RU2746973C1 - Device for fixing schanz and steinmann pins - Google Patents

Abstract

FIELD: medical equipment.

SUBSTANCE: invention relates to medical equipment and namely to devices used in traumatology and orthopedics. The device for screwing Sсhanz or Steinmann pins into the bone consists of parts of the Ilizarov apparatus and namely of a threaded sleeve, a threaded rod, a bolt, and nuts. The cross bore of the coupling is intended for Schanz or Steinmann pins. Both ends of the threaded sleeve are designed to accommodate the threaded rod and threaded shank of the bolt. There is a possibility of clockwise rotation of the threaded rod and/or the threaded shank for pressing and blocking the Schanz or Steinmann pins in a given position with the end surface of the threaded rod and additionally the threaded shank of the bolt.

EFFECT: increased efficiency and reduced terms of treatment of patients requiring osteosynthesis using Schanz or Steinmann pins.

1 cl, 2 dwg

Description

The device belongs to medical equipment, namely to instruments used in operative orthopedics and traumatology.

Relevance. In the treatment of fractures and pseudarthrosis of bones, osteosynthesis is performed - an operation to achieve reduction and fixation of bone fragments. In this case, the role of provisional callus is played by the corresponding metal structures that perform the function of periosteal and endosteal callus. The absence or loss of stability of osteosynthesis is a consequence of both the imperfection of the metal structures and the technique of the operation, and the absence of adequate conditions for the normal course of reparative osteogenesis. Therefore, during osteosynthesis, a balance must be maintained between the mechanical and biological conditions of fracture healing, which directly depends on the instrumentation, the quality of the metal structures used and the atraumatic nature of the surgical technique of intervention.

Analogs

In modern surgical traumatology and orthopedics, a wide range of implants for atraumatic minimally invasive osteosynthesis and the instruments necessary for their application are used. As intraosseous implants for fixing fractures, screws, plates, pins, rods, nails, external fixation devices (AVF) and wire cerclage are used. To reposition bone fragments during the operation, use AVF, distractors, repositioning forceps, joysticks - Shants screws with special removable handles.

Criticism of analogues

A common disadvantage of all the analogs given is the narrow focus and specificity of each of them with the need for a wide inventory of auxiliary tools.

Prototype

As a prototype device, we have chosen a control knob or a joystick for repositioning bone fragments (Ankin LN, Ankin NL Practical traumatology. European standards of diagnosis and treatment - M .: Kniga-plus, 2002. - 480 p; - S. 58 - 74; - prototype device), used in closed intramedullary osteosynthesis of long bones, such as the femur. The essence and application of this prototype device are as follows. The patient lies on the operating table on a healthy side with the injured limb bent at the knee joint at an angle of 100 degrees. Reposition of bone fragments is performed using devices of an orthopedic table, distractor, AVF, or Shants' rods, which are inserted into the bone fragments and used as control knobs - joysticks (Fig. 1). When bone fragments are repositioned, the Shants 'rods should be placed as close to the fracture as possible: the Shants' rod is inserted into the proximal fragment monocortically, and into the distal fragment, bicortically. Then, with the help of two T-shaped handles, the bone fragments are repositioned under the control of an image intensifier (image intensifier). After reduction, closed intramedullary osteosynthesis with locking rods is performed, and Shants rods with joysticks are removed. Criticism of the prototype

T-shaped handles for Shants rods used as joysticks have the following disadvantages:

- the problematic nature of the search and the complexity of manufacturing this device, which is not included in the register of traditionally used instruments in operative orthopedics and traumatology;

- the massiveness of the joystick with a relatively small T-shaped handle for the Shants rod, which causes low handling properties and insufficient efficiency of the prototype;

- too narrow focus and specialization of joysticks with limited indications for their use.

The purpose of the invention is to improve the efficiency of treatment of patients with skeletal fractures by optimizing open and closed intramedullary and extrafocal osteosynthesis with rod devices for external fixation.

The essence of the invention

A device (Fig. 2) is proposed for fixing Shants' rods (pos. 1) or Steinman, which is a knob and is characterized in that it consists of parts of a standard set of the Ilizarov apparatus, namely: a threaded sleeve (pos. 2), a threaded rod ( pos. 3), bolt (pos. 4), nuts (pos. 5), brackets (pos. 6), and dies (pos. 7). In this case, the clamping and fixing of the Shants or Steinman rods is carried out by introducing them into the transverse hole of the threaded sleeve (pos. 2), into both ends of which a threaded rod (pos. 3) and the threaded shank of the bolt (pos. 4) are inserted, by turning one of which or both clockwise fix the Shantz rods (pos. 1) or Steinman in the transverse hole of the threaded coupling (pos. 2) by pressing and blocking them in a given position with the end surface of the threaded rod (pos. 3) or the threaded rod (pos. 3) and additionally a threaded shank of the bolt (pos. 4), and the ram (pos. 7) provides better handling properties of the device with a convenient manual grip and an increase in the lever arm by the presence of a gap of 2.5 cm between it (pos. 7), on one side, and threaded rod (pos. 3), threaded sleeve (pos. 2), bolt (pos. 4) and nuts (pos. 5), on the other. Rotation of the threaded rod (pos. 3) is carried out with an open-end, cap (ring) or socket wrench 10 mm for two nuts (pos. 5), counter-locked ("locked"), namely - for the nut (pos. 5), located more peripherally (centrifugally) when turned clockwise. Unlocking the Shantz rod (pos. 1) or Steinman in the transverse hole of the threaded coupling (pos. 2) is performed by turning counterclockwise the counter-locked nuts (pos. 5), namely the more centripetally located nut, which is a seat for the open-end wrench. The degree of fixation of the Shantz rod (pos. 1) or Steinman by blocking the threaded rod (pos. 3) in the threaded sleeve (pos. 2) is, as a rule, sufficient to securely clamp the rod (pos. 1), however, if long-term intensive manipulations of the device are required , you can additionally block the Shants rod (pos. 1) or Steinman and the bolt (pos. 4) by turning it clockwise and pressing the Shants rod (pos. 1) with the end surface of its threaded shank, and unblocking by turning the bolt (pos. 4 ) counterclock-wise. After fixing the Shantz rod (pos. 1) or Steinman in the hole of the threaded sleeve (pos. 2), tighten the nuts (pos. 5) on both sides of both brackets (pos. 6) and on both sides of the threaded sleeve (pos. 2), than achieve the solidity of the Shants' rod (pos. 1) or Steinman and the device for their fixation.

Application example of the device

As an example of the application of this device for fixing the Shants and Steinman rods, we present the following observation. Patient R., 22 years old, was admitted on 03.03.2020 at the RCTO (Republican Center of Traumatology and Orthopedics) in Makhachkala after an accident with a diagnosis of Concomitant injury. Brain contusion of mild severity. Closed chest injury. Multiple fractures of the III-IX ribs of the right half of the chest along two lines with displacement and floating of the “rib panel”. Rupture of the right lung. Right-sided hemopneumothorax. Closed comminuted fracture of the bones of the middle third of the right tibia with displacement of fragments. Traumatic shock of II-III degree.

Against the background of intensive infusion-transfusion therapy, the operation was performed: Thoracocentesis according to Bulau on the right. In connection with the presence of multiple rib fractures along two or more lines and the floating of the "rib panel" with increasing symptoms of acute respiratory failure, indications for the emergency use of a device for restoring the frame of the chest were presented (patent for invention of the Russian Federation No. 2700257 dated 09/13/2019. ; authors: Guseinov A.G., Kadiev M.A.), for which an AVF was imposed on the chest using a device for fixing the Shants and Steinman rods as follows. The AVF was placed on the right half of the chest over the floating “rib panel” using three 4-mm Shants rods installed on both clavicles and the anterior superior spine of the right iliac bone. In this case, each of the Shants' rods was fixed in a device for fixing the Shants and Steinman rods, consisting of parts of the Ilizarov apparatus, namely: a threaded sleeve, a threaded rod, a bolt, nuts, brackets and a die. In this case, the clamping and fixation of each of the Shants' rods was sequentially performed by introducing them into the transverse hole of the threaded sleeve, into both ends of which the threaded rod and the threaded shank of the bolt were introduced. By turning the threaded rod clockwise, each of the three Shants rods was fixed in the transverse hole of the threaded coupling by pressing and blocking them in a given position with the end surface of the threaded rod, and the die provided the best manipulation properties of the device with a convenient manual grip and an increase in the lever arm by the presence of a gap in 2.5 cm between it, on the one hand, and the threaded rod, threaded sleeve, bolt and nuts, on the other. The threaded rod was rotated with a 10 mm socket wrench for a peripheral nut of two counter-locked nuts clockwise. Blocking was provided by pressing the end surface of the threaded rod, and unlocking was performed by turning the threaded rod counterclockwise - with an open-end wrench for a centripetally located nut, which is a seat for an open-end wrench, from two counter-locked nuts. Shants rods were inserted into the middle third of both clavicles and the anterior superior spine of the right iliac bone after preliminary formation of the intraosseous canals with a drill with a drill, 3.2 mm in diameter. A Stryker AVF with radiolucent (carbon) rods was imposed, mounted in the form of a triangle. Then 4 curved Kirschner wires, 1.5 mm in diameter, were successively implanted into the soft tissues of the chest over the area of the floating "rib panel", and the end of each subsequent wire was inserted under the middle part of the previous one, which provided mutual interconnection of the wires. The supracutaneous segments of the wires implanted into the soft tissues were tied together with a cerclage wire, and the annular end of the first wire was fixed in moderate tension (within 1.5 kg) to the AVF frame over the fenestrated rib fracture with the help of parts of the Ilizarov apparatus. This provided the creation of negative pressure in the pleural cavity during inspiration and expansion of the lung with relief of gross disorders of respiratory biomechanics. A distractor consisting of two semi-rings of the Ilizarov apparatus was placed on the right tibia, converted on 03/06/2020 into anterograde intramedullary osteosynthesis of the tibia with a lockable nail. The result of the treatment was assessed by us as good.

Features of the invention that differ from the prototype

The design features (distinguishing features from the prototype) of the device for fixing the Shants and Steinman rods are as follows:

- the device is a knob for fixing the Shants or Steinman rods;

- the device consists of parts of a standard set of the Ilizarov apparatus, namely: a threaded sleeve, a threaded rod (60 mm), a bolt (40 mm), nuts, brackets (30 mm) and a die (82 mm);

- clamping and fixing the Shants or Steinman rod is carried out by introducing them into the transverse hole of the threaded sleeve, into both ends of which a threaded rod and a threaded shank of the bolt are introduced, by turning one or both of them clockwise, the Shants or Steinman rods are fixed in the transverse hole of the threaded sleeve;

- clamping and fixing of the Shants or Steinman rod is provided by pressing and blocking them in a given position with the end surface of the threaded rod or threaded rod and additionally the threaded shank of the bolt - by turning them clockwise;

- after fixing the Shantz or Steinman rod in the hole of the threaded sleeve, tighten the nuts on both sides of both brackets and on both sides of the threaded sleeve, thereby achieving the solidity of the Shantz or Steinman rod and the device for their fixation;

- the die (pos. 7) provides the volumetric handle of the device with a convenient manual grip and an increase in the lever arm by the presence of a gap between it on one side and the threaded rod (pos. 3), the threaded sleeve (pos. 2), the bolt (pos. 4) and nuts (item 5), on the other;

- turn the threaded rod (pos. 3) with a 10 mm wrench - open-end, ring (ring) or socket, - for two nuts (pos. 5), counter-locked ("locked") with two keys, namely - for more a peripherally, centrifugally located nut when turning clockwise and behind another, centripetally located, nut when turning counterclockwise;

- this blocking of the Shanz rod (pos. 1) or Steinman by the threaded rod (pos. 3), as a rule, is sufficient to securely clamp it in the threaded sleeve (pos. 2), however, if necessary, you can additionally block the Shantz rod (pos. 1 ) or Steinman by turning clockwise and the bolt (pos. 4) pressing the Shants rod (pos. 1) or Steinman by the end surface of the threaded shank of the bolt, and unblocking by turning the bolt counterclockwise;

- clamping of the Shantz rod (pos. 1) or Steinman is possible at any rod level. The technical result (advantages over the prototype) of the device for fixing the Shants and Steinman rods:

- the versatility of the device, due to the possibility of using it in different operations and on different segments and levels of tubular bones with a wide range of acceptability and indications for the use of the device - both for attaching the Shants and Steinman rods and screwing them into the bone during the installation of the rod AVF, and for manipulating them when used as a joystick for intramedullary osteosynthesis, as well as for manual osteoperforation;

- efficiency, speed and simplicity of manufacturing the device, parts for which are usually available in any orthopedic and trauma department;

- the device provides a simple, quick and reliable clamping and fixation of the Shants or Steinman rod by inserting them into the transverse hole of the threaded sleeve and turning the threaded rod clockwise;

- this blocking of the Shantz or Steinman rod by the threaded rod is usually sufficient to securely clamp it in the threaded sleeve, however, if necessary, you can additionally block the Shantz or Steinman rod by turning clockwise and the bolt;

- after fixing the Shantz or Steinman rod in the hole of the threaded sleeve, by tightening the nuts on both sides of both brackets and on both sides of the threaded sleeve, the solidity of the Shantz or Steinman rod and the device for their fixation are achieved;

- the possibility of adjusting the clamping level and dosing the fixing force of the Shantz or Steinman rod contributes to an increase in the manipulation properties of the device;

- the best manipulative properties of the device with a comfortable manual grip and an increase in the lever arm by the presence of a gap of 2.5 cm between the die, on the one hand, and the threaded rod, threaded sleeve, bolt and nuts, on the other, provide the rationality of the surgeon's efforts due to a convenient manual grip a volumetric cruciform handle with a lower load per unit area of the surgeon's hand and without the need for his excessive efforts with dulling of the "muscle sense";

- ergonomics, a significant reduction in the labor intensity and duration of surgery, due to the best manipulation properties of the device;

- compact design, comfort and high efficiency of the device during the osteosynthesis operation, due to the quickness and ease of fixing the Shants and Steinman rods in the device and unlocking and removing them.

Thus, the proposed device makes it possible to increase the efficiency of treatment of orthopedic and traumatological patients requiring osteosynthesis using Shants and Steinman rods.

Claims (1)

A device for screwing Shantz or Steinman rods into the bone, characterized in that it consists of parts of the Ilizarov apparatus, namely: a threaded sleeve, a threaded rod, a bolt, nuts, the transverse hole of the coupling is intended for Shantz or Steinman rods, both ends of the threaded sleeve are intended for introducing a threaded rod and a threaded shank of a bolt, while there is a possibility of clockwise rotation of a threaded rod and / or a threaded shank for pressing and blocking the Shants or Steinman rods in a given position with the end surface of the threaded rod and additionally a threaded shank of the bolt.

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