A method of treating fracture of the leg in the presence of extensive marginal defect of the tibia

 

(57) Abstract:

The invention relates to medicine, namely to traumatology and can be used in the treatment of patients with fractures of the Shin bone. Essence: create angular deformation of damaged bones form the bony fragment from the steam bones, shifting his jaw in the area of the defect with subsequent fixation to heal with compression-distraction device that provides the strength of the bones due to the recovery of bone loss. 1 Il.

The invention relates to medicine, namely to traumatology and can be used in the treatment of patients with fractures of the Shin bone.

Known methods of treatment of fractures of the extremities, involving the mapping of fragments and their stable fixation using the Ilizarov apparatus. These include "a Method of treatment of fractures of the Shin and forearm" (1), including the implementation of an oblique osteotomy of the steam bones, moving osteotomies fragment proximally or distally until bone regenerate in the field of fracture of the underlying bone with the subsequent return of displaced fragment in the original polozhenieob provides for the creation of the angular deformation of the damaged bone, the formation of bone fragments from adjacent to the area of the defect site of the bone, moving it to the area of the defect with subsequent fixation to the seam.

However, this technique is ineffective in the treatment of patients with tibia fracture is accompanied by significant during and volume boundary defect, exciting both pieces. In these cases, the formation of autograft from the adjacent bone is difficult and the substitution of such defect is associated with long term treatment, especially in elderly and senile age.

The objective of the invention is to develop a method of treatment that provides recovery support ability limb fractures of the tibia with extensive regional defect of the tibia.

This task is solved in that in the method, including the creation of angular deformation of the damaged bone, the bone fragment and its offset in the area of the defect with subsequent fixation to heal with compression-distraction device, the bone fragment is formed from steam bones, gradually move it to the overlapping area of the defect and fixed in position tight contact with bolshevize is that the bone fragment is formed from steam bones, gradually move it to the overlapping area of the defect and fixed in position by contact with the tibial bone with simultaneous recovery of the longitudinal axis of the latter. Marked allows to make a conclusion on the conformity of the proposed method the criterion of "novelty".

The analysis of available sources of information on the treatment of patients with fractures of the tibia shows that the proposed technical solution is not obvious and does not follow what has been achieved in this field of knowledge. This gives you the opportunity to judge its compliance with the criterion of "inventive step".

The applicability of the method is confirmed by the fact of its successful clinical use in RISC "RTO" them. Acad. G. A. Ilizarov.

The method is as follows.

After anesthesia and treatment of the surgical field known techniques perform osteosynthesis damage tibia. During the execution of external, cross-spend the locking pins through the bone at the level of the proximal and distal metaphyton, and through the opposing ends of fragments of the tibia near the fracture site. In the, connect the threaded rods and swivel nodes with the ability dosed move and pivot relative to each other.

After completion of installation of major components of the apparatus to produce a closed reposition of fragments of the tibia, compare their ends and set at an angle open towards the existing boundary of the defect. After that, based on the clinical picture of the condition of the fibula do:

- osteotomy of one of the fragments, if there is a fracture of the fibula;

- double osteotomy of the fibula in cases preserve its integrity.

As a result of executing one of these manipulations form an intermediate fragment of fibula diaphysis, which by its size should correspond to the longitudinal dimensions of the regional defect of the tibia. If initially there was a double fracture of the fibula, in the course of the operation are limited by fixing the traction spokes. The free ends of the spokes, locking allocated or available to the fragment of the fibula diaphysis, secure traction in the nodes mounted on an adjacent support apparatus.

Surgery is m aseptic dressings.

In the postoperative period, starting with 3-5 days, produce dosed offset selected (existing) fragment of the fibula in the direction of the edge of the defect of the tibia while maintaining an angular position of the fragments of the latter. Keeping this situation creates favorable conditions for the movement of the fragment in the thickness of the soft tissue tension side of the defect weakened. Upon reaching the contact roaming fragment with both ends of fragments of the tibia last display position of normocalcemia with the restoration of the longitudinal axis of the tibia. As a result of this displaced fragment of the fibula along the entire length goes into a state of tight contact with areas of marginal defect of fragments of the tibia and at the same time overlaps the seam zone between them. Thus resulting traction fragment of the fibula and restore the axis of the tibia areas regenerate promote strong adhesion of the contacting fragments of the tibia bone type multiple synostoses. In the future, provide a stable fixation of the damaged segment of the apparatus to obtain a clinically significant is niceley immobilization of the limb after dismantling the apparatus, as a rule, is not required. The patient is prescribed a course of physical therapy.

Practical use of the method is illustrated by the following clinical supervision.

Patient P. , 72 years old, was admitted to the hospital Ilizarov scientific centre with a diagnosis of Closed comminuted fracture of the left tibia; double fracture of the left fibula.

To restore the support ability of the limb the patient underwent surgery: bone Fixation of the left tibia by Ilizarov.

During osteosynthesis, according to the proposed method was implemented fixation of the fragments of the tibia bone transosseous held spokes; completed the installation of the device.

In the postoperative period produced dosed offset intermediate fragment of the fibula in the direction of the edge defect fragments of the tibia. During movement of the latter held in position at an angle to each other. Upon completion of movement of a fragment of the fibula fragments of the tibia gradually led to the position of normocalcemia. Simultaneously, the fragment of the fibula is set to contact with the fragments of the tibia in the region of their cue commit - 58 days.

As a result of treatment restored the support function of the extremities, created resistant to the static-dynamic loading bone structure of the leg. The patient walks without additional funding support, fully load the operated limb.

The method provides recovery support ability limb fractures of the tibia with extensive regional defect of the tibia, including the elderly and senile age.

Sources of information

1. AC USSR 1120985, publ. 30.10.84, bull. 40.

2. AC USSR 1568991, publ. 07.06.90, bull. 21.

A method of treating fracture of the leg in the presence of extensive marginal defect of the tibia, including the creation of angular deformation of the damaged bone, the bone fragment and its offset in the area of the defect with subsequent restoration to the axis of the bone and fixation of bone fragments to heal with compression-distraction device, characterized in that the fragment formed from the steam bones, gradually move it to the tibial fragments with overlapping zones of fracture and fixed in position tight contact with the side surfaces of these fragments throughout their Messiah.

 

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