RU2546101C1 - Method for surgical stabilisation of flail foot - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: vertical incision is made along an anterior surface from a lower one-third of shinbone up to an ankle joint to expose a tibial crest, and a transplant of the required length is cut out. The latter is segmented so as to provides an adequate stabilisation of foot. The longest transplant is driven in through the ankle and subtalar joints, whereas the shorter ones are integrated through ankles into a body of talus in the lateral direction. The foot is fixed with a deep plaster cast all the way up to a knee joint. After removal of sutures, the plaster cast is transformed into a plaster boot for a period of 3 or 4 months.

EFFECT: method stabilises the flail foot by inserting the autotransplants through the ankle, subtalar joints and into the body of talus in the lateral direction through the ankles.

1 ex, 1 dwg

Description

The invention relates to medicine, namely to traumatology and orthopedics. There is a method of stabilizing the foot in the ankle joint by arthritis (according to Putty, Mitbraith), arthrodesis (according to Campbell, Chaklin), etc. However, they all concern only one joint - ankle or subtalar. There is also a known method of panartrodesis with a “dangling” foot according to Movshovich, which consists in extraarticular transplantation of the lower end of the fibula with resection of the articular surfaces of the ankle, subtalar and shopar joints, which is technically quite complicated. This circumstance prompted us to search for a simpler solution that provides the same goal - stabilization of the foot. Patent search has shown that there are no more rational solutions to this problem.

A method for the operative stabilization of a “dangling” foot is proposed, which consists in introducing autografts taken from the tibial crest longitudinally through the ankle and subtalar joints and transversely through the ankles of the tibia into the body of the talus.

The proposed method is as follows. Under the tourniquet on the thigh, a longitudinal section in front of the tibia from the lower third of the tibia to the ankle joint exposes the crest of this bone and transplant the required length (usually 10-12 cm). Then it is divided into parts sufficient to stabilize the ankle and subtalar joints. The longest graft is driven through the ankle and subtalar joints, and shorter ones are inserted through the ankles (in the transverse direction) into the body of the talus. At the end of the operation, the foot is fixed with a deep plaster cast to the knee joint. After removing the sutures, the plaster cast is transferred to the plaster boot for up to 3-4 months. In the subsequent conduct a course of rehabilitation treatment and provide the patient with orthobuy. The operation diagram is presented in figure 1.

An example of a specific performance: B-th A.A., born in 1994, was admitted to the Russian Children's Clinical Hospital on October 28, 2009 with a diagnosis of polio, dangling left foot, and a condition after distraction lengthening of the left thigh. The patient complains of pain in the foot when walking, ortho shoes does not relieve them. Pain is noted due to arthrosis and instability in the ankle and subtalar joints. Operated on November 4, 2009 according to the above description. Examined after 6 and 15 months. No complaints, satisfied with the operation. He walks in ortho shoes, but, according to the patient, he can walk even in ordinary boots with a lining of the longitudinal arch. X-ray arthrodesis in the ankle and subtalar joints took place.

Description of the figure. Figure 1. Scheme of stabilization of the ankle and subtalar joints with grafts taken from the crest of the tibia:

but). and b). - view of the lower leg, ankle and subtalar joints in front and side, respectively, the dashed line shows the autograft sampling scheme,

at). and d). - view of the lower leg, ankle and subtalar joints in front and side, respectively, after the implantation of grafts through the ankle and subtalar joints (longitudinally) and through the ankles of the lower leg into the body of the talus.

Literature

1. Movshovich I.A. Operative orthopedics. - ed. "Medicine", Moscow, 1983 p. 293-294.

2. Chaklin V.D. Fundamentals of operative orthopedics and traumatology. - ed. “Medicine”, Moscow, 1964 p.649-650.

Claims (1)

The method of stabilization of the “dangling” foot, which consists in arthrodesis of the ankle and subtalar joints by resection of all articular surfaces and extraarticular transplantation of the lower end of the fibula, characterized in that they stabilize two joints at the same time - ankle and subtalar by introducing autografts taken from the tibial crest longitudinally - through the ankle and subtalar joints, transversely - through the ankles of the lower leg to the body of the talus.

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