RU41250U1 - CONSOLE ADDITION TO THE BELERA BUS FOR OPTIMIZATION OF SKELETONAL EXTENSION IN TREATMENT OF FEMAL BONE FRACTURES - Google Patents

Abstract

For the proposed utility model, “Cantilever attachment to the Belera splint for optimizing skeletal traction in the treatment of leg fractures.” The alleged utility model relates to medical equipment, namely to medical devices. Its purpose is to increase the efficiency, reduce the time and cost of treatment of patients with fractures of the leg bones. This goal is realized by the fact that, using the proposed console attachment with one or two compression heels, they increase the quality of skeletal traction and provide the ability to eliminate the residual displacement of fragments of the tibia along the axis and width. The proposed utility model consists of parts of a standard set of Ilizarov apparatus, namely, a 180-mm half-ring, threaded rods, short straight and reverse (two-plane) plates, bolts, nuts and brackets, and a piece of porous rubber. By using the proposed attachment to the Beler splint with the presence of a compression heel with an adjustable level, direction and pressure on the bone fragment, the residual displacement of bone fragments is eliminated and held in repositional position.

Description

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

Skeletal traction is the most important treatment method used in traumatology and orthopedics for diseases and injuries of the organs of the musculoskeletal system. So, with bone fractures of the lower leg, skeletal traction is successfully used both as an independent method of treatment and as a preliminary one before the operation of osteosynthesis. The advantage of the method under consideration is the ability to overcome muscle retraction of the damaged limb, providing bloodless reposition and keeping bone fragments in a comparable position until bone marrow is formed. The latter is formed at an earlier date due to the non-invasiveness and non-interference of the traumatologist in the natural process of reparative osteogenesis (Kaplan A.V., 1965; Chaklin V.D., 1969; Voronovich I.R., Starovoitov V.I., 1976 ; Korzh A.A., Skoblin AL., Elyashberg F.E., 1981; Klyuchevsky V.V., 1991;

Casaccia M., Cariati E, 1973; White S.H., Kenwright J, 1990; Zagorski J. B., Latta L. L. I 993 and others).

When treating shin bone fractures with skeletal traction, longitudinal skeletal traction is often not enough and lateral pressure or traction of one or both fragments of the tibia is often insufficient to eliminate residual displacement and subsequent retention of bone fragments in a repositional position. The need for this may be due to both the specific nature of the fracture and

the eccentricity of the position of the tibia in relation to the soft tissues of the lower leg. The latter circumstance causes an imbalance in muscle traction of bone fragments with a predominance of muscle retraction along the posterior-outer side of the segment. The main fragments of the tibia at the same time gain leverage, and the degree of their displacement correlates with the ratio of the length of the fragments and the traction force of the muscles attached to them (H.A. Yanson, 1975; V.A. Rodnichkin, A.F. Grobova, 1986; I .M. Pichkhadze, 1989, 1997; L.N. Solomin, N.V. Tishkov, 1990, 1994; V.P. Morozov, 1993; A.T. Brusko, 1994; F.Benazzo, M.Mosconi, 1994 and etc.).

Elimination of residual lateral displacement of fragments of the tibia is usually carried out by means of lateral traction by several gauze strips with a load suspended from them and thrown through an additional roller block, or by placing various ridges under the central or peripheral end of one or both bone fragments. The whole variety of methods for the traditional elimination of residual lateral displacement combines a significant drawback: the elusiveness of the reposition and the instability of its positive result. So, traction with a lateral load behind gauze strips, along with the need to lift and shift the damaged lower leg when installing a lateral traction system, often requires straightening of gauze strips, usually bundled into a squeezing soft tissue tourniquet. The lining of the rollers is also associated with the raising of the lower leg and the inevitability of trauma to soft tissues by bone fragments.

As a prototype device of the proposed utility model, a description is given of the lateral traction system described in the text, depicted in diagrams and figures in the monograph by V.V. Klyuchevsky (1991) "Skeletal traction". So, according to the prototype for fractures of the lower leg, it is recommended to hold the Kirchner needle through the body of the calcaneus in the strictly frontal

the plane. At the entry and exit points of the knitting needles, gauze balls are ligated, supported on the spoke with rubber stoppers from penicillin vesicles. The needle is pulled and fixed in the bracket. To preserve the physiological varus curvature of the tibia, traction is carried out not along the axis of the lower extremity, but along the axis of the lower leg. This can be achieved in two ways: by pulling the outer edge of the bracket and extending the Beler bus block 8-10 cm to the medial side. If this does not help, and the valgus deformation of the damaged segment persists, then resort to lateral thrust with strips of gauze bandage that moves the proximal fragment of the tibia bridge laterally, and the distal - medially. Weights of 1-2 kg suspended over additional blocks are suspended from the gauze bandage strips. The foot is suspended from the superficial frame. By changing the length of the suspension of the foot, it is set in accordance with the position of the knee joint - this eliminates rotational displacement. In addition, a roller can be placed under the distal section, the height of which regulates the axis of the tibia in the sagittal plane: a higher roller eliminates antecurvation, and a low or absent roller eliminates recurrence of the lower leg. For reposition and retention of fragments, weights of 5-7 kg are used, then they are reduced to 4 kg. The traction is stopped after 4-5 weeks, when the patient can raise a damaged lower leg.

The disadvantages of the prototype are the following:

1) The difficulty in achieving reposition of bone fragments and the instability of the achieved positive result;

2) The bulkiness of the lateral traction system with the need to provide certain devices for its implementation;

3) When establishing longitudinal traction not along the axis of the damaged limb, but to the lateral edge of the bracket, - frequent sliding of the spoke in the bone with the displacement of the bracket outside. In addition to distortion of the longitudinal skeletal traction, this

fraught with the development of inflammation of the tissues around the knitting needle;

4) Increasing the dimensions of the patient’s bed with additional devices providing lateral traction, which makes it difficult to approach the patient;

5) The need to transfer the damaged lower leg, which, in addition to subjective discomfort for the patient, leads to trauma to the soft tissues in the fracture zone, delaying the healing time.

To ensure reposition of bone fragments in the treatment of bone fractures of the leg with skeletal traction and to increase the reliability of their further retention in a repositional position, a device is proposed, which is claimed to be a utility model, which is a cantilever attachment to the Beler splint. The device consists of parts of a standard set of Ilizarov apparatus, namely, 180 mm half rings, threaded rods, short two-plane and straight plates, bolts, nuts, brackets, and a piece of porous rubber (Fig. 1). The device is manufactured as follows. In both peripheral openings of the half-ring / apparatus of Ilizarov, 180 mm in size, two threaded rods ^ from 16 to 21 cm in size are inserted and fixed with nuts so that the half-ring is located in the middle of each of the parallel rods. Then, at the ends of the threaded rods, a straight and reverse (two-plane) short (3-5 cm) short (3-5 cm) plate 3, 4 is installed. In one or two half-ring holes on the bracket or brackets, a compression heel 7 of the structure is installed (if necessary, two heels can be used ) Compression Heel

consists of a threaded rod 9, nuts 10, plates 11, and a piece of porous rubber (figure 2).

The length of the plates is selected individually in each case, which is dictated by the selection of the optimal contact area "heel-segment of the leg". The most acceptable length of these plates is 5-7 cm. The larger the heel area of the structure, the less the load per unit area

skin and, accordingly, the likelihood of developing a bedsore. However, in order to avoid the latter, it is recommended to lay a gauze napkin between the fifth structure and the skin of the leg segment, and periodically loosen the distal nut (under the bracket) on the threaded rod of the heel. To reduce the amount of pressure of the heel of the structure on the skin of the damaged segment, which is necessary for reposition and holding bone fragments in the correct position, the following condition must be observed. According to the laws of mechanics on the correlation of the magnitude of the pressure force with the length of the lever arm, the closer the prefix heel is to the end of the bone fragment, the less is the necessary pressure on it (Fig. Z). Thus, the prefix proposed for a utility model is simple and easily controllable with the ability to adjust the level, direction and magnitude of compression of one or two heels of the structure into bone fragments (Fig. 4).

Set the prefix to the Beler bus as follows. With Kocher’s clip, gauze litter is punctured on Beler’s tire next to the horizontal part of its metal frame and the clamp jaws are bred to form a husky space sufficient to hold the plate through it. After holding one plate into the gauze gap, usually a two-plane one, another plate is attached to it with two bolts. By tightening the nuts, both plates tightly cover the metal rod of the horizontal part of the Beler tire carcass, which fixes it. Similarly, the remaining three corners of the proposed set-top box are fixed.

The advantages of the proposed device are as follows:

1) Increasing the effectiveness of skeletal traction when achieving reposition of bone fragments and increasing the stability of a positive result;

2) No need to shift the damaged segment

lower legs when setting up the prefix;

3) The ability to ensure physiological bending of the lower leg without lateral weights and the need for distortion of the longitudinal skeletal traction.

The following observation is given as an example of the practical application of the device proposed as a useful model.

Patient G., 48 years old, 04/14/99 he was urgently admitted to the trauma department of the RTC 20 minutes after the accident with a diagnosis of closed comminuted fracture of both bones of the middle third of the left leg with a shift. Under local anesthesia, a skeletal traction with a load of 5 kg was applied to the fracture zone (15 ml of the 1% solution of novocaine) and to the place of the knitting needle through the calcaneus (6 ml of the 1% solution of novocaine). To restore the physiological varus curvature of the damaged segment, as well as to adapt the sphenoid fragment of the tibia 1.2 cm away from its bed, we installed a prefix console console in the preoperative room to the Beler splint with a compression heel. The direction of compression is from inside to outside and from top to bottom. The console prefix was assembled from the details of the standard set of the Ilizarov apparatus, namely, 180 mm half rings, threaded rods, short two-plane and straight plates, bolts, nuts, brackets, and a piece of porous rubber. Two threaded rods, 16 cm in size, were inserted and nuts secured into both peripheral holes of the half-ring of the Ilizarov apparatus, so that the half-ring was in the middle of each of the parallel rods. Then, at the ends of the threaded rods, they mounted bolted forward and backward (two-plane) plates. A compression heel was installed on the bracket in the half-ring hole. The latter was assembled from a threaded rod, nuts, plates and a piece of porous rubber. The length of the plates was 5 cm. To avoid pressure sores, between the fifth

hands and skin of a segment of a shin put a gauze napkin. When installing the attachment to the Beler tire, Kocher clamped the gauze sheet on the Beler tire in four places next to the horizontal part of its metal frame and spread the clamp jaws to form a shelf-like space sufficient to hold the plate through it. Passing one two-plane plate into the gauze gap, two paired straight plates were attached to each of them with two bolts. By tightening the nuts, they tightly covered the metal rod of the horizontal part of the Beler tire carcass, which was used to attach the attachment to the Beler tire. The level, direction and pressure of the fifth structure were adjusted in such a way that the main fragments of the tibia were held in reposition position, and the sphenoid fragment was adapted to its bed. Radiologically verified satisfactory position of the bone fragments. 05/17/99 after clinical and radiological confirmation of bone callus formation, skeletal traction is removed, and the injured limb is transferred to a circular plaster cast from the upper third of the thigh to the toes of the foot. Dosed axial load is allowed, starting from 15 kg and brought to full within 1 month. The plaster cast was replaced after 1.5 months with a removable plaster cast, and after another month it was removed. After a course of rehabilitation treatment (exercise therapy, massage, mechanotherapy), limb function is fully restored. The result of treatment is regarded by us as good.

Thus, the cantilever attachment to the Belera tire proposed for a utility model can improve the quality of skeletal traction and increase the efficiency of conservative treatment of tibial fractures.

Claims (1)

A cantilever attachment to the Beler splint for optimizing skeletal traction in the treatment of shin bone fractures, consisting of parts of a standard set of Ilizarov apparatus, namely: a 180-mm half ring, threaded rods, short straight and reverse (two-plane) plates, bolts, nuts and brackets, and a piece of porous rubber, characterized in that it additionally uses a compression heel design with an adjustable level, direction and pressure on the bone fragment.