RU2233640C2 - Apparatus for reposition and fixation of fractured fragments - Google Patents

Abstract

FIELD: medicine, in particular, traumatology and orthopedics, may be used for reposition and fixation of fractured fragments in outer fixation devices.

SUBSTANCE: apparatus has hooked rod and traction device attached to outer end of rod for pushing and pulling. Rod shank is pivotally fixed to outer support of perosseous device. Rod curvature does not exceed 1/2 the diameter of bone and concave surface of outer part is equipped with sharpened teeth.

EFFECT: increased efficiency in reposition of fractured fragments, minimal traumatism caused by intervention, elimination of danger for destructing of main vessels and nerves and reduced probability of occurrence of complications owing to infection.

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Description

The present invention relates to medicine, namely to traumatology and orthopedics, and can be used for reposition and fixation of bone fragments in external fixation devices.

A known method of reposition of bone fragments using a device based on cantilever spokes with thrust pads [1]. This method has the following disadvantages:

1. The restriction to the use of the method in the presence of the main vessels and nerves in the projection, in which it is necessary to reposition the knitting needle (s), for example, when localizing a bone fragment along the inner surface of the middle third of the shoulder, thigh, etc .;

2. If there is a large volume of soft tissues from the bone fragment (posterior surface of the thigh, shoulder, etc.), then holding through it a reponding knitting needle (spoke) sharply increases the risk of eruption of soft tissues with the occurrence of pain, restriction of movements in the joints, the occurrence of inflammatory complications;

3. If the bone fragment is located inside the interosseous space (forearm, lower leg), then it is not possible to use this device;

4. The need to drill a bone fragment to carry the spokes through it increases the invasiveness of the intervention and poses a threat to the development of “spoke” osteomyelitis.

Closest to the proposed is a method for reposition of bone fragments using hook-shaped rods pivotally fixed to the external supports of the transosseous apparatus [2]. The disadvantages of using this device are:

1. The use of the known hook-shaped fixative is possible only if its tubular structure is preserved in the bone fragment, i.e. there is no defect in any of the cortical plates. Thus, the reposition of the marginal bone fragment by the specified device is impossible;

2. The use of a device taken as a prototype is not possible in the presence of the main vessels and nerves in the projection in which it is necessary to introduce a hook rod.

3. The need to form holes for the introduction of the rod-hook increases the morbidity of manipulation.

4. The introduction into the bone of a hook with a bend of large 1/3 of the circumference is technically difficult, especially in places with a large volume of soft tissue.

The proposed device is deprived of these drawbacks, which provides an effective reposition of bone fragments with minimal invasiveness of the intervention, eliminating the risk of damage to the great vessels and nerves and reducing the likelihood of infectious complications.

A positive effect is achieved due to the fact that the immersed (“working”) part of the hook-shaped curved rod for reposition of bone fragments has a hook-shaped bend, the concave surface of which is equipped with pointed protrusions (teeth), tightly pressed against the bone fragment. The middle third of the outer part of the hook-shaped curved rod is pivotally attached to the external support of the transosseous device, and a load is transferred to the outer end of the rod using the traction device, as a result of which the pointed teeth of the concave surface of the “working” part of the device come into contact with the bone fragment, reponing, and then fixing it.

The design of the device for reposition of bone fragments and the principle of its action are illustrated by the figures: Fig. 1, a - view of a hook-like curved rod in a lateral projection; figure 1, b is a view of a hook-shaped curved rod of a direct projection; figure 2, a and 2, b presents the scheme of reposition and fixation of the marginal bone fragment using the developed device.

Thus, the proposed device for reposition of bone fragments consists of two parts: a rod with a hook-like curved gear immersion that is pivotally fixed to the external support of the transosseous device, and a device that allows the rod with a hook-shaped bend to work like a two-shouldered lever, dosing a repositional force on the bone fragment.

A flat hook-shaped bend with pointed protrusions on the concave side is made for the purpose of better adaptation and fixation of the bone and eliminates the appearance of pressure sores.

The hook-shaped bend of the device, occupying up to 1/2 the diameter of the bone, does not cause difficulties when introducing the device to the site of bone damage, and also provides the necessary stability of the bone fragment, which optimizes reposition and its subsequent fixation.

The traction device (Fig. 2) is a rod (1) pivotally fixed at one end to the external support of the apparatus (2). The other end of this rod is fixed to the distal (outer) third of the hook-shaped curved rod (3). Depending on the location of the node (2), traction is carried out (Fig. 2, a), or pushing (Fig. 2, b) of a hook-shaped curved rod. The place of the hinged fastening of the hook-shaped curved rod to the external support of the transosseous device is the center of the redistribution of power loads from the traction device to the bone fragment.

The main indications for the use of the proposed device is the need to reposition an edge bone fragment, in the projection of which (from the side of the external cortical plate) there are the main vessels and nerves and (or) there is a large volume of soft tissues, as well as cases of the bone fragment inside the interosseous gap of the forearm, lower leg .

The specified device can also be used to reposition the main bone fragments, having an advantage over knitting needles with thrust pads or screw rods, for example, in the case of osteoporosis.

Use the proposed device as follows.

The radiograph determines the localization of the bone fragment, its size, location, the necessary direction of reposition, bone diameter, remoteness of the fragment from the annular support. Sterilize a hook-like curved rod. On the limbs, the most preferred place for the introduction of the fixative is determined (away from the neurovascular bundle and where there are fewer soft tissues above the bone). After processing the surgical field and local anesthesia, skin puncture up to 5 mm is performed. A curved clamp forms a channel in the soft tissues to the bone fragment. A hook-like curved rod is inserted into the formed channel, orienting it so that its concave part with teeth comes into contact with the external cortical plate of the bone fragment. The middle section of the non-submersible part of the hook-shaped curved rod is pivotally attached to the external support of the transosseous device. A traction device is pivotally attached to the distal (outer) third of the hook-shaped curved rod, which in turn is pivotally fixed to the external support of the apparatus. After that, traction or pushing for the outer end of the hook-shaped curved rod (depending on the location of the hook-shaped curved rod relative to the external support of the transosseous apparatus) is carried out. In this case, the bone fragment is repositioned and fixed by compression to the main bone fragment.

We present the clinical observation of the use of the device for reposition and fixation of bone fragments.

Patient K., born in 1953, medical history No. 3412, 01/17/01 received a closed comminuted fracture at the border with / 3 and n / 3 of the right femur; while a large bone fragment was located on the posterior surface of the bone.

Ambulance delivered to the clinic RosNIIITO them. P.P. Harmful. Here, transosseous osteosynthesis of the right femur was performed urgently. For reposition and fixation of the bone fragment, a spoke with a persistent pad, which was introduced in the sagittal plane, was used. On the 6th day from the moment of the operation, when the patient began to intensify, there was eruption and inflammation of the soft tissues in the area of the reponing needle with a persistent pad. This was facilitated by the relatively large volume of soft tissues of the posterior surface of the segment, as well as the fact that the displacement of soft tissues arising from movements in the knee joint in the area of insertion of the needle is greater than, for example, along the lateral surfaces of the segment. The conservative treatment of soft tissue inflammation had no effect and the needle was removed on 01/26/01. This caused a secondary displacement of the bone fragment. Carrying out a knitting needle in the frontal plane with its subsequent curved anterior bend in this case was impossible because of the danger of damage to the femoral artery. 01/29/01 Under local anesthesia from a 0.5 cm incision along the outer surface of the n / 3 thigh, a channel is formed with a curved clamp to the posterior cortical plate of the bone fragment. A hook-shaped curved rod is introduced into this channel. In the middle third of its non-submersible part, a hinge is formed, which is fixed to the annular support of the apparatus. A traction device was attached to the free end of the hook-shaped curved rod. By pulling the free end of the hook-like curved rod, reposition and fixation of the bone fragment were achieved. The introduction of a hooked curved rod was made from the outer surface of the segment, i.e. where there are no main vessels and nerves, soft tissue displacement is minimal. The fracture healed and on April 30, 01 the device was dismantled. In this case, signs of eruption, inflammation of the soft tissues of the hook-curved rod were not observed.

Sources of information

1. Certificate No. 7302 for a utility model of the Russian Federation, MKI 6 A 61 V 17/56. A device for the treatment of comminuted fractures of tubular bones / Yu.M. Sysenko, S.I.Shved, S.I. Novichkov (RF). - Application No. 97112713/20; Claim 07/29/97; Position decision 10/14/97; Publ. 08/16/98; Bull. No. 8.

2. Barabash A.P. Compression distraction apparatus // RF Patent No. 2068241.

Claims (1)

A device for reposition and fixation of bone fragments containing a hook-shaped curved rod, characterized in that it has a traction device that is attached to the outer end of the rod with the possibility of pushing and traction, while the shaft shank is pivotally fixed to the external support of the transosseous device, and the bending of the rod is not exceeds 1/2 the diameter of the bone, and its outer part has pointed teeth on a concave surface.

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