RU2615665C1 - Osteosynthesis method for multi-fragment comminuted fracture of patella - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: knee is washed with an antiseptic solution. Small pieces of patella are removed. The patellar defect is filled with hydroxyapatite. Two spokes are directed vertically in the interior of the patella in the longitudinal direction so that the lateral and medial spokes fixed the lateral and medial patellar fragments, and the spokes are tightened with a 8-shape directed wire behind the quadriceps tendon. Two parallel spokes are injected in the horizontal direction in the interior of the patella to secure the proximal and distal fragments of the patella, the wire is directed transversely to the patella, and the spokes are tightened with a 8-shaped drawn wire loop.

EFFECT: method increases osteosynthesis stability, reduces the risk of non-union, reduces the risk of contracture.

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Description

The invention relates to medicine, namely to traumatology, and is intended for the treatment of complex comminuted fractures of the patella, accompanied not only by severe damage to the capsule-ligamentous apparatus of the anterior knee joint surrounding the patella, but also by crushing the patella into four or more fragments.

Closest to the claimed method is a method for vertical osteosynthesis of Weber patellar fragments (Weber) using two spokes stably fixed with an 8-wire (Weber MJ, Janecki CJ, McLeod P., Nelson CL Efficacy of various forms of fixation of transverse fractures of the patella. J Bone Jt Surg Am. 1980 Mar; 62: 215-220). The method includes the following stages: processing and comparison of two fragments of the patella; holding in the vertical direction of two knitting needles through two fragments of the patella, tight tightening of the held knitting needles with an 8-shaped wire.

The disadvantage of this method is the impossibility of fixing all fragments with multifragmental comminuted fractures of the patella and their retention in a repaired state until the fracture is completely fused.

The technical result of the invention is stable osteosynthesis of the patella with multifragmental comminuted fractures of the patella (four or more bone fragments).

The technical result is achieved by the fact that the method of osteosynthesis for multifragmental comminuted fractures of the patella involves processing and matching two fragments of the patella, holding two spokes vertically in the thickness of the patella in the longitudinal direction so that the lateral and medial spokes fix lateral and medial fragments of the patella, tight tightening 8-shaped behind the quadriceps tendon with a wire, washing the knee with an antiseptic solution, removing small fragments of the patella, filling the patellar defect with hydroxyapatite and additionally holding two parallel spokes in the horizontal direction in the thickness of the patella to fix the proximal and distal fragments of the patella, holding the wire transversely above the patella, pulling off the needles of an 8-shaped wire loop, biting the ends of the spokes, the remaining parts and immersion in soft tissue to prevent their migration, suturing the wound.

The method is as follows. An incision is made in the skin and soft tissues with a size of 10 cm along the front surface of the knee joint. In the presence of small (tiny) patellar fragments, often found in multifragmental fractures, small fragments are removed after thoroughly washing the knee joint with an antiseptic solution to prevent the development of adhesions, blockade and hemarthrosis in the knee joint. The resulting patellar defect is filled with hydroxyapatite in order to preserve the anatomical volume of the patella, which is important for the complete maintenance of the tension function of the patellar ligament proper. After washing the joint with an antiseptic solution and removing small fragments, the fragments are repaired using mechanical forceps. After that, two parallel knitting needles are held in the thickness of the patella in the longitudinal direction so that the lateral and medial spokes fix the lateral and medial fragments of the patella, respectively. After that, an 8-shaped wire loop is carried out behind the quadriceps tendon and tightens it. However, after this, the vertical-axial displacement and instability of the fragments remains. Therefore, in order to achieve stability of fixation of all (four or more) fragments, two more parallel knitting needles are held in the horizontal direction in the thickness of the patella

for fixing proximal and distal patellar fragments. These spokes are also pulled together in an 8-shape wire loop in order to achieve stability of retention of all fragments until they are completely fused. The ends of the spokes are removed, the remaining part is bent and immersed in soft tissue to prevent their migration. Thus, a stable, cruciform osteosynthesis of a multifragmental comminuted fracture of the patella was obtained. Then, the wound is sutured in layers after hemostasis and washing the joint with aseptic solutions. In the postoperative period, the operated lower limb is immobilized in a removable splint, which is removed for physical therapy. At the same time, patients remove the splint with a partial load on the sore leg in the very first day after the operation. The migration of the spokes, the divergence of the wire suture, non-healing of patellar fractures and contracture of the knee joint were not observed in patients.

Using this technique of osteosynthesis of multifragmental comminuted fractures of the patella, it was possible to achieve such a level of stability of the fragments that created the possibility of an early (from the next day) start of movement in the knee joint, which served as a prevention of the development of contracture in the knee joint after osteosynthesis of complex patella fractures. And contracture in the knee joint due to forced long-term immobilization with a plaster cast after a rocky fracture of the patella occurs, as a rule, always.

In FIG. 1 is a photograph of an injured patella, FIG. 2 - kneecap after osteosynthesis.

Clinical example 1.

Patient B.A., 35 years old, was injured on 01/29/2015, jumping from a height of about two meters. Delivered by the ambulance team in the 12th hospital, where the diagnosis was made: closed comminuted fracture of the right patella with displacement of fragments. On February 03, 2015, the osteosynthesis of the patella was performed according to the method described above. A longitudinal incision was made in the patella region 12 cm in size, a multifragmental fracture of the patella with longitudinal and frontal fracture lines was revealed. After removal of small fragments, the defect was filled with hydroxyapatite. Fragments are juxtaposed and fixed with two spokes held longitudinally and two held transversely. An additional fixation was made with two 8-shaped wire loops. Osteosynthesis is stable. The protruding parts of the spokes are bent, bitten off. Layered closure of the wound, aseptic dressing. The lower limb is immobilized by a removable splint. The patient is activated the very next day, was discharged from the hospital 02/09/2015.

Clinical example 2.

Patient N.V. (39 years old) after falling on the street on his left knee joint was injured on 12/20/2015, signs of a comminuted fracture of the patella were revealed on radiological images. On the fourth day, an operation was performed under epidural anesthesia: osteosynthesis of the patella with knitting needles and wires according to the method described above. On the front surface of the knee joint with a 10 cm incision, the fracture site is open. During the audit, the fracture is multi-fragmented, comminuted — the distal fragment is split lengthwise, the proximal fragment is split lengthwise and there is a triangular fragment of 1.5 * 2 * 1 cm along the front surface of the patella at% of its depth. After removal of small fragments, the defect was filled with hydroxyapatite. The fragments are repaired using mechanical forceps. The distal and proximal patellar fragments are fixed longitudinally by two knitting needles, they are pulled together by an 8-shaped held wire. Additionally, two spokes are held in the transverse direction through the medial and lateral fragments, they are fixed by an 8-shaped wire in the transverse direction. On the P-control, the condition of the fragments, spokes and wire is satisfactory. The proximal and lateral ends of the spokes are tapered, bent and immersed in soft tissue. The distal and inner ends of the spokes are tapered. Osteosynthesis is stable. Hemostasis. Rinsing a postoperative wound with antiseptic solutions. Layered seams on the wound. Dressing with alcohol. Stable osteosynthesis was achieved, which allowed the early movement in the right knee joint to begin without disturbing osteosynthesis. The knee joint is immobilized with a removable splint. The next day, the patient is activated, ligation of the surgical wound was performed. The patient was discharged from the hospital on 04.01.2016.

Claims (1)

The method of osteosynthesis in multifragmental comminuted fractures of the patella, including processing and matching of two fragments of the patella, holding two spokes vertically in the thickness of the patella in the longitudinal direction so that the lateral and medial spokes fix lateral and medial fragments of the patella, tightly pulling the knitting needles 8 quadriceps tendons with wire and wound closure, characterized in that after washing the knee joint with an antiseptic solution, they are removed small fragments of the patella, fill the defect of the patella with hydroxyapatite and additionally hold two parallel knitting needles in the horizontal direction in the thickness of the patella to fix the proximal and distal fragments of the patella, then conduct the wire in the transverse direction above the patella, knitting the needles with an 8-shaped wire loop, biting the ends of the knitting needles and the remaining parts are bent and immersed in soft tissue to prevent their migration.

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