RU2530726C1 - Method for olecranon osteosynthesis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: olecranon setting controlled by the intraoperative electron-optical image converter is followed by inserting two parallel pins with using a single-toothed hook through an apex of the olecranon with fixing a fracture area towards the elbow crest in an upper one-third of a forearm in the distal direction from the fracture line and percutaneously brought on a posterior surface of the forearm. A control X-ray examination is followed by hooking proximal ends of the pins forward and inserting into the olecranon apex through skin punctures made by a scalpel. That is followed by a one-stage compression of the fracture area through the skin punctures of the pin exit points on a posterior surface of the forearm by pulling the parallel pins up. K-wires are hooked in the posterior direction and cut off. The ends of the cut-off pins are arranged above the skin surface. The opposite direction of the pin hooking on both ends prevents a possibility of migration. The postoperative period involves the plaster immobilization of an upper limb with fixing the elbow and carpal joints.

EFFECT: method enables reducing para-articular tissue injuries, eliminating repeated operations for the metal structure removing.

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Description

The present invention relates to medicine, namely to traumatology and orthopedics, and can be used in the surgical treatment of fractures of the ulnar process, including in the presence of contraindications for open surgery.

The basis for the development of the method of osteosynthesis of the ulnar process was the need to create a minimally invasive method of osteosynthesis of the ulnar process, since in the case of fractures of the ulnar process, especially in the adolescent period, open surgery on the elbow joint leads to a pronounced scarring process in the paraarticular tissues, in turn difficult to treat contractures.

For the prototype of the present invention, a method for osteosynthesis of the ulnar process was selected, including reposition and subsequent conducting of two parallel Kirchner spokes through the fracture zone of the ulnar process with bending of their proximal ends (M. Muller, M. Allgover, R. Schneider, X. Villinegger. "Guide on internal osteosynthesis ", 1996).

The known method is as follows.

After access by the posterior midline incision, slightly curved to the radial side and enveloping the apex of the ulnar process, the selection of fragments and their exact anatomical reposition, two parallel Kirchner spokes are inserted through the center of the proximal fragment in a slightly beveled anterior direction to perforation of the anterior cortical layer. Then, in the distal fragment, a transverse hole is drilled through both cortical layers of the ulnar crest, through which the wire is drawn, laying it in the form of an 8-shaped loop, while one of the ends of the wire is held under the tendon of the triceps muscle and knitting needles. To create a symmetrical tension, the wire is individually tightened on both sides. The ends of the spokes are bent in the shape of a hook and immersed in bone over a pulling wire.

The disadvantage of this method is the inability to reposition bone fragments without exposing the fracture zone, resulting in significant trauma to soft tissues, leading to the formation of paraarticular scars, as well as the impossibility of percutaneous fixation of a fragment of the ulnar process with Kirschner knitting needles, which subsequently leads to the need for repeated surgical removal of metal structures intervention.

The objective of the proposed technical solution is to create a minimally invasive method of osteosynthesis of the ulnar process, avoiding the disadvantages of the prototype.

The problem is solved in that in the known method of osteosynthesis of the ulnar process, including reposition and subsequent two parallel Kirschner spokes through the fracture zone of the ulnar process with bending of their proximal ends, reposition is performed closed under the control of the intraoperative image intensifier using a single-tooth hook, the needles are carried out in the direction from the apex of the ulnar process to the crest of the ulna with the removal of their distal ends cutaneously along the posterior surface of the upper third of the ulna with the last pulling knitting needles to compress fragments, bending and biting their distal ends above the surface of the skin.

The criteria of "novelty" and "inventive step" of the proposed method is confirmed by the lack of data on the use of a combination of the claimed features, necessary and sufficient to solve the problem, in accessible sources of information.

The technical result of the application of the proposed method is to reduce trauma to soft tissues, including trauma to the growth zone in children and adolescents, to reduce the risk of postoperative infectious complications, to shorten the rehabilitation period after osteosynthesis of the ulnar process, to improve functional results in patients with fractures of the ulnar process, especially in children and the elderly with severe concomitant pathology, the absence of repeated surgical interventions in order to remove metal structures d.

The proposed method is as follows.

After reposition of the ulnar process, carried out under the control of the intraoperative image intensifier using a single-tooth hook, two parallel 1.5 mm spokes are drawn through the top of the ulnar process in the direction of the ulnar crest in the upper third of the forearm distal to the fracture line, which are transdermally brought to the posterior surface of the forearm. After performing control fluoroscopy, the proximal ends of the spokes are bent in the form of a hook in the anterior direction and, through skin punctures made with a scalpel, they are inserted into the apex of the elbow process. After that, through skin punctures, the exit points of the knitting needles on the back surface of the forearm by pulling parallel-spaced knitting needles perform simultaneous compression of the fracture zone, the Kirchner knitting needles are bent in the back direction (opposite to the knitting needles at the apex of the ulnar process) and bite, while the ends of the bitten knitting needles are placed above the skin surface . The opposite direction of bending of the spokes at both ends prevents the possibility of their migration. In the postoperative period, gypsum immobilization of the upper limb is performed with fixation of the elbow and wrist joint.

An example of a specific performance is given in the form of an extract from a medical history.

Patient V-va N.A., 28 years old, medical history No. 146, was undergoing treatment at the Clinical Center of the Russian Ministry of Internal Affairs in the Nizhny Novgorod Region for a closed fracture of the ulnar process of the right ulnar bone with a displacement of 11/27/2012. On December 6, 2012, an operation was performed under conduction anesthesia - closed reposition, osteosynthesis of the ulnar process with two spokes. Surgical intervention was carried out in the following way: after reposition of the ulnar process under the control of the intraoperative image tube using a single-tooth hook through the apex of the ulnar process, fixing the fracture zone, two parallel 1.5 mm spokes were made in the direction of the ulnar crest in the upper third of the forearm distal to the fracture line and were transdermally on the back surface of the forearm. The proximal ends of the spokes are bent in the shape of a hook in the anterior direction and through the skin punctures made with a scalpel, are embedded in the apex of the ulnar process.

After that, through a skin puncture of the exit point of the knitting needles on the back surface of the forearm by pulling parallel-located knitting needles, a simultaneous compression of the fracture zone was performed, the Kirchner knitting needles were bent in the back direction (opposite to the knitting of the knitting needles at the apex of the ulnar process) and were bitten over the skin surface. The limb is fixed by the posterior plaster cast with fixation of the elbow and wrist joint. The needles are removed after 6 weeks from the time of surgery. Discharged to work 8 weeks after the operation.

Claims (1)

The method of osteosynthesis of the ulnar process, including the reposition and subsequent conducting of two parallel Kirchner spokes through the fracture zone of the ulnar process with the bending of their proximal ends, characterized in that the reposition is performed closed under the control of the intraoperative image intensifier using a single-tooth hook, the needles are carried out from the top of the ulnar process to the crest of the ulnar bone with the removal of their distal ends cutaneously along the posterior surface of the upper third of the ulnar bone, followed by pulling the spokes to compression of bone fragments, by folding and skusyvaniem their distal ends on the surface of the skin.