RU2601850C1 - Method of open reduction and osteosynthesis of distal radius fractures - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to traumatology and orthopaedics and can be used for open reduction and osteosynthesis of distal radius fractures. Surgical aid is being performed in conditions of a module of the distraction external fixation apparatus. Distraction external fixation apparatus consists of two circular supports, when attached one pin is being inserted on the hand so that it passes in direction from the proximal II metacarpal bone to the distal V metacarpal bone, proximal pin is being inserted through the olecranon. Under the control of the EOP distraction is being performed between supports, the correct axial interrelation in the distal radial bone and length of the latter are being recovered, biomechanically correct reduction fracture level is being provided due to ligamentotaxis. Extra-cortical metal osteosynthesis of the fracture is being performed by a plate in the achieved position. Distraction external fixation apparatus is being removed. Final x-ray control is being performed.

EFFECT: method enables recovering the painless movement in the wrist joint.

1 cl, 5 dwg

Description

The invention relates to medicine, namely to traumatology and orthopedics, in particular to methods used in the surgical treatment of fractures of the distal radius of the bone by open reduction and internal fixation.

A known method of treating fractures of the distal metaepiphysis of the radial bone [J.B. Jupiter, E.K. Shine Current Concepts in the Management of Distal Radius Fractures / Acta Chirurgiae Orthopedice et Traumatologiae Cechosl, 74, 2007, p. 233-246], including conducting open reduction and internal fixation of a radius fracture. The method consists in an open reposition of the fracture, performed from the palmar access, reposition of the fragments, achieved by comparing the extraarticular sections of the bone fragments and their provisional fixation with knitting needles. To control the reposition, an electron-optical converter is used. Final fixation is achieved with a bone plate.

However, the absence in the known method of the possibility of intraoperative static hardware recovery of the length of the radius can lead to difficulties in reposition and internal fixation in multi-fragmented fractures with an impression defect in bone tissue, as well as an increase in the time of the operating session.

A known method of surgical treatment of intraarticular fractures of the distal radial metaepiphysis [N.L. Ankin, L.N. Ankin, N.M. Satyshev, V.V. Katsalap. Combined osteosynthesis in patients with intraarticular fractures of the distal radial epimetaphysis / Surgery of Ukraine. 2011. No4 (40). P. 104-107.], Which consists in combining the methods of operative correction of fractures: extrafocal osteosynthesis with an external fixation device with knitting needles and osteosynthesis with plates with knitting needles.

However, in the known method, when combining osteosynthesis with plates and knitting needles, there is the possibility of migration of needles in the postoperative period at the beginning of the early development of movements and, as a result, loss of reposition and length of the radius. In addition, in the case of combining extra focal osteosynthesis with an external fixation device with knitting needles, the known method is the lack of the possibility of early development of movements in the wrist joint and, as a consequence, the occurrence of contractures.

The closest analogue to the claimed invention is a method for surgical treatment of intraarticular fractures of the distal radius with a defect in the metaepiphyseal zone [Patent RU No. 2453288. Publ. 06/20/2012], including the restoration of the length of the radius using the external fixation of the monolateral rod apparatus of the monolateral rod, open access and bone grafting of the epimetaphyseal defect with local tissues from the styloid process of the radius.

Imperfections of a close analogue are the use of a monolateral external fixation apparatus, which does not allow distraction in the mode of ulnar deviation of the radius, and also does not allow intraoperatively increasing or decreasing distraction for optimal control of fracture reposition and bone fixation, and to restore painless movements in the wrist joint.

The objective of the present invention is the ability to achieve a biomechanically correct reposition of an intraarticular comminuted fracture of the distal radius, the result of which is to provide conditions in the near postoperative period for the restoration of painless movements in the wrist joint.

The problem is solved in that in the method of open reposition and osteosynthesis of fractures of the distal radial bone, including the implementation of the surgical manual in the conditions of the external distraction apparatus module, fixation of the forearm and hand in a given position, the distal spoke is oriented in the direction from the proximal metacarpal II to distal part of the V metacarpal bone, create the effect of ulnar deviation, restore the angle of radiation inclination of the distal radius, the correct axial in the dist the main part of the radius and the length of the latter, then under the control of the image intensifier, the distraction between the supports is performed, the fracture is repositioned due to the ligamentotaxis phenomenon, then the bone metal osteosynthesis of the fracture is performed by the plate in the reached position of the fragments, the external fixation distraction apparatus is dismantled, the final x-ray control is carried out, the wound is layer-by-layer, sutured, in the postoperative period they begin physical therapy exercises under the supervision of a methodologist, to restore movement in the beam carpal joint.

The present invention is illustrated by a detailed description, a specific example of the method with links to copies of x-rays and photos, in which:

FIG. 1 (a, b) - presents copies from radiographs of the wrist joint in the direct (a) and lateral (b) projections in a plaster cast with a comminuted intraarticular fracture of the distal radius;

FIG. 2 - an intraoperative photograph is depicted, which shows the performance of open reduction and internal fixation by a plate under the conditions of a module of a distraction circular external fixation apparatus;

FIG. 3 (a, b) - presents copies from radiographs of the wrist joint in the direct (a) and lateral (b) projections after osteosynthesis of a fracture with a bone plate;

FIG. 4 (a, b) - presents copies from radiographs of the wrist joint in the direct (a) and lateral (b) projections of patient F., 65 years old, 9 months after surgery: an healed fracture of the radius in its correct position is determined;

FIG. 5 - presents copies of photos characterizing the function of the wrist joint of patient F., 65 years old, 9 months after surgery: the range of movements is sufficient.

The method of open reduction and osteosynthesis of fractures of the distal radius is as follows.

Before performing anterior palmar access to the distal radius, a module of an external fixation distraction apparatus consisting of two annular supports is mounted on the forearm and hand. On the brush spend one Kirchner needle with a diameter of 2 mm. Moreover, the latter is oriented so that it passes in the direction from the proximal section of the II metacarpal bone to the distal section of the V metacarpal bone. This conduct creates the effect of ulnar deviation and facilitates the restoration of the angle of radiation inclination of the distal radius. The brush in the device is fixed in the supination position to facilitate the location of the patient on the operating table. The proximal spoke is passed through the ulnar process of the ulna. When an external fixation distraction apparatus (DABF) is applied, front palmar access to the distal radius is performed according to Henry. To facilitate reposition and restoration of biomechanically correct axial relationships in the distal radius, as well as to restore the length of the last, under the control of the image intensifier, distraction between the supports of the DAF is performed, which provides the biomechanically required level of reposition of the fracture due to the phenomenon of ligamentotaxis. Next, bone metal osteosynthesis of the fracture is performed by the plate in the reached position. DAVF is dismantled, final x-ray control is carried out, the wound is sutured in layers. On the second day of the postoperative period, physiotherapy exercises are started under the supervision of a methodologist to restore movements in the wrist joint.

Clinical example of the method

Patient F., 65 years old, was sent to the emergency room of the Central Clinical Hospital No. 24 in Yekaterinburg from a trauma center after two attempts of closed manual reposition. In the emergency room, the diagnosis was made: "Fracture of the distal radius, dislocation of the ulnar head" (Fig. 1). During hospitalization in the trauma unit No. 1, it was decided to carry out surgical treatment in the amount of open reposition and osseous fixation with an LCP plate, transfixation of the forearm bones with two Kirschner spokes with a diameter of 2 mm. On the 3rd day after admission and preoperative examination, the patient was taken to the operating room. After anesthesia, the patient was laid on the operating table in a supine position. In sterile conditions, the patient was mounted module (forearm-hand) DAF with a brush in the position of supination and ulnar deviation. Anterior access to a radial fracture was performed according to Henry. During the revision of the fracture, there was a significant shortening of the radius, dislocation of the head of the ulna. Under the control of the image intensifier, metered distraction was performed until the normal anatomical relationship of the radius and ulna was restored. After optimal distraction, osteosynthesis of the fracture was performed with an LCP plate (Fig. 2). The directed dislocation of the head of the ulna is fixed by two Kirschner spokes with a diameter of 2 mm transossally (Fig. 3). The wound was sutured in layers tightly.

On the second day after the operation, the patient was activated, namely: active and passive development of movements in the wrist joint was started under the supervision of a physiotherapist. On the 10th day after the operation, the patient was discharged from the hospital.

9 months after the operation at the follow-up examination, fusion at the fracture site and the absence of ulnar subluxation were determined by X-ray (Fig. 4). The end result is regarded as good, limb function is restored, the patient is satisfied with the treatment, no complications were observed, the range of movements in the wrist joint is sufficient (Fig. 5).

The proposed method of open reduction and osteosynthesis of fractures of the distal radius is safe and economical, allows you to achieve complete anatomical reduction and stable fixation of bone fragments.

In addition, it allows to ensure the correct anatomical reposition of the intraarticular fracture, the early painless functioning of the wrist joint with the restoration of the full range of movements.

The proposed method allows the patient rehabilitation period to be carried out at home, which contributes to the complete social adaptation of patients and the restoration of lost health in a short time. The method is used in the Central city clinical hospital No. 24 of the city of Yekaterinburg.

Claims (1)

The method of open reduction and osteosynthesis of fractures of the distal radius of the radius, including the implementation of the surgical manual in the conditions of the module of the distraction apparatus of external fixation, fixation of the forearm and hand in a predetermined position, characterized in that the distraction apparatus of external fixation consists of two annular supports, when installed on the hand hold one spoke so that it extends in the direction from the proximal metacarpal II to the distal metacarpal V, which creates the effect of ulnar deviation and facilitates the restoration of the angle of radiation inclination of the distal radius, the proximal spoke is passed through the ulnar process of the ulna, under the control of the image intensifier, the distraction between the supports is performed, the correct axial relationship in the distal radius and the length of the radius are restored, they provide the biomechanically correct level of fracture reposition due to ligamentotaxis and then perform bone metal osteosynthesis of the fracture with the plate in the reached position, the distraction apparatus externally th fixation is dismantled, final x-ray control is carried out, the wound is sutured in layers.

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