RU2535509C1 - Device for treating patients suffering from injuries and consequences of injures of proximal femur - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: device consists of pins, a compression screw shaft, a retractable screw nail for the greater trochanter and a screw nail for the middle one-third of the femur, an adjusting pin guide and a removable support. The removable support is presented in the form of a plate with grooves inclined to the plate plane, holes for the adjusting pin guide and for the pins; the latter are bolted in these holes, and a hole for the compression screw shaft, which is fastened in this hole by screws and washers. The adjusting pin guide is presented in the form of an elongated sleeve with a collar at one end. The above screw shafts are mounted on the plate and gradually movable in three directions by sliding bars, thread rods, bolts and cuffs. The sliding bar moves in the plate groove by the thread rod arranged in the screw hole of the sliding bar and mounted on the plate. The screw shaft is pivotally connected to the sliding bar with a cylindrical hollow created in the sliding bar, wherein there is a ball-end and a through-hole bolt; the through hole comprises the thread rod arranged on the sliding bar. The bolt is connected to the screw shaft by means of the cuff. The pins and compression screw shaft consist of two portions, submersible and outer detachable ones, connected by a threaded connection. The submersible portion has a thread on a section length screwed into the femoral fragment only, and comprises a stop nut. The submersible portion of the pins has a hydroxyapatite coating.

EFFECT: invention provides the angular positioning of the screw shafts in relation to the support enabling inserting fixation elements into the bone in the preset direction, thereby providing the compression at the junction between the bone fragments followed by the intraoperative disassembly of the support and an outer portion of the fixation elements.

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Description

The invention relates to medicine and can be used in traumatology and orthopedics, namely in the treatment of fractures of the femoral neck.

A known method of osteosynthesis of fractures of the neck of the femur and a device for its implementation. The device comprises a supporting aiming element equipped with a device for holding in the undertrochanteric region of the femur and equipped with a set of rotating tools. The supporting aiming element has a central guide needle with a thread on the working end and peripheral guide needles with a thread on the working end, designed to install cannulated spongy screws. The supporting aiming element is made with the possibility of installation over the skin of the patient in the undertrochanteric region of the femur along its longitudinal axis and consists of two plates connected by a ball joint. In the plate closer to the large trochanter, there are central and peripheral threaded holes for removable threaded bushings with passage channels for installing, respectively, the central and peripheral guide spokes. The device for holding the supporting aiming element in the undertrochanteric region of the femur is made in the plate further located from the greater trochanter, in the form of a longitudinal slot under the fixing screw screwed into the bone. The head of the fixing screw is elongated, and at its end there is a threaded section for a lock nut installed under the plate with a slot, and a wing nut installed on top of the plate. A smooth cylindrical section is made in the middle of the elongated head of the fixing screw, the diameter of which is larger than the diameter of the threaded section. A plate with a slot for a fixing screw has the ability to reciprocate linear movement within the length of the slot and rotate in one direction or another relative to the fixing screw. A plate with threaded holes for removable threaded bushings with bushing for installing guide spokes has the ability to rotate relative to the ball joint and change the cervical-diaphyseal inclination angle. The ball joint is equipped with a conical screw lock (RU 2446767 C2).

However, the described device does not allow compression at the junction between the fragments, and also does not provide rigid fixation of bone fragments.

A device is known for treating patients with injuries and consequences of injuries of the proximal femur, containing a support with bone fixation elements installed on it. The support is made in the form of a plate on which screw rods are installed perpendicular to the support with the possibility of metered movement in three directions by means of a slide and threaded rods, while the support contains through holes for holding the spokes located at angles to the plane of the support, the spokes are fixed with bolts in through holes, and in one of the holes by means of nuts a compression screw rod is fixed, in addition, for conducting the spokes in the through hole there is a guide made in the form of an elongated second sleeve with a shoulder at one end (RU 120354 U1).

However, this device does not provide angular positioning of the helical rods relative to the support, and in addition, it does not provide, after reposition of bone fragments and their compression, intraoperative dismantling of the support and the outer part of the fixation elements.

The objective of the invention is to develop a device that provides angular positioning of the screw rods relative to the support, allowing in a given direction to introduce fixation elements into the bone, providing compression at the junction between bone fragments, followed by intraoperative dismantling of the support and the outer part of the fixation elements.

The problem is solved in that in a device consisting of a support, with fixed bone fixation elements mounted on it, made in the form of a plate, perpendicular to which, with the possibility of metered movement, in three directions, by means of a slide, threaded rods, clutch and bolt, screw the rods, the support contains holes for holding the spokes, located at an angle to the plane of the support, the spokes are bolted into the holes, in one of the holes by means of nuts and washers a compression screw rod is fixed, and in the other is a guide made in the form of an elongated sleeve with a shoulder at one end, screw rods are pivotally connected to the slider, spokes and compression screw rod consist of two parts, immersed and external, connected by a threaded connection, the immersed part is made with screw thread, while immersed part of the compression screw shaft contains a thrust nut, and the immersed part of the spokes is made with a hydroxyapatite coating.

In addition, in the device, on the immersed part of the compression screw rod, screw cutting is performed only along the length of the section screwed into the fragment of the femur.

The invention is illustrated by the description and diagrams, which depict:

Figure 1 - device for the treatment of patients with injuries and consequences of injuries of the proximal femur, a view with a cut of some elements;

Figure 2 - device for the treatment of patients with injuries and consequences of injuries of the proximal femur, disassembled;

Figure 3 - connection of the screw rod with the support, in the context;

Figure 4 - fixation of a fragment of the femur after removing the outer part of the fixation elements of the device.

A device for treating patients with injuries and consequences of injuries of the proximal femur contains a support 1 (Figure 1), sliders 2 (Figure 2, Figure 3), threaded rods 3 (Figure 1, Figure 2, Figure 3), bolts 4 (FIG. 2, FIG. 3), couplings 5 (FIG. 2, FIG. 3), bone fixation elements in the form of screw rods 6 (FIG. 1, FIG. 2, FIG. 3), compression screw rod 7 (FIG. 1, FIG. 4), knitting needles 8 (FIG. 1, FIG. 4), as well as nuts 9 (FIG. 1, FIG. 2, FIG. 3) and washers 10 (FIG. 1, FIG. 2). The support 1 is made in the form of a plate 11 (Figure 2) with grooves 12 (Figure 2) and holes 13 located at an angle α (Figure 1, Figure 2) to the plane of the plate 11 (Figure 1, Figure 2). On the support 1, with the possibility of dosed movement, in three directions, by means of sliders 2, threaded rods 3, bolts 4, couplings 5, screw rods 6 are installed. In this case, the slider 2 is moved into the groove 12 by the threaded rod 3 located in the threaded hole 14 ( Figure 2) of the slider 2 and mounted on the support 1. The screw rod 6 is pivotally connected to the slider 2, for this purpose a cylindrical recess 15 is made in the slider 2 (Figure 2), in which the bolt 4 with the ball head 16 is placed (Figure 2, Figure 3) and a threaded hole 17 (Figure 2). In the threaded hole 17 of the bolt 4, a threaded rod 3 is installed, located on the slider 2. The bolt 4 is connected to the screw rod 6 through the sleeve 5. In the holes 13 there are spokes 8 fixed by bolts 18 (FIG. 2) installed in the threaded holes 19 (FIG. .2) bearings 1. Spokes 8 are carried out in holes 13 using a guide 20 (FIG. 1, FIG. 2) made in the form of a sleeve 21 (FIG. 2) with a shoulder 22 (FIG. 2). A compression screw rod 7 is installed in the hole 23 (Figure 2) of the support 1 and fixed with nuts 9 and washers 10. The spokes 8 and compression screw rod 7 consist of two parts, immersed 24 (Figure 2, Figure 4) and the outer 25 ( Figure 2), connected by a threaded connection 26 (Figure 1, Figure 2), the immersed part 24 is made with a screw thread 27 (Figure 1, Figure 2). The immersed portion of 24 spokes 8 is made with a hydroxyapatite coating. When this immersed portion 24 of the compression screw rod 7 contains a thrust nut 28 (Figure 4).

In addition, in the device, on the immersed part 24 of the compression screw rod 7, the screw thread 27 is made only on the length "d" (Figure 1) of the section screwed into the fragment of the femur 29 (Figure 1).

The device is used as follows.

During the operation, after a closed reposition of bone fragments of the proximal femur, on the orthopedic table, two screw rods 6 are attached to the support 1 by means of the trochanter 30 (Figure 1) and the middle third 31 (Figure 1) of the femur 29 couplings 5. Rotation of the threaded rods 3, couplings 5, support 1 is installed parallel to the longitudinal axis of the femur 29. After that, the guide 20 is installed in the hole 13 and the spoke 8 is passed through it until the femur 29 is inserted into the neck 32 (Fig. 1). Radiography of the proximal la hips in direct and axial projections. The angular and linear deviation of the spoke 8 from the axis of the neck 31 of the femur 29 is calculated. The spoke 8 is removed, and, taking into account the roentgenograms, the support 1 is displaced by means of threaded rods 3 and couplings 5 by the required angular and linear magnitude, while the angular position is ensured by turning the ball head 16 bolts 4 on the threaded rod 3. After correcting the position of the support 1, the guide 20 is inserted into the hole 13 and the spoke 8 is drawn to the calculated depth in the femur 29. The guide 20 is moved to another hole 13 and the held pin 8 is clamped volume 18. Similarly, the spokes 8 are inserted into the remaining holes 13. A compression screw rod 7 is passed into the hole 23, the rod is inserted into the femur 29, the washers 10 are installed, fixing the position of the compression screw rod 23 with nuts 9. To compress the fragments of the femur 29, turn the nuts 9 , achieving rotation around its own axis, without longitudinal movement, of the compression screw rod 7. After making a strong fix, loosen the spokes 8, unscrewing the bolts 18, twist the nuts 9 with compression screw the rod 7 and the clutch 5 from the screw rods 6, remove the support 1. Remove the screw rods from the femur 29. The threaded connections 26, the spokes 8 and the compression screw rod 7 are disconnected, separating the outer part 25 from the immersed part 24. The immersed part 24 of the compression screw the rod 7 is fixed with a thrust nut 28. In this case, if the compression of the fragments of the femur 29 is weakened, by rotation of the nut 28, the immersed part 24 of the compression screw rod 7 is rotated, thereby bringing together the fragments of the femur 29. The wound surface soft tissue be decontaminated, and a sterile bandage applied. The hydroxyapatite coating of the immersed portion of the 24 knitting needles 8 provides a rigid fixation of the knitting needles 8 in the femur 29 in the postoperative period.

Using the device allows insertion of fixation elements into the bone in a predetermined direction, provides compression at the junction between bone fragments and their stable relative position, followed by intraoperative dismantling of the support and the outer part of the fixation elements.

Claims (1)

A device for treating patients with injuries and consequences of injuries of the proximal femur, consisting of knitting needles, a compression screw shaft, characterized in that it has a removable screw shaft for the region of the greater trochanter and a screw shaft for the middle third of the femur, a permutation guide for holding the needles, a removable support made in the form of a plate with grooves located at an angle to the plane of the plate, holes for a permutation guide for holding knitting needles and for knitting needles, the latter are fixed bolts in these holes, and a hole for the compression screw rod, which is fastened in this hole with nuts and washers, the permutation guide for holding the spokes is made in the form of an elongated sleeve with a shoulder at one end, the aforementioned screw rods are mounted on the plate with the possibility of metered movement, in in three directions, by means of sliders, threaded rods, bolts and couplings, while the slider is moved into the groove of the plate by means of a threaded rod located in the threaded hole of the slider and installed mounted on the plate, moreover, the screw rod is pivotally connected to the slider, for this purpose, a cylindrical recess is made in the slide, in which a bolt with a ball head and a threaded hole is placed, in the latter there is a threaded rod located on the slide, the bolt is connected to the screw rod by means of a coupling, knitting needles and the compression screw rod consist of two parts, immersed and detachable outer, connected by a threaded connection, the immersed part is made with screw thread only along the length of the section screwed into the exchanger pits femur, and comprises a thrust nut and the mounting part is provided with spokes hydroxyapatite coating.

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