RU2344776C1 - Method of distal radioulnar forearm joint recovery - Google Patents

Abstract

FIELD: medicine; orthopedics and traumatology.

SUBSTANCE: method of distal radioulnar joint recovery involves access to the joint, channel forming and autotendon drafting. Two lengthwise cuts are made at radial and ulnar forearm side at the level of radioulnar joint, ulna neck is bared. Two transverse channels, distal and proximal one, are drilled through distal ulna epimetaphysis at the frontal plane. End of free reinforced autotransplant is put through distal channel from radial to ulnar side of forearm. Then the transplant is looped around ulna neck and put through proximal channel in reverse direction. Ulna head is fixated in joint indent of ulna, transplant ends are pulled together, bound in nod and attached to the transplant. Ulnar bones are fixated in neutral position by two wires for 4 weeks.

EFFECT: recovery of ulna head dislocation displacement, prevention of instability in distal radioulnar joint, recovery of rotary forearm movement.

1 ex, 6 dwg

Description

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

In case of traumatic ruptures of the distal radiolarnar joint of the forearm, especially in old cases of rupture, it is very difficult, sometimes impossible, to restore the integrity of the ligamentous apparatus of the articulation while maintaining the function of movement in the radiolarular articulation and in the wrist joint. There are the most well-known methods of treating this category of dislocation with a rupture of the radiolar joint. So, to prevent recurrence of dislocation of the head of the ulna, percutaneous fixation should be performed to the epiphysis of the radius (1). However, due to the fact that the damaged ligaments of the distal radiolar joint are not restored, subsequent rotational movements of the forearm do not exclude repeated dislocations of the ulnar head.

After the closed reposition of an isolated dislocation of the head of the ulna, it is much more reliable to temporarily stabilize the distal radiolbow joint with transosseous extra-articular holding of needles (2). But even with this method of treatment without restoring the damaged ligamentous apparatus of the joint, it is not possible to exclude relapses of dislocation of the ulnar head.

Closest to its technical solution, the claimed method is a method of restoring ligaments of the distal part of the radicular ulnar joint (Method N. Milcha), in which two transverse channels are drilled along the back and radial side of the distal epimetaphysis of the radius, a transplant is made under the tendons of the flexors and extensors around the head ulna, the ends of the graft are passed through these channels and stitch them (3). With this method, the formed new ligament does not completely cover the head of the ulna and does not attach directly to the inner edge of the radius, as a result of which the possibility of palmar-dorsal movement of the head of the ulna and relapse of it is not ruled out. The likelihood of relapse is increased by the fact that the method after its implementation does not even provide for a temporary spoke fixation of the radicular joint.

The invention consists in a combination of distinctive features sufficient to achieve the desired technical result, consisting in the elimination of dislocation of the head of the ulna with the exception of instability in the distal radiolar joint and restoration of the rotational movements of the forearm.

The essence of the invention lies in the fact that the method of restoring the distal radiolar joint of the forearm includes access to the joint, channel formation and autotendoplasty. Two longitudinal cuts are made along the radial and ulnar sides of the forearm, at the level of the radicular joint, and the neck of the ulnar bone is exposed. Two transverse channels are drilled through the distal epimetaphysis of the radius in the frontal plane: proximal and distal. The end of a free reinforced autograft is carried out through the distal canal from the radial side of the forearm to the ulnar, then, by looping around the neck of the ulnar bone, the transplant is passed through the proximal canal in the opposite direction. The head of the ulna is fixed in the articular recess of the radius, pulling the ends of the graft, knotted with a knot, attached to the graft, the bones of the forearm are in neutral position with two knitting needles for 4 weeks.

Two longitudinal sections along the radial and ulnar sides of the forearm provide the most atraumatic and wide access to the operated area of the forearm.

Exposing the neck of the ulna provides the most optimal fit of the head of the ulna in the articular recess of the radius.

The formation of two transverse bone channels at the distal and proximal levels in the frontal plane through the distal radial epimetaphysis provides the most durable fixation of the autograft to the radial bone. These channels allow you to recreate a damaged radio lunar ligament.

The loop fastening of the transplant head of the ulna in the articular recess of the radius provides mechanical fixation of the bones of the forearm and leaves the possibility of rotational movement of the head of the ulna in the articular recess of the radius during adduction (pronation) and abduction (supination) of the forearm.

Attaching the free ends of the node to the autograft prevents spontaneous loosening of the node.

The fixation of the needle of both bones of the forearm in a neutral position in the transverse direction with respect to the axis of the forearm eliminates the dislocation of the head of the ulnar bone from the articular groove until the newly created ligament of the radiolar joint is fused.

The fixation period of 4 weeks ensures the strengthening of the newly created ligament due to the scar-adhesion process, which prevents re-dislocation of the head of the ulna.

The scheme of the transplant is presented in figure 1 (view of the right limb in front). The photographs in FIGS. 2-6 illustrate the described method and the results of the operation. Figure 2 shows the fixation of the bones of the forearm in the neutral position with two knitting needles (x-ray); figure 3 shows the x-ray of the operated joint after 22 years; figure 4-6 - shots of the hand 22 years after surgery.

The method is as follows.

Anesthesia. Longitudinal sections are made along the ulnar and radial sides of the injured forearm at the level of the radicular joint. From the elbow access, the neck of the ulnar bone is released from the soft tissues along the circular surface of the bone for 1.5 cm. From the beam access, the bone channels are drilled in the transverse direction in the radial epimetaphysis of the radius: the channel 1 is proximal, the other channel 2 is distal from the level of the wrist joint . As an autograft, a tendon of the long palmar muscle of the same arm is used, which is reinforced with silk thread along the entire length of the graft. The end of the reinforced graft 3 using a flexible metal conductor is passed through the distal transverse bone channel 2 of the radius and then, bypassing the head of the ulna in the form of a loop, this end of the graft is passed through the proximal bone channel 1 in the opposite direction (figure 1). Pulling both ends of the graft over the outer edge of the radius, fix the head of the ulna in the articular recess of the radius and, without loosening the traction, the ends of the graft 3 are tied into node 4, fixing them to the graft. In a neutral position, the bones of the forearm are fixed with two knitting needles for 4 weeks. Hemostasis. Skin sutures before drainage. Alcohol dressing. Gypsum.

Clinical example.

Patient L., 36 years old. Case history No. 2252. He entered the Department of Hand Surgery of the Institute of NIITO on August 17, 1984 with a diagnosis of a closed rupture of the distal radiolar joint of the right forearm with a dislocation of the head of the ulnar bone to the rear two months ago. The circumstances of the injury: 06/20/1984 when towing a car with a pry, hit the wrist of the right hand. He was treated for a bruise of the right wrist joint. Upon admission to the wrist compartment, significant mobility was found in the right distal radiolar joint, under the skin, to the rear of the forearm, the head of the ulna protrudes. With increased pressure on the head, it sinks into place; when the pressure on the head is removed, it immediately dislocates to the rear of the forearm. 08/23/1984 an operation was performed according to the method described above. Intravenous anesthesia with a bleeding cuff on the shoulder. Longitudinal cuts were made along the ulnar and radial sides of the right forearm at the level of the radial joint. With elbow access, the neck of the ulna is freed from the soft tissues for 1.5 cm along the circular surface of the bone. Bone channels were drilled from the radial approach with an electric drill at the level of the radicular joint in the transverse direction on the radial bone epimetaphysis: one channel is proximal, the other channel is distal. As an autograft, a tendon of the long palmar muscle of the same arm was used, which was reinforced with silk thread along the entire length of the graft. One end of a reinforced autograft using a flexible conductor passed through the distal bone channel of the radius. Further, bypassing the tendon loop around the head of the ulna, the same end of the graft was passed through the proximal bone channel in the opposite direction. Pulling at both ends of the graft, the elbow bone head was put in place and, without loosening the traction, the ends of the graft were tied into a knot. The free ends of the node were fixed to the graft. In the neutral position, the bones of the forearm were fixed with two knitting needles for a period of 4 weeks (Fig. 2). Hemostasis. Skin sutures before drainage. Alcohol dressing. Gypsum. Primary healing. Skin sutures were removed after 14 days. The spokes are removed 4 weeks after surgery. Next, physiotherapy was carried out at the place of residence.

On April 24, 2006, that is, 22 years after the operation, a second examination was performed. The range of motion in the right wrist joint is complete. Rotational movements of the right forearm are not limited. Symptoms of dislocation of the head of the ulna are not (Fig.3). The result of the operation, the patient is very satisfied even at a long time after the operation (Fig.4-6).

Thus, the proposed method for restoring the distal radiolarnar joint of the forearm allows to eliminate the chronic dislocation of the head of the ulna, to exclude instability in the distal radiolar articulation and to restore the rotational movements of the forearm.

Information sources

1. Korzh A.A., Bondarenko N.S. Damage to bones and joints in children. Kharkov, Prapor., 1994, 445 p.

2. Ashkenazi A.I. Hand surgery Moscow, Medicine, 1990, p. 212-212.

3. Boychev B, Conforti, Chokanov. Operative orthopedics and traumatology. Sofia, 1961, p. 311-312.

Claims (1)

A method for restoring the distal radiolarnar joint of the forearm, including access to the joint, the formation of channels and autotendoplasty, characterized in that two longitudinal cuts are made along the radial and ulnar sides of the forearm, at the level of the radialarnar articulation, the neck of the ulna is exposed, through the distal radial epimetaphysis of the radius in the frontal plane two transverse channels are drilled: proximal and distal, the end of a free reinforced autograft is carried out through the distal channel with the beam side of the forearm to the ulnar side, then, by looping around the neck of the ulnar bone, the transplant is carried out through the proximal canal in the opposite direction, the head of the ulna is fixed in the articular groove of the radius bone, the ends of the graft are tightened, tied with a knot, attached to the graft, the forearm bones are fixed in neutral position with two knitting needles for four weeks.

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