RU2720483C1 - Method of osteosynthesis in fracture of olecranon - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention refers to medicine, namely to traumatology and orthopedics, and can be used for fixing bone fragments in fractures of an olecranon. When osteosynthesis is performed in fractures of an olecranon, two K-wires are intramedullary introduced on the side of an apex of the olecranon through a fracture zone parallel to each other and a constricting loop is performed. Constricting loop is a wire which is annealed beforehand. After the K-wires are brought in and the wires are cooled down, one end of the needle is delivered outside the elbow joint through the cortical layer of the ulnar bone between the K-wires. Drawn end of the wire is fixed in the formed hole in the ulnar cortical layer. Second end of the wire is grasped, simulated to form a U-shaped loop. Formed loop is made around proximal ends of K-wires, arranged on external surfaces of bone fragments. Second end of the wire is fixed with tension in the formed hole in the cortical layer of ulnar bone. To exclude injuries of surrounding soft tissues, proximal ends of K-wires are bent after looping around them.EFFECT: method provides early recovery of elbow function in full due to adequate fixation of ulnar fracture area.1 cl, 3 dwg, 2 ex

Description

The invention relates to medicine, namely to traumatology and orthopedics, and can be used for fractures of the ulnar process.

A known method of osteosynthesis of fractures of the ulnar process (RU 2409327, C1), which we have chosen as a prototype. It involves the implementation of osteosynthesis of the ulnar process using two Kirschner spokes, the introduction of a tightening wire by drilling the bone with a drill, tightening the wire loop by twisting its ends one after another. The method is used in the treatment of fractures of the ulnar process using immersion osteosynthesis.

The disadvantage of the prototype method is that the osteosynthesis of a wire loop lengthens the time of surgical treatment, due to the fact that the wire is twisted by the ends one after another mechanically. In addition, fractures and fragmentation of the wire in the twisting area are possible due to the fact that the wire can break. The wire loop does not stretch enough, which leads to unstable osteosynthesis.

The mechanical tightening of the loop in the known method due to the twisting of its ends one after another leads not only to damage to the wire in the area of twisting, but also to the technical difficulties of the method of osteosynthesis. Insufficient force of fixation of the tightening wire occurs due to the fact that the wire has a smaller diameter compared to the diameter of the spokes.

The prototype method requires the formation of through holes in the ulna by reaming its cortical layer during the distal part of the tightening loop, which increases the invasiveness of the intervention.

Mechanical tightening due to the twisting of the wire end to each other complicates the surgical intervention and does not provide sufficient fixation for fractures of the ulnar process.

The technical problem lies in the early restoration of the function of the elbow joint in full with adequate fixation of the fracture zone of the ulna.

The technical result achieved by the implementation of the invention is:

- reducing the invasiveness of the operation by eliminating the formation of a through hole in the cortical layer of the ulna with a drill, damage to the cortical layer of the ulna in the area of exit of the distal ends of the Kirschner spokes, using less traumatic access while maintaining the integrity of soft tissues;

- ensuring stable fixation of the fragments and prevention of their secondary displacement during fracture of the ulnar process due to reliable tightening of the bone fragments, eliminating the migration of the fixation fracture loop by using an originally processed knitting needle as a constricting loop;

- early restoration of the full function of the elbow joint.

The burnt knitting needle that we offer as a tightening loop (it is advisable to use medical stainless steel X18H10T, a needle with a diameter of 1 mm, a length of 200 mm) is in the “plastic” (soft) state when it is held, which prevents bone destruction when it is bent (forming a tightening loop) and increase the reliability of fixation, as well as conduct surgical treatment without additional reaming of the bone and without mechanical tightening of the tightening loop, which eliminates its damage.

In addition, the charred knitting needle is more durable due to its larger diameter compared to the tightening wire used in the prototype method, which also increases the reliability of fixation of fragments.

The needle was first burned on a gas burner (optimal heating to 450 ° C), after which the metal goes into a plastic state. At the same time, the contracting needle pulls together the fragments, as it were, “automatically”. Upon cooling, the outer layers of the metal (colder) used to reach the transition temperature from the plastic to the elastic state. With further cooling, the inner layers were exposed to tensile forces that did not disappear due to the low ductility of the cold metal. At the same time, a spoke that has cooled but retained plasticity does not have an effect on bone tissue. The proposed method, due to the fact that the spoke was in a “plastic” (soft) state, allows to prevent bone destruction during bending of the spoke and increase fixation reliability, as well as to carry out surgical treatment without additional bone reaming and without mechanical tightening of the spoke loop, which eliminates her damage.

Thus, the proposed method can simultaneously eliminate the instability of the fracture and preserve the anatomical and physiological relationships in the fracture of the ulnar process, without interfering with physiological mobility. The method developed by us makes it possible to facilitate and accelerate surgical treatment for fractures of the ulnar process, as well as to begin early (in the first days after the operation) active movements, thereby reducing the period of disability of patients.

Performing osteosynthesis according to the proposed method allows you to create the most favorable conditions for fusion of bone fragments due to the "automatic" constriction of the fragments with a spoke loop, the maximum preservation of the surrounding soft tissues, local blood supply and innervation.

In the early postoperative period, it is possible to carry out early activation of the patient in the scope of rehabilitation measures without fear of secondary displacements due to stable osteosynthesis, and also not to carry out additional postoperative immobilization, since prolonged external immobilization can adversely affect the motor functions of the elbow joint. The minimum operational access used in the patented method significantly reduces the invasiveness of the intervention.

The invention consists in the following.

When performing osteosynthesis in fractures of the ulnar process, two Kirchner spokes are introduced intramedullary from the top of the ulnar process through the fracture zone parallel to each other and a tightening loop is carried out. In this case, a knitting needle is used as a tightening loop, which is preliminarily calcined (burning is optimal to a temperature of 450 ° C). After carrying out the Kirchner knitting needles and cooling the knitting needles (cooling to room temperature equal to 19 ° -24 ° C is optimal), one end of the knitting needle is carried out outside the elbow joint through the cortical layer of the ulnar bone between the Kirchner knitting needles. The spent end of the knitting needle is fixed in the formed hole in the cortical layer of the ulna. Capture the second end of the spoke, simulate it, giving the shape of a U-shaped loop. The formed loop is carried out around the proximal ends of the Kirchner spokes, located on the outer surfaces of the bone fragments. The second end of the knitting needle is fixed with tension in the formed hole in the cortical layer of the ulna.

To prevent injury to the surrounding soft tissue, the proximal ends of the Kirchner spokes are bent after holding a loop around them.

The invention is illustrated by the following figures: in FIG. 1 shows intramedullary conduction of Kirschner spokes; in FIG. 2 shows the holding of a tightening spoke loop (lateral projection);

in FIG. 3 shows the holding of a tightening spoke loop (direct projection), where

1 - charred knitting needle;

2 - Kirschner spokes;

3 - ulnar bone;

4 - a hole in the cortical layer of the ulna (non-through, outside the elbow joint) - the fixation point of the spoke U-shaped loop.

The method is as follows.

In the metaphysis region of the proximal end (base) of the ulna, a drill in the oblique direction along the medullary canal carried out two Kirschner spokes to a length equal to at least one and a half diameters of the ulna at the level of the ulnar process (Fig. 1.)

The needle is burned on a gas burner so that it turns red.

After firing the knitting needles, an S-shaped skin incision is made. Using blunt hooks, the common flexor tendons are pulled to one side. An open reposition of fragments of the ulna is performed. Then two Kirschner spokes are introduced intramedullary from the apex of the ulnar process through the fracture zone parallel to each other. Kirschner spokes to ensure reliable fixation are usually carried out at a length equal to at least one and a half diameters of the ulna at the level of the ulnar process (Fig. 1.)

After carrying out the Kirchner knitting needles and cooling the knitting needles, one end of the knitting needle is carried out outside the elbow joint through the cortical layer of the ulnar bone between the Kirchner knitting needles, without drilling a bone through the hole.

Typically, the cooling of the knitting needles to a temperature of 19-24 ° C occurs 15-20 minutes after firing. This does not lead to an extension of the operation time, since this time is used to form access with an open reposition of fragments and to conduct two Kirschner spokes.

The drawn end of the knitting needle is fixed in the formed hole in the cortical layer of the ulna. Capture the second end of the spoke, simulate it, giving the shape of a U-shaped loop. The formed loop is carried out around the proximal ends of the Kirchner spokes, located on the outer surfaces of the fragments. The second end of the spoke is fixed with tension in the formed hole in the cortical layer of the ulna.

To prevent injury to the soft tissues, the proximal ends of the Kirchner spokes are bent after holding a loop around them.

After which the wound is sutured with a 4/0 thread. Apply an aseptic dressing. The limbs give an elevated position, locally apply hypothermia. The dressing is changed if it gets wet with blood. After the pain subsides from the 2nd day, active-passive gymnastics begins, aimed at developing movements in the elbow joint. Sutures are removed 2 weeks after surgery.

Clinical example 1.

Patient A., 53 years old, was admitted to the clinic 7 hours after the injury. Diagnosis: closed fracture of the ulnar process of the right upper limb. Upon admission, the limb is immobilized by a plaster cast. After preoperative preparation, the operation was performed according to the proposed method, while the cooling time of the knitting needle to 19 ° C was 20 minutes. Plaster immobilization was not carried out. The postoperative wound healed by primary intention. Discharged from the hospital on the 5th day after the operation. The observation was 4 months, the range of motion in the elbow joint was fully restored.

Clinical example 2.

Patient N., 27 years old, was admitted to the clinic 3 days after the injury. He was injured in everyday life while riding a gyro scooter, fell to his right elbow. Upon admission, he was diagnosed with a closed fracture of the ulnar process of the right upper limb. Upon admission, the limb is immobilized with a plaster cast; when removing the cast, the skin is warm, clean, and there is swelling. In the area of the projection of a fracture of the right humerus, pathological mobility of the bone fragment is palpated, the movement in the elbow joint is limited by pain. After preoperative preparation, the operation was performed according to the proposed method, while the cooling time of the spoke to 24 ° C was 15 minutes. Plaster immobilization was not carried out. The postoperative wound healed by primary intention. Discharged from the hospital on the 3rd day after the operation. The observation was 8 months, the range of motion in the elbow joint was fully restored. The function of the right elbow joint is fully restored.

Claims (2)

1. The method of osteosynthesis in fractures of the ulnar process, including the intramedullary conduction of two Kirschner spokes from the top of the ulnar process through the fracture zone parallel to each other, the use of constrictive fragments of a loop, characterized in that a knitting needle is used as a constricting loop, then preliminarily burned, then two Kirschner knitting needles, after cooling the knitting needles, one end is drawn outside the elbow joint through the cortical layer of the ulnar bone between the Kirchner knitting needles and fixed in the formed hole rstia in the cortical layer of the ulna; then, capturing the second end of the spoke, they model it, giving the shape of a U-shaped loop, which is carried out around the proximal ends of the Kirchner spokes, located on the outer surfaces of the fragments, and the second end of the spoke is fixed with tension in the formed hole in the cortical layer of the ulna. 2. The method according to p. 1, characterized in that the proximal ends of the Kirchner spokes are bent after holding a loop around them.

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