Set of metal structures and method for carrying out of stable osteosynthesis with fracture of neck of the femur
FIELD: medicine, in particular, traumatology and orthopedics.
SUBSTANCE: set has sharp nails, wires, diaphyseal faceplates, and screws. Wires are made wavy-curved. Nails are made flat and telescopic. Acute end of nail is equipped with hook. Telescopic nails are provided with lateral dents having increasing size as said dents approach to outer side. Outer ends of nails are curved to the outside and fixed to diaphyseal faceplate by means of washer. Method involves introducing two metal nails and wires, with two nails being introduced in parallel with one another from the outside through base of larger trochanter, neck, fracture place and head of the femur. Diaphyseal faceplate is used for carrying out of said method. Telescopic nails are inserted through preliminarily prepared upper and lower subcortical channels and wavy-curved wires are inserted through front and rear subcortical channels. Outer ends of nails and wires are bent above diaphyseal faceplate and fixed by means of washer.
EFFECT: increased efficiency by providing conditions for stable joining of bones during the entire treatment period, in particular, for patients with bone tissues changing with age, with minimal injury to bone tissues.
3 cl, 6 dwg
The invention relates to medicine, where trauma fractures of the femoral neck are different structures and ways of achieving fixation in patients of elderly and senile age.
Known methods of osteosynthesis in fractures of the femoral neck monolithic structures, for example, rod Smith-Petersen , longitudinally of the blade and a pointed end and a Central channel for holding the guide spokes. Apply and other rods with diaphyseal plate and without it [2, 3, 8]. In patients with subcapital fracture resolves the head of the femur and therefore arthroplasty [1-5]. In connection with degenerative changes and osteoporosis in patients of elderly and senile ages used the rod of smaller diameter: round, flat, set of spokes, etc. the Most successful is the compression method of osteosynthesis in connection with the reduction of the period of regeneration, use spiral, corkscrew and other steel structures [1-7]. Gentle are the methods with the use of needles that are injected in the form of a beam, fan-shaped, cross, angle . Apply flat pointed nails  from 2 to 5 pieces indicated. They vkolachivaya outside, through the site of fracture in the femoral head.
The closest is the method  using a PLoS is their sharp-pointed nails, 3-6 pieces is driven outside-in parallel or cross.
The disadvantages are: the process of vkolachivaya accompanied by considerable destruction spongy tissue of the cervix in patients with degenerative-dystrophic changes and osteoporosis, often with damage to the cortical layer and the articular surfaces. These circumstances reduce the possibility of regeneration of bone tissue, especially in elderly patients. At various locations nails come of their displacement, near the greater trochanter meet additional fractures of the spongy substance. Nails are often squeezed out because of the smooth surface. Due to the lack of diaphyseal plates cases of comminuted fractures decreases the value of this method.
The aim of the present invention are: to create conditions for stable connection of the bones during the whole period of treatment, especially in patients with age-related changes of bone tissue with minimal trauma to the bone.
This goal is achieved by using developed and applied a number of patients of a set of structures and ways of osteosynthesis for fractures of the femoral neck.
The set of structures for holding osteosynthesis of fractures of the femoral neck consists of pointed nails, needles, diaphyseal plates, surupa is, the spokes are made wavy, curved, nails are made flat and telescopic, sharp end of a nail is made with a hook, telescopic nails done with lateral notches, growing in size outwards, the outer ends of the nails are bent outwards and fixed to the diaphyseal plate washer.
Type of fracture osteosynthesis of the femoral neck is the introduction of two metal nails and spokes, with two nails injected parallel to the outside through the base of the greater trochanter, neck, the location of the fracture and the head of the femur, and also that use the diaphyseal plate, telescopic nails implement through pre-prepared upper and lower subcortical channels, and wavy-curved spokes through the anterior and posterior subcortical channels, the outer ends of the nails and spokes bend over diaphyseal plate and fix with washers.
When the medial fractures of the telescopic nails are applied without diaphyseal plates. And in cases of severe osteoporosis, lateral and comminuted fractures applies diaphyseal plate. Before implantation of nails subcortical bore through channels outside, inside, above the neck, below, to prevent vertical displacement of the fragments, and to limit horizontal displacement of fragments also subcar talino was drilled channels closer to the front and rear surfaces of the cervix, these channels were introduced spokes 2 mm in diameter with wavy-curved structure. Their outer ends bent at right angles, so as not to injure the surrounding soft tissue. We offer flat pointed rod with a hook on the end near the base of the pointed part. These rods are the nails are resistant teeth, departing from different angles, increasing the value to the outside and nails telescopic, the case also has teeth on the edges. At the end of the thread for "washer-nut", after the introduction in subcortical channels telescopic nails, their ends bent down over the diaphyseal plate that screws to strengthen the outer surface of the greater trochanter. Enter the front and rear wavy-curved spokes, the ends of which are bent downward, then rotate the washer-nut and firmly strengthen telescopic nails and all the metalwork in General, providing stable osteosynthesis with elements of compression otioseness.
Figure 1 - General view of the telescopic nail. 1 - sharp end of a nail, 1 - hook, 2 - core part of the nail, 3 - resistant teeth growing size, 4 - piece telescopic nail, 5 - resistant teeth corps nail, 6 - outer curved end of a nail, 6A - screw-thread the outer end of the nail, 7 - creased part of the nail.
Figure 2 - Diaphyseal plate. 8 - hole for the top of the nail, 9 - open the e to the bottom of the nail, 10 - hole for wavy-curved spokes, 11a - holes for screws fixing the diaphyseal plate.
Figure 3 - Wavy-curved needle. 12 - wavy-ithuta part spokes, 18 - straight side of the spokes.
Figure 4 - Washer-nut". 14 - housing, 15 - hole to the outer end of the telescopic nail.
5 is a Cross-section of the femoral neck and topography of nails and needles: 16 - cortical layer of the femoral neck, 17 - spongy part of spongiosa, 18 - channel for top subcortical nail, 19 - channel for the lower subcortical nail, 20 - channels for wavy-curved spokes.
6 is Fasna the position of the stabilizing elements. 21 - cortical layer of the femoral head, 22 - cortical layer of the femoral neck, the 23 - position of the upper subcortical telescopic nails, 14 to the lower telescopic nail, 3-5 - resistant teeth, the 11 - diaphyseal plate, 11a - screws fixing the diaphyseal plate, 8-9 - curved ends of the telescopic nails, 7 - stop Playground bent outer end of the nail, 13 - wavy-curved spokes, 14 - washer-nut", between the outer curved end of the telescopic nail and diaphyseal plate.
Due to the presence of resistant chipping and hook in the head of the femur, sagnotti the outer end of the telescopic nail, diaphyseal plates and washers-nuts can create conditions of compression osteosynthesis, FPIC is bstwoe shorten fusion of fragments. Resistant notch telescopic keep nails from displacement, and the flexible connection between the nails and pads provides the functional integrity of structures, creates a stable osteosynthesis. Drilling tunnels for metal reduces the destructive properties of the osteosynthesis and flat telescopic nails and needles low-impact compared to driving 5-6 nails Knowles. Given the way multiactivities does not require expensive cost, it is simple and affordable. Multiple use in patients of elderly and senile age with reduction of treatment time speaks in favor of the proposed technique.
1. Anikin I. - Osteosynthesis and arthroplasty for fractures of the femoral neck. Vestn. traumatol. and orthopedist. 1997, No. 2, p.19-22.
2. Bogdanov FR Boychev b - Multi-volume guide of traumatology and orthopedics. M., "Midges", 1968, str.596-614.
3. Boychev B., Conforti B., Chekanov K. - Operative traumatology and Orthopaedics. Gosizdat, Sofia, "Medicine and physical fitness", 1961.
4. Kaplan AV - Closed injuries of bones and joints. M., 1967, 2nd edition.
5. Lirtzman AM, Zorya VI, Galecki SF - problems of treatment of fractures of the femoral neck at the turn of the century. Vestn. traumatol. and orthopedist., 1999, No. 2, p.12-19.
6. Malygina N.A. - Treatment vertaling fractures of the femur in patients who ogologo and elderly elastic nails. Abstract. Kida. Diss., M., 1971.
7. Shabanov A.N., Kai YU Atlas of the cervical and vertaling of hip fractures and their surgical treatment. M., 1966.
8. Knowles - city. on Lertzman et al., M., 1999.
1. The set of structures for holding osteosynthesis of fractures of the femoral neck, consisting of a pointed nails, needles, diaphyseal plates and screws, characterized in that the spokes are made wavy, curved, nails are made flat and telescopic, sharp end of a nail is made with a hook, telescopic nails done with lateral notches, growing in size outwards, the outer ends of the nails are bent outwards and fixed to the diaphyseal plate washer.
2. Type of fracture osteosynthesis of the femoral neck, which consists in the introduction of two metal nails and spokes, with two nails injected parallel to the outside through the base of the greater trochanter, neck, the location of the fracture and the head of the femur, wherein using the diaphyseal plate, telescopic nails implement through pre-prepared upper and lower subcortical channels, and wavy-curved spokes through the anterior and posterior subcortical channels, the outer ends of the nails and spokes bend over diaphyseal plate and fix with washers.
FIELD: medical engineering.
SUBSTANCE: device has fixing member as three screws having three members for supporting compression. The members are designed as spiral compression springs put on over the screws.
EFFECT: stable prolonged compression.
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: medical engineering.
SUBSTANCE: device has stainless steel plate curved at right angle and having slits along longitudinal axes of each plate side, guiding tube for conducting the guiding wire rigidly fixed along plate angle vertex and two sighting laths having slit-like cuts along longitudinal lath axes. Each of the laths is connected to one plate sides by means of coupling bolts and nuts allowing laths to move along the slit-like cuts in the plate sides. The plates are movable along slit-like cuts in the laths. Lath ends distant from the plate have guiding tubes arranged in one plane with the laths and vertically to longitudinal axes of the laths through which supporting nails pass fixable in tubes by means of transverse screws. The tubes are attached to lath ends by means of coupling bolts and nuts.
EFFECT: high accuracy in introducing guiding wire; rigid fixing condition in device-bone system.
FIELD: medical engineering.
SUBSTANCE: device has flexible elastic wire bent in two and having sharp tip rods arranged in parallel to each other. Rod ends shear planes are produced on internal surfaces facing each other at equal angles relative to rod axis. Angle between two bisecting lines drawn between cut plane and internal surface of each rod does not exceed maximum permissible wire divergence angle in bone.
EFFECT: enhanced effectiveness of surgical treatment; reduced risk of traumatic complications.
2 cl, 4 dwg
SUBSTANCE: method involves carrying out densitometric X-ray bone examination for determining quantitative parameters of bone tissue mineral density. Total bone mineral density being less than -1.5 SD, the endoprosthesis is fixed with bone cement. The bone tissue mineral density being lower than -1.5 SD, proximal femur or cotyloid cavity of the hip joint under examination are fixed with bone cement, respectively.
EFFECT: reduced risk of endoprosthesis instability.