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Method of treating chronic osteomyelitis of long bones All sclerotic changed endosseous bone tissues are excised outside a sanitised osteomyelitic region from the inside through a sequestral bone defect up to a support cortical layer, wherein the porous structure of bone tissue is formed by forming microperforations from the intramedullary bone cavity throughout the sclerotic changes within the periosteum. All the microperforations and sequestral bone defect in the cortical layer is filled with intraoperatively hardening bactericidal osteogenic bone-plastic material. The left intramedullary bone defect is repaired later at the moment of granulation tissue maturation in the bone wound by introducing the X-ray controlled osteogenic bactericidal bone-plastic material through one of two drain tubes. |
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Method for surgical management of osteomyelitis of second metatarsal head Method involves a sequester necrectomy of an involved bone section followed by an operative wound closure. A formed bone defect is replaced by a vascularised complex of tissues including a dorsal intertarsal muscle and a cortical bone fragment of a base of a first metatarsal bone on a first dorsal intertarsal artery with accompanying veins cut out of a first intertarsal space. The complex of tissues is placed into the formed bone cavity in the second metatarsal head. The operative wound is closed with a primary suture followed by immobilising the foot with a back plaster cast. |
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Method for radial nerve defect repair at shoulder height Invention refers to medicine, namely to traumatology, orthopaedics and neurosurgery. A nerve defect is replaced with nerve Alloplant. Neuroma is excised, and a neurolysis is performed. Another piece of nerve Alloplant is excised lengthwise, stretched as a leaf and wrapped around the nerve as a cuff; interrupted sutures are applied on opposite ends of the leaf. |
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Device for correction of displaced cervical articular process positions and method for using it Device for the correction of displaced cervical articular process positions comprises a composite body of a head and a cylindrical base, upper and lower supporting platforms, outer surfaces of which face the vertebral bodies and have pointed flanges. The upper supporting platform is mounted on the head of the composite body. The upper portion of the base comprises a T-flange, projection sides of which are guides for female grooves mounted in the lower portions of the head. The head and base are connected by a thread rod having smooth ends, a diameter of which is less than the diameter of the middle thread portion of the rod. One end of the rod is provided with a closed hole for a box spanner, is mounted in a transfer sleeve having a thread along the outer side surface and a slot at the end face. The sleeved rod is mounted in a through hole in the composite body perpendicular to its long axis. The threaded sleeve thread is created in the hole only in the portion of the base, while the thread of the middle of the threaded rod - on the portion of the head of the composite body. The device also comprises an end plate that can be detachably laid on the head of the composite body The upper surface of the above plate has a horizontal portion with notches inserted into the vertebral body at the side of the dislocation, while two adjacent smooth portions inclined at various angles are mounted on the side of the intact articular process. The lower supporting platform having four diametrical vertical notches on the side surface is integrated with vertical and central threaded rod having four long grooves, a position of which corresponds to the position of the above notches, and a recess on the free end. A cup with a through hole in the middle provided with a long projection is formed on the rod; the hole has the shape and size corresponding to the long grooves on the rod; the notch of the side surface is coaxial with the flange in the hole on the vertical threaded rod. The cup bottom comprises a nut having radical through holes along the mid-line of the outer surface. The vertical rod with the mounted nut is mounted in a step cylindrical cavity arranged axially in the cylindrical base of the composite body. The nut is provided in the cavity with the greater diameter open to the bottom of the cylindrical base. Along the outer surface of the bottom of the base and the inner surface of the cup, there is a thread used to flush connect these parts along the outer surface of the cup and base. There is a window formed from the cup bottom to the height of the nut by the surface section at the mid-diameter. The upper portion of the head comprises a T-flange identical to that on the base of the composite body, side flanges of which are guides for the female grooves mounted in the lower portions of the end plate. Along the inner horizontal surface of the plate, above the grooves, there is a rectangular hollow for mounting the upper supporting platform. Two thread holes for a retainer are created along the side surfaces of the base of the body, and one - along the front surface of the end plate under the horizontal flange. A method for the correction of displaced cervical articular process positions involves placing the patient on a table in the lying position with a roller placed under his/her shoulders under general anaesthesia, performing a standard approach to anterior structures of the vertebral body under its dislocated or fractured body with removing super- and subjacent disks and bone fragments. The above device is laid into the formed compartment. The end plate is laid on the head of the composite body; the angles on the upper surface of the plate shall correspond to the fracture nature, right- or left-sided, of a different height and length so that the upper horizontal platform of the end plate is arranged on the side of the dislocation close to the articular processes of the vertebrae, while its inclined surfaces faces the intact articular process. The nut is rotated with a special instrument, and a working end is alternatively inserted into radial surfaces to lift the composite body in relation to the lower supporting platform. That is followed by performing distraction until translation of the body along the vertical threaded rod along the lower supporting platform is blocked. The device is rotated with the instrument mounted into the holes on the side surfaces of the body. Geared articular processes of the vertebrae are disconnected by EOP control according to pre-calculated CT or visual data, the base is kept to be rotated until the flange on the cup bottom falls into the long groove on the vertical threaded rod. The distraction is reduced by rotating the nut backwards to place the dislocated articular process back into its physiological position. The distraction is kept to be released to enable removing the end plate with an instrument freely. Tension in the vertebral compartment with the installed device is created by generating slight distraction. The device is remained installed in the bed as a body-substitute implant. Layered sutures are applied. |
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Method for performing corrective osteotomy of iliac bone Osteotomy of an isthmus of iliac bone is performed that is followed by a rotation of its distal fragment to be fixed with a cylindrical autograft and K-wires; fixing wires extend through a cortical-spongious allograft placed inside the cylindrical autograft. |
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Method of treating trimalleolar fracture Invention refers to traumatology and orthopaedics and can be used for treating a trimalleolar fracture. The operation involves knee flexure to 90° and hip flexure to 45°. An approach is started from a point at 1/3-1/4 of a distance to the outside from a lateral malleolus to a calcaneal tuberosity, and extended in the cranial direction in parallel to an axis of fibular bone; the approach is deepened to peroneal muscles to be adducted in the medial direction, reduced, and the fragments of fibular bone are fixed temporally; the approach is widened along a posterior-medial surface of short peroneal muscle, and the tissues including sural nerve, short saphenous vein and flexor hallucis longus are adducted in the medial direction en bloc. A posterior edge of shin bone is reduced and fixed finally; thereafter the fibular bone and ligamentous joint are reduced finally and fixed; an X-ray imaging follows. |
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Cortical-spongious autograft sawn out along an anterior surface in a lower one-third of shin bone at a depth to an opposite cortical plate of the shin bone and extending onto an ankle bone to a posterior articular surface of the talocalcaneal joint is formed. The autograft is modelled to re-shape the nail surface to ensure a tight contact thereto. Bone autochips are placed into the processed posterior portion of the talocalcaneal joint, and an intramedullar rod is inserted and locked. A tibial autograft is adapted to the nail, and using a press-fit effect provides moving into the ankle bone with overlapping the ankle joint. Fragments of the ankle bone of the autograft are used to fill the form the defect of the shin bone above the shin bone of the autograft displaced downwards. |
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Compression spine is imaged preoperatively above and below the arranged spines. The prepared image is used to measure along an anterior periphery of spines in the sagittal plane a vertebral body height above the compression spine, ha, a vertebral body height below the compression spine, hb, a compression vertebral spine height hk, a length of the destroyed segment of the compression spine m. The compression spine dimensions d1 and d2 in the middle portion are measured in an axial plane taking into account that the vertebral body is shaped as an elliptic cylinder, wherein d1 is its greater semi-axis, d2 is a smaller one; a cement amount is calculated by formula wherein h=(ha+hb)/2-hk). |
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Method for cotyloid cavity repair in hip joint dysplasia Transosseous apparatus is mounted. A femoral head is gradually moved into a lower part of the cotyloid cavity. The hip joint is fixed in positions of abduction, flexion and internal rotation by means of pins with the optimum orientation of the head in relation to the cotyloid cavity. Through an incision above the anteroinferior spine, an osteotomy is performed in parallel to an edge of the cotyloid cavity anteroposteriorly, superoinferiorly, from the outside inwards of the ilium to the level respective to the centre of the femoral head. An inner edge of the ilium is intact. A bone fragment is cracked with keeping an articular cartilage intact. It is fixed by means of the pins to a hip support. An anteroexternal rotation of the head is combined with a gradual transposition of the cavity anteriorly, outwardly and downwardly to give the shape and volume of the cotyloid cavity respective to the femoral head. The bone fragments are fixed to produce a repaired bone. |
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Method for surgical management of old achilles tendon rupture Posterolateral approach to an Achilles tendon is performed from a first incision. A second skin incision is performed at an origin of a tendon of short peroneal muscle. The tendon of the short peroneal muscle is separated and drawn by a traction suture. A third skin incision is extended along an outer surface of shin in a projection of the origin of the tendon to the short peroneal muscle, which is separated and drawn by the traction suture. The tendon of the short peroneal muscle is dissected away at the origin and brought out into a third incision wound. The first and third incision wounds are connected by a subcutaneous tunnel, through which the tendon of the short peroneal muscle is brought out into the first incision wound. The fourth skin incision is delivered along an inner surface of foot in a projection of the origin of the tendon to the short peroneal muscle, which is separated and drawn by the traction suture. A fifth skin incision is extended along the inner surface of shin in its lower one-third in a projection of the origin of the tendon to the posterior tibial muscle, which is separated and drawn by the traction suture. The tendon of the posterior tibial muscle is dissected away at the origin and brought out into the fifth incision wound. The first and fifth incision wounds are connected by a subcutaneous tunnel, through which the tendon of the posterior tibial muscle is brought out into the first incision wound. The separated tendons of the short peroneal muscle and posterior tibial muscle are delivered through triceps; an Achilles tendon defect is overlapped, draw tight to optimum tension and fixed by means of sutures extending in parallel to each other to reach a distal end of the Achilles tendon. |
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Method for surgical anatomic-functional repair of wrist joint in injured radial bone Invention refers to traumatology and orthopaedics and can be used for the surgical anatomic-functional repair of a wrist joint in an injured radial bone. The method involves corticotomy with an osteoclasis, the radial bone distraction by transosseous osteosynthesis in an external fixation device to recover a length of the radial bone, the following osteotomy and manual reduction of the bone fragments of the distal epiphysial cartilage of the radial bone at the level of an incorrectly united fracture of the epiphysial cartilage of the radial bone. An osteotomy region is fixed with an angularly stable plate. After the distal epiphysial cartilage of the radial bone is united in a combination with removing an external plate, a tendon autograft is formed of an ulnar extensor tendon in the form of a split of no more than 40 mm long to be cut off in the proximal direction from the main tendon stem of the ulnar extensor perpendicularly to the tendon fibres. A canal is formed in the distal epiphysial cartilage of the radial bone in a saggital plane from the back surface of the radial bone to the palm (front) surface. A free end of the tendon autograft is delivered into the canal from the back to front surfaces, wound about the radial bone as a loop, and then the tendon autograft is pulled and sutured on the radial bone transosseously. A 1.5 mm pin is delivered through the distal epiphysial cartilage of both forearms with ensuring the rotational motions to be avoided for the period of at least 3 weeks. |
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Invention relates to medicine, namely to vertebrology. Discetomy is performed on the apex of curvature arc from ventral access and ventral inter-body spondilodesis with autobone from resected rib. After that, dorsal access to posterior bone structures of spine and installation of support elements (transpedicular screws) on concave and convex side of curvature relative to the line of spinous processes into body of each vertebra along deformation arc are carried out. Then, first rod is installed on concave side of deformation, which leads to stabilisation of curvature zone. Ablation of posterior support structures of spine on the apex of scoliotic arc and partial wedge-like resection of apex vertebra body with base, facing apex of deformation arc, are performed from the same access. After that, second rod, curved on physiological spine curvatures, is installed on convex side of scoliotic arc, and correction of main curvature arc is carried out due to direct pressure on deformation apex and segmental contraction of support elements of metal construction along rod to complete joining of remaining parts of apex vertebra in zone of partial resection. First rod is removed during this maneuver. After that, new rod, preliminarily curved on physiological curvatures of spine, is installed on the opposite side relative to the line of spinous processes and final segmental distraction of support elements of metal construction along rod is performed. Rods are joined to each other in upper and lower parts by means of transverse stabilisers, and posterior local spondilodesis with autobone is performed along metal construction. |
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Invention refers to medicine, namely to orthopaedics. The method involves separating a distal portion of the tendon m. flexor pollicis longus and transecting it at the boundary of a distal and middle one-third of a proximal phalanx. The distal fragment of the tendon m. flexor pollicis longus to a phalangeal joint phalanx along a palmar surface. The m. flexor pollicis longus is separated until entering into a carpal canal. A free portion of the tendon m. flexor pollicis longus is extended from a first incision into a second one and subcutaneously brought back, but more radially and passing other than under the retinaculum flexorum. The distal portion of the free tendon m. flexor pollicis longus is fixed to the proximal phalanx of the thumb. |
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Method of treating tibial intercondyloid eminence fracture Arthroscope-assisted anatomic setting of a fracture is combined with a temporal percutaneous Kirschner wire fixation through a proximal tibial metaphysis. The injured extremity is bent in a knee joint at an angle of 90-100 degrees. The 0.4-0.5cm skin incision in the position of two o'clock is performed along a medial edge of an upper pole of a patella. The joint capsule is approached by a layered, blunt and sharp technique, and the 0.2-0.3cm capsular incision is performed in parallel to a patellar edge. A guide pin of the diameter of 1.5mm is inserted through the formed medial port into the joint cavity on the periphery of fossa intercondylaris, not contacting the joint surface in a plane parallel to the tibial axis towards the intercondyloid eminence. A guide wire is inserted along the guide pin into the joint cavity through the medial port. The pin is removed. A bone canal is drilled out along the guide wire in the proximal tibial metaphysis in accordance to the implant diameter. An osteosynthesis of the tibial intercondyloid eminence fracture is performed with the use of the biodegradable implant through the guide wire along the formed canal. The fixation pin delivered through the proximal tibial metaphysis is removed. A plaster immobilisation follows. |
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Method for applying tendon sutures on finger flexors Both ends of the tendon are inside the shaft in the transversal direction; the ends are closed together and fixed. At 1.5 cm from a damaged proximal end of the tendon, the first interrupted suture is applied. For this purpose, one needle is used to underrun the tendon at 1/3 of its cross section; 3-5 knots are pulled up and fixed. Each needle is delivered inside the shaft in an upper one-third of a proximal end of the tendon towards its damaged end and brought out on the opposite side, and a similar interrupted suture is applied at 0.5 cm from the first interrupted suture. Each needle is pricked in behind or in front of the second knot and pricked out in the centre of the section of the proximal end of the damaged tendon. The needles are pricked in the centre of the section of the distal end of the damaged tendon and brought out in an upper one-third of its cross section, matched by a double knot and fixed by 2-3 knots; that is followed by applying a 4-knot suture similar to the second interrupted suture on the proximal end of the damaged tendon. |
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Invention refers to medicine, namely to traumatology and orthopaedics, and can be used in hip replacement surgeries. That is ensured by preparing a silicone tube of a drain system a distal end of which is cut off perpendicularly to a long axis of the tube so that to leave two perforations. This end of the prepared tube is inserted into the prepared intramedullary femoral canal until it stops against the distal bone plug. The perforations are directed into the intramedullary canal cavity. The tube is placed to its inner or outer wall and retained until removed. After placing, the tube us connected to a surgical suction unit, and bone cement mass is tightly implanted into a proximal portion of the intramedullary canal at the phase of modelling. The surgical suction unit is actuated at pressure with a uniform filling of the canal with bone cement mass. A surgeon states the cement visually in the tube and deactivates the surgical suction unit and removes the tube. |
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Lateral release of the ankle joint is performed through an incision along an outer surface of the ankle joint. A tendon of the long head of the fibular muscle is isolated. That is followed by a capsulotomy of the ankle joint. The tarsal fusion is isolated from the performed incision. A modelling U-osteotomy of the ankle bone is created within the fusion. The foot is brought into the middle position along the osteotomy and fixed with K-wires. |
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Knitting device and set of instruments for knitting human or animal joints Group of inventions relates to medicine. A knitting device for knitting a human or an animal joint contains at least one anchor part and at least one support part and additionally contains two rod-like anchor parts and one support part. In its general depth (D), measured from a proximal surface to a distal end of the knitting device, the knitting device is oriented parallel to the direction (I) of implantation, and in its general width (W) and the thickness profile (T1 and T2) the knitting device is oriented perpendicular to the direction (I) of implantation. The anchor part and the support part are alternating or are made with a possibility of alternation along the width (W), with the thickness (T1) of the said at least one anchor part being larger than the thickness (T2) of the said at least one support part. The said at least one anchor part contains a material which is liquidised, with the material, which is liquidised, representing a thermoplastic material and being located on the surface of the anchor part or inside a perforated envelope, forming a part of the anchor part. The said surface of the anchor part or the said perforated envelope is placed on the knitting device in such a way that they are capable of coming in contact with the bone tissue in the process of implantation. The support part is placed between the anchor parts, and the anchor part has a depth which is larger than the depth of the support part. The support part, if possible together with the anchor part, forms a concave profile of the device and in this way limits an osteoconduction area. The method of knitting the human or animal joint in accordance with the first version contains the following stages: provision of the availability of the said knitting device, preparation of at least one of joined surfaces and introduction of the knitting device in such a way that the said at least one anchor part comes in contact with the bone tissue in the area of the said at least one prepared surface to be joined. A sage of introduction includes the supply of energy to the proximal surface of the knitting device due to its connection to a vibration or rotation drive or to a source of energy of electromagnetic radiation of visible or infrared range in the process of introduction or after the introduction and switching on a drive or a source for the time sufficient for liquidising of at least part of the material to be liquidised and penetration of the liquidised material into the said bone tissue, where after solidification the liquidised material forms with the said bone tissue a compound with the positive tightness. In accordance with the second version the method contains the following stages: provision of availability of the said knitting device, preparation of at least one of the joined surfaces and introduction of the knitting device in such a way that the said at least one anchor part comes in contact with the bone tissue in the area of the said at least one prepared surface to be joined. In accordance with the third version the method contains the following stages: provision of availability of the said knitting device, fixation of the joined surfaces in a preliminarily specified mutual position, introduction of the knitting device between the fixed surfaces to be joined and release of fixation of the surface to be joined. A set of instruments for knitting a synovial human or animal joint contains vibroinstrument or a pusher and the said knitting device or a part of the said device, installed or to be installed on th distal end of the vibroinstrument or pusher. |
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Group of inventions refers to medicine, namely to traumatology and orthopaedics for managing articular compression fractures of calcaneal bones. After the calcaneal bone is approached, fibrous canals of the fibular tendons are opened and moved upwards. Calcaneofibular and talocalcanean ligaments are dissected away; a subtalar joint capsule is opened, and a subtalar joint is exposed. A flap of the bone is separated en bloc with a periosteum, a cortical plate and a spongy bone. The bone fragments are reduced with using a mouth expander with a ratchet. A porous titanium nickelide implant in the form of a hollow octagonal rod filled with an autograft or osteoplastic material is introduced into the bone. There are used two memory-shape brackets made of an L-plate a long leg of which has an arched curve and a short leg of which is inclined at 45 degrees and is hook-ended. The long leg of one bracket is introduced into the canal formed through the bone fragment of a calcaneal knot, a median intra-articular fragment and partially through an ankle. A short leg is inserted into a calcaneal knot canal formed below an input of the long leg canal. The long leg of the other bracket is inserted into a canal passing through the calcaneal knot and the bone fragments along a plantar contour of the calcaneal bone, while the leg is inserted into the calcaneal knot. After the bracket strain recovers, the arch of the upper bracket is opened upwards, and the arch of the lower bracket is opened downwards; the hook of the short leg of both brackets is directed and rests from the inside into the cortical plate of the calcaneal knot. |
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Distraction apparatus for finger formation in children Distraction apparatus consists of one basic/first oval closed two-plane ring, two oval long semi-rings (second and third) for the II-V fingers and two oval short semi-rings (fourth and fifth) for the I finger. All five elements are rigidly fixed to each other and to the basic/first two-plane ring by means of five braces with a thread and nuts, as well as to the hand bones by pins in the quantity required. The basic/first oval closed two-plane ring has an inclination of 150° taking into account the physiological deviation of the I metacarpal. The supports are fixed by pins to the hand bones in the quantity required. The fingers are formed by rotating the nuts above and below the distal third and fifth semi-rings about the braces four times a day, every 3-4 hours by 90-360° for one day that leads to the gradual travel of the distal semi-rings every time distracting the distal fragments of the extensible bones by 0.1-0.25 mm, and elongating the phalanxes of the formed fingers by 0.4-1.0 mm a day. The invention enables reducing the number of complications in the form of deformities of the formed bone regenerate. Using the apparatus avoids the rotation effect related to the nuts rotation on the distraction brace preventing the regenerate breakage and injuries in the extensible finger segment in the distraction procedure. |
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Method for thumb reconstruction in total defects of radial border of hand At the first stage, restoring a ball of the thumb and forming a soft-tissue finger frame are ensured by a repair of the radial border of hand with using a double skin-fat flap. After the flap survives, a fragment of the second instep bone on microanastomosis with a small skin-fat flap is grafted in a position of the first metacarpal bone. A transverse osteotomy of the restored first metacarpal bone is performed in the middle one-third. A pin is brought through its distal fragment; a bearing plate for formed on a proximal end of the pin. A distal end of the pin is brought out through the soft-tissue thumb frame and fastened to a screw rod of an external fixation apparatus applied to a forearm. That is followed by a distraction of a distal fragment; thereafter a nonvascular cortical-spongious bone autograft is placed between the bone fragments of the metacarpal bone with preserving the formed distraction regenerate, and an osteosynthesis of the bone fragments is performed. |
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Method for free osteoplasty of false joints of long bones Ends of both bone fragments are conically expanded throughout 2-3 cm by means of a chamber bit with cutting sides of a drill with an electric drill moving circularly. A procedure of cortical spongy autografting uses a double circular saw of the diameter of 5 cm and the disk distance of 1-1.8 cm, and a single circular saw of the diameter of 3.5 cm. A procedure of autografting involves creating two parallel lines of osteotomy by means of the double circular saw in the donor's segment; then the single circular saw is used to extend the ends of both lines of osteotomy on either side by 2.5-3.5 cm and to connect them to form a rhomb-shaped cortical spongy autograft with pointed ends. The pointed-end autograft is tightly penetrated into the conically expanded intramedullary canals of both bone fragments. The external fixation operation is completed by inserting the screws into a plate from the periphery to the centre so that the last screws shall be inserted through the middle engaging openings, except the bone fragments and rhomb-shaped autograft. |
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Method cotyloid plasty in revision hip replacement Primary total hip replacement involves removing cartilaginous and necrotic bone tissue from a femoral head by sawing; the graft prepared thereby is screwed to an outer to inner surface of a wing of ilium; that results in pre-forming an auto-bone depot. The revision hip replacement involves removed the fixing screw; and the formed depot is used to saw out the auto-bones which have stocking coating of patient's platelet-rich autoplasma and tightly placed into the cotyloid defects. Additionally, the repair procedure uses a vascular pedicle auto-bone of a greater trochanter supplied from ventral and minimal gluteal muscles which is screwed to the pelvis bone. |
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Method for performing cotyloid cavity rotation transposition Para-acetabular osteotomy of the iliac bone is performed. That is followed by rotating and inclining the acetabular fragment of the hip bone and fixing it with a cylindrical autograft taken from the base of the greater trochanter after dissected away from the hip bone, and with K-wires. The greater trochanter is reduced and fixed with a screw and a K-wire. |
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Method for fixation of distal tendon of biceps muscle of arm to tuberositas radii Method involves isolating a distal tendon through a skin incision along an anterior surface of a lower one-third of the shoulder, applying a tendon suture, approaching the tuberositas radii along a posterior surface of an upper one-third of the forearm. The suture of the distal tendon of the biceps is applied in a sagittal plane; two parallel canals of the diameter of 2 mm are formed in the tuberositas radii with two ligature ends brought through, tightened and tied up on the posterior surface of the radial bone opposite to the tuberositas radii. |
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Method for minimally invasive knee replacement Minimally invasive approach Quad-Sparing (Q-S) is exercised involving no incision of a quadriceps muscle of thigh of straight and medial portions. The skin is incised for 7-10 cm along an inner surface of the knee joint in a parapatellar direction from an upper pole of the patella to a tibial tuberosity. After the articular surface of the tibia is resected, a resection guide is intramedullary inserted into the tibial canal. A resection unit is fixed on a medial surface of the femur. That is followed by a one-stage resection of the articular surface of the femur in the direction from the medial to lateral condyle. The operation is completed according to the known technique. |
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Method for hip replacement with using corrective osteotomy X-ray examination is performed. The hip joint is approached, and the trochanteric region is isolated. That is followed by a transverse osteotomy of the femoral bone in the subtrochanteric region. A proximal fragment is mobilised along the entire length with preserving muscle attachment points. A baseline (1) is drawn on the X-ray image through apexes of the ischial tuberosities. A true rotation centre (2) of the cotyloid cavity is determined. A length of a perpendicular (3) dropped from the rotation centre (2) on the baseline (1) is measured. A length of a perpendicular (4) from an apex of the greater trochanter to the baseline (1) is measured. A required length of the bone resection (5) is determined as a difference of the measured length of the perpendiculars (4) and (3). A line of the corrective osteotomy (6) is specified at 8 mm and more from the subtrochanteric region of the lesser trochanter. That is followed by a shortening osteotomy of the distal portion of the feromal bone with the bone resection of the planned length (5). Proximal and distal fragments of the femoral bone are notched according to the Russian lock technique. |
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Method of treating ganglia of long bones At 1.5-3 cm from a cyst envelope along the long axis of the bone along its anterior outer surface, a cortical layer of the bone is perforated to drill out an intramedullary canal to reach the cyst left unexposed, and a canal is created. An elastic curved tube with a flexible mandrel inside is inserted through the created perforation along the formed canal, and one of the tube ends is inserted inside the cyst cavity, herewith exposing the soft tissue, osseous septums and lepidic tissues of the cyst with using the flexible mandrel. The flexible mandrel is removed, and the cavity is washed with normal saline through the tube to visualise the absence of impurities in the wash liquid. The cavity is treated through the tube, and the bone tissue content is drained off with the cyst treated with 2-3% chymotrypsin. The bone defect is repaired with a bone plastic material through the tube. The surgical intervention is completed by performing the intramedullary osteosynthesis of the bone. |
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Double femoral osteotomy technique Greater trochanter is dissected away and reduced. Double femoral osteotomy follows. A fragment is dissected away from the femoral diaphysis. The fragment is inserted as an autograft between an angled plate and a lateral surface of the femoral neck. The femoral fragments are fixed with an angled plate and screws. |
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Method for foot reconstruction with absent ankle bone Processing the tibial and calcaneal surfaces put together involves preserving an anterior wall of a distal epiphysis of the tibial bone, an anterior edge of the calcaneal bone is resected by a respective value. The resected surfaces are put together and grafted that is combined with recovering the extremity length. |
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Method for olecranon osteosynthesis Olecranon setting controlled by the intraoperative electron-optical image converter is followed by inserting two parallel pins with using a single-toothed hook through an apex of the olecranon with fixing a fracture area towards the elbow crest in an upper one-third of a forearm in the distal direction from the fracture line and percutaneously brought on a posterior surface of the forearm. A control X-ray examination is followed by hooking proximal ends of the pins forward and inserting into the olecranon apex through skin punctures made by a scalpel. That is followed by a one-stage compression of the fracture area through the skin punctures of the pin exit points on a posterior surface of the forearm by pulling the parallel pins up. K-wires are hooked in the posterior direction and cut off. The ends of the cut-off pins are arranged above the skin surface. The opposite direction of the pin hooking on both ends prevents a possibility of migration. The postoperative period involves the plaster immobilization of an upper limb with fixing the elbow and carpal joints. |
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Method of osteosynthesis of acromioclavicular joint dislocation Capstan-headed screw is inserted into the middle of a base of a coracoid process of scapula with a lavsan tape passed therethrough; the clavicle is set; the lavsan tape is brought about the clavicle, tightened and fastened with three surgical knots. |
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Method for anatomic surgical simulation of external rotational hip contracture experimentally Hip joint of Kocher-Langenbeck type is posteriorly approached on an unclaimed corpse. External hip rotators are separated from an anatomic attachment to the hip. Femoral head and neck, and edges of a cotyloid cavity are exposed. A guide pin locating a plane line of an entry into a cotyloid cavity in a horizontal section of the hip joint is laid. That is followed by an osteotomy of the femoral neck and head in the horizontal plane. The guide pin is delivered through an apex base of a greater trochanter in the direction from the outside inwards along a long axis of the femoral neck and head along the horizontal plane of the osteotomised femoral head and neck up to a subchondral medial edge of the femoral head. A horizontal hip inclination angle is simulated with a lower limb with a knee bent at 45° by hip rotation with internal ankle rotation so that a measured crossing angle of the guide pins is 56°. The shortened external hip rotations are simulated by a temporary fixation of the external hip rotators to the anatomic attachment in a trochanteric fossa at the horizontal hip inclination angle of 56° with a negligible tension of the external hip rotators. It is predicted to correspond to the degree 1 external rotational hip contracture. That is followed by similar actions with the horizontal hip inclination angle of 46° that corresponds to the degree 2 external rotational hip contracture. The horizontal hip inclination angle of 36° corresponds to the degree 3 external rotational hip contracture. |
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Method of treating proximal femur deformities Pelvic X-ray pattern is formed in an anteroposterior projection. An anatomical axis of femur, a centre of a femoral head, a vertical inclination angle of a cotyloid avity (Sharp angle) are localised. The femur is disintegrated by transtrochantic C-osteotomy. A transosseous device is used to move and fixe to correct the collum-epiphyseal and collum-diaphyseal deformities, to recover a femoral neck length. Depending on a degree of misalignment of the femoral head in relation to the cavity determined by the relation of the Sharp angle and an angle formed by a horizontal and a transverse angle of the femoral head, the X-ray pattern is used to calculate a centre and a rotation angle of the proximal bone fragment. Taking into account the rotation angle of the proximal bone fragment, a radius of the femoral head, a relation of an apex of the greater trochanter and the centre of the femoral head, an optimum location of the greater trochanter in relation to the femoral head providing the femoral neck shortening is determined. A direction and a value of the distal bone fragment displacement are determined. |
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Method of treating old pronation-everting malunions of distal shin External-lateral approach is made. An oblique osteotomy of a lateral malleolus is performed, its external rotation is eliminated, and the length is restored. The osteotomy is started from a distal end of the deformity upwards in the oblique direction backwards without involving a cortical layer to a proximal end of the deformity. The osteotomy is performed at the length exceeding the shortening of the lateral malleolus. That is followed by sawing outer and inner walls of the fibular bone. The cortical layer is transected on the proximal and distal fragments of the fibular bone with the saw placed in the front plane. A ring location support is applied above an ankle slot. An externally soldering pin is delivered through a heel bone which is fixed in a semi-ring support of an external fixation apparatus. Two pins or a pin and a Schanz screw is delivered through a distal fragment of the fibular bone. A length displacement is eliminated. An X-ray control is conducted. An additional apparatus correction is performed if necessary. The pin can be removed from the heel bone 3-4 weeks after the surgery taking into account the achieved reposition and stable fixation of the damage, and the apparatus can be partially demounted. If observing a rigidity of the osteotomised fragment of the lateral malleolus and evident external rotation, adhesions are dissected. The cortical layer of an upper end of the saw line and a lower end of the saw line of the fibular bone within the contact of the osteotomised fragment of the lateral malleolus. The fragment is fixed to the external fixation apparatus. The lateral malleolus deformity is eliminated by osteotomy, or a deltoid ligament is restored. |
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Method of shank elongation in dogs Z-shaped tenotomy of tendon ends of muscles of the rear surface of the shank is carried out, the intimately connected bundles of the tendons of the gastrocnemius muscle and flexor digitorum sublimis are isolated. Then they are crossed at sliding movement of the skin incision, made from the caudal surface of the Achilles tendon. At that first the Achilles tendon is incised in the area of the muscle-tendon junction, then the sublimit tendon, departing distally at a distance corresponding to the value of the elongation, keeping the additional tendon. The flexion efforts to ankle joint are made to the position of the ends of the incised tendons end to end, the soft tissues are sutured, after osteosynthesis by Ilizarov frame and solution of continuity of shinbones the elongation of the shank is performed with the rate of 3 mm per day for 120 manoeuvres, with a single step of spreading the fragments by 0.025 mm for 10 days to obtain a regenerated cartilage with the height of 30 mm. |
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Method of treating old injury of supraspinatus tendon and device for implementing it Invention refers to medicine, namely to traumatology and orthopaedics for treating old injuries of supraspinatus tendon. The method involves approaching a shoulder joint, detecting a tendon defect, mobilising a distal end of the tendon, forming parallel canals in a greater tubercle of humeri. A cone-shaped deepening is formed in a place of sclerous insertion ground of the greater tubercle. After fixing sutures are delivered through bone canals on a humeral periosteum, a device for treating old injuries of supraspinatus tendon. The device comprises a handle connected to a rectangular plate curved after an outer surface of the humerus with through holes for sutures, screws and nails. Cone-shaped pins are placed in the corners of the plate. The fixing sutures are delivered into the holes of the plate temporary fixed by means of the handle and cone-shaped pins within an exit of the fixing sutures to be tightened. The plate is raised slightly and reduced along a slope of the greater tubercle with pulling the fixing sutures up optimally to achieve an immersion of the distal end of the supraspinatus tendon into the cone-shaped deepening. The plate is temporary fixed with the nails, and then the conically threaded screws The temporary fixing elements and handle are removed, and the wound is closed in layers. |
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Method of treating patients with paraprosthetic hip joint infection Method provides debridement of pyoinflammatory area and stabilisation of hip joint by means of external fixation apparatus. If the pyoinflammatory process involves only soft tissues, the suppurative focus is sanitated without endoprosthesis removal; if the pyoinflammatory process involves soft tissues and bones with no prominent features of bone tissue destruction, the endoprosthesis is temporary removed and replaced by an articulating spacer with antibacterial preparations and recurrent endoprosthetic replacement; if the pyoinflammatory process involves soft tissues and bones with prominent features of bone tissue destruction, a neoarthrosis is formed with extremity length recovery. |
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After mobilisation of the common digital artery and its branches - palmar proper arteries of III and IV fingers, two flaps are cut out on the basis of the common digital artery: one from the medial surface of III finger, the second - from the lateral surface of IV finger. After that, an additional skin-fascial cut from the base of the neurovascular pedicle to the defect zone is performed. Then, the flaps are lifted, their common vascular pedicle is lifted and turned and placed in the wound surface of a defect. The flaps are fixed with installation sutures. By means of osteosynthesis apparatus the position of bone fragments is corrected with achievement of optimal configuration and a condition of the flap blood supply. |
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Method for surgical management of sudeck atrophy Invention refers to medicine, namely traumatology, orthopaedics and neurosurgery. The median nerve neurolysis is performed. An alloplant is used for the peripheral nerve grafting; it is split longitudinally and stretched in the form of a leaf. The split alloplant is brought under the nerve; the nerve is isolated by wrapping in the form of a cuff; interrupted sutures are applied on the opposite ends of the leaf. |
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Method of treating median nerve neuropathy Method involves incising the skin, the subcutaneous fat, the superficial fascia in the radiocapral region in a projection of the median nerve. A tendon of the long palmar muscle is abduced in the lateral direction. A grooved probe is inserted between the nerve trunk andthe capral ligament, and the capral ligament is incised along the whole length with the use of micro scissors. |
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Method of treating neuropathy of deep branch of radial nerve Method involves incising the skin, the subcutaneous fat, the superficial fascia 8-10 cm long in the upper and middle one-third of the forearm in a projection of the deep branch of the radial nerve. The deep branch of the radial nerve is recovered and decompressed. The distal end of the arch support is dissected at a distance from an outlet of the deep branch of the radial nerve from a canal; the dissected portion of the arch support is turned under and fixed to the proximal end of the arch support. |
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Method for mobilising dural structures in epidural fibrosis of vertebral canal Dural structures are mobilised within the posterior surface of vertebral bodies in the cranial and caudal direction of an operated intervertebral disk. Posterior bone overgrowths or posterior limbs of the vertebral bodies adhered to the dural structures are cut off en bloc from the adjacent vertebral bodies. The dural structures are taken away in the medial direction, and the anterior surface of the dural sac is decompressed. |
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Method for osteoplasty of false joints Reposition of fractured bone ends is followed by their longitudinal osteotomy with a twin disk saw of 5 cm in diameter to form two autografts extending one another of the width of 0.8-2 cm and the total length of 7-15 cm, one of which 2.5-5 cm long is sawed out of a smaller fractured bone, and another one 4.5-10 cm long - of a greater one. A single saw of 3.5 cm in diameter is used to extend a longitudinal osteotomy line to both sides by 2-3 cm from each of the two sides of the autografts extending one another, and the same saw is used to connect the ends of the parallel longitudinal osteotomy lines at an angle of about 45 degrees to the long axis of the autografts to form congruent pointed peripheral ends of the autografts. With a flat chisel of the width equal to or a little less than the width of the autografts both autografts are removed and interchanged with the greater one overlapping the false joint. A bone comb prepared by processing the fractured bones is tightly inserted between one of the two lateral sides of the autograft and the bone bed, and between both autografts. |
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Invention refers to medicine, namely traumatology and orthopaedics and is intended for a closed reduction of fractures of the surgical neck of the humerus. A patient is anaesthetised. A kind of an adduction fracture of the surgical neck of the humerus, as well as a lateral or medial dislocation of the humeral diaphysis is determined. The dislocation is typed if observing the humeral dislocation in a combination with the fracture. Preliminary myorelaxation is followed by manual or countertraction reposition of the detached head into the humeral joint to evaluate a relation of the head of the humerus to the distal portion of the humerus under electronic-optical control. The curved cannulated awl inserted through a 3-4 mm skin incision along the external posterior surface of the lateral condyle of the humerus is used to form the condylar canal towards the bone marrow canal of the humerus. A strained fixation nail is inserted into the bone marrow canal of the humerus through the formed canal and through the formed skin punctures along the inferior-exterior posterior surface of the external condyle of the humerus outside of the elbow joint to the fracture line. Each individual fixation nail of 2 mm in diameter is inserted by rotation. Ten rods and Ender rods in a quantity of 5 to 8 are used as the strained flexible fixation nails. The required quantity of the strained fixation nails is inserted to form a nail bundle. That involves using the fixation nails with the ends bent at an angle of 25-30°C at 30-40 mm from a sharp edge. The bent ends of the fixation nails inserted to the fracture line are turned in opposite directions to form a fan of the strained nails. A percutaneous reposition device is inserted through the skin puncture between the fragments and used to eliminate the edgewise dislocation of the diaphysis, as well as to eliminate its rotational and angular dislocations. The fixation nails pre-arranged to the fracture line are driven into the head of the humerus to touch its internal cortical layer. The fixation nails projecting from the condyle are cut off leaving the 2-3-mm ends. The surgery is terminated by applying one suture on the skin in a place of insertion of the fixation nails and conducting antibacterial therapy for 4-5 days. The post-operative patient management involves an active workout of the humeral and elbow joints 2-3 days after post-traumatic pain syndrome relief with the exercises done 3-4 times a day until the operative upper extremity function is completely recovered. |
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Method for selecting approach to knee replacement in patients with comorbid conditions Clinical, laboratory and instrumental patient examination is conducted. A comorbid diagnosis is stated; the Charlson comorbidity index is calculated. The ASA severity level is detected. If observing the ASA severity level of 4 with the comorbidity index of more than 7 points, the knee replacement is not required. If the comorbidity index is 5-7 points, and the ASA severity level is 3, the patient is admitted to a specialised hospital for preparation to arthroplasty. If the Charlson index is up to 4 points, and the ASA severity level is 1 or 2, the total knee replacement is conducted. |
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Filament is brought inside a trunk through ends of an injured tendon and delivered out onto an end face. The filament is a nickelide-titanium tubular mesh implant. A guide needle with the implant is delivered into the ends of the injured tendon avoiding the phalangeal tendon when in motion. The implant is brought out from the guide needle. The implant is fixed and tightened to put the injured ends of the tendon together. |
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Method for nail osteosynthesis Sterile carpule with a pharmaceutical composition containing osteoinductive, or osteoconductive, or anti-inflammatory, or antibacterial, or antiseptic, or immunomodulatory, or contrasting preparations is placed into a guide. A piston of the diameter equal to or less than an internal diameter of the carpule is fixed on a nail at a length of the nail greater than a depth of a fracture line. The nail is inserted into the guide carpule with the piston being immersed into the carpule and delivering the pharmaceutical composition from the carpule into the bone canal and the fracture line. Specifically, the bone canal is pre-formed to the fracture line, and a nail of a smaller diameter than the diameter of the canal is inserted through the carpule. Specifically, a nail with a screw having a direction of the pharmaceutical composition delivery into the fracture line is inserted into the carpule. |
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Method for simulation of false joint in shin fractures and device for implementing it External fixation apparatus (EFA) is applied on a rabbit's shin, then an osteoperforation and an osteoclasis are performed between the 2nd and 4th levels. Shin bone fragments are separated at 1 cm and fixed with EFA pins in this position for 14 days; that is followed by a one-stage compression between supports of the 4th and 5th levels until resist completely. Ends of the separated fragments are combined and fixed; the EFA is stabilised. A device for simulating the false joint in an experimental animal's shin fracture comprises proximal and distal bases in the form of a sector equal to 3/4 of a ring. Proximal base consists of 2nd and 4th levels, distal base consists of 5th and 7th levels, sectors of levels 2, 4 and 5 are placed one below the other while 7th level sector is flipped through 180° in a horizontal plane in relation to the sectors of levels 2, 4 and 5. Two threaded fixing rods connect the 2nd and 4th, 4th and 5th, 5th and 7th levels, and one fixing rod connects the 2nd level with 4th and 5th levels. Each base comprises two pairs of bolted pin fixators. Model reproducibility makes 100%. |
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Method for acromial osteotomy and device for implementing it Group of invention refers to traumatology and orthopaedics and can be used for acromial osteotomy. After separating, the acromial process is placed between a body of a device and a protective element. Pins are inserted into the acromial process through holes in guide cones in an auxiliary unit of the device, a depth of insertion of which into the acromial process makes no more than 25 mm. Before the osteotomy, the wires are partially brought out keeping the depth of insertion into the acromial process no more than 5 mm. Through pin holes in the body, counter passages are created in the acromial process wherein the pins are inserted for final fixation of the device on the acromial process. That is followed by an osteotomy parallel with an edge of the acromial process, the main stage of the intervention within a subcoracoid space; thereafter, a dissected fragment of the acromial process, pinned in the auxiliary unit is adapted to a parent bed. An osteosynthesis of a bone shaft and dissected fragment of the acromial process is performed. |
Another patent 2544867.