RU2121315C1 - Method for treating ruptured acromial end of clavicle - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves transcutaneously bringing wire through the exterior end of proximal fractured bone fragment of clavicle and spatula spine in subspinal region. Bayonet-shaped curve is created at the end and immersed into the soft tissues as deep as possible into the clavicle spine. Hook-shaped bend is created at the frontal free end of the wire. The wire is inclined downward to reach antero-lateral surface of the corresponding side of the chest. It is kept in bent position by means of bandage loop placed on the back surface of the chest. The ends are tied on the frontal side enveloping healthy forearm. EFFECT: prevented postoperative complications.

Description

 The invention relates to medicine, namely to traumatology and orthopedics.

 There is a method of treating fractures of the acromial end of the clavicle, in which 1 or 2 spokes are inserted through the acromial process of the scapula into the clavicle using the closed or open method, fixing the fracture site (Yu.O. Kolesnikov et al. “Dislocations and fractures of the clavicle”; Voronezh, 1992). However, one of the main drawbacks is the migration of spokes, the lack of a guarantee of the strength of the connection. After the operation, fixation with plaster bandages is necessary.

 Various external devices for fixation of the fracture are also used. Closest to the proposed method is the Kolesnikov-Cherkashin-Dubrovin method, which consists in holding the knitting needle through a proximal clavicle fragment displaced upward. The needle is fixed and stretched in the Kirchner bracket, placed in the armpit. A circular plaster cast is applied from the upper third of the shoulder to the metacarpophalangeal joints. A bracket in the form of a loop is gypsum-plated to the inner surface of the elbow joint. The bracket by means of a steel rigid spring in the tension position is fixed to the bracket. In this case, the force exerted by the spring from 2 to 8 kg is enough to reposition and hold the fragments. From 4-6 days, the patient begins to engage in physical therapy. The period of immobilization is 4-4.5 weeks. This method was taken by us as a prototype (Yu.O. Kolesnikov et al. "Dislocations and fractures of the clavicle"; Voronezh, 1992). A negative property of this method is the long-term fixation of the joints of the upper limb with a plaster cast, which requires rehabilitation treatment after immobilization. The device also restricts movement in the shoulder joint.

 The aim of the invention is to ensure the stability of the position of the fragments while maintaining mobility in the joints of the limbs during treatment.

 The goal is achieved as follows. In the position of the patient on a healthy side under local anesthesia reposition of fragments. Using an electric drill, a needle is passed through the distal end of the proximal fragment at a distance of 1-2 cm from the fracture line. To implement the method, a standard needle for transosseous osteosynthesis with a diameter of 2 mm and a length of 400 mm is used. The needle is carried out in a sagittal direction with the calculation of its passage through the axis of the scapula. After it leaves the bayonet-like bend at the end, it forms a bayonet-shaped bend, immersed in soft tissue all the way into the axis of the scapula, while holding the fragment of the clavicle from displacement. A bend in the form of a hook is made at the front free end of the spoke, for which the spoke is tilted down to the anterolateral surface of the corresponding side of the chest, while the spoke in an elastically stressed state exerts constant pressure on the end of the proximal fragment down, stabilizing the fracture. The needle is held in an inclined position by a loop of bandage, which is carried out along the rear surface of the chest and the ends are tied in front, covering a healthy shoulder girdle.

 This method of fixation of the clavicle was used in 7 patients with fractures of the acromial end of the clavicle, in which the clavicular clavicle is damaged. The needle is removed after 6 weeks.

 The needle is removed by moving it back until its end comes out of the skin and, after cutting off the bayonet-shaped bend, is removed from the clavicle.

 In all cases of fractures of the acromial end of the clavicle, a complete anatomical and functional recovery was achieved.

 We give examples of the clinical use of this method.

 Example 1. Patient S., 32 years old. Profession is a locksmith. Case history N 4509. Diagnosis: closed fracture of the acromial end of the left clavicle with a shift. The operation was performed on the second day after the injury. In the position of the patient on the healthy side, anesthesia was made on the fracture site, supraclavicular and subclavian region to the spine of the scapula, and also the infraspinatus, respectively, for the passage of the spoke. After reposition of the fragments, the sharp end of the needle was punctured through the skin displaced back from the front surface of the clavicle and placed on the front upper surface of the clavicle at a distance of 2 cm proximally from the fracture site. Using an electric drill, the spoke was drawn through the clavicle and upper spine of the scapula in the sagittal plane. A bayonet-shaped bend is made at the end of the spoke, brought out, then the needle is immersed in soft tissue all the way to the spine of the scapula. The front end of the spoke is tilted downward in a relatively frontal plane; a bend in the form of a ring is made at its end. In the tilt position, the spoke in an elastically stressed state is fixed to the ring by a screw loop to the body. In the postoperative period, immobilization of the upper limb was not used. In the second week, active movements in the shoulder joint are allowed with the arm raised to a horizontal level. In the third week, a full range of shoulder movements was achieved. The spoke is removed after 6 weeks. Clinically and radiologically, the collarbone fracture has healed. Two weeks later he was discharged to work. Examined after 3 months, does not show complaints, there are no restrictions on the volume and strength of movements in the shoulder joint.

 Example 2

 Patient N., 43 years old. Profession - chauffeur. Case history No. 6753. Diagnosis: closed fracture of the acromial end of the right clavicle with a shift. The operation was performed on the second day after the injury. In the position of the patient on the healthy side, anesthesia was made on the fracture site, supraclavicular and subclavian region to the spine of the scapula, and also the infraspinatus, respectively, for the passage of the spoke. After reposition of the fragments, the sharp end of the needle was punctured through the skin displaced back from the front surface of the clavicle and placed on the front upper surface of the clavicle at a distance of 2 cm proximally from the fracture site. Using an electric drill, the spoke was drawn through the clavicle and upper spine of the scapula in the sagittal plane. A bayonet-shaped bend is made at the end of the spoke, brought out, then the needle is immersed in soft tissue all the way to the spine of the scapula. The front end of the spoke is inclined downward relative to the frontal plane, and a bend in the form of a ring is made at its end. In the tilt position, the spoke in the elastically stressed state is fixed to the ring with a bandage loop to the body. In the postoperative period, immobilization of the upper limb was not used. In the second week, active movements in the shoulder joint are allowed with the arm raised to a horizontal level. In the third week, a full range of shoulder movements was achieved. The spoke was removed after 44 days. Clinically and radiologically, the collarbone fracture has healed. Two weeks later he was discharged to work. Examined after a month, does not show complaints, there are no restrictions on the volume and strength of movements in the shoulder joint.

 Example 3

 Patient K., 28 years old. Profession is a painter. Case history N 8874. Diagnosis: closed fracture of the acromial end of the left clavicle with an offset. The operation was performed on the second day after the injury. In the position of the patient on the healthy side, anesthesia was made for the fracture site, supraclavicular and subclavian region to the spine of the scapula, as well as the cavity region, respectively, for the passage of the spoke. After reposition of the fragments, the sharp end of the needle was punctured through the skin displaced back from the front surface of the clavicle and placed on the front upper surface of the clavicle at a distance of 2 cm proximally from the fracture site. Using an electric drill, the spoke was drawn through the clavicle and upper spine of the scapula in the sagittal plane. A bayonet-shaped bend is made at the end of the spoke, brought out, then the needle is immersed in soft tissue all the way to the spine of the scapula. The front end of the spoke is inclined downward relative to the frontal plane, and a bend in the form of a ring is made at its end. In the tilt position, the spoke in the elastically stressed state is fixed to the ring with a bandage loop to the body. In the postoperative period, immobilization of the upper limb was not used. In the second week, active movements in the shoulder joint are allowed with the arm raised to a horizontal level. In the third week, a full range of shoulder movements was achieved. The spoke is removed after 6 weeks. Clinically and radiologically, the collarbone fracture has healed. Two weeks later she was discharged to work. Examined after 3 months, does not show complaints, there are no restrictions on the volume and strength of movements in the shoulder joint.

 The method provides stable fixation of the proximal fragment with the exception of any additional fixation of the limb and allows functional treatment from the first days during outpatient monitoring of the patient. Comparative data with known methods of treating fractures of the acromial end of the clavicle show the high efficiency of the proposed method with low invasiveness of the operation, which can be carried out in each specialized medical institution.

Claims (1)

 A method for treating fractures of the acromial end of the clavicle by reposition of fragments, percutaneous holding of the spoke through the outer end of the proximal fracture of the clavicle in the sagittal plane, characterized in that the spoke is carried out with the calculation of its passage through the bone of the scapula, in the infraspinatus, a bayonet-shaped bend is formed at the end, immersed in soft tissues all the way into the spine of the scapula, on the front free end of the knitting needle make a hook bend, the needle is tilted down to the front-side surface of the corresponding side of the chest and erzhivayut tilt position loop of the bandage, which is carried on a back surface of the chest and the front ends of the link, spanning the healthy shoulder girdle.