Method for external fixation at treating acromial clavicular dislocations

FIELD: medicine, orthopedics, traumatology.

SUBSTANCE: one needle with support area should be applied through acromial clavicular end in sagittal plane from the front backwards, another one - through acromial clavicular end, towards outwards against it, in counter direction, the third needle should be directed through acromial scapular process in sagittal plane in direction from the front backwards, the fourth one - parallel to the third needle, towards inside against it, in opposite direction, then needles should be fixed upon semicircular supports of Ilizarov's apparatus. After dislocation reposition semicircular supports should be rigidly connected to develop stable fixation and provide reliable fixation of acromial clavicular end in articular cavity of acromial scapular process in reset position that enables to conduct earlier functional therapy.

EFFECT: higher efficiency of external fixation.

6 dwg, 1 ex

 

The invention relates to medicine, namely to traumatology and orthopedics, and is designed to clamp acromiale end of the clavicle during breaks clavicle-acromiale articulation.

There is a method of treatment acromiale dislocations of the clavicle method external transosseous osteosynthesis with the use of the device to reposition and fixation acromiale end of the clavicle [2, 3]. This one spoke with thrust pad is held through acromegaly process of the scapula in the sagittal plane from front to back, the second spindle with thrust pad is held through acromegaly the end of the clavicle in the sagittal plane in the direction back to front. The sharp ends of the spokes attached to distraction, and the shank in a simple specification. The third needle passes through the coracoid process in the direction from front to back and from the inside outwards. Spokes are fixed in the original bracket. Reposition vivanativa end of the clavicle is accomplished by moving the spokes on the distraction specification special design.

The disadvantages of such a method of treatment of dislocation of the acromial end of the clavicle are:

- High risk of eruption single spokes with thrust pads made through the clavicle and the processes of the scapula, which occurs after tightening the spokes on the distraction specification, and later, after the beginning of the fu is clonally load on the operated limb. Prorezyvatsja spokes do not already have a control function that causes stiff enough and stable fixing the damaged segment of the device, as well as the trauma of bones and soft tissues of the shoulder girdle with the risk of development of local inflammatory complications.

- Carrying out one of the spokes through the coracoid process of the scapula there is a risk of damage to the neurovascular bundle located in proximity to the coracoid process of the scapula on the inner edge of m. coracobrahialis [4]. When conducting spokes, especially in people with a developed layer of subcutaneous fat, when it is difficult to use the coracoid process as an external reference point, may damage the neurovascular bundle at the deviation of the spokes from the intended direction. During the eruption of this spokes also may pressure her to the elements of the neurovascular bundle.

- For the implementation of repositions needed distraction specificatory special design, not included in the set of series-produced parts of the apparatus Gailizarov.

To address these shortcomings, we have proposed a method of treatment of dislocation of the acromial end of the clavicle with the use of external fixation device, picking from a standard set of parts of the apparatus Gailizarov. When picking apparatus as an external support uses two is lucernaria arc apparatus Gailizarov and distraction rods, but as osteofixation - four spokes with thrust pads. The spokes are held in anatomically and functionally safe areas of the shoulder girdle. First spoke with thrust pad is held through acromegaly the end of the clavicle in the sagittal plane in the direction from the rear to the front, the second is through acromegaly the end of the collarbone, outwards from a previously installed spokes, parallel to her head her direction. Through acromegaly process of the scapula are the third and fourth needles on the hard ground, parallel to the previously established. The third pin is held in the direction from front to back, the fourth - medially from the previously installed spokes, her in the opposite direction. Then the spokes are mounted in specification to the brackets and pairs are fixed in a semicircular bearings apparatus Gailizarov. By manipulating a semicircular pillar with spokes made through acromegaly the end of the clavicle, is the reduction of the dislocation. After reduction of the dislocation semicircular bearing rigidly connected to three of the distraction rods. The spokes are tightened, and produced the final stabilization of the device. If necessary, the compression ratio in the damage zone due to the convergence of the semicircular bearings for distraction connecting rods.

The General layout of the apparatus shown is a figure 1, where

1 - acromegaly the end of the clavicle;

2 - acromegaly process of the scapula;

3 - spoke with thrust pad, conducted through acromegaly the end of the clavicle in the sagittal plane in the direction from front to back;

4 - spoke with thrust pad, conducted through acromegaly the end of the clavicle in the sagittal plane in the direction from back;

5 - spoke with thrust pad, conducted through acromegaly process of the scapula in the sagittal plane in the direction from front to back;

6 - spoke with thrust pad, conducted through acromegaly process of the scapula in the sagittal plane in the direction from back;

7 - specificator;

8 - bracket;

9 is a semicircular bearing apparatus Gailizarov;

10 - distraction rod.

The method is as follows. Patient is placed on the operating table at the back, between the shoulder blades fit the roller. Under General intravenous anesthesia after processing the surgical field is carried out through acromegaly the end of the collarbone (hollow needle (3) with thrust pad in the sagittal plane in the direction from the rear to the front, a second pin (4) through acromegaly the end of the clavicle, parallel to the first spindle outwards from her head to her direction (front to back). Through acromegaly process of the scapula spend the third and fourth needles with thrust pads, PA is allele previously established. The third pin (5) is conducted in the direction from front to back, the fourth pin (6) is parallel to the third needle, medially from her head to her direction (back to front). Then the spokes are fixed in specification (7) to bracket (8) and pairwise fixed on a semicircular bearings apparatus Gailizarov (9). By manipulating a semicircular pillar with spokes made through acromegaly the end of the clavicle, carry out the reduction of the dislocation. After reduction of the dislocation semicircular bearings rigidly connect the three distraction rods (10). Spokes pull and make final stabilization of the device.

The period of immobilization is 6-8 weeks. If necessary, the convergence of the semicircular bearings for distraction connecting rods create dosed compression in the damage zone. While conducting functional treatment.

Use it to reposition and fixation of dislocation of the acromial end of the clavicle as osteofixation four spokes with persistent sites conducted through acromegaly the end of the clavicle and acromegaly process of the scapula, increases the rigidity and stability of fixation and reduces the risk of local inflammatory complications compared using three-spoke fixation. Holding the spokes in pairs through acromegaly the end of the clavicle and acromegaly process of the scapula reduces the risk of eruption of the JV is C under the action of the contact force loads due to the increase in the number of osteofixation, thereby increasing the rigidity of the structure.

By this way the spokes are held through acromegaly the end of the clavicle and acromegaly process of the scapula, which are clear, easily palpable external landmarks of the shoulder girdle, in the immediate vicinity are large neurovascular education [1].

Thus, the spokes are held in the neutral zone, which reduces intraoperative risk of damage to important anatomical structures and makes surgery safer.

When closed reduction of the clavicle is necessary to create conditions for a solid fixation of the clavicle in the joint socket acromiale process to better adapt the ends of the torn ligament and the most favorable course of reparative processes in the area of the damaged ligaments. Through the convergence of semicircular external supports for connecting the distraction rods is achieved convergence deponirovano acromiale end of the clavicle and glenoid acromiale process of the scapula and the creation of additional compression efforts in this area. It does not require special devices to reposition and fixation vivanativa acromiale end of the clavicle.

Example. Patient K., aged 26, was admitted to the Department of traumatology, on the fourth day after the Tr is WMI. The injury was accidental fall onto an outstretched left hand. At survey: deformation in the injured left shoulder girdle due to the protrusion acromiale end of the clavicle, tenderness to palpation of the left clavicle-acromiale articulation, positive symptom "keys"moderate limitation of movement in the left shoulder. The diagnosis of Rupture of the left acromiale-clavicle joint with complete dislocation acromiale end of the clavicle on the radiograph confirmed (figure 2, before treatment).

Operation: closed reduction of dislocation acromiale the end of the left clavicle fixing its compression-distraction apparatus". In the position of the patient on the back, with the platen between the shoulder blades, under General intravenous anesthesia after processing the surgical field conducted through acromegaly the end of the clavicle spoke with persistent space in the sagittal plane in the direction from the rear to the front, the second needle through acromegaly the end of the clavicle, parallel to the first spindle outwards from her head to her direction. Through acromegaly process of the scapula held the third and fourth needles on the hard ground, parallel to the previously established. The third needle held in the sagittal plane in the direction from front to back, the fourth is parallel to the third needle, medially from her head to her direction. The ZAT the spokes anchored in specification to the brackets and pairs recorded on the semicircular bearings apparatus Gailizarov. By manipulating a semicircular pillar with spokes made through acromegaly the end of the clavicle, carried out the reduction of the dislocation. After reduction of the dislocation semicircular bearing rigidly connected to three of the distraction rods. Then the spokes were tight and made final stabilization apparatus. Performed a control radiograph (figure 3, during the operation).

The postoperative period was uneventful, with no complications. In the postoperative period, the convergence of the semicircular bearings for distraction connecting rods were created dosed compression ratio in the damage zone. Had physiotherapy and physiotherapy. The General appearance of the patient in the treatment process is presented in figure 4. Throughout the period of fixation of the patient is actively used by the limb-side damage (figure 5, during treatment)

In 1.5 months after surgery carried out the dismantling of the apparatus. On the radiograph (6, after treatment) dislocation acromiale end of the clavicle is resolved.

Viewed through the year. No complaints. Anatomical and functional outcome is good. The function of the upper limb at the shoulder joint in full. She has been practicing.

The proposed method of external fixation in the treatment of dislocation of the acromial end of the clavicle allows you to:

- securely hold acromegaly the end of CL is city in deponirovano position, ensuring high rigidity and stability of fixation and, consequently, to eliminate the risk of relaksacii and local inflammatory complications;

- to improve the safety of surgical intervention, reducing the risk of damage to the neurovascular structures;

to create more compression in the injured clavicle-acromiale articulation for a more favorable course of reparative processes.

Sources of information:

1. Ostroverkhov, G. Operative surgery and topographic anatomy / Geistreiches, Hummas, Dinleyici. - Kursk. Moscow: JSC "Letter", 1996. - 720 S.

2. Urazgildeev R.Z. functional Stable osteosynthesis devices external fixation at dislocations and Pereloma-dislocation of the acromial end of the clavicle: author. dis... Kida. the honey. Sciences / Resursele; cyto them. You. - Moscow, 1997. - 19 S.

3. Urazgildeev R.Z. functional Stable osteosynthesis apparatus transosseous fixation at dislocations and Pereloma-dislocation of the acromial end of the clavicle / Resursele // Bulletin of traumatology and orthopedics named. You. - 1998. No. 4. - P.44-48.

4. Shovkunenko NR. A short course of operative surgery with topographic anatomy / Vnesheconom): Medgiz, 1947. - 567 S.

The method of external fixation in the treatment of acromiale dislocations of the clavicle, which is effected by externally what about the transosseous osteosynthesis, including in the sagittal plane of the spokes with thrust pad through acromegaly the end of the clavicle front and rear spokes with thrust pad through acromegaly process of the scapula in the direction from front to back, characterized in that additionally hold the needle with thrust pad through acromegaly the end of the collarbone, outwards from a previously installed head her direction, and hold the needle with thrust pad through acromegaly process of the scapula medially from the earlier set, her in the opposite direction, and the spokes are conducted in parallel to each other.



 

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