RU33701U1 - Cantilever compression device for extrafocal osteosynthesis of comminuted fractures of the lower leg with Ilizarov apparatus - Google Patents

Description

THE CONSOLE COMPRESSING DEVICE FOR EXTRA-FOCAL OSTEOSYNTHESIS OF SQUARE FRACTURAL TERNAL FRACTURES BY THE ILIZAROV APPARATUS

The utility model relates to medical equipment, namely medical devices.

Extra focal osteosynthesis occupies an important place in orthopedics and

traumatology, being the Biii6opa method for fractures and false joints of the lower leg bones. This is due to the optimal combination of minimally invasive and atraumatic osteosynthesis operations with stable fixation of bone fragments and the ability to manipulate them throughout the entire period of wearing the Ilizarov apparatus (Gulnazarova S.V., 1986. 1993; Shevtsov V.I., Makushin V.D., Kuftyrev L. .M., 1994; Barabash A.A., Solomin L.N., 1995; Beidik O.V., 1996; Vazina I.R., Petrov S.V., 2001; Vvedensky S.P., Vvedensky P. .S., 2001; Ciuccarelli S., Cervellati S., Montanarl 6., 1989; Cibo S., 1992, etc.). However, osteosynthesis according to Ilizarov is not without drawbacks, which include frequent complications in the process of carrying out Kirschner spokes and the likelihood of subsequent development of inflammation of the soft tissues around them (Zakirov Yu.A., 1993; Golubev G.Sh., Veselov N.Ya., Krivets D.V., 1995 and others). So, during knitting needles, especially knitting needles with a thrust pad, it is far from always possible to be guided only by biomechanical expediency in the Ilizarov apparatus-limb segment system. Based on the specific local anatomical and topographic conditions in the fracture zone, one often has to deviate from the optimal level and direction of the needles, so as not to come into conflict with the neurovascular bundle

Object: utility model

Author: Huseynov Asadula Huseynovich

MPK7: A 61V 17/34

or not stitch a large mass of muscles with a knitting needle. The latter circumstance not only increases the risk of suppuration of soft tissues, but also minimizes such an important advantage of extra focal osteosynthesis as maintaining active movements in adjacent joints of a damaged limb. Meanwhile, holding a knitting needle with a thrust pad is often a necessary condition for a closed reposition of one or more fragments, especially if the latter are large, such as wedge-shaped fragments or fragments formed during bumper fractures of the type of butterfly that occur during auto-visits.

So, in order to eliminate the displacement of the bone fragment and adapt it to your own groove, you often have to carry out a fragment of a spoke with a persistent pad. However, together with the reproduction of the fragment to its bed, one or both bone fragments and soft tissues on the other side of the fragment are inevitably stitched with a knitting needle (Fig. 1}. This in itself is an unpleasant circumstance especially undesirable for comminuted fractures of the lower leg, since the topographic the peculiarity of this segment is the location of the tibia eccentric with respect to the soft tissues and the predominance of an array of muscles along its posterior side. ak back tone muscle groups prevail NDM front, promoting the adaptation of the fragment to his bed.

As a device of the prototype, we present a typical spoke with a persistent

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platform through a fragment of the tibia described in the Manual on transosseous osteosynthesis by the method of Ilizarov V. Golyakhovsky and V. Frenkel (1999). After X-ray clarification of the position of the bone fragments in the Ilizarov’s apparatus and the degree of displacement of the bone fragment, a needle with a thrust pad (metal brazing) from the outer surface of the fragment to the side of its bed is drawn through the last drill so that when tensioned

knitting stubborn pad pressed the splinter to the box. In this case, one should take into account the danger of damage to blood vessels and nerves, as well as the undesirability of fixing an array of soft tissues with a spoke. This consideration dictates the need for some deviation of the spokes from the biomechanically appropriate direction of its implementation. When the needles exit to the opposite side of the lower leg, the drill is disconnected, and the point of the spoke is seized with pliers and a sharp pulling and at the same time twisting motion is carried out until the brazing stops to the surface of the fragment. The needle is fixed in the drawbar, consisting of a short threaded rod with a longitudinal slot, nuts and an arm, with which it is fixed to the nearby parafracture ring of the Ilizarov apparatus. By centripetally framing both nuts on the bracket, the needle is pulled with an emphasis and thereby the fragment is pressed to its bed.

The disadvantages of the prototype are the following:

1} The necessity of holding a knitting needle is not strictly consistent with specific biomechanical requirements, but is guided by the possibility of damage to the neurovascular bundle on the back of the lower leg;

2} The inevitability of fixing the back of the calf muscles with a knitting needle, which on the one hand increases the risk of soft tissue inflammation around the knitting needles, and on the other hand, limits the freedom of movement in adjacent joints;

3} The lack of visual control of the degree of tension of the knitting needle with the thrust pad, which, with excess tension of the knitting needle, increases bone resorption at the point of contact with the solder, and if the tension is insufficient, it can cause a gap between the fragments, that is, inefficiency of manipulation.

To prevent the above drawbacks when adapting a bone fragment to its bed, a device is proposed for a utility model (Fig. 2}, consisting of parts of a standard set of Ilizarov apparatus (Fig. 3), namely Kirchner spokes (1), nuts (2), washers with a lateral slot (3), a threaded rod (4} and brackets (5). Fragments of the spokes are laid in the washer slots and secured with two counter-screwed nuts. Then, the knitting needles are bent and dried, matching the specified length, as well as the area and the shape of the perimeter of their ends. Usually, the distance between the ends of the spokes is slightly less than the area of the outer surface of the bone fragment, and the shape approximately corresponds to an equilateral triangle as the most geometrically stable figure.The length of the spokes varies from 4 to 10 cm and the diameter from 1.0 to 1.8 mm. It should be borne in mind that the longer the knitting needles, the greater the springiness and less rigidity of the stop of the knitting needles in the splinter.Therefore, if it is necessary to increase the rigidity of the stop, thick (1.8 mm) and short (4-6 cm) needles should be chosen. The manufactured device, punctured soft tissues, rests on the outer surface of the bone fragment of the tibia and is installed by means of an arm to one of the two middle (parafracture) rings of the Ilizarov apparatus. Then centrifugal tightening of the nuts on the bracket creates a compression of the fragment to a visible increase in the curvature of the spokes (Fig. 4}. The created compression is due to both tightened nuts and elastic (spring) bending of the spokes.

The advantages of the proposed device are as follows:

1) There is no danger of damage to blood vessels and nerves on the other side of the tibia during compression on a bone fragment and the ability to be guided by only biomechanical expediency, without fear of the possibility of a conflict with important anatomical structures;

2) The absence of the need to fix the back of the muscle with a knitting needle with the inevitable restriction of movements in adjacent joints and an increased risk of developing inflammation of the tissues around it; due to an increase in the curvature of the spokes pressed into it;

4) Compression of the fragment not only by tightening the nuts on both sides of the bracket, but also due to the elastic elasticity of the spokes, which, on the one hand, prevents the fragment from overpressing the bed, and on the other hand, gives the compression a prolonged character, which is more optimal for reparative osteogenesis.

The following observation is given as an example of the application of the proposed utility model.

Patient G., 48 years old, was admitted to the traumatology department of the RTC on 07.24.00. 25 minutes after the car trip with a diagnosis of closed comminuted fracture of both bones of the middle third of the left lower leg with a shift. According to the activity, skeletal traction was applied for the calcaneus with a load of 6 kg, which was reduced to 4 kg after the control x-ray the next day.

07.28.00g. under conduction anesthesia, an operation of extra focal osteosynthesis of the left lower leg was performed using an Ilizarov apparatus of four rings. Given the nature of the fracture, namely, the presence of a large sphenoid fragment of the tibia with the base facing forward and the presence of diastasis between him and his bed, established indications for the use of the proposed device. The latter was pre-assembled in several copies, each of which was a threaded rod, 5 to 12 cm long, on one end of which fragments of three Kirchner spokes were fixed with nuts and washers with an isosceles triangle, the ends of which were at the same distance from the end of the rod . The length of the spokes is from 4 to 9 cm. Their ends were spear-shaped. In this example, we used fragments of knitting needles 6 cm long. Before use, they are curved in an arc, and the distance between their ends created a triangle that is smaller than the area of the fragment. Then, the ends of the sharpened knitting needles punctured the soft tissues until they were firmly pressed against the outer surface of the fragment and

; IC C; ; -5secured this device to the bracket to the nearest parafracture ring. By tightening the peripheral nut, an increase in the curvature of the spokes and an even more springy adaptation of the tibial fragment to its bed were achieved. On control radiographs, an adequate reduction of the bone fragment was confirmed.

The device was removed 25.10.00g. after x-ray confirmation of the fusion of the fracture and a positive clinical test for bone marrow consolidation. The result of treatment is regarded by us as good.

Thus, using the device proposed for a utility model, one can achieve an increase in the quality of extrafocal osteosynthesis of comminuted fractures of the lower leg with the Ilizarov apparatus, increasing its effectiveness and improving the treatment time for this pathology.

Claims (1)

A cantilever compression device consisting of parts of a standard set of Ilizarov apparatus, namely, Kirschner spokes, nuts, washers with a side slot and brackets, which is additionally equipped with a threaded rod and three curved fragments of Kirschner spokes that have a spring effect and abut against the outer surface of the bone fragment.