RU2472462C1 - Apparatus for treatment of injuries and diseases of proximal part of femoral bone in children - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to traumatology and ortghopedics, and is intended for treatment of fractures of long tubular bones. Apparatus contains supports, threaded bars, connecting supports, intraosseous rods, rod-fixers and remote rod-fixers on form of beam. Supports are made in form of arch-like plates, curved on radius in their plane, and bent in said plane in form of projections from terminal parts of plate toward its salience. Projections and terminal parts of plate are provided with holes with bilateral countersink. Holes, located on radius, are made along plate. Beam of remote rod-fixer is immovably fixed on cylindrical pedestal, which has axial threaded hole and is installed on base in form of washer, on the centre of lower surface of which placed is square boss with axial through hole. Base is installed on base with boss in hole, located on radius along plate. On the upper surface of base made are radial teeth, which contact with teeth of respective shape on the lower surface of pedestal. Pedestal and base are connected with support by means of screw connection. On wide sides of rod-fixer beam made are transverse teeth, along axis of said sides made is through oval slot for installation of intraosseous threaded rods, fixation of which in remote rod-fixer is performed by means of special nuts and washers. Nut has spherical head and hexagonal shank, which are connected to each other by means of tube. Washer is made rectangular and is provided with longitudinal oval slot for intraosseous rod. In the centre of slot made is depression of respective shape for head of spherical nut. On the end of upper surface, along short side of said washer, made is step, on the opposite end of lower surface, for the half of washer height - depression in the centre, for the width of central slot. On the lower surface of washer made are transverse teeth, in shape corresponding to teeth on lateral surfaces of remote bracket.

EFFECT: invention ensures increase of fixation rigidity, reduction of operation treatment trauma with improvement of its outcome and creation of comfort for patient.

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Description

The invention relates to medicine, namely to traumatology, orthopedics, and is intended for the treatment of fractures of long tubular bones.

In the treatment of diaphyseal fractures of the femur in children and adolescents, monolateral external fixation devices are currently widely used. Their advantages include light weight and dimensions, speed of application, with the possibility of postoperative correction of the position of the fragments, convenience for the patient in the postoperative period [1]. However, in the treatment of fractures of the upper third of the femur (through-, post-fracture fractures), or in the correction of the cervical-diaphyseal angle (VAS) with varus or valgus deformities of the femoral neck, one has to face certain difficulties in fixing the proximal femur (POBK ) This can be explained both by the architecture of POBK and by the fact that in the case of traumatic injury, or with orthopedic pathology, we are dealing with a short proximal fragment, and for its stable fixation, “spatial dispersion of fixation elements” is necessary [2], which orthopedists achieve by installing on the proximal support of the apparatus of two intraosseous rods. In this case, there are two options for fixing the PHC. The first is the holding of one rod strictly in the frontal plane near the fracture line (the posttrochanteric fracture), of the other intraosseous rod along the axis of the femoral neck. The second option for fixing POBK is to conduct intraosseous rods along the axis of the femoral neck, at an angle of 25-30 ° relative to each other in the frontal plane. The use of intraosseous rods performed in this way has shown its effectiveness in terms of creating fixation stiffness and postoperative controllability of the proximal bone fragment [1]. For this, two standard remote arms of the Ilizarov apparatus are used, interconnected at an angle of 90 ° [3, 4]. However, the installation of the intraosseous rod on the proposed design from assembled external brackets is unstable, since there is a possibility of rotation of the external bracket relative to the support, as well as their rotation relative to each other. This is observed during the correction of deformity of the POBK (for example, during the correction of SJE), which is explained by the constant, growing compressive efforts of the muscles of the trochanteric group during the correction. Such a spontaneous rotation leads to a loss of distraction mode and premature fusion of fragments in the osteotomy zone. Also, the rotation of the brackets mounted on the proximal support is also observed in the treatment of fractures of the femur, which usually occurs when the fragments are repositioned. Thus, the use of well-known standard devices does not allow (adequately arising during reposition, or during distraction, loads) fixation of the intraosseous rod to the supports of the external fixation device according to the spatial location of the femoral neck (taking into account the angle of antetorsia and the neck-diaphyseal angle).

The essence of the invention lies in the combination of distinctive features sufficient to achieve the desired technical result, which consists in increasing the rigidity of fixation of POBK, reducing the morbidity of surgical treatment, while improving its outcomes, creating convenience for the patient.

The essence of the invention lies in the fact that the apparatus for treating injuries and diseases of the proximal femur in children contains supports in the form of arched plates curved along the radius in their own plane and bent in this plane in the form of protrusions from the end sections of the plate towards its convexity. In this case, the protrusions and end sections of the plate are equipped with openings with double-sided countersink, and along the plate there are holes arranged along the radius. The device contains threaded rods, connecting supports, intraosseous rods, rod fixators and external rod fixators in the form of a bar. The beam of the remote rod-retainer is fixedly mounted on a cylindrical pedestal having an axial threaded hole, and is mounted on the base in the form of a washer, in the center of the lower surface of which there is a square boss with an axial, through hole. The boss of the base is mounted on a support in a hole located radially along the plate. On the upper surface of the base there are made radial teeth in contact with the teeth of the reciprocal form on the lower surface of the pedestal, while the pedestal and the base are connected to the support by a screw connection. Transverse teeth are made on the wide sides of the bar of the bar-fixer, along the axis of these sides there is a through oval groove for installing intraosseous threaded rods. The fixing of threaded rods in the remote stem-clamp is carried out using special nuts and washers. The nut has a spherical head and a hexagonal shank, which are interconnected by a tube. The rectangular washer is equipped with a longitudinal oval groove under the intraosseous shaft. In the center of the groove, a counter-shaped recess is made under the head of the spherical nut, a step is made along the short side of the washer at the end of the upper surface. At the opposite end of the bottom surface there is a depression in the center, half the height of the washer, the width of the central groove. On the bottom surface of the washer, transverse teeth are made, corresponding in shape to the teeth on the side surfaces of the extension bracket.

The fixed fastening of the beam of the external stem-fixer on a cylindrical pedestal allows to increase the stability of the system of fastening the rod-clamp with a threaded rod on a support having a sufficiently large linear size, and hence the instability of fastening a fragment of the bone in the required position.

A square boss on the bottom surface of the base in the form of a washer is designed to place the base on a support, and is installed in holes located along the radius of the plate. The shape of the boss prevents spontaneous rotation of the base, provides the possibility of longitudinal movements of the base in the through oval grooves of the supports.

The installation of the pedestal with a bar on the base in the form of a washer, on the upper surface of which there are made radial teeth in contact with the teeth of the reciprocal form on the lower surface of the pedestal, provides the possibility of stepwise rotation of the rod clamp relative to the support and stability of fixation in the required position.

Equipping the base with axial, through, and the pedestal with a through, threaded hole, with the possibility of connecting the screw of the remote rod clamp with a pedestal installed on the base, with a support, provides rigidity.

The presence of through oval grooves along the axis of the bar of the rod retainer, on its wide sides, and a rectangular washer, steps at the end of its upper surface along the short side, and a recess half the height, at the opposite end of its lower surface, the width of the central groove, as well as a spherical head the nuts installed in the deepening of the reciprocal form in the center of the longitudinal oval groove of the special washer allow the rod to be installed in the rod retainer under the necessary ballast (up to 130 °).

The design of special nuts and washers ensures reliable fixation of the intraosseous shaft in the external shaft clamp and ease of installation for the surgeon. A spherical screw head installed in the groove of the reciprocal form, in the center of the longitudinal oval groove, a special washer, provides significant angular movements of the intraosseous shaft until the desired angle is achieved, with sufficient stability of fixation due to contact between the screw head and the recess across the entire contact ball surface of the nut. The hexagonal shank allows you to use a regular wrench during operation.

The execution of transverse teeth on the lower surface of the washer, in the form corresponding to the teeth on the side surfaces of the beam of the remote bracket, provides reliable fixation, without slipping, of the intraosseous shaft at the required level.

The design of the apparatus and the remote stem fixer are illustrated in the illustrations, where Fig. 1 shows an apparatus for treating injuries and diseases of the proximal femur in assembled children; figure 2 - remote rod retainer assembly, figure 3 - remote rod retainer disassembled.

The apparatus for treating injuries and diseases of the proximal femur in children contains supports 1 made in the form of plates curved along the radius in their own plane and bent in this plane in the form of protrusions from the end sections of the plate to the side of its convexity. In the holes 2, placed along the radius 1 along the supports 1, the bases of the rod-fixing 3 are installed with bosses 4 located in the center of the lower surface of the bases 3. The base 3 has the shape of a washer, the boss 4 is square in shape and equipped with an axial, through hole (Fig. 3 ) On the upper surface of the base 3 there are radial teeth 5, which are in contact with the teeth 6 of the reciprocal shape, located on the lower surface of the pedestal 7 of the external rod clamp 8 in the form of a bar, which is installed on the base 3. The rod clamp 8, with the pedestal 7, is connected by a screw 9 to the base 3 and support 1. On the wide sides 10 of the bar of the rod retainer 8 transverse teeth 11 are made, along the axis of the sides 10 there is a through oval groove 12 for installing intraosseous threaded rods 13, the fixation of which in the external rod retainer 8 is carried out using special nuts 14 and washers 15. The nut 14 has a spherical head 16 and a hexagonal shank 18, which are connected by a tube 17. A rectangular washer 15 is made with a longitudinal oval groove 19 for installing an intraosseous shaft 13 with a recess of the response form 20 in the center of the groove ( figure 3) under the spherical head 16 of the nut 14. At the end of the upper surface of the washer 15, along the short side, a step 21 is made, at the opposite end of the lower surface of the washer 15, in the center, a recess 22 half the height of the washer 15, a cent cent the groove 19. The transverse teeth 23 on the lower surface of the washer 15 correspond in shape to the teeth 11 on the lateral surfaces of the extension bracket 8. The supports of the apparatus 1 are interconnected by threaded rods 24 installed in the holes of the supports 1. The apparatus is fixed to the femur with intraosseous rods 13a and 13b .

The apparatus is used as follows.

After anesthesia, distraction, subsequent x-ray control and preliminary reposition of the fragments, two intraosseous rods 13a are inserted into the proximal fragment: one strictly in the frontal plane above the fracture line, the other along the axis of the femoral neck. The rods are fixed in the external barrels 8, controlling the position of the support - the proximal support should be perpendicular to the axis of the proximal fragment of the bone. The fixation of the intraosseous rods 13a at the required level and in the necessary direction is achieved by using rectangular washers 15, on one side of which transverse teeth 23 are made, corresponding in shape to the teeth 11 on the lateral surfaces of the extension bracket. The presence of a through oval groove 12 along the axis, on the wide sides of the beam 10 of the rod clamp 8, and along the axis of the washer 15 of a rectangular shape - a through longitudinal groove 19, with a recess of the response form 20 in a special washer 15, under the spherical head 16 of the nut 14, allows the installation of intraosseous threaded rods 13a in the rod retainer 8 both at an angle and perpendicular to the axis of the bone fragment. The fixation of the rods 13a in the rod clamp 8 is carried out by special nuts 14 using a conventional wrench. After fixing the intraosseous threaded rods 13a on the proximal support, they begin to impose a distal support with the difference that the intraosseous rods 13b are inserted into the distal bone fragment perpendicular to the fragment axis, with a rotational slope relative to each other. In this case, the position of the support should also be perpendicular to the axis of the distal fragment. Both supports 1 should be located at equal distance from the bone fragments, which is achieved by temporary installation of one threaded rod 24 and the correction of the position of the supports by moving special nuts 14 having a spherical head 16 mounted in the recess of the mating shape 20, with washers 15, along the shaft 13b.

Clinical example

B-naya Island, 11 years old, and.b. No. 1767, was admitted to the Department of Pediatric Orthopedics on 05/14/2010 with a diagnosis of Closed subtrochanteric fracture of the left femur with displacement. Under combined anesthesia, the patient underwent left-side femoral surgery in the operating room of the admission department on the day of admission: the patient was placed on an orthopedic table, bone fragments were distracted, followed by x-ray control, preliminary reposition of the fragments was achieved. Two intraosseous rods were introduced into the proximal fragment: one strictly in the frontal plane above the fracture line, the other along the axis of the femoral neck. The rods are fixed in remote rod clamps. The proximal support was set perpendicular to the axis of the proximal bone fragment. The intraosseous rods were fixed at the required level and in the necessary direction using rectangular washers, on one side of which transverse teeth are made, corresponding in shape to the teeth on the side surfaces of the extension bracket. The presence of a through oval groove along the axis, along the wide sides of the bar of the rod retainer, and along the axis of the washer of a rectangular shape - a through longitudinal groove and a recess of the reciprocal form in a special washer, under the spherical head of the nut, made it possible to install intraosseous threaded rods in the rod retainer at the required angle to the bone fragment . The rods were fixed in the rod clamps using a conventional wrench. After fixing the intraosseous threaded rods on the proximal support, we proceeded to impose a distal support. Intraosseous rods were inserted into the distal bone fragment perpendicular to the axis of the fragment, with a rotational slope relative to each other. In this case, the support position was maintained perpendicular to the axis of the distal fragment. Both supports are located at equal distance from the bone fragments, which is achieved by temporary installation of one threaded rod and correction of the position of the supports by moving special nuts with a spherical head, with washers, along the shaft. After visually determining the position of the threaded rod parallel to the axis of the damaged segment, a second threaded rod was installed. Conducted x-ray control. By moving the special nuts along the intraosseous rods and turning the bracket around its axis, on the lower surface of the pedestal of which there are radial teeth in contact with the teeth of the reciprocal form on the upper surface of the base, the fragments were finally repositioned.

Information sources

1. RF patent No. 2201168, А61В 17/66, BIPM No. 9, 2003.

2. V. Golyakhovsky, V. Frenkel. Guidance on transosseous osteosynthesis using the Ilizarov method. St. Petersburg, Nevsky dialect, 1999, p. 97.

3. A set of compression and distraction apparatus G. A. Ilizarov for the upper limb, lower leg, thigh. Passport A.101.00.00.00.PS (Operating Instructions and Technical Description) - Gudermes - 1991.

4. LN Solomin Fundamentals of transosseous osteosynthesis using the apparatus of G. A. Ilizarov. St. Petersburg, 2005, p. 215. Fig. 2.4.6, p. 216 fig. 2.4.7.

Claims (1)

The apparatus for treating injuries and diseases of the proximal femur in children contains supports in the form of arched plates curved along the radius in its own plane and bent in this plane in the form of protrusions from the end sections of the plate towards its convexity, while the protrusions and end sections of the plate equipped with holes with a two-sided countersink, and along the plate there are holes arranged along the radius, the apparatus contains threaded rods, connecting supports, intraosseous rods, rod fixators, and external rod fixers in the form of a beam, characterized in that the beam of the external rod fixer is fixedly mounted on a cylindrical pedestal having an axial threaded hole, and mounted on the base in the form of a washer, in the center of the lower surface of which there is a square boss with an axial through hole, the base is mounted on the support with the boss in the hole is placed along the radius along the plate, on the upper surface of the base there are radial teeth in contact with the teeth of the reciprocal form on the lower surface of the pedestal, the pedestal and the base are connected by a screw connection to the support, transverse teeth are made on the wide sides of the bar of the bar fixer, along the axis of these sides there is a through oval groove for installing intraosseous threaded rods, the fixation of which in the remote bar of the clamp is carried out using special nuts and washers, the nut has a spherical head and a hexagonal shank connected by a tube, the rectangular washer is equipped with a longitudinal oval groove under the intraosseous shaft, in the center of the groove There is a deepening of the reciprocal shape under the head of a spherical nut, a step is made at the end of the upper surface, along the short side of the said washer, at the opposite end of the lower surface, half the height of the washer, a central depression, the width of the central groove, on the lower surface of the washer teeth corresponding in shape to the teeth on the lateral surfaces of the extension bracket.

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