RU2718270C1 - Method for fixation of meta-epiphysial fractures of hand bones - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to traumatology and orthopedics, can be used in surgical treatment of transverse, oblique, intra-articular, spiral and other unstable hand tubular bones fractures. For osteosynthesis, a wire is used, a portion of which is subjected to annealing with subsequent cooling to a temperature which preserves plasticity of the wire material, but does not destroy bone tissue. Specified length of the part of the wire is subjected to treatment, which is determined taking into account that after the treated part is inserted into the bone, it should protrude from both sides. Thereafter, the wire is inserted into the bone with non-annealing end, carried through fragments and the fracture line, the treated portion is placed into bone. Non-annealing part of the wire is bitten, and the ends of the processed part of the wire protruding from the bone are bent.

EFFECT: method provides early restoration of the full hand function and stable fixation of the area of meta-epiphysial hand tubular bones fractures by osteosynthesis with a wire retaining its plasticity.

1 cl, 2 ex, 2 dwg

Description

The invention relates to medicine, namely to traumatology and orthopedics, can be used in surgical treatment of transverse, oblique, intraarticular, spiral and other unstable fractures of the tubular bones of the hand.

A known method of fixing a fracture of the tubular bones of the hand (RU 2322210, C2), which we have chosen as a prototype. It involves the formation of an external skeleton, passing the knitting needles through the fragments with securing its ends on the external skeleton, holding the knitting needles through the fragments, providing compression in the fracture zone. In this case, the outer frame is formed at the level of the damaged phalanx, the base spoke is passed transversely in the frontal plane through the base of the damaged phalanx, its ends are bent at right angles, departing from the skin, and the ends of the spokes are connected to form a rectangular frame. Then, the needle is passed through the distal fragment of the damaged phalanx in the same plane parallel to the base needle, the fragments are aligned along the axis with simultaneous reposition, and the needle is fixed on the frame.

This method has the following disadvantages: loss of function of the brush for a long time (1-1.5 months); the risk of contractures, the development of purulent complications in the places of exit of the spokes is not excluded; subjective discomfort for the patient, unstable osteosynthesis due to the L-shaped bending of the knitting needle.

In addition, the prototype method requires 4 to 6 spokes through the distal and proximal fragments. The disadvantage of this method is that the introduction of solid knitting needles into the bone often leads to destruction of the bone (joint), and the fixation of bone fragments due to insufficient flexibility of the knitting needle is traumatic and unreliable.

This method lengthens and complicates surgical treatment due to the fact that the external frame is formed and the need for many spokes through fragments.

The technical problem lies in the early restoration of the function of the hand in full with adequate fixation of the zone of metaepiphyseal fractures of the tubular bones of the hand.

The technical result achieved by the implementation of the invention is:

- while ensuring early restoration of the full function of the hand and stable fixation of the metaepiphyseal fractures of the tubular bones of the hand;

- prevention of the development of flexion contractures of the metacarpophalangeal and interphalangeal joints;

- achieving reliable fixation during osteosynthesis of comminuted, oblique, and other unstable fractures of the metacarpal bones of the hand;

- prevention of purulent-septic complications due to the exclusion of the formation of the external frame and the conduct of a large number of spokes.

These technical results are achieved due to the following set of essential features:

- for osteosynthesis, a spoke is used, part of which is fired before being inserted into the bone, followed by cooling to a temperature that preserves the plasticity of the spoke material, but does not destroy bone tissue,

- the processing is subjected to a predetermined length of the knitting needle, determined taking into account the fact that after installing the treated part in the bone, it should protrude outward from both sides,

- after which the needle is inserted into the bone with an unfired end, carried through the fragments and the fracture line, the treated part is placed in the bone,

- bite the unburned part of the knitting needle, and the ends of the treated part of the knuckle protruding from the bone, bend.

The developed method allows to simultaneously eliminate the instability of the fracture and maintain the anatomical and physiological relationships in the joints, without interfering with the physiological mobility of the fingers.

The method involves the use of a specially processed spoke (it is advisable to use a spoke made of medical stainless steel X18H10T, diameter 1.5 mm, length 200 mm), bringing it into a plastic (soft) state. This allows you to prevent bone destruction during bending of the spokes and to increase the reliability of fixation, as well as to carry out surgical treatment without additional bone reaming, to do without secondary displacements of bone fragments.

To give the desired consistency, we fired the spoke, followed by its sharp cooling. With sudden cooling, the bonds in the crystal lattice are broken. At this moment, the metal passes from the crystalline state to the amphoteric one. With rapid cooling, the crystal lattice does not have time to recover completely, as a result, the material acquires uncharacteristic properties (soft form).

Thus, the proposed method allows to simultaneously eliminate the instability of the fracture and preserve the anatomical and physiological relationships with metaepiphyseal fractures of the tubular bones of the hand, without interfering with physiological mobility, as well as simplify the method of surgical treatment and avoid the development of purulent complications at the exit points.

The method we developed makes it possible to facilitate and accelerate surgical treatment for transverse, oblique, intraarticular, spiral and other unstable fractures of the tubular bones of the hand, as well as to begin early (in the first days after the operation) active movements, thereby reducing the period of disability of patients.

Performing closed osteosynthesis according to the proposed method allows you to create the most favorable conditions for the fusion of bone fragments due to the fact that only the burnt (soft) part of the spoke remains in the bone.

In the early postoperative period, it is possible to carry out early activation of the patient in the scope of rehabilitation measures without fear of secondary displacements due to stable osteosynthesis, as well as not to carry out additional postoperative immobilization, which is especially important in the treatment of metaepiphyseal fractures, since prolonged external immobilization can adversely affect motor functions . The minimum operational access used in the patented method significantly reduces the invasiveness of the intervention.

The invention consists in the following.

For osteosynthesis of metaepiphyseal fractures of the tubular bones of the hand, one spoke is used. One end of the spoke is subjected to the following treatment: before being inserted into the bone, it is first fired (firing is optimal at a temperature of 450 ° C) and then cooled (optimal from the point of view of preserving the plasticity of the spoke material and not destroying bone tissue is cooling to a temperature of 10 ° C, achieved on average within 2-5 minutes). The treated spoke with an unburned end outside the joint is drawn through the fragments and the fracture line so that its burnt portion is located inside the bone and protrudes outward from its two sides, and the lengths of the protruding ends are equal to each other. Then they bite the unbaked part of the knitting needle, and the ends of the baked part of the knitting needle are bent.

The invention is illustrated by the following figures:

in FIG. 1 shows the passage of knitting needles through fragments;

in FIG. 2 shows the bending of the ends of the burnt part of the spoke;

Where:

1 - the first fragment of a bone fragment;

2 - the burnt part of the knitting needle;

3 - the second fragment of a bone fragment;

4 - unburnt part of the knitting needle.

The method was carried out as follows.

In the surgical treatment of transverse, oblique, intraarticular, spiral and other unstable fractures of the tubular bones of the hand, a closed reposition is carried out under the control of an electric - optical transducer (EOP) and osteosynthesis with a spoke.

For osteosynthesis, a spoke is used, one end of which is burned on a gas burner, and then sharply cooled.

In this case, before the end of the spoke is introduced into the bone for processing, the end of the spoke is first fired, before glowing - until the needles appear red during firing, and then immediately sharply cooled, for which they are placed in a cooled physiological solution. After a sharp cooling, the needle becomes soft. The length of the needles is chosen individually depending on the type of fracture and the fixed segment of the metacarpal bone or phalanx of the finger.

One end of the selected spokes is fired followed by cooling, as shown above. A needle is drawn outside the joint through fragments and a fracture line, leading its end to the opposite side of the bone (Fig. 1). The introduction of the knitting needle begins with an unburned end and the introduction ends when the baked end of the spoke extends from the opposite side of the bone. Thus, through the fragments and the fracture line, the burnt part of the spoke is drawn, and the ends of the burnt part should go out on both sides of the bone and be equal to each other in length.

In this case, the bone is drilled with the unbaked end of the spoke, and the baked end of the spoke is clamped in a drill. After the unbaked part of the spoke passes through the fragments, its free end is clamped and drilling continues until the baked part of the spoke enters the fragments.

The unbaked part of the knitting needle is bitten, and the ends of the baked part of the knitting needle located outside the bone are bent, ensuring the fixation of the fragments (Fig. 2).

Then apply an aseptic dressing. The limbs give an elevated position, locally apply hypothermia. The dressing is changed if it gets wet with blood.

After the pain subsides from the 2nd day, active-passive gymnastics begins, aimed at developing movements in the fingers of the hand. The needle is removed 6 weeks after surgery with a minimum of point access through a minimum incision of 3 mm puncture. The spoke is removed without technical difficulties due to its mild condition.

The proposed method for surgical treatment of transverse, oblique, intraarticular spiral and other unstable fractures of the tubular bones of the hand allows you to get a stable fixation, in which the “soft” spoke does not destroy the bone during surgical treatment.

Clinical example 1.

Patient S., 27 years old, was admitted to the clinic a day after the injury. Diagnosis: closed oblique metaepiphyseal fracture of the fifth metacarpal bone of the right hand. Upon admission, the limb is immobilized by a plaster cast. After preoperative preparation, the operation was performed according to the proposed method, while the needle was cooled to a temperature of 10 ° C for 2 minutes. Plaster immobilization was not carried out. An aseptic dressing was applied. Discharged from the hospital on the 2nd day after the operation. The observation was 6 months, the range of motion in the joints of the fingers of the hand was fully restored.

Clinical example 2.

Patient L., 39 years old, a musician (guitarist) by profession entered the clinic 3 days after the injury. Injury was received when falling from his own height to the right upper limb. The diagnosis was made: closed oblique fracture of the main phalanx of 4 fingers of the right hand. After preoperative preparation, the patient underwent surgery. Closed reduction, osteosynthesis of a burnt knitting needle in accordance with the proposed method, while the needle was cooled to a temperature of 10 ° C for 5 minutes. The operation was performed under a tourniquet in the lower third of the forearm of the right upper limb, as well as under conduction anesthesia. The patient was discharged for outpatient aftercare 2 days after surgery. The observation was 8 months, the range of motion in the joints of the fingers of the hand was restored completely, continues his professional activities (guitarist).

Claims (1)

A method for fixing metaepiphyseal fractures of the tubular bones of the hand, in which one needle is used for osteosynthesis, a part of which is fired before being inserted into the bone, followed by cooling to a temperature that preserves the plasticity of the material of the knitting but not destroying the bone tissue, and the treatment is subjected to a predetermined length of the knitting needle, defined taking into account the fact that after installing the treated part in the bone, it should protrude outward from two sides, after which the needle is inserted into the bone with an unfired end, is passed through the fragments and a fracture line, the treated part is placed in the bone, the unburned part of the spoke is bitten, and the ends of the treated part of the spoke, protruding from the bone, are bent.

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