Surgical rehabilitation method for treating hallux valgus patients

FIELD: medicine.

SUBSTANCE: method involves carrying out exostatsis resection, wedge-like resection of distal portion of the first metatarsal bone and introducing the wedge into the split bone after having done osteotomy in proximal part. Foot bones are fixed with console forceps attached to external supports of Ilizarov's apparatus.

EFFECT: enhanced effectiveness of treatment; prevented arthritis occurrence.

1 dwg

 

The invention relates to medicine, namely to traumatology and orthopedics, and can be used for the treatment of deformities of the feet, as well as to restore basic function of an extremity.

Known solution of deformity [1] by removing bone and cartilage growth on the medial edge of the head of the 1st metatarsal bone, resection 1/3 of the base of proximal phalanx of the 1st finger (operation Sheda-Brandes), subperiosteal transverse osteotomy of the base of the 1st metatarsal bone, introducing between the fragments on the site of osteotomy of the bone wedge from resected base of the proximal phalanx of the thumb.

The method has drawbacks:

a) intra-articular intervention;

b) transarticular fixing spokes, which leads to damage to the articular surface of the proximal phalanx and the metatarsal head, which subsequently contributes to the development of early arthrosis deformans;

C) application of spokes is unstable and requires external immobilization with a plaster Longuet, for a period of 4-6 weeks, which in turn leads to the development of contractures in joints of the foot and ankle, severely limits the patient's weight-bearing capacity and necessitates the use of external supports, crutches);

g) long plaster immobilization is limited to the e support ability of the lead to long videopokeronline rehabilitation of the patient.

Closest to the proposed method is the following [1]. Produce a curved incision on the inner surface of the metatarsophalangeal joint of the bulge downward. Incision continue straight along the 1st metatarsal bone to its proximal end. Cut the skin in the area of the metatarsophalangeal joint usepreview in the form of a graft, comprising the wall of the bag, to the rear of the foot: the flap is stitched with thread and hold the clip. A longitudinal incision to the bone cut through the soft tissue on the inner surface of the articular ends, and then produce the mobilization of the metatarsal head and proximal phalanx of the thumb up to her mid. The surface remaining after resection of exostosis, make smooth (the Shed), and the shape of the head model in accordance with the glenoid cavity of the proximal phalanx of the finger, so that his cartilage "looked" straight up. In this position using the saw Gigli resetinput the proximal third of the proximal phalanx (Brandes). Depending on the severity of deformation size repetiremos plot phalanx ranges from 1/5 to 1/2 of its length.

The next stage performs the correction of the position of the 1st metatarsal bone. Subperiosteal with three sides (inner, bottom and back) expose the proximal division of the bone and the indentation is 12-15 mm from klinopisnogo joint, produce transverse osteotomy without crossing the lateral plates of the cortical substance. Cleft between bone fragments introduce a wedge formed from the resected area of the proximal phalanx, so that the base of the wedge was drawn medially. Thanks metatarsal bone takes the correct position. Transarticular spend spokes for fixation of bone fragments.

At the final step, remove transverse flatness of the foot and put a plaster bandage type "boots" for a period of 4-6 weeks.

The disadvantages of this prototype:

1) mobilization of the metatarsal head and proximal phalanx is traumatic;

2) the early development of deforming arthrosis due transarticular fixing spokes, which leads to damage to the articular surface of the proximal phalanx and the metatarsal head;

3) immobilization plaster cast to allow stable osteosynthesis and an additional correction of the deformity in the recovery period;

4) prolonged immobilization plaster Longuet, in 4-6 weeks, leads to the development of contractures;

5) limitation of support ability of the patient that requires the use of external supports (crutches).

6) long term rehabilitation of patients - up to 1.5-2 months.

We first suggested:

a) producing a wedge resection of the distal 1st metatarsal bone with the formation of the wedge angle open medially;

b) to introduce the wedge formed by resection of the distal section of the 1st metatarsal bone, cleft bone obtained by resection of the distal section of the 1st metatarsal bone;

C) to perform osteosynthesis of the proximal phalanx of the big toe and 1st metatarsal bone with a console spokes that attach to the supports external fixation device.

The method is as follows.

Figure 1 shows the left foot, where 1 is the lateral surface of metatarsal bone after resection of exostosis, 2 - repetitvely wedge-shaped section of the distal 1st metatarsal bone, 3 - place the transverse osteotomy of the proximal part of the 1st metatarsal bone.

Figure 2 shows the left foot in a lateral projection, where 1 is the bone wedge, previously resected from the distal section of the 1st metatarsal bone, 2 - console spokes-clamps installed in the proximal phalanx of the thumb, 1st metatarsal bone, at the level of the head, the middle third of the diaphysis and the base, 3 - washer with slot, 4 - megalyridae plates from the apparatus Gailizarov, 5 - threaded rod.

Produce a curved incision along the medial surface of the foot in the projection of the 1st metatarsophalangeal joint. Usepreview capsule 1 shank is alanguage joint. Then perform the resection of exostosis on a lateral surface of the head of the 1st metatarsal 1.1 (Sheda) and process the surface of the saw cut for the prevention of relapse of exostosis.

Perform a wedge resection of the distal 1st metatarsal bone with the formation of the wedge base, open medially 1.2.

Using oscillatory saw from the additional section of the base of the 1st metatarsal perform transverse osteotomy of the proximal part of the 1st metatarsal bone without crossing the lateral plates of the cortical substances 1.3.

Cleft between bone fragments introduce the wedge is formed from a resected distal section of the 1st metatarsal 2.1. The base of the wedge should be directed outwards, thereby restoring the right axis of the 1st metatarsophalangeal joint.

Stable intra-articular fixation is carried out by introducing the console spokes-clamps 2.2 from the rear surface of the foot, perpendicular to the long axis of the 1st toe and metatarsal bones in top-down direction from the outside-medially and from within outwards, at an angle to each other 90°in the proximal phalanx of the thumb, 1st metatarsal bone, at the level of the head, the middle third of the diaphysis and the base, which by means of washers with a cutout 2.3 fixed in the outer mnogodenek plates from the apparatus Gailizarov 2.4. Plan and connect the threaded couplers 2.5. By moving the nuts on the tie-rods, respectively straps, carry out compression or distraction, depending on the degree of deformation.

The advantages of our method:

1) resection of exostosis without mobilization of the metatarsal head and proximal phalanx of the 1st finger is less traumatic manipulation;

2) the unloading of the joints due to cartilage immobilization and preservation of the articular surfaces of the proximal phalanx and the head of the 1st metatarsal bone, thus, prevention of deforming arthrosis;

3) stable fixation of the 1st metatarsal bone after the deformation is carried out using external fixation device, which allows an additional correction of the deformity in the recovery period;

4) stable fixation does not require external plaster immobilization, and therefore does not lead to the development of contractures in joints of the foot and the ankle joint; it's also the prevention of contractures is the dismantling of the apparatus with the main phalanx of the 1st finger on the 3rd week post-operative period;

5) the location of the device from the rear surface of the foot and stable fixation allows the load from the 1st day after operation, without the use of external supports (crutches) when walking;

6) reduction of term immobilization and rehabilitation PAC is having up to 3-4 weeks.

Example. Patient I., 24 years. The diagnosis of Hallux valgus both stop. Figure 3 presents the x-ray of both feet in a direct projection before the operation.

The operating field is processed in the usual method. Of the arcuate incision 3 cm medial surface of the 1st metatarsophalangeal joint of left foot resection of exostosis head of the 1st metatarsal bone and wedge resection of the distal metaphysis of the 1st metatarsal bone of the left foot. Additional incision of 1.5 cm of the base of the 1st metatarsal bone made her osteotomy with the movement of the sphenoid bone autograft. Wounds sutured level seams. Made osteosynthesis of the 1st metatarsal and the main phalanx of the 1st finger of the left foot with external fixation device. 4 shows the radiograph of the left foot in two projections in the treatment process. Figure 5 presents the x-ray of the left foot in the direct projection in the treatment process.

The location of the device from the rear surface of the foot and stable fixation was allowed to carry the load from the 1st day after the operation.

On the 3rd week post-operative period, prevention of contractures, was the dismantling of the apparatus with the main phalanx of the 1st toe.

The device is removed after 4 weeks. The deformation is fixed, the right axis of the joint is restored, the movement in the 1st metatarsophalangeal the Charter in full, pain is not defined. Figure 6 presents the radiograph of the left foot in the direct projection after dismantling the external fixation device.

Sources of information

1. Cherkes-Zadeh, DI foot Surgery./ Dierkes-Zadeh, UPHClean// M.: Medicine. - 1995. - 288 S.

A method of surgical rehabilitation of patients with Hallux valgus, which includes resection of the exostosis, osteotomy of the proximal part of the 1st metatarsal bone, wherein through an incision along the medial edge of the foot in the projection of the 1st metatarsal bone cut out wedge, base, open medially from the distal 1st metatarsal bone and implement it in the splitting of the proximal part of the 1st metatarsal bone, angle, open outwards, perform osteosynthesis by introducing a console spokes-clamps from the rear surface of the foot, perpendicular to the long axis of the 1st toe and metatarsal bone, at the top-down outside-medially and from within outwards, at an angle of 90° to each other, the proximal phalanx of the thumb, 1st metatarsal bone, at the level of the head, the upper third of the diaphysis, the middle third of the diaphysis and the basis that using washers with slot is fixed in the outer mnogodenek plates from the apparatus Gailizarov.



 

Same patents:

FIELD: medicine.

SUBSTANCE: method involves cutting out a flap for wrapping implant from synovial fat tissue available on anterior surface of the posterior cruciform ligament and intercondylar fossa roof capturing superficial layer of the posterior cruciform ligament.

EFFECT: enhanced effectiveness of treatment; improved ligament transplant remodeling conditions.

1 dwg

FIELD: medicine.

SUBSTANCE: method involves applying computer-aided processing of general plan survey X-ray films with one or several zones of interest being detected on digitalized image corresponding to the number of osteogenesis foci. Quantitative osteogenesis intensity estimate is obtained by applying test grid and interpreting ratio of areas corresponding to distraction regenerate mineralization degree. Boundaries are determined in each zone of interest for delimiting intensity ranges characterizing tissue mineralization degrees at osteogenesis stages and reference points are marked. The first reference point is selected on proximal bone fragment end turned to diastasis. Lower boundary line of the proximal test grid, composed of parallel lines being perpendicular to long bone axis, is superposed with the first reference point. The second one is selected on distal bone fragment end turned to diastasis and the upper line of the distal test grid is superposed with it. Every region belonging to a zone of interest confined by neighboring test grid lines is segmented within the scope of established boundaries into intensity ranges and intensity range area shares in the total area of each region belonging to zone of interest. The intensity range area share proportions are used for estimating osteogenesis intensity.

EFFECT: wide range of functional applications.

11 dwg

FIELD: medicine, surgery.

SUBSTANCE: amputation should be fulfilled at the level of cuboid and navicular bones, as an arch-like trimming in plantar-rear direction without affecting tarso-calcaneal-cuboid-navicular articulation for removing wound defect, that forms a callosity partially uniting both bones at keeping the fixation of tendinous plantar aponeurosis at trimming level that strengthens the present area and decreases further possibility for the development of stump's equines deformity and provides prophylaxis in developing trophic disorders.

EFFECT: higher efficiency.

2 dwg, 1 ex

FIELD: medicine, neurosurgery.

SUBSTANCE: the present innovation deals with treating patients with hernias of intervertebral lumbar disks: out of yellow ligament one should cut "an apron" and on a ligature the latter should be applied towards spinous processes, after removing disk hernia the "apron" of yellow ligament should be put into inter-arch space to be fixed with a suture that does not restrict the survey of operational field and keeps normal anatomical interactions in inter-arch space, prevents the development of postoperational muscular-membranous cicatrix and adhesive process in epidural fiber.

EFFECT: higher efficiency.

1 dwg, 2 ex

FIELD: medicine, orthopedics.

SUBSTANCE: in the course of dosed lengthening limbs; segments, at initial stage of fragments' traction a patient should be prescribed the seances of hyperbaric oxygenation and acupuncture. At its middle stage one should perform the course of medicinal therapy. And at its final stage the latter should be supplemented with the course of hyperbaric oxygenation. At stage of fixation it is necessary to carry out successively altering courses of medicinal therapy, acupressure and hyperbaric oxygenation. The innovation prevents the development of contractures in adjacent joints and avoids neurological complications.

EFFECT: higher efficiency.

1 cl, 2 dwg, 1 ex

FIELD: medicine, orthopedic, traumatology.

SUBSTANCE: one should perform, at minimum, a double osteotomy of a bone followed by a dosed longitudinal shift of isolated fragments till restoration of desired osseous length, replace intermediate fragment against longitudinal axis of the segment during the shift and move it in this position longitudinally. In peculiar case, at simultaneous shift of several intermediate fragments their adjacent ends should be replaced in opposite directions. In peculiar case, during osteotomy in adult patients one should perform periosteal exfoliation at the ends of intermediate fragment under development. The innovation enables to form steadily a regenerate which is capable to withstand statico-dynamic loading after reconstruction.

EFFECT: higher efficiency of osseous lengthening.

2 cl, 4 dwg, 1 ex

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

FIELD: medicine, traumatology, orthopedics.

SUBSTANCE: for surgical correction of caput femoris defect in case of aseptic necrosis, osseous cyst, osteochondropathy of caput femoris. Towards the defect one should form a trepanation foramen in anterior department of collum femoris, remove necrotized sections of caput femoris through developed canal subchondrally and substitute with reduced autotransplant taken out of ilium's wing, then trepanation canal should be filled in with developed osseous column that keeps sphericity of caput femoris in case of loadings and its own articular cartilage.

EFFECT: higher efficiency of autoplasty.

5 dwg, 2 ex

FIELD: medicine, traumatology.

SUBSTANCE: one should substitute affected ligaments with doubled tendon of semitendinous muscle. For this purpose one should conduct tendolysis to remove a tendon, then one should drill intraosseous canals: in the collum of ankle bone - in cross-sectional direction, in the body of a heel bone - in longitudinal direction, and in fibula - in anterior-posterior direction and from the top downwards at the angle of 45° so, that output opening should be in area of the lower pole of external ankle. After that, a tendinous transplant should be applied through a canal in an ankle bone, then - into the canal in fibula and heel bone and after withdrawing out of the heel bone it should be applied in back direction through fibular canal to be sutured with a free end that protrudes from the canal of ankle bone with tendinous suture by "end-to-end" type. The method enables to perform operative treatment in case of chronic lesions of fibular ligaments in talocrural joint.

EFFECT: higher efficiency of autoplasty.

2 dwg

FIELD: medicine, orthopedics.

SUBSTANCE: the method deals with an access to the caput and bottom of the 1st metatarsal bone, removal of osseous-cartilaginous growth in area of metatarso-phalangeal joint, cut a fragment out of articular capsule with its bottom being on proximal phalanx, suturing a cut fragment at tension towards soft tissues in area of distal metaepiphysis of the 1st metatarsal bone to withdraw the great toe out of defective position, resection of the bottom of proximal phalanx in a hammer-like toe, osteotomy of the bottom of the 1st metatarsal bone, forming wedge-like autotransplants out of resected bottom of proximal phalanx of the second toe followed by their introduction into area of osteotomy of the bottom of the 1st metatarsal bone to prevent the relapse of deformation.

EFFECT: higher efficiency of therapy.

2 dwg, 1 ex

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!