A method of surgical treatment of medial femoral neck fractures

 

(57) Abstract:

The invention relates to medicine, namely to traumatology in the treatment of hip fractures. Essence: linear incision on the outer surface of the upper third of the thigh access podarennoi area. Through formed galobutyl chisel a hole in the head hold the needle, on which RAM pointed to the end of the three-bladed nail with a through longitudinal channel with a diameter of 2.5-3 mm, threaded lobby with a diameter of 12-13 mm, a depth of 9-10 mm and three remote from the edge of 10-12 mm holes in the channel with a diameter of 2-3 mm, from which the grounds are grooves-grooves with a length of 40-60 mm and a depth of 1.5-2 mm, the Needle is removed, the nail injected gel kalapana and the lobby is closed by a screw-plug, followed by suturing of the wound, thus reducing the number of complications.

The invention relates to medicine, namely to traumatology and orthopedics and may find use for the treatment of medial femoral neck fractures closed and open methods.

The most common treatment of medial femoral neck fractures is surgical, which perform cervical osteosynthesis be a pointed towards the end of the three-bladed nail with a longitudinal channel for the guide spokes and screw lobby at the base (1).

Osteosynthesis are usually under General anesthesia or epidural anesthesia after simultaneously reposition on an orthopedic table. Control the position of the patient on the table is carried out using x-ray images or electron - optical Converter. A linear incision on the outside of the thigh naked podarennuyu region. At the base of the trochanter with a chisel make notches respectively to the blades of the nail. Under constant x-ray control in two projections from podarennoi the area of the guide needle into the head of the hammer in a nail to the cortical layer.

However, this method has some significant drawbacks:

1. Three nail with the introduction of violating the internal structure of the neck and the spongy substance of the femoral head, leading to the deterioration of microcirculation in data segments that, in turn, may cause long nonunion, a false joint and aseptic necrosis of the femoral head.

2. Activation of the patient with delayed consolidation of the fracture dangerous migration of the nail.

The objective of the invention is to reduce the number of complications.

This problem is solved by the method lies in the fact that lines formed galobutyl chisel a hole in the head hold the needle, on which RAM pointed to the end of the three-bladed nail with a through longitudinal channel with a diameter of 2.5 - 3 mm, threaded lobby with a diameter of 12-13 mm, a depth of 9-10 mm and three remote from the edge of 10-12 mm holes in the channel with a diameter of 2-3 mm, from which the grounds are grooves-grooves with a length of 40-60 mm and a depth of 1.5-2 mm

The needle is removed, the nail injected gel kalapana and the lobby is closed by a screw-plug, followed by suturing of the wound.

Above the nail for the proposed method can be obtained on the basis of a nail Smith-Petersen modification cyto by increasing rifled lobby to the above dimensions and create the described grooves-grooves.

As we have established, beyond the specified size increase leads to the decrease of the strength characteristics of the nail; reduce the size dramatically impairs the delivery of osteogenic material.

Callahan-gel is a complex of adaptive collagen, hydroxyapatite and antibiotic lincomycin.

Practically the method is as follows.

Under spinal anesthesia, closed method with periodic x-ray control Appiah on Whitman. On the outer surface of the upper third of the thigh is cut in length to 7.0 see Bluntly and sharply stands out (exposed) podberesina region. Through the prepared hole in the femoral head hold the guide pin, which score above the nail. The needle is removed and the nail to the field of fracture 2 ml syringe serves gel kalapana. In the base of the nail set bolt stub. When this gel passes through the channel of the nail, out of the holes at the tip and extends through grooves-grooves, blocking the fracture area. Part of kalapana impregnorium head and neck of the femur. Hemostasis. The wound is washed with antiseptic solution and sutured in layers. Leaving a nail, Callahan swells, compacting the surrounding tissue and fixing the nail in the femur, while providing a source of material for osteogenesis.

Here is a specific example of the method.

Patient, 76 years, were enrolled in 11 trauma CCH N 7 2 hours after injury due to a fall on the right side. Examined clinically and radiographically. Diagnosed: Closed medial fracture of the right femur. HIBS, angina, atherosclerosis military bones suggested by the nail and kalapana. The postoperative period without complications. The wound healed primarily. Sutures were removed on the 10th day. Patient activated on crutches on the 7th day. Discharged to outpatient treatment at the 12th postoperative day. Migration design is not marked. Consolidation of the fracture after 6 months. Examined through 1.5 years after surgery. Walking with a load on the right leg, the pain is not. Radiographically - consolidated fracture of neck of right femur. Signs of avascular necrosis no.

This method operated 16 patients. In all cases, the wound healed by primary intention. 12 patients activated on the 7th postoperative day and was discharged on the 10th day. Four somatically burdened patients activated on the 10th postoperative day and was discharged on the 12th day. Migration structures are not marked. Consolidation of the fracture occurred 6 months after surgery. 1.5 years after surgery in patients with no signs of avascular necrosis of the femoral head.

When the operation is performed in a known manner, according to different authors, complications were observed in 50% of cases (2).

Literature

1. Denisenko C. D. cervical Osteosynthesis of the femur three nail. /Orthopaedics, traumatology, procesie fractures of the proximal femur./Moscow medical journal. - 1999. - N 12. - S. 27-30.

A method of surgical treatment of medial femoral neck fractures by simultaneously reposition, fixing the three-pointed pin with a through longitudinal channel, the through holes on three faces of the pin between the blades and the screw-cap and the introduction of osteogenic preparation, characterized in that use pin having a threaded lobby at the base with a diameter of 12 to 13 mm, a depth of 9 to 10 mm through holes in the channel have a diameter of 2 to 3 mm away from the edge of 10 - 12 mm, on which basis are grooves-grooves with a length of 40 - 60 mm and a depth of 1.5 - 2 mm, and as osteogenic drug use kollapen.

 

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