RU2576094C1 - Method for forming radiocubital joint of distal forearm - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to a traumatology and orthopedics. Perform incision on the radial side of the forearm, set the ulna head. Fixed in a neutral position with needles. At the same time after the removal of a subluxation of the head of the ulna and fixation of forearm bones in the frontal plane, at radiocubital junction channel formed in the distal epimetaphysis radius and ulna. Fill channel collagen biomaterial "Collost".

EFFECT: method provides a way to restore the integrity of joints and ligamentous apparatus saving function radiocubital movement in the joint.

1 cl, 2 ex, 3 dwg

Description

The invention relates to medicine, namely to traumatology and orthopedics, and can be used to restore the ligamentous apparatus of the radio-lunar articulation after dislocation.

One of the most difficult problems in the surgery of the pathology of the wrist joint is surgical intervention for traumatic ruptures of the distal radiolar joint. The peculiarity lies in the restoration of both the ligamentous apparatus of the articulation, and in preserving the function of movement in the radio-lunar articulation. There are the most well-known methods of treating this category of dislocation with a rupture of the radicular joint. So, to prevent relapse of the dislocation of the head of the ulna, it is fixed with a wire to the radial bone epiphysis [1]. However, despite stability, the mobility of supination-pronation movements in the joint is lost, which leads to a sharp restriction of function in the wrist joint.

Closest in its technical solution to the claimed method is the "Method of restoring the distal radiolar joint of the forearm" [2]. The essence of the invention lies in the fact that they provide access to the joint, the formation of channels and autotendoplasty. Two longitudinal cuts are made along the radial and ulnar side of the forearm, at the level of the radicular joint, and the neck of the ulnar bone is exposed. Two transverse channels are drilled through the distal epimetaphysis of the radius, in the frontal plane: proximal and distal. The end of a free reinforced autograft is carried out through the distal canal from the radial side of the forearm to the elbow, then, by looping around the neck of the ulnar bone, the transplant is passed through the proximal canal in the opposite direction. The head of the ulna is fixed in the articular recess of the radius, pulling the ends of the graft, knotted with a knot, attached to the graft, the bones of the forearm are in neutral position with two knitting needles for 4 weeks

This method is traumatic, the formed ligament does not always stably hold the head of the ulna, as a result of which the possibility of palmar-dorsal movement of the head of the ulna and relapse of its dislocation is not ruled out. And with significant physical exertion on the joint, the likelihood of obtaining a pathological fracture of the radius and / or ulna increases.

The essence of the invention lies in the combination of distinctive features sufficient to achieve the desired technical result, which consists in eliminating the dislocation of the head of the ulnar bone and forming a radiolar ligament from the Collost biomaterial, which ensures stability and restoration of rotational movements in the distal radiolar joint.

The essence of the invention lies in the fact that the method of forming a distal radiolar articulation of the forearm includes an incision on the radial side of the forearm, reduction of the head of the ulna and fixation in a neutral position with knitting needles. After elimination of the subluxation of the ulnar head and fixation of the forearm bones in the frontal plane, at the level of the radicular joint, a channel is formed in the distal epimetaphyses of the radius and ulna. The channel is filled with collagen biomaterial “Kollost”.

The formation of the channel in the frontal plane, in the distal epimetaphyses of the bones of the forearm, allows you to form a new ligament in the same anatomical place.

The introduction of collagen biomaterial “Kollost” provides the creation of a lost ligament.

The availability of biomaterial "Kollost" allows you to distribute the method everywhere.

The method is illustrated by illustrations, where:

In FIG. 1. a diagram of the fixation of the bones of the forearm with knitting needles is presented, after the head of the radial bone is repositioned, a diagram of the formation of the channel and its filling with collagen biomaterial “Kollost”.

In FIG. 2 is a radiograph showing the fixation of the bones of the forearm in the neutral position with two knitting needles.

In FIG. 3 shows a functional result 6 months after surgery.

The method is as follows.

Conduction anesthesia, under the cuff. A longitudinal incision is made in the projection of the radial bone of the forearm, 1.5-2 cm long. The head of the ulna is removed from the state of subluxation. The bones of the forearm are fixed in neutral position with two to three spokes. Using a hollow drill, a canal is drilled in the radius and ulna, at the level of the distal radiolar joint, through three cortical layers. The formed channel is filled with collagen biomaterial “Kollost”. Hemostasis. Skin sutures before drainage. Alcohol dressing. Gypsum.

Clinical example

Patient N., 20 years old. Received March 25, 2014. The diagnosis: closed rupture of the distal radiolar joint of the left forearm, with a dislocation of the head of the ulna to the rear, 3.5 months ago. The circumstances of the injury: December 6, 2013 - fell on her arm at the rink. I did not receive treatment. On examination, instability was found in the left distal radiolar joint, a positive “key symptom”. Pain during exercise and at rest in the region of the left wrist joint.

03/26/2014, the operation was performed according to the method described above (Fig. 1). The operation was performed under conduction anesthesia. A longitudinal incision was made in the lower third of the forearm in the projection of the radius of 1.5 cm long. The subluxation of the head of the ulna with fixation of the bones of the forearm by knitting was fixed (Fig. 2).

After the canal was formed with a hollow drill, the collost biomaterial “Kollost” was introduced into the projection of the distal radiolar articulation. Hemostasis. Skin sutures. Alcohol dressing. Gypsum. Primary healing. Skin sutures were removed after 14 days. Knitting needles removed 4 weeks after surgery. The patient underwent a single course of physiotherapy.

Control examination 6 months after surgery. The patient disappeared pain both during exercise and at rest. The range of motion in the left wrist joint is complete (Fig. 3). Rotational movements of the left forearm are not limited. There are no symptoms of dislocation of the head of the ulna. The patient is satisfied with the result of the operation.

Thus, the proposed method allows to eliminate dislocation of the head of the ulnar bone and form a complete ligamentous apparatus of the distal radiolar joint.

Information sources

1. Ericka Lawler & Brian D. Adams Reconstruction for DRUJ Instability. HAND (2007) 2: 123-126.

2. RF patent No. 2344776, A61B 17/56, BI No. 3, 2009.

Claims (1)

A method of forming a distal radiolarnar joint of the forearm, including an incision on the radial side of the forearm, reducing the ulnar head and fixing in a neutral position with knitting needles, characterized in that after eliminating the subluxation of the ulnar head and fixing the forearm bones in the frontal plane, a channel is formed in distal epimetaphyses of the radius and ulna, the canal is filled with collagen biomaterial “Kollost”.

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