Device for carrying out medial malleolus osteosynthesis in transverse fracture cases

FIELD: medical engineering.

SUBSTANCE: device has supraosseous part and intraosseous part parting at an angle of 90° and having rectangular rectilinear longitudinal segment having protrusion on both ends. The supraosseous part is longitudinal, narrow, 2 mm wide member having transverse protrusions modeled along the frontal boundary of the medial malleolus having holes for receiving fastening members. The intraosseous part protrusions are rounded and sharp along curvature arc.

EFFECT: improved functional results; improved fracture consolidation conditions.

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 internal fixation of ankle - screws perpendicular to the fracture plane of the inner ankle after a preliminary reduction (Muller M.E. Ter-Minassian, Allgower M., Schneider R., Villinger X. "Manual of internal fixation" 1996, str-611).

The disadvantages of this method are:

insufficient strength of fixation of the fragments of the inner ankle due to the specific structure of the distal metapelite tibia.

A known method of "hard loop on the Weber for fixing the inner ankle (Muller M.E. Ter-Minassian, Allgower M., Schneider R., Villinger X. "Manual of internal fixation", str-611). The method consists in the fixation of the fragment of the inner ankle after removal of interposition soft tissue, pre reposit and two spokes and creating mejregionalnoi compression by tightening the wire loop.

The disadvantages of this method are the following:

- the possibility of secondary displacement due to insufficient stability of the fixation of bone fragments;

the extensiveness of the damage to the soft tissue region of the inner ankle to hold osteosynthesis;

- possibility of migration of the spokes.

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 two intraosseous 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 technical result is to improve the functional results of treatment of patients with fractures of the inner ankle by creating conditions for the best consolidation is the fracture due to the strong fixation of fragments of the internal malleolus of the tibia with minimal intraoperative injury to the soft tissue region of the inner ankle and prevent displacement of fragments at an early load on the damaged the limb.

This result is achieved through a device for osteosynthesis of the inner ankle with transverse fractures, including osseous part and radiating at an angle of 90 degrees intraosseous portion having a rectangular longitudinal section with flanges on both ends. Bone fixing part is made of longitudinal, narrow, with a width of 2 mm, and provided with lateral projections, simulated on the front contour of the inner ankle, with holes for fasteners. The tabs intraosseous made rounded and pointed along the arc of curvature.

The novelty of the device is that:

bone fixing part is made of longitudinal, narrow, with a width of 2 mm, and provided with lateral projections, simulated on the front contour of the inner ankle, with holes for fasteners;

- ledges intraosseous made rounded and pointed along the arc of curvature.

The proposed form of plate part allows you to enter the mounting screws for additional fixation of the fragment of the inner ankle with a minimum size of plate parts, which allows the fixation of the inner ankle with minimal trauma to the soft tissue and to create conditions for better healing of postoperative wounds. The locking screws are in a different plane, which increases the reliability of the attachment is Oia.

Intraosseous portion has a rectangular longitudinal section with rounded protrusions on both sides. This configuration intraosseous allows you to create the optimal shape in which a rectangular longitudinal section serves as a reference area in the cortical plate of the inner ankle and is located in the fracture area, and rounded areas are separated from this zone and deeper into the bone, which increases the rigidity of fixation. Due to this form at the seat of fracture is a minimum of metal and won the area for germination bone tissue, which improves the consolidation of the fracture. The tabs are placed at a distance from the fracture and create a better contact with the spongy substance, prevent rotary displacement of fragments at an early load on the damaged limb.

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

A device for osteosynthesis of the inner ankle of the leg in the transverse fractures consists of intraosseous part 1 and bent at 90 degrees osseous part 2. Bone fixing part 2 is a longitudinal, narrow, with a width of 2 mm, and has lateral projections 3 with 4 holes for mounting elements, for example screws. Intraosseous part 1 has a rectangular longitudinal section with rounded protrusions 5 on both ends. The tabs sost is received by the arc of curvature.

The device is made of stainless steel, thickness 1 mm, width of plate parts 2 mm, from her depart transverse protrusions 3, separated from each other at a distance of 15 mm At the lugs with holes of circular shape with a diameter of 3 mm Screws injected into the bone fixing part for additional fixation of bone fragments. Intraosseous part 1 has a height of 3 mm, the height of the rounded protrusions 5-5 mm.

Osteosynthesis of the inner ankle of the leg in transverse fractures of the proposed device is as follows.

Linear cut length up to 5 cm on the inner surface of the ankle joint in the projection of the internal fracture of the ankle the skin is cut. If the wound is large subcutaneous vein, she stupidly stands out and is medially. The scalpel carefully allocated the place of fracture of the inner ankle, removed interponere soft tissue in fresh fractures and granulation tissue or scar tissue when stale and old fractures. Is the reposition of the fracture of the inner ankle (possible temporary fixation of the fragment spokes) with graduated compression at the seat of fracture. Simulated shape of the transverse projections 3 of plate portion 2 in accordance with the contour of the inner ankle. Oscillatory saw in proportion to the magnitude of the intraosseous part 1 is a linear channel, which introduces nutricote the part of the plate 1. Drill 2.5 mm created channels for mounting screws. Through openings in the transverse protrusions plate of the device are the mounting screws with a diameter of 3.5 mm And the direction of the holding screw is set so as to create compression to the fracture area, and screws passed through both the cortical layer of the inner ankle. Hemostasis is performed during the operation using thermocoagulation. After controlling for fixing the wound is sutured in layers. Aseptic bandage.

Clinical example

The patient Century, 20 years, was admitted to the Department of traumatology IFL (NCCOSC) Leninsk city-Kuznetsk on the occasion of a Closed fracture of the internal malleolus of the right ankle with offset 15.01.2002,

Trauma patient 07.01.2002, Treatment in an urban trauma center Leninsk city-Kuznetsk - conservative (gypsum langenau bandage). After consultations trauma clinic IFL (NCCOSC) the patient was referred for surgical treatment in the Department of traumatology IFL (NCCOSC).

The patient 17.01.2002 had surgery - open reposition, osteosynthesis of the internal malleolus of the right ankle of the proposed device. Under aseptic conditions after 2-fold treatment of an alcoholic solution of chlorhexidine under the harness in the middle third of the right femur linear incision on the inner surface of the right ankle with the rod layers revealed a lesion of the internal malleolus of the right ankle. The scalpel carefully cut thick periosteum of the tibia and granulation tissue lying in the place of fracture of the internal malleolus of the right ankle, and a location on the surface of the inner ankle to the plate of the device. Using the Elevator in position, bring the right foot made reposition of the fracture of the inner ankle. Oscillatory saw made linear channel to a depth of 3 mm Capcoa produced by the compression ratio at the seat of fracture. Formed in the linear channel of the inner ankle entered the device, which had autodelivery on the front contour of the inner ankle transverse ledges osseous part. A drill with a diameter of 2.5 mm in the inner ankle above and below the fracture in the direction close to the cross-shaped channels for mounting screws. Screwdriver into the channels entered the screws with a diameter of 3.5 mm, which was slightly greater than the length of the channels. Movement of the right foot checked the stability of the osteosynthesis - mobility at the site of fracture was not determined. Hemostasis during surgery using thermocoagulation. The wound is sutured in layers. Aseptic bandage.

The postoperative period was uneventful. Postoperative wound healed by first intention, the sutures were removed after 10 days. From the 3rd day after the operation started active movement in the ankle joint. PA is Ianto allowed to walk on crutches dosed with increasing load on the right foot by 7 days after surgery. Inpatient treatment for 10 days. Ambulatory monitoring was carried out at the casualty's office clinic IFL (NCCOSC). The patient was engaged in the development of active movements in the ankle joint. Range of motion in the ankle has recovered to 14 days. Walking with a full load on the right foot was initiated 14 days. The patient started to work again after 1 month. Radiographic control after 2 months revealed consolidation of the fracture of the internal malleolus of the right ankle. Removing was taken after 6 months (23.07.2002). Results were assessed after 1 year. The patient lived a full life without limitations. Pain in the right ankle didn't bother. Range of motion in the ankle joint is not limited compared to the left. On x-ray of the right ankle - consolidated fracture of the internal malleolus of the right ankle, signs of deforming arthrosis of the right ankle joint no.

Conclusion: the Use of a device for osteosynthesis of the inner ankle when its transverse fracture in a patient Century, 20 years has made it possible to produce a stable osteosynthesis of the ankle, to begin early development of motion in the affected joint, early loading of the right lower extremity, is ussite quality of life.

Thus, the proposed device for osteosynthesis of the inner ankle with transverse fractures can improve the functional results of the treatment. The device allows for stable fixation of a fracture of the inner ankle and early motion in the affected joint, and early load on the damaged limb to prevent secondary displacement of the fragment of the inner ankle.

Osteosynthesis of the inner ankle with transverse fractures of the proposed device was produced in the Department of traumatology of the Federal medical-preventive institution "Scientific-clinical center of health of miners" Leninsk city-Kuznetsk in 5 patients with transverse fractures of the inner ankle. In 100% of cases with good results.

A device for osteosynthesis of the inner ankle with transverse fractures, including osseous part and radiating at an angle of 90° intraosseous portion having a rectangular longitudinal section with flanges on both ends, characterized in that the plate portion is made of a longitudinal, narrow, with a width of 2 mm and provided with lateral projections, simulated on the front contour of the inner ankle with holes for fasteners, and the tabs intraosseous made rounded and pointed along the arc of curvature.



 

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