A method of treating non-consolidation of fractures and false joints of long bones

 

(57) Abstract:

The invention relates to medicine, in particular to the field of traumatology and orthopedics in the treatment of false joints and unjoining fractures of long bones. Essence: cut through soft tissue to bone, subperiosteal produce false joint or non-consolidation of the fracture, perform decortication over 2/3 of the perimeter, in the splitting of the cortical layer implanted Kollapen. Split plate cortical pressed to his bed by means of ligatures, held around the bones. In case of a defect of the bone tissue in the area of false joint Kollapen placed additionally in the form of plates, overlapping the area of the defect. Soft tissue sutured together with the periosteum. Within three days prior to surgery patients to designate Wobenzym 5-6 tablets three times a day with subsequent dose reduction up to 3-5 tablets for 5-6 days after surgery that provides bone formation and reduces postoperative complications. 1 C.p. f-crystals.

The invention relates to medicine, in particular to the field of traumatology, orthopedics, and can be used for the treatment of false joints and unjoining long bone fractures.

There is a method of treatment slowed down what asticou spongy autobone [1]. Cut through the soft tissue to the bone (together with the periosteum). Longitudinal incision of the periosteum turn in T - or H-shaped. Using a drill bit through a longitudinal incision of the periosteum perform the splitting of the cortical layer of bone over 2/3 of its circumference. Taken from the iliac crest of the patient spongy bone after mechanical processing (grinding, etc.,) is placed in a cleft of the cortical layer of the bone in the area of primary surgical intervention. The stitches are made in the soft tissue so that the splitting of the cortical layer was clamped transplanted bone. Plastic can be combined with one or another variant of osteosynthesis depending on the form of a false joint or fracture. In the postoperative period prescribed antibiotics to prevent infectious complications.

The disadvantages of this method are:

1. the operation to capture autocost with donor site;

2. the need for mechanical preparation taken autocast for plastics (fitting to the bed, grinding, and so on);

3. the duration of the intervention;

4. high likelihood of infection due to the lengthening of time of the operation;

5. the need for mandatory application and is the author of the joints and unjoining fractures of long bones, with less traumatic, less complexity of surgery, less risk of infectious complications and shorter-term consolidation.

The problem is solved by the method lies in the fact that cut through soft tissue to bone, subperiosteal produce false joint (non-consolidation of the fracture), perform decortication in the area of pseudarthrosis over 2/3 of the perimeter, implanted Kollapen in the splitting of the cortical layer, press split plate cortical to your box using ligatures conducted around the bones. Soft tissue sutured together with the periosteum. For three days before surgery, patients prescribed complex prefermentative preparation Wobenzym 5-6 tablets three times a day with subsequent dose reduction up to 3-5 tablets for 5-6 days after surgery.

Kollapen firm Intermediate" is a combination of highly purified collagen, hydroxyapatite and antibiotic is gentamicin or lincomycin In case of a defect of the bone tissue in the area of false joint Kollapen can be used optionally in the form of plates laid subperiosteal blocking the area of the defect.

Clinical example. Sick is after fixation pin. Was operated for 1.5 years before admission. Clinico-radiologically defined migration of the pin. In the fracture area rentgenograficheski remains a gap between the bone fragments in the background hypertrophy of the articulated surfaces. The patient performed the following operation. Of access from the greater trochanter removed migratory pin. In the fracture area is dissected soft tissue to bone, subperiosteal selected fracture. When the audit reveals non-consolidation of the fracture of the left femur - b/3 - c/3 with signs of hypertrophic false joint (the nature and mobility of the articulated fragments). Performed decorticate zone of fracture over 2/3 of the perimeter, the osteosynthesis plate 10 with screws. In the splitting of the cortical layer implanted granules Kalapana. Derived cortical plate is fixed ligatures conducted around the bone, pressing the implanted Callahan and partially blocking the plate. Podatkowego blocking the area of non-consolidation of the fracture, stacked plate Kalapana. Soft tissue sutured together with the periosteum. The postoperative period is smooth. Postoperative antibiotics were not administered. Wobenzym received by the scheme described above, during the three days before operatica after surgery clinical and radiological picture of full consolidation. The patient walks without crutches. Remove the plate through the year. The latter has grown into a callus to a considerable extent.

This method of treatment used in seven patients aged 16 to 45 years. The period of consolidation ranged from 2.5 to 3.0 months. Infectious complications in any case, was not observed.

The proposed method is less traumatic, since it eliminates the need for additional surgery to take autocast from the donor area, which both simplifies the technique and reduces the time of surgical intervention. The proposed method can be combined with any type of osteosynthesis. There is no need of antibiotic therapy in the postoperative period. Use prefermentative drug complex action. Wobenzym helps to improve the metabolic processes not only in the area of operation, but in the body as a whole, which also improves the results of treatment of this complex category of orthopedic patients.

Literature

1. Muller, M. E. , Allgower M., Schneider R., Villinger H. Manual of internal fixation. M.: 1996, S. 721.

1. A method of treating non-consolidation of fractures and false joints of long bones, including the creation of access and Stanichno produce false joint or non-consolidation of the fracture, perform decortication 2/3 of the perimeter of the bone implanted Kollapen in the splitting of the cortical layer, fixed Kollapen in the cleft of the cortical layer by pressing split plates of the cortical layer to your bed ligatures conducted around the bones, the soft tissues are sutured together with the periosteum, within three days prior to surgery the patient was given Wobenzym 5 - 6 tablets three times a day with subsequent dose reduction to 3 - 5 tablets for 5 to 6 days after surgery.

2. The method according to p. 1, characterized in that in the case of a bone defect in the area of false joint defect overlapping plates of Kalapana laid subperiosteal.

 

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