Device for making external crural malleolus osteosynthesis

FIELD: medical engineering.

SUBSTANCE: device has part fixed on bone and intraosseous part parting from it at an angle of 90є and having protrusion and slit. The on-bone part is longitudinal and narrow and has transverse protrusions having holes for receiving fastening members, and the narrow part has longitudinal rectangular area having rounded protrusion and slit 0.5-1.0 cm far from the protrusion. The slit originates on the lower edge in perpendicular to the longitudinal device axis occupying half of height of longitudinal area of the intraosseous part.

EFFECT: improved functional properties; accelerated treatment course; stable fixation of fractured bone fragments.

3 cl, 1 dwg

 

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

Fractures of the ankle and the distal end of the tibia and fibula bones occur very often and are from 20 to 22% in relation to all the injuries to the bones of the skeleton (Shabanov A.N., Kai YU, Sartan, VA, 1972).

Each author mentions the plurality and a wide variety of damage to the ankle joint. This explain the complexity of the anatomical and functional characteristics of the ankle joint. Fractures of the ankle with displacement of fragments total of 61.4% (Martyniuk GY, 1974).

The most common method of fixing the outer ankle - plate plate after a preliminary reduction (Muller M.E. Ter-Minassian, Allgower M., Schneider R., Villinger X. “Manual of internal fixation”, 1996, str-610).

The disadvantages of this method are:

insufficient strength of fixation of the distal fragment of the external malleolus due to its anatomical structure (stable fixation of the distal fragment of the external malleolus cortical screws in the developing post-traumatic osteoporosis is virtually impossible).

A known method of fixing the outer ankle nail (Krupko I.L., Glebov UL “fractures of the ankle joint and their treatment”, “Medicine”, 1972, p.100-101).

The disadvantages of this method:

- the possibility is of secondary displacements of the instability of fixation of bone fragments);

- possibility of migration of the implant.

There is a method of use of intraosseous latch, which is used for treatment of fractures of tubular bones (A.S. No. 1489748, class. And 61 In 17/58, bull. No. 24, 1989), selected as a prototype in which to enhance the rigidity of fixation of osteosynthesis is carried out by the construction of the two elements Poltavaoblenergo forms, shared among themselves. The corners have a bone fixing part and intraosseous portion located at an angle of 90 degrees relative to each other. Adjacent shelf corners are made with longitudinal and transverse tabs with the slots at the base. Cross the ledges of one area intended for location in the slots of the other with the possibility of contact. Longitudinal and transverse protrusions bent outwards of the area.

The disadvantages of the prototype:

- the complexity of the matching elements;

a significant volume of intraoperative injury due to the size of the structure.

The objective of the invention is to improve functional outcomes and to reduce the duration of disability in patients with fractures of the external malleolus by creating conditions for stable fixation of bone fragments with minimal trauma to the bone at the various types of fractures and prevent secondary displacement of fragments at an early load on the damaged limb, and the adaptation of the device to anatomizes the first form of the bone.

This object is achieved in that the device for osteosynthesis of the external malleolus of the tibia contains osseous part and radiating at an angle of 90 degrees intraosseous part with the tab and slot. Bone fixing part is made of longitudinal narrow and provided with transverse protrusions with holes for fasteners. Intraosseous portion has a rectangular longitudinal section with a rounded lip and a cut on the distance of 0.5-1.0 cm from this ledge. The slit goes from the lower edge perpendicular to the longitudinal axis of the device at half the height of the longitudinal section intraosseous. All lower edge of the intraosseous part has a pointed. In some cases, only a section of a rounded protrusion intraosseous perform a pointed arc of curvature.

Mounting screws are conducted through the holes of plate parts for additional fixation.

The novelty of the device:

- Osseous part is made of longitudinal narrow and provided with transverse protrusions with holes for fasteners.

- Intraosseous portion has a rounded projection at the distal end of the device.

At a distance of 0.5-1.0 cm from the rounded protrusion made the cut, coming from the lower edge perpendicular to the longitudinal axis of the device.

The slot runs at half the height of the longitudinal section within ecostay part.

The proposed form of plate part allows you to enter the fixing screws for additional fixing of the individual fragments with minimum dimensions of plate parts, which facilitates closure of the wound and improves healing in the postoperative period.

Intraosseous portion has a rectangular longitudinal section with a rounded projection at the distal end that provides the best stabilization of comminuted fracture and prevent secondary displacement of the distal fragment of the external malleolus. Rounded ledge more deeply immersed in the distal fragments of the external malleolus, where the bone is spongy structure, thereby increasing the area of contact of the device with the bone, thus increasing the stability of the osteosynthesis of a fracture of the outer ankle.

The slot allows for the installation of a design change its shape and be curved in accordance with the anatomical shape of the outer ankle. The value of the slot provides a bending device without loss of structural strength.

We offer the device shown in the drawing, which shows a General view of the installation device.

A device for osteosynthesis of fractures of the external malleolus of the tibia consists of intraosseous part 1, bent at 90 degrees relative to the osseous part of the plate 2. Osseous part 2 made food is Inoi narrow and has lateral projections 3 with 4 holes for mounting elements, for example, screws. Intraosseous part 1 has a rectangular longitudinal section with a rounded ledge 5 at the distal end and the slot 6.

The device is made of stainless steel with a thickness of 1 mm.

Osseous part 2 of the device has lateral projections 3, separated from each other at a distance of 20 mm Lateral projections 3 have holes round shape 4 with a diameter of 5 mm, which is injected mounting screws. The height of the rectangular longitudinal section intraosseous 5 mm Rounded projection at the distal end of the intraosseous to 12 mm height. Cut 6 is made at a distance of 0.5-1.0 cm from the rounded ledge and directed from the lower edge perpendicular to the longitudinal axis of the device at half the height of the longitudinal section intraosseous, i.e. 2.5 mm, slit width 1 mm In this place the unit deform, giving it a bend corresponding to the anatomical shape of the outer ankle. The lower edge of the intraosseous part is pointed to facilitate entry into the bone. Can sostrates only rounded protrusion 6 on the arc of curvature.

Osteosynthesis of the external malleolus of the tibia is as follows.

A longitudinal incision on the outer surface of tibia length to 10 cm layers exposed the place of fracture of the external malleolus.

The surgeon removes blood clots, interponere cloth seats re the Ohm (fresh cases), in old - excising severe scarring of the fracture site. Is the reposition of fragments of the outer ankle to hold customersthese. Control of reposition. The oscillatory saw at the outer surface of the fibula in proportion to the length of the device is linear channel to the depth of the cortical layer with increasing depth in the area of the external malleolus to 10-12 mm. Before the introduction of the device it is deformed by bending in the area of the slot in such a way as to adapt to the anatomical shape of the outer ankle. Intraosseous part 1 of the device is inserted into the channel so that the rounded protrusion intraosseous was oriented to the distal end of the outer ankle to the contact plate portion 2 with the cortical fibula. A drill with a diameter of 2.5 mm are formed channels in the fibula for the mounting screws. Used small cortical screws with a diameter of 3.5 mm, the length of which is slightly greater than the length of intraosseous channel. The screws injected into the formed channels. Hemostasis is performed during the operation using thermocoagulation. The wound is closed in layers overlapping nodal joints. Aseptic bandage.

Clinical example:

Patient D., 33, enrolled in the Department of traumatology IFL (GNCC OSS) , Leninsk-Kuznetsky 9.08.2002 year about the Closed comminuted fracture of the external malleolus of the right ankle, rupture of the distal tibiofibular of syndesmosis right Shin. Subluxation of the right foot outwards. Flirtini the area of the right ankle.

Before enrolling in the Department of traumatology IFL (GNCC OSS) the patient was in outpatient treatment gortrasporte Leninsk city-Kuznetsk. Treatment was conservative and was in plaster immobilization of the right ankle.

At the Department of traumatology was conducted antibacterial therapy, infusion therapy, antispasmodics, vitamin therapy, local treatment flicted. Right lower extremity immobilizovana on the bus of Bellera lakoplastyrna extension. In the conservative treatment of flickery the area of the right ankle healed again.

12.09.2002 year patient surgery - open reposition, osteosynthesis of the external malleolus of the right ankle of the proposed device, the fixation of the distal tibiofibular of syndesmosis position with the screw.

Under aseptic conditions after 2-fold processing 1% alcoholic solution of chlorhexidine under the harness in the middle third of the right femur linear incision on the outer surface of the right tibia length up to 12 cm layers open place comminuted fracture of the external malleolus. Feature of the fracture was krupnomasshtabnogo the fragment of cylindrical shape and otlak is triangular in shape with a size of up to 1.5-1 -0,sm The fragments except the fragment of a triangular shape, tactfully selected using customerarea mapped. The restored length of the outer ankle. The oscillatory saw produced a linear channel on the outer surface of the fibula and the external malleolus of the right ankle, comparing its length with the length of the plate and the height of intraosseous. In the bone canal without technical difficulties after some modeling introduced intraosseous part of the device, focusing rounded protrusion in the region of the external malleolus. A 2.5 mm diameter drill bit through the holes in the two proximal transverse edges of plate of the device produced channels, in which a screwdriver to put the screws with a diameter of 3.5 mm Drill bit 3.2 mm through hole in the transverse ledge plate portion of the device at the level of the distal tibiofibular of syndesmosis right Shin made a channel into which a screwdriver entered positional screw diameter of 4.5 mm Hemostasis using thermocoagulation. The wound is sutured in layers. Aseptic bandage.

Intraoperatively after implantation of the device was carried out test on the mobility of fragments: doubts about the stability of fixation of fracture of the external malleolus, in spite of comminuted nature of the fracture, no.

Postoperative wound area right ankle has healed primarily, the sutures were removed n is 10 days. The patient is permitted load on the right foot on the 14th day after surgery. The patient completed a course of rehabilitation treatment on an outpatient basis. After 1 month the patient refused cane and began to walk with a full load on the right lower extremity. Started to work again after 1 month and 7 days after surgery. The result of the treatment were assessed after 1 year: pain in the right ankle is not bothering, swelling, limitation of motion in the ankle joint no.

Conclusion: the Use of a device for osteosynthesis of the outer ankle stale comminuted fracture of the external malleolus of the right ankle of the patient D., 33, helped to produce a stable fixation of the fracture site, to begin early movement in the ankle joint and early loading on the injured lower right leg, to reduce the period of temporary disability.

Thus, the proposed device for osteosynthesis of the external malleolus of the tibia allows you to install it with minimal trauma to adapt its shape to the anatomical shape of the bone. The device provides rigidity fixation of bone fragments to prevent secondary displacement in the postoperative period. All this reduces the possibility of postoperative complications and improves functional outcome of treatment of PA is antov with fractures of the outer ankle.

Osteosynthesis of the external malleolus of the tibia proposed device produced in the traumatology Department of the Federal medical-preventive institution “Scientific-clinical center of health of miners” , Leninsk-Kuznetsky 10 patients, with a fresh and non-consolidation of fractures of the external malleolus of the tibia. In 100% of cases with good results.

1. A device for osteosynthesis of the external malleolus of the tibia containing plate part and radiating at an angle of 90° intraosseous portion with a rounded protrusion and the slot, wherein the plate portion is made narrow longitudinal and provided with transverse protrusions with holes for fasteners, and intraosseous portion has a rectangular longitudinal section with a rounded projection at the distal end and a slot at a distance of 0.5-1.0 cm from the rounded protrusion coming from the lower edge perpendicular to the longitudinal axis of the device at half the height of the longitudinal section intraosseous.

2. A device for osteosynthesis of the external malleolus of the tibia according to claim 1, characterized in that the lower edge of the intraosseous part has a pointed.

3. A device for osteosynthesis of the external malleolus of the tibia according to claim 1, characterized in that the transverse rounded ledge intraosseous made a pointed arc of curvature.



 

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