RU2732693C1 - Savushkin's ruler-pattern for the operation of the blocked intramedullary osteosynthesis with the overhanging fractures of the femoral bone - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to templates for performing the operation of blocked intramedullary osteosynthesis in transverse fractures of the femoral bone. Template-ruler consists of a leg, a central part and a shoulder. On the end of the leg at equal distance there are 3–5 rows of holes for selection of the rod. Leg, the central part and the shoulder are made in the form of a single plate bent into side and 2 mm thick. Bend in side of plate corresponds to neck-neck diameter of 130°. Graduated marking is applied on the shoulder. Leg has length of 154 mm and, moving away from central part, tapered. In the lower part of leg 3–5 rows of holes have size from 9 to 11 mm for determination of femoral canal diameter and selection of rod of appropriate diameter. In the central part of the ruler-pattern there is a cross-hairs at angle of 130°, which is configured to position it accurately in the femoral bone center in accordance with the trabecular lines.

EFFECT: reduced time for reposition of femoral bone and performing an operation, as well as higher reliability of osteosynthesis.

1 cl, 1 dwg

Description

The technical field to which the invention relates

The invention relates to medicine, namely to traumatology and orthopedics, in particular, to the line-template Savushkin I.S. for performing the operation of blocked intramedullary osteosynthesis in case of pertrochanteric fractures of the femur and can be used to increase the contact area and accessibility of blocking the pin with the condyles in complex fractures.

State of the art

Known three-blade Smith-Peterson nail, which is a piece of a metal rod of a given diameter, bearing blades on the body, located at an angle of 120 ° (see Osteosynthesis. A guide for doctors. Edited by S. Tkachenko - L .: Medicine, 1987, p. . 78-83).

The disadvantage of this three-bladed nail is that it does not provide for possible migration in the postoperative period and, at the time of insertion into the fragments, causes significant destruction of bone tissue.

A device for closed osteosynthesis in complex fractures of the femur is known, which contains a cylindrical intramedullary pin, in which locking holes are made on the side of the end and on the side of the tip, respectively, for fixing the distal and proximal fragments, and at the end there is a coaxial threaded hole, a trocar for coaxial the location of the working tool or locking screws in it and a guide made with holes for a trocar corresponding to the locking holes in the pin, and with a centering hole in which the connecting sleeve is coaxially installed. The end face of the connecting sleeve is mated with the end face of the pin through reciprocal grooves and projections made in the pin and the sleeve. The pin is fastened to the guide with a tie screw passed through the coupling sleeve and screwed into the threaded hole of the pin. The pin is made in two stages with a step of a larger diameter for blocking distal fragments, the length of which is equal to the average axial length of the human femoral condyles. The locking holes are located along this entire length with an offset from the axis of the proximal locking hole. From the end of the pin not less than 1/6 of this length and with a step of a smaller diameter located on the side of the tip, at least three holes are made on the latter. The distance between the axes of adjacent blocking holes in the steps is not less than a quarter of the length of the step with a larger diameter. The guide is made in the form of a console with monolithically connected support and bent ends. Holes for the trocar are located in the reference end of the guide, and the centering hole for the connecting sleeve is made in the bent end. The axes of the locking holes in the pin and the axes of the corresponding holes for the trocar in the guide are located in planes perpendicular to the axis of the pin and are equidistant from the base plane passing through the end of the pin (see US Pat. RU No. 2262321, IPC A61B 17/72, publ. 20.10. 2005, No. 29).

The disadvantage of this device is the long-term operation, low strength, axial and end stability and reliability of osteosynthesis, while expanding the possibilities of the operation.

A device for the treatment of complex fractures of the femur is known, containing a two-stage cylindrical intramedullary pin with a step of a larger diameter, in which there are four blocking holes crossing the axis for locking screws to block fragments of the proximal section, with a step of a smaller diameter with a tip for blocking fragments of the distal section, and in the end of the pin has a coaxial threaded hole, a guide made with straight and bent ends and having inclined holes for a trocar at the straight end corresponding to the locking holes in the pin, and at the bent end there is a centering hole with a connecting sleeve coaxially installed in it, and the end of the pin is mated with the end face of the connecting sleeve and fastened to it with a tie screw passed through the connecting sleeve and screwed into the coaxial threaded hole of the pin, while the pin has a constant length and diameter of a step of a larger diameter, and the diameter of a step of a smaller diameter is the corresponding diameter of the bone marrow canal, while two locking holes in the step of the larger pin are located at an angle of 130 ° to the axis of this step, and two other locking holes of this step are located at an angle of 90 ° to the axis of this step, and the axis of the step of the pin of the smaller diameter, located with an offset from the end of the pin equal to 1.27 of the length of the step of a larger diameter, bent relative to the axis of the step of a larger diameter by an angle equal to 6 °, in the plane of the location of the axes of the locking holes of a step of a larger diameter and has the shape of an arc whose radius is 100 times larger than the diameter of the step of the pin of a larger diameter, with the center of the arc of this section, located perpendicular to the axis of the step of a larger diameter, while in the steps of a smaller diameter on the side of the tip, a round hole and a through oblong rounded groove are made for locking screws, the length of which is 8.6 times less than the length of a step of a larger diameter, and the width is 2 times less than the length of the groove, and the axes of this holes and elongated groove are turned to the right and left, respectively, for the left and right extremities at an angle of 15 ° relative to the axis of the step section of a smaller diameter of the pin, turned at an angle of 6 °, while the straight and bent ends of the guide are made in one piece.

In the device, locking holes made in the pin, inclined at an angle of 130 ° to the axis of a larger step, are located between the locking holes inclined at an angle of 90 ° to this axis (see US Pat. RU No. 2271768, IPC AVI 17/72, publ. 03/20/2006, No. 8).

The disadvantage of this device is the long-term operation, the impossibility of ensuring the stability of osteosynthesis in fractures of the femoral neck.

Known hybrid blocking fixation of the fracture of the proximal femur, while the internal fixation device for fixing the intracapsular fracture of the femoral neck contains a tubular element with a sharp end and a blunt end; at least one channel formed in said tubular member, said at least one channel extending from said pointed end to said blunt end; at least one screw configured to pass through said at least one channel and extend outwardly past said sharp end; a thread formed at a portion of said at least one screw that is configured to extend beyond said sharp end; a screw head formed on said at least one screw to prevent the at least one screw from being inserted completely into said at least one channel; and thus, after said tubular element is implanted into the bone with an intersection of approximately 1 or 2 millimeters of the fracture line, said at least one screw is inserted through said at least one canal so that compression of the bone fragments is provided for acceleration of the fusion process. A hybrid blocking fixation device for fixing a fracture in the femoral neck or transtrochanteric region comprises a tubular element with a sharp end and a blunt end; at least one channel formed in said tubular member, said at least one channel extending from said pointed end to said blunt end; at least one screw configured to pass through said at least one channel and extend outwardly past said sharp end; at least two holes formed across said tubular element, said at least two holes formed on opposite sides of said tubular element; at least four pin screws, wherein at least two pin screws are configured to lock said tubular element and said at least two pin screws and at least two pin screws are inserted into the distal bone fragment, to ensure the stability of the tubular element in the bone; a connecting element configured to fasten said at least two pin screws; and thus said tubular element is implanted into the femoral neck, said at least one screw is inserted through said at least one channel so that compression and sliding of bone fragments is ensured, at least one pin screw is inserted through said a tubular element through said at least two holes and at least two pin screws are fixed in said distal bone fragment, while the pin screws are connected through said connecting element to accelerate the fusion process, and the connections by said connecting element can be adjusted after operation. The method of fixing an intracapsular fracture of the femoral neck contains the following steps: an internal fixator is provided containing a tubular element with a sharp end and a blunt end; at least one channel formed in said tubular member, said at least one channel extending from said pointed end to said blunt end; at least one screw configured to pass through said at least one channel and extend outwardly beyond said pointed end; a thread formed at a portion of said at least one screw that is configured to extend beyond said sharp end; a screw head formed on said at least one screw to prevent the at least one screw from being inserted completely into said at least one channel; make a skin incision 2-3 cm long in the trochanteric area; insert the said tubular element into the femoral neck at an angle of approximately 95-110 degrees relative to the centerline of the femoral body, so that one screw from at least one lag screw is adapted to be positioned in the direction of the lower quadrant of the femoral head to slightly touch the healthy the cortical layer of the cervical spur of the femur, wherein said tubular element crosses the fracture line by approximately 1 or 2 millimeters; screw in said at least one lag screw (see patent RU No. 2359635, IPC А61В 17/74, А61В 17/60, publ. 27.06.2009, No. 18; PCT application: P. 2004/000259 ( 2004); PCT Publication: WO 2004/084761 (07.10.2004)).

The disadvantage of this hybrid blocking fixation of the fracture of the proximal femur is the duration of the operation.

The closest in technical essence and the achieved positive effect and pleasant by the author for the prototype is a fixator for osteosynthesis of the femoral neck, consisting of two legs with a V-shaped section and pointed ends at an angle of 60 °, and a compression screw, while at the legs attached to the plate at an angle of 130 °, a section is made at an angle of 90 °, open to the outside and the free ends are sharpened at angles of 60 ° from the center to the outside, and between them is a compression screw - a self-tapping screw having a spherical head with a cross-shaped slot and a thread with a pitch of 5 mm , at the other end of the plate at an equal distance there are 3-5 holes for cortical screws (see US Pat. RU No. 2225181, IPC А61В 17/78, publ. 03/10/2004, No. 7).

The disadvantage of this fixator is that, for example, with pronounced osteosynthesis of the femoral neck, the design is not always a reliable fixator, as well as long-term reposition of the femur and, accordingly, surgery.

Disclosure of invention

The objective of the present invention is to develop a ruler-template for performing the operation of blockable intramedullary osteosynthesis in pertrochanteric fractures of the femur, which has a decrease in the time for repositioning the femur and performing the operation, increasing the strength, axial and end stability and reliability of osteosynthesis.

The technical result, which can be achieved with the help of the present invention, is reduced to a decrease in the time for the reduction of the femur and the performance of the operation, an increase in strength, axial and end stability and reliability of osteosynthesis.

The technical result is achieved using a ruler - a template for performing the operation of blocked intramedullary osteosynthesis in pertrochanteric fractures of the femur, consisting of a leg, a central part and a shoulder, and at the end of the leg, at an equal distance, there are 3-5 rows of holes for the selection of the rod, which differs in that that the leg, the central part and the shoulder are made in the form of a single side-curved plate with a thickness of 2 mm, and the bending to the side of the plate exactly repeats the anatomical bend of the femur and corresponds to the cervical-diaphyseal angle equal to 130 °, and graduated markings are applied to the shoulder, at the same time, the leg has a length of 154 mm and, departing from the central part, tapers to a cone, and in the lower part of the leg, 3-5 rows of holes have a size from 9 to 11 mm, to determine the diameter of the femoral canal and select a rod of the appropriate diameter, while in the central part of the ruler - the template has a crosshair at an angle of 130 °, which is made with the ability to position positioning it exactly in the center of the femur in accordance with the trabecular lines.

Thus, the implementation of a template ruler for performing the operation of blocked intramedullary osteosynthesis in pertrochanteric fractures of the femur, consisting of a leg, a central part and a shoulder, with a graduated marking applied to the shoulder and made in the form of a single 2 mm thick plate curved to the side, while the bend to the side of the plate exactly repeats the anatomical bend of the femur and corresponds to the cervical - diaphyseal angle equal to 130 °, while the leg is 154 mm long and, departing from the central part, tapers to a cone, and in the lower part of the leg, at least 3 -5 rows of holes have a size from 9 mm to 11 mm, to determine the diameter of the femoral canal and select a rod of the corresponding diameter, while in the central part of the ruler - the template has a cross at an angle of 130 °, which is made with the ability to position it exactly in the center of the femur bones in accordance with the trabecular lines allows you to achieve the set technical result.

Brief description of drawings and other materials

The drawing shows a ruler-template for performing the operation of blocked intramedullary osteosynthesis in pertrochanteric fractures of the femur, general view.

Implementation of the invention

The template ruler for performing the operation of blocked intramedullary osteosynthesis in pertrochanteric fractures of the femur consists of a leg 1, a central part 2 and an arm 3, made in the form of a plate curved to the side (not indicated in the drawing), 2 mm thick with graduated markings applied on the shoulder 3 4, and the leg 1, the central part 2 and the shoulder 3 are made in the form of a single plate bent to the side, and the bending to the side of the plate exactly repeats the anatomical bend of the femur (not shown in the drawing) and corresponds to the cervical-diaphyseal angle equal to 130 ° , while the leg 1 has a length of 154 mm and, departing from the central part 2, tapers to a cone (not indicated in the drawing). This narrowing allows you to more accurately position the ruler - the template in the center of the femur at the time of measurement. In the lower part, the leg 1 has at least 3-5 rows of holes 5 from 9 mm to 11 mm - they serve to determine the diameter of the canal (not shown in the drawing) of the femur and select a rod (not indicated in the drawing) of the corresponding diameter. The overwhelming majority of manufacturers have a rod length of 240 mm and is standard, so no length measurement is required. In the central part 2 of the template ruler there is a cross 6 for positioning it exactly in the center of the femur in accordance with the trabecular lines. Crosshair 6 has an angle of 130 ° and is also used to accurately determine the cervical-diaphyseal angle during the reposition of the femur. When positioning the ruler - the template from the edge of the compact substance, the length of the cervical screw (not shown in the drawing) is measured, which is used for osteosynthesis of the femur.

In the shoulder there are 3 template rulers, graduated markings 4, applied to the central line 7 with a step of 5 mm. Most manufacturers of rods for blocked intramedullary osteosynthesis have just such a pitch in their screw size range. The selection of a screw of a suitable length is an important point in the osteosynthesis of the femur.

Examples of specific use of a ruler-template for performing an operation of blocked intramedullary osteosynthesis for pertrochanteric fractures of the femur.

Example 1. The patient is placed on a specialized orthopedic table, lying on his back, the lower limbs are fixed in holders. Before the start of the operation, the femur is repositioned, and the ruler - template allows you to shorten this stage, and also allows you to correctly select the size of the retainer before the operation, due to the fact that the ruler - template is made in the form of a 2 mm thick plate curved to the side and consists of a leg 1, central part 2 and shoulder 3, with graduated markings 4 applied to shoulder 3, while the bending to the side of the plate exactly repeats the anatomical bend of the femur and corresponds to the cervical-diaphyseal angle equal to 130 °, while the leg 1 has a length of 154 mm and, departing from the central part 2, tapers to a cone, the latter allows you to more accurately position the template ruler in the center of the femur at the time of measurement, and in the lower part of the leg 1 has at least 3-5 rows of holes 5 from 9 mm to 11 mm, which are used to determine the diameter of the femoral canal and select a rod of the appropriate diameter, since the length of the rod for the overwhelming majority of manufacturers is 240 mm and is I am standard, so no length measurement is required. In the central part 2 of the template ruler, the existing cross 6 positions it exactly in the center of the femur in accordance with the trabecular lines. The crosshair 6 has an angle of 130 °, which is also used to accurately determine the cervical-diaphyseal angle during the reduction of the femur. When positioning a ruler - a template from the edge of the compact substance, the length of the cervical screw used for osteosynthesis of the femur is measured. In the shoulder there are 3 template rulers, graduated markings 4, applied to the central line 7 with a step of 5 mm. The screw is selected, since the selection of a screw of a suitable length is an important point in the osteosynthesis of the femur. Reposition and measurements are performed with complete anesthesia of the patient and until the processing of the operating field, that is, not under sterile conditions. Reposition is performed with X-ray imaging with an electron-optical converter (EOC) in anteroposterior projection. The template ruler is placed on the anterior surface of the femur in the projection of the trochanteric zone. Reposition is performed by increasing or decreasing traction (traction along the axis of the limb), as well as adduction or abduction of the limb (not shown in the drawing). After setting the correct cervical-diaphyseal angle of the femur, the diameter of the femoral canal is measured using the leg 1 of the template ruler, this will allow you to select a rod of a suitable size. Using the shoulder 3 of the template ruler, determine the length of the cervical screw. The information obtained during the measurements is reported to the operating nurse (assistant), who by the time of the start of the operation is fully prepared and dressed in sterile operating clothes, and the sterile instrument is laid out on the operating table. The operator proceeds to prepare for the operation (hand treatment, change of clothes if necessary). The operating room nurse at this moment fixes the rod of the required size in the guide structure, and the cervical screw in a specialized screwdriver holder (not shown in the drawing).

Example 2. Patient M. 76 years old was injured as a result of falling on her right side. Hospitalized in the trauma department with a diagnosis of a closed pertrochanteric fracture of the right femur. A general clinical examination of the patient, prevention of pulmonary embolism was performed. On the third day from the moment of injury, a blocked intramedullary osteosynthesis of the femur was performed. The operation time was 45 minutes from the beginning of the introduction of anesthesia to the application of an aseptic dressing. The next day after the operation, the patient is activated - she walks with a walker without support on the injured leg. She was discharged in satisfactory condition for a further stage of treatment on the 7th day after the operation.

Example 3. Patient K., 38 years old, was injured as a result of falling from a height of 2.5 meters on his left side. He was admitted to the traumatology department with a diagnosis of a closed basi-cervical fracture of the neck of the right femur. A general clinical examination of the patient, prevention of pulmonary embolism was performed. On the third day from the moment of injury, a blocked intramedullary osteosynthesis of the femur was performed. The operation time was 45 minutes from the beginning of the introduction of anesthesia to the application of an aseptic dressing.

On the next day from the moment of the operation, the patient is activated - he walks with a walker without support on the injured leg. Was discharged in satisfactory condition for a further stage of treatment on the 5th day after the operation.

Example 4. Patient S., 45 years old, was injured as a result of an accident. She was admitted to the trauma department with a diagnosis of a closed subtrochanteric fracture of the right femur. A general clinical examination of the patient, prevention of pulmonary embolism was performed. On the third day from the moment of injury, a blocked intramedullary osteosynthesis of the femur was performed. The operation time was 50 minutes from the beginning of the administration of anesthesia to the application of an aseptic dressing. On the next day from the moment of the operation, the patient is activated - she walks with a walker without support on the injured leg. She was discharged in satisfactory condition for a further stage of treatment on the 7th day after the operation.

Thus, the proposed invention makes it possible to reduce the time for the reduction of the femur and perform the operation, to increase the strength, axial and end stability and reliability of osteosynthesis.

The proposed invention in comparison with the prototype and other known solutions has the following advantages:

- reducing the time for repositioning the femur and performing the operation;

- increased strength, axial and end stability;

- provides the possibility of minimally invasive fixation of a fracture with early callus formation in extracapsular fractures, permanent compression due to sliding properties and convenience in the preliminary use of a template ruler.

Claims (1)

Ruler-template for performing the operation of blocked intramedullary osteosynthesis in pertrochanteric fractures of the femur, consisting of a leg, a central part and a shoulder, and at the end of the leg at an equal distance there are 3-5 rows of holes for the selection of the rod, characterized in that the leg, central part and the shoulder is made in the form of a single side-curved plate with a thickness of 2 mm, and the side bending of the plate exactly repeats the anatomical bend of the femur and corresponds to the cervico-shaft angle of 130 °, and the shoulder has a graduated marking, while the leg has a length of 154 mm and, departing from the central part, it tapers to a cone, and in the lower part of the leg, 3-5 rows of holes have a size from 9 to 11 mm to determine the diameter of the femoral canal and select a rod of the appropriate diameter, while there is a crosshair in the central part of the template ruler at an angle of 130 °, which is configured to position it exactly in the center of the femur in accordance associated with trabecular lines.

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