RU208207U1 - Revision anterior plate for osteosynthesis for pseudarthrosis of the clavicle - Google Patents

Abstract

The utility model relates to medical technology, namely to traumatology and orthopedics, and can be used in the surgical treatment of false joints of the clavicle. EFFECT: technical result consists in providing reliable and long-term fixation in case of false joint of the clavicle. The technical result is achieved by the fact that the revision front plate for osteosynthesis in false joints of the clavicle, containing an extra-osseous plate with holes and a fixing unit in the form of a "fork", in which the teeth are made arcuately curved along the longitudinal relief of the anterior surface of the outer third of the clavicle, adjacent to the acromial part of the plate , sections of the teeth are fan-shaped, and the end sections of the teeth are directed in planes parallel to each other to accommodate an external fragment between them, the plate is bent in an S-shape, the holes in the acromial part are made angle-stable, according to the utility model, combined holes are located in the medial part, containing a compression and a threaded the angularly stable parts, the surface in contact with the bone is made in the form of a gutter with a constant radius of curvature, and the radii of the gutter and the surface of the fixing unit base in contact with the bone coincide up to the point where the teeth pass into parallel planes.

Description

The utility model relates to medical technology, namely to traumatology and orthopedics, and can be used in the surgical treatment of the false joints of the clavicle.

Known device - 2.7 / 3.5 mm plate VA-LCP (Variable Angle Locking Compression Plate) of the Synthes / AO-ASIF system [1], which is placed on the anterior surface of the clavicle, having previously modeled it taking into account the anatomical features of the patient's bone.

The disadvantages of this device are the complexity of the application associated with the need to use original instruments and screws of two standard sizes, the multi-stage implantation process, provided by the technology, increasing the duration of the operation. So, in order to comply with the technology of implantation of this fixator, it is necessary to have nine special instruments, five of which are highly specific for this implant. To comply with the technology of implantation of the plate with a minimum number of screws, it is necessary to perform a total of more than thirty operations using nine special instruments. In difficult cases (multi-fragment fracture of the outer third, pseudoarthrosis with osteoporosis or fragmentation of a short lateral fragment), only two screws can be inserted into the fragment, which is not enough for reliable fixation. An attempt to use plaster immobilization does not increase efficiency, since together with the weight of the upper limb it overloads the metal structure, can lead to its failure and loss of fixation.

Known device Forked plate for osteosynthesis of fractures and false joints of the clavicle [2], containing an extraal plate with holes and a fixing unit in the form of a "fork", the teeth are made arcuate curved along the longitudinal relief of the front surface of the outer third of the clavicle, and the areas of the teeth adjacent to the acromial part of the plate are directed fan-shaped, and the end portions of the teeth are directed in planes parallel to each other, to accommodate an acromial fragment of the clavicle between them, the plate is bent S-shaped, compression holes are located in the medial part, and angle-stable in the acromial part of the hole.

The disadvantage of this fixator is the low resistance to the eruption of conventional cortical screws in the medial fragment of the clavicle with extreme degrees of osteoporosis and large bone defects that develop with multiple relapses of the pseudarthrosis, which does not allow ensuring the proper duration of stable fixation in the most difficult situations. The known device is the closest since it is a direct predecessor of the claimed one.

The task of the utility model is to develop a reliable fixator, devoid of the above disadvantages.

The technical result consists in providing reliable and long-term fixation in the pseudarthrosis of the clavicle.

The technical result is achieved by the fact that the revision anterior plate for osteosynthesis with false joints of the clavicle, containing the extraal plate with holes and a fixing unit in the form of a "fork", in which the teeth are made arcuate along the longitudinal relief of the anterior surface of the outer third of the clavicle, adjacent to the acromial part of the plate the sections of the teeth are directed fan-shaped, and the end sections of the teeth are directed in planes parallel to each other for placing an external fragment between them, the plate is bent S-shaped, in the acromial part of the hole are made angle-stable, according to the utility model, in the medial part there are combined holes containing compression and rifled angle-stable parts, the surface in contact with the bone is made in the form of a groove with a constant radius of curvature, and the radii of the groove and the surface in contact with the bone of the base of the fixing unit until the transition of the teeth into planes parallel to each other coincide.

The illustrations show

Fig 1. Revision anterior clavicular plate, front view, where the medial part 2, acromial part 3, teeth 6, forked fixing unit ("fork") 7, planes 8 of teeth 6, angle-stable holes 9, combined holes 10, compression part 11 holes 10, angle-stable (threaded) part 13 of the hole 10.

Fig 2. Revision anterior clavicular plate, front and bottom views, where: S-shaped bend 1, medial part 2, acromial part 3, teeth 6, forked fixing node ("fork") 7, planes 8 teeth 6, angle-stable holes 9 , combined holes 10, the compression part 11 of the hole 10, the angle-stable (threaded) part 13 of the hole 10.

Fig. 3. Revision anterior clavicular plate, top-front perspective view, where: S-shaped bend 1 medial part 2, acromial part 3, acromial end (fragment) 4 clavicle, clavicle 5, teeth 6, forked fixing node ("fork" ) 7, planes 8 of teeth 6, angle-stable holes 9, combined holes 10, compression part 11 of holes 10, angle-stable (threaded) part 13 of holes 10, medial fragment 15, cortical 3.5 screw 12, angle-stable ∅3.5 screw 14 , non-union area (including defect-diastasis) 17, corresponding to the area of placement of autografts for bone grafting.

Fig 4. Revision anterior clavicular plate, view from the surface in contact with the bone, projection onto the groove, where: medial part 2, acromial part 3, teeth 6, forked fixing node ("fork") 7, plane 8 of tooth 6, angle-stable holes 9 , combined holes 10, the compression part 11 of the hole 10, the angle-stable (threaded) part 13 of the hole 10, the groove 16, R is the radius of curvature of the groove 16 and the base of the "fork" 7.

Fig 5. Clinical example, X-ray of the clavicle before surgery, where: acromial (lateral) end (fragment) 4, medial fragment 15, defect-diastasis 17.

Fig 6. Revision anterior clavicular plate installed on the clavicle after implantation of a bone graft and the introduction of the last screw, view in the wound during surgery, where: S-shaped bend 1, medial part 2, acromial part 3, acromial (lateral) fragment 4, tooth 6, combined holes 10, compression part 11 of the hole, cortical 3.5 screw 12, angle-stable (threaded) part of the hole 13, angle-stable ∅3.5 screw 14, medial fragment 15, zone of defect-diastasis 17 filled with an autograft.

Fig 7. Revision anterior clavicular plate installed on the clavicle after osteosynthesis on the roentgenogram, where: medial part 2, acromial part 3, acromial (lateral) end (fragment) 4, tooth 6, forked fixing node ("fork") 7, plane teeth 8, angle-stable hole 9, combined holes 10, compression part 11 of the hole, cortical ∅3.5 screw 12, angle-stable (threaded) part of the hole 13, angle-stable ∅3.5 screw 14, zone of defect-diastasis 17, filled with an autograft.

Fig 8. Clinical example, X-ray of the clavicle before surgery, where: acromial (lateral) fragment 4, medial fragment 15, defect-diastasis 17, rebuilt into normal bone.

The revision anterior clavicular plate for osteosynthesis of fractures and pseudarthrosis of the clavicle (Fig. 1-4) contains an S-shaped bend 1, a medial part 2 and an acromial part 3. To capture the acromial end (fragment) 4 of the clavicle 5, two teeth 6 extend from the acromial part 3 forming a forked fixing unit ("fork") 7. The teeth 6 are made arcuate curved along the longitudinal relief of the front surface of the acromial end (fragment) 4 of the clavicle 5. The areas of teeth 6 adjacent to the acromial part 3 of the plate are fan-shaped, and the end sections of the teeth 6 are directed to planes 8 parallel to each other to accommodate an acromial fragment of the clavicle 5. In the acromial part 3 there are three angle-stable 3.5 mm holes 9, oriented to the acromial end (fragment) 4 of the clavicle 5. In the medial part 2 there are combined 3.5 mm holes 10, containing a compression part 11 for the introduction of cortical 3.5 mm screws 12 and a threaded (angle-stable) part 13 for insertion angle-stable 3.5 mm screws 14, which enhance the stability of fixation of the medial fragment 15. The surface in contact with the clavicle is made in the form of a uniform groove 16 with a constant radius of curvature R. 6 in parallel planes 8 coincide.

This device is used as follows. After the implementation of the surgical access and reaching the front edge of the clavicle 5, the plane 8 of the teeth 6 is oriented in the direction of the forthcoming introduction on the surface of the acromial end (fragment) 4 and put on it with a certain effort 4. The planes 8 of the teeth 6 act as raspators, paving their way between soft tissues and bone 4. If there is a discrepancy between the thickness of the acromial fragment 4 and the gap between the planes 8 of the teeth 6, the latter are bent (reduced or diluted) by 0.5-1 mm with instruments. For the final landing on the fragment 4, the retainer is tapped with a light blow until the groove 16 is fully in contact with the acromial fragment 4. The acromial part of the plate 3, when the fork 7 is pushed onto the fragment 4, receives the acromial fragment 4 and sets the entire shape of the restored clavicle, for which the S-shaped bend 1 is responsible When the acromial fragment 4 is clamped between the planes 8 in the "fork" 7 and the groove 16, angle-stable screws 14 are inserted into the holes 9, after which, manipulating the fixator as a bone holder, reposition is carried out, the medial part 2 is placed on the medial fragment 15 and, clamping with compression the autograft is fixed with a cortical screw 12 (if necessary), by introducing the screw 12 through the compression part 11 of the hole 10. When fixing the remnants of the clavicle during reconstructive surgery, when only incomparable and completely incongruent parts 3 and 15 remain of the clavicle, bend 1 helps surgeons to correctly restore the lost form, and with it the function lost by and collarbone destruction. With a wide area of the defect-diastasis 17 of the pseudarthrosis, after filling with grafts, screws 17 can not be inserted into it, using the principle of bridge fixation. With a pronounced loss of bone density, fixation is enhanced by introducing angle-stable screws 14 into the threaded parts 13 of the combined holes 10 into the clavicle 5, mainly into the medial fragment 15. The wound is sutured in layers. In the postoperative period, immobilization is not indicated.

Clinical example.

Patient R., 39 years old, was admitted to the first department of the Institute with a defect-pseudoarthrosis of the right clavicle, which developed as a result of complications after osteosynthesis of a multifragile fracture on the border of the middle and outer third of the right clavicle. X-ray revealed a defect-diastasis 17 4.5 cm long. with a thinning of the end of the medial fragment 15. The patient underwent a reconstructive plastic operation, including bone grafting with filling the defect zone 17 with an extensive insert autograft with osteosynthesis with the claimed plate, which was fixed according to the technique described above with fixation of the acromial fragment with 4 angle-stable screws 14, 12 compression, cortical screw inserted into the compression part 11 of the combined hole 10 and after reaching sufficient compression, the final fixation was performed by introducing angle-stable screws 14 through the angle-stable parts 13 of the combined holes 10 into the medial fragment 15. After 4 months, consolidation of the fragments with the graft was noted, and after 12 months of exposure, the area of bone defect 17 filled with a graft, completely rebuilt into normal bone tissue, which made it possible to remove the plate (Fig. 8).

The device allows

in case of false joints of the clavicle, increase the reliability of fixation due to the combination of angle-stable screws and a tight fit of the forked fixing node on the cortical surfaces of the acromial end of the clavicle;

to exclude intraoperative adjustment of the fixator to the individual anatomy of the clavicles of different patients;

to optimize the specific load on the clavicle affected by osteoporosis;

facilitate and speed up the operation at the stage of fixing the external fragment and use the device fork first as a bone holder, and after osteosynthesis - as an additional stabilization tool.

Literature.

1. Guide to Surgical Implantation Technique http://www.synthes.com/MediaBin/US%20DATA/Product%20Support%20Materials/Technique%20Guides/SUSA/SUTG27-35VALCPAntClavJ9860B.pdf 2010

2. Voronkevich I.A., Gerashchenko A.I. Combined forked plate for osteosynthesis of fractures and false joints of the clavicle Application No. 2015149415, from 17.11.15, patent No. 163252 from 10.07.2016

Claims (1)

Anterior revision plate for osteosynthesis with pseudarthrosis of the clavicle, including a body with holes and a fixing unit in the form of a "fork", in which the teeth are made arcuate along the longitudinal relief of the anterior surface of the outer third of the clavicle, the areas of the teeth adjacent to the acromial part of the plate are directed fan-shaped, and the end the sections of the teeth are directed in planes parallel to each other for placing an external bone fragment between them, the plate is bent S-shaped, in the acromial part of the hole are angle-stable, in the medial part there are holes for the screws, characterized in that in the medial part of the hole they are made with combined compressing and coal-stable parts; the surface in contact with the bone is made in the form of a groove with a constant radius of curvature; the radius of the groove and the radius of the surface of the base of the fixing unit in contact with the bone to the point of transition of the teeth into planes parallel to each other coincide.

Images