RU2742192C1 - Method for surgical treatment of complex, multicomponent deformations of forearm bones in children with underlying exosteal chondrodysplasia - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to traumatology and orthopedics, and can be used for surgical treatment of complex, multicomponent deformations of forearm bones in children on the background of exostosis chondrodysplasia. An osteotomy of the radial bone is performed at the top of the deformation to form a flap. A wire is retrograde intra-canalally in the correction position, the proximal end of the wire is bent in the form of a hook on which an allogeneity pad for an additional support is inserted. That is followed by osteotomy of the ulna and forming a flap. A wire, a proximal end, which is brought out onto the skin and bent in the form of a hook, is retrograde intra-canally in the deformation correction position. Wounds are closed in layers. An external fixation apparatus is installed, wherein two rods are inserted into a proximal segment of the ulnar bone, and two rods - into a distal fragment, as well as two rods - into the distal radius. Rods are fixed in external fixation apparatus.

EFFECT: method enables single-stage elimination of all deformation components, namely: dislocation of a radial head, shortening of forearm bones and deformation in three planes, due to a set of methods of the declared invention.

1 cl, 1 ex, 8 dwg

Description

The invention relates to medicine, namely to orthopedics.

A known method of treating ulnar clubhand with the presence of dislocation of the radial head [dis. Cand. honey. Sciences., Tsybanov A.S., 2004, 123-124 pp.]. This method consists in the fact that two crossing Kirschner wires are passed through the proximal metaphysis of the ulna, two crossing wires are passed through the distal metaphysis of the ulna. Two needles are passed through the middle third of the radius. The Ilizarov apparatus of three rings is being mounted. Osteotomy of the ulna is performed through exostosis in the distal metaphysis. The method of distraction osteosynthesis is used to lengthen the ulna and bring the radius down to restore the length of the ulna and eliminate the dislocation of the radial head.

The disadvantage of this method is:

- The multistage nature of the method, in which the length of the limb is restored, but the deformation of the forearm is not eliminated;

- Not eliminated deformity of the forearm contributes to a more pronounced limitation of movements.

A known method of treatment of ulnar clubhand with a combination of dislocation of the radial head with deformation of the radius [dis. Cand. honey. Sciences., Tsybanov A.S., 2004, 124-125 p.]. This method consists in the fact that an oblique osteotomy of the forearm bones is performed at the apex of the curvature, the axis of the radial bone is restored, in the position of correction, the osteosynthesis of the fragments of the radius is performed with two wires drawn in the opposite direction with support pads. Two crossing Kirschner wires are passed through the proximal and distal metaphysis of the ulna. The method of distraction osteosynthesis is used to lengthen the ulna and bring down the radius until the dislocation of the radial head is eliminated.

The disadvantages of this known method are as follows:

- the implementation of this method can cause a slow fusion of bone fragments and, accordingly, contribute to a longer wearing of the Ilizarov apparatus;

- the method is suitable for eliminating unexpressed deformations with minor functional limitations.

To eliminate the torsional deformation of the forearm bones, the known method proposed by V.L. Andrianov [1988]. This method is used for congenital radioulnar synostosis and consists in the fact that in the area of the proximal third of the forearm along the projection line of the radius, an oval incision of 3.0-3.5 cm is made. The proximal end of the radius is isolated in the place of its transition into synostosis, and resection is performed diaphysis throughout. The wound is sutured tightly in layers. 2 wires are passed in a cross direction through the proximal end of the ulna and the distal metaphysis of the radius. The needles are reinforced in two rings of the rotary apparatus. On the third day after the operation, dosed elimination of the forearm to the middle position begins.

The disadvantages of this method are that:

- the known method provides for the elimination of the incorrect position of the forearm and hand, but does not provide elimination of deformation and shortening of the limb.

A known method for the treatment of congenital radioulnar synostosis by the method of Galeazzi modified by Nikiforova E.K. [Movshovich I.A. Operative Orthopedics: (A Guide for Physicians). - 1983, p. 113-114].

This method consists in the fact that an incision is made along the posterolateral surface of the upper third of the forearm. The own fascia is dissected between the muscles, reaching the radius. The latter is exposed subperiosteally. The radius is resected downward from the synostosis for 3 cm. At the same time, the ulna is resected for 1 cm in the lower third. The wound is sutured tightly in layers. The forearm is brought out of the middle position and set to the middle position. Immobilization with a plaster cast.

The disadvantages of this method are:

- this method allows you to eliminate the incorrect position of the forearm, while the shortening of the limb remains;

- this method does not imply elimination of the deformation of the forearm.

The objective of the present invention is to eliminate complex (multicomponent) deformities of the bones of the forearm in one step.

The technical result of the task is achieved by the fact that in the method of surgical treatment of complex, multicomponent deformities of the bones of the forearm (in combination with dislocation of the radial head) intramedularly (through the ulna and radius, Kirschner wires are passed (for the simultaneous elimination of all components of the deformity).

The method for correcting multiplanar deformities of the forearm bones is illustrated by the attached graphic materials, where:

Figure 1: Diagram of the operation in the frontal plane

Pos. 1 level of ulna osteotomy

Pos. 2 level of radial osteotomy

Figure 2: Scheme of the operation in the sagittal plane

Pos. 1 level of ulna osteotomy

Pos. 2 level of radial osteotomy

Figure 3: Diagram of the operation after deformity correction

Pos. 3 in-channel Kirschner wires

Pos. 4 performed osteotomy of the ulna

Pos. 5 performed osteotomy of the radius

Pos. 6 allograin platform

Pos. 7, the location of the transosseous elements (rods).

Figure 4: Clinical example: Patient R., 16 years old: Ds: Multiple exostous chondrodysplasia, Left-sided ulnar clubhand. Radial head dislocation: Radiographs of the left forearm in 2 projections (before treatment);

Figure 5: Clinical example: Patient R., 16 years old: Ds: Multiple exostous chondrodysplasia, Left-sided ulnar clubhand. Radial head dislocation: Computed tomography of the forearm (before treatment);

Figure 6: Clinical example: Patient R., 16 years old: Ds: Multiple exostous chondrodysplasia, Left-sided ulnar clubhand. Radial head dislocation: Radiographs of the forearm (intraoperatively):

Pos. 3 in-channel Kirschner wires

Pos. 4 performed osteotomy of the ulna

Pos. 5 performed osteotomy of the radius

Pos. 6 allograin platform

Figure 7: Clinical example: Patient R., 16 years old: Ds: Multiple exostous chondrodysplasia, Left-sided ulnar clubhand. Radial head dislocation: Radiographs of the left forearm (after treatment - removal of the AVF).

Figure 8: Clinical example: Patient R., 16 years old: Ds: Multiple exostous chondrodysplasia, Left-sided ulnar clubhand. Radial head dislocation: Computer tomogram of the left forearm (after treatment - removal of the AVF)).

The method of surgical treatment of complex, multicomponent deformities of the forearm bones is carried out as follows. In the operating room, first, the osteotomy of the radius is performed at the apex of the deformity with the formation of a flake using an oscillating saw and chisel. The axial wire is passed retrograde intracanal (in the correction position). The proximal end of the spoke is bent in the form of a hook, on which an allograft pad is placed for additional support. Then, with the help of an oscillating saw and chisel, a similar osteotomy of the ulna is performed with the formation of a flake. The axial wire is passed retrograde intracanal (in the position of deformity correction), the proximal end of the wire is brought out on the skin and bent in the form of a hook. The wounds were sutured in layers. Then the external fixation device is mounted: 2 rods are inserted into the proximal fragment of the ulna, 2 rods - into the distal fragment, and 2 rods - into the distal radius. The passed elements are fixed in the apparatus.

The positive effect of the proposed technical solution is: one-stage elimination of all components of the deformity (dislocation of the radial head, shortening of the forearm bones, deformity in three planes).

Claims (1)

A method of surgical treatment of complex, multicomponent deformities of the forearm bones in children against the background of exostous chondrodysplasia, including: performing osteotomy of the radius at the apex of the deformity with the formation of a flake; the needle is inserted retrograde intracanal in the correction position, the proximal end of the needle is bent in the form of a hook, on which an allograft platform is placed for additional support; osteotomy of the ulna is performed with the formation of a flake; retrograde intracanal in the position of deformity correction, a wire is drawn, the proximal end of which is brought out to the skin and bent in the form of a hook; the wounds are sutured in layers, then an external fixation device is installed, while two rods are passed into the proximal fragment of the ulna, and two rods - into the distal fragment, as well as two rods - into the distal radius, the rods are fixed in the external fixation device.

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