RU2562824C1 - Method of treating false joints of humeral apophysis in children - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves the open reduction and fixation of the apophysis to its bed with using bulb-tipped pins. The first two pins are inserted in parallel to each other, at 90° to the false joint region and fixed by means of distraction pin clamps on a standard plated extension of the Ilizarov's apparatus. The third pin is cut short on one side at one centimetre from the bulb; a short end of the third pin is inserted from an outer side of the humerus between the two pins mentioned above, in parallel thereto until the bulb touches the bone, and also fixed with the distraction pin clamp on the plated extension of the Ilizarov's apparatus. The distraction pin clamps are used to generate compression within the false joint of the humeral apophysis.

EFFECT: method enables reducing injuries and risk of contractures.

1 dwg

Description

The invention relates to medicine, namely to traumatology and orthopedics, and is intended for the treatment of the false joint of the apophysis of the humerus in children.

Currently, various metal structures using knitting needles or screws are used to treat the pseudoarthrosis of the humeral apophyses in children. However, due to the need for repeated surgical treatment to remove metal structures, their use in childhood is undesirable.

Closest to the proposed invention in its technical solution is a method of using a device for osteosynthesis of apophyses of the humerus [1]. The device, consisting of a plate equipped with a longitudinal slot, bone rods, orienting tension nodes, and knitting needles, has several structural nodes and considerable weight. The presence in this design of bone rods passing near the vessels and nerves is dangerous, and the fixation of the apophysis using a spoke with a thrust pad creates the possibility of rotational displacement of the fragment around this spoke. A wide range of attachment points of the device limits the movement in the elbow joint, which eliminates the mobility of the joint and increases the likelihood of contractures.

The invention consists in a combination of essential features sufficient to achieve the desired technical result, which consists in reducing the morbidity and reducing the time of surgical intervention, reducing the time of surgical treatment and improving its results by simplifying the layout of the apparatus.

This essence lies in the fact that the method of treating the false joint of the apophysis of the humerus in children involves open reposition and fixation of the apophysis to their bed using knitting needles with thrust pads. Fixing spokes - three. The first two are carried out parallel to each other, at an angle of 90 ° to the zone of the pseudoarthrosis, and are fixed with the help of regular distraction special clamps on a regular prefix of the Ilizarov plate apparatus. The third is cut off on one side, having retreated one centimeter from the thrust pad, carried out with a short end on the outside of the humerus between the two previous knitting needles, parallel to them, until the thrust pad touches the bone and is also fixed with distraction special clamp on the same attachment of the Ilizarov plate apparatus. Distraction special clamps create compression in the area of the false joint of the apophysis of the humerus.

The use of three spokes with thrust pads provides uniform compression of the pseudoarthrosis, eliminates the displacement of the apophysis relative to its bed.

Holding the first two knitting needles parallel to each other, at an angle of 90 ° to the zone of the pseudoarthrosis, securing them with the help of regular distraction special clamps on the standard attachment of the plate apparatus Ilizarov excludes the possibility of rotation of the apophysis.

Shortening the third knitting needle indented one centimeter from the thrust pad by cutting on one side is necessary to fix this knitting needle in bone tissue with the least injury to the humerus.

Holding the shortened end of the third knitting needle from the outside of the humerus, between the two previous knitting needles until the thrust pad touches the bone, creates an anti-stop in the system, making the fixation more rigid.

Fastening the spokes with the help of regular distraction special clamps of the Ilizarov apparatus provides the ability to create the necessary compression in the system.

The use of a standard set-top box of the Ilizarov plate apparatus as a supporting element significantly reduces the weight of the device without impairing its fixing and compression qualities.

The creation of compression by distraction special clamps in the area of the pseudoarthrosis of the apophysis of the humerus ensures the condition of bone fusion.

The method is illustrated by the drawing, where 1 and 2 are the first two parallel knitting needles held at an angle of 90 ° to the line of the pseudoarthrosis; 3 - shortened knitting needle; 4 - regular distraction special clamps; 5 - prefix plate apparatus Ilizarov.

The method is as follows.

After excision of the pseudoarthrosis, using the example of the internal epicondyle of the humerus, the internal epicondyle is repositioned. The epicondyle is fixed with two knitting needles with thrust pads perpendicular to the inner epicondyle of the humerus, from the inside of the elbow joint. The spokes are brought out through the skin, from the outside of the lower third of the shoulder, and fixed with the help of distraction clamps on the plate prefix from the standard parts of the Ilizarov apparatus. The third is cut from one side one centimeter below the level of the thrust pad, held with a short end on the outside of the humerus between the two previous knitting needles, parallel to them, until the thrust pad touches the bone and is also fixed with a distraction special clamp on the same plate attachment of the Ilizarov apparatus. Distraction special clamps create compression in the area of the false joint of the apophysis of the humerus.

The absence of Schantz rods near the passage of the radial nerve allows you to avoid injury to the radial nerve. Reducing the spread of attachment points of the device narrows the area of damage to soft tissues, which provides a greater range of motion in the elbow joint, which contributes to the early healing of fractures and is the prevention of contractures. The use of regular units of the widely used Ilizarov apparatus allows the method to be used in clinics of any equipment level.

Information sources

1. Traumatology and orthopedics / Ed. G.S. Yumasheva. - M.: Medicine, p. 278, Fig. 176 (a, b). 1990 g.

2. RF patent No. 2163102, A61B 17/66, BI No. 5, 2001

Claims (1)

A method for treating the pseudarthrosis of the apophysis of the humerus in children, including open reposition and fixation of the apophysis to his bed using knitting needles with thrust pads, characterized in that the fixing knitting needles are three, the first two are parallel to each other, at an angle of 90 ° to the zone of the false joint , and fixed with the help of regular distraction knitting needles on the standard attachment of the Ilizarov plate apparatus, the third is cut from one side, stepping back one centimeter from the thrust pad, carried out with a short end from the outside of the shoulder to STI between the previous two spokes, parallel to them, before contact with the thrust pad and bone distraction spitsezazhimom also fixed on the same console plate Ilizarov apparatus, create distraction spitsezazhimami compression zone in a false joint apophysis humerus.

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