Method of performing periacetabular triple osteotomy of pelvis in teenagers
SUBSTANCE: invention relates to traumatology and orthopaedics and can be applied for realisation of periacetabular triple osteotomy of pelvis in teenagers. Access to ischial and pubic bone is realised in projection of adductor muscles - longitudinal adductor access, in position of bending and abduction in hip joint. Tenomyotomy of adductor muscles is performed. In intermuscular space in blunt way performed is access to femur trochantin, where tendon part of iliolumbar muscle is exposed and its tenotomy is carried out. Branch of ischial bone, covered from outside with external obturator muscle, is identified under acetabulum. External obturator muscle is perforated. Ischial bone is bypassed with raspatories from inside and outside and oblique osteotomy is performed in front-to-back direction. Osteotomy of upper branch of pubic bone is performed. Osteotomy of ilium is performed from front access.
EFFECT: method makes it possible to reduce access trauma, provide realisation of surgery under conditions of hip head compression or its high position in case of dislocation.
The invention relates to medicine, namely to traumatology and orthopedics, and is intended for the treatment of hip disease in adolescents with severe forms of violations of relationships in the hip joint caused by breach of the centration of the femoral head, the bone deficit coverage.
The main indications involving the use of a triple osteotomy of the pelvis are: Perthes disease, residual subluxation and dislocation of the hip, dysplastic coxarthrosis, spastic subluxation and dislocation of the hip. Hip dysplasia is a congenital inferiority of the joint, due to its irregular development, which leads to subluxation or dislocation of the femoral head. Spastic subluxation or dislocation of the femoral head - a key element in the development of deformities in the hip joint is an increased tonus of the adductor muscles and the weakness of the gluteal and abductor muscles that inhibit physiological processes decline cervico-diaphyseal angle. As a consequence, the redistribution of the load of the femoral head on the outer edge of the acetabulum and the development of bone deficit coating head through the acetabular component.
There is a wide variety of approaches in the operation triple osteotomy of the pelvis, where the main difference bookmark�greater access to the ischium and the number of accesses. In recent years, the most popular are periacetabular triple pelvic osteotomy, in which the intersection of the pelvis is performed in the vicinity of the acetabulum.
The known method of triple osteotomy of the pelvis by periacetabular ischial osteotomy, pubic and iliac bones of the pelvis with the reorientation of the acetabulum, this exercise lateral access to the upper thigh, perform corrective osteotomy of the proximal femur by resection of the bone wedge, the upper section of which is carried directly above the small trochanter, and the second depending on the direction of the required correction, cut the tendon of the iliopsoas muscle from the small trochanter, plant fragments thighs, longitudinally divided muscle to the lateral border of the ischium and transversely or cooperate her cut from multlanguage space immediately below the bottom edge of the acetabulum with resection of the osteotomy of the lateral edges of the U-shaped or conventional osteotome width of 0.5 cm and osteotomy-osteoclasis its inner edge, perform osteosynthesis of fragments of the femur metal l-shaped plate, provide access to the anterior part of the pelvis, cut through the pubic bone at the base, transverse or semicircular cross podvzdoshnoj� bone above her front bottom spine, rotating mobilized the acetabular fragment to the femoral head with his medialization, which detect fragments of the pelvis with the help of spokes Kirchner, depending on the ratio of bone fragments fill the defects resected from my thigh bone autograft (Patent RF №2438609).
The disadvantages of this method are the high risk of injury to the neurovascular tract, passing through the inner thigh and a significant depth of the wound, passing through all layers of the thigh muscles, which reduces the operational review of the field.
The known method of triple osteotomy proposed by Sokolov A. M. (A. M. Sokolowski Features of our technology triple pelvic osteotomy / A. M. Sokolov, O. A. Sokolov // Actual problems of pediatric traumatology and orthopedics: Materials of scientific-practical conference of the children's orthopedic traumatology of Russia. - Staraya Russa, 2000. Pp. 320-322), according to which the patient on the back with a raised pelvis on the side of the surgery is performed the incision Smith-Petersen. After clipping the iliopsoas muscle from the small trochanter in the lower corner of the wound below the acetabulum 2-3 cm by palpation determine the ischial bone and is isolated subperiosteal. According to the author, the selection of the ischium is the most difficult phase of the operation, since the depth of the wound was significantly increased, and the angle of the surgical dei�the third decreased, but sufficient for safe osteotomy of the ischium. Subsequently, the author refused to carry out a complete osteotomy, replacing it with osteotomy-osteoclasis ischium.
The disadvantages of this method are the large depth of wound and a significant decrease in the angle of operative activity.
The known method of transposition of the acetabulum after triple pelvic osteotomy, whereby as close as possible to the bottom of the trench is performed subperiosteal allocation of the pubic bone. After installing subperiosteal limiters osteotomy is performed. From the same access as close as possible to the bottom of the trench is performed subperiosteal allocation of the ischium upwardly from the ischial tuberosity without affecting the point of attachment of the muscles of the back of the thigh, and after installing subperiosteal limiters is oblique periacetabular osteotomy. After subperiosteal separation of the Ilium is then osteotomy saw Gigli. Produce transposition of the acetabular fragment. The resulting position is fixed spokes of Kirchner. (Patent RF №2414186).
The disadvantage of this method are narrow indications for triple pelvic osteotomy. Application of this method in children with Perthes disease, spastic subluxation and dislocation of the hip, where one of the TC�Cevik pathogenetic mechanisms of development of secondary deformities of the femur and pelvic components is compressed iliopsoas muscle, requires additional access to the small trochanter of the femur.
The method chosen as a prototype.
The object of the invention is the development of an original method of triple pelvic osteotomy of the minimal invasive access.
The technical result of the implementation of the task is a multi-access ischial and pubic bones of the pelvis and the iliopsoas muscle.
The invention consists in the original less traumatic access to the ischium, and through this access can be trometamol the adductor muscles and the lumbar-iliac muscle. The choice in favor of transposition of the acetabulum due to the severity of the deformation of the acetabulum and the age of the patient. The method can be combined with corrective osteotomy of the femur.
The method is carried out as follows. In the patient on the back with a cushion under the hip joint on the side of the operation, the foot in the position of flexion and abduction in the hip joint (Fig.1) make the cut of a length of 7-8 cm in the upper third of the thigh on the inner surface in the projection of the adductor muscles - longitudinal adductors access (Fig.2). After incising the skin and subcutaneous tissue perform trometamol the adductor muscles (as indicated). In the intermuscular interval blunt carry dost�p to the small trochanter of the femur, where allot of the tendinous portion of the iliopsoas muscle (Fig.3) and produce tenotomy m. The Iliopsoas. In place of the cut-off of the adductor muscles, just below the acetabulum of the determine the upper branch of the ischium, which is covered by the outer sphincter muscle. The latter is perforated clamp and seat bone curved bypass aspatore inside and out (Fig.4). There is no need to strictly subperiosteal to highlight the location of the osteotomy. Chisel perform oblique osteotomy in the posterior direction from front. In the upper corner of the wound palpation determine the upper branch of the pubic bone as close as possible to the body of the pubic bone (the leg is necessarily in the position of flexion and abduction in the hip joint to prevent contact with the femoral vessels and nerve), where for small isolated subperiosteal space for osteotomy. Osteotomy performed with a chisel or a saw, Gigli. Surgical wound is sutured leaving rubber graduate.
Osteotomy of the Ilium perform anterior length of 8-10 cm Subperiosteal allocation advertures produced only on the inner surface in a limited area in the venue saw Gigli. On the outer surface of the Ilium do not separate the periosteum. Saw Gigli produce arcuate osteotomy bulge, located n� articular fragment of the pelvis. Clinical example of a method
Patient K. 10 years admitted with a diagnosis of Perthes Disease on the right, 3 Catterall group, the stage of fragmentation. The child was admitted with complaints of pain in the right hip radiating to the right knee. The pains came at movement in the hip joint and by relying on the right lower limb. According to x-ray examinations in the direct projection and the projection Launstein (Fig.5): radiological signs of Perthes disease, saddle deformity of the epiphysis of the right femur, the stage of fragmentation. Shown and underwent surgery. In the patient on the back, after the processing of the entire right lower extremity and groin area up to the navel, in the position of flexion of the lower limb and abduction in the hip joint hold the skin incision in the projection of the adductor muscles - longitudinal adductors access a length of 7-8 cm in the upper third of the thigh on the inner surface. After incising the skin and subcutaneous tissue perform trometamol of the adductor muscles, decompression of the femoral component of the hip joint. In the intermuscular interval blunt access to the small trochanter of the femur, which is isolated tendinous portion of the iliopsoas muscle and produce tenotomy m. The Iliopsoas. In place of the cut-off of the adductor muscles, just below the acetabulum WPA�other determine the upper branch of the ischium, which is covered by the outer sphincter muscle. The latter is perforated clamp and seat bone bypassed curved raspatory inside and out. Chisel perform oblique osteotomy in the posterior direction from front. In the upper corner of the wound palpation determine the upper branch of the pubic bone as close as possible to the body of the pubic bone (the leg is still in the position of flexion and abduction in the hip joint to prevent contact with the femoral vessels and nerve), where for small isolated subperiosteal space for osteotomy. Osteotomy performed with a chisel or a saw, Gigli. Surgical wound is sutured leaving rubber graduate. Osteotomy of the Ilium perform anterior length of 8-10 cm Subperiosteal allocate adverturous only area on the inner surface in a limited area in the venue saw Gigli. On the outer surface of the Ilium do not separate the periosteum to reduce blood loss. Saw Gigli produce arcuate osteotomy bulge located on the articular fragment of the pelvis. Next, using a single-tooth hooks produce the displacement of the acetabular fragment anteriorly and laterally. Under image intensifier control fix the acetabular fragment in the correct position to the body of the Ilium 4-5 spokes. R�well sutured in layers with rubber graduate. X-ray picture of the hip joint after surgery (Fig.6.). Postoperative lower limb is fixed in a circular plaster cast for a period of 3 months. X-ray picture of the hip joint after removal of plaster (Fig.7). Radiographs in frontal projection and the projection Launstein 12 months after surgical treatment (Fig.8).
Triple pelvic osteotomy is an effective high-tech intervention in adolescents.
The advantage of the proposed method is to develop a new access when performing the osteotomy of the bones of the pelvis, osteotomy of the ischium is produced in the safest direction from front to backward.
Such access leads to the reduction of trauma intervention and implements krovoobrazhenie that allowed to avoid red blood cell transfusions.
Decreases the depth of wound when you access the ischium, there is no need to allocate the sciatic nerve. Longitudinal adultery incision minimizes damage to exterior pudendal blood vessels. Does not change the position of the patient during surgery, which reduces the time of surgery.
A method for performing periacetabular triple pelvic osteotomy in adolescents, including osteotomy of the iliac, pubic and ischial bones and�division of the ischium of the same access that pubic bone, characterized in that the access to the ischial and pubic bones is performed in the projection of the adductor muscles - longitudinal adductors access, in the position of flexion and abduction in the hip joint, perform trometamol the adductor muscle, in the intermuscular interval blunt access to the small trochanter of the femur, which is isolated tendinous portion of the iliopsoas muscle and produce its tenotomy, under the acetabulum of the determine the branch of the ischium, which covered the outside of the outer sphincter muscle, the external obturator muscle is perforated, ischium bypass aspatore inside and out and perform oblique osteotomy in the direction from front to back, then do an osteotomy of the upper branch of the pubic bone, and then perform the osteotomy of the Ilium anterior.
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.
SUBSTANCE: invention relates to traumatology and orthopaedics and can be applied for the treatment of purulent arthritis. Arthrotomy is carried out. Necrotised tissues, injured elements of the joint are ablated. Primarily a spacer from bone cement with an antibiotic is installed. The wound is sutured layer-by-layer. Drainage is carried out in portions, with the periodical closure of draining tubes in such a way, that drainage is realised for 5-10 min each hour on the first 2-3 days after operation. The spacer is replaced for the joint endoprosthesis after cupping the infectious process.
EFFECT: method makes it possible to reduce a risk of endoprophesies septic instability.
SUBSTANCE: invention refers to medicine, namely orthopaedics, and aims at treating a long-term rotator cuff injury. An incision 5-8 cm long is made from an inferior edge of a clavicle along an anterior surface of a shoulder along sulcus deltoideus (Ollier type) to access a rotator cuff. In an inner rotation position, the rotator cuff is sutured two or three times successively with the stitches transversely directed under each other to form a duplex rotator cuff segment.
EFFECT: invention enables reducing tissue injuries potentially accompanying a surgical intervention and the lengths of treatment and rehabilitation.
1 dwg, 2 ex
SUBSTANCE: point skin incision is made in a projection of a base of the 5th metacarpal bone, and a pin is inserted into a canal of the 5th metacarpal bone to reach a fracture level. That is followed by closed reduction of the fracture, and the pin is inserted transarticularly up to the level of a lower one-third of a proximal phalanx of a little finger.
EFFECT: more effective treatment ensured by the stable fixation of comminuted, spiral fractures and eliminating purulent-septic complications.
1 ex, 3 dwg
SUBSTANCE: formed concave spherical cutters are used to process end faces of bone fragments of the forearm to enlarge a contact area to a graft. An open reduction of the fragments involves measuring an existing defect in between. The graft of the required dimensions is created; the end faces of the graft are processed with convex spherical cutters of the similar radius. After the open reduction is completed and the graft is embedded between the fragments, the optimum contact area of the bone and graft is aimed. External or internal fixation is carried out to create compression between the fragments and graft and to ensure an extra stability of the maximum contact by shaping the end faces of the graft and fragments spherical.
EFFECT: method enables increasing fixation stability, providing the early functional load, and recovering the adjoining joint function.
SUBSTANCE: group of inventions refers to traumatology and orthopaedics and is applicable for subchondral strained reinforcement. The first version: one end of at least two pins is inserted subchondrally through articular surface fragments above a bone defect up to its cortical layer. The mechanical strain is generated in the pin; an arched curve is formed at an outer end of each pin, whereas a free linear segment of the pin thereafter is inclined by 45-60 degrees to a long axis of the bone, and then pressed to the bone with a clamp element by means of screws. The second version: one end of each pin is brought until it comes out from the opposite side of the bone, and a support pad is formed thereon; each pin is pulled up to contact the support pad to the opposite cortical layer of the bone; the pin is pulled up by its outer end; that is ensured by forming the arched curve of the pin at the end of each pin opposite the support pad and fixing it by at least two loops around the axis of the pin rod; the arched curve is bent to the bone, whereas the free linear segment of the pin end is placed on the surface of the bone surface for fixation thereto.
EFFECT: group of inventions enables preventing the secondary fragment displacement.
3 cl, 8 dwg
SUBSTANCE: not longer than 3 cm skin cut is performed above place of rupture on posterior surface of shin. Crucifirm sutures are applied on proximal and distal ends of Achilles tendon transcutaneously in front plane in such a way that one cruciform suture is located in deep and another - in superficial layer of Achilles tendon ends. Ends of Achilles tendon are brought into wound by threads, which are used to additionally apply blocking knots on proximal and distal tendon ends in order to prevent eruption of cruciform sutures. Threads are tightened and tied to each other, approaching tendon ends. Tendon ends are additionally strengthened with U-shaped sutures.
EFFECT: method increases accuracy of matching fragments of Achilles tendon by width and by length, reduces risk of injuring sural nerve.
3 dwg, 1 ex
SUBSTANCE: invention refers to medicine, namely orthopaedics and traumatology for eliminating an extension contracture of a wrist combined with flexion contractures and an ulnar deviation of triphalangeal fingers in the children suffering arthrogryposis. The method involves a corrective shortening extension osteotomy of metacarpal bones within distal metaphyses with excising a fragment as a trapeze. A greater base of the trapeze is directed radially.
EFFECT: method improves the gripping function by eliminating the contractures of the wrist joint and triphalangeal fingers.
16 dwg, 1 ex
SUBSTANCE: invention relates to traumatology and orthopaedics and can be applied for the single-step transiliac elongation of a lower extremity. The lower edge of the semiluna notch is osteotomated with the formation of an insection to the base of the anterior-lower spine. Rearward from the sciatic notch the ischium is sawed to the arc-like line with the formation of a saw cut. An external cortical plate is sawn on the external surface of the iliac bone from the insection to the saw cut, with the formation of a line of transverse osteotomy. The insection and the saw cut are connected on the internal surface of the ilium by a line of arc-like osteotomy of the internal cortical plate, passing in front of the semilunar notch upwards - on the internal edge of the ilium wing, then down its crest and downwards - on the posterior part of the iliac bone, with an indent from the arc-like line with the formation of a tongue-shaped bone flap. The external and internal cortical plates are moved with respect to each other in the saggital plane for distant, equal shortening of the extremity.
EFFECT: method makes it possible to reduce a risk of recurrence, and reduce the term of rehabilitation.
SUBSTANCE: invention refers to medicine, namely to traumatology, orthopaedics and oncology orthopaedics. The method involves radio-frequency ablation, metastatic cavity curettage, cement repair with using additional tools and a fastening intramedullary structure PFN. That is preceded by manufacturing a metal pipe fitting from 250 to 300 mm long with an inner diameter equal to the diameter of a gamma nail port, which is threaded at one end at a pitch equal to the inner thread pitch of the gamma nail with the number of turns adequate to press-fit the fitting and to fasten the fitting and the gamma nail together. The other end of the pipe is threaded at a pitch equal to the inner thread pitch of a bone cement injector with the number of turns adequate to couple the fitting and bone cement injector tightly; flat mount grooves for a mounting instrument are milled at 5 mm from the last turn of the thread for coupling the fitting and bone cement injector of the pipe end together; the groove width is equal to two widths of a working part of the mounting instrument. An electrode is inserted through trephine openings along a bone trephine into the metastatic lesion, and radio-frequency ablation is performed in the cervical and diaphyseal directions. Thereafter, a trochanteric region is perforated to insert a pin; trochanteric curettage and aspiration of the RF ablated tumour are performed. A canal is formed, and the pin is inserted; that is followed by perforating in the cervical direction; where it may be necessary, cervical curettage and aspiration of the RF ablated tumour are performed through the formed perforation. The canal is further formed to insert the gamma nail, which is completely mounted and unscrewed partially so that an outlet of its central canal is aligned at the level of the cavity centre; thereafter, the respective thread is used to couple and fasten the prepared fitting first with the gamma nail, and then with the cement injector. The assembled structure is used to introduce the bone cement in the cavity; then, the fitting and injector are removed; a guide pin is inserted into the central canal, and the gamma nail is mounted completely, whereas polymerised bone cement is impacted.
EFFECT: method enables preventing the pathological fracture accompanying the metastatic lesion of the proximal femoral bone, delaying or blocking the metastatic lesion growth, postponing or avoiding a procedure of hip replacement involving proximal femoral resection.
15 dwg, 1 ex
FIELD: medicine, orthopedics, traumatology.
SUBSTANCE: one should isolate and dissect the tendons of anterior tibial and long fibular muscles to dissect the tendon of posterior tibial muscle against the site of fixation and direct it towards plantar rear area in front of internal ankle through the tunnel in subcutaneous fiber, then one should subcutaneously direct dissected tendons of anterior tibial and long fibular muscles onto plantar rear area to suture them so to leave free the tendinous end of posterior tibial muscle which should be intraosseously fixed to median wedge bone that keeps the process of foot repulsion during walking.
EFFECT: higher efficiency of therapy.
5 dwg, 1 ex
FIELD: medicine, traumatology, orthopedics.
SUBSTANCE: one should perform reposition of talus fragments followed by resection of articular surfaces of talus and calcaneus by maximally restoring anatomy of tarsal plantar department without forming any groove in talus and resecting wedge-like fragments with their wedge bottom towards the side being opposite to deformation. Then one should develop an autotransplant out of ileum's ala by taking into account the form of modulating resection at its length being from talus' posterior edge up to Chopart's joint without vascular pedicle. Autotransplant should be fixed due to applying Ilizarov's apparatus that enables to cure aseptic necrosis, pseudoarthroses, remove pathological foot's phenomena at shortened time for operative interference and narcosis, decreases traumaticity of operative interference at total decrease of therapy terms.
EFFECT: higher efficiency of therapy.
FIELD: medicine, traumatology, orthopedics.
SUBSTANCE: one should perform incision along internal surface of talocrural joint, open internal ankle and distal tibial metaepiphysis, perform osteotomy of internal ankle, remove cartilages at articular surfaces of internal ankle and internal department of patient's talus, carry out fibular osteotomy being above incorrectly fused fracture, dissect distal fibular fragment outwards, perform osteotomy of incorrectly fused fracture of posterior tibial edge to be then repaired and osteosynthesized, remove cartilages from articular surfaces of fibula and tibia and talus, remove posterior-external subluxation of talus, conduct temporal transarticular fixation of talocrural joint with needles at correct position of talus, perform osteosynthesis of osseous fibular fragments after osteotomy fulfilled, fix external ankle with a screw to tibial and talus epiphysis, perform osteosynthesis of internal ankle, remove transarticularly introduced needles, fill talocrural fissure developed with osseous transplants developed out of anterior-external department of distal tibial metaepiphysis.
EFFECT: increased accuracy of reposition, improved conditions for fusion.
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.
SUBSTANCE: method involves elongating arm biceps and brachial muscle in distal part. Brachioradial muscle is partially detached from the place of its attachment to achieve full forearm extension.
EFFECT: complete repair of mobility in articulation.
SUBSTANCE: method involves carrying out reduction and fixation of fractured bone fragments. At least two adjustable length rods are used. The rods have end heads and openings for making attachment to mandible. One of the heads is freely rotatable relative to the rod and the other one is movable along longitudinal rod axis. Reduction and fixation is made in positioned centric jaw relation. The rods are set between the mandible and maxilla to the right and left of the center at the level of failed second incisor and second bicuspid teeth.
EFFECT: reduced risk of traumatic complications; reduced periosteum detachment.
3 cl, 3 dwg
SUBSTANCE: method involves producing and transplanting and implantable segment containing mature cartilage tissue cells fixed on absorbable supporting matrix for repairing animal cartilage. The implantable segment has absorbable elastic supporting matrix for culturing and fixing living cells thereon. Instrument for introducing the implantable segment, having mature cartilage tissue cells on supporting matrix, into defective animal cartilage area, has clamps and external tubular envelope. The envelope has an end holdable by user and an end for making introduction into defective cartilage area. Holder and telescopic member are available in the envelope end holdable by user. Injection canal is partially embedded into the holder and projects beyond the holdable envelope end towards the end for making introduction. The clamps are attached to the telescopic member. They are well adapted for catching and releasing the implantable segment when telescopically moving the holder in the envelope.
EFFECT: enhanced effectiveness in arranging and fixing implantable segment in the implantation place.
47 cl, 11 dwg
FIELD: medicine, orthopedics, traumatology.
SUBSTANCE: one should perform reposition of osseous fragments at simultaneous reinforcing their thickness with porous titanium nickelide implants. Then one should perform osseous fixation of apophysotendinous stump with titanium nickelide clips at shape memory effect. In particular case, reinforcing should be fulfilled due to implanting elastic porous titanium nickelide plate. In paticular case, reinforcing could be performed due to implanting finely granulated porous titanium nickelide at granules size being 0.1-2 mm. In particular case, reinforcing should be carried out due to implanting elastic porous titanium nickelide plate and finely granulated porous titanium nickelide at granules size being 0.1-2 mm.
EFFECT: higher efficiency of fixation, decreased traumaticity.
3 cl, 2 dwg, 1 ex
FIELD: medicine, traumatology, orthopedics.
SUBSTANCE: in case of the suggested method of treating one should isolate extensor's tendon damaged in area of nail phalanx to suture it with a certain suture, the ends of ligature should be directed through oblique canal in nail phalanx to withdraw through the skin and fix them on S-likely curved free end of a needle that fixes the nail phalanx. In case of the present method of therapy it is possible to exclude the pressure upon soft tissues of volar surface of nail phalanx to prevent the development of scar-resulting bedsore and disorder of palpable sensitivity of patient's finger.
EFFECT: higher efficiency of therapy.
1 cl, 2 dwg
FIELD: medicine, orthopedics, traumatology.
SUBSTANCE: one should form a transplant out of femoral biceps' tendon, form an oblique-cross-sectional transfemoral canal in isometric area upon external femoral condyle, right to the front against insertion fibular collateral ligament, apply proximal end of crossed femoral biceps' tendon through this canal, fix the end of crossed femoral biceps' tendon upon internal femoral condyle. The method enables to prevent tendinous rupture at the site of its new fixation and avoid the loss of articular bending function.
EFFECT: higher efficiency of therapy.
2 dwg, 1 ex