RU2357692C1 - Method of surgical treatment of comminuted fractures of proximal part of upper arm bone with strained pins - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention pertains to medicine, in particular to traumatology and orthopedics, and is intended for surgical treatment of patients with comminuted fractures of proximal part of the upper arm bone. Dislocated big and lesser tubercles are fixed without exposition of the fracture site by insertion of Kirshner pins intramedullarly through perforation openings in external cortical layer of diaphysis of the upper arm bone. Pins are directed through the tubercles, pulled to the surface of the arm, their periphery ends are bent into the mooring - shape. Traction is conducted and central ends of the pins are bent on the surface of the upper arm bone, so that periphery ends of the pins fit counters of tubercles.

EFFECT: joint function recovery, stable fixation of bone fragments, reduced traumatism, prevention of post-surgical complications.

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Description

The invention relates to medicine, namely to traumatology and orthopedics, and is intended for surgical treatment of patients with comminuted fractures of the proximal humerus.

A known method for performing osteosynthesis of comminuted fractures of the proximal humerus using screws and an 8-shaped wire loop (M.E. Muller, M. Allgover, R. Schneider, X. Willinger // Guide to internal osteosynthesis. Method recommended by the AO group - Springer-Verlag. - 1996 - M. Ad Marginem. S.439-441).

The disadvantages of this method are: high invasiveness of the operation, wide exposure of the humerus is required; high probability of aseptic necrosis of bone fragments; high specific pressure of the wire on the bone tissue is complicated by the possibility of its eruption, the requirement of additional external immobilization for a long time.

A known method of osteosynthesis of metaepiphyseal fractures using the device - RF patent No. 2228723 (A61B 17/56, 17/58. Authors Kashansky Yu.B., Bessaev G.M., Shapot Yu.B., Kozhevin AA, Pivnyuk BC , Radysh V.G., Kucheev I.O., Kuzmin V.A.), which consists in introducing the external screw shaft into the proximal fragment and short diverging spokes into the distal fragment and fixing them in the fixation nodes.

The disadvantage of this method is that biasing forces acting on the fragments due to muscle traction lead to loosening of the device and, as a result, to a decrease in the rigidity of fixation of fragments, which creates conditions for inflammation of soft tissues and bones and increases the likelihood of device migration, as well as a sharp restriction of active movements in the shoulder joint in the early postoperative period.

A known method for the operative fixation of fractures of the surgical neck of the humerus, see RF patent No. 2231320 (АВВ 17/56), authors Lazarev AF, Nikolaev VM, Malt E.I., based on the introduction of intramedullary γ-shaped knitting needles in two mutually perpendicular planes from the minimum accesses. The disadvantage of this method is the lack of fixation of dislocated bone fragments (large and / or small tubercles), which does not allow for active movements in the shoulder joint in the early postoperative period. This method is adopted as a prototype.

The aim of the proposed method for the surgical treatment of comminuted fractures is to eliminate the above disadvantages, which allows for stable osteosynthesis of comminuted fractures of the proximal humerus.

To achieve the medical-technical result of the proposed method, we perform it in stage II. The first step in the methodology chosen for the prototype is to make a closed manual reposition of the fracture under the control of an electron-optical transducer (EOP), perform osteosynthesis with strained knitting needles, which ensure the strength of fixation of the main fragments (head and diaphysis of the humerus). The second stage is a closed reposition of dislocated bone fragments (large and / or small tubercles) and fixation by strained knitting, which reduces the likelihood of secondary displacements of fragments, the absence of external immobilization in the postoperative period, the possibility of early development of movements in the shoulder joint, and reduction of treatment time.

The inventive method is illustrated by drawings.

The method is as follows: the position of the patient on the back. The entire operation is carried out under the control of the image intensifier. After performing stage I according to the method of the method selected for the prototype (Figure 1), in a neutral position of the upper limb in the shoulder joint, a closed reposition of the large tubercle is made and held with an awl, through a separate puncture on the surface of the shoulder joint. Retrograde, through the existing cortical opening on the outer surface of the diaphysis of the humerus, the Kirschner needle is inserted into the medullary canal. At the same time, when passing through the medullary canal, the “reflection” from the opposite cortical wall takes a curved shape, receiving primary tension. The needle is passed through a large tubercle to the surface of the head of the humerus and the peripheral end of the spoke is brought to the surface of the shoulder joint through a separate puncture of the skin. The end of the needle is bent, giving it the shape of an anchor. The central end of the spoke is pulled by traction, while the peripheral end of the spoke is immersed in soft tissue through a small skin incision, fitting the contours of a large tubercle. The central end of the spoke is bent on the surface of the diaphysis of the bone, it is tensioned, giving secondary tension to the spoke.

In case of fracture of a small tubercle in the position of the external rotation of the shoulder, an intramedullary needle is inserted through the cortical hole on the front surface of the diaphysis of the humerus. At the same time, when passing through the medullary canal, the “reflection” from the opposite cortical wall takes a curved shape, receiving primary tension. The needle is passed through a small tubercle to the surface of the head of the humerus and the peripheral end of the spoke is brought to the surface of the shoulder joint through a separate puncture of the skin. The end of the needle is bent, giving it the shape of an anchor. The central end of the spoke is pulled by traction, while the peripheral end of the spoke is immersed in soft tissue through a small skin incision, fitting the contours of a small tubercle. Bend the central end of the spoke on the surface of the diaphysis of the bone, it is tensioned, giving secondary voltage to the spoke (Figure 2). Under the control of the image intensifier, a fixation stability test is performed, i.e. create the full range of movements in the shoulder joint, by performing passive movements (flexion, extension, abduction, external and internal rotation).

An example of practical application.

Patient Gracheva LS, 63 years old, medical history No. 1548, was hospitalized on the 2nd day after receiving an injury with a diagnosis of: Cellular fracture of the surgical neck of the right humerus with separation of both tubercles with displacement of fragments (Figure 3). Under the control of the image intensifier, a closed manual reduction of the fracture and osteosynthesis by strained knitting were performed (Figure 4). The day after the operation, active physiotherapy exercises with movements in the shoulder joint were started. In the postoperative period, additional external immobilization was not performed. The patient was discharged on the 14th day after surgery for outpatient treatment. Eight weeks after the operation, the control radiograph revealed a fracture fusion, joint function was fully restored. 7.5 months after osteosynthesis, strained knitting needles were removed (Figs. 5, 6). A patient with a limb function is satisfied; she serves herself independently.

According to this method, 9 patients were operated, of which 7 patients had fixation of a large tubercle, 2 patients had fixation of both tubercles. In 8 patients, the function of the injured limb was restored, the existing restrictions on movements within 15-20 degrees do not constrain movements and do not impede self-care. In one patient, limb abduction was 90 degrees, a patient with limb function was satisfied, serving herself independently.

List of figures

Figure 1 - scheme of osteosynthesis of the neck of the shoulder with strained knitting needles.

Figure 2 is a diagram of the fixation of tubercles with strained knitting needles:

1 - a large tubercle;

2 - small tubercle;

3 - strained knitting needles fixing the neck of the shoulder;

4 - strained knitting needles fixing tubercles.

Figure 3 - x-ray of the right shoulder joint after injury.

Figure 4 - radiograph of the right shoulder joint after surgery.

5 is a radiograph of the right shoulder joint 7 months after surgery. Fused fracture of the neck and tubercles of the humerus.

6 is a radiograph of the right shoulder joint after the removal of strained knitting needles.

Claims (1)

A method for surgical treatment of comminuted fractures of the proximal humerus with strained knitting needles, comprising introducing the spokes under the control of an electron-optical transducer from minimum accesses, characterized in that the dislocated large and / or small tubercles are fixed without exposing the fracture site through insertion through perforations in the external cortical the layer of the diaphysis of the humerus of the Kirschner knitting needles is intramedullary, while the needles are passed through the tubercles, brought to the surface of the shoulder, zags their peripheral ends, giving them the shape of an anchor, traction and bend the central ends of the spokes on the surface of the humerus so that the peripheral ends of the spokes fit the contours of the tubercles.

Images