RU2629050C2 - Device for treatment of femoral bone comminuted fracture in children - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: device for treatment of comminuted fractures of the femoral bone in children contains distal and proximal supports, each made in the form of an arcuate plate with through slots arranged along the circle arc, the end sections of the plates have protrusions equipped with a single hole with a double-sided countersink, two holes with double-sided countersink are made in the end sections, threaded rods and additional threaded rods connecting these supports, intraosteal threaded bars with fixing nuts and a square geared washers, remote bar fixators formed as a beam with transverse teeth on the broad sides for the square washers teeth and threaded shank in the end face, and a through slot arranged along the beam axis, spherical nuts for fixation of the said threaded rods. The invention is characterized by an intermediate reponning support located between the distal and proximal supports and made in the form of an arcuate plate with end sections having protrusions directed towards the plate convexity, one hole with a double-sided countersink for additional threaded rods are made in each end section and end section protrusion, through slots for threaded shanks of remote bar fixators are arranged along the plate on the circle arc. In the end sections, slots for the remote brackets open towards the plate concavity are made and equipped with fixed spoke fixators in the form of hollow bars with an external thread and a collet clamp at the end.

EFFECT: possibility to treat children of any age and physical condition with comminuted fractures of the femoral bone while creating convenience for the patient in the postoperative period, subject to early verticalization of the victims and improvement of treatment outcomes.

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Description

The invention relates to medicine, namely to traumatology, orthopedics, and is intended for the treatment of fractures of long tubular bones.

Currently, for the treatment of fractures of long tubular bones, rod compression-distraction apparatuses of external fixation are most widely used. The number of intraosseous rods used in adults varies from 6 to 8. The use of a four-section external fixation apparatus was first proposed by G.A. Ilizarov [1] is the “classic” version of the arrangement of the external fixation device, whether it be spoke analogs or single-sided rod fixation devices. The four-sectional arrangement of the apparatus provides for the use of two supports - distal and proximal - as the “base” supports - they are used for distraction and elimination of the displacement of bone fragments along the length and axis (rotational), and two repairing ones - they are eliminated for the displacement of fragments in width.

For the treatment of comminuted fractures, a “device for the treatment of comminuted fractures of long tubular bones” is used [2]. The apparatus contains 2 base and 2 reponor supports (four in total) and is equipped with an insertable fifth reponor support, which is installed after eliminating the rotational displacement, as well as displacement along the length and width. The use of a reponier support, equipped in the end sections with slots with a double-sided countersink, makes it possible to install it on the rods strictly against the center of the bone fragment after x-ray control, for which pairs of spherical nuts are pre-screwed onto these rods. On the supporting support, fix the spoke fixator for the spoke with a thrust pad, which provides compression of the intermediate fragment (fragment) of the bone. However, the disadvantages of the method include the significant weight and dimensions of the apparatus, which negatively affects the early verticalization of the victim and the implementation of rehabilitation measures. Especially problematic is the use of this apparatus in preschool children and hypotrophic children.

The closest in its technical solution is an apparatus for treating injuries and diseases of long tubular bones in children [3]. Its distinguishing feature from other rod fixation devices is the use of only two supports, while the osteofixers (intraosseous rods) are fixed on external rod fixators made in the form of a bar. The device has lightness and compactness, is easily tolerated by affected children, but is not applicable for the treatment of comminuted fractures of the femur in children.

The essence of the invention lies in the combination of distinctive features sufficient to achieve the desired technical result, consisting in the possibility of treating children of any age and physical condition with comminuted fractures of the femur, against the background of creating convenience for the patient in the postoperative period, subject to early verticalization of the victims and improving treatment outcomes .

The apparatus for the treatment of comminuted fractures of the femur in children contains distal and proximal supports, each of which is made in the form of an arcuate plate with through cuts located along an arc of a circle, the end sections of the plates have protrusions equipped with one hole with a two-sided countersink, in the end sections made by two holes with a two-sided countersink, threaded rods and additional threaded rods connecting these supports, intraosseous threaded rods with fixing nuts and square w ybami with teeth remote sterzhnefiksatory formed as a rod with transverse teeth on the broad sides of the tine under the square washers and threaded shank in the end face and arranged along the axis of the beam through slot, spherical nut for fixing said threaded rods. Between the distal and proximal supports there is an intermediate reponent bearing made in the form of an arched plate with end sections having protrusions directed towards the convexity of the plate. In the end sections and protrusions of the end sections, one hole is made with a two-sided countersink for additional threaded rods. Through the plate along the arc of a circle there are through cuts under the shank of the remote stem fixators. In this case, in the end sections, slots open under the concavity of the plate are made for remote brackets with special fixators installed in them in the form of a hollow rod equipped with an external thread and a collet clamp at the end.

An intermediate, reponier bearing, made in the form of an arched plate with end sections having protrusions directed towards the convex side of the plate, in the end sections and protrusions of the end sections of which there is one hole with a double-sided countersink for additional threaded rods, designed to be installed strictly against the center bone fragment

Special fixators in the form of a hollow rod, equipped with an external thread and a collet clamp at the end, installed in the slots under the remote brackets in the end sections made in the intermediate support, are intended for installation in them of a releasing spoke with a thrust pad.

Placing the collet clamp on the end of the hollow rod provides fixation of the reponting spoke in the spoke.

Equipping the hollow rod with an external thread allows it to be fixed, with the help of nuts, in the remote bracket, which ensures reposition and movements of the bone fragment. When the intermediate fragment is located outside or inward from the femur, it is necessary to carry out both the tension of the reponenting needle and make pusher movements, i.e., to compress the intermediate fragment with the main fragments of the femur due to the persistent platform of the reponting needle.

A through slot along the plates, along an arc of a circle, provides the ability to install and move around the bone external stem fixators with intraosseous rods.

Additional threaded rods, with pre-installed pairs of spherical nuts in the middle part, are designed to install and fix an intermediate reponent support on them.

The device is illustrated in the illustrations, where:

in FIG. 1 shows a general view of the apparatus;

in FIG. 2 - support of the apparatus

in FIG. 3 - intermediate reponent bearing apparatus;

in FIG. 4 - a special fixator in the form of a hollow rod with a collet clamp at the end and a repositive spoke with a thrust pad installed in it.

In FIG. 5 is a diagram of a knitting needle with a thrust pad depending on the location of the intermediate fragment.

The device for the treatment of comminuted fractures of the femur in children contains two supports 1 (distal and proximal) in the form of arcuate plates, protrusions 2 and end sections 3 of which are equipped with holes with a two-sided countersink. Along the plates 1 are made located along an arc of a circle of the slot 4 (see Fig. 2). The supports of the apparatus 1 are interconnected by means of threaded rods 5 installed in the holes of the end sections 3 of the plates 1 and fixed in them by means of spherical nuts 6 (Fig. 1). Remote core clamps 7 in the form of a bar with transverse teeth on wide sides are installed in the slot 4 of the supports 1 and fixed in them with screws 8. A through groove (not shown) is made along the axis of the beam, the width of which corresponds to the diameter of the intraosseous threaded rods 9. Fixation of the rods 9 in the remote rod-retainer 7 carry nuts 10 with washers 11 of a square shape. The washers 11 have teeth on one of the working surfaces, corresponding in shape to the teeth on the surfaces of the external bracket 7. If necessary, move along the bone and fix the intraosseous rods 9 installed in the external rod clamps 7, produce nuts 10. Intermediate reponier support 12, equipped with open grooves 13 with a double-sided countersink (Fig. 3) in the end sections 3, with a special fixator 14, mounted on the said rods 5. The special fixator 14, in the form of a hollow rod 15, is equipped with an external thread and a collet clamp 16 on nce, is designed to install and fix the knitting needle with the stop 17, is installed in the slot 13 of the support 12 using the remote bracket 18 (Fig. 4), with the ability to move and fix the knitting needle 17 with nuts 19.

Additional threaded rods 20 are installed in the protrusions 2 after the complete reposition to prevent the development of varus deformity of the structure and fracture consolidation area.

The apparatus is used as follows.

Before the operation, in order to clarify the position of the fragments, an X-ray of the damaged limb is made in direct and lateral projection. On the skin, projection, mark the position of these fragments. Two intraosseous rods 9 are inserted into the proximal fragment from the lateral side, each at an angle of 90 ° to the bone fragment so that the upper intraosseous rod is located below the growth zone of the greater trochanter, and the lower one is above the line of bone fracture (Fig. 1). Accordingly, on the distal fragment, the intraosseous rods are positioned as follows: the upper one is below the fracture line, the lower one is above the growth zone of the femoral condyles. After distal and proximal pairs of intraosseous rods 9 are drawn, proximal and distal supports 1 are mounted on them, respectively, in the form of curved plates so that the threaded rods 5 connecting them are parallel to the direction of the bone fragments identified by the X-ray taken in lateral projection. Intraosseous rods 9 are installed in the longitudinal grooves (not shown) of the remote fixators 7, fixed with nuts 10, using square washers 11, placing the toothed surfaces of the washers 11 and the external fixators 7 towards and parallel to each other. Remote rod clamps 7 are fixed on the supports 1 with a screw 8. After installation, the distal and proximal supports are interconnected using threaded rods 5 and spherical nuts 6, using holes in the end sections 3 (Fig. 2) of the supports 1. On the threaded rods 5, before connecting the supports 1, screw on a pair of pre-installed spherical nuts 6, which are subsequently used to fix the intermediate reponier support 12.

The removal of fragments along the length is carried out by moving the spherical nuts 6 along the threaded rods 5 connecting the distal and proximal supports 1. The fragments are repositioned in the lateral projection by pre-installing the distal and proximal supports 1 on the rods 9, with respect to the axis of each bone fragment strictly on 90 degrees. When the parallelism of the arrangement of the threaded rods 5 connecting the distal and proximal supports 1 is achieved, the fragments are repositioned in the sagittal plane. The displacement of fragments in the anteroposterior projection is eliminated by moving (pulling or pulling) the intraosseous rods 9, working with the nuts 10. After the reposition is completed and the main fragments are corrected, X-ray inspection is performed with marks in the form of intramuscular needles to determine the position of the intermediate fragment of the bone segment (fragment) and its center. Moving the pairs of pre-installed spherical nuts 6 along the threaded rods 5 connecting the distal and proximal supports 1, they are installed opposite the intermediate fragment of the bone (fragment), where the intermediate reponent support 12 is placed, which is fixed opposite the intermediate fragment of the bone, taking into account the height of the extension bracket 18. Depending on the location of the intermediate fragment of the bone, outside or inside, from the central fragments of the femur, which are already in a repaired position, to the center of this fra With a drill, a needle with a thrust pad 17 is inserted. When the intermediate fragment is located outside the central fragments of the femur (Fig. 5), the spoke with the thrust pad 17 is bent so that the distance from the thrust pad to the end of the spoke is not more than the diameter of the femur. The end of the needle is bite at an acute angle to allow its introduction into the intermediate bone fragment. In the case of the location of the intermediate fragment inside from the central fragments of the femur, the spoke 17 with the thrust pad is carried out from the inside out. At any location of the intermediate fragment, the spoke 17 is fixed in the spoke 14 mounted on the intermediate reponent support 12. Such fixation is possible by installing the remote bracket 18 in the slot 4 of the intermediate reponent support 12 and using the special fixator 14 in the form of a hollow rod 15 equipped with thread and nuts 19, at the end of which a collet clamp 16 is made. With the outer location of the intermediate bone fragment, to create compression, the end of the spoke 17, placed in the spoke 14, is extended the movement of nuts 19 located on the hollow shaft 15.

In the case of the location of the intermediate bone fragment inside, relative to the central fragments of the femur, a spoke with a thrust pad 17 is carried out from the inside out, through the center of the intermediate bone fragment, and its sharpened end should go at the level of the extension bracket 18. The sharpened end of the spoke is placed in the spoke 14, mounted on the remote bracket 18. To create compression by moving the nuts 19, a hollow rod 15 equipped with a thread is moved backward relative to the remote bracket 18. After the repo is over In order to prevent varus deformation of the apparatus, additional threaded rods 20 are inserted into the holes of the protrusions of 2 plates 1. For compression and creation of the intermediate bone fragment, the compression created on the threaded rods 20 located lateral to the threaded rods 5, mounted in the holes of the end sections of 3 plates 1, stops the forces aimed at the formation of the varus deformation of the apparatus.

Clinical example

The case of the external location of the intermediate bone fragment relative to the central fragments of the femur.

Patient K., born in 2002, was admitted to the Department of Pediatric Traumatology of the Republic of Kazakhstan on 01.21.2015 with a diagnosis of Closed comminuted fracture of the middle third of the left femur with displacement. After preoperative preparation and production of general anesthesia, the patient was laid on an orthopedic table on which the primary reposition of the fragments was performed (usually only the displacement along the length of the fragments is eliminated). Radiography of a limb segment in two projections with “marks” was performed to clarify the location of the fracture line and determine the displacement of the fragments. Distal and proximal base rods were drawn into distal and proximal bone fragments. At a distance of 1.5-2 cm from the fracture line, repairing intraosseous rods were made, depending on the fracture line and the nature of the displacement of the fragments. The reposition was carried out by repairing intraosseous rods according to the above method. From the lateral side, two intraosseous rods were introduced into the proximal fragment, each at an angle of 90 ° to the bone fragment so that the upper intraosseous rod was located below the growth zone of the greater trochanter, and the lower - above the line of bone fracture. Accordingly, on the distal fragment, the intraosseous rods are located as follows: the upper one is below the fracture line, the lower one is above the growth zone of the femoral condyles. After distal and proximal pairs of intraosseous rods were carried out, proximal and distal supports in the form of curved plates were mounted on them, so that the threaded rods connecting them were parallel to the direction of the bone fragments determined by the radiograph made in the lateral projection. Intraosseous rods were installed in the longitudinal grooves of the external stem fixators, fixed with nuts, using square washers, placing the toothed surfaces of the washers and external stem fixators towards and parallel to each other. Remote core fixators were fixed on the plates with a screw. After installation, the distal and proximal supports were interconnected using threaded rods and spherical nuts, using holes in the end sections of the plates. An additional pair of spherical nuts was screwed onto the threaded rods, placing them in the middle part of the rods, for mounting an intermediate reponier support.

The removal of fragments along the length was made by moving the spherical nuts along the threaded rods connecting the distal and proximal supports. The reposition of fragments in the lateral projection was made by pre-installing the distal and proximal supports on the rods, in relation to the axis of each bone fragment strictly 90 degrees. Upon reaching parallelism in the arrangement of the threaded rods connecting the distal and proximal supports, the fragments were repositioned in the sagittal plane. The displacement of fragments in the anteroposterior projection was eliminated by moving (pulling or pulling) the intraosseous rods by working with the nuts that fix the rods in the fixation rod.

After the reposition was completed and the main fragments were corrected, X-ray control was performed with labels in the form of intramuscular needles to determine the position of the intermediate fragment of the bone segment (fragment) and its center. Moving the nuts along the threaded rods connecting the distal and proximal supports, they were installed opposite the intermediate fragment of the bone (fragment), the intermediate repairing support was installed, it was fixed opposite the intermediate fragment of the bone, taking into account the height of the extension bracket. In the intermediate fragment, outside the central fragments of the femur, a spoke with a persistent pad was introduced. This needle was previously bitten so that the distance from the thrust pad to the end of the spoke was no more than the diameter of the femur; the end of the spoke was bitten at an acute angle to allow its insertion into the intermediate bone fragment. A spoke with a thrust pad was fixed in a spoke mounted on an intermediate repositioning support. The end of the spoke, located in the hollow shaft of the spoke, was clamped with a collet clamp. Pulling the hollow rod out of the extension bracket by moving the nuts, they created compression of the bone fragment. After the end of reposition and fixation of the intermediate bone fragment, for the period of stabilization, for the prevention of varus deformation of the apparatus, additional threaded rods were installed in the holes of the protrusions of the plates. The limb load is allowed for 4 days. Examination of the patient a month after exercise. The patient serves himself, moves with reliance on the operated limb, without additional devices. Dismantling the device made 3 months after application. The patient was prescribed physiomechanical procedures.

Information sources

1. A set of compression and distraction apparatus G.A. Ilizarova for the upper limb, lower leg, thigh. Passport. A.101.00.00.00. P.S. (Instruction manual and technical description). - Gudermes. - 1991.

2. RF patent No. 2271168, А61В, 17/66, BI No. 7. 10.032005.

3. RF patent No. 2454963, А61В, 17/66, BI No. 19, 10.07, 2012.

Claims (1)

The apparatus for the treatment of comminuted fractures of the femur in children, containing distal and proximal supports, each of which is made in the form of an arched plate with through slots located along an arc of a circle, the end sections of the plates have protrusions equipped with one hole with a two-sided countersink, in the end sections it is made two holes with a double countersink, threaded rods and additional threaded rods connecting these supports, intraosseous threaded rods with locking nuts and square washers with teeth, remote rod clamps made in the form of a bar with transverse teeth on wide sides under the teeth of square washers and a threaded shank at the end and a through groove located along the axis of the bar, spherical nuts for fixing the said threaded rods, characterized in that between the distal and proximal the supports are an intermediate repairing support made in the form of an arcuate plate with end sections having protrusions directed towards the convexity of the plate in the end sections and the protrusion groove of the end sections made one hole with a two-sided countersink for additional threaded rods, along the plate along the arc of a circle there are through cuts under the shank of the remote stem fixators, while in the end sections there are openings towards the concave side of the slot for remote brackets with special fixators installed in them in the form of hollow rod equipped with external thread and collet clamp at the end.

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