RU2781034C2 - Device for extra-focal osteosynthesis of hand bones - Google Patents

Abstract

FIELD: medical equipment.

SUBSTANCE: device relates to medical equipment, namely to devices used in traumatology and orthopedics. The device for extra-focal osteosynthesis of hand bones consists of a basic rod and rods transferred through hand bones outside a damaged area. On the basic rod, thread is cut, holes are drilled for transfer of rods transferred through hand bones, and nuts are put on for their clamp in holes by rotation of nuts.

EFFECT: use of the invention allows for provision of improvement of stability of fixation of fragments, and simplification of operative technology in open fractures of hand bones, accompanied by crushing and infection of soft tissues.

1 cl, 7 dwg

Description

Information taken into account.

1. O.A. Kaplunov. Transosseous osteosynthesis according to Ilizarov in traumatology and orthopedics. M. 2002 p. 12;

2. T.V. Revenko, V.A. Guryev, N.A. Gear. Operations for injuries of the musculoskeletal system. M. 1987 p. 110-117;

Z.V.A. Sokolov. Multiple and combined injuries. M. 2006 p. 118-126;

4.A.P. Chadaev, M.S. Alekseev, A.Sh. Garmaev. Treatment of open fractures and dislocations of the phalanges of the fingers, complicated by a purulent-inflammatory process. M.2005 p. eleven; 56-57

The device relates to medical technology, namely to devices used in traumatology and orthopedics.

Hand injuries account for 1/3 of all injuries of the musculoskeletal system (Chadaev A.P. et al. 2005). At the same time, open fractures and dislocations of the phalanges of the fingers range from 10 to 20%. Most often, open fractures are obtained by persons of working age from 50.8 to 85.6%. Disability in severe hand injuries ranges from 20 to 51.9%.

Given the complexity of the treatment of open fractures of the bones of the hand, especially in terms of restoring function due to its extreme importance for human life, a large number of external fixation devices have been proposed, as well as methods for fastening bones with metal structures of various modifications. (O.A. Kaplunov, 2002; T.A. Revenko, 1987; V.A. Sokolov, 2006)

The most commonly used fixation is percutaneously carried out with a needle along the axis of the phalanges of the fingers and metacarpal bones (T.A. Revenko, 1987). This method is effective in the absence of infection, but requires additional fixation with a plaster cast. The presence of the pin in the area of an open fracture can provoke and maintain infection in the wound.

The Ilizarov apparatus (O.A. Kaplunov, 2002), which is widely used on large segments of the limbs, has not been used on the hand due to the lack of developed devices.

Rod devices used to stabilize fractures of the humerus, femur, and tibia are distinguished by the complexity of fixation nodes, which, when used on the hand, the assembly of small parts leads to a lengthening of the operating time. (V.A. Sokolov, 2006)

Reliable fixation is provided by the Volkov-Oganesyan apparatus (A.P. Chadaev, 2005), however, the need to pass an axial pin through the damaged area excludes the possibility of its use in conditions of an infected fracture or dislocation.

Reliable fixation of the phalanges of the fingers can be achieved with the Lazarev-Korshunov distraction apparatus. Design features include the use only on the phalanges of the fingers, its use is impossible with fractures of the metacarpal bones, as well as with combinations of fractures of the phalanges of the fingers and metacarpal bones and multiple fractures of the bones of the hand. (A.P. Chadaev, 2005, p. 56, fig. 48, 49.)

A more effective apparatus is known, used for fractures and dislocations in the metacarpophalangeal joints (V.A. Chadaev, 2006, p. 56, Fig. 50, 51), which allows traction for the nail plate and be able to regulate it (prototype) .

This device is taken as a prototype, since it is used not only for fractures of the phalanges of the fingers, but also for fractures of the metacarpal bones.

Criticism of the prototype. 1. The device is a complex technical structure, consisting of an arch for the hand, connecting rods, hinges, an arch for the distal phalanx of the finger. The installation of such a structure during the operation seems to be a complex and lengthy process, prolonging the operation time.

2. The presence of one spoke on the supports creates instability, migration occurs, and contributes to infection of the spoke wounds.

3. The presence of a three-dimensional structure on the hand complicates the work of the surgeon in restoring integumentary tissues and manipulating the wound.

4. The use of this device is technically impossible for multiple fractures of the bones of the hand.

The purpose of the invention is to improve the stability of the fixation of fragments and simplify the surgical technique for open fractures of the bones of the hand, accompanied by crushing and infection of soft tissues.

The essence of the invention. This goal is achieved by using a device (Fig. 1) (Fig. 2), consisting of a base rod (1) on which a thread (2) is cut, nuts (3) are put on, holes (4) for rods (5) are drilled all over introduced into the bone (6) through the holes (4) and fixed by rotating the nuts (3) to the stop, while fixing the pins is achieved, which is transmitted to the fragments (7), which are stabilized. The passage of the rods (5) in an oblique direction does not worsen, but rather enhances the degree of stability, it is not necessary to achieve the mathematical accuracy of the perpendiculars when passing the rods.

Brief description of the drawings.

On the drawings:

In FIG. 1 shows a base rod (1) with reamed holes along its length (4) and a thread (2). Nut of appropriate dimensions (3). The rods inserted into the bone (5) have a sharpening at the end in the form of a triangular sharpening or spear-shaped sharpening.

In FIG. 2 shows the ratio of the device for extrafocal osteosynthesis of the bones of the hand with the bone. The rods (5) pass through the base rod and through the bones (6) outside the fracture zone (7), are fixed by rotating the nuts (3), thus stabilizing the fragments in the achieved reduction position.

In FIG. 3 shows a radiograph of a hand with a comminuted fracture of the 3rd metacarpal bone with a fixed, axial pin passing through the fracture zone. In closed fractures this may not matter, but in open fractures it may be the basis for the onset and maintenance of infection.

In FIG. 4 - purulent necrotic wound of the hand with a needle protruding above the skin, passing through the fracture zone and supporting the infection. Tendons and bone fragments are exposed, they are involved in the purulent process. Further stay of the needle threatens the development of osteomyelitis, tendon necrosis, dysfunction of the hand.

In FIG. 5 shows the state of the hand after secondary surgical treatment of the wound and osteosynthesis with a device for extrafocal osteosynthesis of the bones of the hand. Bone and tendons are closed by moving flaps and free skin grafting. Fragments are stabilized.

In FIG. 6 shows a radiograph of the hand, where the stabilization of fragments was achieved using a device for extrafocal osteosynthesis of the bones of the hand.

In FIG. 7 shows wound healing without additional complications before removal of the device for extrafocal osteosynthesis of the bones of the hand.

An example of clinical use.

Patient A.D. 45 years old, injured while working as a grinder. Upon admission, the primary surgical treatment of the wound was performed, the fragments were fixed with an axial pin, which passes in the fracture zone (Fig. 3), necrosis of the wound edges and suppuration occurred (Fig. 4). Produced secondary surgical treatment of the wound, the pin in the fracture zone is removed, the fragments are fixed by the proposed device (Fig. 5). The design does not interfere with wound closure. The wound was closed by tissue transfer and free skin grafting. Saved reposition of fragments (Fig. 6). Wound healing achieved (Fig. 7)

Features of the invention, distinguishing from the prototype.

The design features (distinguishing features from the prototype) of the device for extrafocal osteosynthesis of the hand bones are:

- the presence of a basic threaded rod with holes and nuts drilled in it throughout the entire length.

- fixing rods are passed through the holes in the threaded rod into the bone.

- fragments are stabilized by rotating the nuts by pressing the rods to the edges of the hole.

Technical result. Advantages over the prototype.

- Ease of use.

- Stabilization of rods and fragments is achieved with one turn of the nut.

- Compact design allows you to work freely with soft tissues.

- In the event of unforeseen circumstances, it is possible to remove existing rods and install them through other holes.

- The device allows you to eliminate the source of infection in the wound and at the same time stabilize the fragments, which significantly improves the results of treatment and reduces the rehabilitation period.

Claims (1)

A device for extrafocal osteosynthesis of the hand bones, consisting of a base rod and rods passed through the bones of the hand outside the area of damage, moreover, threads are cut on the base rod, holes are drilled for passing the rods through the bones of the hand, and nuts are put on to clamp them in the holes by rotation nuts.

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