Apparatus for combined osteosynthesis

 

The invention relates to medicine, namely to traumatology and orthopedics, and can be used in the treatment of comminuted, intra - and periarticular fractures. The invention provides a primary healing comminuted, intra - and periarticular fractures, reduces the duration of treatment at the expense of achieving a controlled, hard and stable fixation of bone fragments to complete fusion of the fracture. Apparatus for combined bone contains bone fixing device made in the form of a plate with holes, and the outer clamp with rod holders that have transosseous elements. Plate and outer clamps rigidly interconnected transosseous elements that are installed in the holes of the plate and have the support area on the border of the transition plate part in intraosseous in the form of increased external diameter of the element in the osseous part. 1 Il.

The present invention relates to medicine, namely to traumatology and orthopedics, and can be used in the treatment of comminuted, intra - and periarticular fractures.

Known methods of fixation of fractures: p ochagovogo osteosynthesis, containing a threaded rod, which features slides, fixed on the rod by nuts. Floaters have a groove made in a perpendicular direction with respect to the rod to secure it to the threaded rod with nuts. The threaded rod has a transverse hole for attaching external items with nuts. Transosseous elements made in the form of a smooth rod having threads at 1/3 length [1].

Known devices for submersible osteosynthesis, for example in the form of plates or intramedullary nails [2]. On the plate with holes, which are injected screws for connection of the plate with a broken bone. However, the plate is subjected to deformation from impact bending strength and the locking screws can be displaced. An intramedullary nail under load is also subject to deformation due to resorption of the bone in the place of its contact with the metal, decreases the stability of the bone fragments.

Closest to the proposed treatment is tradevision bone fractures with the use of two devices: external fixation device and the immersion element, applied simultaneously or sequentially [3]. As the submersible element used PL is internal fixation impose a temporary external fixator, for example, in the form of a threaded rod, which strengthened the rod holders and screw terminals. Great lever outer clamp provides efficient unloading of internal implants up until "the bone will not seize".

However, the known constructions have significant disadvantages, namely: 1. To achieve a lasting fixation of comminuted, complex fractures requires the use of massive metal structures with a large number of fixing elements (screws, screws, etc.,), which leads to disruption of blood supply to the bone over a large area.

2. The possibility to control the rigidity of fixation in the treatment process.

3. Use only external fixation devices requires to ensure the rigidity of fixation to apply at least three rods in each of the bone fragments, which can result in a significant restriction of motion in adjacent joints due to fixation of soft tissue to bone rods. With a large number of bone fragments, covering the greater part of the bone, the achievement of stable osteosynthesis of AVF impossible, since the introduction of the rod in each of the fragments is technically unattainable.

4. The impossibility of achieving a strong anchoring at skolgatan and support function of the limb before the formation of sufficiently strong bone spikes.

5. When the osteosynthesis of bone fractures only extramedullary plate is completely eliminated, the load on the limb within 3-6 weeks with simple fractures, comminuted fractures, complex fractures classification) within 8-12 weeks.

6. If the location of the rods in the bone area with a low density (for example, metaphysi), and also due to the resorption of bone tissue at the border of the junction of the fixing element with the cortical layer of the bone is impossible to achieve a rigid connection of the rod with the bone, which leads to instability of the osteosynthesis.

7. The more complex the design of external fixation device, the more nodes of the connection structure, the harder it is to achieve the necessary rigidity of the connection of all elements, and this in turn may lead to renewed displacement, and fracture of the regenerate in the treatment process.

8. The load on the limb when using the rod of the device is possible only in 3-6 weeks.

9. The duration of treatment due to the introduction of the training period bone regenerate is considerably longer.

Based on the current level of technology and eliminate the disadvantages of the known constructions the task was: to ensure the to ensure through achieving a controlled, rigid and stable fixation of bone fragments to complete fusion of the fracture.

The problem is solved as follows.

Apparatus for combined bone contains bone fixing device made in the form of a plate with holes, and the outer clamp with rod holders that have transosseous elements. New in the solution of the problem is that the plate and the outer clamps rigidly interconnected transosseous elements that are installed in the holes of the plate and have the support area on the border of the transition plate part in intraosseous in the form of increased external diameter of the element in the osseous part.

Explain the significance of the distinctive features of the proposed technical solutions.

The rigid connection between the plate and the external fixator using transosseous elements that are installed in the holes of the plate, provides the connection plate with the bone and immobilizes the arm, and through the outer part of the retainer is inserted to the second external mechanism Immobilise. In addition, combining in a single structure plate and the external parts of the apparatus for combined osteosynthesis allows you to get kleinich interventions, several times to increase the contact area of the outer part of the lock with the bone and accordingly increase the fixation capabilities of transosseous elements (rods), thus without compromising the rigidity of fixation of the fracture to reduce the number of cores in the machine. The locking features of plate part of the device allow you to remove the outer part of the vehicle to a complete realignment of callus, reducing the treatment time, as it excludes the period of training, bone regenerate.

Execution of foothold on external item at the junction of plate parts in intraosseous in the form of increased external diameter of the element in the osseous part can give it the function of the screw head and, thus, simultaneously to build bone fixing device in the outer part of the clamp that connects the design into a coherent whole and creates the possibility to control the rigidity of osteosynthesis for the entire period of fixation.

Conducted patent research in subclass a 61 In 17/58, and analysis of scientific and medical information that reflects the current level of known devices for osteocyte did not reveal structures that are identical to proposed. Thus, the proposed device DL the different elements of the proposed system allow you to obtain a new technical and medical outcome in problem solving namely: to ensure that primary healing of bone fractures and to reduce the duration of treatment at the expense of achieving a controlled, hard and stable fixation of bone fragments to complete fusion of the fracture. Thus, the proposed design of the apparatus for combined osteosynthesis involves an inventive step.

The proposed apparatus for the combined osteosynthesis is industrially applicable in the field of practical health care, as it can be repeatedly reproduced and used for the treatment of comminuted, intra - and periarticular fractures.

The essence of the design of the device for the combined osteosynthesis is illustrated in the drawing, which presents his General appearance.

Apparatus for combined osteosynthesis contains outer and bone fixing clamps. Bone fixing device is a plate 1 with 2 holes for screws 3. The outer retainer - for example, threaded rod 4 with serenelystormin 5, which posted transosseous elements made in the form of rods 6 with the screw cutting. Intraosseous portion of the rod 6 is threaded, corresponding to the size and thread pitch of the standard screws for plate osteosynthesis. The rods 6 are oporno the measures twice in the osseous part. Transosseous elements 6 are located in the holes 2 of the plate 1 and connect the device into a single unit.

The proposed apparatus for the combined osteosynthesis is used as follows.

Execute access to the site of fracture and produce an open reposition of bone fragments under visual control. Then fix the arm plate 1 is curved in accordance with the contour of the cortical bone layer with use of a minimum number of screws 3, which is placed in the hole 2 of the plate 1, adjacent to the site of fracture. Then enter the rods 6 in the bone fragments through available holes 2 located at the ends of the plate 1. The rods 6 are separated by the maximum length of the line of fracture and in a plane at an angle of 90 degrees relative to the plane of arrangement of screws of the plate 1. The rods 6 twist in bone fragments to solid contact plate 1 with the bone and fixed in stalinification 5 external latch 4. Check the rigidity of fixation of a fracture by motion in adjacent joints, axial and lateral loads on the segment. If there is instability, in addition, departing proximal to or distal from the line of fracture (depending on the length of fragments), enter on the Sabbath. If necessary, in a separate large bone fragments also introduce the rods 6. The amount of the rods 6 is determined by achieving rigid fixation of the fracture. Convinced of the strength of fixation of the fracture, the wound sutured in layers. On the second day after surgery, the patient is put on a foot with the greatest possible bearing on the operated limb (up to significant pain syndrome) and allow full function. Stitches are removed after 10 days from the day of the operation.

1 month after the operation, make the control chest x-ray, to check the presence of callus, the quality of fixation, the condition of the bone tissue around the terminals 6 and 3 screws. If necessary, the rods 6 rigged for the protruding above the skin part of the mechanical key, after loosening its mounting in the outer retainer 4, and then firmly fixed to the outer retainer 4.

If clinical and radiological examination establish the fact of Union fracture, then disassemble the outer retainer 4 and remove the rods 6. Workout of the regenerate do not produce.

After a full rebuild bone spur removed extramedullary plate 1. Rehabilitation for the development of joint motion of the operated limb is not required.

Thus, the proposed Device for the combined osteo - and periarticular fractures, as well as reducing the duration of treatment at the expense of achieving a controlled, hard and stable fixation of bone fragments to a complete fusion of the fracture, as well as the full inclusion of function of the affected joint from the first days after the operation.

Sources of information 1. Auth. mon. The USSR 1806661, 1993. Bull. 13, MCI D 61 17/58.

2. Manual of internal fixation (group TO Switzerland) M. E. Muller, M. Allgower, R. Schneider, H. Villinger // Translation into Russian language - Publisher Ad Marglnem, Moscow, 1996, S. 23-24.

3. Manual of internal fixation (AO Switzerland) M. E. Muller, M. Allgower, R. Schneider, H. Villinger // Translation into Russian language - Publisher Ad Marg'inem, Moscow, 1996, S. 26, Fig. 1.12. a, b, C.

Claims

Apparatus for combined bone containing bone fixing device made in the form of a plate with holes, and the outer clamp with rod holders that have transosseous elements, characterized in that the plate and the outer clamps rigidly interconnected transosseous elements, the second set in the holes of the plate and have the support area on the border of the transition plate part in intraosseous the increasing diameter

 

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