RU2521350C1 - Device for reposition of tubular bone fragments - Google Patents

Abstract

FIELD: veterinary medicine.

SUBSTANCE: device comprises the hinged archwise bent gripping jaws and the fixing jaws, made with handles on one side and the working elements on the other side, and the cremaillere lock fixing in the closed position. The working element of the gripping jaws is made in the form of a hook. The working element of the fixing jaws at the free end is made in the form of a fork. At the end of the handle of the gripping jaws a ring for I finger is made. The handle of the fixing jaws is made in the form of a platform for the brush. The hook of the working element of the gripping jaws is made blunt. The working element of the fixing jaws is made with a groove. The fork of the working element of the fixing jaws is provided with drop-shaped tips and is bent at an angle of 12° outwards from the groove.

EFFECT: invention enables to eliminate the damage to soft tissues; to reduce the trauma of bone fragments; to reduce the cost of radiographic support of the operation; to reduce the radiological burden on the operated animal; to simplify and improve the reliability of equipment for matching the fragments of tubular bones.

3 dwg, 1 tbl

Description

The invention relates to veterinary surgery, and in particular to instruments for operations on damaged bones of animal limbs. The most effective use of the device for the reposition of fragments during osteosynthesis of tubular bones.

A known method of installing a pin for osteosynthesis, in which, after introducing a pin into one of the fragments, a V-shaped groove of the working part of the tool is installed on its protruding end. Another fragment is placed in the trough of the working part of the tool. At the same time, his handle is turned towards the second fragment and move it along the gutter until the fragments are compared. Then advance the pin (USSR Author's Certificate No. 1217397, class A61B 17/58, publ. March 15, 1986, Bull. No. 10) - [1].

However, there are disadvantages of this method of installing an intramedullary fixator in the form of a pin for osteosynthesis. So the wedge-shaped end face of the V-shaped groove of the working element of the instrument may cause additional damage to bone fragments from the side of their fracture line with the formation of longitudinal cracks under the action of the retraction force of the muscles transmitted to the instrument. In addition, the tool is not fixed by the fragment or protruding intramedullary fixator, therefore, when turning its handle, the V-groove of the working element of the tool can slide away from the bone fragment. This will provoke a sharp jerk, accompanied by a reverse movement of the bone fragments after they slide off the tool. In this case, squeezing of soft tissues between fragments is possible, including the damage to blood vessels and nerves.

Closest to the proposed device is a device for reposition of fragments of tubular bones, consisting of two branches with handles. The exciting jaw is made in the form of a pointed hook directed by the sharp part towards the fork-shaped fixing jaw with teeth perpendicularly fixed at its ends. The device is formed by articulating two branches. The rapprochement of the handles brings the jaws together, making it possible to grasp and hold the cylindrical bone on one side of the arched jaw, and on the other hand, with jaws teeth located at the middle of the jaw hook. Fixation and immobility of the jaws in the gripping position is carried out with a creme lock located at the end of the handle. A device with a double gripping jaw has a pivotally connected handle with a locking jaw with the possibility of turning the jaw along the axis of symmetry. The device provides percutaneous reduction and rigid fixation of fragments. After control radiography, any type of closed osteosynthesis can be carried out (USSR Author's Certificate No. 1600739, class A61B 17/58, publ. 10/23/1990, Bull. No. 39) - [2].

However, a device for reposition of fragments of tubular bones of known design provides for their percutaneous reposition and fixation, which does not exclude a number of control radiographs. At the same time, fragile fixation of fragments and their loose comparison are possible, which leads to the formation of hypertrophic periosteal callus and to an extension of the period of consolidation of fragments of damaged bone.

The objective of the proposed solution is to eliminate the cost of additional radiography, reduce the radiological load on the body of the operated object, reduce injuries of soft tissues and bone fragments.

The technical result is to simplify the technique of comparing fragments of tubular bones and increase its reliability.

The task and the specified technical result is achieved due to the fact that in the known device for the reposition of fragments of tubular bones, containing connected by a hinge arcuate curved gripping jaw and locking jaw made with handles on one side and working elements on the other hand, and fixed in the closed position lock, while the working element of the gripping jaw is made in the form of a hook, and the working element of the locking jaw on the free end is made in the form of a fork, according to As per the invention, a ring for the I finger is made at the end of the handle of the gripping jaw, and the handle of the locking jaw is made in the form of a platform for the brush, while the hook of the working element of the gripping jaw is made blunt and the working element of the locking jaw is made with a groove, while the fork of the working element of the locking jaw made with drop-shaped tips and bent at an angle of 12 ° to the outside of the gutter.

The technical essence of the proposed device for the reposition of fragments of tubular bones is presented in the drawings, where:

figure 1 - the proposed device for the reposition of fragments of tubular bones (General view);

figure 2 - the proposed device for the reposition of fragments of tubular bones (side view);

figure 3 - the proposed device for the reposition of fragments of tubular bones in the working position.

A device for reposition of fragments of tubular bones contains two overlapping non-identical branches, locking 1 and gripping 2, connected by a hinge 3, fixed in the closed position by a lock 4 located on the handles 5 and 6, while the handle 5 of the fixing jaw 1 is made in the form of a platform for the brush and on the handle 6 of the exciting jaw 2 there is a ring 7 for the I finger. The working element of the locking jaw 1 is made in the form of a groove 8 with a fork 9 at its free end made with atraumatic drop-shaped tips 10, and the working element of the gripping jaw 2 is made in the form of an atraumatic blunt hook 11.

In this case, the plug 9 extends to the outside of the gutter, namely at an angle of 12 ° from its longitudinal axis. This allows the movable fragment to maintain a gap between the fragments of 0.5-1.0 cm, so that when it is brought out in line with the fixed fragment, it does not catch on the protruding pin.

A device for reposition of fragments of tubular bones works as follows. An intramedullary fixator is inserted into one of the bone fragments, which is not intended to be moved, which should protrude from the lumen of the medullary canal by 0.5-1.0 cm. A fork 9 of the device is installed on its lateral end. Then, placing the brush on the platform of the handle 5 and I finger in the ring 7 of the handle 6, conduct pressure. The convergence of the arms 5 and 6 brings together the locking jaw 1 and the gripping jaw 2, turning on the hinge 3, while the atraumatic hook 11 captures the protruding part of the intramedullary latch. The immobility of the locking jaw 1 and the gripping jaw 2 in the gripping position is carried out with a creme lock 4. Thus, the fragment is fixed with an intramedullary fixator in the operating cavity.

Then proceed to move the fragment without an intramedullary fixator, in which there is a bayonet-shaped displacement relative to another fragment. So, a fragment without an intramedullary fixator is installed in the groove 8 of the working element of the fixing jaw 1. Then, pressure is applied to the handles 5 and 6 in the opposite direction from the fragment with an intramedullary fixator. In this case, a bone fragment intended for movement is advanced parallel to the axis of the fragment with an intramedullary fixator and in the opposite direction from it. Such a movement is continued until the displacement of fragments along the length is eliminated. The direction of movement of the fragment in the operating cavity is shown by a black arrow.

At the same time, bone fragments are aligned coaxially and eliminate their displacement in width. For this, the handles 5 and 6 are advanced towards the long axis of the bone fragments, while the direction of movement of the fragment without an intramedullary fixator is shown by a white arrow. Thus, this fragment, while maintaining the parallelism of the long axes of the fragments, is shifted in line with the fragment with an intramedullary fixator. The fork 9, bent at an angle of 12 ° to the outside of the gutter, allows the movable fragment to maintain a gap between the fragments of 0.5-1.0 cm, so that when it is brought out in line with the fixed fragment, it does not catch on the protruding pin.

Fragments are moving towards each other under the influence of the musculo-ligamentous apparatus and the efforts of the surgeon transmitted through the lever of the device. In this case, the device for reposition of fragments of tubular bones is supported by drop-shaped tips 10 on a fragment with an intramedullary fixator on the side of the bone fracture line, which makes this moment atraumatic.

After removing the fragments on one line, they are compared, targeting the bone marrow channel of the moved fragment to the protruding intramedullary fixator from the fragment recorded by the device. The device is removed from the operating cavity, thereby eliminating the gap between the fracture lines of the fragments. In this case, a smooth and atraumatic comparison of fragments is observed. After completing the reposition of the fragments, they are immobilized by promoting the intramedullary fixative into the lumen of the medullary canal of the combined fragment. When performing reposition, preference is given to the proximal fragment when installing the working element of the device, since the distal fragment is easier to move. However, it is first of all taken into account in which fragment it is more rational to install the initially intramedullary fixative.

Let us consider the operation of a device for reposition of fragments of tubular bones using an example: a male, an East European shepherd dog at the age of 6.5 years, with a live weight of 28 kg. The diagnosis is a transverse diaphyseal fracture of the tibia in its middle third with a bayonet-shaped displacement of the fragments, namely in width and length. Osteosynthesis was performed under general anesthesia.

The preparation of the operation field was carried out according to the generally accepted method and operative access to bone fragments was performed from the medial side of the lower leg - at the location of the fracture. Then they began to reposition the fragments. For this, an intramedullary fixator was inserted into the medullary canal of the proximal tibial fragment, which protruded 0.5 cm from the lumen of the medullary canal.

Next, the proximal fragment was fixed with a device for reposition of fragments of tubular bones, on the platform of the handle 5 of which the hand was placed, and I finger in the ring 7 of the handle 6. After fixing the device in the hand, we directed its working element into the operating cavity, and installed the lateral end of the intramedullary fixator the plug 9 of the working element of the fixing jaw 1. Pressure on the handles 5 and 6 leads to their rapprochement and, accordingly, to the rapprochement of the locking jaw 1 and the gripping jaw 2, turning on the hinge 3. A a traumatic hook 11 circled around the intramedullary fixator protruding from the medullary canal. The immobility of the locking jaw 1 and the gripping jaw 2 in the gripping position was carried out with a creme lock 4. This ensured the immobility of the fragment with an intramedullary fixator in the operating cavity.

Then, the distal fragment was placed by the fracture in the groove 8 of the working element of the fixing jaw 1. After that, moving the handles 5 and 6 towards the distal fragment parallel to the long axis of the bone, we moved it to eliminate the displacement of the fragments along the length. The application of mechanical force to the handles 5 and 6 causes a directly proportional pressure of the device to the fracture line of the fragment with an intramedullary retainer. However, the traumatic effect of the device is prevented by a large area of the support - drop-shaped tips 10 and the lateral part of the atraumatic hook 11. Further, by moving the handles 5 and 6 perpendicular to the long axis of the bone fragments, they eliminated the shift of the tibial fragments in width. Having weakened the pressure on the handles 5 and 6, the fragments were compared and the combined fragments were released from the device, opening the cremallera lock 4. Then, osteosynthesis was performed with an intramedullary fixator, moving it to the end of the medullary canal of the distal fragment. The operating cavity was sanitized and closed according to the standard technique. The animal has recovered.

The use of the proposed device for the reposition of fragments of tubular bones allows you to:

- apply it regardless of the degree of displacement of fragments and their parameters;

- eliminate damage to the soft tissues by the device for reposition and comparable fragments;

- reduce the trauma of bone fragments during their reposition;

- reduce the cost of radiographic support of the operation;

- reduce the radiological load on the operated animal;

- simplify the technique of comparing fragments of tubular bones during osteosynthesis;

- to increase the reliability of the technique of matching fragments of tubular bones;

- observe a smooth and atraumatic comparison of fragments.

When using the proposed device for performing manipulation on the reposition of bone fragments, the tactile relationship of the surgeon's hands with comparable fragments was noted. When working with the proposed device, skills are acquired for smooth and instantaneous comparison of fragments. This significantly reduces the complexity of comparing bone fragments and increases the efficiency of the operation (see table).

Device for reposition of fragments of tubular bones The number of animals operated Soft tissue injury and additional damage to fragments Complications after surgery Proposed eighteen - - Famous eighteen 6 6

As can be seen from the table, the use of the proposed device for the reposition of fragments of tubular bones is more effective when installing an intramedullary fixator for osteosynthesis of tubular bones in animals in comparison with the known one and eliminates postoperative complications.

The proposed device for the reposition of fragments of tubular bones was successfully used during osteosynthesis in 18 dogs and cats on the basis of the veterinary diagnostic center FGBOU VPO Orlovsky GAU and the Department of Clinical Veterinary FGBOU VPO Russian Peoples' Friendship University.

Claims (1)

A device for repositioning fragments of tubular bones, comprising a hinged arcuate curved gripping jaw and a fixing jaw, made with handles on one side and working elements on the other hand, and fixed in the closed position by a lock with a lock, while the working element of the gripping jaw is made in the form of a hook, and the working element of the fixing jaw on the free end is made in the form of a fork, characterized in that at the end of the handle of the gripping jaw there is a ring for the I finger, and the handle the coding jaw is made in the form of a platform for the brush, while the hook of the working element of the gripping jaw is made blunt, and the working element of the locking jaw is made with a groove, while the fork of the working element of the locking jaw is made with drop-shaped tips and bent at an angle of 12 ° to the outside of the gutter .

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