RU38284U1 - DEVICE FOR REPOSITION OF BONE FRACTURES IN EXTERNAL FOCAL OSTEOSYNTHESIS OF CRANIAL FRACTURES - Google Patents

Description

2063160070

Object: utility model

Author: Huseynov Asadula Huseynovich

MKI 6: A 61 V 17/34

DEVICE FOR REPOSITION OF BONE FRAGMENTS IN EXTERNAL FOCAL OSTEOSYNTHESIS OF CRANIAL Fractures

The utility model relates to medical equipment, namely to medical devices used in surgical traumatology and orthopedics.

Ilizarov extra-focal osteosynthesis is the treatment of choice for fractures and false joints of the lower leg bones. This is due to the optimal combination of atraumaticity of the method with the stability of fixation of bone fragments and the ability to manipulate them throughout the entire wearing of the apparatus (Gulnazarova S.V., 1986; 1993; Shevtsov V.I., Makushin V.D., Kuftyrev L. .., 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., Montanari G., 1989; Clbo S., 1992, etc.). So, in the fracture zone, it is possible to attract such osteoinducing factors

like compression, distraction or their alternation. However, the condition for the realization of these advantages is an adequate reposition of bone fragments, without which all other parts of osteogenesis are ineffective and lose their meaning. Meanwhile, the Ilizarov method does not always allow achieving

anatomical comparison of bone fragments, since its repositional properties are imperfect (Zakirov Yu.A., 1993; Golubev G.Sh., Veselov N.Ya., 1995;

Kuzmenko V.V., Skoroglyadov A.V., 1995 and others). The reposition is usually carried out manually during the operation, and since the knuckles must be kept on the weight or changed its position when carrying out knitting needles and installing external supports, the need to compare bone fragments and hold them in the achieved position is a laborious task and does not

the need for a second assistant. The condescending attitude to the residual displacement of bone fragments, based on subsequent repressive manipulations, is not justified, because they are not always effective and are associated with remounting the device, frequent retightening and even retransmission of spokes, increased radiation exposure to the patient due to multiple x-ray control.

As a device of the prototype, 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 Ilizarov's 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 other side 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 anatomical structures, and, with

the other is the appearance of biomechanical distortions in the Ilizarov apparatus of the leg segment. After carrying out the knitting needles, the assistant helps the surgeon to mount the outer frame - the rings of the Ilizarov apparatus. Therefore, to hold the damaged tibia in the repositional position of the bone fragments, a second assistant is needed, since the first assistant plays an important role in conducting the spokes and installing the apparatus. Thus, the prototype device has the following disadvantages:

3) The complexity of the long (1.5-2 hours) retention of the injured limb segment in weight;

4) The dichotomy of a traditional boathouse with supports on the periphery of the lower leg, which causes the lingering of the middle third of the lobe} | of the segment with the formation of an angle open to the cleared. To deal with the last one, the assistant has to support the sagging middle part of the lower leg from below, which actually eliminates the advantage of using a stand;

5) The inability to provide a dosed longitudinal

bone fragment distraction performed manually by the scabbard or

only the Losle installation of the Ilizarov apparatus due to its middle rods.

To prevent the above drawbacks and optimize extra-focal osteosynthesis of shin bone fractures, a device is proposed for lactic reduction and keeping bone fragments in a comparable position during surgery (Fig. 1). It consists of a curved and drilled in the middle of a metal plate (1) and parts of a standard set of Ilizarov apparatus, namely: 225-, 195- and 100-mm half rings (2), 346-, 120-, 82-, 60- and 30-mm plates (3), 270-, 220- and 140-millimeter telescopic (4) and 150-, 120- and 100-mm threaded (5) rods, 3, 2 and 1-hole brackets (6) , bolts (7), bolt slice fixators (8) and nuts (9).

The proposed device is applied as follows. Through the condyle of the thigh and the calcaneus or talus, one Kirschner needle is passed, which, after manual removal of the rotational displacement of bone fragments, is fixed in tension in the repositioner. As a rule, a spoke has already been inserted through the calcaneus, as skeletal traction is the most frequent component of emergency therapeutic measures for fractures of the lower leg, so in fact you have to carry out only one spoke. If skeletal traction for the calcaneus has not been superimposed, Cho will draw a knitting needle and fix it in a 100 mm half ring. A skeletal traction bracket for the calcaneus (or half-ring) is strengthened between two plates of the device, bolted together. Longitudinal distraction along telescopic rods is carried out with some extension of the damaged segment of the limb. Moreover, in addition to eliminating muscle retraction and shortening of the lower leg, the shift of fragments in width is partially or completely eliminated, because stretched muscles compress them along the perimeter of the bone section. To prevent sagging of the tibia at the fracture site and eliminate angular displacement, a grooved support is installed (Fig. 2), consisting of a figuredly curved metal plate with a hole in the middle (1), a threaded rod (5) and nuts (9). Considering the physiological varus bend of the lower leg, it is better to install this stand not strictly perpendicularly under the damaged segment, but more medially, so as to exert a physiological curvature of the segment from below and somewhat from the inside (at an angle of 30-45 degrees) to its middle third. In the presence of residual displacements of bone fragments, they are eliminated manually, after which a typical extra focal osteosynthesis is performed.

As an example of the clinical application of the proposed device

The following observation serves. Patient 6., 48 years old, was urgently admitted to the trauma unit

ROTC 11.01.01g. after household injury with a diagnosis of: Closed comminuted fracture of the middle third of the left leg with displacement of fragments. Imposed skeletal traction for the calcaneus with a load of 5 kg. 01/14/01 osteosynthesis according to Ilizarov was performed in a planned manner. For preliminary reposition and retention of bone fragments in a comparable position during the latter, the proposed device was used, consisting of a curved and drilled in the middle of a metal plate (copper plate, size 20 by 5 by 0.2 cm) and parts of a standard set of Ilizarov apparatus. Under conduction anesthesia 1red by extrafocal osteo,

By synthesizing through the condyles of the thigh, a Kirschner spoke was held, which was fixed in tension in a reposition device. A skeletal traction bracket on the calcaneus was fixed between two plates of the device, bolted together. Carried out longitudinal distraction through telescopic rods. At the same time, the displacement of fragments along the length and width was eliminated. To prevent sagging of the tibia at the fracture site and eliminate angular displacement, a grooved support was installed, consisting of a curved copper plate with a hole in the middle, a threaded rod and nuts. Given the physiological varus bend of the lower leg, this stand was set somewhat medially (under a crowbar of 30 degrees) and from the bottom. After this, a typical extra focal osteosynthesis with an Ilizarov apparatus of four rings was performed with one assistant in 40 minutes. On control radiographs, a satisfactory position of the bone fragments was verified. Osteosynthesis is wealthy. The result of the operation is regarded as good.

The advantages of the proposed device are as follows:

1) The ability to eliminate gross displacement, and often to ensure complete reposition of fragments of the tibia ;,

2) Preservation of reposition of bone fragments throughout the operation;

3) Tricycle of the device, which allows to avoid sagging of the middle part of the tibia with the formation of an angle open anteriorly, and to achieve the repositional position of bone fragments. In addition, the ability to adjust

the level and direction of installation of the middle support of the device provides the ability to restore the physiological bending of the leg segment;

4) Accessibility of the tibial segment along the entire perimeter of the unhindered manipulation of the surgeon;

6) Profitability and lack of need to search for parts for manufacturing.

Thus, the proposed device is efficient and economical, and its use allows you to get by with one assistant, improve the quality and reduce the duration of the operation of extra focal osteosynthesis by the Ilizarov apparatus.

Claims (1)

A device for reposition of bone fragments during extrafocal osteosynthesis of tibial fractures, which is a sliding stand for the damaged segment, consisting of a curved metal plate with a hole in the middle and parts of a standard set of Ilizarov apparatus, namely half rings, plates, telescopic and threaded rods, brackets, bolts, special fixators and nuts.