RU35710U1 - Device for optimizing the operation of extrafocal osteosynthesis of the lower leg with Ilizarov apparatus - Google Patents

Description

DEVICE FOR OPTIMIZATION OF OPERATION OF EXTERNAL FOCAL OSTEOSYNTHESIS OF THE LOWER BY THE ILIZAROV APPARATUS

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

Extra focal osteosynthesis occupies an important place in orthopedics and traumatology, being the method of choice 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 stability of fixation of bone fragments and the ability to manipulate them throughout the entire period of wearing Ilizarov’s 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; Ciuccarell S., Cervellati S., Montanari G., 1989; Cibo S., 1992, etc.). However, osteosynthesis according to Ilizarov is rather laborious (Zakirov Yu.A., 1993; Golubev G.Sh., Veselov N.Ya., 1995; Kuzmenko V.V., Skoroglyadov A.V., 1995 and others), and this is due to including the need to keep the lower leg above the level of the operating table during the entire operation in the position of fragments of the tibia, close to repositional. So, the correct conduct of transosseous elements (usually four pairs of mutually intersecting spokes) and the installation of external supports are possible only when holding the lower leg above the plane of the operating table. This is usually done by an assistant or with the help of a traditional stand. In both cases, the following disadvantages occur:

Object: utility model

Author: Huseynov Asadula Huseynovich

MKI 6: A 61 V 17/34

2) The complexity of the long (1.5-2 hours) retention of the damaged segment by weight;

3) The double support of traditional substrates with supports on the periphery of the lower leg, which causes sagging of the middle third of the damaged segment with the formation of an angle open anteriorly. To prevent the latter, the assistant has to support the sagging middle part of the lower leg from below, which actually eliminates the advantage of using the stand;

4} Since most of the traditional coasters are plastic and, accordingly, thermolabile, it is not sterilized in a dry heat cabinet. Therefore, during the operation, it should be covered with sterile linen. This complicates the manipulation of the stand during the operation of osteosynthesis and leaves the danger of violating the sterility of the surgical field.

As a prototype device, we present the traditional shin support used during the osteosynthesis operation, described by V. Golyakhovsky and V. Frenkel (1999) in the Manual on Transosseous Osteosynthesis by the Ilizarov Method. Holding needles for transosseous fixation during surgery is a key point in applying the Ilizarov apparatus, so it must be performed with absolute accuracy. Therefore, the repositional position of the bone fragments, held by the assistant, must be observed, while the surgeon holds the needles. The role of an assistant is not limited to keeping the lower leg. While the surgeon, being on the side of the knitting needle, is preparing to draw it through the segment being operated, the assistant on the opposite side of the operator should point to him with the finger or the end of a thin instrument the intended exit point of the knitting needle. Otherwise, on the one hand, there is a risk of damage to important topographic and anatomical structures, and, on the other hand, the appearance of biomechanical distortions in the Ilizarov apparatus — shin segment. After carrying out the knitting needles, the assistant helps the surgeon to mount the outer frame - the apparatus rings

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Ilizarova. Therefore, it is quite obvious that in order to keep the damaged tibia in the repositional position, bone fracture of the 1st fv is necessary for the second assistant, since the first one: the systen plays a dandy role of tsi, knitting needles and the knot of the apparatus .; ,

To prevent} | building the above disadvantages m optimization

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extrafocal osteosynthesis of fractures of the lower leg bones is proposed

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claimed for a utility model,; | f (Ey) I have 1 HNfiACTaBi; damaged limb segment (FIG. 1), Company | rt device

standard set of Ilizarov apparatus: three half rings (l sizes t usually from 110 to 150 mm, plates (2), threaded rods (3), nuts (4), bolts (5) and

brackets (6). The height of each of the three pillars of the assumed mouth (ju

adjust in a fairly wide range (from 15 to 45 cm)

rods with nuts. If necessary

telescopic rods - if the pagment is very obese, and the mass

damaged lower leg more than 15 ia

The device is used as follows: 1

ukupyut on the stand in a reposition position so that

the level of the middle support is indicative of correspondence to the 1E level of the fracture of the tibia. The height of the supports in this case is approximately at the same level, - 25-ZOsm, - with a slight predominance of peripheral ones, washing out a different perimeter of the lower leg along its length and eccentric: the position of the tibia in soft tissues). In order to avoid friction on the skin of the operated segment, it is advisable to flush it on a crushed head

coasters folded napkin or waffle towel. In p | X)

From time to time, the assistant will perform the osteosynthesis operation on the patient’s top, making sure that her anterior section is perpendicular (laren

the plane of the table for the prevention of bone fragments rotation, i

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be used and

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Thus, the advantages of the proposed device are the following:

1) Profitability, due to the lack of need for the manufacture of parts - taken entirely from the standard set of Ilizarov apparatus - and the simplicity of assembly and operation;

2) No need for a second assistant;

3} Tri-support of the stand, which allows to avoid sagging of the middle part of the lower leg with the formation of an angle open anteriorly, and to achieve the repositional position of the bone fragments. The same circumstance caused the absence of the need for constant longitudinal traction for the distal fragment of the tibia;

4) The ability to sterilize the device in a dry oven, which corresponds to the principles of asepsis and antiseptic and makes it unnecessary to cover it with sterile sheets (figure 2).

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

Patient S., 29 years old, was urgently admitted to the traumatology department of the RTC on 06/18/99. after an accident with a diagnosis of: Closed comminuted fracture of the middle third of the right lower leg with displacement of fragments. On duty, skeletal traction for the calcaneus with a load of b kg was applied, and after 4 days, 06/23/99. extra-focal osteosynthesis by Ilizarov apparatus was carried out in a planned manner. On the eve of the operation, 06/22/01 from the parts of the standard set, the Ilizarov apparatus of four rings, 160 mm in size and a shin stand of three half rings, 120 mm in size, were selected. The stand is assembled and for convenience of sterilization it is unmounted into four parts: the base of two dpin and three short plates fastened with bolts and nuts, and three support stands made of floor), salts, threaded rods and plates fastened with nuts and fontains.

06/23/99 under combined anesthesia in the patient’s position on the back with the right lower leg laid on the assembled stand (each of the three half rings of the stand is lined with a Mikulich napkin on top), a closed reposition of tibial fragments was performed. The assistant held the forefoot upright to prevent the rotational displacement of the fragments. The surgeon held four pairs of mutually intersecting spokes, with a cross angle of 60-80 degrees, in a strictly perpendicular plane. In this case, the assistant each time showed the place of exit of the spokes on the opposite side from the surgeon with the tip of Kocher clamp. After carrying out the needles, dressing them with gauze balls and stringing rubber plugs on them from penicillin vesicles, the external supports were mounted - the rings of the Ilizarov apparatus. The spokes were pulled and fixed in rings. The latter were fixed with threaded rods to each other. Between the middle (parafracture) rings, moderate distraction was performed until residual shortening was eliminated (about 0.5 cm). On the control radiographs, the position of the bone fragments is good. The duration of the osteosynthesis operation was 1 hour 10 minutes.

Monthly control x-rays were taken in standard projections, on which the timely formation of bone marrow was noted. 10/22/99 after a week-long clinical test (walking without crutches with loose nuts on the threaded rods of the apparatus) and X-ray control, the Ilizarov apparatus was removed. The fracture was fully consolidated. The function of the right lower limb is restored.

Thus, the proposed device allows you to get by with one assistant, improve the quality, and often reduce the duration of the operation of extrafocal osteosynthesis by the Ilizarov apparatus.

Claims (1)

A device for optimizing the operation of extra-focal osteosynthesis of the lower leg with the Ilizarov apparatus, which is a stand for the damaged segment, consisting of parts of the standard set of the Ilizarov apparatus, namely: half rings, plates, threaded rods, nuts, bolts and brackets, characterized in that a third support is additionally inserted with the ability to adjust the level and height of each of the three supports.