The external fixation device for the treatment of fractures and false joints of long bones (options)

 

(57) Abstract:

Usage: in medicine, in particular for the treatment of bone fractures. Effect: reduce the morbidity of the operation by eliminating the autopsy bone medullary canal, and the increase in the rigidity of the fixation device into the bone tissue, and thereby improving the rigidity of the fixation of bone fragments. The essence of the invention: external fixation device consists of two kinds - to reposition and stabilize the fragments. The external fixation device for reposition of fragments consists of two threaded rods, which are connected repairwoman node consisting of two casings 3 of rectangular shape, rigidly interconnected. On one threaded rod pairs are using the adjusting rings staples on the branches which has a threaded connection with the shank. The rod has a tapered end threaded. The adjusting ring has a locking bolt with a support, the surface of which is made corresponding to the threaded rod. On the other threaded rod is mounted a tube, there are also installed in pairs of rings with clips. The external fixation device for the treatment of fractures and false joints of long bones consists of a threaded stangray. On the other end of the threaded rod is mounted a tube to rotate and move along the axis of the rod. There are brackets with mounting rings. The external fixation device for the treatment of fractures and false joints of long bones contains two threaded rods, one of which has at one end two perpendicularly arranged on one side of the threaded rod, the axis of which is placed in the same plane, and the other is made l-shaped, on one of the strips with the longitudinal slot under the screw terminals and with the lock pin 3 C. p. f-crystals., 10 Il.

The invention relates to medicine, namely to devices for the treatment of bone fractures.

Known compression-distraction apparatus for treatment of bone fractures, containing the guide bracket, repairwoman device made in the form of coupling terminals, installed in pairs in cylindrical guides swivel arms attached to the brackets, and fasteners and fixing [1]

The most loved and accepted us for the prototype device is to reposition and fixation of bone fragments, which contains staples, needles, spiranthinae in the form of a cylindrical fitting with external thread, distro, installed in buildings with the possibility of independent rotation around the longitudinal axis of the hull [2]

However, the known external fixation devices have the following disadvantages:

the instability of the device with insufficient tension of spokes leading to suppuration tissues around the spokes, weak Union or nonunion of fracture;

through the conduct of the spokes through the soft tissue of the limb segment increases the percentage of damage neurovascular formations and limits the amount of movement in the joints due to flashing the opposite muscle groups;

when drilling the bone spokes additionally exposed the bone marrow canal and there is a change in intraosseous pressure;

when suppuration of the soft tissues around the spokes infection can easily penetrate into the bone marrow canal that leads to the development of osteomyelitis.

The technical result of the proposed device is to reduce the morbidity of the operation by eliminating the autopsy bone medullary canal, and the increase in the rigidity of the fixation device into the bone tissue, and thereby improving the rigidity of the fixation of bone fragments.

New in the achievement of the technical result is that distrac, orpus repairaudio site is designed as two casings of rectangular shape, rigidly connected with each other at an angle of 90o.

What is new is that one of the threaded rod pairs are brackets with fastening elements, and on the other through the tube, with the possibility of rotation and movement along the axis of the threaded rod.

What is new is that each transosseous fixation element bracket is installed by means of a threaded sleeve and is made in the form of a rod having a pointed working end cone with thread.

What is new is that each fastening element made in the form set ring with a locking bolt having a bearing on the ribs, the spacing between which is equal to the thread pitch on the threaded rod.

The presence of two threaded rods in the machine allows you to work two subsystems simultaneously, which improves the accuracy of reposition of bone fragments.

Perform body repairaudio site in the form of two rectangular enclosures eliminates swinging movement of the threaded rod, which increases the stability of the fixation of bone fragments.

Installation of external fixation element bracket by cutting the allows you to enter the cortical layer and at the same time rigidly fix the fragments does not penetrate into the bone marrow canal, which reduces the invasiveness of the surgery.

The presence of the stopper bolt of the fastening element made in the form set ring, allows rigidly fix the bracket to the threaded rod, and the implementation supports the locking bolt with the ribs, the spacing between which is equal to the thread pitch on the threaded rod, also allows rigidly fix the bracket to the threaded rod, which, in turn, increases the rigidity and stability of the fixation of bone fragments.

The presence of the tube onto the threaded rod, with the possibility of rotation and movement along the axis of the threaded rod allows you to manipulate the distal tomcom in different directions for fast and accurate matching with the proximal tomcom and rigid fixation.

New is also the fact that one of the threaded rod has at one end two perpendicularly arranged on one side of the threaded rod, the axis of which is placed in the same plane that allows you to place the device at the rear subluxation of the tibia, when relaxed muscles-flexor tibiae and loosened the tension on the neurovascular formations popliteal fossa.

What is new is that the other threaded rod made Garivait the diastasis between the articular surfaces, not hurting them, while retaining the rigid fixation of the femur and tibia.

From the above it follows that the claimed apparatus external fixation for treatment of fractures and false joints of long bones (options) has a distinctive essential features, namely, that the distracters of the device is made in the form of two threaded rods, repairbuy site is located between the threaded rods, the housing repairaudio site is designed as two casings of rectangular shape, rigidly connected with each other at an angle of 90o, the bracket pairs are using fastening elements on one threaded rod, and on the other through the tube, with the possibility of rotation and movement along the axis of the threaded rod, each transosseous fixation element bracket is installed by means of a threaded sleeve and is made in the form of a rod having a pointed working end cone with thread, each fastening element made in the form set ring with a locking bolt having a bearing on the ribs, the spacing between which is equal to the thread pitch on the threaded rod; also one of the threaded rod has at one end two perpendicularly arranged on one side of the threaded rod, the axis d of the threaded rods and with the lock pin, that meets the criterion of "novelty."

A new set of features enables to achieve a high positive effect, which consists in reducing the morbidity of the operation, by eliminating the autopsy bone medullary canal, and the increase in the rigidity of fixation of bone fragments, and also allows you to use the apparatus for repositioning and stabilization of bone fragments, fractures of the patella, to eliminate the rear subluxation of the tibia, fractured olecranon, for talocrural joint that meets the criterion of "industrial applicability".

When analyzing the level of technology was not identified solutions that have the signs consistent with the distinguishing characteristics of this solution, which corresponds to the "inventive step".

The proposed external fixation device for the treatment of fractures and false joints of long bones is illustrated by the following drawings, where Fig. 1 shows a General view of the external fixation device for reposition of fragments; Fig. 2 repairbuy node of Fig. 3 bracket with snap ring external fixation device for reposition of fragments; Fig. 4 the rod inside the threaded sleeve of the bracket; Fig. 5 General view of the device of external fixate unloading apparatus after stapling own the patellar tendon; in Fig. 8 overlay stabilizing apparatus at fracture of the olecranon, and Fig. 9 overlay repairaudio apparatus for removing the rear subluxation of the tibia; Fig. 10 stabilizing apparatus for arthrodesis of the knee joint.

The external fixation device for the treatment of fractures and false joints of long bones is used to reposition and stabilize the fragments.

The external fixation device for reposition of fragments consists of two threaded rods 1 and 2 (Fig. 1 and 2), which are connected repairwoman site, building repairaudio node is composed of two casings 3 of rectangular shape, rigidly interconnected at an angle of 90. Inside the casing 3 posted by the core 4, with the outer screw thread, on which there is mounted a sleeve 5 with internal thread. Clutch 5 each casing 3 rigidly, for example by welding, are connected to screw terminals 1 and 2. Core 4 ends hex head 6, which protrudes from the casing 3 (Fig. 2). Clutch 5 move together with threaded rods 1 and 2 in two planes, thus avoiding swinging movement of the threaded rod. For movement in the casing 3 is made of the slot 7 along the entire length of the casing, the width of the slot is not less than the diameter of the threaded rod. On responisible sleeve 10 with the rod 11, having a thread at 2/3 of its length. The rod 11 has a pointed working end of the cone 12, which is also threaded (Fig. 3 and 4), and at the other end of the rod is perpendicular to the axis of the pivot of the crank 13, which rotates the shaft 11 for the introduction of the pointed end 12 into the bone. Between the threaded sleeve 10 and the crank 13 is a nut 14 for rigid fixation rod within the threaded sleeve (Fig. 4). The branches of the bracket 9 is reduced clamping screw 15 and have a flexible connection with the mounting ring 8 by means of steel rivets 16 (Fig. 3). Ring 8 is fixed on the threaded rod 1 by means of the clamping bolt 17 with support from the ribs, the spacing between which is equal to the thread pitch on the threaded rod 1. The bolt 17 ends with a head in the form of the spider 19. Ring 8 with the brackets 9 is moved along the threaded rod 1 and is fixed thereto by means of two screws 20 that are located on either side of the mounting ring 8 (Fig. 1). On the threaded rod 2 is freely mounted a tube 21, with the possibility of movement along the threaded rod 2 by means of screws 22, which are located on both sides of the tube 21. The tube 21 are placed in pairs mounting ring 8 with the brackets 9, which are fixed to the tube posledie rods 1 and 2 move along the slots 7 3 covers the loosening of the nuts 23, which tightly fix the rods 1 and 2 to the casing 3. Between the nuts 23 and the casing 3 are washers 24 (Fig. 1).

The external fixation device for reposition of fragments is as follows.

The two branches of the brackets 9 is fixed on the proximal bone fragment through the introduction of the pointed end of the rod 11 in the cortical layer does not penetrate into the bone marrow canal, while the branches of the bracket 9 reduce the clamping screw 15. Through the setting ring 8 hold the threaded rod 1, which are connected to threaded rod 2 through repairaudio site. Brackets 9 are secured on the threaded rod 1 bolt 17 from the support 18 and lock nuts 20 located on either side of the mounting ring 8 (Fig. 1). Next on the threaded rod 2 put the tube 21. This tube 21 is also set in pairs mounting ring 8 with the brackets 9, which are secured therein by bolts 17. After information of the branches of brackets coupling screw 15, begin to bring the rods 11 in the cortical layer by promoting the pointed end of the rod 12. The rod thus moves along the threaded sleeve 10 by rotation of the crank 13. After this, the tube 21 is fixed to the threaded rod 2 two nuts 22.

Reposition of fragments with rotary mixing Provo is Yat offset tube 21 mounted on it in pairs with brackets 9 with nuts 22. When the displacement of bone fragments in width and at an angle with repairaudio device. Thus weaken the nut 23, then rotate the head 6 of the core 4, and the clutch 5 is displaced along the threaded core 4 together with rigidly fixed thereto a threaded rod 1 or 2 in the slots of the casing 3 (Fig. 1). During the movement of the clutch 5 with the screw rod 1 or 2 nut 23 and washer 24 slides on the flat surface of the casing 3, therefore, excluded swinging movement of the threaded rod 1 and 2, which greatly increases the accuracy of the position and stiffness of the fixation of bone fragments.

The external fixation device for stabilizing bone fragments consists of a single threaded rod 1. On one half of the threaded rod 1 installed in pairs of the ring 8 with the brackets 9. The setting ring 8 on the threaded rod 1 is fixed with a locking bolt 17 with the support 18 with ribs, the spacing between which is equal to the thread pitch on the threaded rod 1. The branches of the bracket 9 is reduced clamping screw 15 and have a flexible connection with the mounting ring 8 by means of steel rivets 16. The setting ring 8 is fixed to the threaded rod 1 by means of nuts 20 located on either side of the adjusting ring (Fig. 5). For the second half of the threaded rod 1 is freely mounted a tube 21 with the who 8 staple 9, which are fixed to the tube by means of a bolt 17 with the support 18 and are moved along the axis of the rod as a single unit together with the pipe 21.

The external fixation device for stabilizing bone fragments is as follows.

Two brackets 9 is fixed on the proximal bone fragment through the introduction of a sharp ends 12 of the rod 11 in the cortical layer does not penetrate into the bone marrow canal, while the branches of the brackets 9 is fixed clamping screw 15. The setting ring 8 is fixed to the threaded rod 1 locking bolt 17 with the support 18 and the two nuts 20 on both sides of the ring. After application of the brackets 9 on the proximal bone fragments, conduct reposition the distal fragment of the bone (under the control of the electro-optical Converter) and the fixation of the two brackets 9 mounted on the tube 21, which, in turn, mounted on the other end of the threaded rod 1. The tube 21 is fixed to the rod with two nuts 22. Compression or distraction of the fragments is performed by displacement of the tube 21 on the threaded rod 1 together with the brackets 9 as a single unit eliminates the displacement of the distal fragment in width.

The external fixation device for stabilizing bone fragments in fractures of the patella consists of those brackets 9, which are using the installation the sharp end 12 of the rod 11, located inside the threaded bushing 10 (Fig. 6). At the same time spend the reposition of bone fragments and unloading itself of the patellar tendon. Compression of bone fragments carry out the mixing of the upper and middle bracket 9 by means of nuts 20 and unloading own the patellar tendon mixing middle and lower brackets 9 by nuts 20.

The external fixation device after stitching the actual the patellar tendon consists of a single threaded rod 1 on which are using the adjusting rings 8 bracket 9, and the branches which has a threaded sleeve 10 with the rods 11. The rod 11 has a pointed working end 12 and is also threaded. The branches of the bracket pivoted clamping screw 15 and have a flexible connection with the mounting ring 8 by means of steel rivets 16. Ring 8 is fixed to the threaded rod 1 by means of the clamping bolt 17 with the support 18 and nuts 20 (Fig. 7).

The rods 11 of the brackets 9 is installed in the patella and the tibial tuberosity bone. On the threaded rod 1 bracket 9 brought together by nuts 20 for unloading the stitches on their own ligament of the patella. This design of the inventive apparatus performs the unloading function and turns off his own joint, which is favourable for power cartilage and prevent the development of contractures of the knee joint.

The apparatus for external fixation of fractured olecranon (Fig. 8) consists of a threaded rod 1 on which are using the adjusting rings 8 bracket 9, and the branches which has a threaded sleeve 10. The branches of the bracket pivoted clamping screw 15. Ring 8 is fixed to the threaded rod by means of the locking bolts 17 and nuts 20.

The rods 11 of the brackets 9 is introduced into the ulnar diaphysis of the bone and fragments of the olecranon. Reposition the fragment is performed by turning the setting ring 8 around the threaded rod 1 together with the bracket 9 that is installed in the fragments of the olecranon. After reposition carry out compression of bone fragments with nuts 20. Patients recommended dosage of motion in the elbow joint, thereby conducting the prevention of the development of contracture of the joint.

The external fixation device for eliminating chronic subluxation of the tibia consists of two threaded rods 1 and 2, one of which (1) has at one end two perpendicularly arranged on one side of the threaded rod, the axis of which is placed in the same plane, and at the end of the rod 2 is made of the regiment 25 with the dents who Alec 8 pairs are brackets 9, which the clamping screw 15.

Two brackets 9 is fixed on the medial condyles of the femur by inserting rods 11, two brackets placed on the upper third of the tibia in the same way.

Then run the installation ring 9 on the hip threaded rod 2 with the plate 25. Next, hold the rod 1 through the setting ring 8 at the tibia. Connect the threaded rod 2 rod 1 so that the ends of the rod 1 has entered into the slot 26 of the shelf 25, further secured by nuts 29. Sliding double l-shaped rod down to unload the articular surfaces of the femur and tibia and fixed the diastasis between the articular surfaces of the stud 28. If you want to nominate the tibia anteriorly from the state posterior subluxation, the rotation of the nut 29, the rod 1 is pushed forward and drags brackets that attach to the tibia.

After removing the rear subluxation of tibia, external fixation device successfully holds the shank in the set condition, the apparatus for external fixation for arthrodesis of the knee joint (Fig. 10) consists of a threaded rod 1, one half of which pairs are using the adjusting rings 8 bracket 9, the branches of which establish the Tanga 1 by means of the locking bolts 17 and nuts 20.

On the other half of the rod 1 is mounted a tube 21, which are fixed to the bracket 9 by means of the adjusting rings 8. Ring 8 is fixed to the tube 21 by means of the clamping bolt 17. The tube 21 is moved and fixed on the rod 1 by means of nuts 22.

The external fixation device placed on the knee joint for arthrodesis open after removal of the articular surfaces of the femur, patella and tibia.

Two brackets 9 is fixed in the lower third and medial condyles of the femur by inserting rods 11. The second pair of brackets 9, which are fixed on the tube 21 are laid on the upper third and Misaki tibial also the introduction of the rods 11.

After imposition of an external fixation device on the knee hold compression of the articular surfaces of the femur and the tibia by moving the tube 21 together with the brackets 9 as a single block in the proximal direction with nuts 22. After that is rigidly secured to the tube 21 on the rod 1 by tightening the nuts 22.

The efficiency of the unit (and its variants) is confirmed by the following clinical examples.

Example 1. The patient And. 22 years. Diagnosis: oblique diaphyseal fracture PR is the length, the width and angle.

The tibia imposed external fixation device, for 10 days fixed displacement of fragments. The patient began to walk with a full load on the operated limb, thereby conducted compression of bone fragments. Fixation was terminated after 60 days.

Anatomical and functional results are good. The axis of the limb is correct. Control radiographs celebrated the Union of the fracture. The period of treatment was 3.5 months.

This example illustrates the treatment of external fixation device for reposition of bone fragments (Fig. 1).

Example 2. Patient Z. 34 years. Diagnosis: transverse open diaphyseal fracture 2B degree (by Kaplan-Markova, 1968) bones of left lower leg with displacement of bone fragments by length, width, angle and rotation laterally of the distal fragment of the tibia and fibula. The patient underwent surgery within 2 hours after the injury.

The initial debridement of the left tibia, orthopedic table produced reposition of bone fragments under the control of the electro-optical Converter, the applied external fixation device for stabilizing bone fragments, carried out the compression ratio in the zone of junction fragments of the tibia.

Anatomical and functional results are good. The axis of the limb is correct. On the control x-ray analysis demonstrated a bone spur on the seat of fracture. Mobility in the fracture area is not defined. The treatment period was 3 months.

This example illustrates the treatment of external fixation device for stabilizing bone fragments (Fig. 5).

Example 3. Patient B. 40 years. Diagnosis: open transverse fracture of left patella with displacement of fragments. The operation carried out for 3 hours after the injury: primary debridement, drainage of left knee joint, produced reposition of bone fragments, fragments of the patella and the tibial tuberosity bone imposed external fixation device, implemented compression of fragments of the patella. From the first day of the operation started swinging motion in the left knee joint. Wound healing by first intention.

In 1.5 months. after the surgery removed the bracket, fixed to the tibial tuberosity. The apparatus dismantled within 2 months after the operation.

After 3 months. after the operation of motion in the joint 180-90. After 6 months. the full range of motion. The patient when youdim apparatus at fracture of the patella (Fig. 6).

Example 4. Patient Z. 43 years. Diagnosis: fresh rupture own ligament patella of the right knee joint.

Patient was operated after 6 hours after the injury. The completed seam own ligaments of the knee and the applied external fixation device. From the first day after the operation started swinging motion in the right knee joint. In 1.5 months. the external fixation device was removed.

Anatomical and functional results are good after 3 months. after the operation of motion in the joint 180-90 Sch. After 4 months. the full range of motion. The patient began to work (works as a loader).

This example illustrates the treatment of the discharge unit after stapling own the patellar tendon (Fig. 7).

Example 5. Patient B. 42 years. Diagnosis: transverse closed fracture of the olecranon of the left elbow joint. Patient was operated through 3 days after injury, the applied external fixation device on the fragments of the olecranon, given the compression ratio. Started swinging movement of the left elbow joint.

Fixation was stopped after 2 months. after the operation. Anatomical and functional results are good. After 4 months. the amplitude of movements in the left actiongo process (Fig. 8).

Example 6. Patient P. 34 years. Diagnosis: Chronic posterior subluxation of the right tibia with rupture of the ligaments of the right knee joint. The injury 3 months.

Subluxation of the right tibia persists in manual and skeletal traction.

Imposed repairbuy device with fixation on the right thigh and bolsevicii bones. After 10 days subluxation of the tibia is fixed. Made of plastic ligaments of the right knee joint (anterior and posterior cruciate, internal and external collateral ligaments). In the postoperative period was conducted immobilizacja right knee plaster splint for 1.5 months. After removal of plaster bandages development of motion in the right knee joint. After 3 months. movement in the joint 180-100. After 6 months. the amplitude of the motion is complete.

This example illustrates the treatment repairwoman device for removing the posterior subluxation of the tibia (Fig. 9).

Example 7. Patient B. 50 years. Diagnosis: deforming arthrosis of the 3 tbsp. of the left knee.

The patient was worried about the expressed painful syndrome, crackle in the left knee joint, naoborot left lower extremity. After arthrotomy left knee sustavi fixation on the femoral and tibial bone to the angle of flexion in the knee joint 5. Given the compression ratio between mewelcome femur and tibia.

The fixing apparatus discontinued after 3 months. Anatomical and functional results are good. The axis of the limb is correct, mobility between femur and tibia is not defined. Control radiographs - fusion in the left knee joint was held.

This example illustrates the treatment of a stabilizing apparatus for arthrodesis of the knee joint (Fig. 10).

1. The external fixation device for the treatment of fractures and false joints of long bones that contain brackets with transosseous fixation on the branches, distracters connecting bracket with fastening elements, repairbuy unit having a housing and associated with distracters, characterized in that the distracters are made in the form of two threaded rods, repairbuy site is located between the threaded rod, the housing repairaudio site is designed as two casings of rectangular shape, rigidly connected with each other at an angle of 90o, the bracket pairs are using fastening elements on one threaded rod, and on the other through the tube, with the possibility of rotation and movement along the axis of the threaded rod, each Cres is ustrendy working end cone with thread, each fastening element made in the form set ring with a locking bolt having a bearing on the ribs, the spacing between which is equal to the thread pitch on the threaded rod.

2. The external fixation device for the treatment of fractures and false joints of long bones that contain brackets with transosseous fixation on the branches, distracters connecting bracket with fastening elements and repairbuy node associated with distracters, characterized in that the distracters are made in the form of a threaded rod, the bracket pairs are using fastening elements on one end of the threaded rod, and the other through the tube, with the possibility of rotation and movement along the axis of the threaded rod, each transosseous fixation element bracket mounted on the bracket by means of a threaded sleeve and is made in the form of a rod, having pointed working end cone with thread, each fastening element made in the form set ring with a locking bolt having a bearing on the ribs, the spacing between which is equal to the thread pitch on the threaded rod.

3. The external fixation device for the treatment of fractures and false joints of long bones that contain brackets with transosseous elements on brennami, characterized in that the distracters are made in the form of two threaded rods, one of which has at one end two perpendicularly arranged on one side of the threaded rod, the axis of which is placed in the same plane, and the other is made l-shaped on one of the shelves with a longitudinal slot under the screw terminals and with the retainer pin.

 

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