Method of surgical treatment of complicated form of complete doubling of first foot ray of children

FIELD: medicine.

SUBSTANCE: tendons of flexors and extensors of additional and basic rays are cut at the level of medium third of metatarsal bone and medium third of second instep bone respectively. Underdeveloped metatarsal bone of additional ray and underdeveloped first finger of base ray are removed. Anatomically correctly developed finger of additional ray is transferred on anatomically correctly developed metatarsal bone of basic ray. Flexor and extensor tendons of formed first ray are sutured at the level of medium third of formed ray. Fixation of transferred fragments is realised due to K-wires and gypsum bandage in medium position of foot to knee joint.

EFFECT: method ensures normal growth of first ray and support ability of foot.

9 dwg

 

The invention relates to the field of medicine, namely to orthopedics.

A method of treating children with complex form of a doubling of the first ray of the foot involving the first metatarsal hypoplasia of bone in an anatomically normal developed the first finger and well-developed metatarsal bones and severe malformation of the extra first toe, which produces the incremental removal of the first ray. (I. Y. Gankin author's abstract of candidate's dissertation, 2007).

The disadvantage of this method is the presence in the future in the child anatomically defective remainder of the first ray of the foot, dramatically impairing the functionality of the foot, the support ability and the availability of the cosmetic defect.

The objective of the proposed method of treatment is the creation of anatomically normal growing of the first ray of the foot of two partially aborted first rays.

The technical result of the task is achieved by a method, which made the removal of immature bone segments primary and secondary rays, characterized in that the tendons of the flexors and extensors of the additional and main beams cut at the level of the middle third of the metatarsal bone and the medial third of the second metatarsal bone, respectively, are removed hypoplastic metatarsal bone dopolnitelnye and underdeveloped first finger of the main beam, then developed an anatomically correct finger additional beam travels at developed anatomically correct metatarsal bone of the main beam, the tendons of the flexor and extensor formed of the first ray was ligated at the level of the middle third of the beam formed, and deliver the fixation of the spokes of Kirchner and plaster cast in the middle position of the foot to the knee joint.

Method of surgical treatment of complicated forms full doubling of the first ray of the foot in children is illustrated by the following figures:

Figure 1. Photo of the foot of a child With.. 2 years, with a complex form of doubling of the first ray.

Figure 2. Computed tomography of the foot of the child S., 2 years, with a complex form of doubling of the first ray.

Fig. 3. Radiograph of the feet of the child S., 2 years, with a complex form of doubling of the first ray.

Fig. 4. A schematic representation of a complex shape full doubling of the first ray of the foot:

position 1 - rudimentary first metatarsal bone;

position 2 - aborted second finger.

Fig. 5 - Intraoperative removal of the rudimentary first metatarsal bone.

Fig. 6 - Remote underdeveloped second finger.

Fig. 7. - Schematic image formed forefoot.

Fig. 8 - Foot baby S. a year after surgery.

Fig. 9 - Radiograph of the foot of a child C. a year after Prov´┐Żdaily surgery.

Method of surgical treatment of complicated forms full doubling of the first ray of the foot in children (Fig. 1, 2, 3) is as follows. An incision on the dorsum of the foot, in the area of first metatarsal bone, "type racecourses access to disarticulation additional second finger (Fig. 4, position 2). Bluntly and sharply distinguish hypoplasianus first metatarsal bone (Fig. 4, position 1) cut through the capsule of the first metatarsophalangeal joint, the flexor and the extensor of the first finger is crossed transversely in the middle third metatarsal bone. Rudimentary first metatarsal bone is removed (Fig. 5). From the same incision recovered the bulk of the first metatarsal bone and underdeveloped basic first finger. The flexors and extensors of the main first finger is crossed transversely at the level of the middle third of the second metatarsal bone. Produce disarticulation of the main underdeveloped first finger (Fig. 6). Anatomically correct developed additional finger beam travels at developed anatomically correct metatarsal bone of the main beam. Flexors and extensors formed the first finger ligated at the level of the middle third metatarsal bone shaped beam. Is the fixation of the formed first ray spokes of Kirchner and plaster cast in the middle position of the foot to the knee joint

The implementation of these interventions on the osteo-articular apparatus forefoot combined with tendon-muscle plasticity allows to form a normally growing the first ray of the foot, to create anatomically correct ratio at the level of the joints of the forefoot, to improve the support ability of the limb, allows you to use regular shoes (Fig. 7, 8, 9).

Method of surgical treatment of complicated forms full doubling of the first ray of the foot in children, which is the removal of immature bone segments primary and secondary rays, characterized in that the tendons of the flexors and extensors of the additional and main beams cut at the level of the middle third of the metatarsal bone and the medial third of the second metatarsal bone, respectively, are removed hypoplastic metatarsal bone of the additional beam and underdeveloped first finger of the main beam, and then developed an anatomically correct finger additional beam travels at developed anatomically correct metatarsal bone of the main beam, the tendons of the flexor and extensor formed of the first ray was ligated at the level of the middle third of the beam formed, they were carried out by fixing the spokes of Kirchner and plaster cast in the middle position of the foot to the knee joint.



 

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