RU2407476C1 - Method of operative treatment of isolated fracture of shin bone in children - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to traumatology and orthopedics. Transcutaneous introduction of pins is carried out through fibular bone to shin bone, above and below its fracture zone. Into each of bone fragments of shin bone pins are introduced in pairs, at acute angle to each other, from level of fibular bone, corresponding to middle third of fixed fragment, in direction to fragment ends. In fibular bone pins are introduced at distance 0.5-1.0 cm from each other, with crossing on border of skin. Free ends of pins are left above skin and fastened in apparatus of external fixation, which consists of lath with openings and pin-fixers of standard set of Ilizarov's external fixer.

EFFECT: method ensures stable fixation of fragments with minimal quantity of fixing pins, reduction of trauma, reduction of apparatus weight and size.

1 ex, 5 dwg

Description

The invention relates to medicine, namely to traumatology - orthopedics, and can be used to treat isolated fractures of the tibia in children.

From the literature it is known that isolated fractures of the tibia are often found in childhood. Their characteristic feature is the absence of a concomitant fracture of the fibula, the oblique or helical nature of the fracture line, with a slight (allowable) displacement of bone fragments. The reason for this is the splint function of the intact fibula, which quite firmly holds fragments of the tibia through the interosseous membrane. However, conservative treatment of these fractures with a fixative bandage often leads to secondary displacement of bone fragments, which is the basis for the primary surgical treatment of such fractures [1].

A known method of surgical treatment of bone fracture of the leg in children by percutaneous injection into the tibia, through the fracture zone, two cross-spoke. The needles are passed through the shin through, their ends are placed above the skin, and the lower limb is fixed with a plaster cast to the buttock fold, with its transfer in a circular plaster bandage 5-7 days later [1]. However, this method has several significant disadvantages. Holding the spokes directly through the fracture zone, with the cutaneous arrangement of their ends, can lead to infection of the fracture, the development of the osteomyelitis process, and the slowing down of bone fusion processes, up to the formation of a false joint. Fixation of the lower limb with a high plaster cast significantly complicates the patient's ability to move freely, and contributes to the development of contractures in adjacent joints. The gypsum dressing, and especially its circular version, significantly complicates the dressing of the cutaneous ends of the fixing knitting needles, which requires the creation of special “windows”, which reduces the strength and, accordingly, the fixing properties of the dressing at the fracture level. In case of inaccurate knitting of needles or careless behavior of the patient, especially at relatively late periods of treatment, when bone resorption occurs around the spokes, even despite the protective function of the plaster cast, the spokes can be partially and even completely removed from the bone with impaired fixation, secondary displacement of fragments.

The closest, in terms of its technical solution, the claimed method is the “Method of osteosynthesis of metadiaphyseal fractures of the lower leg” with a fracture of the fibula in the upper third and the tibia in the lower third. The method includes closed intraosseous osteosynthesis of the tibia, transdermal introduction of 2-3 parallel spokes, through the distal fragment of the fibula, into the tibia above and below the zone of its fracture, in the transverse direction, with the free ends of the spokes subcutaneous [2].

The method uses the splint function of the tibia, which, in view of the anatomical features, is located as close as possible to the tibia and, thus, is an intermediate fixation between the bone osteosynthesis and osteosynthesis in the external fixation apparatus. The method avoids such a significant drawback of the previous method, as the spokes through the fracture zone with the possibility of infection. The subcutaneous arrangement of the free ends of the spokes eliminates the need for their dressing. The absence of a plaster cast is the prevention of the development of contractures in adjacent joints.

However, like the previous method, this method has a number of significant drawbacks. Intraosseous osteosynthesis of the tibia is undesirable in pediatric practice due to the possibility of damage to the growth zones, which subsequently can lead to impaired limb growth. In addition, it increases the severity and increases the time of surgical treatment. The subcutaneous arrangement of knitting needles in pediatric practice requires repeated surgical intervention under general anesthesia. With careless behavior of the patient, migration of spokes may occur with perforation of the skin and, accordingly, the possibility of infection of soft tissues.

The essence of the invention lies in the combination of distinctive features sufficient to achieve the desired technical result, and consisting in increasing the effectiveness of surgical treatment of isolated fractures of the tibia in children by improving the technique of osteosynthesis.

The invention consists in the transdermal insertion of spokes through the fibula into the tibia, above and below the zone of its fracture. In each of the bone fragments of the tibia, the spokes are introduced in pairs, at an acute angle to each other, from the level of the fibula corresponding to the middle third of the fixed fragment, towards the ends of the fragment. Knitting needles are inserted into the fibula bone at a distance of (0.5-1.0) cm from each other, with a cross at the border of the skin. The free ends of the spokes are left over the skin and fixed in the external fixation apparatus, consisting of a strap with holes, and special fixators of the standard set of Ilizarov apparatus.

The presence of four spokes that stabilize fragments of the tibia at the level of their metaphysical divisions and near the fracture area is a condition for the most stable fixation with a minimum number of fixation spokes.

Holding the spokes at an acute angle to each other, from the level of the fibula corresponding to its middle third, towards the ends of the fixed fragment, provides the same fixing properties of both the proximal and distal spokes in each pair.

The cutaneous arrangement of the spokes eliminates the need for repeated surgical intervention to remove them. In this case, the introduction of knitting needles into the fibula is carried out at an acute angle to each other, at a distance of (0.5-1.0) cm from each other, depending on the age and constitution of a particular patient. The cross at the border of the skin reduces the number of “entry gates” for infection and makes it easier to care for the places where the knitting needles exit, as it makes it possible to simultaneously bind two knitting needles simultaneously.

The location of the spokes at an angle to each other and fixing them in the apparatus creates the conditions for fixing each pair of spokes in the bones of the lower leg according to the type of anchor, which prevents their free movement in the bone. This eliminates the possibility of accidental extraction or perforation of the skin on the opposite side of the lower leg with improper dressing or careless behavior of the patient.

The use of an external fixation apparatus, consisting of parts of a standard set of Ilizarov apparatus [3], which is widespread in hospitals of a traumatological profile, allows the proposed method to be widely applied in practice.

The simple design of the external fixation apparatus in the form of a strap with holes and special fixators allows minimizing the weight of the apparatus and its dimensions, which facilitates the care of the apparatus and also increases the patient's mobility.

The method is illustrated by drawings. Figure 1 presents a diagram of an isolated fracture of the tibia in the frontal plane after surgical treatment according to the proposed method, where 1 and 2 are the distal pair of spokes, 3 is the fracture line of the tibia, 4 and 5 is the proximal pair of spokes, 6 is the proximal fragment of the tibia bones, 7 - fibula, 8 - strap, 9 - special fixators of the proximal pair of knitting needles, 10 - free holes of the plate, 11 - special fixators of the distal pair of knitting needles, 12 and 13 - outer and inner borders of the skin of the lower leg, respectively, 14 - dis cial otlomok tibia. Figure 2 presents the x-ray of a clinical case before treatment. Figure 3 and 4 presents the radiographs of the clinical case after performing surgical treatment according to the proposed method in the front and side projections, respectively. Figure 5 presents a photograph of a clinical case after performing surgical treatment according to the proposed method.

The method is as follows.

Focusing on clinical and radiological data, using a drill, draw the spoke 4 through the fibula 7 at a level corresponding to the middle third of the fixed (proximal) fragment of the tibia 6 at the distal end of this fragment. After passing the opposite tibial cortical, the introduction of the spoke 4 is stopped. Then carry the spoke 5 to the proximal end of the fixed fragment 6 at an angle to the spoke 4, departing from it upward (0.5-1.0) cm, depending on the age and constitution of a particular patient. The knitting needles are carried out so that a cross of knitting needles 4 and 5 is formed on the outer border of the skin of the lower leg 12. After passing the opposite tibial cortical, the introduction of the knitting needle 5 is stopped. In a similar manner, a pair of knitting needles 1 and 2 is installed in the distal fragment of the tibia 14. Then, the cutaneous ends of the knitting needles 1, 2, 4 and 5 are fixed to the strap 8, in the holes 10 located on it, using pairs of special fixators 9 and 11.

Clinical example.

Patient M., 2.5 years old, East. bol. No. 6974. He entered the Scientific Research Center "WTO" in December 2008 at the front desk, with complaints of pain, swelling of the soft tissues of the left lower leg. The circumstances of the injury - falling on the street. Clinical and radiological examination of the child revealed a closed helical fracture of the right tibia in the lower third with an allowable displacement (figure 2). Under general anesthesia, under aseptic conditions, after processing the surgical field, osteosynthesis of the fracture was performed according to the proposed method. The ends of the spokes are fixed in the external fixation apparatus assembled from the parts of the standard set of the Ilizarov apparatus. Performed x-ray control in two projections (figure 3 and 4). Two sterile wipes with a half-alcohol solution were applied at the exit points of the spokes (Fig. 5). In the postoperative period - the device is covered with a tissue cover of small sizes. Needle dressing 2 times a week, there are no complaints about the uncomfortable position of the limb in bed. The child began to step on the foot at the end of the second week after the operation, the removal of the device and removal of the spokes - for a period of 6 weeks on an outpatient basis. Full restoration of limb function - 10 days after the dismantling of the apparatus.

Information sources

1. Bairov G.A. Children's traumatology. St. Petersburg, 2000, S.316-318.

2. RF patent No. 2028107, A61B 17/56, BI No. 4, p. 99, 1995

3. Osteosynthesis: A Guide for Physicians, Ed. S.S. Tkachenko, - L .: Medicine, 1987, S.124-127.

Claims (1)

A method for the surgical treatment of isolated tibial fractures in children, including transdermal insertion of spokes through the tibia into the tibia, above and below the zone of its fracture, characterized in that the spokes are introduced into each of the bone fragments of the tibia in pairs, at an acute angle to each other, from the level of the fibula corresponding to the middle third of the fixed fragment, towards the ends of the fragment, while in the fibula of the knitting needle is introduced at a distance of 0.5-1.0 cm from each other, with a cross at the border likely impacts sheets, the free ends of the spokes leave the skin and secured to the external fixation device consisting of a strap with holes and spitsefiksatorov standard set Ilizarov.

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