UA64931A - Technique for osteosynthesis of trochanteric fractures of thighbone and device for its realization - Google Patents

Abstract

The technique for the osteosynthesis of the trochanteric fractures of the thighbone comprises the closed reposition of the fragments and the application of the threaded compression rods inserted into the bone fragments providing for their compression and stabilization. Two compression rods are disposed in the same plane while the auxiliary stabilizing rod is inserted in the plane located at an angle to the plane of the first two rods (as a rule perpendicular to them). The device for the osteosynthesis of the trochanteric fractures of the thighbone comprises the basis support with the openings for at least two threaded compression rods. The additional base has the auxiliary stabilizing rod arranged at an angle to the plane of the first base. Two bases are joined via the dismountable connection.

Description

The invention relates to medicine, namely to traumatology and orthopedics and is intended to restore the function of the limb in case of acetabulum fractures of the femur.

One of the important areas of development of traumatology and orthopedics is the treatment of old and elderly victims with various injuries of the support and movement system. In this connection, the problem of treatment of fractures of the acetabulum, which in terms of frequency occupy one of the first places in this category of victims, is of particular importance.

Despite the use of various treatment methods, a significant percentage of unsatisfactory results in the form of mortality draws attention. The only means of prevention of possible somatic complications in such victims is their early activation, which is possible only with reliable and minimally traumatic osteosynthesis of fragments.

A known method of osteosynthesis of femoral neck fractures and a device for its implementation, see patent

of the Russian Federation Me2087133, IPC Ab1817/56). According to a known method, the operation is carried out in an open manner using a metal plate and a tubular fixator.

Such surgical interventions are not always possible due to their traumatic nature and the general condition of the victim, and they can also lead to various complications by themselves.

In recent years, there has been a search and application of minimally traumatic surgical interventions based on the method of closed transosseous osteosynthesis, which involves closed percutaneous fixation of fragments.

A known method of osteosynthesis of acetabulum fractures of the femur and a device for its implementation, which includes a closed reposition of fragments and the application of a rod apparatus, with the help of which the fragments are fixed by introducing into them at least two rods in the same plane (see patent of the Russian Federation Me2162304

IPC? Ab1817/56). Closed percutaneous fixation of fragments in one frontal plane is carried out according to a known method.

The method and device are the closest to the proposed ones, and therefore are chosen as prototypes.

The disadvantage of this method is that the acetabular area in old and elderly people is osteoporotic, and it is not always possible to ensure reliable osteosynthesis of fragments by introducing metal structures in only one plane. As a result of this, cutting of structures and their migration may occur, which is also facilitated by the biomechanical features of the hip joint.

The basis of the invention is the task of osteosynthesis of acetabulum fractures of the femur and a device for its implementation by additional fixation in two planes of fragments of the acetabulum and changing the spatial orientation of the elements of the rod apparatus to ensure a more reliable and strong fixation and prevent cutting and migration of structures.

The given task is ensured by the fact that in the method of osteosynthesis of acetabulum fractures of the femur, including the closed reposition of fragments and the application of a rod apparatus, with the help of which the fragments are fixed by inserting into them at least two compressing screw rods in the same plane, their compression and stabilization, according to the invention , additionally fix by inserting a stabilizing screw rod in a plane located at an angle, preferably perpendicular, to the plane of the location of the first two rods.

In the device for carrying out osteosynthesis of acetabulum fractures of the femur, which contains a base support with holes where at least two compressing screw rods are installed, according to the invention, the device contains an additional base support with a stabilizing screw rod, located in a plane that lies at an angle, preferably , straight to the plane of the first base support and connected to it by a disconnecting connection.

The detachable connection is made in the form of a screw rod installed on the base support with an eye and a tie pin, which is fixed at one end into the eye, and at the other end - on an additional base support.

The base support is installed with the possibility of rotation and fixation in two mutually perpendicular planes.

Implementation of the proposed method and device into traumatological practice increases the effectiveness of treatment of fractures of the acetabulum in older and elderly victims and allows to reduce the number of complications.

The invention is explained by a drawing showing the general view of the femur with the spatial location of the fixing structures:

The method is carried out as follows

The operation is carried out in the position of the patient on his back. With the help of skeletal traction, the reduction of the fragments is achieved in an orthopedic bed, which is monitored radiologically. Local anesthesia is performed intra-articularly and in the places where the rods are inserted. Through the acetabulum, two landmark spikes (not shown in the drawing) are inserted into the head of the femur 1, after which a control X-ray is taken.

Focusing on the spire, two compressing screw rods 2 are inserted. The depth of insertion is controlled radiographically.

Below the fracture line, approximately 3 cm, an additional stabilizing screw rod C is inserted into the diaphysis of the femur in a plane located at an angle, preferably perpendicular, to the plane of the location of the first two screw rods 2. The rod insertion sites are closed with sterile napkins with locking plugs.

After that, the skeletal extension is dismantled. On the second day after the operation, the patient sits up in bed, returns to the healthy side. Three days after the operation, the patient learns to walk with the help of crutches without loading the limb. Extremity loads are allowed from the third week.

The device for carrying out osteosynthesis of acetabulum fractures of the femur includes a basic support 4 with holes 5, where two compressing screw rods 2 with nuts 6 are installed, an additional basic support 7 with holes 8 with a stabilizing additional rod C with a nut 9. The additional basic support 7 is located at an angle , preferably, direct to the plane of the first base support 4 and connected to it by a detachable connection.

The detachable connection is made in the form of a screw 10 with a lug 11, a nut 12 and a tie pin 13 installed on the base support 4, which is fixed at one end to the lug 11, and the other - to the additional base support 7 with the help of nuts 14.

The additional base support 7 is installed with the possibility of rotation and fixation in two mutually perpendicular planes.

Example. Patient K. 78 years old. entered the clinic on January 3, 2002. with the diagnosis: closed acetabular fracture of the left femur with displacement. Through the supracondylar zone of the femur, a Kirchner tip was passed and a skeletal traction system was established in bed, which achieved reduction of the fragments. After 5 hours in the bed in the operating room under local anesthesia, percutaneous fixation of the fracture with a rod apparatus was performed using the proposed method.

The postoperative period was uneventful. She started walking with the help of crutches on the 5th day after the operation, dosed loading of the limb began two weeks later, full loading of the limb was carried out at the end of the second month. The term of fixation of the limb with the device was 2.5 months. Fracture union has occurred.

Patient T. 81 years old. entered the clinic on March 12, 2002. with the diagnosis: closed lateral fracture of the neck of the right femur with displacement. Treatment with permanent skeletal traction was started. After repositioning of fragments on 03.14.02. the patient underwent percutaneous osteosynthesis with a rod device in the proposed method.

The postoperative period was uneventful. He started walking with the help of crutches 7 days after the operation, dosed loading of the limb began two weeks after the operation, and full loading of the limb - after 2.5 months. The term of limb fixation with the proposed device was 3 months. Complete fusion of the fracture with correct angular relationships has occurred.

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Claims (4)

1. The method of osteosynthesis of acetabulum fractures of the femur, which includes closed repositioning of fragments and the application of a rod apparatus, with the help of which the fragments are fixed by introducing into them at least two compressing screw rods in the same plane, their compression and stabilization, which is distinguished by the fact that additionally perform fixation by inserting a stabilizing screw rod in a plane located at an angle, preferably perpendicular, to the plane of the location of the first two rods. 2. A device for carrying out osteosynthesis of acetabulum fractures of the femur, containing a base support with holes where at least two compressing screw rods are installed, which is characterized by the fact that the device contains an additional base support with a stabilizing screw rod, located in a plane that lies under angle, preferably, straight to the plane of the first base support and connected to it by a detachable connection. 3. The device according to claim 2, which is characterized by the fact that the detachable connection is made in the form of a screw rod installed on the base support with an eyelet and a fastening pin, which is fixed at one end in the eyelet, and at the other end - on an additional base support. 4. The device according to claim 2, which differs in that the additional base support is installed with the possibility of rotation and fixation in two mutually perpendicular planes.