RU2557369C1 - Method for restoring distal radioulnar joint - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: osteotomy is performed with exposing the distal ulnar metaphysis by a long linear incision 3.0-4.5 cm along the ulnar surface. Distal ulnar osteotomy and intraoperative single-step redressment are performed through the approach created at 3.0 cm above the ulnar styloid at an angle of 45°. The radiocarpal joint is fixed with an orthosis for 2-2.5 weeks.

EFFECT: method enables reducing the number of intraoperative injuries, gaining in the radiocarpal motions as much as possible, avoiding metal structures to be applied, and reducing the immobilisation length.

2 ex, 1 dwg

Description

The invention relates to medicine, orthopedics and traumatology, and can be used in case of damage to the radio-ulnar joint, for example, with improperly fused radial bone fractures in a typical place.

A standard operation is known when an osteotomy of the radius (distal radial metaepiphysis of the radius) and fixation of fragments by a T-shaped or L-shaped plate on screws are performed through a 5-6 cm access. The resulting defect is filled with a free autograft taken from the iliac wing crest. Stitches. Immobilization with a plaster cast for 1.5 months [see, for example, Littman I. Operative surgery. Budapest, 1985. S. 994].

Disadvantages:

1. High invasiveness.

2. Two operations.

3. Long term immobilization.

4. The use of metal.

5. Frequent complications - post-mobilization contracture of the wrist joint.

The objective of the invention is to develop a method to avoid reoperation and reduce the time of immobilization, to prevent due to this possible postoperative complications associated with prolonged functional immobility.

The problem is solved by creating a method for restoring the distal radio-ulnar joint, when a longitudinal linear section of 3.0-4.5 cm in length along the ulnar surface, departing 3.0 cm above the styloid process of the ulna, performs an osteotomy of the distal ulnar bone at an angle of 45 ° with intraoperative simultaneous redress, after which the wrist joint is fixed with an orthosis for 2-2.5 weeks.

The method is as follows.

Under anesthesia, a longitudinal linear incision of 3.0-4.5 cm long along the ulnar surface, departing 3.0 cm above the styloid process of the ulna at an angle of 45 °, is performed with a chisel osteotomy of the distal ulna with intraoperative redress. After this, brush movements in all directions are restored simultaneously, especially elbow flexion. Rare seams on the wound. Fixation of the wrist joint for 2 weeks.

The method is illustrated by the image.

With an incorrectly fused ray fracture in a typical place (distal metaepiphysis of the radius), ulnar subluxation.

The drawing is an implementation of the method, where A is the direction of the osteotomy, B is the picture of Norma after surgery. 1 - radius, 2 - ulna.

Clinical examples

Example 1

Patient S. 24 l., Injury 1.5 months. back.

12/24/2013, operation for an incorrectly fused fracture of the distal metaepiphysis of the right radial bone, contracture of the right wrist joint.

Under anesthesia, a section of 4.5 cm in length along the ulnar surface exposes the distal metaphysis of the ulna. At an angle of 45 °, an osteotomy of the ulna was performed. Intraoperatively made a reduction of the wrist joint. Stitches on the wound. Orthosis for 2.5 weeks. Then LFK, FTL. 4 weeks after the operation was discharged to work in satisfactory condition.

Example 2

Patient U. 64 years old, trauma 8.01.2014. Closed comminuted fracture of the distal metaepiphysis of the left radius with displacement of the fragment. Closed manual reposition; plaster cast.

After 1.5 months. upon removal of gypsum immobilization, the patient was admitted with an incorrectly fused fracture of the distal metaepiphysis of the left radial bone. “Bayonet-shaped deformation”; persistent contracture of the left wrist joint.

02/27/14 operation: under anesthesia with a section of 3.0 cm, the distal metaphysis of the left ulna was exposed. At an angle of 45 °, an ulnar osteotomy was performed with simultaneous intraoperative redress. Stitches on the wound. Bandage for 2 weeks. After 2 weeks of exercise therapy, FTL. By the end of 4 weeks from the day of surgery, movements in the left wrist joint are painless, in a satisfactory volume.

The advantages of the proposed method

1. Small injuries

2. Intraoperation. Maximum restoration of movements in the wrist joint

3. The lack of metal structures

4. Short terms of immobilization and rehabilitation

Claims (1)

A method for restoring a distal radio-ulnar joint, including an osteotomy, characterized in that a longitudinal linear incision of 3.0-4.5 cm long on the ulnar surface exposes the distal metaphysis of the ulna, through access, retreating 3.0 cm above the styloid process of the ulnar bones, at an angle of 45 °, osteotomy of the distal ulnar bone is performed with intraoperative simultaneous redress, after which the wrist joint is fixed with an orthosis for a period of 2-2.5 weeks.

Images