RU2724271C1 - Method of treating old monteggia fracture-dislocation in children - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention refers to medicine, namely to traumatology and orthopedics, and can be used in treating an old fracture of the upper one-third of ulnar bone with dislocated head of radial bone in children (Monteggia fracture-dislocation). X-ray exposure of the forearm is used to define elongation of the radial bone relative to the ulnar bone. Shortening osteotomy of the radial bone is performed in the distal metadiaphysis by half its elongation relative to the ulnar bone. Osteotomy is performed in a distal metadiaphysis of the ulnar bone and a radial bone fragment is inserted between the ulnar bone fragments. Fragments of the radial and ulnar bones are fixed intramedullary with wires. Make a closed correction of radial bone head and intramedullary nailing the radial bone is ensured by fixing the humerus through head to 3 weeks. Wounds are closed in layers, plaster immobilisation of ulnar joint. At end of 3 weeks, the wire is pulled up releasing the humeroradial joint.EFFECT: method enables reducing operative injures, improving the anatomical and functional outcome of the treatment ensured by a combination of the methods of the declared method.1 cl, 9 dwg, 1 ex

Description

The invention relates to medicine, namely to traumatology and orthopedics, and can be used in the treatment of a chronic fracture of the upper third of the ulna with dislocation of the radial head in children (Montage fractures).

In the case of chronic Montage fractures, when a significant period has passed since the injury, fragments of the ulnar bone, as a rule, grow together at an angle, the apex of which is directed to the radial side. In this case, due to the angle of deformation, there is a shortening of the ulna relative to the radius, weakening of the interosseous membrane, due to which even the openly adjusted head of the radius does not hold in the joint. In addition, with a significant period from the moment of injury, the growth of the radial bone, deprived of emphasis in the shoulder joint, becomes excessively intense, due to which the length of the radial bone becomes longer than the length of the radial bone on a healthy limb. These features of Montage fracture in children determine a significant number of unsatisfactory outcomes of surgical treatment and the ineffectiveness of conservative treatment methods in chronic cases.

There is a method of open reduction of the radial head during dislocation in children [1], in which open reduction of the radial head is performed, with its stabilization, and osteosynthesis. Before open reduction, an osteotomy of the upper third of the radial bone is performed; after the reduction of the head, a shortening osteotomy of the distal radius is performed, followed by osteosynthesis of the distal and proximal radius. The disadvantages of this method of treatment are the open board of the radial head, and osteotomy in the proximal radius, which leads to the formation of heterotopic ossificates, and a high risk of contractures in the radiolactic joint. An osteotomy in the proximal and distal radius of the radius increases the length of the fusion of the radius, which leads to an extension of treatment.

The closest, in its technical solution, to the proposed invention is a method for the treatment of chronic, isolated dislocation of the radial head in children [2], including arthrotomy of the brachioradial joint with excision of scars and open reduction of the radial head. The retention of the radial head is carried out due to the osteotomy of the ulna, the application of the two-section Ilizarov apparatus, the installation of fragments of the ulna until the regenerate is formed with an angle open to the radial side, and the head of the radial bone is turned to tension the interosseous membrane. The proposed method is traumatic due to the open positioning of the radial head, which, in turn, is fraught with frequent arthrogenic complications. The proposed two-sectional arrangement of the Ilizarov apparatus does not allow tension of the interosseous membrane, since it uses deliberately long (uncontrollable) levers for controlling bone fragments of the ulna. In addition, in order to deploy fragments on the knitting needles, a significant cross-section is required when installed on supports, and this is impossible in these areas of the forearm due to its anatomical features, since there is a risk of damage to significant neurovascular formations.

The aim of the invention is to improve the results of treatment while reducing its time.

The invention consists in the combination of essential features sufficient to achieve the desired technical result, consisting in reducing the morbidity of surgical intervention and improving the anatomical and functional outcomes of treatment.

The essence of the method for the treatment of chronic Montage fracture includes osteotomy of the humerus, reduction of the radial head, and fixation of limb fragments. The radiograph of the forearm determines the extension of the radius relative to the ulna. Shortening osteotomy of the radius is performed in the distal metadiaphysis, half its elongation relative to the ulna. An osteotomy is performed in the distal metadiaphysis of the ulna, and a fragment of the radius is inserted between the fragments of the ulna. Fragments of the radius and ulna are fixed intramedullary with needles. A closed board of the head of the radial bone is produced and, advancing the spoke intramedullary through the radius, fix it through the head of the hind bone condyle for up to 3 weeks. Wounds are sutured in layers, gypsum immobilization of the elbow joint. After 3 weeks, the needle is tightened, releasing the brachioradial joint.

Shortening the osteotomy of the radius in the distal metadiaphysis by half its elongation relative to the ulna is performed to shorten the radius.

An osteotomy is performed in the distal metadiaphysis of the ulna, and a fragment of the radius between the fragments of the ulna is injected in order to anatomically correct their lengths.

Fragments of the radius and ulna are fixed intramedullary with needles - for the possibility of their fusion.

A closed board of the head of the radial bone is made and, advancing the spoke intramedially through the radius, fix it through the head of the condyle of the humerus for 3 weeks - to prevent dislocation of the radius.

After 3 weeks, the needle is tightened, releasing the brachioradial joint - to restore movement in the elbow joint. The method is illustrated in the illustrations, where:

In FIG. 1 - shows a chronic fracture of Montage;

In FIG. 2 - Osteotomy of the ulna;

In FIG. 3 - correction of the length of the bones of the forearm with fixation of the eliminated dislocation of the radius;

In FIG. 4 - The release of the radius to give movement in the elbow joint;

In FIG. 5 the final result of the operation, where: 1 - shortening osteotomy of the radius, 2 - fragment of the radius inserted between the fragments of the ulna;

In FIG. 6, FIG. 7, FIG. 8, FIG. 9 shows x-rays for a clinical example, where:

In FIG. 6, FIG. 7 - a forearm in a direct and lateral projections after a shortening osteotomy of a radius, and lengthening of an ulnar. The head of the radial bone is set and fixed with needles.

FIG. 8, FIG. 9 is a view of the forearm in a direct and lateral projection after removal of the spokes from the brachioradial joint.

A method of treating a chronic fracture of Montage is as follows.

Prior to surgical treatment, the radiograph of the forearm determines the elongation of the radius relative to the ulna. After treating the skin with an antiseptic solution, an incision is made in the distal region of the dorsal surface of the forearm, soft tissues are removed, the periosteum is dissected in the distal metadiaphysis of the radius. A shortening osteotomy of the radius is made by half of its elongation relative to the ulna. An osteotomy is performed in the distal metadiaphysis of the ulna and a fragment of the radius between the fragments of the ulna is injected to correct its length and the possibility of repositioning the radius head. Fragments of the radius and ulna are fixed intramedullary with needles. A closed reduction of the head of the radial bone is made and, advancing the spoke intramedially through the radius, fix it through the head of the condyle of the humerus for up to 3 weeks. After 3 weeks, the needle is tightened, releasing the brachioradial joint. Wounds are sutured in layers. Plaster immobilization of the elbow joint.

Clinical example.

Patient М-СБ., B. 2006, was admitted to the Department of Pediatric Traumatology and Orthopedics GAUZ RKB MH RT with a diagnosis of Elderly Fractured Montage. From the anamnesis: the injury was received 6 months ago - fell from a swing. In the CRH at the place of residence the diagnosis was made: Fracture of the ulna without displacement, made gypsum immobilization.

Surgical treatment was performed for the patient at the GAUZ RKB MH RT: closed reduction of the radial head, shortening of the osteotomy of the radial bone, elongation of the ulna, synthesis of the radius and ulna with spokes with overlapping of the radial joint. The radiograph of the forearm determined the extension of the radius relative to the ulna, shortened the osteotomy of the radius in the distal metadiaphysis of the radius by half its elongation relative to the ulna. An osteotomy was performed in the distal metadiaphysis of the ulna, a fragment of the radius between the fragments of the ulna was introduced. Fragments of the radius and ulna were fixed intramedullary with needles (Fig. 6, Fig. 7). They made a closed reduction of the head of the radial bone and, advancing the spoke intramedially through the radius, fixed it through the head of the condyle of the humerus for 3 weeks. The wounds were sutured in layers. Plaster immobilization of the elbow joint was performed. After 3 weeks, the needle was tightened, releasing the brachioradial joint (Fig. 8, Fig. 9). The needles were removed at a period of 6 weeks after the consolidation of fragments of the radius and ulna. Post-mobilization contractures, after removal of the spokes, were resolved for a period of 2 weeks with a full range of movements in the elbow joint.

Sources of information:

1. RF patent No. 2421172, A61B 17/56, Bull. No.17, 06/20/2011

2. RF patent No. 2033761, A61B 17/56, Bull. No. 12, April 30, 1995

Claims (1)

A method for the treatment of a chronic Montage fracture, including osteotomy of the bone, reduction of the radial head and fixation of the limb, characterized in that the radiograph of the forearm determines the extension of the radius relative to the ulna, shortens the radius of the radius in the distal metadiaphysis of the radius relative to half osteotomy is performed in the distal metadiaphysis of the ulna, a fragment of the radius is inserted between the fragments of the ulna, fragments of the radius and ulna are fixed intramedullary with needles, a closed reduction of the head of the radius bone is made, and the needle is inserted intramedullary through the radius, the arm is fixed through the head through the arm 3 weeks, wounds are sutured in layers, gypsum immobilization of the elbow joint, after 3 weeks the needle is tightened, releasing the brachioradial joint.

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