RU2063185C1 - Method for performing phalangization of adactylous hand - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves applying external fixation apparatus to hand and forearm and move second metacarpal bone fragments to the distal end of the first and third metacarpal bones using distraction method to enable the first and third radii to be elongated, interdigital space to be formed without the muscle driving the first finger being injured and to enable gripping function with adactylous hand. EFFECT: enhanced effectiveness of reconstructive operation.

Description

 The invention relates to medicine, namely to orthopedics and reconstructive surgery of the hand.

 A known method of treating adactyly of the first, second fingers by moving part of the second metacarpal bone on the stump of the first finger with the formation of the metacarpophalangeal joint (1). However, this method involves the mandatory safety of 3 fingers.

 The closest in its technical solution is the method of metacarpal phalanxis with a fingered brush (2), which consists in removing the second metacarpal, trapezoid and distal heads of the third metacarpal bone in combination with skin grafting. However, the authors apply this method with intact metacarpophalangeal joints on the first and fourth rays.

 The invention consists in a combination of essential features that ensure the achievement of the desired technical result. Significant signs are that prior to metacarpal phalanxis, transverse osteotomy of the second metacarpal bone is performed in the middle section and at the level of the proximal epimetaphysis, spokes are inserted through the proximal base and the osteotomy plane of the distal fragments along the axis of the fragments in the direction of their movement, distraction is performed with distal installation fragment on the third metacarpal bone, and proximal on the first metacarpal bone, upon completion of distraction, the displaced fragments fix the spokes E to the metacarpal bones.

 Thus, the above essential features that distinguish this method from the known ones, allow you to lengthen the first and third rays, to form the interdigital gap without damaging the muscle leading to the first finger, which provides coverage with fingertips.

 The method is as follows.

 Under intravenous anesthesia, a G.A. apparatus is placed on the wrist and n / a of the forearm Ilizarova. The base support on two intersecting needles is placed in the upper arm of the forearm, the distal support, also on two intersecting needles at the level of the wrist bones. From the incision in the projection of the second metacarpal bone, an osteotomy is performed in the middle section and at the level of the proximal epimetaphysis. Through the fragments in the distal direction, knitting needles are carried with divergence to the elbow side for the distal and to the radial side for the proximal fragment. Stitches to the skin. Aseptic dressings.

 On the distal base support, brackets with holes in the projection of the first and third rays are mounted on threaded rods. In the holes of the brackets are placed, with the possibility of distraction, threaded rods at the ends of which fix the spokes with stops.

 Distraction begins on 2 3 days after surgery at a rate of 2 mm / day, then, when the bone fragment approaches the skin, distraction is slowed down to 0.75 1 mm per day.

 Distraction is completed when the proximal edge of the proximal fragment reaches the level of the distal end of the first metacarpal bone, and the proximal edge of the distal fragment reaches the level of the distal end of the third metacarpal.

 Then, the second stage of the operation is performed, in which the apparatus is dismantled. Displaced fragments are fixed with axial knitting needles. An interdigital gap is formed, while the remainder of the second metacarpal bone and trapezoid bone are removed. Stitches to the skin. Aseptic dressings.

 Clinical example. B. A. 25 years old, source.ball. M2348, was diagnosed with frostbite of the fingers of both hands. Attempts to transplant fingers from the foot to the hand using the microsurgical technique were unsuccessful. On September 18, 90, the external fixation apparatus was superimposed; the basic supports were placed on two crossed needles in the region of the lower third of the forearm and metacarpal bones. Out of two small incisions, a transverse osteotomy of the second metacarpal bone was made in the middle section and at the level of the proximal epimetaphysis. Through the base of the proximal and the osteotomy plane of the distal fragments, spokes were drawn with stops along the axis of the fragments with some divergence. On day 2 after surgery, distraction was started at a rate of 2 mm per day, then after 8 days, the distraction was slowed down to 1 mm per day. The necessary correction has been reached. 11/14/90, the second stage of the operation was performed, the displaced fragments are fixed with needles to the 1st and 3rd metacarpal bones. 1 year after the treatment, the grip is satisfactory.

Claims (1)

 A method of phalangization of a fingered brush, including metacarpal phalanxis by removing the second metacarpal, trapezoid bones, skin plastics during the formation of the metacarpal gap, characterized in that transverse osteotomy of the second metacarpal bone in the middle section and at the level of the proximal epimetal base is performed before metacarpal phalanxation the plane of the osteotomy of the distal fragments spend the spokes with stops along the axis of the fragments in the direction of their movement, carry out the dist ktsiyu with the installation of the distal fragment to the third metacarpal and proximal to the first metacarpal bone, at the end of the distraction displaced fragments are fixed to the spokes metacarpal bones.