The method of osteosynthesis of hip fracture
(57) Abstract:The invention relates to medicine, namely to traumatology and orthopedics, and can be used for osteosynthesis of hip fracture. Produce the reposition of bone fragments. Enter perpendicular to the fracture plane of the spokes in the neck and the head of the femur out of the bones as to the fracture consolidation. Spokes are made of elastic material or from a material with shape memory, have a bend in the proximal part. In the particular case of unstable fractures of the distal ends of the spokes coming from the bones, put the springs. In the particular case of the proximal end of the spokes of the elastic material is made spear form, the spokes have curves: near the sharpened end at the proximal site and at the site corresponding to the distal fragment hips, needles are injected in the neck and the head of the femur in straight tubes, which are then removed from the femoral head. The method allows to reduce the trauma, to reliably stabilize the fracture. 2 C.p. f-crystals. The invention relates to medicine, namely to traumatology and is intended for the treatment of stable and unstable fractures of the femoral neck spokes.There are many methods of osteosynthesis arrangement is Intesa of hip fractures is to prevent migration of the spokes.The term "migration" understand the movement of the spokes relative to the bone fragments, and the absence of migration means, respectively, the stiffness of the spokes against them. This provision needs to be clarified.It is well known that when the fracture fracture occurs shortening of the femoral neck. This is due to resorption - resorption ends of fragments. The degree of shortening is different, but it always takes place in the process of fusion. The latch, in particular spokes, of course, not shorter. If we assume, together with the authors of the known methods that the relative positions of fragments and spokes remains unchanged, it is necessary to recognize that between the bone fragments occurs some diastasis, distance. Indeed, sometimes detected this situation, when the latches become spacers between the bone fragments and it usually precedes the complications. Complications due to the fact that in the absence of contact of the fragments, maintaining their relationship is only retainers. The tabs, as well as bone tissue in contact with them, in such cases, are subjected to stresses, which leads, eventually, or fractures of securing due escalalodges.com displacement of fragments and nonunion of the fracture.Meanwhile, a more careful analysis, you can identify some sort of navigation tabs. However, their clinical significance is not clear. Therefore, it is advisable to clarify the terminology and ways of movement.Under "migration" means the movement of the latch in the distal direction with respect to both bone fragments from the head and from vertelney hip area. In connection with the shortening of the femoral neck after osteosynthesis should consider two options for moving clamps - telescopic effect and the protrusion.Under telescopic understand the effect of moving the pin in the distal fragment with partial access to the soft tissue as resorption and shortening of the femoral neck in the absence of any movement relative to the head, i.e., proximal fragment.Under the protrusion understand the movement of the latch relative to only the proximal fragment, i.e., the femoral head in the proximal direction, wherein the retaining elements is a subsidence of the femoral head followed by perforation of the articular cavity ends of the locking elements. Of course, there are possible combinations of species, and different severity ukazannoi effect is favorable.Thus, the methods of osteosynthesis, including the fixation of the spokes to the distal fragment to the outer parts of the thighs are dangerous in terms of development protrusion, whereas other known methods of fixation of hip fractures, the behavior of the spokes is unpredictable.Closest to the claimed is a method of osteosynthesis of hip fracture with dynamic implantable spaceway system - THESIS (ed. St. USSR, 17006602, 1992).The method provides a telescopic effect by eliminating the rigid connection of the base system with cortical shell of the femur. However, as resorption and shortening of the femoral neck, DISS out of bone in soft tissue podarennoi area that maintains a constant contact of the fragments.The method is as follows: first conical base system using a hollow threaded sleeve rigidly oriented and is fixed to corticalis podarennoi hip area. Then through the channels of a cone-shaped base of the neck and the head of the femur enter the desired number of locking elements. After this hollow threaded sleeve is removed than is interrupted rigid connection conical osnovnoe with the bolt, crucivora in the screw channel of a cone-shaped base.However, the known method has drawbacks. Surgical intervention is relatively traumatic due to the need of surgical access - incision of soft tissue and additional damage to the bone tissue with the aim of temporarily fixing the Foundation of theSIS to the bone, this is especially important for elderly patients. The technique of operation is fairly complicated, and needs to provide a set of special tools. Elderly people that make up the bulk of patients with hip fractures, need the most sparing surgery.Surgery is long, because it requires a series of manipulations during system setup and very accurate orientation of the spokes to ensure stable fixation of bone fragments and manifestations telescopic effect. In addition, the required telescopic effect is not always apparent in connection with a variety of clinical options and not always highly effective, even in the best - author - it does not provide a telescopic effect. In 10.1% of cases were observed migration or protrusion design (Gruber Y. E., Prompt l is Kida.the honey.Sciences, Kiev, 1992).Tasked with providing a telescopic effect at the exclusion of other types of moving the locking pins, a reduction in the morbidity of surgical intervention in the treatment of stable and unstable fractures of the femoral neck spokes and reliable stabilization of the fracture, is solved as follows.When the osteosynthesis of hip fracture, including the reposition of bone fragments and the introduction of the spokes in the neck and the head of the femur out of the bones as shortening of the femoral neck in the process of fusion of the fracture, according to the invention, the needles are injected into the head of the femur is perpendicular to the fracture plane, with the possibility of a snap-in system proximal spokes in the femoral head, used needles, made of elastic material or from a material with thermo-mechanical memory, in addition, unstable fractures, the distal ends of the spokes coming out of bone put the springs.The proximal end of the spokes of elastic material has a spear shape with an expanded base while the spokes are bending near the sharpened end at the proximal site and at the site corresponding to the distal fragment thighs and injected into the cervix and golovchak hips are divided into stable and unstable (L. N. Ankin, C. B. Levitsky, Principles of functional stable osteosynthesis, Kiev, 1991, S. 83). The advantages include such fractures, in which the strength of the muscles that attach to the distal fragment hips are favorable, lead to komissii fragments between themselves and stabilize the fracture. In stable fractures of the direction of action of the forces of the muscles is close to perpendicular to the fracture plane, and coincides with the longitudinal axis of the held spokes.Thus, stable fractures of the telescopic effect of securing and stabilizing the fracture forces of friction of the bone fragments between them occur in response to compression of the muscles. Spokes, in this case, maintain the correct position of fragments and serve as guides along which the distal fragments approaching the head of the femur, when the shortening of fragments due to cervical resorption.In unstable fractures, on the contrary, the plane of the fracture is held so that the direction of action of the muscles attached to the distal fragment, is parallel or at an acute angle thereto and displace bone fragments. The direction of muscle action therefore does not coincide with the direction of the spokes that hold the fragments in the correct paragraph is tion of fragments hips are multidirectional forces and moving it when resorption of the femoral neck, determines the resultant of these forces. Therefore, we can assume that for the development of a full telescopic effect, requires the predominance of the force component acting on the distal fragments along the axis of the spokes.Introduction spokes perpendicular to the fracture plane with samopoczucia proximal spokes in the head of the femur allows you to create optimal conditions for compressicauda forces of free movement of the spokes to the outside together with securely fastened by the head of the femur as resorption and shortening of the femoral neck, i.e., occurs telescopic effect.Using the spokes of the elastic material is preferred in stable fractures of the neck of the femur, which is caused, according to the calculations of the author, the adequacy of snap-in system of spokes in the head of the femur due to bending, and compression of bone fragments sufficient forces muscles. At the same unstable fractures, according to the calculations of the author, sufficient compression to create the spokes of a material with thermo-mechanical memory, self-restrained (due to bending) in the femoral head, and spring from the other end.Use during osteosynthesis of femoral neck bone townie tube for holding the spokes of a flexible material and compliance with the proximal end of the spear shape with an expanded base and bend at the proximal and distal sections allow you to quickly enter the pin in the head of the femur, using it as a drill and lock it in the head of the femur.Thus, the proposed method of cervical osteosynthesis of the femur allows you to provide a telescopic effect, to the exclusion of other ways to move the locking pins to ensure reliable stabilization of the fracture and reduce the invasiveness of surgery.The method is as follows.Example 1. Stable fracture of the femur.By the standard method repairbot fracture, produce x-ray control and start osteosynthesis. Through podarennuyu zone in the neck and then perpendicular to the plane of the fracture in the head of the femur by the conventional technology impose self-holding the spokes of a flexible material placed in the tube. Self-holding the spokes together with tubes introduced by the conventional technology - pierce the soft tissue and then into the bone using a drill. The number of spokes is determined by the nature of the fracture and the accuracy of their conduct. Repeat x-ray control, and then leave on the spokes, the position of which is optimal for reliable fixation of the fracture, the rest are removed. Then tighten spokes tube kPa fracture. The positions of the spokes save, holding them at the ends protruding from the soft tissues. Complete surgery, shortening captive spokes together with tubes, scuseva them as close as possible to the bone. On the skin after surgery are scatter wound.Spokes are extended and sharpened spear proximal end. Each spoke has curves - near the sharpened end, in the part of the spokes, which will be at the head of the femur, and on that site which will correspond to the distal fragment of the thigh. Needles are injected into the straight tube ends not ground forward (their diameter corresponds to the lumen of the tubes) so that they were only sharpened the ends. When this tube straighten put them in the spokes of a flexible material that allows them to work as a drill and form channels in the bone tissue. Moreover, due to the expansion of the cutting part of the spokes corresponding to the outer diameter of the tubes, are formed bone channels, which together with spokes pass and tubes. After pulling tubes and removal from the femoral head, the ends of the spokes, are exempt from the tubes, due to the elasticity curve, respirate in the wall of the bone channels, VMF the fragment of the femur, aimed to prevent migration of the tube remaining in it after the operation. Moreover, the tubes are fixed to the spokes of the forces of friction between the curved section of the spokes and the inner walls of the tubes. Tube being straight, are able to move together with spokes in the channels of the distal fragment. The friction force of the spokes, curving in the bone channels of the femoral head and holding them there, exceed the friction force straight tubes (fixed in their lumen spokes) in the bone channels distal fragment. Therefore, when moving the fragments along the axis of the spokes, the spokes follow the head of the femur.Thus, it is reliable fixation of bone fragments spokes, and directly in the head of the femur is samopoczucia the required number of spokes, with their smooth movement outwards together with the head of the femur as resorption and shortening of the femoral neck - telescopic effect. While the spokes act as guides, hold the fragments correctly oriented, and the main role in stabilization of the fracture perform strength physiological muscle compression.Example 2. Unstable fracture of the femoral neck (present bias force of the muscles).The proximal sections of the spokes intended for insertion into the channels of the femoral head, bent. Refrigerated deformation is easily removed, which allows the operation to conduct unhindered straight spokes in the bone channels. After warming to body temperature, due to the shape memory effect occurs termovosstanovleniyu the proximal spokes that are in the channel is, the thanks to which developing frictional forces that hold the spokes in the head of the femur.Thus, the spokes of one ends fixed in the head of the femur, at their other ends fixed compressed spring abutting against the outer divisions of the distal fragment of the femur, in the channels which are straight spokes. Therefore, the distal fragments of the femur provides additional impact forces directed along the axis of the spokes, on compression of bone fragments and stabilization of the fracture. According to the bench test, the force required to pull one of the spokes of the femoral head reaches 15 kg Thus, the resultant of the forces acting on the distal fragments, provides a telescopic effect of osteosynthesis.Materials for the manufacture of tabs available, are produced industrially. For example it is possible to use extra long clips from nickeled-titanium (guide for the application of clamps to thermo-mechanical memory, including 1, Novokuznetsk, 1996, S. 16, Fig.2.19).Thus, the proposed cervical osteosynthesis of the femur provides a telescopic effect, low-impact and provides reliable fixation of bone fragments, for the entire period required for fusion of the PE the hips including the reposition of bone fragments and the introduction of the spokes in the neck and the head of the femur out of the bones as shortening of the femoral neck in the process of fusion of the fracture, wherein the spokes of a flexible material or from a material with thermo-mechanical memory with a bend in the proximal part is introduced into the head of the femur is perpendicular to the fracture plane.2. The method according to p. 1, characterized in that in unstable fractures on the distal ends of the spokes coming from the bones, put on the springs.3. The method according to PP. 1 and 2, characterized in that the proximal end of the spokes of the elastic material is made spear form, the spokes have curves - near the sharpened end at the proximal site and at the site corresponding to the distal fragment hips, needles are injected in the neck and the head of the femur in straight tubes, which are then removed from the femoral head.
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.
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