SU1324662A1 - Arrangement for reposition of bone fragments - Google Patents

Abstract

The invention relates to medical technology. The purpose of the invention is to provide spatial movement of the distal fragment. The device includes telescopic guides 1c with tips 2. In the groove of the arc 3 two arms 4 with grooves are fixed in console. On the distal tips 2 is fixed frame, which includes two

Description

vertical grooves 5 with grooves and lintel 6; Threaded hook 7 is placed in groove of lintel 6 7. Nut 9 and lock nut IO allow tension, rotation and fixation of threaded hook 7. Clamps II are mounted in pairs for fastening, moving, Eni and fixing rings 12 with brackets 13 and bone clamps,

The invention relates to medical technology, namely to traumatology and orthopedics.

The purpose of the invention: - ensuring the spatial movement of the distal fragment.

Figure 1 shows the device, an axonometric projection, a general view; figure 2 - the same, n; 1 lay on the legs; fig.Z - the same imposed on the thigh.

The device includes two telescopic guides; -1, ending with tips 2. Proximal tips 2 are intended for connection with arc 3. In the groove of arc 3, two strips 4 with grooves are fastened firmly. On the distal tips 2 a frame is fixed, comprising two vertical beams 5 with grooves and a horizontal bridge 6 with a groove, having the possibility of alternation along the beams

5 and the possibility of fixing, in the groove, the jumper 6 is placed threaded hook 7. On the bend of the hook 7 there are nuts 8,

On the long longitudinal section of the hook 7, there is a nut 9 and a counter-nut 10, allowing tension, rotation and fixation of the threaded hook 7. The presence of a groove in the jumper

6 allows moving the threaded hook 7 in the frontal plane. Clamps 11 are placed in pairs on the guides 1 for fastening, moving and fixing the rings 2 with the brackets 13 and the bone clamps, made in the form of rebar rods 14.

In the bracket 13 there is a sleeve 15 with external and internal threads, and on the rod x-supports 14, having

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made in the form of reponitor rods 14. In the bracket 13 there is a sleeve 15 with an external and internal thread. A lock nut 16, a knob 17 and a lock nut 18 are located on the rods 14. This allows the rod to be dosed by rotating the sleeve 15 along the internal thread. 3 il.

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smooth and threaded sections, a counter nut 16, a knob 17 and a counter nut 18 are arranged. Due to this, it is possible to move the rod forward until it stops against the bone and then precisely dosed it by rotating along the internal thread of the sleeve 15 with final fixation. In the arc 3, the needle 19 is fastened, and in the slots of the strips 4, where it is also possible to fasten the spokes between the nuts 8, a bracket 20 is fixed, in the branches. which is fixed one or two needles 21,

The device works as follows.

With nepejioMax, at the beginning of the leg, the needle 21 is held through the exact bone, pulled out and fixed in the 20 dp skeleton of the skeletal extension. Through the proximal, metaphysis of the tibia in the frontal plane anterior of the head of the fibula, a second needle 19 is held, which is tensioned and fixed on the arc 3, the elongation bracket 20 is fixed to the threaded hook 7. By tightening the hook 7 with the nut 9, remove The rotational displacement of the thread hook, rotational displacement, movement of the thread hook 7 along the groove of jumper 6, and the jumper 6 itself along the grooves of the vertical beams 5 correct the displacement in the sagittal and frontal planes.

The reached position is fixed with a counter-nut 10. With the purpose of tight contact and fixation of fragments on pairs of clamps 1, located proximal and distal to the fracture site, rings 12 are fixed;

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which, in the frontal or approaching plane, install pre-sterilized brackets 13 with reversing rods 14. With helical and long 5 oblique fractures of the tibia, two reporters 14 are sufficient for fixing the lateral, 14 of which one is installed from the outer or inner side of the proximal fragment, and the second, O, on the opposite side of the distal fragment.

Through a skin puncture with a scalpel, the reporters 14 are brought to the bone surface, then the sleeve 15 is screwed in 5 with bracket 13 and, simultaneously rotating the sleeves 15, the repeaters 1A are inserted into the cortical layer of both fragments, thereby bringing the fracture plane tightly together. For transverse 20 and comminuted fractures on the rings 12, over each of the fragments, at diametrically opposite points, are fixed by a pair of brackets 13 with hubs of reparators 14. At first, the proximal fragments are fixed with counter-rotation of reporters, and then the distal fragments are fixed in the same way . If necessary, scaling corrections are carried out and fixed in the skeleton stretch brace 20. The distal hip fragment is carried out with the help of the clamp 20, the needle is driven through the proximal fragment perpendicular to its axis in the direction of the spine from the inside outwards and backwards, and indent outwardly from the projection of the vascular bundle by 1.5-2 cm. The needle 19 is pulled and fixed in the arc 3 or on the strips 4. After that, the bracket 20 is fed to the transverse segment of the threaded hook 7, after which the screw is pulled out from the bracket with a modern correction of the rotational displacement.

After the visually correct axis of the femur is reached and the displacement of the fragments along the length (determined by measuring the comparative length of both thighs) is established, X-ray monitoring is performed. If there are unresolved offsets in width and at an angle, the latter are eliminated by moving the cutting hook 7 along the notch in lintel 6 and moving the beam along the grooves of the beam 5. In order to accurately match and fix fragments on pairs of

width or angular displacement - 30 | the proximal ones are removed by unscrewing one retainer 14 by simultaneously screwing in a pair retracter 14.

The operation of the closed intramedullum p-. osteosynthesis in a planned manner with a satisfactory general condition of the patient and the integrity of the skin of the damaged segment. For this, the patient is placed on the operating table on his back in the position of bending of the knee joint at right or acute angle. A vertical stand 22 with a roller 23 is placed in the popliteal arch. Under the bridge 6, a vertical stand 24 is installed. The subsequent steps of the closed osteosynthesis — reaming the bone marrow cavity and insertion of nail C (not shown) are performed by known methods. After the final piercing of the nail, Sne is shown to have a final radiographic control.

For hip fractures, at first, two parallel needles 21 are held in the front of the plane, through the distal metaphor of the femur bone, the spokes 21 are pulled and fixed in the brace 20 for skeletal stretching. Carrying out the distal fragment of the femur with the help of the clamp 20, the needle 19 is carried out through the proximal fragment perpendicular to its axis in the direction from the front inside and outside to the back, offset to the outside from the projection of the vascular nerve by 1.5-2 cm. The needle 19 is pulled and fixed in arc 3 or on the slats 4. After that, the bracket 20 is fixed to the transverse segment of the threaded hook 7, after which the screw is pulled out by the bracket with simultaneous correction of the rotational displacement.

After the visually correct axis of the femur has been reached and the bone fragments have been displaced along the length (x, determined by measuring the comparative length of both thighs), radiographic monitoring is performed. If there are unresolved offsets in width and at an angle, they are eliminated by moving the threaded hook 7 along the notch of lintel 6 and moving the beam along the slots of the beams 5. In order to accurately match and fix fragments on pairs disposable proximals

it and distal to the fracture site, are fixed to rings 12 with brackets 13 and rods with reamers 14. The latter are brought into the bone fragments all the way and inserted into the cortical layer of the bone in the same way as this is done for tibial fractures.

The patient is placed on the patient's operating table on his back with a vertical intermediate stop 25 mounted to the end of the operating table 26. The distal end of the device is fixed on the vertical stand 24, the pair hip is fixed to the same stand in the extension position in the hip joint and slight bending in the knee joint. The operated limb is imparted to the hip joint position. From the incision above the greater skewer of the piercer and the drills form a tunnel in the promaximal metaphysis to the bone-brain canal. Through the tunnel into the medullary canal proximal as well; then a conductor (not shown) is inserted into the distal fragments, after which the promaximal needle 19 is removed.

The subsequent steps of the operation are carried out in accordance with known techniques, after the final nail piercing (not shown; final radiographic control is performed.

Example. Ill L., 39 years old, - entered on 01/05/85 g with a diagnosis of a closed spiral fracture of the right

01/08/85 Surgery: Closed intramedullary osteosynthesis. On the operating table, the right shin is laid on the popliteal roller 23 in the position of bending of the knee and hip joints at an angle of 90, the distal end of the device is fixed on the stand 24. The medial subpatelle has an anterior marginofibial bone on the border of the mid-joint and the tibial horses lower third with displacement, fracture of the ankle on the right. On admission, the patient was superimposed with a skeletal extension of the pectoral bone.

01/07/85 an additional needle 19 was drawn through the proximal tibial metaphysis, the needle 19 was tensioned and fixed to the arc 3. The bracket 20 connected to the needle spoke 21 was fixed to the hook 7. The screw tension of the hook 7 and its rotation removed the displacement along the length and rotational displacement of the distal fragment. Moving the bridge 6 along the slots of the beams 5, and the hook 7 - along the slot groove

6 removed by offset width. Hook

7 Fixed with lock nut 10.

B-clamps 1 1, placed on rails 1 proximal and distal to the fracture site, are secured with two rings 12. A bracket 13 with a retaining rod 14 is mounted on the proximal ring 12 in the projection of the inner surface of the tibia, the same bracket 13 with reporters 14 is fixed on the distal ring 12 in the projection of the outer surface of the tibia. The hinge pins 14 are brought all the way into the cortical bone. Simultaneous rotation of the rods-reporters 14 achieved dense contact and fixation of fragments.

01/08/85 Surgery: Closed intramedullary osteosynthesis. On the operating table, the right shin is laid on the popliteal roller 23 in the position of bending of the knee and hip joints at an angle of 90, the distal end of the device is fixed on the stand 24. The frontal joint-tibial area is exposed by medial subpatelle

STI, a tunnel is made in it to the bone-brain canal. The channel was calibrated with drills up to 11 mm, a 10 mm caliber nail was driven in by a conductor, and a wound was applied to the wound. The final x-ray control was performed, good matching and stable fixation of fragments were achieved. The duration of the operation is 20 minutes.

Thus, the proposed device allows reposition of bone fragments of the hip and tibia and does not interfere with the subsequent intramedullary osteosynthesis.

Form m. La la invention and

A device for repositioning bone fragments, containing two guides, at the ends of which there is an arc with a needle and a frame with a threaded hook connected to the bracket with a needle attached to it, characterized in that, in order to ensure spatial displacement of the distal fragment, the frame is full With a bridge in which a threaded hook is mounted for spatial movement, between the guides are placed rings with bone locks with the possibility of longitudinal movement.

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Compiled by L. Povarov Editor P. Gereshi Tehred I.Popovich Proofreader. Shekmar

Order 2988/4 Circulation 595 Subscription

F) IIPI of the USSR State Committee for Inventions and Discoveries 113035, Moscow, Zh-35, Raushsk nab., 4/5

Production and printing company, Uzhgorod, st. Design, And

Claims (1)

Claim A device for reposition of bone fragments, containing two guides, at the ends of which there is an arch with a spoke and a frame with a threaded hook connected to a bracket with a spoke fixed on it, characterized in that, in order to ensure spatial movement of the distal fragment, the frame is made with a jumper , in which a threaded hook with the possibility of spatial movement is installed, rings with bone retainers with the possibility of longitudinal movement are placed between the guides. 1.324862