A method of treatment of fractures of the calcaneus and the device for its implementation

 

The invention relates to medicine and can be used in traumatology and orthopedics in the treatment of intra-articular fractures of the calcaneus. The task in the way that is the fact that to reposition the fragment l-shaped end of the lever device is slid under the rear facet joint, pressed into the heel bone, the mobile capture device set to the metatarsal tubercle in front of the Achilles tendon. Acting on the free end of the lever, hold the fragments in the anatomical position and make him commit. The device then to reposition removed. The device includes a lever, one end of which is made in the form of an l-shape mounted blade, and the pivot arm has a gripper movable along the rod arm. 2 S. and 2 C.p. f-crystals, 2 Il.

The invention relates to medicine and can be used in traumatology n orthopedics in the treatment of intra-articular fractures of the calcaneus. There is a method of treatment of comminuted intra-articular fractures of the calcaneus (RF patent No. 2178996, class. And 61 In 17/56, 2002), which uses the device in the form of a compression-distraction apparatus

The method provides for the reduction and fixation of which is fixed to the distal pole of the apparatus, and after a displaced fragment of the calcaneus from the displacement spend at least two spokes with emphasis, the ends of which are fixed to the brackets in the distal threaded rods installed with the possibility of axial displacement, in the holes of the base support unit and after elimination of all types of displacements are stabilizing.

The disadvantage of this method is the complicated process of reduction due to the use of the device. A special difficulty arises when restoring a turning point, when the posterior articular facet pressed into the heel bone.

The closest technical solution is known a method of treatment of fractures of the calcaneus N. a device for its implementation (New solutions to pressing problems in traumatology and orthopedics. The tutorial. Moscow: the Edict Print, 2001, S. 107-114), wherein the reposition of fragments is carried out using a lever device, called a screw Trench. Screw Trench after reposition fix a plaster bandage. The period of fixation in plaster for 8 weeks, and the screw Trench is removed after 4 weeks (see S. 111 prototype). The known method is inconvenient at the moment reposition and during the period of treatment, because the presence of the speaker within 4 weeks for predelay the invention is to improve outcomes reduction of fractures of the calcaneus, especially when restoring intra-articular fracture, when the posterior articular facet pressed into the heel bone. When this device to reposition should be removable after completing the process of fragment fixation of the calcaneus.

The problem is solved as follows. In the method of treatment of fractures of the calcaneus by reposition of bone fragments using the device and fixation of bone fragments to reposition set lever device, one end of the lever which is slid under the rear facet joint, pressed into the heel bone, the mobile capture device set to the metatarsal tubercle in front of the Achilles tendon, acting on the free end of the lever, hold the fragments in the correct position and make him commit by known methods, and then remove the lever device. In the device for treatment of fractures of the calcaneus, containing a lever, one end of the lever is made in the form of an l-shape mounted blade, and the pivot arm has a gripper movable along the rod arm. Moreover, the grip is mounted on the pivot lever can be locked, and the blade is mounted on the arm for rotation around its axis. The solution of this problem allows us to simplify PR is bit device, not having rigid fixation of the calcaneus.

The distinguishing feature of the claimed method from the prototype is that after an online access to a closed fracture of the calcaneus in the prototype of the lever device in the form of a screw Trench is introduced into the heel thigh and his arm is reposition the traction along the length under the supervision of the electron-optical Converter. And then superimposed circular plaster bandage with vgipsovannye screw Trench.

In the claimed invention is used the most gentle method. It lever device, one end of which is made in the form of an l-shape mounted blade, slid directly under the rear facet joint, pressed into the heel bone, and a movable gripping device mounted with a possibility of movement and fixation on his rod, mounted on metatarsal tubercle in front of the Achilles tendon. Acting on the free end of the lever, the axis of rotation of which is to capture, based on metatarsal tubercle, perform reposition and hold the fragments in the correct position, make its fixation by known methods. At the moment the position when the lever is an l-shape mounted blade gently holding the Zan General view of the device; in Fig.2 - the device installed on the calcaneus to perform the method.

Device for treatment of fractures of the calcaneus contains the lever on the rod 1 which has movable along the grip 2. The grip 2 is provided with a screw clamp 3. At the end of the rod 1 arm at an angle of 90 degrees is mounted can be rotated around its axis, the blade 4. When performing the method in a hook device movable gripper 2 mounted on the rod 1 and is fixed by the screw 3 in the desired position, depending on the size of the foot and the fracture site. Then through a curved incision on the outer surface of the heel region set the movable grip 2 to the metatarsal tubercle 5 in front of the Achilles tendon, and an l-shaped end of the arm in the form of a rotary blade 4 is slid under the rear facet joint 6, embedded in the heel bone 7. Acting on the free end of the rod 1 lever device towards the base of the foot, taking the fragment to its anatomical position. The process is carried out under x-ray control. When positive results are fixation of bone fragments, and a lever device is removed.

Example. Patient S. was admitted with a fracture of the calcaneus. X-ray issledovaniia made arcuate incision on the outer surface of the heel region. To reposition the fracture lever device was set so that the rotary blade was placed under of fragments, and the movable grip relied on the calcaneal bone. Acting on the free end of the lever device towards the base of the foot, was carried out by mutual rotation of the calcaneal tuber down, and the fragment up to return him to the anatomical position. When exposed to fragments of the blade due to the possibility of rotation around its axis is most advantageous position relative to the fragment. After the reposition was performed temporary fixation of a fracture spokes Kirchner, then lever the device was removed. With proper positioning of the fragments defined by the x-ray control, on the heel bone superimposed plate, developed by the Association of Orthopaedics Switzerland, and the fragments were fixed with screws.

The inventive method of treatment of fractures of the calcaneus and the device for its implementation are used at the Department of traumatology and orthopedics of the Yaroslavl state medical Academy and in the first Department of the Yaroslavl clinical hospital of emergency medical aid to them. N. In.Solovyov.

Claims

1. A method of treatment of fractures of the heel to Tanglewood lever device, one end of the lever is slid under the rear facet joint, pressed into the heel bone, the mobile capture device set to the metatarsal tubercle in front of the Achilles tendon, acting on the free end of the lever, hold the fragments in the correct position and make it fit, then remove the lever device.

2. Device for treatment of fractures of the calcaneus, containing the lever, wherein one end of the lever is made in the form of an l-shape mounted blade, and the pivot arm has a gripper movable along the rod arm.

3. The device according to p. 2, characterized in that the grip is mounted on the pivot lever can be locked.

4. The device according to p. 2, characterized in that the blade is mounted on the arm for rotation around its axis.

 

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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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