RU2487683C1 - Method of interphalangeal arthrodesis after correction of rigid hammer deformation of middle toes - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, exactly, to traumatology and orthopedics. After arthrotomy and resection of main toe phalange head, removal of joint cartilage from base of middle toe phalange, canals in main and middle phalanges with diameter not more than 1 mm are formed. Implant with diameter not more than 1.5 mm is introduced intramedularily into canal of main to complete contact of butt end surfaces of main and middle phalanges. In position of external 80-90° rotation normal position of middle phalange is achieved by following "screwing on" and compression efforts are created. Interphalangeal fixation is realised with screw-shaped implant.

EFFECT: creation of conditions for formation of bone anchylosis of joints after elimination of hammer deformation of middle toes, prevention of deformation recurrence and implant migration.

2 ex, 8 dwg

Description

The invention relates to medicine, more specifically to traumatology and orthopedics, and is intended for fixation and stabilization of the proximal interphalangeal joint during the correction of hammer-like deformation of the middle toes.

A known method of arthrodesis of the knee joint, in which the joint arthrotomy is performed by front access from the lower third of the thigh to the tibial tuberosity. The tibial component of the endoprosthesis, cicatricial and granulation tissues are removed. Cartilage residues are removed and the patella is mobilized. After mobilization, the patella is moved to the cavity of the proximal tibia formed after removal of the tibial component of the endoprosthesis. Then, a vertical channel is formed in the condyles of the femur and tibia. A metal plate is passed through the channel. The plate is fixed with screws on the diaphyseal sections of the femur and tibia (Pat. No. 2438610 RU. Publ. 10.01.2012).

There is a method of surgical treatment of hallux valgus deviation of the first toe of the II-IV degree and hammer-like deformation of the second toe, which consists in accessing the head and base of the first metatarsal bone, removing bone-cartilaginous growths in the metatarsophalangeal joint, and cutting the flap from the capsule the joint with the base on the proximal phalanx; the cut flap is sutured with tension to the soft tissues in the distal metaepiphysis of the first metatarsal bone to remove the first finger from the vicious sores, resect the base of the proximal phalanx of the hammer finger, the osteotomy of the base of the first metatarsal bone, in addition, they are made from the resected base of the proximal phalanx of the second finger of the sphenoid autografts with their subsequent introduction into the osteotomy zone of the base of the first metatarsal host (Pat. No. 2257174 RU. Publ. )

However, the known method is more concerned with the correction of deformation of the first ray, has a high degree of trauma, fixation by tensioning only soft tissues does not create sufficient conditions for the formation of bone ankylosis.

There is a method of surgical treatment, when during resection of the head of the main phalanx of the toes of the feet during their vicious installation, a number of authors supplement the transarticular fixation of the operated fingers in the correct position with a Kirschner needle or injection needle ("Reconstructive plastic surgery of transverse flat feet", AM Savintsev, St. Petersburg, 2006 , C 32, 34).

However, with this method of osteosynthesis, unreasonable transarticular fixation of adjacent joints is performed during the entire period (2-3 weeks). In addition, using the known method, the risk of fracture, migration of the metal structure and infectious complications remains. After removal of the knitting needle, a relapse of deformity can be observed and stiffness of the proximal interphalangeal joint may form, which is accompanied by pain.

A known method of surgical treatment is when, after resection of the distal part of the main phalanx and the proximal part of the middle phalanx of the toes, a titanium implant is inserted intramedullary, which is stored in the refrigerator before surgery and expands when it reaches body temperature (metal with shape memory). (Marino Delmi, MD foot & Ankle Center, Clinique des Grangettes, 1224 Chene-Bougeries / Geneva, Switzerland).

However, the known method is expensive due to the significant cost of the titanium implant, an appropriate tool is required to install the implant, and this implant is not certified in the Russian Federation.

There is a method of surgical treatment of the hammer-shaped deformation of the II-IV toes, which consists in isolating and taking on the holders the tendon of the long flexor of II-IV toes. The foot is set at right angles to the lower leg. Suture marks on the skin and tendon at the same level. The toes of the foot are unbent and the magnitude of the mark shift on the tendon relative to the mark on the skin is noted. Produce a Z-shaped dissection and lengthening of the tendon of the II-IV finger behind the inner ankle. The method allows to correct the hammer-like deformation of the II-IV fingers while maintaining the flexion function (Pat. No. 2285477 RU. Publ. 02.20.2006).

However, this method is applicable only for non-fixed (not rigid) hammer-like deformation of the middle toes.

The task is to create conditions for the formation of bone ankylosis of the joints, after eliminating the hammer-like deformation of the foot, preventing recurrence of deformation and migration of the implant, convenience for the patient and low cost of the method.

The problem is solved in that in the method of interphalangeal arthrodesis after correction of rigid hammer-like deformation of the middle toes, including resection and implant insertion, the level of resection is established, arthrotomy is performed, and the resection of the head of the main phalanx of the toe, the articular cartilage is removed from the base of the middle phalanx of the toe, form channels in the main and middle phalanges, then one end of the implant having a diameter of not more than 1.5 mm and a small fragmentary a flap, while the second end of the implant is inserted into the canal of the middle phalanx in the position of its external rotation of 80-90 ° until the end phalanx surfaces are completely in contact, then the next “screwing” of the middle phalanx is carried out until normal position and creation of compression efforts, the wound is sutured, an aseptic dressing is applied .

It is advisable to prevent migration of the implant to carry out interphalangeal fixation with the implant, which is performed in the form of a screw.

For a more dense contact of the surfaces and an exact comparison of the axial channels of the main and middle phalanges, it is advisable to use a spoke with a diameter of not more than 1.0 mm for their formation,

The present invention is illustrated by a detailed description, examples of its implementation and illustrative material, on which:

Figure 1 - illustrates a diagram of a joint arthrotomy with resection of the head of the main phalanx and the removal of articular cartilage from the base of the middle phalanx in direct projection;

Figure 2 - illustrates a resection scheme of the head of the main phalanx and the removal of articular cartilage from the base of the middle phalanx in a lateral projection;

Figure 3 - illustrates the intramedullary insertion of a screw ⌀1.5 mm into the channel of the main phalanx;

Figure 4 - illustrates the process of "sticking" the middle phalanx along the formed channel until the surfaces are in full contact in the outer rotation position of 80-90 ° with the subsequent "screwing" of the middle phalanx to the standard position;

Figure 5 - represents a copy of the radiograph of patient K. before surgical treatment;

6 is a copy of a radiograph of patient K. after surgical treatment;

Fig.7 is a copy of the radiograph of patient F. before surgical treatment;

Fig. 8 is a copy of a radiograph of patient F. after surgical treatment.

The method of interphalangeal arthrodesis after correction of rigid hammer-like deformation of the middle toes is as follows.

After examination and diagnosis, surgery is performed. In this case, the patient is placed on the operating table in a supine position, standard skin treatment is performed. Surgery is performed under a pneumoglythe in the supradermal region after preliminary bleeding of the feet. Surgery begins with correction of the deformation of the first ray of the foot (hallux valgus deformation of the first toe), then the deformity of the hammer like middle fingers is corrected. With surgical intervention, spinal anesthesia (hereinafter referred to as SMA) is used.

Pre-establish the level of resection of the main phalanx of the toe and the removal of articular cartilage from the base of the middle phalanx. Then, along the back of the finger in the projection of the proximal interphalangeal joint of the foot, an incision is performed with excision of hyperkeratosis (Figure 1). Produce arthrotomy of the joint and resection of the head of the main phalanx of the finger (Figure 2). The articular cartilage is then removed from the base of the middle phalanx. Using a spoke with a diameter of 1.0 mm, channels are made in the main and middle phalanges of the finger (Figure 3). An implant is inserted intramedullary into the canal of the main phalanx. A screw with a diameter of 1.5 mm is used as an implant. When this screw has a small fragmentary thread (Figure 4). When using a screw, they bite off his hat. One or another implant is inserted into the formed channels of the main and middle phalanges until their end surfaces are in full contact. In the outer rotation position of 80-90 °, the subsequent “screwing” of the middle phalanx to the normal position is carried out with tight pressing of the end surfaces, thereby creating compression forces. The wound is sutured. Apply an aseptic dressing.

Examples of the method.

Example 1

Patient K. Hospital Record of Patient No. 1119.

Diagnosis: Hallux valgus deformity of the first toes of both feet, varus deformity of the fifth toes, valus deformity of the fifth toes of both feet, hammer-like deformation of the second toe of the right foot.

Conducted x-ray examination of tables in direct projection with a load (Figure 5).

We established the level of resection of the heads of the main phalanx and the removal of articular cartilage from the base of the middle phalanx of the toes.

In the operating room under the MCA, the first step was the correction of the deformation of the first finger, then the correction of the deformation of the fifth ray and the correction of the hammer-like deformation of the second toe of the right foot - an incision was made along the back of the finger in the projection of the proximal interphalangeal joint with excision of hyperkeratosis. They performed arthrotomy of the joint and resection of the head of the main phalanx of the second finger, removed articular cartilage from the base of the middle phalanx. Using a spoke with a diameter of one (1) mm, channels were made in the main and middle phalanges of the finger. A screw with a diameter of 1.5 mm and a half with a small fragmentary thread was intramedullary introduced into the canal of the main phalanx, a screw cap was bitten, and the middle phalanx was "inserted" along the formed channel until the end surfaces were completely in contact in the outer rotation position of 80-90 °. Then carried out the subsequent "screwing" of the middle phalanx to the norm and tightly fitting the end surfaces of the ends of the phalanges created a compression force. The wound was sacked. An aseptic dressing was applied (Figure 6).

Example 2

Patient F. Hospital Record No. 1140.

Diagnosis: Hallux valgus deformation of the first toes of both feet, varus deformity of the fifth toes, hammer-shaped deformation of the second toes.

Conducted x-ray examination of the foot in direct projection with a load (Fig.7).

We established the level of resection of the heads of the main phalanx and the removal of articular cartilage from the base of the middle phalanx of the toes.

In the operating room under the MCA, the deformations of the first and fifth rays were corrected, and then the deformation of the second toes of both feet was corrected - an incision was made along the back of the finger in the projection of the proximal interphalangeal joint with excision of hyperkeratosis. They performed arthrotomy of the joint and resection of the head of the main phalanx of the second finger, removed articular cartilage from the base of the middle phalanx. Using a spoke with a diameter of one (1) mm, channels were made in the main and middle phalanges of the finger. A screw with a diameter of one and a half (1.5) mm with a small fragmentary thread was intramedullary introduced into the canal of the main phalanx, a screw cap was bitten and the middle phalanx was “inserted” on the remaining free end along the formed channel until the end surfaces were in contact in the outer rotation position 80-90 °. Then carried out the subsequent "screwing" of the middle phalanx to the norm and tightly fitting the end surfaces of the ends of the phalanges created a compression force. The wound was sacked. An aseptic dressing was applied (Fig. 8).

The proposed method of interphalangeal arthrodesis after correction of rigid hammer-like deformation of the middle toes allows creating conditions for the formation of bone ankylosis of joints, preventing relapse of the deformity, and preventing implant migration due to the presence of a small fragmentary thread. In addition, the proposed method is convenient for the patient, in that he has the ability to wear ordinary rather than special orthopedic shoes. The implant in the proposed method is covered with soft tissues and does not interfere with wearing shoes, is not a threat of infectious complications (suppuration of the wound).

The proposed method has a low cost, due to the use of implants made from approved for use medical screws and cortical screws made of steel, recommended for use in clinical practice in healthcare.

The proposed method was applied in clinical conditions in 2010-2011 in 30 patients (34 fingers). Duration of observation from 4 months to one year. There were no complications and recurrence of hammer-like deformation.

The proposed method for correcting claw-like deformation of a finger is used in the traumatology department of the Road Clinical Hospital of the Chelyabinsk station of JSC Russian Railways and the traumatology department of the City Clinical Hospital No. 1 of Chelyabinsk.

Claims (3)

1. The method of interphalangeal arthrodesis after correction of rigid hammer-like deformation of the middle toes, including resection and implant insertion, characterized in that the level of resection is established, arthrotomy and resection of the head of the main phalanx of the toe are performed, articular cartilage is removed from the base of the middle phalanx of the toe, channels are formed in the main and middle phalanges, then one end of the implant is inserted intramedullary into the channel of the main phalanx, having a diameter of not more than 1.5 mm and a small fragmentary thread, while second end of the implant is introduced into the channel middle phalanx in its outer position rotating 80-90 ° until complete contact of end surfaces metacarpophalangeal then carried out subsequent to the screwing middle phalanx normopolozheniya and creating compressive forces, the wound is sutured, aseptic bandage is applied. 2. The method according to claim 1, characterized in that interphalangeal fixation is carried out with an implant, which is performed in the form of a screw. 3. The method according to claim 1, characterized in that the channels in the main and middle phalanges are formed using a spoke with a diameter of not more than 1.0 mm

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