RU2698088C1 - Method of treating diaphysis fractures of long tubular bones - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to traumatology and orthopedics, and can be used for treating fractures of diaphysis of long tubular bones. Method involves conducting wires with thrust areas until tight contact of stops to cortical surfaces of fragments taking into account location of neurovascular formations, fixing and tensioning them in semi-rings of external fixation apparatus, reposition and retention of fragments until their adhesion. Three wires are delivered through each fragment in accordance with fig. 1. At that, two pins with thrust pads are arranged parafracturally parallel to each other in one plane with their stops arranged mutually opposite.

EFFECT: method provides a high degree of elimination of displacement of fragments along a fracture line and rigid fixation until their adhesion, reduces the frequency of developing a false joint due to the possibility of early load on a limb in the postoperative period.

1 cl, 1 dwg, 1 ex

Description

The invention relates to medicine, namely to traumatology and orthopedics and disaster medicine and can be used to treat diaphysis fractures of long tubular bones.

A known method for the treatment of fractures of the diaphysis of long tubular bones, including holding knitting needles with thrust pads until the abutments contact tightly against the cortical surfaces of the fragments, taking into account the location of the neurovascular formations, fixing and tensioning them in the semicircles of the external fixation apparatus, repositioning and holding the fragments to their fusion, (A .Z Dyusupov et al. “A method for treating diaphysis fractures of long tubular bones.” Preliminary patent of the Ministry of Justice of the Republic of Kazakhstan No. 8587, published March 15, 2000, bull. No. 3).

Its disadvantages are that through the peripheral and central fragments of the long tubular bones, conduct spokes with thrust pads, placing their thrust pads in mutually opposite directions of relations of each other. In this case, only one of these spokes is located parafractually, along the lengths of the peripheral fragment, and the second spoke on the lengths of the central fragment, is also close to the bone fracture line, and the others are closer to the articular ends of the peripheral and central bone fragments. Such arrangement of the spokes does not provide sufficient rigidity for holding fragments along the fracture line until they are fused, since the ends of both the peripheral and central fragments retain mobility in each other's relations along the fracture line along the spokes located parafracturely, in the opposite direction where there are no thrust pads in these spokes, during a functional load in the postoperative period with support or support, for example, during isometric contraction of muscles at rest for early development of movements in the joint located above and below the fracture of the diaphysis of the long tubular bones of the limbs for the prevention of contracture in the joints and thromboembolic complications from the veins of the limbs. In this regard, along the line of contact of fragments macro- or

micromobility is a destructive forming bone regenerate, and the risk of complication increases, in the form of an increase in the terms of coalescence of fragments, the development of false joints and pain syndromes that reduce the quality of treatment and life.

In addition, with the mobility of bone fragments and their integumentary tissues along the spokes, part of the spokes located in the external environment is immersed in the thickness of the integumentary tissues, with the development of soft tissue inflammation from 8.6 to 41.8% of cases, with the development of spoke osteomyelitis in 4.8- 15% of patients worsening treatment outcomes and leading many to disability. (G.A. Ilizarov 1982: A.A. Dyusupov 2007)

The above-described disadvantages were discovered and registered in clinical practice by employees of the BSMP TO Semey RK, using the method for treating diaphysis fractures of long tubular bones, according to the description of the prototype, since 1998.

The objective of the invention is to improve the treatment of fractures of the diaphysis of long tubular bones.

Technical effect - a high degree of elimination of all types of displacement of fragments along the line of their fracture and their rigid fixation to fusion is achieved, thereby reducing the time of fusion of the fragments, reducing the frequency of development of the false joint and improving the quality of life of patients, due to the possibility of an early load on the limb in the postoperative period resting on crutches, without the risk of possible mobility of the end surfaces of the fragments along the fracture lines of the bone.

In Fig 1, shows the implementation of a method of treating fractures of the diaphysis of long tubular bones, where:

1, 2 - fragments;

3, 4, 5, 7, 8, 9 - spokes with thrust pads;

6 - persistent pad of knitting needles;

10 - line fracture of the tibia of the leg.

The method is as follows.

A method for treating diaphysis fractures of long tubular bones involves holding knitting needles with abutment sites until the abutment contacts tightly against the cortical surfaces of the fragments, taking into account the location of the neurovascular formations, fixing and tensioning them in the semicircles of the external fixation apparatus, repositioning and holding the fragments to their fusion, and through each of the fragments is carried out in three spokes in accordance with figure 1, moreover, two spokes with thrust pads conduct a pair of fractions parallel to each other in the same plane with their stops mutually opposite.

Under cerebrospinal anesthesia, on the TsUG apparatus, reposition of fragments 1, 2 is carried out, possibly eliminating their displacement along the length, width and angle. Further, in one plane, taking into account the location of large vessels and nerves, bypassing them, spokes 3, 4 and 5 with thrust pads 6 are passed through the central fragment 1 and 7, 8, 9 through the length of the injured segment of the diaphysis of the long tubular bone

peripheral fragment 2, parallel to each other, alternating the location of the thrust pads of the spokes in the opposite direction, placing them on the side of a typical displacement (due to the pulling of bone fragments after the fracture) of the fragments.

In this case, the knitting needles 5 and 7 are passed through the fragments parafractically, close to the fracture line 10 of the diaphysis of the bone in the opposite direction on the side of the typical displacement of the fragility to the stop of the abutment sites to the cortical layer of the bone, and the needles 4 and 8 are parallel to the needles 5 and 7, respectively in the opposite direction, to the stop of their thrust sites to the cortical layer of fragments from the opposite side in relation to the thrust sites of the previous spokes 5 and 7.

Such a parafractural, paired arrangement of thrust pads of knitting needles 4, 5 and 7, 8 provides metered, high-precision displacements of the peripheral 2 and central 1 fragments in relation to each other by pulling along the axis of the needles 4, 5 and 7, 8 for their sharp ends along the plane of their holding.

Elimination of the displacement of fragments in another plane perpendicular to the original is achieved by moving the spokes in a parallel direction to its axis in one or the other direction, depending on the type of displacement of the fragments.

In addition, the fixing capabilities of such knitting needles are 2 times higher compared to the known analogue given above, for holding fragments 1-2 along the line of fracture 10 of the bone after their reposition, thereby excluding micromotion of the fragments, which helps to extend the terms of fusion, development of the false joint or suppuration of the wound , there is the possibility of an early load on the injured limb during their treatment in the postoperative period.

Spokes 3, 4, 5 and 7, 8, 9 with tension are mounted to the rings of the apparatus G.A. Ilizarova (not shown), at the same time performing reposition of fragments under the control of X-ray images, by eliminating the residual displacement of the fragments, after their primary reposition on the ZUG apparatus.

Thus, a high degree of elimination of all types of displacement of fragments along the fracture line is achieved, since conducting two-spokes paraffractically with thrust pads located in mutually opposite directions in the same plane, close, parallel to each other, allows a metered displacement of the ends of the fragments along the line of their fracture in relations with each other in any direction, until complete, perfect juxtaposition of fragments, during repositions, eliminating all types of their displacement, under the control of the image intensifier screen (electron-optical conversion specimen) or x-ray images and tight fixation to fusion, the terms of fusion of fragments are reduced, the frequency of development of the pseudoarthrosis is reduced and the quality of life of patients is improved, due to the possibility of early functional load on the limb in the postoperative period, relying on crutches, from the first days of the postoperative period.

Example: Patient A., was admitted to the trauma unit of the BSMP of Semey city on 10.04.2015 with a diagnosis: “Closed comminuted fracture of the middle third of both bones of the right tibia with displacement of fragments”. After appropriate preparation, 04/14/2015, produced

transosseous osteosynthesis of bone fragments of the right tibia according to the method as described above. The condition of the fragments on the control radiographs is good. 04/17/15, the patient was discharged for outpatient treatment. From the first days after the operation, he was able to walk on crutches, with a moderate load on his injured leg.

Bone fusion occurred after 3 months. The device is removed from the limb.

Conducted exercise therapy. Disability restored 3.5 months after the injury. Discharged for easy physical labor. No inflammatory complications from the wounds around the spokes were observed.

Thus, the method allows to reduce the morbidity of operative administration of osteosynthesis and the number of purulent-inflammatory complications from wounds around the spokes, provides a high degree of reposition of fragments, improves the quality of life of patients in the postoperative period and reduces the time of fusion of fragments. This improves the treatment of fractures of the diaphysis of long tubular bones.

Claims (1)

A method of treating diaphysis fractures of long tubular bones, including holding knitting needles with thrust pads until the abutments contact tightly against the cortical surfaces of the fragments, taking into account the location of the neurovascular formations, fixing and tensioning them in the semicircles of the external fixation apparatus, reposition and holding of the fragments to their fusion, characterized in that through each of the fragments spend three spokes in accordance with FIG. 1, and two knitting needles with thrust pads are paraffractically parallel to each other in the same plane, placing their stops mutually opposite.

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