial and fibular fragment union in an anatomically correct position and reduced length of hospital treatment.

2 cl, 1 ex, 6 dwg

Description

The invention relates to medicine, in particular to orthopedics and traumatology, in particular to methods used in the treatment of non-surgical fractures of the lower leg bones.

There is a method of reposition of tibial fractures in a spoke distractor, consisting of parts of a standard multipurpose set for Ilizarov osteosynthesis (half rings, rings, telescopic rods), followed by (after reaching a satisfactory position of the bone fragments) introduction of an intramedullary titanium rod to fix the fracture. After the introduction of the intramedullary shaft, the spoke distractor is removed (Chelnokov A.N., Bekreev D.A. Closed braking with metadiaphysar fractures of the tibia - a solution based on the methods of transosseous osteosynthesis. Modern methods of treating patients with injuries and their complications. Materials of the scientific-practical conference. Kurgan. - 2006 .-- S.413-414).

However, this method is traumatic, associated with the introduction of a massive foreign metal implant into the bone canal, the prolonged presence of which in the bone can lead to the development of an inflammatory reaction, purulent process and osteomyelitis.

There is a method of external fixation of fractures, which consists in the fact that before applying the bandage in the places of its application to the anatomical bone protrusions in the proximal and distal parts of the damaged segment of the limb, the reposition apparatus eliminates edema, creating a positive pressure of 0.6-1.4 kg with the reponent plates / cm ² on the area of 0.2-0.6 cm ² from the area of the edema for 4-6 minutes, then the limb is removed from the apparatus, a plaster bandage "boot" is placed on the shin and foot and again placed in the apparatus, which is pressure on a hardening dressing, achieving reposition and fixation of fragments, elimination of subluxations of the foot with a hardened dressing (Pat. No. 2119309 RU. Publish. 09.27.1998).

However, in the known method, the application of a gypsum dressing is carried out after removal of the transosseous device, which can lead to a repeated displacement of fragments, since at the time of removal of the limb from the apparatus, the fracture is not fixed.

A device for treating intra-articular and extra-articular fractures is known in which a damaged limb is fixed in the first and second fixation nodes (2) and (3). Depending on the specific type of fracture, the required number of repair nodes is selected (4). Each of the repair nodes (4) is installed on the basis of (1) so that one of its patch plates (19) or (33) is at the level of damage. Using a screw rod (20) or (32), the overlay plate (19) or (33) is moved towards the lower leg until the loose end of the long fragment is in its anatomical position. To prevent the displacement of this end of the bone fragment in the opposite direction from the reverse side of the damaged segment, another plate (19) or (33) can be placed (Pat. No. 2111730 RU. Publ. 27.05.1998).

However, the known device is intended for the repair of bone fragments and does not provide for further reliable fixation of fragments in the repaired position with the application of a plaster cast.

A known method of treating injuries in the ankle joint, in which anesthesia is repositioned of ankle fragments. A longitudinal-circular bandage “boot” is applied to the shin-foot segment, leaving the toes and the knee joint free from immobilization. The bandage is gradually shortened to the level of the ankle joint, leaving the joints of the foot free for functional movements during treatment and prevention and stiffness (Pat. No. 2104677 RU. Publ. 02.20.1998).

However, the known method avoids the stiffness of the joints of the foot, but it is not intended to reposition the fracture and eliminate the displacement of fragments along the length using skeletal traction and the displacement of fractures in width and rotational displacements using a transosseous device, which allows to achieve high-quality reposition and reduce the patient’s treatment time in in a hospital.

The objective of the present invention is to achieve an anatomically correct relationship between the position of the fragments of the bones of the leg using skeletal traction, a derotation device and a plaster cast, which can reduce the time of treatment of a patient in a hospital.

The task is carried out as follows, in a method of conservatively treating shin bone fractures, including repositioning of the shin bone and applying a bandage, the needle is drawn through the calcaneus, skeletal traction is performed using it, until the bone fragments are removed along the length, then two additional ones are carried out in the frontal plane knitting needles: into the distal tibial epimetaphysis and into the proximal tibial epimetaphysis, after which additional knitting needles are fixed in the supports of the derotational mouth Joints from two rings of the standard set for Ilizarov osteosynthesis, which are connected by three telescopic rods, then reposition the fracture, eliminate the displacement of bone fragments in width and rotational displacement of bone fragments, after which the telescopic rods are fixed in the reached position, and the spoke is removed from the calcaneus , carry out x-ray control, apply a plaster cast on the lower leg with the capture of the knee and ankle joints, after drying the plaster cast of the derot insulating device is dismantled and removed two additional needles.

It is advisable to eliminate the swelling on the foot of the plaster cast partially cut.

The present invention is illustrated by a detailed description, a specific example of the method with links to copies of radiographs and photos of the lower leg of the patient before and after reposition of the fracture, on which:

figure 1 is a copy from x-rays of the bones of the leg of a patient A., 39 years old, in a direct and lateral projection with a fracture of the distal metadiaphysis of the left tibia and lower third of the left fibula upon admission to the clinic;

figure 2 represents a copy from x-rays of the bones of the leg of the patient A., 39 years old, in a direct and lateral projection with a fracture of the distal metadiaphysis of the left tibia and lower third of the left fibula on skeletal traction for the calcaneus;

figure 3 is a copy from x-ray of the bones of the leg of a patient A., 39 years old, in a direct and lateral projection with a fracture of the distal metadiaphysis of the left tibia and lower third of the left fibula after reposition in a derotation device with a plaster cast;

figure 4 is a copy from a photograph of the lower leg of patient A., 39 years old, fixed in a plaster cast after reposition in a derotation device using additional knitting needles;

figure 5 represents a copy from x-rays of the bones of the leg of the patient A., 39 years old, in a direct and lateral projection with a fracture of the distal metadiaphysis of the left tibia and lower third of the left fibula in a plaster cast after dismantling the derotation device and removing additional knitting needles;

6 is a copy from radiographs of the bones of the leg of the patient A., 39 years old, in direct and lateral projection after plaster removal and fusion of the distal metadiaphysis of the left tibia and lower third of the left fibula (2.5 months after injury).

A method of treating closed fractures of the lower leg bones is as follows.

When a patient enters a clinic with a closed fracture of the lower leg bones and the patient refuses surgical treatment with the use of metal fixators or if there are contraindications to surgical treatment, they perform skeletal traction over the spoke through the calcaneus. By traction, the displacement of the shin bone fragments along the length is eliminated. Then, two additional knitting needles are carried out in the frontal plane: into the distal tibia epimetaphysis and into the proximal tibia epimetaphysis. Additional knitting needles are fixed in a derotation device, composed of large rings of the Ilizarov apparatus or a similar apparatus. A derotation device of two rings is mounted, which are interconnected by three telescopic rods. When the rods are not fixed, the fracture is repositioned, the displacement of the fragments across the width is eliminated, and the rotational displacement of the fragments is eliminated. After that, the telescopic rods are fixed in the reached position. A needle for skeletal traction from the calcaneus is removed. Then carry out x-ray control. With a satisfactory position of the fragments of the tibia and fibula inside the derotation device, a plaster bandage is applied to the limb, which fixes the lower leg with the capture of the knee and ankle joints. After the plaster cast has dried, the derotation device is removed and additional knitting needles are removed.

The patient is monitored by a medical staff for 2–3 days. Walking with two crutches is allowed, with a partial load on the injured limb. When edema appears in the area of the foot, the plaster cast is partially dissected. In the absence of edema on the patient’s foot, they are discharged for outpatient treatment. After 1.5-2.5 months, when the fusion of the shin bone fragments is achieved, the plaster cast is removed.

When foot edema occurs, the plaster cast is partially dissected to eliminate it.

A clinical example of the method.

Patient A., 39 years old, turned to the emergency room of the Central Clinical Hospital No. 24; Yekaterinburg 05/17/2010 with a closed fracture of the distal metadiaphysis of the left tibia and a fracture of the lower third of the left fibula (Figure 1). The patient refused surgical treatment of the fracture. When hospitalized in the trauma unit No. 1 superimposed skeletal traction for the calcaneus, which eliminated the shortening along the length (Figure 2). On the next day after admission, two additional knitting needles were made in the frontal plane: in the distal tibia epimetaphysis and in the proximal tibia epimetaphysis. They put together a derotation device (DRU) of two rings of the Ilizarov apparatus on the left shin. By means of the DRU, the final fracture was repositioned, namely, the displacement of the fragments in width and their rotational displacement were eliminated. The calcaneus needle was removed for skeletal traction. After reaching a satisfactory position of the fragments, confirmed by x-ray, the limb was fixed with a circular plaster cast to the upper third of the thigh. The tibia remained fixed in the derotation device until the plaster cast was dried (Figure 3, Figure 4). After drying of the gypsum, the derotation device was dismantled, additional knitting needles were removed (Figure 5). On the third day after admission to the hospital, the patient was allowed to walk with crutches, with a partial load on the injured limb. Swelling of the foot was absent. On the 4th day after reposition and fixation of the fracture, the patient was discharged for outpatient treatment. After 2.5 months on the control examination, the plaster cast was removed. Radiography data diagnosed fracture consolidation (FIG. 6).

The end result is regarded as good, limb function is restored, the patient is pleased with the treatment, no complications were observed.

The proposed method for the conservative treatment of shin bone fractures is safe and economical, it allows to achieve a satisfactory reposition and fixation of bone fragments, to achieve an anatomically correct relationship between the position of the shin bone fragments using skeletal traction, a derotation device and a plaster cast.

The rehabilitation period of patients treated by this method takes place at home, which contributes to the complete social adaptation of patients and allows you to restore health in a short time. In addition, it allows to reduce the period of treatment of a patient in a hospital.

The method is used in the Central city clinical hospital No. 24 of the city of Yekaterinburg.

Claims (2)

1. A method of conservative treatment of leg fractures, including reposition of the leg bones and applying a bandage, characterized in that the needle is passed through the calcaneus, skeletal traction is carried out with it to eliminate the displacement of bone fragments along the length, then two additional knitting needles are carried out in the frontal plane: into the distal tibial epimetaphysis and the tibial proximal epimetaphysis, after which additional spokes are fixed in the supports of a two-ring derotation device as standard about the set for osteosynthesis according to Ilizarov, which are interconnected by three telescopic rods, then reposition the fracture, eliminate the displacement of the bone fragments in width and rotational displacement of the bone fragments, after which the telescopic rods are fixed in the reached position, the knitting needle from the calcaneus is removed, radiological control is performed impose a plaster cast on the shin with a grip of the knee and ankle joints, after the plaster cast has dried, the derotation device is removed removed two extra spokes. 2. The method according to claim 1, characterized in that the plaster cast is partially dissected.

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