Method for treating comminuted fractures

FIELD: medicine.

SUBSTANCE: method involves using wires as temporary fixing members. The wires are introduced reach the external cortical layer after setting the fracture for the period a permanent fixing member is under setting. The wires are removed from the opposite bone side with respect to the fixing member.

EFFECT: enhanced effectiveness in fixing and holding small-sized splinters; high reposition accuracy.

2 dwg

 

The present invention relates to the field of surgery, traumatology and orthopedics, in particular to methods for treating comminuted fractures.

There is a method of temporary fixation of the bone fragments by means of wire after reposition (Caclin E Operative Orthopaedics. M: Medgiz, 1951 p.44). The disadvantage of this method is that it is not always possible to securely fasten and hold the fragments in the correct position before the final fixing of submersible design (e.g., plate). At the same time, not all fragments, due to their size and shape, it is possible to connect the wire. Along with this, the wire in the specific form of the bevels of the fragments (e.g., fracture type “butterfly”) can interfere with reposition of bone fragments. In addition, cases of comminuted fractures, temporarily bonded wire at the time of the establishment of plate retainer is required prior removal of the wire that leads to the re-displacement of the fragments and, consequently, poorly executed osteosynthesis.

The closest to the technical nature of the claimed our invention is a process comprising the reposition of bone fragments and fixation of the fragments with screws (Muller M.E. Ter-Minassian, Allgower M., Schneider R., Villinger X. Manual internal osteosynthesis. M. 1996, -s). The disadvantage of this method, wybranego as a prototype, is that not all pieces may be fixed with screws. So, the small size of the particles may be small for the accommodation of a screw, but at the same time to make up a large bone defect of the deletion. This leads to a slowdown in consolidation or nonunion of the fracture. In addition, the screw that secures the fragment can be an obstacle to further reposition of bone fragments, and also to be necessary in the plane of arrangement of the latch (e.g., plates), thereby inhibiting its proper drying. This is especially true in the treatment of comminuted fractures of the musculoskeletal system. Moreover, when fixing the fragment screw reposition is final due to the stiffness of the screw. Therefore, even a slight inaccuracy of the location of the fragments will result in insufficient reduction of fracture in General.

The technical task of the invention is to improve the quality of treatment of comminuted fractures due to efficiency reposition and fixation of bone fragments.

The solution is achieved in that in the method of treatment of comminuted fractures of the reduction with fixation of fragments and fragment uses needles that are injected to the outer cortical layer after reposition of the fracture during the process of establishing a permanent retainer, and then the needles are removed from the opposite of officiator hand bones.

Use as retainers spokes allows to perform a full reposition of fracture during compression osteosynthesis, even if inaccurate primary adaptation of the fragments. Spokes can be entered into pieces without splitting them, even in the face of the cortical layer of the bone. Use shorter spokes on the outer cortical bone layer allows you to set up a permanent retainer in the proper plane and without the threat of secondary displacement of the fragments.

According to scientific-technical and patent literature, the use of spokes for temporary connections, as well as retention of shards and fragments with plate osteosynthesis is not known.

The proposed method for the treatment of comminuted fractures is as follows and is illustrated by figure 1. After doing the standard access to exposure of the fracture site of the bone is gentle reposition of fragments and fragments (1), which in turn are fixed using shorter spokes Kirchner (2). If possible, each fragment is fixed 2 spokes in different planes to avoid bias in the final reduction and osteosynthesis. After such temporary fixation of all fractures in General, the spokes are shortened with the help of pliers at the level of the cortical layer on the side of the bone, where it is assumed the establishment of a plate (3). Then you oleosin the ez bone plate (3) and screws (4) with fixed spokes fragments. After osteosynthesis spokes removed (5).

The essence of the proposed solution is illustrated by examples taken from clinical practice. The patient halts IB, No. 37994/143583, was admitted to the hospital 12/11/2002 diagnosed with: Autorama: Closed craniocerebral injury. A concussion. Closed comminuted fracture of the right femur with displacement of fragments. SHOCK-1. In a delayed manner made the right femur osteosynthesis by the proposed method. Through standard access was the reduction and temporary fixation pins shortened at the level of the cortical layer at the outer side of the femur. In this position made the osteosynthesis plate 14 by screws. After the needles are removed from the bone. The wound is sutured in layers. The postoperative period was uneventful. The wound healed by first intention. In satisfactory condition two weeks after the operation the patient without additional plaster immobilization was discharged for outpatient treatment. An example is illustrated copies of radiographs, attached to the application (Figure 2:a,b,C).

The application of the proposed method for the treatment of comminuted fractures increases the efficiency of the operational benefits, enables fixing, including the end of the cortical layer of the bone, even small and difficult to hold while R is the position and fixation of the fracture fragments. Creates sufficient reliable fixation of all fractures in General, the runtime of the application of those or other fixative (e.g., plate). Does not prevent an exact adaptation of the fragments under compression plate osteosynthesis of a fracture. Allows you to set the bone fixing device in any needed right of the fixation plane. Reduces during surgery trauma to the bone and surrounding soft tissues, as well as the cost of treatment by reducing the number of structures required to perform stable osteosynthesis.

A method of treating comminuted fractures involving reduction with fixation of fragments and fragments, characterized in that as temporary clamps use needles that are injected to the outer cortical layer after reposition of the fracture during the process of establishing a permanent retainer, and then the needles are removed from the opposite from the latch side of the bone.



 

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