A method of treatment of fractures of the heel bone with displacement of bone fragments

 

(57) Abstract:

The invention relates to medicine, namely to traumatology and is intended for treatment of traumatic injuries of the heel bone with displacement of fragments. The invention provides improved results in the reduction of fractures of the calcaneus, the recovery of the longitudinal and transverse arches of the foot and as a result, prevent the development of post-traumatic complications. The method is carried out by two intersecting spokes Kirchner through metatarsal tubercle. When implementing the method uses a device that includes a main ring with bracket for fastening spokes, ropinirole ring with two brackets for mounting the spokes, the spokes of Kirchner and spokes with oplossingen in its middle third, and main and repairwoman ring is fixed between a swivel. The fixing is conducted through metatarsal tubercle two perekrasivshis spin Kirchner carry on repairwoman ring. Spend Kirchner spoke through the head of the talus bone and fix it on the main ring. Hold the needle with the flattening of the top of the anterior process of the calcaneus pericostal from outside to inside under the neck Tarana and fixed curved downwards - th bone, located in the projection of the posterior articular facet of the heel pericostal from the inside outwards and fixed curved up to the brackets. Produce reposition, pulling spokes with flattening with the rotation of the brackets and shifting repairwoman ring relative to the main bottom. 2 Il.

The invention relates to medicine, namely to traumatology and is intended for treatment of traumatic injuries of the heel bone with displacement of bone fragments.

The closest analogue is a method of treatment of fractures of the calcaneus by multi-axis reposition using reperuse device and layout Neocaesarea of the device from the set of Ilizarov (Ziganshin I. N. Diagnosis and treatment of fractures of the calcaneus in polytrauma. The dissertation on competition of a scientific degree of candidate of medical Sciences. Ufa, 1999, page 18; Diagnosis and treatment of fractures of the calcaneus in polytrauma. The dissertation on competition of a scientific degree of candidate of medical Sciences. Ufa, 1999, pp. 81-86). However, the treatment does not take into account the shifting nature of the anterior process of the calcaneus, when conducting reposition possible gap in the field podernovo joints, inflammation in the conduct of the spokes with the flatness in the area of the tarsal bones.

The technical result is an improvement of results in the reduction of fractures of the calcaneus, the recovery of the longitudinal and transverse arches of the foot and as a result, prevent the development of posttraumatic complications.

In the implementation of the method uses a device that includes a main ring with bracket for fastening spokes, repairwoman ring with two brackets for mounting the spokes, the spokes of Kirchner and spokes with flattening in its middle third. Basic and repairwoman ring is fixed between a swivel.

A method of treatment of fractures of the heel bone with displacement of fragments is carried out by two intersecting spokes Kirchner through metatarsal tubercle. Carry out the fixation is conducted through metatarsal tubercle two intersecting spokes Kirchner on repairwoman the ring, hold the needle Kirchner across the head of the talus and fix it on the main ring, hold the needle with the flattening over the anterior process of the calcaneus pericostal from outside to inside under the neck Tarana and fixed curved down - medial to the main ring and the outside of the bracket, hold the needle with the flattening under the middle part of the heel bone, located in proam, produce reposition, pulling spokes with flattening with the rotation of the brackets and shifting repairwoman ring relative to the main bottom.

In Fig. 1 shows a device which implements the method of Fig.2 - the same in working condition.

The device comprises a main ring 1 bracket 2 for fastening spokes, repairwoman ring 3 with a semicircle of 4 and with two brackets 5, 6 for fastening the spokes, the spokes of Kirchner 7, 8, 9 and pins 10, 11 with flattening in its middle third. Main 1 and repairwoman 3 ring fixed between a swivel.

The method is as follows.

After processing the surgical field with antiseptic solutions under local or regional anesthesia using drills are conducted two intersecting or parallel spokes Kirchner 7, 8 through metatarsal tubercle, which is stretched and fixed on repairwoman ring with spiegelzaal. Through the head of the talus bone drill spend a third spoke of Kirchner 9, which is fixed and pull on the main ring 1. The needle 10 is conducted over the anterior process of the calcaneus pericostal from outside to inside under the neck Tarana, while the medial attached to VI is m, after fixing the needle 10 is curved downwards. A pin 11 carried out manually under the middle part of the heel bone, located in the projection of the posterior articular facet of the heel pericostal from the inside outwards and fixed curved upward to the brackets 5, 6.

Produce rasklinivanie bone fragments heel bone by distraction nut 13 threaded on the rods 12 of the brackets with a hole connecting the rings 1, 3 devices and fixed on repairwoman ring 3. Thus, the elimination of post-traumatic expansion of the calcaneus. By rotation of the brackets 5, 6 repairwoman ring 3 outwards from soft tissue and downwards produce elevation and disimpaction the middle part of the heel bone, which corresponds to the posterior articular facet of the talus-calcaneal joint. The next step produce the elimination of bias upwards the anterior process of the calcaneus (eliminated transverse flatness of the Tarsus) by rotating upward and to the soft tissues of the limbs of the bracket 2. Achieved reposition fixed reference radiograph. In poor matching of fragments possible donepezil fragments by additional rotation of visheopisannie retainer between a ring device, set in the position angle correction. The nut 13, the locking brackets between them, weaken. Spend reposition the calcaneal tuber by the reduction of repairaudio ring 3 (Fig.2). At the moment reposition the calcaneal tuber needle 11, held under the middle part of the calcaneus, performs a control function and prevents a gap in the field podernovo articulation. After reposition the nuts 13 are tightened. Control x-rays. When a satisfactory mapping of fragments conduct transarticular fixation of bone fragments three, four spokes of Kirchner. The device is removed. Put a plaster immobilization to the upper third of the leg with the careful formation of the arches of the foot.

The above way we have treated six patients.

Clinical example: patient B., 1963 birth, entered the CCH 13, Ufa urgently, within 1 hour after katuramu (fall from a height of 3.5 meters to feet). When the inspection is determined by the swelling in the area of the left calcaneus and in the area of the right ankle, the arch of the left foot is flattened, there was extensive subcutaneous hemorrhage on the plantar surface of the left foot and the right ankle joint. Otmechalas the ankle joint. Movement in the right ankle and the left ankle-heel (pronation and supination) joints are severely limited due to pain. There enlargement and deformity of the left heel area.

On radiographs was determined comminuted intraarticular fracture of left calcaneus with displacement of fragments, at the corner of Capitol records negative (-2o), right ankle - comminuted intra-articular fracture of the distal epimetaphyseal of the tibia and lateral malleolus offset otlomkov and subluxation of the foot outwards.

After the examination diagnosed with Multiple trauma: closed comminuted intra-articular fracture of the distal epimetaphyseal of the tibia and the outer ankle with offset otlomkov and subluxation of the foot outwards to the right, closed comminuted intraarticular fracture of left calcaneus with displacement of fragments. Treatment: under regional anaesthesia was conducted distraction osteosynthesis of bones of the right tibia by Ilizarov, closed reduction of subluxation of the foot. On the left foot held reposition the device proposed design by conducting two perpendicular pins 7, 8 through otka calcaneus spokes 10, fixed on the primary ring 1, bent down, and under the middle division of the calcaneus spokes 11, fixed on repairwoman ring 3, the curved upward. The reduction is carried out by rotation of the brackets and offset repairaudio ring 3 relative to the base 1 at the bottom. Reposition achieved, at the corner of Capitol records +18o(corner of Capitol records intact calcaneus +19o). Conducted transarticular fixation of a bone, the device is dismantled. Superimposed plaster bandage. Recommended: remove the spokes 6 weeks, followed by plaster immobilization for up to 12 weeks after injury, the dismantling of the apparatus Ilizarova 10 weeks after injury.

A method of treatment of fractures of the calcaneus with the mixture of fragments is carried out by two intersecting spokes Kirchner through metatarsal tubercle, characterized in that use, the device including a main ring with bracket for fastening spokes, ropinirole ring with two brackets for mounting the spokes, the spokes of Kirchner and spokes with flattening in its middle third, and main and repairwoman ring is fixed between a swivel, carry out the fixation is conducted through metatarsal tubercle two perekreschivayutsya on the main ring, hold the needle with the seal on top of the anterior process of the calcaneus pericostal from outside to inside under the neck Tarana and fixed curved down - medial to the main ring and the outside of the bracket, hold the needle with the flattening under the middle part of the heel bone, located in the projection of the posterior articular facet of the heel pericostal from the inside outwards and fixed curved up to the brackets, produce reposition, pulling spokes with flattening with the rotation of the brackets and shifting repairwoman ring relative to the main bottom.

 

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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

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