RU2609058C1 - Method of surgical treatment of fractures of proximal part of shoulder bone in children and teenagers - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: two wires are introduced in criss-cross manner towards distal part through minor and major tubercles. Wires are clipped off from tubercle side. Distal end of wire is pulled until submergence into shoulder bone head and bent.

EFFECT: method makes it possible to increase osteosynthesis stability, reduce risk of development of contracture of shoulder and elbow joints.

6 dwg, 1 ex

Description

The invention relates to medicine, namely to traumatology and orthopedics, and can be used for surgical treatment of fractures of the proximal humerus in children and adolescents, such as proximal epiphysiolysis, osteoepiphysiolysis and fracture of the surgical neck.

A known method of surgical treatment of fractures of the proximal humerus according to the patent of the Russian Federation No. 2295312. By pulling on the hand and shoulder, reposition is performed under the control of the image intensifier, a skin incision is made 1.5 cm proximal to the ulnar fossa, a guide for the spokes is installed, through which two knitting needles are drilled into the humeral canal, and with a hammer through the canal into the humeral head bones. Under the control of the image intensifier, a spoke is made from the lateral epicondyle and, having moved the ulnar nerve to the side, a needle is drawn from the medial epicondyle of the humerus. The method of treatment is technically difficult in terms of getting into the canal of the humerus with the introduction of a spoke in the supracondylar region through the guide. Skin cuts 1.5 cm proximal to the ulnar fossa and installation of the guide - additional trauma to the soft tissues, lengthening the time of surgical treatment, the risk of injury to the ulnar nerve and the development of contracture of the elbow joint. Holding the spokes through the entire medullary canal is an additional trauma to the bone.

A known method of osteosynthesis with knitting needles according to patent No. 2152763. The essence of the method includes the introduction through the hollow guide of the diverging pointed ends of a double spoke into the bone using a pusher, the subsequent introduction of regular spokes in other planes, x-ray control and removal of the guide and pusher from the wound. An elastic element is placed between the ends of the knitting needles, the ends of which are held outside. After introducing the knitting needle, if necessary, pulling up or removing the knitting needle is carried out by traction of the elastic element at both ends. After installing all the knitting needles, the ends of the elastic element of the inserted first spoke are fastened together above the last knitting needle, its free ends above the fastening point are cut off and, together with the guide and other elastic elements, are removed by pulling one end of each. The disadvantage of this method is the technical complexity of the implementation, which increases both the time it takes and the duration of anesthesia; there is a high risk of damage to blood vessels and nerves when holding spokes and removing an elastic element.

The well-known "Method of surgical treatment of comminuted fractures of the proximal humerus with strained knitting needles" according to patent No. 2357692. In this method, a displaced large and / or small tubercle is fixed without exposing the fracture site by intramedullary insertion of Kirchner spokes under the control of image intensifier tubes through perforations in the external cortical layer of the humerus diaphysis. The spokes are passed through the tubercles, brought to the surface of the shoulder, bend their peripheral ends, giving them the shape of an anchor. They produce traction and bend the central ends of the spokes on the surface of the humerus so that the peripheral ends of the spokes fit the contours of the tubercles.

The invention consists in a combination of essential features that ensure the achievement of the desired technical result, and consists in creating a less traumatic method for stable osteosynthesis of the proximal humerus, which provides prevention of contracture of the shoulder and elbow joints.

The essence of the method of surgical treatment of fractures of the proximal humerus in children and adolescents includes a closed reposition of fragments of the proximal humerus, insertion of needles through the small and large tubercles, bending of their ends. Two knitting needles are introduced through the tubercles, crosswise, towards the distal part, from the tubercle side, the knitting needles are bent, they are pulled at the distal end until immersed in the humeral head and bent.

The introduction of two cross spokes provides sufficient rigidity of the connection of the fragment and bone.

The introduction of the spokes towards the distal section with the exit to the proximal metadiaphysis of the humerus ensures the accuracy of their installation, facilitates this process.

In the proximal part, the knitting needles are bite, and in the distal part they are pulled up until they are immersed in the head of the humerus so that the needles protruding from the head of the proximal part of the humerus do not injure the joint capsule.

The method is illustrated by illustrations, where:

In FIG. 1 shows a radiograph of the shoulder of the patient upon admission to hospitalization in direct projection;

In FIG. 2 - x-ray of the shoulder after surgery, in direct projection;

In FIG. 3 - radiograph of the shoulder after surgery, in lateral projection;

In FIG. 4, 5 - roentgenograms of a shoulder after plaster removal;

In FIG. 6, 7 - functionality after treatment.

The method is as follows.

Under general anesthesia under aseptic conditions, a closed reposition of the proximal humerus is performed. Through the head of the humerus, two knitting needles are crossed crosswise towards the distal section with the exit in the proximal metadiaphysis of the humerus and through the skin. In the proximal part, the needles bite, and in the distal part they are tightened until they are immersed in the head of the humerus.

Clinical example

Patient G., born 2005, entered the children's department of injuries. Center GAUZ RKB MH RT 09/12/2014 (IB No. 26531) with a diagnosis of closed fracture of the surgical neck of the left humerus with displacement. Injury the day before admission: fell from the horizontal bar. At the place of residence in the CRH, a diagnosis was made, a plaster cast was applied and sent to the GAUZ RKB MH RT. On examination: severe edema, pain. On the radiograph: a fracture of the surgical neck of the left humerus with a shift (Fig. 1). An operation was performed at the clinic on September 12, 2014: a closed reposition of a fracture of a surgical neck of the left humerus, osteosynthesis with needles (Fig. 2, 3). Plaster immobilization of the left shoulder joint according to Smirnov-Weinstein. The postoperative period was uneventful, the fracture was healed (Figs. 4, 5), the spokes, plaster cast were removed after 5 weeks. The functional result of surgical treatment is good (Fig. 6, 7).

The proposed method operated on 7 patients aged 8 to 15 years. The application of the proposed method reduces the time of surgical treatment, trauma of soft tissues, increases the reliability and stability of fixation of bone fragments, is a prevention of contracture of the shoulder and elbow joints, and also reduces the time of postoperative rehabilitation.

Claims (1)

A method for the surgical treatment of fractures of the proximal humerus in children and adolescents, including a closed reposition of fragments of the proximal humerus, insertion of needles through the small and large tubercles, bending of their ends, characterized in that two knitting needles are inserted through the tubercles, crosswise, towards the distal to the department, from the tubercle side, the knitting needles are bent, the distal end is pulled up to immersion in the head of the humerus and bent.

Images