RU2499571C1 - Method of intramedullar osteosynthesis of distal metaphysis of tibia - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, in particular to traumatology and orthopedics, and can be used for achievement of intra-operation reposition in case of intramedullar osteosynthesis of distal metaphysic of tibia. Two rods, fixed on bar by means of rod-holders and means of dosed travel of rod-holders along bar, are introduced into proximal fragment. After that, into distal fragment of bone passed are 2 pins, fixed on ring by means of pin-holders, ring, fixed to bar, bars, connected to each other by means of pivotal device, with possibility of changing angle of their mutual position, with further performance of tibia osteosynthesis operation with intramedullar rod.

EFFECT: reposition method makes it possible to obtain precise reposition of bone fragments, eliminating their displacement both in sagittal and in frontal planes, as well as to eliminate rotational displacements, displacements in width, and restore segment length, without creating obstacles for passing intramedullar rod and its blocking, both distal and proximal.

1 ex, 1 dwg

Description

The invention relates to medicine, in particular to traumatology and orthopedics, and can be used to achieve intraoperative reposition for intramedullary osteosynthesis of distal tibia metaphysis.

Extra-articular fractures of the distal third of the tibia with displacement can cause difficulties in treatment due to possible varus, valgus displacements, as well as recurrence and antecurvation. The small size of the distal fragment can complicate both the achievement of reposition and the adequate location of the distal locking screws, the centering of the rod in both the proximal and distal fragments.

A known method of reposition and polyaxial stabilization of fragments during intramedullary osteosynthesis of fractures of long tubular bones (RF patent No. 2353317), including intramedullary metal osteosynthesis with locking without fixing the locking screws in the rod, during which, after the insertion of the rod, the intramedullary transducer is controlled electronically and optically using a reproductive transducer - blocking screws through bone fragments and threaded holes in the rod, when installing screws achieve compression of fragments from the mouth injury to their residual displacements due to the attraction of fragments to the rod by screw heads and achieve the final reposition and polyaxial rigid stabilization of the fragments.

However, this method violates the principles of relative stability that occur during intramedullary osteosynthesis, which can lead to delayed fusion / non-fusion fracture, breakdown of the metal fixator and the development of instability of osteosynthesis.

There is also known a method of intramedullary osteosynthesis of the tibia, including the application of a distractor, reposition of fragments under x-ray control and the introduction of an intramedullary nail, characterized in that for reposition of fragments using a spoke distractor consisting of a half ring and a ring or half ring connected by three telescopic rods and the support half-ring of two telescopic rods connected to the other end by a bar, while the half-ring is placed at the level of the proxima metaphysis of the tibia in front, and the ring or half ring - at the level of the distal metaphysis, the knitting needles are carried out one in the frontal plane into the proximal and distal metaphyses of the tibia, while the proximal knitting needle is placed in the posterior semicircle of the bone, the knitting needles are fixed in the distractor and carried along telescopic rods distraction, after restoring the segment length, the knee joint is bent to an acute angle and the limb is fixed in this position using the stand, after which an intramedullary is introduced a nail (RF patent No. 2350295, 03/27/2009).

The disadvantages of this method is that it does not allow for accurate reposition and increases the invasiveness of the operation.

The objective of the invention is to increase the accuracy of intramedullary osteosynthesis and reduce the number of postoperative complications.

The problem is solved by the method of intraoperative reposition during intramedullary osteosynthesis of the distal tibia metaphysis on the external fixation-rod apparatus, which consists of 2 rods mounted in the proximal fragment of the bone, which are mounted on the rod using rod holders and then means for dosed movement of the rod holders along the rod the distal bone fragment is carried out by 2 knitting needles fixed to the ring with the help of spoke holders, a ring fixed to the rod, the rods connected interconnected by a hinged device with the ability to change the angle of their relative position, followed by the operation of osteosynthesis of the tibia with an intramedullary shaft.

The method is practically carried out as follows. Under the control of the image intensifier, after drilling both cortical layers with a spiral drill (D 3.2 mm), two Shants screws (D 4.5 mm) are inserted into the proximal metaepiphysis of the tibia through a prick incision of not more than 0.5 cm, located mutually perpendicularly. 1 screw is inserted from the inside to the outside, the insertion point is located somewhat anterior to the projection of the head of the fibula, but also remains posterior enough from the marrow canal so as not to impede the introduction of the intramedullary shaft. Then, under the EOP control, the 2nd Shants screw is inserted from front to back, the injection point is located 1 cm medial to the tip of the tibial tuberosity, remaining medial enough from the axis of the medullary canal so as not to impede the introduction of the intramedullary rod (1). The trench screws are fixed to the rod with the help of rod holders and means of dosed movement of rod holders along the rod (6) (see drawing).

The next step is to carry 2 spokes through the distal fragment (3), the insertion point of the spokes is 2-3 mm proximal to the articular surface of the tibia in the ankle joint, fixation of the spokes in the spoke holders on the ring (2), tension with fitting devices and stabilization of the fixing elements of the apparatus , further fixing the ring to the bar (4). The rods are interconnected by a hinge device with the ability to change the angle of their relative position (5).

Clinical example.

The patient was admitted to the trauma department of the City Clinical Hospital named after S.P. Botkin with a diagnosis of "comminuted bifocal fracture of the tibia in s / 3 and n / 3 with displacement."

After the preparation, on January 20, 2012, the tibia osteosynthesis was performed using a Synthes pin with distal screw locking with angular stability and proximal locking using the intraoperative reduction and osteosynthesis technique.

Operation progress:

2 rods were inserted into the proximal fragment of the bone and 2 spokes into the distal section, their free ends were fixed in the external fixation apparatus, further closed reposition and final fixation of the fragments due to the installation of the articulated support of the fixation apparatus and subsequent further osteosynthesis operation tibia with intramedullary shaft. After processing the surgical field, a 2 - 2.5 cm incision is made from the lower pole of the patella to the tibial tuberosity through the ligament of the patella. The reference point for the access is the axis drawn along the crest of the tibia. Next, a channel for the rod is formed with a bone awl. The optimal entry point is located on the horizontal part of the epimetaphysis - the anterior intercondylar field. This point is extrasynovial at the anterior edge of the tibia. Next, a bone marrow canal is drilled to ensure that the rod is of the selected diameter. After the formation of the canal in the proximal metaphysis and the reaming of the marrow canal, a rod is inserted. Then the screws are locked

static version. After that, the spoke-rod apparatus is dismantled and the final X-ray control is performed.

The postoperative period was uneventful, the wounds healed primarily, the sutures were removed on day 12. The patient is activated on crutches, was discharged for outpatient treatment. At the control examination after 6 weeks, a full load on the operated lower limb is allowed. There is no pain syndrome. On radiographs - stable fixation of bone fragments with good reposition.

The method of reposition under conditions of a small size of the distal fragment made it possible to achieve a closed reposition, while not creating obstacles for the intramedullary rod and its blocking, both distal and proximal.

The technical result is achieved by fixing the spoke component to the core component of the external fixation apparatus.

Thus, the location of the trench screws and knitting needles in the distal fragment according to the proposed method allows to achieve accurate reposition of bone fragments, eliminate their displacement both in the sagittal and in the frontal plane, also eliminate rotational displacements, displacements in width and restore the segment length, while not creating obstacles to the intramedullary rod and its blocking, both distal and proximal.

Claims (1)

The method of intraoperative reposition during intramedullary osteosynthesis of the distal tibia metaphysis on the spoke-external fixation apparatus, which consists in the fact that 2 rods are held in the proximal fragment of the bone, mounted on the rod using rod holders and means of dosed movement of the rod holders along the rod, then into the distal fragment spend 2 knitting needles fixed to the ring with the help of spoke holders, a ring fixed to the rod, rods connected by a hinged device ystvom, with the possibility of changing the angle of their mutual arrangement, and then performing operations osteosynthesis tibial intramedullary rod.

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