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 . 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.
FIELD: medicine, orthopedics, traumatology.
SUBSTANCE: one should isolate and dissect the tendons of anterior tibial and long fibular muscles to dissect the tendon of posterior tibial muscle against the site of fixation and direct it towards plantar rear area in front of internal ankle through the tunnel in subcutaneous fiber, then one should subcutaneously direct dissected tendons of anterior tibial and long fibular muscles onto plantar rear area to suture them so to leave free the tendinous end of posterior tibial muscle which should be intraosseously fixed to median wedge bone that keeps the process of foot repulsion during walking.
EFFECT: higher efficiency of therapy.
5 dwg, 1 ex
FIELD: medicine, traumatology, orthopedics.
SUBSTANCE: one should perform reposition of talus fragments followed by resection of articular surfaces of talus and calcaneus by maximally restoring anatomy of tarsal plantar department without forming any groove in talus and resecting wedge-like fragments with their wedge bottom towards the side being opposite to deformation. Then one should develop an autotransplant out of ileum's ala by taking into account the form of modulating resection at its length being from talus' posterior edge up to Chopart's joint without vascular pedicle. Autotransplant should be fixed due to applying Ilizarov's apparatus that enables to cure aseptic necrosis, pseudoarthroses, remove pathological foot's phenomena at shortened time for operative interference and narcosis, decreases traumaticity of operative interference at total decrease of therapy terms.
EFFECT: higher efficiency of therapy.
FIELD: medicine, traumatology, orthopedics.
SUBSTANCE: one should perform incision along internal surface of talocrural joint, open internal ankle and distal tibial metaepiphysis, perform osteotomy of internal ankle, remove cartilages at articular surfaces of internal ankle and internal department of patient's talus, carry out fibular osteotomy being above incorrectly fused fracture, dissect distal fibular fragment outwards, perform osteotomy of incorrectly fused fracture of posterior tibial edge to be then repaired and osteosynthesized, remove cartilages from articular surfaces of fibula and tibia and talus, remove posterior-external subluxation of talus, conduct temporal transarticular fixation of talocrural joint with needles at correct position of talus, perform osteosynthesis of osseous fibular fragments after osteotomy fulfilled, fix external ankle with a screw to tibial and talus epiphysis, perform osteosynthesis of internal ankle, remove transarticularly introduced needles, fill talocrural fissure developed with osseous transplants developed out of anterior-external department of distal tibial metaepiphysis.
EFFECT: increased accuracy of reposition, improved conditions for fusion.
SUBSTANCE: method involves using wires as temporary fixing members. The wires are introduced reach the external cortical layer after setting the fracture for the period a permanent fixing member is under setting. The wires are removed from the opposite bone side with respect to the fixing member.
EFFECT: enhanced effectiveness in fixing and holding small-sized splinters; high reposition accuracy.
SUBSTANCE: method involves elongating arm biceps and brachial muscle in distal part. Brachioradial muscle is partially detached from the place of its attachment to achieve full forearm extension.
EFFECT: complete repair of mobility in articulation.
SUBSTANCE: method involves carrying out reduction and fixation of fractured bone fragments. At least two adjustable length rods are used. The rods have end heads and openings for making attachment to mandible. One of the heads is freely rotatable relative to the rod and the other one is movable along longitudinal rod axis. Reduction and fixation is made in positioned centric jaw relation. The rods are set between the mandible and maxilla to the right and left of the center at the level of failed second incisor and second bicuspid teeth.
EFFECT: reduced risk of traumatic complications; reduced periosteum detachment.
3 cl, 3 dwg
SUBSTANCE: method involves producing and transplanting and implantable segment containing mature cartilage tissue cells fixed on absorbable supporting matrix for repairing animal cartilage. The implantable segment has absorbable elastic supporting matrix for culturing and fixing living cells thereon. Instrument for introducing the implantable segment, having mature cartilage tissue cells on supporting matrix, into defective animal cartilage area, has clamps and external tubular envelope. The envelope has an end holdable by user and an end for making introduction into defective cartilage area. Holder and telescopic member are available in the envelope end holdable by user. Injection canal is partially embedded into the holder and projects beyond the holdable envelope end towards the end for making introduction. The clamps are attached to the telescopic member. They are well adapted for catching and releasing the implantable segment when telescopically moving the holder in the envelope.
EFFECT: enhanced effectiveness in arranging and fixing implantable segment in the implantation place.
47 cl, 11 dwg
FIELD: medicine, orthopedics, traumatology.
SUBSTANCE: one should perform reposition of osseous fragments at simultaneous reinforcing their thickness with porous titanium nickelide implants. Then one should perform osseous fixation of apophysotendinous stump with titanium nickelide clips at shape memory effect. In particular case, reinforcing should be fulfilled due to implanting elastic porous titanium nickelide plate. In paticular case, reinforcing could be performed due to implanting finely granulated porous titanium nickelide at granules size being 0.1-2 mm. In particular case, reinforcing should be carried out due to implanting elastic porous titanium nickelide plate and finely granulated porous titanium nickelide at granules size being 0.1-2 mm.
EFFECT: higher efficiency of fixation, decreased traumaticity.
3 cl, 2 dwg, 1 ex