Fork plate for performing fractures and false joints osteosynthesis

FIELD: medical engineering.

SUBSTANCE: device has plate with holes and fork-like fixing unit having two teeth. The teeth are arc-shaped along longitudinal relief of frontal surface of external clavicle one-third. The teeth divergent in planes parallel to each other for arrange external fractured bone fragment. Longitudinal part of the plate is S-shaped.

EFFECT: enhanced effectiveness of treatment; high multisplitter fracture fixation reliability.

4 dwg

 

The invention relates to medical equipment, namely to traumatology and orthopedics, and can be used in surgical treatment of fractures and false joints clavicle.

A device - 3.5mm DCP plate system AO-ASIF (Measurer, Mellower, Rsnyder, Juillenay. Manual of internal fixation. - Springer-Verlag. - Berlin-...-Moscow 1996. - c.434-435), which is placed on the front surface of the clavicle, tmodelbag her on the curvature of the bone.

The disadvantage of the prototype is its low efficiency in complicated surgical task: cases of comminuted fracture of the outer thirds and a false joint with osteoporosis lateral fragment, as well as in obesity. In comminuted fractures requirements fixation is increased, and the location can be entered screws, damaged. Securely manages to deliver usually the one screw, and only in the absence of osteoporosis, while the rest are oriented in the fracture area. Attempt additional fixation in a cast leads to the fact that the weight of the latter is added to the weight of the limb and only adds to the overload of the screws and the outer fragment. In obesity the weight of the limb is large, and the cast even harder. When false joint osteoporosis in the outer fragment is inevitable, resulting in anterior and posterior cortical region of the clavicle much and Tonini, and screws to accommodate if possible, you mount them unreliable and the potential risk of repeated loosening and necromania.

It is known Device for osteosynthesis of fractures of the proximal humerus", patent RU 2143862 containing plate plate with holes and a pair of teeth for the introduction of sponge epiphysis (i.e. locking fork site), selected as a prototype. As stated in the description of the effect of a higher stability of fixation of the bone fragment (the head) using a fork, it should be expected to its high effectiveness and commit lateral (also spongy) end of the clavicle, and the size and shape of a plate suitable for modeling of her clips on S-shaped curved anterior surface of the clavicle as in analog. The disadvantages of this release are the shape of the teeth and the plate. When putting it on the outside of the fragments in the front, teeth, responsible for the bulk of fixation are outside of the bone, and flexion of teeth (closer to each other) leads only to a point contact with the surface of the bone. With the strong convergence of teeth, in which the possibility of their implementation in spongy acromegaly the end, damage to the latter is excessive, threatening to fracture the hole with a tooth. The high curvature of the bend straight plate when fitting to arena surface of the clavicle threatens excessively high residual stresses in the metal, especially when delayed consolidation that cases of comminuted fractures and pseudoarthrosis predictable.

The technical result of the present invention is to increase the reliability of fixation in comminuted fractures and false joints with osteoporosis clavicle, as well as a reduction in the morbidity of the operation.

Shortcomings of the prototype and analogues was possible to create a comprehensive internal clamp for any fractures and false joints clavicle.

The technical result is achieved by the fact that in the known device containing plate plate with holes and fixing the site in the form of a fork, the prongs are made arcuate curved longitudinal elevation of the front surface of the outer third of the clavicle and the fan-shaped diverging in a parallel plane to accommodate between them the outer fragment, while the longitudinal part of the plate is curved S-shape.

The significance of the distinctive features is that:

1. Running a pair of teeth fork node arcuate curved longitudinal elevation of the front surface of the outer third of the clavicle and the fan-shaped diverging in parallel planes changed the principle of fixation of the lateral fragment, which "hangs" pretty massive hand with a shovel. During the installation of this release of fragments is kazyvaetsya squeezed between the surfaces of teeth, which hold it firmly over the cortical surface near acromiale end. The orientation of the planes of teeth, turned out to be the most efficient to counteract the weight of the limb, and the contact planes of the teeth with the planes of the surfaces of the clavicle allowed not to damage the bone at the location of maximum stress and even reduce the specific pressure of the metal on the cortical layer with increasing stability in General. The role of the screws in this part of the plate is reduced in subsidiary: to prevent slipping of the bone from between teeth, so that the load on them is minimal, and the risk of loosening negligible.

All this has resulted in a more reliable fixation in comminuted fractures and pseudoarthrosis defeat the fragment osteoporosis due to more dense and less traumatic installation of the clamping site to the surface of the clavicle.

2. Because this lock is created for complicated surgical tasks (pseudoarthrosis and comminuted fractures), he shall not lose strength over at least double the time of consolidation, which can be expected after severe trauma or necromania. Because the clavicle has a very pronounced curve, and the outer radius of curvature is quite small, attempt to bend the latch from direct plate leads to hover dangerous stresses the metal is in the points of maximal curvature (the holes) and threatens fatigue fracture of the retainer. The original (factory) S-shape allows you to avoid dangerous voltages metal that occurs when cold bending in the operating room. In this form the surgeon only has to slightly bend the clamp to fit to the individual forms, the differences between them are very small.

Achieving high reliability of fixation allows you to more confidently engage in active motion to prevent contractures after severe fractures and functional treatment of existing contractures when pseudoarthrosis.

The technical solutions according to the criterion "novelty" is defined by the absence in the prior art similar technical solutions to achieve the claimed result.

The criterion of "inventive step" was determined by the fact that this decision contradicts known trends and therefore not obvious from the prior art, and also that the effect achieved by the claimed solution, revealed accidentally by the applicant. Trauma to increase the reliability of fixation, one way or another "stitch" fixer problematic fragment or use compression or a combination thereof. On porezna, small and overloaded the lateral fragment in the presence of intermediate fragments of these mechanisms are ineffective. Coverage of the "fork" fixer top is the loud and peripheral fragment immediately decided several tasks: (a) the final fixing (for which only one screw, but it is possible to put two and three), b) the temporary fixation effect customersales" is very highly appreciated by surgeons for convenience), g) preservation of blood circulation in the fragment (it is not damaged by the fork and its installation does not require the skeletization), d) reduction of the specific load on the affected osteoporotic bone, (e) retaining all the advantages of a forward position of the latch. Side effect, confirming the reliability of such fixation was continued tight fit planes fork observed when removing from a fused clavicle regardless of the type of pathology (false joint or comminuted fracture).

The criterion of "industrial applicability" is determined by the effectiveness of the treatment of comminuted fractures of the clavicle and pseudarthrosis characteristic data using a device that supports the interest of Health, and the willingness of the company that manufactured the prototypes, go to mass production, for which it is advisable to obtain patent protection for new development.

In the drawings shows:

Figure 1. The clevis plate for osteosynthesis of fractures and false joints clavicle, front view.

2 is a Forked plate for osteosynthesis of fractures and false joints clavicle, lateral view.

Figure 3. The clevis plate for osteosynthesis of the fracture is in and false joints clavicle, view from the top.

Figure 4. The clevis plate for osteosynthesis of fractures and false joints clavicle, is a perspective view of bone.

The clevis plate for osteosynthesis of fractures of the clavicle (Figure 1-4) consists of the extramedullary plate 1 with 2 holes. In the part corresponding acromiale the end of the clavicle, from her depart two teeth 3, forming a clevis retainer node ("fork") 4. The teeth 3 arcuately curved longitudinal elevation of the front surface of the outer third of the clavicle and diverge fan-shaped, smoothly moving in the plane 5 teeth that are parallel to each other.

This device is used as follows. After the implementation of the surgical approach and achievements the front edge of the clavicle to the plane of the prongs 5 are oriented in the direction of the upcoming introduction on the surface acromiale end 6 and with a certain amount of pressure put on the fragments. The plane of the teeth 5 of this act as Raptor, paving its way between the soft tissue and bone. When the mismatch between the thickness of the fragment and the gap between the planes of the teeth 5, the latter is reduced or diluted by 0.5-1 mm instruments. For the final landing of the latch dokladivayut a light hammer blow. Outer fragments fixed sandwiched between the planes of the teeth of the clamp. By manipulating the latch, as customerdataset, perform reposition,put the plate on the front surface of the medial fragment and fix with the screw. The compression ratio is indicated. Enter screws into the holes on medial and lateral fragments (Figure 4). When the wound closure latch cover the deltoid and pectoralis major muscles. In the postoperative period the function of the limbs begin upon termination of postoperative pain. External immobilization is not shown.

The device allows you to:

- in comminuted fractures and false joints clavicle to improve the reliability of fixation by eliminating trauma spongy bone outside the fragment of the clavicle and snug locking fork node to its undamaged cortical surface;

- reduce unit load (pressure) on the cortical surface are less strong lateral fragment;

- to facilitate and speed up the operation at the stage of fixing the outer fragment;

to minimize vnutripopulyatsionnoe fitting clamps to the individual anatomy of the clavicle.

The clevis plate for osteosynthesis of fractures and false joints clavicle containing the plate with the holes and fixing the site in the form of a fork consisting of two prongs, wherein the prongs are made arcuate curved longitudinal elevation of the front surface of the outer third of the clavicle and the fan-shaped diverging in a parallel plane to accommodate between them outside Tomka, while the longitudinal part of the plate is curved S-shape.



 

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