RU2804187C1 - Method for reposition and fixation of bones in repeated fractures of clavicle in children with repeated fractures of clavicle with closed medullar canal in fracture area - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention is related to surgery and traumatology, and can be used for repositioning and fixing bones in case of repeated fractures of the clavicle in children with repeated fractures of the clavicle with a closed medullary canal in the fracture zone. The method involves exposing clavicle fragments, eliminating interposition and scar tissue in the fracture zone. The medullary canal of the clavicle is formed using a milling cutter. The needle is passed through the medullary canal. The proximal end of the wire is brought out through the cortical layer of the sternal end of the clavicle and bent at an angle of 90°. The distal end of the wire is brought out through the acromial end of the clavicle. Traction is applied along the longitudinal axis, and then the end of the knitting needle is bent in the same plane in the opposite direction at an angle of 90°, giving the spoke a Z-shape. After comparing the fragments, the wound is sutured in layers.

EFFECT: proposed method ensures a reduction in trauma and postoperative complications due to the peculiarities of reposition and fixation.

1 cl, 5 dwg, 2 ex

Description

Field of technology.

The invention relates to medicine, namely to surgery, traumatology and orthopedics, and can be used in the reposition of repeated clavicle fractures in children with a closed medullary canal in the fracture zone.

State of the art.

Optimization of the treatment process in patients with orthopedic-traumatological pathology complicated and uncomplicated purulent infection, development of new pathogenetically substantiated (expedient) methods of surgical treatment aimed at comprehensive restoration of the anatomical and functional state of the limb, general homeostasis and persistent suppression of purulent-inflammatory phenomena are urgent tasks of modern times. traumatology and orthopedics.

From the existing level of technology, a method is known for treating clavicle fractures using transosseous osteosynthesis, which includes passing through both cortical layers from 2 to 3 wires through the central fragment and from 2 to 3 wires through the peripheral fragment, fixing the wires using pin fixators on 1 or 2 threaded rods. In this case, an open reposition of the fragments is performed and they are fixed with a knitting needle, 2 to 3 knitting needles with a diameter of 1.5 mm are inserted into each fragment at an angle of 45° to the axis of the clavicle, the knitting needles are fixed using clamps directly above the skin, the free part of the knitting needle is bent at an angle of 45° (Patent RU 2281052 RF A 61 B 17/60, 2006).

This method is traumatic in children, not convenient to use, it is difficult to eliminate diastasis of interosseous fragments and various postoperative complications are possible.

The closest in technical essence to the claimed method is a method for repositioning old clavicle fractures, which includes exposing fragments of the clavicle, eliminating interposition and scar tissue in the fracture zone; drilling out the medullary canal and passing a metal rod through it. Before drilling out the bone marrow canal for old clavicle fractures, a single-tooth hook is placed under the acromial end of the clavicle and a dosed load is applied for 1-2 minutes (RF Patent RU 2241403 A61B 17/56, published 12/10/2006).

This method is traumatic in children, not convenient to use, it is difficult to eliminate diastasis of interosseous fragments and various postoperative complications are possible.

Thus, it is important to create a method for repositioning and fixing bones in case of repeated fractures of the clavicle, which reduces the traumatic nature of the operation and reduces postoperative complications.

The essence of the invention.

The technical result consists in expanding the arsenal of methods for fixing bone fragments in case of repeated fractures of the clavicle in children, while ensuring that the traumatic nature of the operation is reduced and the risk of postoperative complications is reduced.

The technical result is achieved by the fact that in the method of repositioning and fixing bones during repeated fractures of the clavicle in children with repeated fractures of the clavicle, when the bone canal of the clavicle fragments is closed, including exposure of the clavicle fragments, elimination of interposition and scar tissue in the fracture zone, a bone marrow is formed canal of the clavicle using a milling cutter, pass the pin through the medullary canal, the proximal end of the pin is brought out from the cortical part and bent at an angle, the distal end of the pin is brought out through the acromial end of the clavicle, traction is carried out along the longitudinal axis, and then the end of the pin is bent in the opposite direction at an angle, giving the wire a Z-shape, after comparing the fragments, the wound is sutured in layers.

The invention is illustrated by diagrams:

Fig. 1 - diagram of a clavicle with a fracture and displacement of fragments;

Fig. 2 - diagram of the clavicle; a pin is installed; the pin is passed through the bone marrow canal, connecting the fragments;

Fig. 3 - diagram of the clavicle, the proximal end of the needle is curved;

Fig. 4 - diagram of the clavicle, the distal end of the wire is brought out through the acromial end of the clavicle, traction is applied to the distal end of the wire, the distal end of the wire is curved;

Fig. 5 - radiograph of the clavicle, the spoke is visible.

In fig. 1-5 indicated:

1 - Fragment of the clavicle;

2 - Fragment of the clavicle;

3 - Spoke;

4 - Distal end of the wire;

5 - Proximal end of the wire.

Implementation of the invention.

In children with repeated fractures of the clavicle, when the bone canal of fragments 1 and 2 of the clavicle is closed (Fig. 1), after exposing the clavicle, eliminating the interposition and removing scar tissue in the fracture zone, the bone marrow canal of the clavicle is formed with a milling cutter, and wire 3 is passed through the bone marrow. brain canal (Fig. 2), its proximal end 5 is removed from the cortical part and bent at an angle (Fig. 3), its distal 4 end is brought out through the acromial end of the clavicle, then traction is carried out by the distal end 4 of the spokes 3 along the axis of the clavicle, after then it is bent in the opposite direction at an angle (Fig. 4), that is, a “Z”-shaped fixation of the fragments is performed. The wound is sutured in layers.

The technical result consists in expanding the arsenal of methods for fixing bone fragments in case of repeated clavicle fractures in children.

An example of the method.

Patient M., 14 years old, refracture of the middle third of the right clavicle with displacement of bone fragments (Fig. 5). In the operating room, under general anesthesia, the patient underwent repositioning of the bone fragments of the clavicle, during which open access was made to the fracture zone of the clavicle, its fragments were exposed, the bone canal of the clavicle fragments was opened with a drill, the interposition was eliminated and scar tissue was removed in the fracture zone, then a pin was passed through the bone -brain canal, its proximal end was brought out from the cortical part of the clavicle and bent at an angle in the proximal direction, and the other distal end was brought out through the acromial end of the clavicle, traction was carried out along the axis of the clavicle, then it was bent in the opposite direction at an angle, distally, that is, “Z” - shaped fixation of fragments (Fig. 4). The ends of the needle were immersed under the skin. The wound was removed in layers. The pin was removed 1.5 months after surgery and development of the limb began.

Under general anesthesia, the patient is given open access to the area of the clavicle fracture, its fragments 1 and 2 are exposed, the bone canal of fragments 1 and 2 of the clavicle is opened, through incisions of no more than 2-3 cm, which ensures a reduction in the trauma of the operation and a reduction in postoperative complications. Next, the interposition is eliminated and scar tissue is removed in the fracture zone, then the wire is passed through the bone marrow canal (Fig. 2), its proximal end is removed from the cortical part of the clavicle and bent (Fig. 3), and the other distal end is brought out through the acromial end of the clavicle , carry out traction along the axis, then bend in the opposite direction at an angle (Fig. 4), that is, they produce a “Z”-shaped fixation of the fragments. After comparing the fragments, the wound is sutured in layers.

The pin is removed 1.5 - 2.0 months after surgery and development of the limb begins.

The method allows you to eliminate displacement of bone fragments simultaneously.

The method allows for dosed compression and elimination of diastasis between bone fragments.

“Z”-shaped fixation of fragments eliminates repeated displacement of bone fragments and prevents the occurrence of complications.

Example 2. Patient A., born in 2003, (Ib. No. 1362). Admitted on June 14, 2018 (discharged on June 21, 2018) with a diagnosis of “Old clavicle fracture (refracture of the middle third of the right clavicle with displacement of bone fragments).”

On June 18, 2018, the patient underwent repositioning of chronic clavicle fractures, during which fragments of the clavicle were exposed, interposition and scar tissue in the fracture zone were eliminated, and a wire was passed through the bone marrow canal, its proximal end was removed from the cortical part of the clavicle and bent at an angle of 90°, the other the end is brought out through the acromial end of the clavicle, then traction is applied along the axis, the pin is bent in the same plane in the opposite direction at an angle of 90°, that is, “Z”-shaped fixation of the fragments is performed, after comparing the fragments, the wound is sutured in layers. The needle is removed after 1.5 - 2.0 months and development of the limb begins. Using the proposed method, 21 operations were performed, as a result of which good results were achieved, without the usual injuries and complications of this kind.

The method is simple to implement, accessible, reduces the development of complications and can be widely used in traumatological practice in childhood.

Claims (1)

A method for repositioning and fixing bones in case of repeated fractures of the clavicle in children with repeated fractures of the clavicle with a closed medullary canal in the fracture zone, including exposure of fragments of the clavicle, elimination of interposition and scar tissue in the fracture zone, characterized in that the medullary canal of the clavicle is formed with a cutter, a needle is passed through bone marrow canal, the proximal end of the wire is brought out through the cortical layer of the sternal end of the clavicle and bent at an angle of 90°, the distal end of the wire is brought out through the acromial end of the clavicle, traction is carried out along the longitudinal axis, and then the end of the wire is bent in the same plane in the opposite direction at an angle of 90 °, giving the needle a Z-shape, after comparing the fragments, the wound is sutured in layers.