RU2475203C1 - Method for intramedullary osteosynthesis of long bones - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention refers to medicine, namely traumatology and orthopaedics, and aims at intramedullary osteosynthesis of long bones in purulent complications, as well as for prevention of purulent complications and postoperative osteomyelitis. A fracture is reduced by inserting a hollow rod with outputs on end faces and perforations on a side surface into an intramedullary canal of distal and proximal bone fragments. A cylindrical slot of the diameter 1.5-2 cm exceeding that of the rod and of the height of 2-3 cm is formed intraoperatively in addition in an epiphyseal portion of one of the bone fragments. It is followed by creating a drain canal by putting a drain tube on a free end of the rod, brining it out and attached to an aspirator. The wound is tightly closed. Bone synthesis is accompanied by wound exudate draining through the created drain canal with vacuum 0.15-0.35 atm generated in the drain canal. For the purpose of prevention of purulent complications, the drainage process is continues to form a primary osteotylus, while purulent complications, osteomyelitis requires the drainage process to be terminated after complete consolidation of the fracture.EFFECT: method provides fracture consolidation, prevention of purulent complications, and if observing developed osteomyelitis, prevented progression and generalisation of inflammatory process.3 cl, 1 ex, 3 dwg

Description

The invention relates to medicine, namely to surgery, traumatology and orthopedics, and is intended for osteosynthesis of tubular bones with purulent complications, as well as for the prevention of purulent complications and postoperative osteomyelitis.

In aseptic bone, the use of the osteosynthesis method sometimes leads to purulent complications. There is a need to remove metal structures, the choice of another method or a temporary rejection of osteosynthesis. To dismantle and remove the metal structure, a repeated, traumatic, invasive operation is required. The development of surgical infection makes the use of osteosynthesis sometimes impossible.

Known methods for open intramedullary osteosynthesis using a hollow rod CITO having a circular cross section in diameter, a hollow rod Dubrov, Elansky NN, or Bogdanov having a triangular cross section across. The rods of CITO, Bogdanov and Elansky N.N. have holes on the ends and on the side surface (in the form of a longitudinal slot or perforations). The Dubrov rod has end holes and no side holes. The pins are designed to fix fresh transverse fractures of long tubular bones mainly in the middle third of the segment (G. Yumashev Traumatology and Orthopedics. Publishing House "Medicine", Moscow, 1977, p.297).

The disadvantages of these methods are their limited capabilities, due to the fact that when using this method of intraosseous synthesis for open fractures and infected wounds, there is a risk of developing postoperative osteomyelitis, as well as a decrease in the effectiveness of treatment due to the possibility of purulent complications in the process of bone synthesis, which significantly worsens the results and lengthens the duration of treatment and consolidation of the fracture.

A known method of intramedullary osteosynthesis of tubular bones, including reposition of the fracture by introducing proximal and distal bone fragments, a hollow rod with outlet openings at the ends and perforations along the lateral surface into the medullary canal (Müller M.E. et al. “Guide to Internal Osteosynthesis”. Third edition, expanded, translation into Russian, ed. Ad Marginem, Moscow, 1996, p. 291-364).

The presence of perforations on the lateral surface of the rod contributes to better adaptation of the rod in the medullary canal, and also provides an outflow of inflammatory exudate from the medullary canal into the canal of the rod. This can in some cases prevent the removal of metal structures and the forced transition to another method of fixing fragments during a fracture. However, if necessary, external sanitation (washing the rod with antiseptic solutions) is carried out by removing the rod from the bone marrow canal. For extraction, a second operation is carried out, which, as a rule, is laborious, traumatic and not effective enough. The antimicrobial coating of the perforated pin does not always have a sufficient spectrum of antimicrobial effects and does not prevent suppuration in the medullary canal. Antibiotic and cementitious compositions themselves are toxic and can cause allergic reactions.

In accordance with this, the authors set a task aimed at increasing the effectiveness of osteosynthesis, as well as the prevention of purulent complications and postoperative osteomyelitis, which is carried out through complex treatment.

To solve this problem, in the method of intramedullary osteosynthesis of tubular bones, including reposition of the fracture by introducing distal and proximal bone fragments of the hollow rod into the medullary canal with exit openings at the ends and perforations along the lateral surface, it is proposed during the operation to additionally in the epiphyseal part of one of the bone fragments, around the end of the rod to create a cylindrical recess with a diameter of 1.5-2 mm larger than the diameter of the rod, a height of 2-3 cm, then create a drainage channel, for which to put a drainage tube on the liberated end of the rod, bring it out and connect to an aspirating device, sew up the wound tightly, and then drain the wound exudate through the formed drainage channel simultaneously with bone synthesis, while creating a pressure discharge in the formed drainage channel 0.15 to 0.35 atm.

Moreover, for the prevention of purulent complications, drainage should be carried out before the formation of the primary bone callus, with purulent complications, osteomyelitis, drainage should be carried out until the fracture is completely consolidated.

Improving the effectiveness of treatment is achieved due to the fact that, simultaneously with bone synthesis, continuous long-term aspiration drainage and removal of inflammatory exudate, which is formed due to adverse factors caused by tissue injury, prevents suppuration, and in the conditions of developed osteomyelitis, the progression and generalization of the inflammatory process. It has a therapeutic, sanitizing effect due to the external outflow of purulent-inflammatory detachable tissues. In conditions of tissue edema and their impaired blood supply, when access of antibacterial and anti-inflammatory drugs through the blood to the focus of osteomyelitis is extremely difficult, the drainage mechanism becomes the main surgical intervention in complex treatment.

Figure 1, 2, 3 shows a diagram of the method.

The method is as follows.

After reposition of fracture 1 and insertion of rod 2 into the medullary canal 3 of the proximal bone fragment 4, in its epiphyseal part 5, a hollow cutter 6 (not shown in the drawings) around the lower end of the rod 2 creates a cylindrical recess 7 with a diameter of 1.5-2 mm larger the diameter of the rod (5-8 mm), 2-3 cm high. The dimensions of the recess allow you to tightly string on the end of the rod 2 a plastic tubular drainage 8 adjacent to the wall of the channel 9 created after extraction of the bone portion. The outer end 10 of the tubular drainage 8 is brought out through the contraperture . The postoperative wound is sutured, after which the system: the drainage tube-rod becomes leakproof and is able to work in the aspiration mode, with the creation of a vacuum in the drainage system from 0.15 to 0.25 atm in the initial period of drainage and from 0.25 to 0.35 at the end of drainage, with the possible transition to different modes in this interval of discharge. Forced or non-forced aspiration of the inflammatory exudate from the bone marrow canal 11 is carried out through the outer end of the drainage tube. Due to this system, a pressure drop in the range of 0.15-0.35 atm is created in the cavity of the rod (constant discharge). In this case, drainage is carried out from 1 month to 3 years, until bone marrow formation or until the fracture is completely consolidated.

The main method is the duration of aspiration osteosynthesis. It is known that purulent complications of bones and soft tissues after injury and surgery occur at different times (early and late) and for various reasons, which violates the timing of fracture consolidation. Therefore, with the prophylactic use of the method, it is necessary to drain until the formation of primary bone callus (up to 1 month) and in the absence of suppuration of bone tissue and soft tissues, after which it is possible to stop aspiration without removing the drainage tube. Subsequently, tubular drainage can be shortened and drowned. In the event of a deviation from the standard course of the disease, it can again be used to establish external sanitation aspiration osteosynthesis. Use its clearance to retrieve the pin at the end of the final fracture consolidation.

In the case of osteomyelitis and significant changes in bone tissue and its destruction, the duration of drainage is carried out until the fracture is completely consolidated and the main bone structures are restored. The pin and tubular drainage are removed at the same time. Additional operations to remove bone fragments or sequesters do not affect the implementation of the method.

Clinical example 1.

Patient V., 46 years old. In an accident on August 16, 2011, she received a comminuted fracture of n / a of the right humerus. 08.24.11, the operation. Under general anesthesia, osteosynthesis of the humerus was performed with a solid pin with a locking screw. In the postoperative period, a complication occurred - suppuration of tissues at the site of the operation, with the development of chronic osteomyelitis of the humerus. Purulent nerves of soft tissues were repeatedly drained, osteomyelitic fistulas were formed, lack of fracture consolidation, according to X-ray control, within 3 months, the formation of a large bone sequestration in place of a comminuted fragment of bone. Limb dysfunction, intoxication have increased. After preparation, the patient was operated on, the bone sequestration was removed, a solid pin, which was replaced by a hollow perforated pin. No fracture consolidation was noted. The operation performed by the proposed method. In the epiphyseal part of the proximal bone fragment, around the lower end of the rod, a cylindrical recess was formed with a diameter of 7 mm, a height of 2.5 cm, a drainage tube was put on the liberated end of the rod, it was brought out, the wound was sutured tightly, after which wound exudate was drained simultaneously with bone synthesis. in aspiration mode. At the same time, a vacuum was created up to 0.25 atm and continued long drainage up to 1 year, until the fracture was completely consolidated.

Using the method will increase the effectiveness of osteosynthesis, as well as prevent the occurrence of purulent complications and postoperative osteomyelitis.

Claims (3)

1. The method of intramedullary osteosynthesis of tubular bones, including reposition of the fracture by introducing into the medullary canal distal and proximal bone fragments of the hollow rod with outlet openings at the ends and perforations along the lateral surface, characterized in that during the operation, additionally in the epiphyseal part of one of the bone fragments, around the end of the rod form a cylindrical recess with a diameter of 1.5-2 mm larger than the diameter of the rod, a height of 2-3 cm, then create a drainage channel, whereupon a drainage tube is put on the liberated end of the rod, it is brought out and connected to an aspirating device, the wound is sutured tightly, after which, simultaneously with bone synthesis, the wound exudate is drained through the created drainage channel, while a pressure rarefaction of 0.15-0 is created in the drainage channel , 35 atm. 2. The method of intramedullary osteosynthesis of tubular bones according to claim 1, characterized in that for the prevention of purulent complications, drainage is carried out before the formation of the primary callus. 3. The method of intramedullary osteosynthesis of tubular bones according to claim 1, characterized in that with purulent complications, osteomyelitis, drainage is carried out until the fracture is completely consolidated.

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