Method for restoring distal radioulnar joint

FIELD: medicine.

SUBSTANCE: osteotomy is performed with exposing the distal ulnar metaphysis by a long linear incision 3.0-4.5 cm along the ulnar surface. Distal ulnar osteotomy and intraoperative single-step redressment are performed through the approach created at 3.0 cm above the ulnar styloid at an angle of 45°. The radiocarpal joint is fixed with an orthosis for 2-2.5 weeks.

EFFECT: method enables reducing the number of intraoperative injuries, gaining in the radiocarpal motions as much as possible, avoiding metal structures to be applied, and reducing the immobilisation length.

2 ex, 1 dwg

 

The invention relates to the field of medicine, orthopedics and traumatology, and can be used when damage to the radio-ulnar articulation, for example, when an improperly healed fractures of the radial bone in a typical place.

Known standard operation when using the access of 5-6 cm is performed osteotomy of the radius (distal metapelite radius) and fixation of bone fragments of the T-shaped or l-shaped plate with screws. The resulting defect is filled by a free graft taken from the crest of the iliac wing. The sutures. Immobilization with a plaster splint for 1.5 months [see, e.g., Littman I. Operative surgery. Budapest, 1985. S. 994].

Disadvantages:

1. High traumatic.

2. The two operations.

3. Long periods of immobilization.

4. The use of metal.

5. The frequent occurrence of complications - postmobilization contracture of the wrist joint.

The object of the invention is to provide a method for avoiding repeated operations and reduce the time of immobilization to prevent this postoperative complications associated with prolonged functional immobility.

The problem is solved by creating a method of reconstruction of the distal radio-ulnar articulation, when a longitudinal incision with a length of 3.0-4.5 cm at the elbow�th surface, some distance 3.0 cm above the styloid process of the ulna, at an angle of 45° perform an osteotomy of the distal ulna with simultaneous intraoperative redressable, after which the wrist fixing brace in 2-2,5 weeks.

The method is as follows.

Under anesthesia, a longitudinal incision with a length of 3.0-4.5 cm cm elbow on the surface, some distance 3.0 cm above the styloid process of the ulna at an angle of 45° perform a chisel osteotomy of the distal ulna with intraoperative redressable. After that simultaneously restores the movements of the brush in all directions, especially of the elbow flexion. Rare stitches to the wound. Fixation of the wrist joint for 2 weeks.

The method is illustrated by the image.

When an improperly healed fracture of the beam in a typical place (distal metapelite radius) subluxation of the ulna.

Drawing - the implementation of the method, where A - indicates the direction of the osteotomy, B - picture Norma after surgery. 1 - radial bone, 2 - ulna.

Clinical examples

Example 1

Patient S., 24 l, trauma 1.5 months. ago.

24.12.2013 G. operation on an improperly healed fracture of the distal metapelite right radius, contracture of the right wrist joint.

Under General anesthesia an incision with a length of 4.5 cm by l�cheveu the naked surface of the distal metaphysis of the ulna. At an angle of 45° is performed osteotomy of the ulna. Intraoperatively made Redressal wrist joint. The stitches on the wound. Orthosis for 2.5 weeks. Then physical therapy, the TTF. 4 weeks since the surgery has been discharged of work in satisfactory condition.

Example 2

Patient W. 64 L., trauma 8.01.2014 G. Closed comminuted fracture of the distal metapelite left radius with displacement of the fragment. Closed manual reposition; plaster of Paris splint is placed.

After 1.5 months. upon removal of cast immobilization the patient was admitted with an improperly healed fracture of the distal metapelite left radius. "Shtykovidnoe strain; persistent contracture of the left wrist joint.

27.02.14 operation: under General anesthesia incision of 3.0 cm exposed distal metaphysis of the left ulna. At an angle of 45° is performed osteotomy of the ulna with simultaneous intraoperative redressable. The stitches on the wound. Bandage for 2 weeks. After 2 weeks of physical therapy, TTF. By the end of 4 weeks from the operation of motion in the left wrist joint painless, at a satisfactory level.

The advantages of the proposed method

1. Minor trauma

2. Interoperate. Maximum recovery of movements in the wrist joint

3. The lack of metal

4. Short period of immobilization and rehabilitation

Method restore�of moving the distal radio-ulnar articulation, including osteotomy, characterized in that the longitudinal linear incision of 3.0-4.5 cm elbow on the bare surface of the distal metaphysis of the ulna, accessed via some distance 3.0 cm above the styloid process of the ulna, at an angle of 45° perform an osteotomy of the distal ulna with simultaneous intraoperative redressable, after which the wrist fixing brace for a period of 2-2. 5 weeks.



 

Same patents:

FIELD: medicine.

SUBSTANCE: musculocutaneous vascularised and innervated island flap comprising the active greater teres muscle, a descending branch of the circumflex scapular artery, and the subscapular nerve is separated. The above flap is moved towards the elbow joint, with its muscular portion placed between the caput mediale and caput longum of the triceps muscle of the arm and anchored to a transition point of the tendon portion of the triceps muscle into the muscular one. The greater teres muscle is preserved attached to the humerus. As it may be required to bring the above flap down, it is possible to dissect away its attachment point of the greater teres muscle from the humerus. A tendon auto- or allograft is used to anchor the flap to the transition point of the tendon portion of the triceps muscle into the muscular one if the muscular portion does not appear to be long enough.

EFFECT: eliminating flexion contracture in the elbow joint and recovering the active flexion of the forearm in the motor unit deficiency.

4 cl, 7 dwg, 1 ex

FIELD: medicine.

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.

8 dwg

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

FIELD: medicine.

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.

FIELD: medicine.

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

FIELD: medicine.

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

FIELD: medicine.

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.

4 dwg

FIELD: medicine.

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

FIELD: medicine.

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

FIELD: medicine.

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

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.

1 ex

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.

3 dwg

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

FIELD: medicine.

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.

1 dwg

FIELD: medicine.

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

FIELD: medicine.

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

Up!