RU2625647C1 - Method for surgical access to radial bone distal department in case of fractures - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: surgical access is performed by cutting soft tissues along the lateral margin of the radial bone along the forearm anterior surface. The incision is extended to the proximal palmar fold, gently rotated at an angle of 90° and continued to the lateral edge of the long palmar muscle tendon. The cutaneous flap is removed to the ulnar bone and fixed. The wound is dilated by blunt dissection. The abdomen of the long thumb flexor of the hand is exposed in the proximal part of the access and the square pronator in the distal part. The radial artery is withdrawn laterally. Simultaneously, the wrist radial flexor and the thumb long flexor tendons are removed in the ulnar bone direction. The square pronator is dissected at the lateral margin of the radial bone. When the wound is sutured, the square pronator is sewn to the brachioradial muscle. Fracture reposition and plate osteosynthesis are performed.

EFFECT: method provides optimal visualization of the radial bone distal epimetiadephysis fracture, especially the radial bone region in the area of the elbow cut and the radial bone styloid process, prevents formation of painful postoperative scars in the wrist joint area.

1 ex, 6 dwg

Description

 The invention relates to traumatology and orthopedics. Used for open reduction and internal fixation of fractures of the distal radius Inside and periarticular fractures of the distal radius of the radius are a common group of injuries among the bone pathology of the traumatic genesis of the wrist joint. In most cases, fractures of this localization are accompanied by bone tissue impression in the metaphysical zone and displacement of bone fragments, which requires an open reposition of the fracture, bone grafting and stable fixation of the plate.

Known surgical access in the treatment of a distal radial bone fracture according to Henry (Editor Amitava Gupta 2014 year.Options for Surgical Exposure and Soft Tissue Coveragein Uppe Extremity Trauma), which is carried out along the tendon of the radial wrist flexor and continues below the joint gap of the wrist. However, such a longitudinal incision leads to the formation of painful postoperative scars that restrict movement in the wrist joint. Moreover, such access does not allow to fully visualize the distal parts of the medial part of the radius.

A modified anterolateral approach (David J. Slutsky, MD, FRCS 2009 year Fractures and lnjuries of the Distal Radiusand Carpus), which is performed by dissecting the skin along the tendon of the radial flexor of the wrist, is taken as an analogue of the L-shaped access, then the incision is shifted towards the styloid process of the radial bones and continues distal to the articular surface of the wrist joint. This access allows you to better visualize the distal radius of the radius than the above access, however, this access also leads to the formation of scars in the wrist joint, which causes pain during joint development in the early postoperative period.

The technical result consists in the development of convenient surgical access, the configuration of which allows to increase the visibility of the wound, to avoid an incision distal to the articular line, thereby preventing the formation of painful scars and limiting flexion-extension of the hand in the early postoperative period.

Access, which can significantly increase the visibility of the surgical field, especially with multi-fragmented fractures of the medial part of the distal radius

The postoperative scar runs proximal to the center line of the wrist joint, which allows painless postoperative rehabilitation.

A method of surgical access to the distal radius of the radius during fractures, including a soft tissue incision: skin, subcutaneous tissue, fascia and muscles by soft tissue incision along the lateral radius of the radial bone along the anterior surface of the forearm, is disclosed, the incision is extended to the proximal palmar fold and gently rotated at an angle 90 ° and continue to the lateral edge of the tendon of the long palmar muscle. The skin flap is retracted towards the ulnar bone and is fixed with a single suture. The wound is widened by blunt dissection, exposing the abdomen of the long flexor of the thumb in the most proximal part of the wound and the square pronator in the distal part. The radial artery is diverted in the direction of the radius, while the tendons of the radial flexor of the wrist and the long flexor of the thumb are retracted in the direction of the ulna with the help of the Farabef hook. The square pronator is dissected in that part of it that is closest to the radius. Further, when suturing the wound, the square pronator is sutured to the brachioradialis muscle, which ensures the absence of cutting joints, reliable fixation of the square pronator. Next, fracture reposition and osteosynthesis with a plate are performed. If necessary, bone grafting is performed.

The invention is illustrated by illustrations.

In FIG. 1 shows surgical access to the distal radius of the bone for osteosynthesis in fractures.

In FIG. 2 and 3 are radiographs of the right wrist joint in direct projection.

In FIG. 4 and 5 are the radiographs of the right wrist joint in the direct and lateral projections after surgery.

In FIG. 6 is a photograph of the right wrist joint with a postoperative suture during surgery.

The invention is as follows.

In the position of the patient lying on his back, under the conditions of the existing external fixation apparatus, L-shaped access to the distal radius of the radius is performed in a reduced volume, performed by cutting soft tissues along the lateral edge of the radius on the front surface of the forearm, the extension is extended to the proximal palmar fold and smoothly rotate at an angle of 90 ° and continue to the lateral edge of the tendon of the long palmar muscle. The skin flap is retracted towards the ulnar bone and is fixed with a single suture. The wound is widened by blunt dissection, exposing the abdomen of the long flexor of the thumb in the proximal part of the access and the square pronator in the distal part. The radial artery is laterally retracted, while the tendons of the radial flexor of the wrist and the long flexor of the thumb are retracted in the direction of the ulna using the Farabeff hook. The square pronator is dissected in that part of it that is closest to the radius. Further, when the wound is sutured, the square pronator is sutured to the brachioradialis muscle, which ensures the absence of cutting joints, reliable fixation of the square pronator. Next, fracture reposition and osteosynthesis with a plate are performed. If necessary, bone grafting is performed. The wound is sutured in layers. Flexion and extension of the wrist joint in the postoperative period 24 hours after surgery begin.

Clinical example.

Patient K., 52 years old. An injury was received on 03.03.2016 as a result of a fall on the street with emphasis on the right upper limb. She was hospitalized in the traumatology department No. 1 of the MAU Central Clinical Hospital No. 24 with a diagnosis of Fracture of the distal epimetaphysis of the right radial bone, fracture of the styloid process of the right ulna (Fig. 2, Fig. 3).

On the sixth day after reducing swelling and resorption of subcutaneous hemorrhage, an operation was performed through the proposed L-shaped access (Fig. 1). Reposition of bone fragments was achieved, a bone defect was made up with a xenograft, fixation of a fracture by a plate, an additional diafixation of the bones of the forearm with knitting needles was performed (Fig. 5). The restoration of the anatomy of the wrist joint and the congruence of its articular surfaces, free movement in the joint, and discomfort during the implementation of the rehabilitation program is achieved. The view of the postoperative scar after surgery is shown in the photograph (Fig. 6).

Claims (1)

A method of surgical access to the distal radius during fractures, including cutting soft tissues of the skin, subcutaneous tissue, fascia and muscles by cutting soft tissues along the lateral radius of the radius on the front surface of the forearm, characterized in that the incision is extended to the proximal palmar fold and rotated smoothly at an angle of 90 ° and continue to the lateral edge of the tendon of the long palmar muscle, the skin flap is removed towards the ulnar bone and fixed with a single suture, the wound is enlarged by bluntly dissection, expose the abdomen of the long flexor of the thumb in the most proximal part of the wound and the square pronator in the distal part, the radial artery is removed in the direction of the radius, while the tendons of the radial flexor of the wrist and long flexor of the thumb are removed in the direction of the ulna with the help of the Farabef hook, the square pronator is dissected in that part which is closest to the radius; when the wound is sutured, the square pronator is sutured to the brachioradialis muscle, and then reposition w and fracture osteosynthesis plate.

Images