RU2637110C1 - Method of elastic-stressed osteosynthesis of distal segment of humerus - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: posterior access to the middle and distal humerus is performed. Open reduction of fragments is conducted. 2 Kirschner's wires with diameter of 2 mm are drilled to a depth of 80-100 mm through the tops of the external and internal epicondyle of the humerus. Wires are flexed so that the intramedullary parts form a crosshair, and external parts bend, surrounding cubital fossa on both sides, but not blocking it, the place wire penetration in cortical layer becomes a place of inflection. On the external part of wires, a disk with side slits for the wires is put on, on the back of the humerus on the 3-5 cm above the cubital fossa the hole is drilled, the disk with the fixed wires is pressed against the surface of the bone and is attached by cortical screw.

EFFECT: method, due to the provision of sufficient compression, allows to reduce the period of immobilization of the limb.

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Description

The invention relates to medicine, namely to traumatology, and can be used in the surgical treatment of fractures of the distal humerus.

There are many ways to treat distal humerus fractures. Shuttles A.M. et al. (Chelnokov AM, Bazhenov A.V., Korzh O.E. Closed antegrade intramedullary osteosynthesis of fractures of the distal third of the humerus. Bulletin of Traumatology and Orthopedics of the Urals. 2009; (1): 49-53) rod fixation was performed after closed reposition . Using this method, damage to the cartilage of the shoulder head, trauma to the structures of the rotational cuff and tendon of the long biceps head, with closed reposition of fragments due to traction or pinching between the fragments, iatrogenic damage to the radial nerve is possible. Jojua A.V. (Jojua A.V. Retrograde osteosynthesis of the femur and humerus. Bulletin of the N.I. Pirogov National Medical and Surgical Center. 2008; (2): 25-27) used a retrograde lockable pin. The disadvantages of the method are associated with significant damage to the capsule of the elbow joint, the risk of iatrogenic condyle and supracondylar fractures with the introduction of a rigid shaft in violation of the operation technique. Idoine J.D. at al. (Idoine JD, French BG, Opalek JM, DeMott L. Plating of acute humeral diaphyseal fractures through an anterior approach in multiple trauma patients // J. Orthop. Trauma. - 2012 .-- Vol. 26 (1), January - P. 9-18) apply bone osteosynthesis. Among the shortcomings: a large incision with exposure of the fracture zone, extensive soft tissue damage, periosteum trauma, risk of infection.

Close to our proposed method is fixation according to the method described by Heim D. et al. (Heim D., Herkert F., Hess P., Regazzoni P. Surgical treatment of humeral shaft fractures - the Basel experience // J. Trauma. - 1993. - Aug, 35 (2). - P. 226-232) . The disadvantages of this method include: violation of periosteal circulation, leading to the risk of nonunion fracture; the risk of repeated fractures after removal of the fixative; risk of iatrogenic damage to the neurovascular bundle.

The technical result of the invention is the creation of an optimal method of elastically stressed osteosynthesis of fractures of the distal humerus.

The technical result is achieved by the fact that 2 Kirschner spokes with a diameter of 2 mm are drilled to a depth of 80-100 mm through the tips of the external and internal epicondyles of the humerus, then the needles are bent so that the intramedullary parts form a crosshair, and the outer parts are bent, surrounding the ulnar fossa on both sides but without blocking it, the place of penetration of the spoke into the cortical layer becomes the place of inflection; after that, a washer with lateral slots for the knitting needles is put on the outer part of the knitting needles, a hole is drilled on the back surface of the humerus to the thickness of two cortical layers, the washer with fixed knitting needles is pressed to the bone surface and fixed with a cortical screw.

The invention is illustrated in the drawing.

The drawing shows a supracondylar fracture of the humerus, fixed during operation by a spoke-screw system. 1 - humerus, 2 - Kirchner spokes, 3 - ulnar fossa, 4 - washer, 5 - screw.

The method is as follows.

After rear access to the middle and distal parts of the humerus (1), an open reposition of fragments is performed. The tops of the external and internal epicondyles of the humerus drill into a depth of 80-100 mm 2 Kirschner spokes (2) with a diameter of 2 mm. The needles are bent so that the intramedullary parts form a crosshair, and the outer parts are bent, surrounding the ulnar fossa (3) on both sides, but not overlapping it. The place of inflection becomes the place of penetration of the spoke into the cortical layer. The outer ends of the spokes are threaded into the washer (4), with two lateral longitudinal slots for the spokes. On the back surface of the humerus 3-5 mm proximal to the ulnar fossa, a hole with a diameter of 3.5 mm is drilled to the thickness of two cortical layers. The washer pressed to the surface of the bone fixes the spokes located in the slots. A screw (5) with a diameter of 4.5 mm is screwed through the hole in the washer until the screw head and spokes touch. Then the free ends of the needles bite. The screw is tightened, spreading the spokes located in the slots of the washers, thus creating the necessary compression. The wound is sutured in layers. Apply a kerchief immobilization (up to 3 weeks).

Full load is allowed after 3 months.

Clinical example

Patient A. was admitted to the trauma department of the City Clinical Hospital No. 4 of Kursk on 06/18/2016.

Upon receipt of a complaint of intense pain in the left elbow, the inability to move in the left elbow joint.

Diagnosis: closed supracondylar fracture of the left humerus with displacement.

The operation "open reposition of fragments of the humerus. Osteosynthesis of an elastically strained spoke-screw system."

Operation progress

After rear access to the middle and distal parts of the humerus, an open reposition of fragments is performed. The tops of the external and internal epicondyles of the humerus drill into a depth of 80-100 mm 2 Kirschner spokes with a diameter of 2 mm. The needles are bent so that the intramedullary parts form a crosshair, and the outer parts are bent, surrounding the ulnar fossa on both sides, but not overlapping it. The place of inflection becomes the place of penetration of the spoke into the cortical layer. The outer ends of the spokes are threaded into the washer, with two lateral longitudinal slots for the spokes. On the back surface of the humerus 3-5 mm proximal to the ulnar fossa, a hole with a diameter of 3.5 mm is drilled to the thickness of two cortical layers. The washer pressed to the surface of the bone fixes the spokes located in the slots. A screw with a diameter of 4.5 mm is screwed through the hole in the washer until the screw head and spokes touch. Then the free ends of the needles bite. The screw is screwed, spreading the spokes in the slots of the washers. The wound is sutured in layers.

The postoperative period without features. Immobilization stopped 3 weeks after surgery.

Analysis of patient observation indicates a good result: the joint is stable, pain is not observed, flexion in the elbow joint is 60 °, extension is 170 °

Thus, the method provides sufficient compression does not violate periosteal trophism and provides a reduction in the immobilization time of the limb.

Claims (1)

The method of elastically stressed osteosynthesis of the distal humerus, including rear access to the middle and distal parts of the humerus, conducting an open reposition of fragments, characterized in that 2 Kirschner spokes with a diameter of 2 mm are drilled to a depth of 80-100 mm through the tops of the external and internal epicondyle the humerus, then the needles are bent so that the intramedullary parts form a crosshair, and the outer parts are bent, surrounding the ulnar fossa on both sides, but not blocking it, the place where the needle penetrates into the vertical layer becomes a place of inflection; after that, a washer with lateral slots for the knitting needles is put on the outer part of the knitting needles, a hole is drilled on the back surface of the humerus to the thickness of two cortical layers, the washer with fixed knitting needles is pressed to the bone surface and fixed with a cortical screw.

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