A method of treatment of fractures of the proximal humerus

 

The invention relates to medicine, namely to traumatology and orthopedics, and may be applicable to the treatment of fractures of the proximal humerus. Handle pre autograft in the form of an open tube. Enter the graft in the bone-marrow channel and post autograft open part to the rear surface of the humerus. Fixed with screws proximal and distal ends of the autograft. Hold the screws in mutually perpendicular planes at an angle of 45 degrees to the open part of the autograft. The method provides a tighter fit of the graft to the walls of the bone marrow cavity, increases the stability of fixation, accelerates germination vessels in the autograft. 3 Il.

The present invention relates to medicine, namely to traumatology and can be used for the surgical treatment of fractures (including comminuted fractures and false joints of the proximal humerus.

The known method of osteosynthesis of fractures of the proximal humerus, proposed by A. P. Makarov [1]. The author used homotransplant igna half of this bone with the ankle) in the treatment of patients with fractures and dislocations fractures of the surgical neck of the humerus. The essence of the known method consists in the following: the end of the diaphyseal portion of the graft is slightly thinner, giving it a slightly conical shape for introduction into the bone marrow canal of the distal fragment of the shoulder to a depth of 7-9 see From the head or ankle fibula after processing (release from cartilage, periosteum) is formed thicker end of the graft krugloprjadov form with the spongy bone structure, that's when osteosynthesis implement pre-made from the fracture plane, the slot in the head of the humerus depth of about 2.5-3 cm and a diameter of about 2-2,5 cm, i.e. in accordance with the form, the size and bone structure of the thickened end of the graft. The operated limb is fixed coracobrachialis plaster bandage on average 1.5-2 months.

Closest to the present invention is a method intramedullary use of fibula graft for fixation of the humerus, described by T. W. Wright et al. [2]. The authors use the diaphysis autograft fibula, iliac crest or frozen allograft, placing it in the bone marrow canal of the humerus in addition to fixing comprep fibula) of the cortical layer, at the ends of the plate and graft placed on different levels in order to reduce stress concentration.

However, the known methods have significant disadvantages, namely:

- instability of osteosynthesis with autograft, and therefore there was a need for external immobilization using plaster bandages, which does not allow to start early functional treatment;

- fixing plate plate requires to use an additional detachment of the soft tissues that limited blood supply of the proximal humerus has a negative impact on reparative processes;

- known methods can be used sparingly in comminuted fractures.

Based on the existing level of technology of treatment of fractures of the proximal humerus was tasked to improve the effectiveness of treatment of fractures of the proximal humerus by maintaining extrasales the blood supply to the proximal fragment of the humerus, creating conditions for a more rapid recovery of intramedullary blood supply and increase the versatility of treatment technologies, i.e. the stable ficoraze.

The problem is solved as follows.

A method of treatment of fractures of the proximal end of the humerus includes the reposition of the fracture, the harvesting of autograft from the fibula diaphysis in accordance with the dimensions of the reamed bone medullary canal and osteosynthesis by autotransplantation. New in the solution of the problem is that the autograft pretreated in the form of an open tube, then injected into the bone marrow canal and place the open part to the rear surface of the humerus. Then fix the screws proximal and distal ends of the autograft, and the screws hold in mutually perpendicular planes at an angle of 45 degrees to the open part of the autograft.

Explain any significant distinguishing features of the proposed method.

Pre-treatment of autograft from the fibula in the form of an open tube, i.e., the presence of the slot along the entire length of the graft, prevents stress concentration on the top end, especially in torsion, and provides uniform distribution of voltage along the entire length of the graft due to its elastic and plastic deformation, as well as ensuring the am bone marrow cavity), which in turn leads to increased stability of fixation and faster sprouting of blood vessels in the autograft. Accommodation open part to the rear surface of the humerus is a need for more rapid vascularization of the graft and the fracture site, because topographically place sign-diaphyseal artery in the upper third of the humerus is usually found on the posterior surface of the humerus [3].

Subsequent fixation screws proximal and distal ends of autotransplanted, as well as holding screws in mutually perpendicular planes ensures the stability of the osteosynthesis torsion and tension, and the holding screws at an angle of 45 degrees to the open part of the autograft provides passing the screw through the cortical layer 4 (2 cortical layer of the humerus and 2 - peroneal), which allows to achieve the formation of additional points of fixation of the threaded part of the screws in the place of entry and exit through the cortical layers of the graft, which significantly improves the stability of fixation screws (which is especially important in reducing the quality of the bone). When the comminuted nature of the fracture of the humerus can be used more screws for fixing the kami.

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

The relationship and interaction of the essential techniques of the proposed method achieves a new medical technology results in solving the task, namely improving the efficiency of treatment of fractures of the proximal humerus by maintaining extrasales the blood supply to the proximal fragment of the humerus, creating conditions for a more rapid recovery of intramedullary blood supply and increase the versatility of treatment technologies, i.e. the stable fixing of any fracture of the neck and head of the shoulder regardless of the form of a comminuted fracture and the degree of osteoporosis. Thus, the proposed solution involves an inventive step.

The proposed method of treatment of fractures of the proximal end of the humerus is industrially applicable in the field of practical health care, the effect.

The essence of the method consists in the following.

Available in length up to 5 cm along the fibers of the deltoid muscle in the upper part thereof at the junction of the anterior and middle third of the tendon of the supraspinatus muscle is cut along the grain, in the region of the greater tubercle at the distance of 0.5 cm from the outer part of the cartilage of the humeral head (on the border of the cartilage and tendon of the head of the humerus) reveal the bone marrow canal of the proximal fragment of the humerus. The drilling of the bone medullary canal is carried out in the distal direction to a diameter of 10-14 mm, depending on the individual characteristics and the estimated diameter of the bone-marrow channel of the distal fragment in the upper third. Simultaneously, produce a subperiosteal collection of autograft fibula diaphysis of two approaches 2 cm according to the method described by A. P. Barbasol [4], with a length approximately equal to 1/2 the length of the humerus, which is an average of 15 see the Selected length of the graft is less than 50% of the length of the fibula, which has no effect on the function of the legs in the postoperative period, but at the same time is sufficient to perform osteosynthesis of fractures of the humerus and warnings konzentrationslager the anatomical structure of the bone medullary canal of the humerus, which has a constriction in its diaphyseal part, starting approximately from the middle of the diaphysis, and therefore the optimal length of intraosseous retainer for osteosynthesis of fractures of the proximal end of the humerus is considered to be the distance equal to approximately half of its length, which averages 30 cm From the subjects with more wide and short or long and narrow bone marrow canal of the humerus can be used longer or shorter autograft, respectively, which are easy to achieve, because the length and diameter of the fibula, as a rule, is directly proportional to the length and diameter of the other bones, including the shoulder. Autograft treated using an electric cutter diameter bone medullary canal. Given the fact that the fibula on cross-section generally has a shape similar to an irregular triangle, the graft without special effort shape “open tube” by cutting the most acute angle. To control the diameter of the graft for use plate with calibrated holes, for example from a standard set AO for intramedullary osteosynthesis.

Perform closed repoze control using Rg-graphy in two projections. The needle used as a guide, perform antegrade osteosynthesis treated with autograft, with its open part to the rear surface of the humerus. In this case, the graft is kanalirovaniem” lock, where the axial bore is a bone-marrow channel of the fibula. The graft is immersed without Vistana over the cortical layer of the head arm (prevention impingement syndrome), because there is no need to remove the design later. Blocking proximal fragment by one or two screws with thread throughout (choice due to the appearance of additional points of fixation screws in the transplant and, as a result, an angular stable screws, which is especially important in reducing the quality of the bone, due to the age of the patient, or the time after injury). At the moment the proximal blocking additional fixation of fragments of the proximal humerus to the autograft using compressicauda screws passing in any direction relative to the axis of the humerus.

Easy this elbow on the ridge in the direction of the long axis of the humerus or using con and and perform distal locking 1-2 screws, located in mutually perpendicular planes at an angle of 45 degrees to the open part of the autograft.

In case of failure of closed reduction perform open adaptation of fragments using one of the known approaches. Additional immobilization in the postoperative period is not carried out, the patient begins early movement in the shoulder joint.

The essence of the proposed method of treatment of fractures of the proximal humerus is illustrated by a clinical example.

Patient N. 54 years (plasterer-painter) was admitted to the hospital GU NCRWC wsns WITH the RAMS at 5 days after injury.

Diagnosis: Closed comminuted fracture of surgical neck of left humerus with displacement. The Rg-gram: Determined by the violation of the integrity of the upper third of the humerus. The contours of the ends of fragments equal, precise. The offset width of 3.5 cm medially and 1.5 cm proximally. On the outer surface of the proximal fragment - additional bone fragment 1,5×1 see Regional osteoporosis (Fig.1).

From the anamnesis: Trauma 26.01.02., household, got in an accident (he was hit by car), delivered duty in the hospital, where after an examination is made of the fractured bone block imposed plaster bandage type Wypolnena operation. From antegrade access a length of 4 cm along the fibers of the deltoid muscle in the upper part thereof at the junction of the anterior and middle thirds of the partially removed Podkamennaya bag, the tendon of the supraspinatus muscle is dissected along the fibers, in the region of the greater tubercle at the distance of 0.5 cm from the outer part of the cartilage of the humeral head penetrated the bone marrow canal of the humerus. Completed drilling of the bone medullary canal in the distal direction to a diameter of 12 mm. Simultaneously produced a subperiosteal collection of autograft fibula diaphysis length of 15 cm of two approaches in length by 2 cm of Autograft treated using an electric cutter in the form of “open tube” diameter up to 12 mm Performed a closed reduction of the fracture and temporary intramedullary fixation pin with a diameter of 2 mm, the positioning of the fragments and the position of the needles is controlled using Rg-graphy in two projections. The needle used as a guide, made antegrade osteosynthesis treated with autograft, which have an open part to the rear surface of the humerus. Re Rg-graphy: the standing of fragments satisfactory. Made blocking proximal fragment pleonaste humerus, the second is from the outside inwards and upwards, fixing additional bone fragments. Easy this elbow on the ridge in the direction of the long axis of the humerus made solid contact and simultaneous compression between the fragments of the humerus. Made blocking distal fragment of the humerus with one screw located on the outside inwards and front to back at an angle of 45 degrees to the “open” part of the autograft (posterior surface of the humerus), ensuring the passage of the screw through the cortical layer 4. Stitches in the wound.

Rg-control 05.02.02 (Fig.2): the integrity of the humerus restored, the offset length is fixed, the width was reduced to 0.5 cm In projection of bone medullary canal of the proximal humerus is defined bone structure 1×15 cm, fixed with 3 screws. Bone structure is non-homogeneous. Regional osteoporosis.

In the postoperative period additional external immobilization was conducted. Started early functional treatment (physical therapy of the shoulder joint, physiotherapy). Was discharged for outpatient treatment on the 10th day after the operation. The sutures were removed.

Started the job within 3 months after the operation. On controlhome, on the control Rg-gram (Fig.3): signs of fracture consolidation, pronounced periosteal reclaim. Signs of bone reconstruction autograft.

Thus, the Method of treatment of fractures of the proximal humerus” in comparison with other known technology allows you to:

- perform functional stable osteosynthesis almost anyone, including comminuted fracture and the head of the humerus;

to ensure reliable axial and counter-lateral compression of fragments of the humerus;

to increase the reliability of osteosynthesis in terms of osteoporosis due to additional points of fixation screws in the graft (the passage of the screw through the cortical layer 4) and, consequently, reduce the effects of the “extraction” of the screw;

- to reduce, in comparison with the prototype and analogues, the damaging effect of the release on the humeral head and the surrounding soft tissues;

- allows closed osteosynthesis;

- to create conditions for improvement of blood circulation due to the absence of plate parts latch in the fracture area, as well as metal intraosseous latch, preventing the sprouting of vessels;

to avoid more is Nicky information

1. Makarov A. P. Intramedullary osteosynthesis by homotransplantation with complex and chronic fractures of the surgical neck of the humerus: author. dis. Prof. the honey. Sciences. - Leningrad, 1972. - S. 18-20.

2. Wright, T. W., Miller G. J., Vander Griend, R. A., Wheeler D., Dell P. C. Reconstruction of the humerus with an intramedullary fibular graft. A clinical and biomechanical study //J. Bone & Joint Surg. [Br] - 1993. - 75-B. - P. 804-807.

3. Ansarov N. And. The arterial system of the human body //Anatomical-surgical collection. - 1939. - Vol. 11. - S. 73-76.

4. RF patent №216296, MCI And 61 In 17/56, “the Method of sampling autograft for bone autoplasty”. - 2001. - Bull. No. 13. /A. P. Barabash, A. A. Barabash, M. E. Posiva.

Claims

A method of treatment of fractures of the proximal humerus, including the reposition of the fracture, the harvesting of autograft from the fibula diaphysis in accordance with the dimensions of the reamed bone medullary canal and osteosynthesis with autograft, wherein the pre-treated with autograft in the form of an open tube, then injected into the bone marrow canal and post autograft open part to the rear surface of the humerus, and then fixed with screws proximal and distal ends of the autograft,/p>

 

Same patents:

The invention relates to medicine, namely to traumatology, orthopedics

The invention relates to medicine, namely to traumatology for the treatment of fractures of the inner and outer ankles

The invention relates to medicine, namely to surgical vertebrology, and can be used to correct the kyphotic deformity and fixation of the spine in tuberculous spondylitis in children

The invention relates to medicine, namely to traumatology
The invention relates to medicine, particularly surgery, traumatology

The invention relates to medicine, namely to traumatology and orthopedics children

The invention relates to medicine, namely to orthopedics and traumatology

The invention relates to medicine, namely to traumatology in the treatment of fractures of the humerus

The invention relates to the field of medicine and is used in arthrology for plastic recovery bone bed when installing the acetabular component of a total endoprosthesis of the hip joint

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

FIELD: medicine, traumatology, orthopedics.

SUBSTANCE: one should perform reposition of talus fragments followed by resection of articular surfaces of talus and calcaneus by maximally restoring anatomy of tarsal plantar department without forming any groove in talus and resecting wedge-like fragments with their wedge bottom towards the side being opposite to deformation. Then one should develop an autotransplant out of ileum's ala by taking into account the form of modulating resection at its length being from talus' posterior edge up to Chopart's joint without vascular pedicle. Autotransplant should be fixed due to applying Ilizarov's apparatus that enables to cure aseptic necrosis, pseudoarthroses, remove pathological foot's phenomena at shortened time for operative interference and narcosis, decreases traumaticity of operative interference at total decrease of therapy terms.

EFFECT: higher efficiency of therapy.

1 ex

FIELD: medicine, traumatology, orthopedics.

SUBSTANCE: one should perform incision along internal surface of talocrural joint, open internal ankle and distal tibial metaepiphysis, perform osteotomy of internal ankle, remove cartilages at articular surfaces of internal ankle and internal department of patient's talus, carry out fibular osteotomy being above incorrectly fused fracture, dissect distal fibular fragment outwards, perform osteotomy of incorrectly fused fracture of posterior tibial edge to be then repaired and osteosynthesized, remove cartilages from articular surfaces of fibula and tibia and talus, remove posterior-external subluxation of talus, conduct temporal transarticular fixation of talocrural joint with needles at correct position of talus, perform osteosynthesis of osseous fibular fragments after osteotomy fulfilled, fix external ankle with a screw to tibial and talus epiphysis, perform osteosynthesis of internal ankle, remove transarticularly introduced needles, fill talocrural fissure developed with osseous transplants developed out of anterior-external department of distal tibial metaepiphysis.

EFFECT: increased accuracy of reposition, improved conditions for fusion.

3 dwg

FIELD: medicine.

SUBSTANCE: method involves using wires as temporary fixing members. The wires are introduced reach the external cortical layer after setting the fracture for the period a permanent fixing member is under setting. The wires are removed from the opposite bone side with respect to the fixing member.

EFFECT: enhanced effectiveness in fixing and holding small-sized splinters; high reposition accuracy.

2 dwg

FIELD: medicine.

SUBSTANCE: method involves elongating arm biceps and brachial muscle in distal part. Brachioradial muscle is partially detached from the place of its attachment to achieve full forearm extension.

EFFECT: complete repair of mobility in articulation.

1 dwg

FIELD: medicine.

SUBSTANCE: method involves carrying out reduction and fixation of fractured bone fragments. At least two adjustable length rods are used. The rods have end heads and openings for making attachment to mandible. One of the heads is freely rotatable relative to the rod and the other one is movable along longitudinal rod axis. Reduction and fixation is made in positioned centric jaw relation. The rods are set between the mandible and maxilla to the right and left of the center at the level of failed second incisor and second bicuspid teeth.

EFFECT: reduced risk of traumatic complications; reduced periosteum detachment.

3 cl, 3 dwg

FIELD: medicine.

SUBSTANCE: method involves producing and transplanting and implantable segment containing mature cartilage tissue cells fixed on absorbable supporting matrix for repairing animal cartilage. The implantable segment has absorbable elastic supporting matrix for culturing and fixing living cells thereon. Instrument for introducing the implantable segment, having mature cartilage tissue cells on supporting matrix, into defective animal cartilage area, has clamps and external tubular envelope. The envelope has an end holdable by user and an end for making introduction into defective cartilage area. Holder and telescopic member are available in the envelope end holdable by user. Injection canal is partially embedded into the holder and projects beyond the holdable envelope end towards the end for making introduction. The clamps are attached to the telescopic member. They are well adapted for catching and releasing the implantable segment when telescopically moving the holder in the envelope.

EFFECT: enhanced effectiveness in arranging and fixing implantable segment in the implantation place.

47 cl, 11 dwg

FIELD: medicine, orthopedics, traumatology.

SUBSTANCE: one should perform reposition of osseous fragments at simultaneous reinforcing their thickness with porous titanium nickelide implants. Then one should perform osseous fixation of apophysotendinous stump with titanium nickelide clips at shape memory effect. In particular case, reinforcing should be fulfilled due to implanting elastic porous titanium nickelide plate. In paticular case, reinforcing could be performed due to implanting finely granulated porous titanium nickelide at granules size being 0.1-2 mm. In particular case, reinforcing should be carried out due to implanting elastic porous titanium nickelide plate and finely granulated porous titanium nickelide at granules size being 0.1-2 mm.

EFFECT: higher efficiency of fixation, decreased traumaticity.

3 cl, 2 dwg, 1 ex

FIELD: medicine, traumatology, orthopedics.

SUBSTANCE: in case of the suggested method of treating one should isolate extensor's tendon damaged in area of nail phalanx to suture it with a certain suture, the ends of ligature should be directed through oblique canal in nail phalanx to withdraw through the skin and fix them on S-likely curved free end of a needle that fixes the nail phalanx. In case of the present method of therapy it is possible to exclude the pressure upon soft tissues of volar surface of nail phalanx to prevent the development of scar-resulting bedsore and disorder of palpable sensitivity of patient's finger.

EFFECT: higher efficiency of therapy.

1 cl, 2 dwg

FIELD: medicine, orthopedics, traumatology.

SUBSTANCE: one should form a transplant out of femoral biceps' tendon, form an oblique-cross-sectional transfemoral canal in isometric area upon external femoral condyle, right to the front against insertion fibular collateral ligament, apply proximal end of crossed femoral biceps' tendon through this canal, fix the end of crossed femoral biceps' tendon upon internal femoral condyle. The method enables to prevent tendinous rupture at the site of its new fixation and avoid the loss of articular bending function.

EFFECT: higher efficiency of therapy.

2 dwg, 1 ex

Up!