RU2651118C2 - Treatment of medial fractures of thigh - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to traumatology and orthopedics and may be used for osteosynthesis of medial femoral neck fractures. Diaplasis is performed. Incision is made in the subject area. Spokes are introduced into the thigh and the femoral head from the upper third of the thigh at an angle of 30°. In addition, from the upper end of the incision parallel to the inserted spokes, the spokes are held in the neck, the femoral head and the external part of the acetabulum.

EFFECT: method ensures stability of fixation.

1 cl

Description

In the modern treatment of bone fractures, osteosynthesis methods are required, in which strong fixation with low tissue trauma is achieved. Fusion of bone fractures occurs by the formation of primary and secondary tension, when there is a periosteum at the fracture site. And where it is not there, fusion is only primary or direct healing due to the endostomy of the bone marrow reticular cells, as in a fracture of the femoral neck. Endosteal young callus is easily vulnerable, traumatic and requires careful treatment. In the formation of bones, as well as in the formation of corns, the mechanical factor is of great importance. Powels pointed out that the forces acting perpendicular to the plane of the bone fracture favor the process of corn formation, and the tensile forces, cutting and rotating, are unfavorable. Bone fusion of fragments during neck fractures is possible only with primary or direct healing of the fracture. This is achieved only with an exact comparison, close contact, complete and prolonged immobilization of fragments (A. V. Kaplan “Closed injuries of bones and joints.” Moscow, 1967, pp. 307-308).

We studied the acting forces on the fragments of the femoral neck. The axis of the femoral neck is 128 °. When calculating the acting forces on the upper third of the femur (body weight, muscle traction), the load axis passes from the upper outer half of the femoral head through the arc of the neck to the upper third of the thigh and is 150-160 degrees (Fig. 1). We introduce the spokes parallel to the load axis so that the action of the retainer and the acting force coincide. If the latches create rapprochement and stability of the fragments of the femoral neck, then their knocking together leads to their fusion. To bring the current forces closer, the locking spokes were introduced from the upper third of the thigh at an acute angle of 30 ° (patent for invention No. 2181266). With the introduction of knitting needles at angles of 30 °, the treatment results improved.

With medial fractures in the neck of the femur, the blood supply to the femoral head is sharply disrupted, which leads to non-healing of fractures, the development of aseptic necrosis and other complications. The proximal fragment of the osteoporotic femoral neck is often small, unstable and difficult to achieve. This is the reason that with osteosynthesis of a neck fracture in 10-20% of cases of bone fusion does not occur. Aseptic necrosis of the head of the femoral neck fractures is observed in 10-15% of cases (A.V. Kaplan, p. 328). This was the reason that joint prosthetics began to be used for medial fractures of the femoral neck.

For all intraarticular fractures, complete and prolonged immobilization of fragments with fixation of the joint is indicated. With a fracture of the femoral neck, fixation of the hip joint is also indicated.

With “subcapital fractures, the transarticular location of the nail increases the strength of fixation and improves fracture fusion” (G. S. Yumashev, V. A. Epifanov “Surgical traumatology and rehabilitation of patients ...” Moscow, 1983, pp. 195-196). The best fixation of fragments of the femoral neck is achieved with 2-2.5 mm spokes than with thick retainers. For stability of fracture fixation, we also introduced spokes to the bottom of the acetabulum along the load axis in the upper third of the thigh. When introduced into the cortical bone, the spokes in the upper third of the thigh at an angle of 30 ° sometimes change their course, so the canal in the cortical bone is made with a 2 mm drill, which contributes to the correct and stable course of the spokes.

A distinctive feature of the proposed method is the trans-articular fixation of fragments of the femoral neck with spokes from the pectoral region of the thigh for the acetabulum, which stabilizes the short and mobile proximal fragment. The ends of the spokes are fixed in the cortical parts of the bone and stably fix the fragments, which creates the conditions for the fusion of a femoral neck fracture. Spokes 2 and 2.5 mm have a larger adhesion area to the spongy bone than a 6 mm retainer. The cortical canal, made with a 2-mm drill, contributes to the stable and correct course of 2.5 mm spokes. Aftercare is carried out on a functional bed. These proposals indicate the "inventive step" of the proposed method.

Description of the method of osteosynthesis of the femoral neck

On the orthopedic table, field treatment, anesthesia of the fracture area or anesthesia are performed. Reposition of fragments. In the region of the upper third of the thigh and hip joint, 2 Kirschner spokes are laid, focusing on the fracture area. X-ray control. The skin is treated and anesthetized along the outer surface of the subtrochanteric region. From a large trochanter in the upper third of the outer surface of the thigh, a skin incision of 6 cm is made. The wound expands. On the basis of a large trochanter in the cortical layer on both sides of the bone, a 2 mm drill is drilled parallel to the axis of the limb, at an angle of 30 °, 4 bone marrow channels (Fig. 2 and 3). It is indicated: a femoral neck fracture - 6, a needle channel - 7, a spoke in the femoral head - 8, an acetabulum - 9, a spoke in the acetabulum - 10.

Focusing on the knitting needle, we introduce 2.5-mm knitting needles into the bony canals in the neck and femoral head. X-ray control. We bend the protruding ends of the knitting needles at the exit from the bone and cut them off at a distance of 1.5 cm. Expanding the ends of the knitting needles, we lay them on the bone surface. Fragments of the femoral neck are knocked together as a compactor. From the upper end of the wound, parallel to the knitting needles, we introduce three to four 2.5 mm knitting needles into the neck, head and outer part of the acetabulum to a depth of 1.5-2 cm at an angle of 30 °. We cut off the protruding ends of the knitting needles at the exit from the bone at a distance of 1 cm In the outer section, the thickness of the acetabulum reaches 3 cm. We check the stability of the fixation of the joint. X-ray control. Sew the wound, dressing. The hip joint is fixed with Cramer splints.

The patient is laid on a functional bed. The patient is partially seated from the 1st day. The patient needs to be turned on a healthy side with a mattress between his legs. Exercise therapy is carried out, drug therapy. The patient is placed on crutches from the 10th day. After removing the stitches - is discharged home. At home, the patient is seated on the edge of the bunk with his foot down. The patient is hospitalized after 2-2.5 months for examination and removal of the spokes from the acetabulum. After 6 months of treatment, the patient is put on his feet.

Claims (2)

1. The method of osteosynthesis of medial fractures of the femoral neck, including reposition of fragments, incision in the undertrochanteric region, insertion of spokes into the neck and femoral head from the upper third of the femur, characterized in that the spokes in the neck and femoral head are carried out at an angle of 30 °, additionally from the upper end cut parallel to the introduced spokes spend the needles in the neck, femoral head and the outer part of the acetabulum. 2. The method according to p. 1, characterized in that in the postoperative period, physiotherapy exercises are carried out on a functional bed.

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