RU2766771C1 - Method for extra-articular osteosynthesis in finger fractures in children - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to traumatology and orthopaedics, and can be used for surgical treatment of fractures of middle and main phalanges of fingers in children. Diameter of the pins is selected so that the sum of the two pins is less than the thickness of the medullary canal. Then two pins are arched. Using the image intensifier, points of introduction of the pins are determined. Then, the skin is punctured and the pin is delivered through the bone layer and introduced into the medullary canal. Similar manipulation is performed from the contralateral side of the phalanx, after which both pins are delivered to the fracture line. Further, the fracture is closed and the pins are brought into the distal fragment under the control of the image intensifier. Then control X-ray images are taken, the pin ends are bent and bitten at distance of 1 cm above the skin. Aseptic dressings are applied on the needle insertion points, and the hand is immobilized with a plaster cast.

EFFECT: method allows to reduce traumatism of percutaneous introduction of pins due to exclusion of damage of growth zone of middle or proximal phalanx in metaphyseal fractures, as well as elimination of damages of articular surfaces of adjacent joints when introducing the pin.

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Description

The invention relates to medicine, namely to traumatology, and can be used in the treatment of fractures of the phalanges of the fingers, in particular for the surgical treatment of fractures of the middle and main phalanges of the fingers in childhood.

The analysis of the patent and special literature showed that the known methods and inventions for the treatment of fractures of the phalanges of the fingers have such disadvantages as blocking adjacent joints, which prevents the onset of early movements in the joints and worse functional development results after the removal of the pins; the complexity of performing osteosynthesis; the need for additional equipment during surgical treatment, such as a drill, as well as the presence of external fixation devices for fragment stabilization.

There is a known method of fixing fragments in case of fractures of the phalanges of the fingers of the hand, the essence of which is to form an external frame, passing the spokes through the fragments and fixing its ends on the outer frame, passing the spokes through the fragments with compression in the fracture zone, (US Pat. RU No. 2322210, 2006 )

However, this method involves the formation of an external fixation device, which is not desirable, especially in the younger age group of children, which is associated with the inconvenience of care and the risk of damage to the structure.

A device for repositioning and immobilizing intra-articular fractures of the proximal and middle phalanges of the fingers is known, consisting of a rod and two nodes, to which are fixed through the fragments of the spokes (U.S. Pat. RU No. 131598, 2012).

This device is intended for treatment with fixation of fragments with an external unit, which is associated with the inconvenience of care, especially in the younger age group of children, in addition, special rods of different lengths are required.

A known method of fixation of metaepiphyseal fractures of the tubular bones of the hand, which consists in the preliminary burning of a part of the needle before its introduction for osteosynthesis of the fracture (U.S. Pat. RU No. 2718270, 2020).

However, with this method, there is a high risk of thermal damage to the needle insertion site (soft tissues and bone), as well as the growth zone of the child's bone, which will lead to sad consequences.

The objective of the present invention is to create a method with maximum atraumaticity of percutaneous insertion of pins, by eliminating damage to the growth zone of the middle or proximal phalanx of the finger in case of metaphyseal fractures, as well as eliminating damage to the articular surfaces of adjacent joints during the insertion of a pin, which favorably affects further rehabilitation and development of movements in hand joints.

EFFECT: reduction of trauma, simplification and availability of osteosynthesis in the treatment of extra-articular fractures of the main and middle phalanges of the fingers in children.

The problem is solved in the following way.

In the treatment of extra-articular fractures of the middle and main phalanges of the fingers in children, Kirschner wires with spear-shaped sharpening are used to fix bone fragments. The diameter of the wires 1.0-1.5 mm depends on the age of the child and their size is selected by applying two wires, folded together to the damaged phalanx of the patient and control by radiograph. The thickness of the spokes should be less than the width of the medullary canal. For each fracture, osteosynthesis is performed with two wires, which are preliminarily bent in an arcuate manner to increase fixation points in the bone marrow canal of the finger phalanx. After the preparation of the spokes, a closed reposition of the fracture fragments is performed. Holding the fragments in the correct position, the first wire is inserted along the lateral surface of the phalanx in the area of the metaphysis opposite from the fracture. Before the introduction, control is performed using an image intensifier tube (EOP) to exclude the introduction of a spoke through the growth zones. When the percutaneously inserted pin rests on the bone, the cortical layer is drilled with twisting movements of the hand to get the pin into the bone marrow canal. Further, the pin, due to its precurved shape, approaches the opposite cortical plate of the bone and rests against it with an arc, after which, under the control of the image intensifier tube, the pin is passed into the reduced fragment and brought to the opposite metaphysis of the phalanx. Further, similar actions are performed from the contralateral side of the phalanx. After osteosynthesis, control radiographs are performed, after which the pins are bent and bitten at a distance of 0.5-1 cm above the skin. Aseptic dressings are applied to the needle insertion sites and the hand is immobilized with a plaster splint.

Buckley, Moran (Editors) / Перевод с английского А.А. Ситника / В 2-х томах, 2013). Данный способ остеосинтеза прост в подготовке и выполнении и не требует специального инструментария.The use of two precurved Kirschner wires for the treatment of fractures of the phalanges of the fingers in children allows to achieve a greater number of fixation points when carried out in the bone marrow canal, similar to the "gold standard" fixation of fractures of long tubular bones in childhood using titanium elastic rods with six point fixation ( AO-Principles of fracture management /

Buckley, Moran (Editors) / Translated from English by A.A. Sitnik / In 2 volumes, 2013). This method of osteosynthesis is easy to prepare and perform and does not require special tools.

The method is carried out as follows.

Hospitalized child, 10 years old, with a diagnosis of closed fracture of the distal metaphysis of the main phalanx of the 5th finger of the right hand with displacement (Fig. 1). The patient is placed on the operating table, while the hand with the damaged phalanx is placed on the side table. All manipulations are carried out under the control of the EOP. First, the required diameter of the wires is determined by the selection method, for which two wires are applied, for example, with a diameter of 1 mm, to the damaged phalanx of the patient and radiographs are taken. The radiograph shows that the sum of two wires of 1.0 mm is less than the thickness of the patient's bone marrow canal (2.2 mm). The selected needle diameter of 1 mm is suitable. Then the Kirschner wires with a diameter of 1.0 mm are arcuately bent (Fig. 2). Next, the points of introduction of the spokes are determined using an electron-optical converter. The insertion point should not pass through the articular surface or through the growth zone of the phalanx, both proximal and distal insertion of the pins (Fig. 3-4). After determining the place of insertion of the pins, a skin puncture is performed and with translational rotational movements the pin is passed through the cortical layer and inserted into the medullary canal, which is confirmed by a characteristic dip. A similar manipulation is performed from the contralateral side of the phalanx, after which both needles are carried out to the fracture line. Next, a closed reposition of the fracture is performed, and, under the control of an image intensifier tube, the pins are inserted into the distal fragment (Fig. 5). The ends of the spokes should be directed in different directions for a more stable fixation of the fragment. Surgical treatment is completed by adjusting the length of the wires, leaving their ends above the skin by 0.5-1 cm. In the future, dressings of the needle insertion sites are performed and their outpatient removal after 2-4 weeks from the moment of the operation, depending on the age of the patient.

The method of extra-articular introduction of wires in the treatment of fractures of the main and middle phalanges of the fingers in children is affordable and easy to perform. Allows you to quickly fix a broken phalanx and achieve excellent functional results due to the absence of blocking of adjacent joints. The needles are removed on an outpatient basis, without re-hospitalization and anesthesia.

Claims (1)

A method of extra-articular osteosynthesis in the treatment of closed fractures of the main and middle phalanges of the fingers in children, including reposition and percutaneous osteosynthesis with Kirschner wires, characterized in that two wires with a diameter of 1.0 to 1.5 mm are used, while the diameter of the wires is selected in such a way so that the width of the wires is less than the width of the medullary canal, then the points of insertion of the wires are determined under the control of the image intensifier tube both at the distal and proximal insertion, after which the pre-arcuately precurved wires are inserted percutaneously into the medullary canal to the fracture line, first from one side of the phalanx , then on the other hand, a closed reposition of the fracture is performed and the pins are passed into the distal fragment so that the ends of the pins are directed in different directions, the ends of the pins are bent and bitten, leaving 1 cm above the skin, after which an aseptic dressing is applied to the places where the pins are inserted and a plaster splint on the operated hand.

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