The method of transosseous osteosynthesis of fractures and consequences of fractures of the humerus

 

(57) Abstract:

The invention relates to medicine, namely to orthopedics and traumatology, and may be applicable for transosseous osteosynthesis of fractures and consequences of fractures of the humerus. Spend the proximal metafit humerus spoke in the sagittal plane. Introducing the distal metafit spoke in the frontal plane. Some distance in the direction of the fracture, spend one screw terminal in each of the fragments perpendicular to its long axis at an angle of 70-90oto the plane of introduction of the respective spokes. Fix transosseous elements in the external fixation device. The method can reduce the trauma with sufficient rigidity of fixation, to avoid damage to major vessels and nerves. 3 Il.

The invention relates to medicine, namely to orthopedics and traumatology, and can be used in the treatment of fractures and consequences of fractures of the humerus.

There is a method of treatment of fresh fractures of the humerus and their consequences, the essence of which is that using skeletal traction and manual reposition achieve accurate mapping of the bone fragments. Then through humerus Provo is that - through distal fragments at an angle of 25-30oto each other. Mount the Ilizarov two external supports, which are fixed to the spokes. External supports are connected to each other by rods. When conducting spokes with thrust pad take into account the type and nature of the fracture, with thrust pad with front or rear, with the inner or outer surface of the shoulder. Complications of fractures, use additional fixing and repositionned elements [1].

Closest to the present invention is a method of treatment of fractures by means of holding pins and rods with subsequent fixation of the supporting elements of the external device. First, spokes carried out in the frontal plane eccentric anteriorly with respect to the center of the transverse size of the bones on each level of the spokes. Then enter rods transoxania parietal and parallel to the outer cortical plate of the tibia and at an acute angle to the nearest joint [2].

However, the known methods have significant disadvantages, namely:

1. The use of two intersecting spokes in the basic pillars of the Ilizarov increases the risk of "fixing" contractures, t is tion when mounted on the shoulder of the base supports external fixation device in addition to the spokes of a few screw terminals leads to an increase in trauma intervention increases the time and complexity of surgical intervention and possible inflammatory complications because of the numerous perforations tissues transosseous elements.

3. Application for the position of the spokes with thrust areas restricts the movement of the bone fragments as traction for the spoke focusing is possible only in one direction.

4. Transegmental holding repairbuy spokes in the middle third of the shoulder increases the risk of damage to major vessels and nerves.

Based on the existing level of treatment technologies damages and injuries of the humerus, and eliminate the disadvantages of the known technology, the task was set: to reduce the treatment time, reduce the invasiveness of surgery and to prevent inflammatory complications due to minimal amount of insertion into the bone of transosseous elements with sufficient rigidity of fixation of the bone fragments to ensure functional treatment.

The set task is solved as follows.

The treatment of fractures and consequences of fractures of the humerus in each bone fragment is administered spokes and screw terminals with regard to passage I. New in the solution of the problem is that in each of the fragments enter one spoke, and through the proximal metafit humerus spoke performed in the sagittal plane, and through the distal metafit needle is injected in the frontal plane. Then, stepping aside fracture, enter one screw terminal in each of the fragments perpendicular to its long axis at an angle of 70-90oto the plane of introduction of the respective spokes.

The introduction to each of the fragments one spoke, and in the proximal metafit of the humerus in the sagittal plane, the distal metafit - in the frontal plane, reduces trauma intervention and the danger of a "fixation" of contractures.

Introduction one screw terminal in each of the fragments, departing in the direction of the fracture and at an angle of 70-90oto the plane of the respective spokes, provides maximum rigidity of osteosynthesis, as it is known that the rigidity of fixation of the bone fragment in the device increases with the introduction of the screw rod with respect to the needle at a 45-90o[3]. Interval 70-90oprovides the greatest rigidity of osteosynthesis. In addition, the introduction of a rod on a related what terenem.

Thus, using this method of transosseous osteosynthesis only two spokes and two screw rods (rod and a pin in each bone fragment) can reduce the invasiveness of the intervention, the risk of "fixing" contractures without loss of hardness of the fixation of bone fragments.

Conducted patent research subclass a 61 In 17/56, and analysis of scientific and medical information that reflects the current level of technology of treatment of fractures and consequences of fractures of the humerus, did not reveal identical ways. Thus, the proposed method of treatment is new.

The relationship and interaction of the essential techniques of the proposed method achieve a new medical result in the solution of the problem, namely: the proposed method of osteosynthesis of fractures and consequences of fractures of the humerus can be widely applied in clinical practice, as it does not require exceptional resources to implement.

The essence of the proposed method of osteosynthesis damages and injuries of the humerus consists of the following.

When fresh fractures of the patient p is Then carried out by the needle through the proximal metafit humerus - in the sagittal plane and through the distal metafit - in the frontal plane. Fractures at the level of the middle third of the diaphysis mount apparatus of the four pillars, with fractures of the upper or middle third of the diaphysis is based on three pillars. Spokes after the tension is fixed to "basic" transmission apparatus. Skeletal traction is removed. After measuring the length of the segment, if necessary, eliminate the residual displacement of the fragments by length, using the distraction apparatus. Perform a control radiograph. At the level of the second support apparatus for fractures of the middle and lower third of the diaphysis or at the greatest possible distance from the spokes at fracture of the upper third of the diaphysis choose the position for insertion of the proximal threaded stem. For this sector 40o(20oin each direction from the plane perpendicular to the plane of introduction of the proximal spokes) determine the position in the projection which are the main vessels and nerves, and eliminate them for insertion of the rod. Among the remaining choose that position, the projection of which the rod can be as close as possible to the plane of the residual displacement of the proximal fragment. At the selected location in accordance with known techniques centuries the ATA Ilizarov second (when linking apparatus of the four pillars) or "basic" support (for fractures of the upper third of the diaphysis of the humerus and the layout of the apparatus of the three pillars). Following a similar algorithm, injected screw the rod into the distal bone fragment and is fixed to the corresponding support apparatus. Then perform the final reposition of bone fragments using the screw terminals as a "pusher" or "pull". When partial match plane displacement of the bone fragment with the plane of the injection screw rod to eliminate bias fragments in width producing movement of the cantilever attachment of the rod in the appropriate direction to mount in the corresponding hole of the support.

When false joints and deformation reposition of fragments produced in time with subsequent support mejregionalnoi compression to the disappearance of radiographically defined multlanguage diastasis.

Restoration of motion in the shoulder and elbow joints start at 2-3 days after the operation.

The essence of the proposed method is illustrated by a clinical example

Patient M. , 1974 birth, economist, 13.09.1998 year as a result of road traffic accidents have learnt injury. Diagnosis: Closed comminuted fracture of the right humerus in medial third of the offset (see Fig. 1). First aid was provided by MeCN. 23.09.98 was performed combined transosseous osteosynthesis of the proposed method right humerus. After the implementation of block anesthesia of the patient superimposed skeletal traction for olecranon on an orthopaedic table. Then through the proximal metafit perpendicular to the long axis of the proximal bone fragment in the sagittal plane were spoke. The second needle is drawn through the distal metafit in the frontal plane perpendicular to the long axis of the distal bone fragment. Mounted apparatus on the basis of four pillars. Spokes after the tension had been fixed to "basic" transmission apparatus. Dismantled skeletal traction. After measuring the length of the segment is given an additional distraction of 7 mm is Executed, the x-ray, which defined the residual displacement of the fragments. As the proximal fragment was shifted backwards and outwards, to the introduction of the screw rod was selected the posterolateral surface of the humerus. Transit main vessels and nerves in this area is not, so this position has satisfied these conditions. Using well-known techniques of screw rod was introduced into the proximal fragment perpendicula on prednimustine surface of the shoulder in the bottom third are the main vessels and nerves (a.v. brachialis, n. medlanus). Therefore, the core is entered on the posterolateral surface of the segment. Then, using the proximal rod as a "pusher", as distal as "traction", produced reposition of fragments (see Fig.2). The time required to perform the operation, including the execution of radiographs, took 45 minutes.

The fracture has healed 62 days (see Fig.3). The movement in the shoulder joint to the end of the fixation period amounted to: in the sagittal plane - 60/0/25, in the frontal plane - 75/0/10, elbow - 130/0/0. During the treatment of inflammation of the soft tissues in the output of transosseous elements were noted. Immobilization with a plaster splint after dismantling the device was not made. Work began after 17 days after the removal of the device.

Thus, the Method of transosseous osteosynthesis of fractures and consequences of fractures of the humerus in comparison with other known technologies provides the Union of fractures in optimal time due to minimal amount of insertion into the bone of transosseous elements, the maximum reduction of time of the operation, prevention of inflammation of the soft tissues around the transosseous elements, prevent damage to major vessels and nerves PR is then

1. Shevtsov Century. And. , Swede S. I., Sysenko Y. M. Treatment of patients with fractures of the humerus and their consequences method of transosseous osteosynthesis. - Barrow, 1995. - S. 100-160.

2. RF patent 2062611, MCI AND 61 IN 17/56, 1996, BI 18.

3. Evseeva S. A., Barabash, A. P., Solomin, L. N. Theoretical and experimental justification for the rigid fixation of the bone fragments combined external support // Traumatology and Orthopaedics, Russia. - 1995. - 4 - C. 56.

The method of transosseous osteosynthesis of fractures and consequences of fractures of the humerus by introducing spokes and screw rods in each bone fragment with regard to the passage of the main vessels and nerves and the subsequent fastening of transosseous elements in the external fixation device, characterized in that each of the fragments enter one spoke, and in the proximal metafit humerus spoke performed in the sagittal plane, the distal metafit insert the needle in the frontal plane, and then, stepping aside fracture, spend one screw terminal in each of the fragments perpendicular to its long axis at an angle of 70-90oto the plane of introduction of the respective spokes.

 

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