RU2754800C1 - Method for treatment of transcondylar fracture of the humerus in children and adolescents - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to traumatology and orthopedics, and can be used for the treatment of transcondylar fractures of the humerus in children. Reposition and fixation of fragments are performed. Fixation is performed with two intersecting spokes drawn in the frontal plane through the lateral epicondylic of the humerus. One spoke is removed from the outer, and the other from the inner cortical plate of the proximal fragment of the humerus.

EFFECT: provides reliable fixation of fragments and eliminates the risk of damage to the ulnar nerve due to the combination of techniques of the claimed invention.

1 cl, 5 dwg, 1 ex

Description

The invention relates to medicine, in particular to traumatology and orthopedics, and can be used in the treatment of patients with transcondylar fractures of the humerus in children and adolescents.

A known method of surgical treatment of a transcondylar fracture of the humerus with displacement in children and adolescents, in which the reposition of the transcondylar fracture of the humerus with displacement in children and adolescents is fixed with Kirschner wires, or injection needles [Traumatology of childhood G.A. Bairova, Leningrad. 1976]. The disadvantage of this method of treatment is the holding of the spokes in the area of the inner surface of the humerus, which can injure the ulnar nerve, and thereby cause irreversible consequences.

A known method for the treatment of transcondylar extensor fracture of the humerus in children [RF patent No. 2024246 A61B 17/56, publ. 12/15/1994], in which, after reposition of the fragments, a bandage is applied to the neck and wrist joint, fixing the forearm on the anterior surface of the chest in the position of flexion at the elbow joint at an acute angle. The forearm is fixed in the position of maximum pronation. The disadvantage of this method is the unstable fixation of the distal fragment of the humerus with the appearance of secondary displacement, especially after reducing the edema in the elbow joint. Elimination of the rotational displacement by fixing the forearm in the pronation position can also lead to displacement of the distal fragment of the humerus for the above reason. In addition, fixation in the pronation position can lead to additional postimmobilization contracture in the radioulnar joint as well.

The aim of the invention is to provide a method that allows to reduce the time of surgical intervention in the treatment of transcondylar fracture of the humerus in children, providing the possibility of early rehabilitation.

The essence of the invention consists in a set of essential features sufficient to achieve the desired technical result, which consists in the possibility of performing stable osteosynthesis of a transcondylar fracture of the humerus in children and adolescents, eliminating the risk of damage to the ulnar nerve.

The essence of the method of osteosynthesis of a transcondylar fracture of the humerus in children includes reduction and fixation. Fixation is performed with two crossing pins drawn in the frontal plane through the lateral epicondyle of the humerus. One wire is withdrawn from the outer, and the other - from the inner cortical plate of the proximal humerus fragment.

Passing two crossing wires through the lateral epicondyle of the humerus, one to the outer and the other to the inner, cortical plate of the proximal humerus fragment, provides reliable fixation of the fragments, and eliminates the risk of damage to the ulnar nerve.

The method is explained by the following illustrations, where:

Figure 1 shows a diagram of the passage of the needles through the epicondyle and the proximal fragment of the humerus;

In Fig.2, Fig.Z - radiographs of the humerus of the patient MA in frontal and lateral projections upon admission to treatment;

Figure 4, figure 5 - radiographs of the humerus of the patient MA in frontal and lateral projections for a period of 5 weeks after the operation.

The method is performed as follows.

Under general anesthesia, under aseptic conditions, a closed reduction of the humerus condyle is performed. Through the lateral surface of the humerus in the frontal plane, two crossing wires are passed into the region of the proximal fragment of the humerus. One

The wire is passed to the outer, and the other - to the inner cortical plate of the proximal humerus fragment, which allows you to reliably fix the position of the fragments relative to each other.

Clinical example

Patient M.A., born in 2010, was admitted to the pediatric department of GAUZ "RKB M3 RT" on 06.12.2018 with a diagnosis of Closed transcondylar fracture of the left humerus with displacement. The injury was received the day before admission: he fell while rolling down a hill. At the place of residence in the Central Regional Hospital, a diagnosis was made, a plaster cast was applied. On examination: pronounced edema, pain syndrome. On the roentgenogram: transcondylar fracture of the left humerus with displacement (Fig. 2).

Under general anesthesia, under aseptic conditions, the patient underwent a closed reduction of the humerus condyle. Through the lateral epicondyle of the humerus, in the frontal plane, two crossing wires were passed into the region of the proximal fragment of the humerus. One wire was removed from the outer, and the other - from the inner cortical plate of the proximal humerus fragment, which reliably fixed the position of the fragments relative to each other (Fig. 3). The postoperative period was uneventful. The patient was discharged on the third day for outpatient treatment at the local polyclinic. The needles were removed at 5 weeks. After completing the rehabilitation course, the range of motion in the elbow joint was fully restored.

Claims (1)

The method of osteosynthesis of a transcondylar fracture of the humerus in children, including the reduction and fixation of fragments, characterized in that the fixation is performed with two crossing pins drawn in the frontal plane through the lateral epicondyle of the humerus, one pin is withdrawn from the outer, and the other - from the inner cortical plate of the proximal fragment humerus.

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