Y-shaped plate for osteosynthesis of epimetaphyseal fractures (variants)

FIELD: medicine, traumatology, orthopedics.

SUBSTANCE: the present innovation deals with metalloosteosynthesis of intra-articular and peri-articular fractures. According to the first variant, the suggested plate contains an osseous plate with openings and a fixing unit as a fork with teeth and foramens for a screw. Osseous part of teeth, branching fan-shapely, circles metaphysis and has a curvature at the angle of 180°. Submergible parts of teeth are parallel to each other. Teeth are designed to be round in cross-section. Teeth are being in a plane parallel to that of osseous plate. The length of submergible part of teeth knowingly exceeds the diameter of a semilunar fragment of patient's elbow bone. According to the second variant, the plate contains an osseous plate with openings and a fixing unit as a fork with teeth and foramens for a screw. Osseous part of teeth, branching fan-shapely, circles metaphysis. Submergible parts of teeth are parallel to each other. Teeth are designed to be round in cross-section. The distance between submergible parts of teeth is 1.5-2 times higher against the width of an osseous plate. According to the third variant, the plate contains an osseous plate with openings and a fixing unit as a fork with teeth and foramens for a screw. Perosseous part of teeth, branching fan-shapely, circles metaphysis, and submergible parts of teeth are being parallel to each other. Teeth are designed to be round in cross-section. The plate has a curvature according to the shape of condylar edge of patient's brachial bone. Osseous part of teeth is supplied with a crosspiece to provide the chance to be fixed up with screws.

EFFECT: higher efficiency of osteosynthesis.

3 cl, 4 dwg

 

The device relates to medical equipment, namely to traumatology and orthopedics, and is used in surgical treatment epimetaphyseal of fractures of the extremities.

Epimetaphyseal fractures are characterized by properties that hinder the osteosynthesis. This is a small length of the spongy fragment, often comminuted nature of the fracture with the fragmentation of the articular surface, background osteoporosis and susceptibility to the development of contractures requiring early active motion, which can destroy metallocene connection. If the fracture does not contain intermediate fragments, and spongy bone of the epiphysis is not affected by osteoporosis, the problem can be solved by the application of known structures system AO-ASIF and analogues in which the epiphyseal fragment can be fixed bone screws to the extended part of the plate under the condition of axial compression. In practice, such situations are quite rare and is not characteristic for traumatic fractures, but rather for osteotomies. To provide a more secure fit can visit the famous plate (L-shaped, angular and analogues) with one blade that score in the epiphysis. But they are available, usually on the thigh, in which the shape and size of fragments epiphysis allow you to embed them in the massive blade. The presence of the small intermediate fragments can cause them to offset the tion when driving blade. On the other epiphyseal localizations of the plate with the blade to apply it is difficult because of the small size of the fragments of the epiphysis. In addition, the l-shaped plate tougher receiving the blade spongy bone epiphysis, including due to osteoporosis in bones affected by chronic pathology (in the case of osteotomy), which contributes to loosening, loss of fixation and necromania.

Previously developed two devices, allowing to reconcile reliable monoblock blade with comminuted nature of the fracture and low stiffness epiphyseal spongy bone. They contain a plate with holes and a fixing unit, which consists of fine teeth, extramedullary portion of which is fan-shaped spreading around metafit, and the immersed part of teeth parallel to each other. The blade is divided into several teeth, was similar to the plug and consequently its hardness decreased so that the fork node is the commit practically ceased to destroy spongy bone and was able to sew a few small fragments separately. It is: "a Device for osteosynthesis of the condyles of the tibia", patent RU 2031635 selected as analog and a Device for osteosynthesis of fractures of the proximal humerus", patent RU 2143862, selected as a prototype.

The drawbacks Ana is God - patent RU 2031635 are: 1. the faceted shape of teeth (teeth are rectangular in cross-section, see Figure 2 description) and 2. the stiffness of the T-shaped executed plot, corresponding to the slope of the metaphysis, which determines the constancy of the shape of the clamping node embodied in the idea of the device.

The first (rectangular cross-section of the teeth) has led in some cases to damage to the bone fragments when installing the unit (splitting and repulsion small fragments of the articular surface), or to tear the fractured cortical plate when removing the fork blade upon fitting of the clamp during the operation.

The second (rigidity) hindered its modeling, required due to individual differences of the surface shape of the condyles. In the result of the strict enforcement of the clamping node modeling device could take up to 30 minutes operating time and required considerable physical effort and special equipment.

The disadvantage of this device-prototype - patent RU 2143862 remains faceted shape of teeth (teeth are rectangular in cross-section, smpeg descriptions). The disadvantage inherent in the design of analog (excessive rigidity associated with the execution of the latch node), was passed, which simplified the operation at the stage of fitting. Still rectangular cross-sectional shape of teeth remained n is izmennoy. This led sometimes to the fact that in all the channels left over from drilling in the humeral head, with the introduction of blade was uneven jamming of the teeth of rectangular cross-section (one of the prongs were met with more resistance than the other)that with the further power zakolachivanii has led to distortion of the device and the deviation of the wave from channel violation install fork blade, angular deformity and stuck in the bone. This required a rearrangement of the blade (waste of time!), and when extracting (jamming demanded knock out with a hammer) had fractures of the adjacent cortical plate.

The technical result of the present invention is to reduce the trauma of the epiphyses when installing the latch node and increase reliability megaloschemoi commit when epimetaphyseal fractures of different localizations.

The invention according to variant I is that the clevis plate for osteosynthesis epimetaphyseal fractures contains extramedullary plate with holes and fixing the site in the form of a fork with prongs and holes screw, while the osseous part of the teeth, fan-shaped spreading around metafit, and the immersed part of teeth parallel to each other, and the teeth are made in the cross-section is round, and the plate part has a bending at 180°memory which hospitals are in the plane parallel to the plane of plate plate, and the length of the immersed part of teeth, obviously exceeds the diameter of the semilunar cutting the ulna

The invention according to variant II is that the clevis plate for osteosynthesis epimetaphyseal fractures contains extramedullary plate with holes and fixing the site in the form of a fork with prongs and otvetami screw, while the osseous part of the teeth, fan-shaped spreading around metafit, and the immersed part of teeth parallel to each other, and the teeth are made in the cross-section of the circular, and the distance between the immersed parts of the teeth 1.5-2 times the width of the extramedullary plate.

The invention according to variant III is that the clevis plate for osteosynthesis epimetaphyseal fractures contains extramedullary plate with holes and fixing the site in the form of a fork with prongs and holes screw, while the osseous part of the teeth, fan-shaped spreading around metafit, and the immersed part of teeth parallel to each other, and the teeth are made in cross-section round, record includes bending the shape of the edge of the condyle of the humerus, and the osseous part of the teeth is equipped with a jumper for the fixing screws.

The illustrations depict:

Figure 1. The clevis plate (for option I - for proximal epimetaphyseal octavos bone) fractured, exciting articular surfaces of the elbow bones and the proximal metafit;

Figure 2. The clevis plate (for option II for epimetaphyseal femur) at its proximal epimerase;

Figure 3. The clevis plate (for option II for epimetaphyseal femur) at its distal epimerase;

Figure 4. The clevis plate (option III for distal epimetaphyseal humerus) comminuted fracture of both condyles and the block.

The device (Fig.1-2) consists of the extramedullary plate 1 with 2 holes. In the part corresponding to epimerase, from her depart teeth 3, forming a clevis retainer node ("fork") 4. In the clevis locking retainer Assembly also includes 1-2 2 holes at the base plate parts 5 teeth. They (osseous part 5 teeth) curved curved longitudinal relief epimetaphyseal and fan-shaped diverge at an angle 0-40°, gradually turning into immersed part 6 teeth. The immersed part 6 teeth parallel to each other and lie in planes defined by the locations of fractures, devices which differ from each other in size, curved plate parts of teeth 5 and their orientation (depending on the anatomy of the relevant epimerase). For osteosynthesis of the proximal ulnar epiphysis bone bending plate 5 parts of teeth 180°the teeth are in the plane p is parallel to the plane of the plate, and the length of the immersed part of teeth 6 obviously exceeds the diameter of the semilunar notch.

Bone epiphyses of the femur (Figure 2-3) the device contains the plug 4, in which the distance 8 between the immersed parts of the teeth 6 in 1.5-2 times greater than the width of plate plate 1.

For osteosynthesis of the distal epiphysis of the humerus, the device includes a bending plate 9 plate 1 to form the edge of the condyle shoulder (defining right and left of the device), and osseous part 5 teeth provided with a crosspiece 10 for fixing screws 11 (Figure 4).

The device is used as follows. After the implementation of surgical access and reposition of fragments with time fixing their spokes or customerhelp teeth 6 are oriented in the direction of the upcoming introduction and teeth are drilled in the epiphysis two parallel channel. Channels manual type "plug" 4. Upon detection of trends to incomplete fit any of the osseous parts 5 "fork" 4 as a manual remove and turn in tools, then enter again and dokladivayut with a hammer to snug. The epiphysis, is securely fixed to the clevis plate, is fixed to the diaphysis through the holes 2 in the plate 1 according to the rules of plate osteosynthesis using if necessary compression.

When the osteosynthesis of fractures of the proximal EP is the physical and elbow bones the length of the immersed part of teeth 6 allows you to hold the latter in the subchondral layer under a Crescent cut through both pieces (and, if necessary, through all intermediate) and block most functionally significant layer even when dissecting the fractures, and then create both axial and counter compression between the plate and submerged parts of the arrows shown in Fig.6).

During the development of techniques you can use conductors, which in comminuted fractures of the articular surface of the femur is required.

On the medial condyles of the humerus to increase the reliability of the fork-fixing also allows for the introduction of the screw 11 in the fragments condyle between the osseous parts of teeth 5 proximal jumper 10.

Upon reaching the internal fixation of the wound sutured with active drainage. Immobilization in the postoperative period is defined pain syndrome (first three days) or concomitant soft tissue injuries (e.g., suture the meniscus or ligament of the knee joint or concomitant fracture dislocation are exceptions, requiring a private, not associated with fracture and fixation external immobilization). Reliability fork fixing epimetaphyseal fractures in all considered cases sufficient for active movements that begin until the sutures are removed.

The device allows you to:

- to increase reliability megaloschemoi commit when epimetaphyseal fractures of different localizations, including when and intra-articular comminuted;

- to ensure the effect of the lines of elastic compression (as in the prototype) at different locations;

to increase the reliability metallolomnogo connection by reducing trauma spongy bone epiphyses and more snug in her forked clamping node;

- to facilitate and accelerate vnutripopulyatsionnoe fitting retainers to complex individual anatomy epimetaphyseal.

1. Plate for osteosynthesis epimetaphyseal fractures containing plate plate with holes and fixing the site in the form of a fork with prongs and holes screw, while the osseous part of the teeth, fan-shaped spreading around metafit, and the immersed part of teeth parallel to each other, characterized in that the teeth are made in the cross-section is round, and the plate part has a bending at 180°the teeth are in a plane parallel to the plane of plate plate, and the length of the immersed part of teeth, obviously exceeds the diameter of the semilunar cutting the ulna

2. Plate for osteosynthesis epimetaphyseal fractures containing plate plate with holes and fixing the site in the form of a fork with prongs and holes for the screw, while the osseous part of the teeth, fan-shaped spreading around metafit, and the immersed part of teeth parallel to each other, characterized in that the teeth are made in the cross-section of the circular, and the distance between the immersed parts of the teeth 1.5-2 times higher than the Irina extramedullary plate.

3. Plate for osteosynthesis epimetaphyseal fractures containing plate plate with holes and fixing the site in the form of a fork with prongs and holes for the screw, while the osseous part of the teeth, fan-shaped spreading around metafit, and the immersed part of teeth parallel to each other, characterized in that the teeth are made in cross-section round, record includes bending the shape of the edge of the condyle of the humerus, and the osseous part of the teeth is equipped with a jumper for the fixing screws.



 

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