RU2487684C1 - Method of substituting shin bone post-traumatic defect, accompanied by extensive wound surface - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to traumatology and orthopedics and can be applied in treatment of patients with post-traumatic defect of shin bone, accompanied by extensive wound surface. Fragment of fibula diaphysis is formed. Separated fragment of fibula diaphysis is initially, until maximally possible approach of wound edges, moved in direction of its nearest edge, held in given position until commissure of wound edges is formed, and then moved into defect zone.

EFFECT: method ensures restoration of extremity support ability, substitution of bone tissue defect, reduction of tension of adjacent to wound surface sections of covering tissues.

1 ex, 5 dwg

Description

The invention relates to medicine and can be used in the treatment of patients with post-traumatic defect of the tibia, accompanied by an extensive wound surface.

There is a method of treating a leg fracture in the presence of an extensive wound surface, which involves deviating a fragment of the fibula towards the tibia in order to bring the edges of the wound closer, its subsequent return to its original position and stable fixation before consolidation using a compression-distraction apparatus (AS USSR No. 1367955, publ.: 23.01.88., Bulletin No. 3).

However, this method does not provide for compensation for a post-traumatic bone defect.

There is a method of replacing a defect of the tibia, including the formation of a fragment of the diaphysis of the tibia, its metered displacement into the zone of the defect of the tibia and fusion with the opposing ends of its fragments (Shevtsov V.I., Makushin V.D., Kuftyrev L.M. Defects of bones of the lower limb . - M .: IPP "Zauralie", 1996. - 504 p .; ill.).

However, this method does not provide optimization of the conditions for the healing of extensive wounds in the treatment of fresh post-traumatic tibial defects.

The objective of the invention is to develop a method that reduces the tension adjacent to the wound surface of sections of integumentary tissues in the treatment of fresh post-traumatic defects of the tibia.

This problem is solved by the fact that in a method that includes the formation of a fragment of the fibular diaphysis, its metered displacement to the defect area of the tibia and fusion with the opposing ends of its fragments, the selected fragment of the fibular diaphysis is initially moved to the closest possible closure of the edges of the wound the edges are held in a given position until a commissure of the edges of the wound is formed, and then displaced into the defect zone.

The method is illustrated by a description, an example of practical use and illustrative materials, which depict:

Figure 1 - radiographs of the tibia of the patient before treatment;

Figure 2 - appearance of the lower leg of the patient before treatment;

Figure 3 - radiograph of the lower leg of the patient during the replacement of the defect;

Figure 4 - appearance of the lower leg of the patient after wound healing;

Figure 5 - radiograph of the lower leg of the patient after treatment.

The method is as follows.

After anesthesia and treatment of the surgical field, surgical treatment of the wound is carried out with the removal of all non-viable tissues, including bone fragments. Following these well-known techniques, osteosynthesis of the affected segment is performed with holding spokes through the proximal and distal third of both tibia. In a tense state, the spokes are mounted on the supports of the external fixation apparatus, which are interconnected with the possibility of metered displacement. Using an existing wound or through additional tissue incisions from the diaphyseal part of the fibula, a fragment is formed with a size corresponding to the size of the defect of the tibia formed during processing. The fragment thus formed is fixed with spokes introduced into it, the free ends of which are fixed in traction units mounted on the beam connecting the apparatus supports. The operation is completed by performing control radiography, after which the apparatus systems are stabilized. The wound surface is closed with a sterile dressing with a bactericidal ointment.

In the postoperative period, starting from 5-7 days, dosed movement of the selected fragment of the fibula is carried out. In this case, initially, to the maximum possible rapprochement of the edges of the wound, it is moved in the direction of its nearest edge. In the attached position, they are held until the adhesion of the edges of the wound is formed, and then they are displaced into the tibial defect until contact with the ends of its opposing fragments. The rate of movement of a fragment of the fibula varies between 0.5-2 mm per day. Upon replacement of the defect, the apparatus is transferred to the stable fixation mode, which is maintained until the fragment is consolidated with fragments of the tibia.

The practical use of the method is illustrated by the following clinical observation.

Patient P., 50 years old, was admitted to the hospital with a diagnosis of open fragmented fracture of the right tibia; on the outer surface of the leg of the wound size 23 × 17 cm (Fig.1 and 2).

To restore limb support ability and wound healing, the patient underwent surgery: primary surgical treatment of the wound with the removal of non-viable tissues, osteosynthesis with an external fixation device.

During the operation, after anesthesia and treatment of the surgical field, the wound was surgically treated to remove all non-viable tissues, including bone fragments. As a result of this, a defect of the tibia 9 cm in size was formed. Following this, osteosynthesis of the affected segment was performed with holding spokes through the proximal and distal third of both tibia. In a tense state, the spokes were fixed on the supports of the external fixation apparatus, which were connected to each other with the possibility of a metered shift. Using the existing wound, a fragment 11 cm in size was formed from the diaphyseal part of the fibula. The fragment formed in this way was fixed by spokes inserted into it, the free ends of which were fixed in traction units installed on the beam connecting the supports of the apparatus. The operation was completed by performing control radiography, after which the apparatus systems were stabilized. The wound surface was closed with a sterile dressing with a bactericidal ointment.

In the postoperative period, starting from the 5th day, the selected fragment of the fibula was dosed. In this case, initially, within 14 days, until the edges of the wound came closer, he was moved in the direction of its nearest edge. After that, in a given position, a fragment of the fibula was held for 7 days until the adhesion of the edges of the wound was formed, and then for 14 days it was displaced into the area of the defect of the tibia until contact with the ends of its opposing fragments. The rate of fragment movement varied between 0.5–2 mm per day. Upon the replacement of the defect, the apparatus was put into stable fixation, which was maintained for 151 days until the fragment was consolidated with fragments of the tibia. Wound healing by secondary intention was noted 63 days after surgery (Figures 3 and 4).

As a result of treatment, the patient restored the ability of the limb to heal an extensive wound (Figure 5). At the follow-up examination, the achieved treatment result is saved after a year: the patient walks without limping, with a full load on the operated limb, movements in adjacent joints within normal limits, the axis of the limb is correct, a 23 cm scar along the front surface of the lower leg.

Using the proposed method showed that its use optimizes the healing of extensive wounds by reducing the tension of the integumentary tissue adjacent to the wound surface in the treatment of fresh post-traumatic tibial defects.

Claims (1)

A method for replacing a post-traumatic defect of the tibia, accompanied by an extensive wound surface, including the formation of a fragment of the diaphysis of the tibia, its metered displacement into the defect area of the tibia and fusion with the opposing ends of its fragments, characterized in that the selected fragment of the diaphysis of the fibula is initially, to the extent possible wounds, move in the direction of its nearest edge, hold in a given position until a weld of the edges of the wound is formed, and then displaced into the defect zone.

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