RU2701215C1 - Method of treating comminuted intraarticular compression fractures of heel bone with displacement of fragments - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to traumatology and orthopedics, and can be used for treating comminuted intraarticular compression fractures of heel bone with displacement of fragments. Pin is inserted into the heel bone on the calcaneal tuber. Bone fragments are repositioned; the pin is delivered into the calcaneal body below the compression surface of the articular surface in the sagittal plane from the calcaneal tuber, with forming a single fragment of the heel bone. Two overlapping K-wires are delivered along the upper edge of the previously drawn pin, in the frontal plane through the calcaneal tuber and through the inferior third of the shin bone such that the two pins pass through the fragments of the articular surface and heel body.

EFFECT: method provides recovery of longitudinal and transverse arches and foot function, faster consolidation of bone fractures and, as a result, prevention of posttraumatic complications and improved clinical results of heel bone fractures due to strong fixation of bone fragments.

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Description

The invention relates to medicine, namely to traumatology and orthopedics, and can be used in the treatment of comminuted intraarticular compression fractures with displacement of fragments.

Calcaneal injuries account for about 4% of all skeletal bone fractures. Among them, intraarticular fractures predominate (74.7-90.4%). The severity of the injury, the small size of bone fragments, the prevalence of intraarticular fractures create great difficulties in the treatment of these types of fractures. Treatment of patients with comminuted intraarticular compression fractures of the calcaneus, in which there is destruction of the subtalar joint (60% -75% of cases), especially with the appearance of post-traumatic edema, traumatic hematoma, pain, do not satisfy surgeon-trauma surgeons and continues to be one of the urgent problems modern medicine. At present, a significant number of methods for treating this pathology have been proposed, which indicates the absence of a unified approach in assessing their clinical effectiveness (IO Pankov, AM Khan. Calcaneal fractures // Kazan Medical Journal. 2002. No. 4. P. 298- 299; N.A. Koryshkov, S.M. Platonov, Treatment of calcaneus fractures using a device for reposition of fragments // Bulletin of Traumatology and Orthopedics named after N.N. Priorov, 2005; PM Tikhilov, N.F. Fomin, N .A. Koryshkov. Modern aspects of the treatment of the consequences of bone fractures of the posterior la of the foot // Traumatology and Orthopedics of Russia. 2009. No. 2. P. 144-149; A. A. Podsonny, A. V. Bondarenko. Treatment of calcaneus fractures in isolated injuries and polytrauma // Politrauma. 2014. No. 2. P. 6-14; AR Ataev, RT Osmanov. A new method for minimally invasive reduction and fixation of calcaneus fractures // Herald of the DSEA. 2016. No. 2. P. 63-66.

Analogs of the invention

The following methods of treating calcaneus fractures and devices for their implementation are known: Shved S.I., Sysenko Yu.M., Shilov V.G. A method for the treatment of intraarticular compression calcaneal fractures. The genius of orthopedics. - 1997. - No. 4. - S. 51-53; Gafarov H.Z., Pankov I.O., Khan A.M. (Patent for invention RU 2178996, 2002) “A method for the treatment of comminuted intraarticular calcaneus fractures”; Valiakhmetov R.T., Ibragimov Y.Kh. (RU patent for the invention No. 2321396) "Method for the surgical treatment of calcaneus fractures with a spoke-rod apparatus"; Krivoshapko S.V., Krivoshapko G.M., Akhtyamov I.F., Ivanov P.V. (RU patent for the invention No. 2297802) "A method for the treatment of comminuted intraarticular fractures of the calcaneus"; Badakva V.V. (Patent for invention RU No. 2391931) “A method for the treatment of calcaneus fractures and a compression-distraction apparatus for its implementation”; Magaramov M.A., Osmanov R.T. "A method for the treatment of calcaneus fractures" patent No. 2200496. March 20, 2003

Criticism of analogues

The disadvantages of the above methods are:

Known methods of treatment do not fully ensure reposition of the fracture with the elimination of all types of displacements, as well as restoration of the shape of the foot, which leads to the development of flat feet and post-traumatic arthrosis of the joints of the root of the foot, create the prerequisite for stretching the subtalar joint. These methods limit the function of the ankle joint, which leads to distension, reflex pain and spasms of the vessels of the distal extremities, which increases the time of consolidation of the calcaneus.

Prototype

Closest to the invention is a method for the treatment of compression calcaneal fractures with displacement of fragments, proposed by Magaramov M.A., Osmanov R.T. "A method for the treatment of calcaneus fractures" patent No. 2200496. dated March 20, 2003. The method is used as follows: in the lower third of the lower leg two Kirschner cross knitting needles are held, which are fixed on two U-shaped staples connected by themselves. The next spoke is held through the distal third of the metatarsal bones, which is also fixed to the U-shaped bracket. The brackets are connected to each other rigidly by means of threaded rods connected to remote flags. The fourth bracket is installed in the heel region and is fixed to the upper bracket with two threaded rods. Mobile clamping devices are installed on this bracket from the outside and inside, and two rods are held along them. The rods are fixed on a rectangular plate with nuts. The Bellera angle is adjusted using two screws that move the plate in the corresponding direction, as well as traction along the threaded rods.

Prototype criticism

- Insufficient reposition, which does not fully ensure reposition of the fracture with the elimination of all types of displacements, the inability to reposition fractures of type 73c according to the AO classification.

- Long-term immobilization leads to the development of flat feet and post-traumatic arthrosis of the joints of the root of the foot, eliminating all types of comminuted displacements and their fixation.

The purpose of the invention

The goal is to develop a more effective method for improving treatment results by more accurate reduction in comminuted intraarticular and compression calcaneal fractures with displacement of fragments, to create a strong fixation between them and thereby avoid post-traumatic deformation of the foot, pain syndrome and post-traumatic edema, to begin development in the early term functions of the lower limb and full rehabilitation, which significantly accelerates the time of consolidation.

SUMMARY OF THE INVENTION

The essence of the proposed method (see Fig. 1) is that the awl is introduced into the calcaneus from the calcaneal tuber (pos. 1), and the bone fragments are repositioned, and then into the calcaneal body below the compression zone of the articular surface in the sagittal plane from the calcaneal tuber, hold the knitting needle (pos. 2), forming a single fragment of the calcaneus. On the upper edge of a previously held knitting needle in the frontal plane, two more knitting needles are passed through the calcaneal tubercle - through the lower third of the tibia (items 3, 4). These two knitting needles (items 3, 4) are attached to the brackets for fixing the knitting needles with bolts and washers with slots connected by two threaded rods between the brackets. Perform a temporary fixation of the fracture with the needles brought from the calcaneal tuber to the body of the calcaneus in the sagittal plane (pos. 1, pos. 2). In this case, two knitting needles (pos. 3, 4) pass through the fragments of the articular surface and the body of the calcaneus (pos. 3, 4), two more (pos. 1, 2) pass through the calcaneal tuber and the body of the calcaneus (pos. 1, 2,. The needles are held on both sides of the Achilles tendon outside the point of attachment to the calcaneus and calcaneus bursa.

Examples of specific performance of the method

Example 1. Patient B., 54 years old, was admitted to the RTC of the Ministry of Health of the Republic of Dagestan in an emergency, 1 hour after the injury (falling from a height of about 3 meters to his feet). On examination, puffiness in the area of the left calcaneus is determined, the arch of the left foot is flattened, there is extensive subcutaneous hemorrhage on the plantar surface. On palpation and axial load of the left calcaneus, marked pain was noted. Movement in the left talocaneal joint due to pain is sharply limited. Marked expansion and valgus deformity in the left calcaneal region. On the radiograph was determined comminuted intraarticular fracture of the left calcaneus with a mixture of fragments, Beler angle minus 15 degrees. After the examination, the diagnosis was made: Closed comminuted intraarticular fracture of the left calcaneus with a mixture of fragments. Under conduction anesthesia, the reposition was performed by the proposed method: an awl was inserted into the calcaneus from the calcaneal tuber (pos. 1), and bone fragments were repositioned, after which a spoke was inserted into the calcaneal bone body below the compression zone of the articular surface in the sagittal plane from the calcaneal tuber . 2), forming a single fragment of the calcaneus. On the upper edge of a previously held knitting needle in the frontal plane, two more knitting needles are passed through the calcaneal tubercle - through the lower third of the tibia (items 3, 4). These two knitting needles (items 3, 4) are attached to the brackets for fixing the knitting needles with bolts and washers with slots connected by two threaded rods between the brackets. Perform a temporary fixation of the fracture with the needles brought from the calcaneal tuber to the body of the calcaneus in the sagittal plane (pos. 1, pos. 2). In this case, two knitting needles (pos. 3, 4) pass through the fragments of the articular surface and the body of the calcaneus (pos. 3, 4), two more (pos. 1, 2) pass through the calcaneal tuber and the body of the calcaneus (pos. 1, 2,. The needles are held on both sides of the Achilles tendon outside the point of attachment to the calcaneus and calcaneus bursa.

After reposition, the Beler angle was plus 18 degrees. Dismantling after 6 weeks. Plaster cast for a month. Full load was allowed after 3.5 months. Conducted a course of rehabilitation treatment. Control examinations after 2 and 4 months. Foot function restored. The patient returned to his previous work.

Example 2. Patient R., 34 years old, was admitted to the RTC of the Ministry of Health of the Republic of Dagestan on an emergency basis, 1.5 hours after the injury (falling from a height of about 3.5 meters to his feet), examined and diagnosed with Closed comminuted intraarticular fracture of both heel bones with displacement of fragments. On radiographs, a comminuted intraarticular fracture of both calcaneus bones with displacement of fragments was determined, Beler angle to the right minus 3 degrees, left minus 14 degrees. Under conduction anesthesia, the reposition was performed by the proposed method: an awl was inserted into the calcaneus from the calcaneal tuber (pos. 1), and bone fragments were repositioned, after which a spoke was inserted into the calcaneal bone body below the compression zone of the articular surface in the sagittal plane from the calcaneal tuber . 2), forming a single fragment of the calcaneus. On the upper edge of a previously held knitting needle in the frontal plane, two more knitting needles are passed through the calcaneal tubercle - through the lower third of the tibia (items 3, 4). These two knitting needles (items 3, 4) are attached to the brackets for fixing the knitting needles with bolts and washers with slots connected by two threaded rods between the brackets. Perform a temporary fixation of the fracture with the needles brought from the calcaneal tuber to the body of the calcaneus in the sagittal plane (pos. 1, pos. 2). In this case, two knitting needles (pos. 3, 4) pass through the fragments of the articular surface and the body of the calcaneus (pos. 3, 4), two more (pos. 1, 2) pass through the calcaneal tuber and the body of the calcaneus (pos. 1, 2. The needles are placed on both sides of the Achilles tendon outside the point of attachment to the calcaneus and calcaneal bursa. The operation was performed on 04/16/2009. Beler angle after reposition by the proposed method was + 20 degrees. The postoperative period was uneventful, the patient was discharged home through 13 days after surgery.Dismantling after 6 weeks and gypsum was applied I’m a longet, which, after healing of wounds at the place of knitting needles and rods, was transferred to a circular gypsum dressing with a metal stirrup plastered in it. The gypsum was removed after a month. The full load was resolved after 3.5 months. A course of rehabilitation treatment was carried out. 2 and 4 months. Function of the foot restored. The patient returned to his previous work.

Features of the invention, distinctive from the prototype

Signs of the prototype

1. In the lower third of the lower leg, two Kirschner cross needles are held, which are fixed on two U-shaped staples connected by themselves.

2. The brackets are rigidly connected to each other using threaded rods connected to remote flags. The fourth bracket is installed in the heel region and is fixed to the upper bracket with two threaded rods. Mobile clamping devices are installed on this bracket from the outside and inside, and two rods are held along them.

3. The rods are fixed on a rectangular plate with nuts.

4. The Beler angle is adjusted using two screws that move the plate in the corresponding direction, as well as traction along the threaded rods.

Features of the invention

1. Enter the awl into the calcaneus from the calcaneal tuber (item 1),

2. The bone fragments are repositioned, after which a spoke is inserted into the body of the calcaneus below the compression zone of the articular surface in the sagittal plane from the calcaneal tuber (pos. 2), forming a single fragment of the calcaneus.

3. On the upper edge of the previously held knitting needles in the frontal plane, two more knitting needles are passed through the calcaneal tubercle - through the lower third of the tibia (pos. 3, 4).

4. Fixation of the fracture with the needles brought from the calcaneal tuber to the body of the calcaneus in the sagittal plane (pos. 1, pos. 2). In this case, two knitting needles (pos. 3, 4) pass through the fragments of the articular surface and the body of the calcaneus (pos. 3, 4), two more (pos. 1, 2) pass through the calcaneal tuber and the body of the calcaneus (pos. 1, 2,. The needles are held on both sides of the Achilles tendon outside the point of attachment to the calcaneus and calcaneus bursa.

The technical effect of the application of the proposed method.

Good results were achieved in 10 (83.3%) patients, satisfactory - 2 (16.7%) due to severe intraarticular comminuted fractures. Postoperative complications practically did not occur. Patients use ordinary shoes, without supporting aids, no complaints of pain. The terms of rehabilitation were 3.5-4 months, patients returned to their previous profession.

Thus, the proposed method for transosseous osteosynthesis of compression intraarticular heel bone fractures using spoke-rod fixation allows restoration of the heel bone anatomy and functional parameters of the foot, which indicates its effectiveness.

The method fully ensures reposition of the fracture with the elimination of all types of displacement, as well as restoration of the shape of the foot, which prevents the development of flat feet and post-traumatic arthrosis of the joints of the foot.

The above method is applicable for all types of comminuted fractures of the calcaneus, provides sufficient stability for fixation of fragments, and also ensures the elimination of all types of comminuted displacements, the function and physiological distension in the ankle joint are completely preserved, there are no reflex pains and spasm of the vessels of the distal extremities, which leads to acceleration heel bone consolidation dates.

The treatment method fully ensures reposition of the fracture with the elimination of all types of displacements, as well as restoration of the shape of the foot, which prevents the development of flat feet and post-traumatic arthrosis of the joints of the foot. Applicable for all types of comminuted calcaneus fractures, the ability to reposition fractures of type 73 s according to the AO classification.

Information taken into account

1. Kupitman M.E., Atmansky I.A., Chernikov M.K., Maminov D.V., Gashev A.A., Kurguzov S.A. A method for the treatment of calcaneus fractures by the “Axial fixation apparatus”. Treatment of calcaneal fractures with an axial fixation device // Modern problems of science and education. - 2014. - No. 1.

2. "A method for the treatment of calcaneus fractures and a compression-distraction apparatus for its implementation"; Magaramov M.A., Osmanov R.T. "A method for the treatment of calcaneus fractures" patent No. 2200496. March 20, 2003

Claims (1)

A method for treating comminuted intraarticular compression fractures of the calcaneus with displacement of fragments, comprising holding two Kirschner knitting needles in the lower third of the lower leg, characterized in that the needle is inserted into the calcaneus from the calcaneal tuber, the bone fragments are repositioned, and then into the calcaneal body below the zone compresses the articular surface in the sagittal plane from the calcaneal tuber to conduct a spoke, forming a single fragment of the calcaneus, and two overlapping Kirschner spokes are carried out vertically it edge previously held the spokes, in the frontal plane through the calcaneal tuberosity and through the lower third of the tibia, so that the two pieces of knitting needles passed through the articular surface and the body of the calcaneus.

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