Method for treating subcapital femoral fractures

FIELD: medicine, traumatology, orthopedics.

SUBSTANCE: one should alter the loading upon the caput due to the following technique: one should model adjacent surfaces of caput femoris and collum femoris, moreover, it is necessary to isolate the least affected cartilaginous surface of the caput which would be a support one after osteosynthesis, then one should put the caput upon adapted surface of the collum, introduce the screws of graphitized cast iron retrogradely coaxially against the collum from the side of the caput through fracture area, moreover, the screws should pass through the second cortical layer. The innovation enables to create conditions for steady loading upon the caput femoris.

EFFECT: higher efficiency of therapy.

3 dwg, 1 ex

 

Invention refers to medicine, namely to traumatology and orthopedics, and can be used to treat subcapital fractures of the femur.

The known method of osteosynthesis of hip fractures, including the reduction and fixation of bone fragments introduced through the Central three-blade nail Smith-Petersen.

However, the known method causes significant destruction of the trabecular bone of the neck of the head, which has a negative effect on the consolidation process, and sometimes leads to the development of aseptic necrosis of the head or nonunion defects and false joints. In addition, the fixation of bone fragments with a nail passing through the loose spongy bone, not enough stable and its consequence may be a rotary head is moved around the nail, and its displacement along the fracture plane. Analysis of long-term results of patients operated using a nail Smith-Petersen showed that the nonunion fracture and pseudarthrosis of the femur neck developed in 40,1%, 80% developed avascular necrosis of the femoral head. 15.6 per cent complained of moderate pain in the operated joint at rest and severe pain when the load on the limb /Auvasotec, Sgeee, IBM et al. Treatment of patients with fractures of the proximal femur. Traumatology and Orthopaedics. V.3. 1996, P.29-31/.

Closest to the claimed is a method of osteosynthesis of a fracture of the neck of the femur by the RF patent №2056802, including the fixation of bone screws, entered from the side of the greater trochanter to the head of the femur in the upper and lower contours of the neck.

However, this method has several disadvantages, not to guarantee a stable compression along the line of fracture. The achieved density of connections over time as a result of bone resorption is reduced, which affects the consolidation of the fracture.

Cases of necromania fracture with this method of osteosynthesis are found in 30% of patients. Therefore, some patients may need a second operation, but the time is usually lost and repeated surgical intervention is contraindicated because of the severity of patients /Lauraw. 2001. Topical issues of implantology and osteosynthesis. Collection of scientific papers. Part 3. P.9-10/.

The objective of the invention is the reduction of treatment time by increasing stability, mejregionalnoi compression between the fragments, early activation of the patient.

The problem is solved because, according to the method of treatment subcapital fractures of the femur by means of compression osteosynthesis bone screws AO simulate the contact surfaces of the femoral neck and to the tee, identifying the least damaged cartilage, and, thereby altering the load on the cylinder, injected bone screws AO retrograde coaxially with the neck from the head through the fracture passing through the second cortical layer.

The method is as follows.

Under General anesthesia of the anterior-external access identify the place subcapital fracture.

Using levator head freely dislocate. In elderly and senile age round ligament, as a rule, is the scar heavy or missing. Model contact surface of the head and neck of the femur using a spoon Volkmann, pliers Luera. Identify the least damaged cartilage surface of the head, which will be after osteosynthesis reference. In the head to form two flaps, then bait tightly adapted to the neck in the position of the valgus angle 135-140°. Later in the channels twist the required length of the screws firmly with the required compression ratio is fixed fragments. And are the second cortical layer.

Hemostasis during surgery, the joint capsule is sutured separate seams. Layer-by-layer suture of wounds, removing the drainage tube through a separate incision. Aseptic dressing, temporary external immobilization denotational plaster boot.

Izopet the tion is illustrated by a drawing. 1 shows a schematic character of fracture of the femur, where

1 - damage to the cartilaginous surface of the head;

2 - zone fracture;

3 - the area of the proposed modeling resection of the contacting surfaces of the head and neck.

Figure 2 - the proximal part of a femur after simulation.

Figure 3 - the final retrograde of osteosynthesis, where 4 - spongy tightening the screws AO.

Clinical example of application of the method.

Patient S., 77 years old was admitted with a diagnosis of Subcapital fracture of the left femur with displacement of fragments. Injury 27 December 2000 - fell, hit the hip joint. Conducted skeletal traction for 22 days. Then delivered in Kuzbass Institute of traumatology and orthopedics. After 10 days operation: open reposition, retrograde osteosynthesis left femoral neck bone screws AC. Under epidural anesthesia FWD-outside access a dedicated area of the fracture, if the audit reveals subapically his character. Using levator head freely pywikipedia, represents half of the billiard ball, the round ligament is absent. Spoon Volkmann, pliers Luera refreshed and autodelivery mating surfaces of the head and neck. In the cylinder and formed two channels were taken into account for the ache not to damage the least modified articular surfaces of the head, after osteosynthesis will be supporting. Next head firmly pushed on the neck in the position of the valgus angle 135°. Produced osteosynthesis with two screws AO passing through the second cortical layer in the region of the greater trochanter. When conducting passive rotary motion fixation is stable, the micromotion is not revealed. The joint capsule sutured single interrupted sutures. Layered seams on the wound with the removal of the drainage tube through a separate incision. Hemostasis during surgery. Aseptic bandage. External immobilization with a plaster boot. On the fifth day the patient began to walk on crutches without bearing on the operated limb. Healing by primary intention, the sutures were removed on the ninth day.

The proposed method allows for the treatment subcapital fractures of the femur to achieve higher mejregionalnoi compression and fixation stability. This thread of a screw is fixed in the opposite cortical bone. And thus the force of compression is increased six-fold /Measurer, Mellower, Rsnyder, Vellinger. Manual of internal fixation. The methodology recommended by the group AO /Switzerland/ 1996. P.184/.

Given that the phase of the operation is the modeling of the contacting surfaces of the head and neck can be osteosynthesis with regard to aimeee injured articular surface, which will be the reference.

The increase in cervico-diaphyseal angle, creating a valgus position in the proximal femur in future not only provides a solid contact between the fragments, but also the compression of the latter in a functionally advantageous position. The conditions for uniform loading on the head.

Early activation of the patient and his rehabilitation at the expense of the fixation stability.

At the time of filing of the proposed method treated three patients.

The method of treatment subcapital fractures of the femur, including the osteosynthesis bone tightening screws, characterized in that alter the load on the head as follows: simulate the contact surfaces of the head and neck of the femur, thus reveal the least damaged cartilage surface of the head, which will be after osteosynthesis reference get a head adapted to the surface of the cervix, enter the bone screws retrograde coaxially with the neck from the head through the fracture, and the screws pass through the second cortical layer.



 

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