RU2206288C1 - Method for external fixation at treating luxations of clavicular acromial end - Google Patents

Abstract

FIELD: medicine, orthopedics, traumatology. SUBSTANCE: the suggested method is performed due to external perosseous osteosynthesis. Screw-rod should be screwed into scapular spine at the level of its upper third in sagittal plane from the back to the front perpendicular to clavicular axis. The second screw-rod should be screwed into metaphysial department of clavicular acromial end in sagittal plane from the front backwards from the bottom upwards perpendicular to clavicular axis. The third screw-rod should be screwed into clavicular acromial end outwards against previously installed fixator in frontal plane from outside inwards from the bottom upwards along clavicular axis. The method enables to increase rigidity and stability of fixation and decrease traumaticity of interference. EFFECT: higher efficiency of external fixation. 4 dwg, 1 ex

Description

 The invention relates to medicine, in particular to traumatology and orthopedics, and is intended for fixation of the clavicular-acromial joint in the treatment of dislocations of the acromial end of the clavicle.

A known method of treating dislocation of the clavicle with external transosseous osteosynthesis using the apparatus G.A. Ilizarova [1]. In this case, one spoke with a thrust pad is inserted through the acromion in the sagittal plane, the second is parallel to the first through the distal part of the clavicle, the third spoke with a thrust pad is held in position of reposition of the dislocation through the acromion, clavicular-acromial joint and the outer section of the clavicle. The spokes are fixed in the semicircular support of the apparatus G.A. Ilizarova. The disadvantages of this method of treatment of dislocations of the acromial end of the clavicle are:
- insufficient rigidity and stability of fixation with the help of knitting needles, as well as trauma to the bones and soft tissues of the shoulder girdle due to teething of the skin and bones around the knitting needles with the risk of developing local inflammatory complications;
- significant trauma to the clavicular-acromial joint during transarticular fixation with a knitting needle, which subsequently can lead to the development of deforming arthrosis;
- the relative complexity of osteosynthesis due to the need for several spokes and pulling the osteo-fixators before fixing on an external support.

 To address these shortcomings, we have proposed a method for treating dislocations of the acromial end of the clavicle using a rod-type external fixation apparatus. When completing the apparatus, the semicircular arc of the apparatus G.A. is used as an external support Ilizarova, and as osteofixers - cantilever screw rods with a self-cutting pointed end, developed by us [2]. The rods are inserted into the bones of the shoulder girdle by screwing in the handle. The rods are inserted into the anatomically and functionally safe areas of the shoulder girdle. One cantilever screw-rod is installed in the spine of the scapula at the level of its upper third in the sagittal plane posteriorly anteriorly, the second - in the metaphysical part of the acromial end of the clavicle in the sagittal plane in the front-backward direction from the bottom-up, the third screw-rod is installed in the acromial end of the clavicle the frontal plane outward from the previously installed latch, in the direction from the outside inward from the bottom up. After reposition of the dislocation, the rods are mounted on an external support.

The general layout of the apparatus is shown in figure 1 (top view), where:
1 - acromial end of the clavicle;
2 - acromion;
3 - spine of the scapula,
4 - proximal epiphysis of the humerus;
5 - articular cavity of the scapula;
6 - cantilever screw-rod installed in the spine of the blade;
7 - cantilever screw-rod installed in the metaphysical department of the acromial end of the clavicle in the sagittal plane;
8 - cantilever screw-rod installed in the acromial end of the clavicle in the frontal plane;
9 - bracket;
10 - semicircular support apparatus G.A. Ilizarova.

 The method is as follows. The patient is placed on the operating table on his back, a roller is placed between the shoulder blades. Under general intravenous anesthesia after treatment of the surgical field, the skin on the posterior surface of the shoulder girdle is pierced in the projection of the upper third of the spine of the scapula. Set by screwing the screw-rod 6 into the spine of the scapula 3 of the sagittal plane anteriorly posteriorly, perpendicularly to the axis of the clavicle. Pierce the skin on the front surface of the clavicle. A screw-rod 7 is screwed into the metaphysical section of the acromial end of the clavicle 1 in the sagittal plane in the front-back direction from the bottom-up, perpendicular to the axis of the clavicle. Then, the skin is pierced in the projection of the acromial end of the clavicle outward from the previously installed retainer. Insert the screw-rod 8 into the acromial end of the clavicle 1 in the frontal plane in the direction from the outside inward from the bottom up, along the axis of the clavicle. Reposition the dislocation. The screw rods are attached using brackets 9 to the external support 10.

 The immobilization period is 4-6 weeks. Functional treatment is carried out at the same time.

 The use for reposition and fixation of dislocations of the acromial end of the clavicle as osteo-fixators of three cantilever screw rods installed in the spine of the scapula and the acromial end of the clavicle increases the rigidity and stability of fixation and reduces the risk of local inflammatory complications compared to the use of spoke fixation.

 Given the tendency of the acromial end of the clavicle to move upward during ruptures of the clavicular-acromial joint, it is necessary to create conditions for fixing the clavicle in the articular cavity of the acromial process for the most favorable course of reparative processes and the restoration of the damaged ligamentous apparatus. This is achieved by pressure from above on the repaired end of the clavicle. The introduction of one screw-rod into the metaphysical department of the acromial end of the clavicle in the sagittal plane in the front-backward direction from bottom to top, perpendicular to the axis of the clavicle, and the other into the acromial part of the clavicle outward from the previously installed latch, in the frontal plane in the direction from the outside inward from the bottom upward, along the axis of the clavicle, allows you to securely hold and perform additional compression on the repaired acromial end of the clavicle. In this case, transarticular fixation with a clavicular-acromial joint needle is not required, which reduces the invasiveness of surgery.

 The use of cantilever fixing elements installed in anatomically and functionally neutral zones eliminates the risk of damage to the neurovascular bundles of the subclavian region and reduces the complexity of osteosynthesis compared with the use of spokes through the bones and soft tissues of the shoulder girdle. It also simplifies the technology of surgical intervention that the cantilever screw rods with a self-tapping pointed end are installed in the bones of the shoulder girdle by screwing the handle without using a drill and do not need to be tensioned before fixing on the external support.

 Example. Patient X., 30 years old, was admitted to the Department of Traumatology on the second day after the injury. On examination: pain on palpation, deformation in the area of the damaged right shoulder girdle, moderate restriction of movements in the right shoulder joint. The diagnosis of "Upper dislocation of the acromial end of the clavicle to the right" on the radiograph is confirmed (figure 2, before treatment).

 The operation was performed: "Osteosynthesis of the shoulder girdle with an external fixation apparatus." In the patient’s position on the back, with a roller between the shoulder blades, under general intravenous anesthesia after treatment of the surgical field, the skin on the back surface of the shoulder girdle was pierced in the projection of the upper third of the shoulder blade. A screw-rod is installed in the spine of the scapular sagittal plane back-to-front, perpendicular to the axis of the clavicle. Pierced skin on the front surface of the clavicle. A screw-rod is installed in the metaphysical part of the acromial end of the clavicle in the sagittal plane in the front-back direction from the bottom-up, perpendicular to the axis of the clavicle. Then punctured the skin in the projection of the acromial end of the clavicle outward from the previously installed retainer. A screw-rod was inserted into the acromial end of the clavicle in the frontal plane in the direction from the outside inwards from the bottom up, along the axis of the clavicle. Closed reposition of dislocation performed. The screw rods are fixed with brackets to the semicircular support of the apparatus of G. A. Ilizarov. One-stage compression is given through the rods inserted into the acromial end of the clavicle in the sagittal plane in the front-backward direction from the bottom-up, perpendicular to the axis of the clavicle and in the frontal plane in the direction from the outside inward from the bottom up, along the axis of the clavicle. Produced a control x-ray (figure 3, during surgery).

 The postoperative period was uneventful, without complications. Physiotherapy and therapeutic exercises were carried out. 1 month after the operation, the apparatus was dismantled. On the x-ray (figure 4, after treatment) dislocation of the acromial end of the clavicle is eliminated.

 Inspected after six months. There are no complaints. The anatomical and functional outcome is good. He works in the specialty.

The proposed method of external fixation in the treatment of dislocations of the clavicular-acromial joint allows:
- reliably hold the collarbone in the adjusted state, ensuring the greatest rigidity and stability of fixation, and therefore, eliminate the risk of developing local inflammatory complications;
- reduce the invasiveness of the intervention, eliminating the need for transarticular fixation of the acromioclavicular joint;
- make additional compression on the repaired acromial end of the clavicle;
- to simplify the installation technique of the apparatus due to the use of cantilever elements as osseous fixators, which do not require preliminary tensioning before fixing to the external support.

Sources of information
1. Lee A.D. Transosseous osteosynthesis in traumatology, Tomsk, Tomsk University Press, 1992, p. 53-46.

 2. Copyright certificate 2134081 "Rod for external transosseous osteosynthesis."

Claims (1)

 The method of external fixation in the treatment of dislocations of the acromial end of the clavicle, carried out by external transosseous osteosynthesis, characterized in that a console screw-rod is screwed into the spine of the scapula at the level of its upper third in the sagittal plane perpendicular to the axis of the clavicle, and the second screw-rod is screwed into the metaphysical the section of the acromial end of the clavicle in the sagittal plane in the front-to-back direction from bottom to top, perpendicular to the axis of the clavicle, the third to the acromial end of the clavicle an oval fixer, in the frontal plane in the direction from the outside inward from the bottom up, along the axis of the clavicle.

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