RU2722355C2 - Device for reduction and retention of bone fragments of spongy bones during their osteosynthesis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to traumatology and orthopaedics, and aims at reduction and retention of bone fragments of spongy bones during osteosynthesis. Device for reduction and retention of bone fragments of spongy bones during their osteosynthesis consists of crossing two branches interconnected hingedly with a retainer, the distal ends of which are made in the form of hemispheres bent inwards and forked by sharp cone-shaped working teeth restricted by support platforms. Teeth are equipped with detachable support platforms made with sizes and shapes repeating external surfaces of anatomical forms of locomotor segments from spongy bone. Detachable support platforms are provided with holes for teeth to dosed limiting depth of teeth immersion in thickness of cortical layer of spongy bone fragments.

EFFECT: invention provides improved conditions and reduced risk of additional traumatisation of the structure and feeding blood vessels during reposition and osteosynthesis of cancellous bone fragments.

1 cl, 2 dwg, 1 ex

Description

The invention relates to medicine, namely to traumatology and orthopedics, and is intended for reposition and retention of bone fragments of the spongy bones during their osteosynthesis.

A device for reposition and retention of bone fragments of bones is known, consisting of two jaws hinged together like scissors, the distal ends of which are bifurcated, pointed, cone-shaped, hemispherical bent inward teeth (Shch-90 sharp two-pronged tongs Catalog of Medical Equipment of the Russian Federation, M., 2016-http: //tsmedservice.ru).

The disadvantage of this device is that it is designed to capture and hold compact fragments of the diaphysis of the tubular bones, when the capture of the pointed ends of the teeth of the compact fragments is not dangerous and there is no risk of splitting. It is not intended for the reposition and retention of fragments of the spongy bones, in particular, fragments of the epiphysic-metaphysical parts of the long tubular bones (condyles, patella, sternum, vertebral bodies, and others).

So, when grasping with the pointed conical teeth of the branches of the thin cortical layers of the spongy bones, they can be easily punctured, and their further deepening into the thickness of the fragments with large efforts on the branches, aimed at a dense reposition of the fragments, contributes to additional trauma to the spongy bone structure and the vessels feeding the fragments, up to splitting them into new pieces, causing secondary fractures of parts of one or two fragments.

Our fears are objectively confirmed in the description of the bone base of the musculoskeletal system of the human body, given in the textbook: "Human Anatomy". The diaphysis is a bone tube containing yellow bone marrow, perform the functions of support, protection and movement (levers), consists of a dense compact substance (substantia compacta). The ends of the diaphysis end with epi-metaphyses, consists of a spongy substance (substantia spongiosa), in which there is a red bone marrow with blood vessels, covered with a thin layer of a compact (cortical) substance. (Development of bones // M.G. Pribes., N.K. Lysenkov., V.I. Bushkovich. - Human Anatomy. - St. Petersburg. - 1998. - S. 42-44).

In addition, one of the operating surgeons must constantly fix the jaws of the device with his hands, so that there is no secondary displacement of fragments when the teeth of the device are loosened, thereby requiring additional hands for the osteosynthesis operation, and the second needs to expand the edges of the wound and only the third operator can perform an operative reception osteosynthesis of fragments by plates, screws or other devices.

There is another device for reposition and retention of bone fragments of the patella during osteosynthesis, which differs from the previous device in that its working teeth are equipped with small stops, and the proximal ends of the branches with a retainer, which ensures that the branches are retained in the capture of fragments in a repaired position (Device for reposition of bone patellar fragments, application for utility model of the Republic of Kazakhstan No. 2017/0319.2, authors: Dyusupov A.Z. et al., IPC - А61В 17/58).

This device has an advantage than the previous one, since it frees the hands of one of the operators, but the small tooth stops, when applied to the branches of the device with great effort, easily pierce or break through the thin cortical layers of the spongy bones, leading to the same disadvantages described above. This device is suitable for repositioning only patellar fragments, which do not require much effort to compare them due to the availability of the wound for full visual control and the thinness of the integumentary tissues, which are practically under the skin and have great mobility of fragments in each other's relations. Despite these possibilities described above, in our clinical practice in the trauma department of the BSMP of Semey RK in four cases we observed fractures of the cortical layer of the patellar poles with small abutting sites and sagging of the teeth with stops in the thickness of the patellar fragments with negative consequences.

Thus, the structural features of the above two devices exclude the possibility of stable capture, compression along the fracture line and holding fragments of the spongy bones in a repaired position, without the threat of their additional damage and subsequent surgical procedures for their osteosynthesis. For example, holding knitting needles for fixation or transosseous osteosynthesis, performing control x-rays or images using an image intensifier tube (electron-optical converter), without the risk of secondary displacement of fragments in deep wounds with massive integumentary tissues.

The objective of the invention is the creation of a device for reposition and retention of bone fragments of the spongy bones during their osteosynthesis without trauma to the spongy bones.

A brief description of the drawings of the invention is shown in FIG. 1 and 2.

FIG. 1 is a general view of the device.

FIG. 2 is a diagram of the use of the device.

The technical result is achieved by the fact that the device for reposition and retention of bone fragments of the spongy bones during their osteosynthesis consists of two crossing jaws 1, 2, articulated 3 together, with a retainer 4 at the proximal ends of 5.6. Distal ends 7, 8 of the branches 1.2 are made in the form of hemispheres, bent inward, with forked sharp conical working teeth 9, 10, 11, 12.

In this case, the teeth 9-12 are equipped with removable supporting platforms 13 with sizes and shapes repeating the outer surfaces of the anatomical shapes of the segments of the musculoskeletal system of the spongy bone 14. The removable supporting platforms are made with holes 15 for the teeth 9-12, for a dosed limitation of the immersion depth of the teeth in the thickness of the cortical layer 16, fragments 17-18, cancellous bone 14.

It should be noted that the holes 15 anatomically repeat and correspond to the shapes and sizes of the cone-shaped working teeth 9, 10, 11 and 12 of the jaws 1 and 2 and when they are inserted (9-12) into the holes 15, the sharp ends of these teeth protrude beyond the inner, adjacent to the cortical layer of the spongy bone, supporting sites 13 by 4-5 mm for immersion adhesion with the cortical layer of the spongy bone 14 without the risk of slipping them from the fragments.

The device operates as follows.

Under general anesthesia or conduction anesthesia, the sensitivity of sections of the damaged segment of the musculoskeletal system of the human body is blocked (hereinafter, the patella fracture is taken as an example of a cancellous bone fracture).

Departing from the upper patellar pole by 1 cm by a linear incision along the midline to the lower patellar pole, layer-by-layer access is made to the site of its fracture 19. The skin with subcutaneous tissue is peeled off to the side of the patellar poles, while the broken fascia and the site of fracture of the patella are visualized.

The lower leg is bent at an angle of 30-40 ° until the cavity of the knee joint is exposed. Inspect the contents of the joint. Blood clots are removed from the joint. The joint cavity is washed with hydrogen peroxide solutions, and blood clots, small cancellous bone crumbs are removed from the surfaces of the fragments 17, 18 with a spoon. In the absence of other damage to the joint elements, the lower leg in the knee joint is maximally unbent, which helps to relax the quadriceps muscle attached to the upper pole of the patella and fragments 17, 18 easily come together; the lower surfaces of the fragments lie on the intercondylar area of the femur, automatically reponing them in the sagittal plane, that is, in thickness. In the place of capture with sharp teeth of the pole of the patella, support platforms 13 are slightly concave inward and repeating the anatomy of these sections, and are tightly attached to the surfaces, and teeth 9-12 of the device are installed in their holes in the middle part.

At the same time, bringing jaws 1 and 2 closer together, their working teeth 9, 10, 11 and 12 are tightly put on the holes 15 of the supporting platforms 13 and the sharp ends 4 mm long protruding beyond the inner surfaces of the platforms 13 simultaneously pierce the cortical layers 16 of the patella poles and bring the fragments 17 closer , 18 along the line of their kink 19 to each other, visually controlling their correct matching along the horizontal frontal and sagittal planes. Then they are pressed tightly until the gap between them is completely closed, up to their partial micro-mutual penetration of the spongy structure relative to each other along the plane of their fracture, which excludes their secondary mixing, as additional sources of bonding of fragments to each other during reposition fragments and their osteosynthesis.

The achieved positions of the fragments 17, 18 are stabilized by stationary fastening of the jaws 1 and 2 using the latch 4. On the image intensifier tube in 2 projections, check the correctness of the reposition performed. With the correct comparison of fragments 17, 18, spokes with thrust pads in mutually opposite directions are passed through them and a single-plane transosseous apparatus (not shown) is superimposed. The apparatus of CHO is set to fixation and compression of fragments. The device is removed from the patella. By performing control x-rays, we verify the correctness of osteosynthesis.

Example: Patient S., 42 years old. IS No. 1238 was hospitalized at the BSMP Semey Republic of Kazakhstan on 03.03.2017 with a diagnosis of Closed transverse fracture of the right patella with displacement of bone fragments. Hemarthrosis. In an emergency, after appropriate preparation under spinal anesthesia (CMA), the patient was taken for surgery. As described above, an operative technique was performed: reposition, retention and single-plane transosseous osteosynthesis. The apparatus of two half rings is installed in compression and fixation, until the transverse fracture of the right patella is fused (by 2.5 months). On control x-rays, the standing of the fragments and spokes was in satisfactory condition. Wounds were aseptically bandaged. All types of displacement of fragments were eliminated. The limb was immobilized by the posterior plaster cast in the unbent state of the lower leg in the knee joint. On March 16, 2017, skin sutures were removed. On control images before discharge secondary displacement of fragments was not found and the patient was discharged for outpatient treatment.

Thus, the proposed device allows you to: control the depth of immersion of the tip of the teeth of the jaws in the thickness of fragments only within the cortical layer of the cancellous bone; to carry out an exact reposition of fragments with compression by great efforts along the line of their fracture, up to their partial micro-mutual penetration of their spongy structure, with respect to each other, excluding their secondary displacement during surgery and in the postoperative period of osteosynthesis, as additional sources of bonding strength of fragments among themselves, thereby improving the conditions of osteosynthesis, reducing the risk of additional trauma to the structure and nourishing blood vessels during reposition and osteosynthesis of fragments of the spongy bones, and shortens the duration of the operation.

Claims (1)

A device for reposition and retention of bone fragments of the spongy bones during their osteosynthesis, consisting of two crossing jaws, hinged together with a clamp, the distal ends of which are made in the form of hemispheres, bent inward by bifurcated sharp conical working teeth bounded by supporting platforms, characterized in that that the teeth are equipped with removable supporting pads made with sizes and shapes repeating the outer surfaces of the anatomical shapes of the segments of the musculoskeletal system of the spongy bone, while the removable supporting pads are made with holes for the teeth to dose-limit the immersion depth of the teeth into the thickness of the cortical layer of spongy fragments bones.

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