Method of conservative treatment of shin bone fractures

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to orthopaedics and traumatology. A wire is delivered through a heel bone. It is used for skeletal traction to remove lengthwise bone fragment dislocation. Then two supplementary wires are delivered in a frontal plane: in a distal tibial epimetaphys and in a proximal tibial epimetaphys. The supplementary wires are fixed in supports of a derotation device from two rings of a standard Ilizarov's osteosynthesis kit. The rings are coupled by three telescopic rods. The fracture is reduced. Edgewise dislocation of the bone fragments is removed, and the bone fragments are rotationally dislocated. The telescopic rods are fixed in the achieved position. The skeletal traction wire is removed from the heel bone. The X-ray control follows. A plaster bandage is applied on a shin with covering knee and ankle joints. After the plaster bandage is dried, the derotation device is removed.

EFFECT: method provides tibial and fibular fragment union in an anatomically correct position and reduced length of hospital treatment.

2 cl, 1 ex, 6 dwg

 

The invention relates to medicine, namely to orthopedics and traumatology, in particular to methods used in the treatment of fractures of the tibia are not surgically.

Known method of reduction of fractures of the tibia in spicion the distractor, consisting of parts of a standard multi-purpose set for osteosynthesis by Ilizarov (half rings, rings, telescopic rods), followed (after reaching a satisfactory position bone fragments) introduction for fixation of a fracture intramedullary titanium rod. After the introduction of the intramedullary rod spiceboy distractor deleted (Shuttles A.N., Bukreev D.A. closed Stephanie when metadataserver fractures of the tibia - based solution techniques transosseous osteosynthesis. Modern methods of treatment of patients with injuries and their complications. Materials of scientific-practical conference. The mound. - 2006. - S-414).

However, this method is traumatic, associated with the introduction into the bone canal massive foreign metal implant, long-term presence in which the bone may lead to the development of inflammatory reactions, purulent process and osteomyelitis.

There is a method of external fixation of fractures, namely, that before the bandage in place of its application to the anatomical bone vystupav proximal and distal portions of the damaged segment of the leg by repositioning apparatus eliminate edema, creating a positive pressure repairosome plates of 0.6-1.4 kg/cm2on the square of 0.2-0.6 cm2from the area of edema within 4-6 minutes, then the limb is removed from the apparatus, the lower leg and foot impose a plaster cast "boot" and again placed in the apparatus, which provide pressure on the solidifying bandage, trying to reposition and fixation of bone fragments, removal of subluxations of the foot hardened bandage (U.S. Pat. No. 2119309 EN. Publ. 27.09.1998).

However, in the known method the imposition of a plaster bandage is carried out after the removal of external device, which may lead to renewed displacement of the fragments, as in the time of removing the limbs from the apparatus fracture is not recorded.

A device for the treatment of intra-articular and extra-articular fractures in which the damaged limb is fixed in the first and second nodes pinning (2) and (3). Depending on the specific type of fracture choose the required number repairbuy nodes (4). Each of repairbuy nodes (4) mounted on the base (1) so that one of its invoices plates (19) or (33) was at the level of damage. With the help of the screw rod (20) or (32) cover plate (19) or (33) is moved toward the leg up until the loose end of the long fragment does not stand on its anatomical location. To prevent displacement of this is th end of the bone fragment in the opposite direction from the back side of the damaged segment can fit another plate (19) or (33) (U.S. Pat. No. 2111730 EN. Publ. 27.05.1998).

However, the known device is intended to reposition the bone fragments and does not provide further reliable fixation of the fragments in otremontirovannaj position with the imposition of plaster bandages.

There is a method of treatment of injuries in the ankle joint, which under anesthesia are reposition of fragments ankles. Impose on the segment Shin-foot longato-circular bandage "boot", leaving free from immobilization of the fingers of the foot and the knee. The bandage is gradually shortened to the level of the ankle joint, leaving the joints of the foot for functional movements during treatment and prevention and stiffness (U.S. Pat. No. 2104677 EN. Publ. 20.02.1998).

However, the known method allows you to avoid stiffness of the joints of the foot, but it is not intended to reposition the fracture and eliminate bias fragments by length using skeletal traction and displacement of the fracture width and rotational displacements using external devices to achieve high-quality reposition and to shorten the patient's treatment in hospital.

The present invention is to achieve an anatomically correct relationship of the position of the tibia bone fragments using skeletal traction, derotation the CSOs device and plaster of Paris to reduce the duration of treatment of a patient in the hospital.

The task is as follows, in the way of conservative treatment of fractures of the tibia, including the reduction of the Shin bone and dressing, hold the needle through the calcaneus, carried out with the help of her skeletal traction to correct the displacement of bone fragments by length, then in the frontal plane spend two extra spokes in the distal epinettes of the tibia and the proximal epinettes the tibia, after which additional spokes fixed in supports derotation device of the two rings standard set for osteosynthesis by Ilizarov and connect the three telescopic rods, then produce the reposition of the fracture, eliminate the displacement of bone fragments width and rotational displacement of bone fragments, after which the telescopic rods fixed in the position reached, remove the needle from the calcaneus, perform radiological control, put a plaster cast on the leg with the capture of the knee and ankle joints, after drying plaster bandages derotation device disassemble and remove the two extra spokes.

It is advisable to eliminate swelling in the foot plaster bandage partially cut.

The present invention explaining a detailed description of a specific example of the process with links to copies of the x-ray and photo tibia of the patient before and after the reposition of the fracture, where:

figure 1 represents copies of radiographs of the bones of the lower leg of the patient A., aged 39, in frontal and lateral projections with fracture of the distal metadiaphysis left tibia and lower third of the left fibula at admission to the clinic;

figure 2 represents copies of radiographs of the bones of the lower leg of the patient A., aged 39, in frontal and lateral projections with fracture of the distal metadiaphysis left tibia and lower third of the left fibula on skeletal traction heel bone;

figure 3 represents copies of radiographs of the bones of the lower leg of the patient A., aged 39, in frontal and lateral projections with fracture of the distal metadiaphysis left tibia and lower third of the left fibula after reposition in denotational device with a plaster cast;

figure 4 is a copy with pictures tibia of the patient A., aged 39, fixed in a cast after reposition in denotational device by means of additional spokes;

figure 5 represents copies of radiographs of the bones of the lower leg of the patient A., aged 39, in frontal and lateral projections with fracture of the distal metadiaphysis left tibia and igna third of the left fibula in a cast after dismantling derotation device and remove additional spokes;

6 represents copies of radiographs of the bones of the lower leg of the patient A., aged 39, in frontal and lateral projections after removal of plaster and coalescence fracture distal metadiaphysis left tibia and lower third of the left fibula (2.5 months after injury).

The method of treatment of closed fractures of the tibia is as follows.

Upon admission of the patient to the clinic with a closed fracture of the tibia and the refusal of the patient from the surgical treatment with the use of metallicities or with contraindications to surgical treatment methods provide traction for a spindle carried out through the heel bone. On the traction eliminate the displacement of bone fragments of tibia length. Then in the frontal plane spend two extra spokes in the distal epinettes of the tibia and the proximal epinettes of the tibia. Extra spokes fixed in denotational device skompanovano of the rings of the Ilizarov apparatus is large in size or similar apparatus. Mount derotation device of the two rings, which are connected with three telescopic rods. When non-fixed position of the rods produce a reposition of the fracture, eliminate the offset of tiles for the width and eliminate rotational displacement of the fragments. After e is wow telescopic rods fixed in the position reached. The spoke for skeletal traction from heel bone removed. Then carry out a radiological control. When a satisfactory position of the fragments of the tibial and fibular bones inside derotation device on the limb is put into a plaster cast that captures the tibia with the capture of the knee and ankle joints. After drying plaster bandages derotation device will be dismantled and removed the extra spokes.

The patient in 2-3 days watching the medical staff. Allowed to walk with two crutches with partial load on the injured limb. With the appearance of swelling in the foot plaster bandage partially cut through. In the absence of edema in the foot of the patient will be discharged for outpatient treatment. After 1.5-2.5 months on the achievement of fusion of the fragments of the bones of the lower leg plaster cast is removed.

If you experience swelling of the foot plaster bandage partially dissected to remove.

Clinical example of the complete method.

Patient A., 39 years old, came into the hospital cgcb No. 24; Ekaterinburg 17.05.2010 with a closed fracture of the distal metadiaphysis left tibia and fracture of the lower third of the left fibula (Figure 1). From surgical treatment of the fracture, the patient refused. On admission to the trauma Department №1 n the proposed skeletal traction for the heel bone, which helped to eliminate the shortening in length (Figure 2). On the next day after receipt in the frontal plane had two extra spokes in the distal epinettes of the tibia and the proximal epinettes of the tibia. I put derotation unit (DRU) of the two-ring Ilizarov frame on the left Shin. Through the OTHER made a final reduction of the fracture, and it has eliminated the offset of tiles for the width and rotational displacement. He removed the needle from the heel bone for skeletal traction. After achieving a satisfactory position of the fragments, confirmed radiographically, the limb was fixed circular plaster cast to the upper third of the thigh. Shin before drying plaster bandages remained fixed in denotational device (Figure 3, Figure 4). After drying plaster derotation the device is dismantled, extra spokes removed (Figure 5). On the third day after admission to hospital the patient was allowed to walk with crutches, with a partial load on the injured limb. Swelling of the feet was missing. On the 4th day after reposition and fixation of the fracture, the patient was discharged to outpatient treatment. After 2.5 months at the control examination plaster cast was removed. Data radiography was diagnosed with consolidation of the fracture (Fig).

The end result is regarded as good, the function of the limb is restored, the patient is satisfied with the treatment, complications were not observed.

The proposed method of conservative treatment of fractures of the Shin bone is a safe and economical, allows to achieve satisfactory reposition and fixation of bone fragments, to achieve anatomically correct relationship of the position of the tibia bone fragments using skeletal traction, derotation device and plaster bandages.

Rehabilitation of patients treated by this method occurs in the home, which contributes to a complete social adaptation of patients and allows you to restore health in a short time. In addition, you can reduce the duration of treatment of a patient in the hospital.

The method is used in the Central city clinical hospital №24 the city of Yekaterinburg.

1. Method of conservative treatment of fractures of the tibia, including reposition the bones of the leg and the bandage, wherein the conducting pin through the calcaneus, carried out with the help of her skeletal traction to correct the displacement of bone fragments by length, then in the frontal plane spend two extra spokes in the distal epinettes of the tibia and the proximal Epimetheus bolshevize the Oh bones, then extra spokes fixed in supports derotation device of the two rings standard set for osteosynthesis by Ilizarov and connect the three telescopic rods, then produce the reposition of the fracture, eliminate the displacement of bone fragments in width and rotational displacement of bone fragments, after which the telescopic rods fixed in the position reached, remove the needle from the calcaneus, perform radiological control, put a plaster cast on the leg with the capture of the knee and ankle joints, after drying plaster bandages derotation device disassemble and remove the two extra spokes.

2. The method according to claim 1, characterized in that the plaster bandage partially cut through.



 

Same patents:

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely traumatology and orthopaedics. A compression rod apparatus for long bone reduction comprises threaded bearing rods with a threaded portion longitudinally movable with the use of axial movement screw nuts of a tube body with distal and proximal axial deflection assemblies arranged on the body in mutually perpendicular cavities with transosseous rod holders and transosseous rods fixed therein. The apparatus additionally has a spacer ring 1 with proximal 2 and distal 3 hinged joints arranged on both end thereof. The proximal hinged joint 2 is fixed with the use of an O-ring groove 4 and a retaining screw 5 on the proximal end 1-P of the spacer ring 1 with the proximal hinged joint 2 rotating about an axis of the spacer ring 1. The distal hinged joint 3 is arranged on a distal smooth end 1-D of the spacer ring 1 with the distal hinged joint 3 rotating about the spacer ring 1 and movable along the spacer ring 1 and further rigid fixation thereon in a required position with the use of a clamping bolted assembly with a screw 6. The proximal hinged joint 2 and the distal hinged joint 3 are identical and consisting of a body 9 and a loop 10 coupled by a connecting axis 7 with a collar 8. The body 9 is rigidly fixed on a short end 7A of the connecting axis 7 with the use of a pin 11, while the pin 10 is arranged on the other end of the connecting axis 7 rotating and rigidly fixed in the required position with the use of the clamping bolted assembly with the screw 6. Each body 9 has a hole 12 for placing and further rigid fixation in the required position with the use of the clamping bolted assembly with the screw 6 of the proximal threaded bearing rod 13 or the distal threaded bearing rod 14, as well as a hole 15 perpendicular to the hole 12 for placing a short end 7A of the connecting axis 7 of the proximal hinged joint 2 or the distal hinged joint 3. Each loop 10 has a hole 16 for placing and further rigid fixation in the required position with the use of the clamping bolted assembly with the screw 6 of the proximal end 1-P or the distal end 1-D of the spacer ring 1. An axis of the hole 16 is perpendicular to an axis connecting the axis 7 of the hinged joint, as well as there is a hole 30 for placing and further rigid fixation in the required position with the use of the clamping bolted assembly with the screw 6 of the other end of the connecting axis 7. The tube body 17 of the distal threaded bearing rod 13 or the proximal threaded bearing rod 14 comprises small holders 18 of transosseous rods 19 and extensions 20 with placed grasping forceps 21 of the transosseous rod 19. The grasping forceps 21 are movable along the extension rod 20 and further fixation in the required position with the use of the clamping bolted assembly with the screw 6. The transosseous rods 19 are placed in the small holder 18 and the grasping forceps 21 by a second hole 22 a diameter of which matches with an external diameter of the transosseous rod 19, the axis of which are perpendicular to the axis of the tube body 17. The transosseous rods 19 are placed in the hole 22 movable and rigidly fixed in the small holder body 18 and the grasping forceps 21 with the use of screw nuts 23. The second hole 22 is created from one side from the basic hole 27 of the small holder 18. On the opposite side of the small holder 18 there is an opening slot of the clamping bolted assembly with the screw 6. The holder body of the grasping forceps 21 comprises a hole 28 a diameter of which matches with an external diameter of the tube body 17. The tube body 17 of the proximal threaded bearing rod 13 and the distal threaded bearing rod 14 comprises an additionally arranged stop ring 24 of rigid fixation in the pre-set position of a slide tube 17 on the threaded bearing rod 13 or 14 with the use of a lock bolt 26 through a hole 30 in the tube body 17 after pre-set movement of the tube body 17 along the proximal threaded bearing rod 13 and the distal threaded bearing rod 14 with the use of screw nuts 29 of axial movement of the tube body 17. A wall of the stop ring 24 has various walls and comprises a threaded hole 25 for placing a lock bolt 26 thereon and fixation in the pre-set position of the slide tube 17 on the proximal threaded bearing rod 13 and the distal threaded bearing rod 14. The invention provides osteosynthesis of all types of long bones, one-stage bone reduction and bone fragment reduction preceded by application of a structure in a stabilising mode.

EFFECT: invention provides osteosynthesis of all types of long bones with the use of three-dimensional alignment of the rod apparatus, one-stage bone reduction, elimination of all types of remote bone reduction, use for a short bone fragment of patient's extremity, bone fragment reduction preceded by application of the structure in the stabilising mode.

7 cl, 24 dwg

FIELD: medicine.

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4 dwg

FIELD: medicine.

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1 ex, 16 dwg, 1 tbl

FIELD: medicine.

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2 cl, 1 ex, 1 dwg

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1 dwg

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3 dwg

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EFFECT: enhanced effectiveness of treatment; accelerated treatment course.

9 cl, 25 dwg

FIELD: medicine; medical engineering.

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EFFECT: enhanced effectiveness of treatment; reduced risk of traumatic complications.

5 cl, 10 dwg

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EFFECT: avoided bone deformities.

9 dwg

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EFFECT: enhanced effectiveness of distraction and reduction of bone fragments.

6 dwg

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EFFECT: enhanced effectiveness of combined treatment.

5 cl, 3 dwg

FIELD: medicine; orthopedics.

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EFFECT: widened reposition properties; improved reliability of locking; adjusted rigidity of carcass.

2 cl, 6 dwg

FIELD: medical engineering.

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EFFECT: high accuracy and reliability of loading data; high accuracy of bone fragment reposition and recovery.

2 dwg

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SUBSTANCE: apparatus has para-articulation rings equipped with wires and connected through telescopic bars. Apparatus consists of standard set parts of Ilizarov' apparatus and is equipped with para-fracture outer support with wires for additional designing of apparatus, said support including semi-ring connected with plates and threaded bar by means of bolts, nuts and brackets so as to define closed circle. Outer support is secured by means of threaded bars and nuts to plates preliminarily set on telescopic bars. Perimeter of para-fracture outer support is adjusted in accordance with perimeter of cross section of shin, at the level of positioning the support.

EFFECT: increased efficiency and reduced time of treating patient with shin fracture.

6 dwg 1 ex

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7 dwg

FIELD: surgical instruments used in orthopedics and traumatology, in particular, for open setting of displaced cervical vertebrae of spine.

SUBSTANCE: apparatus has spring-loaded branches connected with one another through pivotal lock with shaft and mating opening. Arms and working jaws are provided on branches. One of working jaws is equipped with adjustment retainer provided on first outer supporting surface and other working jaw has pusher adapted for cooperation with displaced vertebral body and disposed on second outer supporting surface. Opening mating with said shaft is made in the form of guiding slot oriented at an angle to plane where working jaws adjoin one another. Length and angle of inclination of guiding slot correspond to maximal height of lift of vertebral body of joint having maximal size. Pusher for cooperation with displaced vertebral body is made in the form of step. Branches are loaded by means of spring formed as branch shifting means which are provided with angular bend for preliminary passage of branches before deformation of spring. Apparatus of such construction ensures injure-free setting of displaced vertebra by one hand for minimal time.

EFFECT: simplified construction, provision for trauma-free cooperation of instruments with vertebral body, convenient use and reduced time for performing setting of displaced vertebra body.

5 cl, 7 dwg

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