RU2552915C1 - Method for surgical management of navicular injury - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: navicular injury is approached. Soft tissues are removed between the fragments, and osteoperforations are formed on the fragment surface. That is followed by open reduction and fixation of the navicular fragments with pins and biodegradable screw for external osteosynthesis. The pins are removed, and the wound is closed in layers. An external fixation apparatus of forearm-hand with a swivelling device is applied. The postoperative period involves alternatively daily replacement distraction and compression in the wrist joint, discretely in time at 0.25 mm 4 times a day for at least 4 weeks. The apparatus is transferred into the fixation mode, while the swivelling device is used to bend and flex the wrist joint until the navicular injury eliminates completely.

EFFECT: method provides the rigid fixation of the navicular fragments, prevents post-fixation contractures of the wrist joint by preserving the early postoperative movements and wrist arthrosis by improving the supply of an intraarticular cartilage of the distal radial bone and wrist bones, and reduces the length of rehabilitation.

1 ex, 6 dwg

Description

The present invention relates to medicine, namely to traumatology and orthopedics, and can be used for surgical treatment of injuries of the scaphoid of the hand (fractures, non-healing fractures, false joints).

Closest to the proposed is a method of surgical treatment of the pseudoarthrosis of the scaphoid of the hand by compression and distraction in an external fixation apparatus. The essence of the method lies in the fact that impose a rod apparatus of external fixation, while the rods are introduced into the radius and metacarpal bones, two rods. Each rod is fixed in half rings, which are interconnected by means of threaded rods. After relief of pain in the places of transosseous elements performed, the patient is first dosed with distraction in an external fixation apparatus for 7-10 days at 0.75 mm daily. The external fixation apparatus is stabilized for 5-7 days, then metered compression of fragments of the scaphoid bone of the hand is performed for 8-11 days at 0.75 mm daily. Then fixation is carried out in the apparatus until the radiographic consolidation of the pseudoarthrosis of the scaphoid bone is complete (1) (Patent of Ukraine No. 1130 UA IPC A61B 17/56: Method for surgical treatment of unjustified suglob of uniquely similar brush / Khmizov S.O., Skrebtsov V.V., Krolev V.O., Garbuznyak I.M. (UA). Published on December 15, 2005, Bulletin No. 12. - 8 pp.).

However, the known method of treating false joints of the scaphoid of the hand by the method of variable distraction-compression has significant disadvantages, namely:

- Damage to the scaphoid refers to intraarticular damage, according to the standard for the treatment of intraarticular fractures, one of the main principles is the exact reduction and fixation of bone fragments, which is not in the known method.

- The presence of only two rods as a transosseous element in the proximal and distal bases of the external fixation apparatus does not provide sufficient stability of the apparatus, which negatively affects the stiffness of fixation of bone fragments of the scaphoid.

- Dosed distraction of the wrist joint for 7-10 days at 0.75 mm and stabilization of the external fixation apparatus for 5-7 days in an overstretched state leads to overstretching, from the physiological norm to 5.25-7.5 mm, which is accompanied by pain syndrome, swelling of the soft tissues.

- Overextension of the wrist joint leads to circulatory disorders due to narrowing of the lumen of blood vessels located in the ligaments of the joint. Subsequent compression for 8-11 days, at the same rate to the initial state, leads to vasodilation and a decrease in blood circulation, which causes edema of adjacent soft tissues.

- Excessive distraction of the wrist joint for 7-10 days leads to a divergence of bone fragments of the scaphoid and increases the displacement, which negatively affects the subsequent regeneration of bone tissue in the damage zone, as well as the function of the wrist joint.

- Long-term (average 2.5-3 months) fixation of the forearm, hand and wrist joint in the external fixation apparatus leads to the emergence of post-immobilization contracture, requiring a long rehabilitation period to restore the function of the upper limb.

Based on the existing level of methods for surgical treatment of injuries of the scaphoid bone and eliminating the disadvantages of known technologies, the task was to increase the effectiveness of treatment, prevent the development of post-fixation contractures of the joints of the hand, arthrosis of the wrist, prevent displacement of fragments of the scaphoid in the postoperative period, and shorten the period of the rehabilitation period to restore the function of the upper limb.

The task of the proposed method for the surgical treatment of injuries of the scaphoid bone is solved as follows:

Treatment of damage to the scaphoid of the hand includes the imposition of an external fixation apparatus, distraction and compression of fragments of the scaphoid, and stabilization in the external fixation apparatus until complete consolidation of the fragments of the scaphoid. New in the proposed method of surgical treatment is that they access the area of damage to the scaphoid of the hand, remove soft tissue from the space between the fragments and cause osteoperforations on the surface of the fragments. Open reposition and fixation of fragments of the scaphoid bone of the hand is done with knitting needles for temporary fixation, then with a biodegradable screw for immersion osteosynthesis, the needles for temporary fixation are removed, the wound is sutured in layers. Then impose an external fixation device "forearm-brush" with a hinged device. In the postoperative period, alternating daily daily distraction and compression in the wrist joint is performed discretely in time in the regime of 0.25 mm 4 times a day for at least 4 weeks. Then, the apparatus is put into fixation mode and the bending-extension in the wrist joint is performed using a hinged device until the fracture of the scaphoid bone is fully merged, after which the external fixation apparatus is dismantled and active movements in the wrist joint are restored.

We explain the significant distinguishing features of the proposed method for the surgical treatment of injuries of the scaphoid of the hand.

Performing operative access to the zone of damage to the scaphoid bone of the hand, removing the hematoma with a fresh fracture, or excising the connective (scar) tissue in the false joint from the space between the fragments ensures good contact between the fragments of the scaphoid of the hand. After processing the ends of bone fragments on the fracture surface of each bone fragment around the circumference, several longitudinal channels (3-5) are made with a spoke with a diameter of 1.0 mm (parallel), parallel blindly ending without reaching the surface, the length corresponding to the size of each fragment of the scaphoid of the hand. The number of channels is determined by the severity of sclerosis of the ends of bone fragments. Using a needle with a diameter of 1.0 mm for osteoperforation reduces the risk of bone burn. A certain ordering of drilling contributes to the revascularization of bone fragments. This method allows low trauma without destroying the bone, while maintaining the mechanical strength of the ends of the fragments of the scaphoid, having a small size, to destroy sclerosis of fragments and to ensure the creation of tight contact between fragments of the scaphoid of the hand.

After the reduction of bone fragments in the correct position is achieved, they are temporarily diafixed with two spokes to perform osteosynthesis with a biodegradable screw for immersion osteosynthesis, after which the diafixing spokes are removed. The use of a biodegradable implant avoids repeated surgical intervention used to remove the metal screw. The properties of the biodegradable screw are already evident on the 2nd day after the operation (decrease in length by 2% and increase in thickness by 0.5%), which causes the effect of autocompression and thereby achieves additional rigidity of fixation of bone fragments.

The imposition of an external fixation apparatus (AVF) “forearm-wrist” with hinges is necessary to perform distraction in the wrist and inter-wrist joints, which allows in the postoperative period to avoid pressure on fixed fragments of the navicular bone of the hand, which can lead to the development of aseptic necrosis of fragments of the navicular bone brushes.

Carrying out alternate daily short-term distraction and compression in the wrist joint, discretely in time in the 0.25 mm mode 4 times a day for at least 4 weeks, improves nutrition of the intraarticular cartilage of the distal radius and wrist, providing gentle stimulation of regeneration and consolidation of the damaged scaphoid bone. Overstretching of the capsule-ligamentous apparatus of the wrist joint does not occur, which does not cause pain and swelling syndrome, is comfortably tolerated by the patient.

Putting the device into fixation mode and performing flexion-extension in the wrist joint with the hinges until the damage (fusion fusion) of the scaphoid of the hand is completely restored allows restoration of movements in the wrist joint by the end of the fixation period in the AFF and reduces the rehabilitation period of patients.

Patent studies on subclass A61B 17/56, 17/58, 17/60, 17/62, 17/66 and analysis of scientific and medical information reflecting the current level of methods for surgical treatment of scaphoid injuries of the hand did not reveal identical technologies. Thus, the proposed method for the treatment of injuries of the scaphoid of the hand is new.

The relationship and interaction of the essential methods of the proposed method of surgical treatment provides a new result in solving the problem, namely: to increase the effectiveness of treatment, to prevent the development of postfixation contractures of the wrist joints, arthrosis of the wrist joint, to prevent the displacement of fragments of the navicular bone in the postoperative period, to shorten the period of the rehabilitation period to restore the function of the upper limb.

The technical result of the proposed method is:

Achieving accurate reposition, rigid fixation of fragments of the damaged navicular bone of the hand by a biodegradable screw for immersion osteosynthesis, the removal of which is not provided, and repeated surgery is not required to remove the immersion structure.

- Holding transosseous elements of the proximal external support of the external fixation apparatus through the radius of the hand allows you to maintain the function of rotation of the forearm for the entire period of fixation in the apparatus, which prevents the formation of rotational postfixation contractures of the forearm.

- The passage of transosseous elements through the metacarpal bones allows you to maintain the function of the metacarpophalangeal and interphalangeal joints of the fingers for the entire period of fixation in the external fixation device, which prevents the formation of postfixation contractures of the joints of the fingers.

- Performing dosed (0.25 mm 4 times) during the day of alternating distraction and the next day of compression at the same rate using an external fixation device is aimed at sparing stimulation of regeneration and consolidation of the scaphoid bone. Overstretching of the capsule-ligamentous apparatus of the wrist joint does not occur, does not cause pain and swelling syndrome, is comfortably tolerated by the patient.

- The gentle regime of daily alternation of distraction and compression stimulates the formation of the primary regenerate between the bone fragments of the scaphoid.

- The alternation of daily distraction and compression in the wrist and inter-wrist joints leads to restoration of the joint fluid (during distraction in the wrist joint, a vacuum arises in the joint cavity, which contributes to the emergence of negative pressure and, as a result, stimulates the formation of joint fluid). Subsequent compression in this joint leads to the appearance of excess synovial fluid pressure in the joint cavity, which helps to increase the pressure of the joint fluid and stimulates the regeneration of the articular cartilage of the wrist, providing prevention of the development and progression of wrist arthrosis. The daily alternation of the compression and distraction modes in the AVF is performed within 4 weeks - this is the average period during which the formation of primary bone callus takes place, i.e. primary elastic connective tissue adhesion, due to which the bone continuity is restored, but there is not enough density in it and the mobility of the fragments is still insignificant when moving.

- After 4 weeks of alternating distraction and compression in the external fixation apparatus, the period of restoration of movements in the wrist joint using the joints of the external fixation apparatus begins, which allows you to continue stimulating regeneration to the radiologically established fusion of the scaphoid bone.

- Carrying out the restoration of movements in the wrist joint at the top of the distraction allows to reduce the load on the articular cartilage of the bones of the wrist and intercarpal joints, which helps to regenerate and prevent the development of arthrosis of the joints, restoring movement in the wrist and intercarpal joints.

- Restoration of movements in the wrist joint is the second stimulating factor in bone tissue regeneration, which allows the restoration of movements in the wrist joint by the end of the fixation period in the external fixation apparatus, which reduces the period of rehabilitation of the upper limb in the patient.

Thus, the proposed method for the surgical treatment of damage to the scaphoid of the hand has an inventive step.

The proposed method for the treatment of damage to the scaphoid can be repeatedly reproduced and applied in practical health care in the departments of traumatology and orthopedics.

The essence of the proposed "Method of surgical treatment of injuries of the scaphoid bone" is illustrated by illustrations, which show:

figure 1 - external fixation apparatus used in surgical treatment of injuries of the scaphoid of the hand, and the scheme of its application;

figure 2 - x-ray of the brush of the right upper limb of patient G. before treatment;

figure 3 - x-ray of the brush of the right upper limb of patient G. after applying the external fixation apparatus and performing immersion osteosynthesis;

figure 4 - x-ray of the brush of the right upper limb of the patient G. the fixation period in AVF and alternating distraction and compression of 4 weeks;

5 is a radiograph of the right hand of patient G. after dismantling the external fixation apparatus;

6 - indicators of the anatomical and functional outcomes of the treatment of patients with injuries of the scaphoid bone according to Lyuboshits-Mattis-Schwarzberg (3).

We explain the positions indicated in the illustrations in the appendix to the application description:

1 - scaphoid bone,

2 - radius

3-1 metacarpal bone,

4-11 metacarpal bone,

5 - support of the external fixation apparatus,

6 - threaded rod,

7 - hinges,

8 - rod conical shape.

"Method for the surgical treatment of injuries of the scaphoid bone" is as follows:

Indication for surgical intervention is the presence of a patient's fracture, pseudoarthrosis, nonunion of fragments of the scaphoid bone of the hand, restriction of movements in the wrist joint, the presence of pain.

Preoperative preparation of the patient is carried out in accordance with the rules generally accepted in surgical practice when performing surgical interventions: clinical laboratory examination, densitometry, dynamometry, radiography of the hand in three standard projections (straight, lateral and three quarters), MSCT.

For surgery, prepare a set of apparatus for transosseous osteosynthesis "forearm-hand" (see the appendix to the description of the application, figure 1), consisting of the following details:

- external supports, 2/3 rings with a diameter of 140 mm,

- threaded rods,

- cantilevered transosseous elements, conical shaped rods,

- brackets,

- hinges.

The upper limb is placed on an orthopedic console to the surgical table. After processing the surgical field on the palmar surface in the projection of the scaphoid bone of the hand, an “L” -shaped access is performed with a total length of 6.0 cm. Each fragment of the damaged scaphoid is selected, soft and scar tissue are removed from the space between the bone fragments. Using a needle with a diameter of 1.0 mm and a drill, osteoperforations are performed over the entire surface area of the fragments of the scaphoid bone of the hand being compared without damaging the cortical layers of the scaphoid of the hand. Then reposition of fragments of the scaphoid bone of the hand is performed in the correct position and temporarily fixed with two needles with a diameter of 1.0 mm. Under the control of an electron-optical transducer (EOP) in real time, bone fragments of the scaphoid bone are mapped and temporarily fixed to each other by two spokes, with a drill bit 2.0 mm in diameter form a channel the entire thickness of the scaphoid bone. According to the size of the formed channel, a biodegradable screw is selected for immersion osteosynthesis with a diameter 0.2-0.3 mm larger than the diameter of the previously formed channel and osteosynthesis of fragments of the scaphoid bone of the hand is performed by a sized biodegradable screw. Spokes for temporary fixation are removed, the wound is washed with antiseptic solutions, and sutured in layers.

Then transosseous osteosynthesis of the damaged scaphoid bone is performed. According to the generally accepted principles of transosseous osteosynthesis (2) (Solomin L.N. Basics of transosseous osteosynthesis by the apparatus of G.A. Ilizarov. - Publishing House LLC MORSAR AV, St. Petersburg, 2005. - S.203-206), the proximal AVF bases: transosseous elements (conical rods 120 mm, d - 6.0 mm) are inserted at an angle of 90 ° to the longitudinal axis of the radius at levels VI and VIII. The rods are fixed with brackets to the external support of the transosseous device (sector 3/4 of the ring, diameter 140 mm). The next stage is the installation of the distal base of the transosseous apparatus: 2 conical shaped rods are inserted into the diaphysis of the metacarpal I and II and fixed to the external support of the transosseous apparatus (sector 3/4 of the ring, diameter 140 mm). The proximal and distal bases of the external fixation apparatus are interconnected using threaded rods equipped with hinges with a rotation axis passing through the axis of rotation of the wrist joint. Hinges fix motionless.

3-5 days after the operation, when the pain syndrome is stopped, the patient is given a daily alternation of distraction and compression in an external fixation apparatus (AVF). Initially, distraction is performed in the mode of 0.25 mm 4 times a day. The next day they perform compression in the 0.25 mm mode 4 times a day. The period of daily alternation of distraction and compression is 4 weeks.

4 weeks after the next distraction in the external fixation apparatus, the period of restoration of movements in the wrist joint begins. The hinges located on the threaded rods between the external supports of the forearm-wrist external fixation apparatus relax, bring into working condition and perform flexion / extension movements in the wrist joint daily with a gradual increase in the range of motion in the wrist joint. The restoration of movements in the wrist joint is performed until the fragments are fully fused and the scaphoid bone regeneration is completed (X-ray control 1 time per month).

In the presence of signs of radiologically determined consolidation of fragments of the scaphoid bone, the external fixation apparatus is disassembled, in the absence of radiologically established consolidation of fragments of the scaphoid bone continue to be fixed in the AFF. After dismantling the AVF, the patient independently engages in the development of upper limb movements in the exercise therapy system.

As a result of the application of this method for the surgical treatment of injuries of the scaphoid bone, accurate reposition and stable fixation of fragments of the scaphoid bone were achieved. By the end of the fixation period in the external forearm-hand fixation apparatus, the patient retained the function of rotation in the joints of the forearm, flexion and extension in the wrist joint, which positively affects the patient's rehabilitation (prevention of postfixation contractures).

Outpatient management

Dressings are performed once every five days or according to indications. The patient is engaged in exercise therapy with an instructor or on their own, gradually increasing the amplitude of movements in the wrist joint of the operated limb until complete recovery. X-ray control is performed 1 time in 4 weeks. Indications for the removal of the apparatus are radiologically determined signs of consolidation of damage to the scaphoid. Determination of the anatomical and functional outcomes of the treatment of patients with scaphoid injuries is carried out according to the system proposed by Lyuboshits-Mattis-Schwarzberg (3) (see the appendix to the description of the application, Fig.6).

The essence of the proposed "Method of surgical treatment of injuries of the scaphoid of the hand" is illustrated by a clinical example.

Patient G., 38 years old, complained of restricted movement in the right wrist joint, pain in the right wrist joint, aggravated by physical exertion, inability to fully use the right upper limb.

Anamnesis of the disease: 02/08/2012 was injured as a result of falling on an outstretched right arm. He turned to the emergency room at the place of residence, the diagnosis was established: a scaphoid fracture of the right hand, adequate treatment has not been carried out.

He went to the clinic of the Federal State Budget Scientific Institution "NTSRVH" SB RAMS after 4 months from the moment of injury, the diagnosis at admission: the false joint of the scaphoid of the right hand. Surgical treatment recommended.

Local status: On examination: the area of the right wrist joint treason due to edema (+1.0 cm), palpation pain in the projection of the scaphoid. Pain is noted when performing active movements in the right wrist joint, fingers of the hand. Movement in the wrist joints: extension / flexion: on the right - 10/0/25, on the left - 50/0/60; beam / elbow: on the right - 10/0/10, on the left - 20/0/30.

On the radiograph of the right hand from 05.24.2012: the integrity of the scaphoid of the hand is broken. The contours of the ends of the fragments are uneven, sometimes sclerotic. The line of enlightenment between the fragments is traced throughout. Free-lying cortical fragments are detected. Radiologically established: the joint spaces of the wrist joint - 0.25 cm and the wrist joint - 0.2 cm (see the appendix to the description of the application, figure 2).

Clinical diagnosis: forming a false joint of the scaphoid of the right hand. Combined contracture of the right wrist joint. Pain syndrome.

The patient underwent surgical treatment according to the proposed method.

After processing the surgical field on the palmar surface in the projection of the scaphoid of the right hand, an “L” -shaped access with a total length of 6.0 cm was made. Fragments of the scaphoid were highlighted, scar tissue between fragments of the hand spoons was removed. Using a needle with a diameter of 1.0 mm and a drill, osteoperforations were performed over the entire area of the surfaces of fragments of the navicular bone of the right hand being compared without interfering with the cortical layers of the navicular bone of the hand. Then reposition of the fragments of the scaphoid bone of the right hand in the correct position was performed and the fragments were temporarily fixed with two needles with a diameter of 1.0 mm. Under the control of the electron-optical transducer (EOP) in real time through bone fragments of the scaphoid that are mapped and temporarily fixed to each other with two spokes, a 1.8 mm deep channel is formed by a drill to the entire thickness of the scaphoid. According to the size of the formed channel, a biodegradable screw for immersion osteosynthesis is selected (Biodegradable screw - ActivaScrew 2.0 × 20 mm), a diameter of 2.0 mm, and osteosynthesis of fragments of the scaphoid bone of the right hand is selected by a sized biodegradable screw. The needles for temporary fixation were removed, the wound was washed with antiseptic solutions, and sutured in layers.

Then transosseous osteosynthesis was performed. The proximal base of the external fixation apparatus (AVF) was mounted: transosseous elements (conical rods 120 mm long, 6.0 mm diameter) were introduced at an angle of 90 ° to the longitudinal axis of the radius at the VI and VIII levels. The rods (AVF-T-01.021.01 L = 90, i = 19) are fixed to the AVF support (sector 3/4 of the ring, diameter 140 mm) using brackets. The next step was the installation of the distal base: 2 rods (AVF-T-01.021.01 L = 90, i = 19) were inserted into the diaphysis of the metacarpal bones of the metacarpal bones, which are fixed to the AVF support (sector (3/4 ring, diameter 140 mm). The proximal and distal bases of the AVF are interconnected using threaded rods equipped with hinges with a rotation axis passing through the axis of rotation of the wrist joint of the right upper limb (see the appendix to the description of the application, Fig. 1). The hinges are fixed motionless.

Performed control x-ray (see the appendix to the description of the application, figure 3). Scaphoid fragments are fixed with a screw. The standing of the fragments is satisfactory. On the roentgenogram: the joint spaces of the wrist and intercarpal joints are expanded to 0.5 cm (normal joint spaces: the wrist joint of 2.0-2.5 mm, the wrist joints of 1.5-2.0 mm). After stopping the pain on the fifth day, the patient began daily alternation of distraction and compression in the external fixation apparatus. During the first day, distraction was performed in the regime of 0.25 mm 4 times a day. The next day, compression was performed in the 0.25 mm mode 4 times a day. The patient was trained to perform distraction and compression in the AVF. On the 4th day of the daily alternation of distraction and compression was discharged from the hospital for outpatient treatment. Alternating daily regimes of distraction and compression along the threaded rods of the external fixation apparatus “forearm-brush” was recommended to be performed for 4 weeks (see the application description of the application, figure 4).

4 weeks after the operation, the period of restoration of movements in the wrist joint of the right upper limb has begun. The hinges located on the threaded rods between the external supports of the AVF “forearm-wrist” are relaxed, put into working condition to perform flexion / extension movements in the wrist joint, daily with a gradual increase in the range of motion in the wrist joint. Restoration of movements in the wrist joint was performed within 4 weeks.

After 8 weeks from the moment of the operation, the patient underwent control radiography of the wrist joint of the right hand in 2 projections. The integrity of the scaphoid of the right hand is restored. The standing of bone fragments is satisfactory. X-ray it was found that the joint spaces of the wrist and inter-wrist joints were expanded to 0.5 cm. The external fixation apparatus “forearm-wrist” was dismantled (see the application to the description of the application, Fig. 5). Further, the patient independently develops the movements of the upper limb according to the exercise therapy system.

Control examination was carried out 4 weeks after the dismantling of the AVF "forearm-brush" on the right (12 weeks from the time of surgery). The patient freely uses the right upper limb, no complaints. Movement in the wrist joints: extension / flexion on the right - 40/0/60; on the left - 50/0/60, beam / elbow assignment: on the right - 20/0/30; left 20/0/30. The patient's ability to work is fully restored. The anatomical and functional result of treatment according to the Lyuboshits-Mattis-Schwarzberg system (see the appendix to the description of the application, Fig.6) is regarded as good, restoration of the anatomy of the scaphoid bone has been achieved, the cosmetic condition of the patient’s right upper limb is satisfactory.

The proposed method treated 5 patients with damage to the scaphoid of the hand. In patients treated by the proposed method, an increase in the amplitude of movements in the wrist joint by 65 degrees is noted, rotational movements in the joints of the forearm are preserved, movements in the elbow joint without negative dynamics.

The results of the treatment of patients with damage to the navicular bone of the hand were carried out according to the Lyuboshits-Mattis-Schwarzberg method [3], which made it possible to take into account the anatomical and functional outcomes of patient rehabilitation, signs of consequences of fractures, and the degree of recovery of disability in trauma patients.

Assessment of treatment outcomes is obtained by dividing the sum of digital indicators by the number of indicators studied. The average numerical value of the result of treatment (index) corresponds to a specific outcome of treatment. With an index of 3.5-4.0 points, the result of treatment is considered good; 2.5-3.5 points - satisfactory; 2.5 points or less - unsatisfactory.

The anatomical and functional result of treatment according to the Lyuboshits-Mattis-Schwarzberg system was rated as good (3.5-4.0 points) in 4 patients, satisfactory in one patient (3.4 points).

Thus, the proposed "Method for the surgical treatment of injuries of the scaphoid bone" in comparison with the known methods of transosseous osteosynthesis allowed to shorten the rehabilitation period (on average by 20 days) by maintaining rotational movements of the forearm during periods of distraction and fixation of the limb in the external fixation apparatus, to achieve full consolidation of fractures of the scaphoid bone of the hand, as well as to exclude the development of contractures in the proximal and distal radiolactic joints, to restore the function of the upper limb.

Information sources

1. METHOD OF SURFACE TICKING OF UNFABRICTED SUGLOB MOST LIKE BRUSHES: UKRAINE UA: pat. 11230, IPC A61B 17/56 / publ. 2005, Bull. No. 12.

2. Solomin L.N. The basics of transosseous osteosynthesis by G.A. Ilizarova / L.N. Solomin. - St. Petersburg: - Publishing House LLC "MORSAR AV", 2005. - S.203-206.

3. Lyuboshits N.A. Anatomical and functional evaluation of treatment outcomes in patients with fractures of long tubular bones and their consequences / Mattis E.R. // Orthopedics, traumatology and prosthetics. - 1980. - No. 3. - S. 47-52.

Claims (1)

A method for the surgical treatment of injuries of the scaphoid bone, including the application of an external fixation apparatus, performing distraction and compression of fragments of the scaphoid, stabilization in the apparatus of external fixation until the fragments of the scaphoid are completely consolidated, characterized in that they access the area of the scaphoid bone damage, soft tissues are removed from the space between the fragments, osteoperforations are applied to the surface of the fragments, an open reposition and fixation of the fragments of the scaphoid is made with knitting needles for temporary fixation and then with a biodegradable screw for immersion osteosynthesis, the needles for temporary fixation are removed, the wound is sutured in layers, then the external fixation apparatus is placed on the forearm-brush with a hinge device, in the postoperative period, alternately daily daily distraction and compression in the wrist joint are performed discretely in time 0.25 mm mode 4 times a day for at least 4 weeks, then the device is put into fixation mode and the bending-unbending into the ray is performed using a hinged device metacarpal joint to completely restore damage to the scaphoid bone of the hand, after which the external fixation apparatus is removed and active movements in the wrist joint are restored.

Images