RU2208415C2 - Device for carrying out combined osteosynthesis of fragments in proximal humeral department - Google Patents

Abstract

FIELD: medicine, traumatology, orthopedics. SUBSTANCE: the suggested device contains intramedullar part as a rod. It has, also, got diaphysial part as perosseously located plate. The latter should be fixed to certain fragment due to inserting curved rods and screws into humeral caput. Curved rods should be fixed with threaded stopper. The present innovation provides fixation of any fractures, multi-fragmental ones in proximal humeral department, among them. EFFECT: higher efficiency. 3 dwg

Description

 The invention relates to medicine, namely to traumatology.

 Treatment of fractures of the proximal humerus remains a complex problem due to the great difficulties that the surgeon has in choosing the design of the fixator. The existing fixators for the most part do not provide neutralization of the leverage properties of the peripheral bone fragment (I. Pichkhadze. A systematic approach to the selection and computerization of stable transosseous osteosynthesis in case of fractures of long bones. Abstract of dissertation, Doc. Medical sciences, M., 1994). The difficulty in resolving the issue depends on the fact that the surgical intervention should be as traumatic as possible, i.e. through a minimal soft tissue incision. But, observing this principle, it is not possible to neutralize the leverage properties of the peripheral bone fragment, since the plate should be adjacent to the peripheral bone fragment for a large length, and this will require extensive access of an appropriate length. With greater access, it is necessary to mobilize the bone over a large extent, disrupting its blood supply. This significantly complicates the operation itself and, accordingly, worsens the prognosis of treatment due to possible suppuration, nerve damage and trophic disturbance.

 For osteosynthesis of the upper end of the humerus there is a plate R. M. Pichkhadze, M.A. Elikishvili (A device for sustainable osteosynthesis of intra- and periarticular fractures. AS USSR 1699445, 08/22/91. Application 4755037 with priority dated 10/30/89. Published in the Bulletin of Inventions, 1991). This device is intended for subcutaneous osteosynthesis. This design involves significant operational access to two-thirds of the total shoulder length for its installation and fixation of bone fragments. Structurally, it provides reliable fixation of bone fragments, but often the volume of surgical intervention is very significant, which complicates its implementation in clinical practice. In order to prevent this factor, it was decided to fix the bone marrow of a long bone fragment with a less traumatic intramedullary fixation.

 The closest analogue is the device according to US patent 5603715 (1997), which is intended for intramedullary osteosynthesis of the diaphysis of the humerus and has a osseous part of the fixative that can prevent only the migration of the rod from the bone marrow channel and no more. It implies osteosynthesis of fractures of the humerus along only along the intramedullary part of the fixative. The humerus in the proximal part is mainly a spongy structure and therefore, with comminuted fractures of this department, it is technically difficult to compare and fix the fragments and each large fragment of the proximal fragment, i.e. humeral head. Thus, the use of such a fixator for fractures, especially comminuted, of the head of the humerus is unacceptable.

 The technical result of the invention lies in the fact that the fixation of any types of fractures is provided, including multi-fragmented proximal humerus.

 The technical result is achieved due to the fact that the device containing the intramedullary part in the form of a rod has a diaphyseal part in the form of a spinal plate, which is attached to a fragment or fragment by introducing curved rods into the head of the humerus and screws, and the curved rods are fixed with a threaded stopper .

 Figure 1 shows the device in General; figure 2 is the same mounted on the bone; figure 3 shows a device indicating the fixation points in the bone marrow canal.

 Description and application of the design.

 The latch (Fig. 1) consists of a diaphyseal part lying flat, smoothly passing into the intramedullary part 2. The diaphyseal part in the form of a plate-mounted plate 1 has holes of two types: 3 - for installing fan-shaped curved rods designed for immersion in the head of the humerus, and holes 4 - for installing screws 6 (the head of which has a threaded part and is firmly fixed to the supporting part of the plate). Fan-shaped curved rods 8 are fixed by a stopper with a threaded thread 7, mounted in the threaded groove 5.

 The intramedullary part is structurally configured to provide three fixation points in the bone marrow canal (FIG. 2): one of which is attached to the area of the bone marrow canal under the intramedullary part of the fixative; the second - at a level in the zone of tight contact with the compact part of the bone marrow canal; the third - at the level of the distal end at the apex of the retainer, with a compact part of the bone.

Operation progress
We make an incision along the anteroposterior surface of the upper third of the shoulder with a length of 6-8 cm, expose the bone fragments of the proximal humerus, and reposition the fragments. An oval hole is made in the peripheral fragment. The oval hole with a special rasp is modeled under the intramedullary positioned part of the latch 2. Into this hole we insert the intramedullary part of the latch 2, tightly bursting it in the bone marrow canal. We attach the osseous part of the plate to the central fragment so that the holes 3 coincide with the central axis of the proximal fragment. In the proximal fragment, we make three holes for the curved rods 8, through the holes 3. We introduce the curved rods 8 and arrange them fan-shaped in the head of the humerus. We insert the threaded stopper 7 into the threaded groove 5, thereby firmly fixing the curved rods 8 in the osseous part 1 of the retainer. If necessary, insert additional threaded screws 6 into the holes for screws 4 and fix fragments and fragments of the proximal humerus. The fixation strength in the bone marrow canal of the intramedullary part 2 is provided by at least three support points 9.

 Thus, from the description of the device and the method of its application, it can be seen that the device solves the goal, easily manufactured industrially and applicable in practice.

Claims (1)

 A device for the combined osteosynthesis of fragments of the proximal humerus, including for multi-fragmented fractures, containing an intramedullary part in the form of a rod, characterized in that it has a diaphyseal part in the form of a spaced plate, and the plate is attached to the fragment or fragment by introducing curved rods into the head of the humerus and screws, and the curved rods are fixed with a threaded stopper.

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