RU2628650C1 - Method for surgical treatment of distal shoulder bone fractures in children and adolescents - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: 2 spokes are directed in closed "cross to the cross" position and which are fixed in the external fixation apparatus (EFA) under general anesthesia, on the outer-lateral surface, through the distal part of the deformed humerus. In the diaphyseal section of the humerus, along the outer-lateral surface, 2 rods are inserted, which are fixed in the EFA. Transverse osteotomy of the humerus is carried out at the apex of deformation with one-stage correction of the distal humerus deformation in the EFA.

EFFECT: method allows to reduce humerus trauma during the operation, to reduce the time of both surgical intervention and anesthesia, to provide an opportunity for early rehabilitation and prevention of contracture development.

3 dwg

Description

The invention relates to medicine, in particular to traumatology and orthopedics, and can be used in the treatment of patients with varus or valgus deformity of the distal humerus in children and adolescents.

There is a method of treating varus deformities of the elbow joint in children, described in the patent of the Russian Federation No. 1570716, providing for an incision along the outer surface of the lower part of the humerus. Soft tissue is separated by instruments and approaches the lower metaphysis of the humerus. At this level, the periosteum is exfoliated. A wedge is cut out with a chisel from the outside of the metaphysis with the base directed outward. The size of the excised wedge is determined by contourograms before surgery. A groove is made in the peripheral part of the distal fragment. After removing the wedge, the varus deformity of the elbow joint is eliminated and the central fragment is moved along the groove outward until it assumes an average position relative to the peripheral fragment. As a result of this, the steps from the outside and the inside are subsequently filled with bone marrow, and clinically there is no cosmetic defect, no deformation. Fragments are fixed with Kirschner spokes. The groove in the peripheral fragment guides the doctor when comparing fragments, and also allows you to reject the fragments in the sagittal plane, if necessary, in order to create the correct epimetafia angle, which is normally 30 degrees. Immobilization is carried out by the rear plaster cast.

The disadvantages of this method of treatment are significant trauma to the bone and soft tissues when knocking out a wedge from the humerus. It is technically difficult to make a groove in the outer part of the distal fragment and insert a proximal fragment into it with restoration of the axis of the limb. Moving along the groove of the central fragment to the middle position, relative to the peripheral fragment, increases the time of both surgical treatment and anesthesia. Fixation of the fragments with Kirschner knitting needles is not rigid enough, which increases the treatment time, and immobilization with the back plaster cast results in the development of contracture, which also leads to a longer rehabilitation period and, accordingly, increases the treatment time.

The purpose of the invention is the correction of deformation of the distal humerus by conducting stable osteosynthesis of osteotomy in the distal humerus.

The invention consists in the combination of essential features necessary to achieve the desired technical result, which consists in reducing trauma to the humerus during the operation, reducing the time of both surgical intervention and anesthesia, the possibility of early rehabilitation and prevention of contracture.

The essence of the method of surgical treatment of patients with varus or valgus deformity of the distal humerus in children and adolescents includes osteotomy of the humerus. On the outer lateral surface, through the distal part of the deformed humerus, carry out a closed "cross to cross" holding 2 spokes, which are fixed in the apparatus of external fixation (AVF). In the diaphyseal section of the humerus, along the outer-lateral surface, 2 rods are inserted, which are fixed in the AFF. Transverse osteotomy of the humerus at the top of the deformity and simultaneous correction of the deformation of the distal humerus in the AFF are performed.

Closed "cross to cross" holding 2 spokes on the outer lateral surface, through the condyles of the deformed humerus, with their fixation in the AFF, provides correction and fixation of the distal fragment of the humerus after osteotomy.

Holding 2 rods in the diaphyseal section of the humerus along the outer lateral surface provides rigid fixation of the proximal humerus in the annular support.

Transverse osteotomy of the humerus at the top of the deformity allows you to simultaneously adjust the distal shoulder in AVF.

Simultaneous correction of the distal shoulder in AVF ensures filling of the formed wedge-shaped bone defect with bone regenerate due to restoration of the periosteum integrity by suturing, without the formation of any bone defect.

Closed application of the Ilizarov apparatus without fixation of the elbow joint, and stable osteosynthesis of fragments of the humerus, with simultaneous fixation in a corrected position, allows for early rehabilitation with the prevention of contracture.

The method is illustrated in the illustrations, where:

In FIG. 1 - shows a deformed humerus;

In FIG. 2. - a deformed humerus with an external fixation device;

In FIG. 3 - the humerus after osteotomy and simultaneous correction in AVF.

The method is as follows.

Under general anesthesia, under aseptic conditions, a closed cross-to-cross knitting is performed in the position of the deformed distal humerus through the condyles of the humerus, and they are fixed in the semicircular support of the external fixation apparatus (AVF). Conducted on the outer-lateral surface of the diaphysis of the humerus 2 Shantsa rods are also fixed in the semi-annular supports of the AVF. An incision is made along the outer lateral surface of the shoulder in the lower third, the periosteum is skeletonized, a transverse osteotomy is made at the top of the deformation of the humerus, and the periosteum and soft tissues are sutured in layers. At the same time, the distal shoulder in AVF is corrected.

Claims (1)

A method for surgical treatment of patients with varus or valgus deformity of the distal humerus in children and adolescents, including osteotomy of the humerus, characterized in that on the external lateral surface, through the distal part of the deformed humerus, a closed cross-to-cross conduct of 2 the spokes that are fixed in the external fixation apparatus (AVF), 2 rods are inserted into the diaphysis of the humerus along the outer lateral surface, which are fixed in the AVF, transverse osteotomy of the brachial braid ty at the top of the deformity and simultaneous correction of the deformation of the distal humerus in AVF.

Images