RU2702873C1 - Method of treating fractures of base i metacarpal bone - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: inventions relate to medicine, namely to traumatology and orthopedics, and can be used for treating patients with Bennett, Rolando fractures and other periarticular fractures. In one of the versions of the method, fragments are repositioned with subsequent fixation of the position achieved with the pins. In the head area of metacarpal bone, percutaneously-transosseously, K-wire is delivered. Ends of the wire are connected to form a loop with a thrust on which along the finger axis, with retraction of the first metacarpal bone, reposition is performed until complete recovery of the metacarpal joint, while preserving the position of reposition, fixing with 3 wires I metacarpal, percutaneously-transosseously, to the II metacarpal bone. X-ray control loop is removed. Gypsum splint is applied on the I ray of the hand for period of 5 days. In another version of the method fragment reposition is performed with subsequent fixation of fragments to metacarpal bone. In the head area of metacarpal bone, percutaneously-transosseously, K-wire is delivered. Ends of the wire are connected to form a loop with a thrust beyond which along the finger axis, with retraction of I metacarpal bone, reposition is performed until complete recovery of metacarpal joint. After the X-ray control, the achieved position of the gypsum ligament is fixed on the I hand ray. After the gypsum hardens, the outer part of the loop is cut off to the border with the gypsum. After three weeks, the gypsum splint is removed, the remaining part of the wire is removed.

EFFECT: inventions provide reduced traumatism and simplified method of treatment both at stage of setting of wires, and their extraction after fracture union with considerable reduction of treatment time.

2 cl, 3 ex, 9 dwg

Description

The treatment method relates to medicine, to traumatology - orthopedics, and allows you to treat patients with Bennett, Rolando, osteoepiphysiolysis of the base of the I metacarpal bone in children, and other periarticular fractures.

Difficulties in the treatment of fractures of the base of the I metacarpal bone are due to the leading role of the I finger in the function of the hand and the fact that almost all of them are near, or intraarticular fractures, which requires the most accurate comparison of fragments. This fracture rarely leads to disability, but if it is improperly fused, it can cause such pain, especially among physical workers, that practically the hand becomes unusable. (B. Boychev. Operational orthopedics and traumatology. Sofia, 1961, p. 390).

A large number of proposed methods for the treatment of these fractures indicates their lack of effectiveness. The desire to restore the anatomical ratio of damaged joints, and the need to keep fragments in their position until the end of the fusion, led practical doctors to surgical methods of treatment.

A known method of treating a Bennett fracture, which consists of a direct extension of the I metacarpal bone and subsequent surgical fixation of a fragment of the metacarpal bone with two Kirschner spokes. (B. Boychev. Operational orthopedics and traumatology. Sofia, 1961, p. 390).

The disadvantage of this method is its trauma, since to fix the achieved position of the fragment with knitting needles, a skin incision is made from the middle of the 1st metacarpal bone to the hand, the first metacarpal bone is exposed from the muscles, and the joint is opened, which turns a closed fracture into an open one.

The essence of the invention consists of a combination of essential features that ensure the achievement of the desired technical result, and consists in the relative simplicity and low traumaticity of the treatment method, both at the stage of installing the spokes and removing them after the healing of fractures, with a significant reduction in the period of temporary incapacity for work.

The essence of the method of treating fractures of the base of the I metacarpal bone includes reposition by a fragment, followed by fixing the position reached with knitting needles. In the area of the head of the metacarpal bone, transdermally - transdermally, a Kirschner needle is inserted, its ends are connected with a loop, the traction of which along the axis of the finger, when the I metacarpal bone is retracted, reposition until the metacarpal joint is completely restored, maintaining the position of reposition, fix 3 with the needles of the first metacarpal bone, transdermal-transosseous, to the second metacarpal bone, after the X-ray control, the spoke loop is removed, a plaster cast is applied on the first beam of the hand for a period of 5 days.

The use of the loop formed by the connection of the ends of the knitting needle, carried out in the area of the head of the metacarpal bone, transdermally - transosseously allows you to close reposition of fragments of the metacarpal bone, restore the anatomical ratio of damaged joints, and hold the fragments to the end of the fusion.

Performing traction for the loop along the axis of the finger, with the abduction of the I metacarpal bone, allows repositioning until the metacarpal joint is completely restored.

Fixation of the I metacarpal bone, transdermally - transosseously, to the II metacarpal bone with 3 knitting needles, allows to fix the achieved position extra-focal, without causing additional injury to the fracture area before fusion.

The application of a plaster cast for 5 days on the first beam of the hand provides rest to injured tissues, in which swelling and pain are relieved, which allows you to start an early, active development of movements of the finger joint with retained knitting needles.

A known method of treating a Bennett fracture, which consists of a direct extension of the I metacarpal bone and subsequent surgical fixation of a fragment of the metacarpal bone with two Kirschner spokes. (B. Boychev. Operational orthopedics and traumatology. Sofia, 1961, p. 390).

The disadvantage of this method is its trauma, since to fix the achieved position of the fragment with knitting needles, a skin incision is made from the middle of the 1st metacarpal bone to the hand, the first metacarpal bone is exposed from the muscles, and the joint is opened, which turns a closed fracture into an open one.

The essence of the invention consists of a combination of essential features that ensure the achievement of the desired technical result, and consists in the relative simplicity and low traumaticity of the treatment method, both at the stage of installing the spokes and removing them after the healing of fractures, with a significant reduction in the period of temporary incapacity for work.

The essence of the method of treating fractures of the base of the metacarpal bone includes the reposition of fragments, followed by their fixation to the metacarpal bone. In the area of the head of the metacarpal bone, transdermally - transdermally, a Kirschner needle is inserted, its ends are connected with the formation of a loop, the pull of which along the axis of the finger, when the I metacarpal bone is retracted, reposition until the metacarpal joint is completely restored. After X-ray control, the achieved position is fixed with a plaster splint on the first beam of the brush. After hardening of the gypsum, the outer part of the loop is cut to the border with the gypsum. After three weeks, the gypsum splint is removed, the remaining part of the spoke is removed.

The use of the loop formed by the connection of the ends of the knitting needle, carried out in the area of the head of the metacarpal bone, transdermally - transosseously allows you to close reposition of fragments of the metacarpal bone, restore the anatomical ratio of damaged joints, and hold the fragments to the end of the fusion.

Performing traction for the loop along the axis of the finger, with the abduction of the I metacarpal bone, allows repositioning until the metacarpal joint is completely restored.

Fixing the achieved position with a plaster splint on the first beam of the brush, with a retained loop from the Kirchner needle held in the area of the head of the metacarpal bone, allows to fix the achieved reposition of fragments without causing additional injury to the fracture area, and provides rest to the injured tissues necessary for complete regeneration.

Cutting the outer part of the loop after hardening the gypsum, to the border with the gypsum, provides the patient with convenience in everyday life.

Immobilization of a damaged finger for 3 weeks provides a fracture in a child.

The method is illustrated in the illustration.

In FIG. 1 - FIG. 3 shows radiographs of patient N, 67 years old:

In FIG. 1 - upon admission;

In FIG. 2 - with a fixed loop from the Kirschner needle, and fixation of the I metacarpal bone, transdermal-transosseous, to the II metacarpal bone with 3 knitting needles;

In FIG. 3 - after removal of the spoke loop;

In FIG. 4 - FIG. 5 - radiographs of the 6th 3., 35 years:

In FIG. 4 - upon admission;

In FIG. 5 - after removal of the spoke loop, where 1 is the trace of the removed spoke loop, and fixation of the repaired fracture with knitting needles;

In FIG. 6 - FIG. 9 - radiographs of a sick child M., 13 years old:

In FIG. 6 - a picture at admission;

In FIG. 7 - after an unsuccessful attempt to reposition fragments by traction for the 1st finger, with the application of a plaster cast;

In FIG. 8, in FIG. 9 - the state of the finger after 3 weeks of immobilization with a plaster cast applied after treatment according to the proposed method.

The proposed method is as follows.

In case of fracture of the base of the 1st metacarpal bone, the surgical field of the hand is treated with antiseptics, under conduction anesthesia, in the area of the head of the 1st metacarpal bone, transdermally - transversely, the Kirschner needle is carried out, its ends are connected with the formation of a loop. By pulling the spoke loop along the axis of the finger, with the abduction of the I metacarpal bone, reposition is performed until the metacarpal joint is completely restored. Keeping the position of reposition, fix with 3 knitting needles of the I metacarpal bone, transdermal-transosseous, to the II metacarpal bone. After the control x-ray, the loop is removed, the plaster casts are superimposed on the first beam of the brush for a period of 5 days.

In case of a fracture of the base of the 1st metacarpal bone, the surgical field is treated with antiseptics, under conduction anesthesia, in the area of the head of the metacarpal bone, percutaneously - transversely, a Kirchner needle is inserted. The ends of the knitting needles are connected with the formation of a loop. By pulling the spoke loop along the axis of the finger, with the abduction of the I metacarpal bone, reposition is performed until the metacarpal joint is completely restored. An x-ray control is performed and the position reached is fixed with a plaster span on the first beam of the brush. After hardening of the gypsum, the outer part of the loop is cut to the border with the gypsum, after three weeks the gypsum splint is removed, the remaining part of the spoke is removed.

Clinical example 1

Patient N., 67 years old, was admitted to the GAUZ “RKB MZ RT” with an injury to the first finger of his right hand - Bennett fracture (Fig. 1). The brush was treated with antiseptics, under conduction anesthesia, in the area of the head of the first metacarpal bone of the injured finger, percutaneously - transcendently, a Kirchner needle was inserted. The ends of the knitting needles were connected, forming a loop (Fig. 2), with a pull for which along the axis of the finger, when I met the metacarpal bone, they were repositioned until the metacarpal joint was completely restored. Keeping the position of the reposition, we fixed it with 3 spokes (Fig. 2), connecting the I metacarpal bone, transdermal-transosseous, with the II metacarpal bone. After the control x-ray, the spoke loop was removed (Fig. 3), a plaster cast was applied on the first beam of the hand for a period of 5 days. The patient was sent for outpatient monitoring at the place of residence. Clinical example 2

Patient 3., 35 years old, was admitted to the GAUZ “RKB MZ RT” with an injury to the first finger of his left hand - Roland's fracture (Fig. 4). After treating the brush with antiseptics, under conduction anesthesia, in the area of the head of the first metacarpal bone of the injured finger, transdermally - transdermally, a Kirschner needle was inserted. The ends of the knitting needles were connected, forming a loop, the traction of which along the axis of the finger, when abducting the I metacarpal bone, repositioned until the metacarpal joint was completely restored. Maintaining the position of the reposition, we fixed it with 3 spokes, connecting the I metacarpal bone, transdermally-transdermally, with the II metacarpal bone (Fig. 5). After the control x-ray, the spoke loop was removed. Plaster casts were applied on the first beam of the brush for a period of 5 days. The patient was sent for outpatient monitoring at the place of residence.

Clinical example 3

Child M, 13 years old, was admitted to the State Children's Health Institution “RKB MZ RT” with a fracture of the base of the 1st metacarpal bone (osteoepiphysiolysis) with displacement of fragments of the right hand (Fig. 6). After an unsuccessful attempt to reposition fragments by a thrust for the 1st finger with the application of a plaster cast (Fig. 7), the patient was treated according to the proposed method. The brush was treated with antiseptics, conduction anesthesia was performed, in the area of the head of the first metacarpal bone of the injured finger, percutaneously - transcutaneously, a Kirchner needle was inserted. The ends of the knitting needles were connected, forming a loop, the traction of which along the axis of the finger, when abducting the I metacarpal bone, repositioned until the metacarpal joint was completely restored. Maintaining the position of the reposition, we fixed it with a plaster cast, performed X-ray control, and cut off the ends of the knitting needle protruding from the plaster. The patient was sent for outpatient monitoring at the place of residence. Three weeks later, control x-rays were performed (Fig. 8, Fig. 9), the gypsum was removed, the needle was removed. The patient was sent for outpatient monitoring at the place of residence.

Claims (2)

1. A method of treating fractures of the base of the metacarpal bone, including reposition of fragments with subsequent fixation of the fragment to the metacarpal bone with knitting needles, characterized in that in the region of the head of the metacarpal bone, transdermally-transdermally, a Kirschner needle is inserted, its ends are connected with the formation of a loop, for which along the axis of the finger, with the abduction of the I metacarpal bone, a reposition is performed until the metacarpal carpal joint is fully restored, maintaining the position of reposition, fixed with 3 spokes of the I metacarpal bone, transdermal-transosseous, to the II metacarpal bone, after x-ray After the loop is removed, the plaster casts are superimposed on the first beam of the brush for a period of 5 days. 2. A method for the treatment of fractures of the base of the I metacarpal bone, including reposition of fragments with their subsequent fixation to the metacarpal bone, characterized in that in the region of the head of the metacarpal bone, transdermally-transdermally, a Kirschner needle is inserted, its ends are connected with the formation of a loop for which the axis of the finger, during abduction of the I metacarpal bone, reposition until the metacarpal joint is completely restored, after x-ray control, the achieved position is fixed with a plaster splint on the first beam of the hand, after curing the gypsum, the outer part of the loop they drive to the border with gypsum, after three weeks the gypsum splint is removed, the remaining part of the spoke is removed.

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