RU2185117C2 - Method for making treating intra-articular compression fractures of the calcaneus - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves conducting at least two wires through tuber and big bone fragment of the calcaneus in perpendicular to the sagittal plane. Two crossing wires are taken through middle foot area and fixed in hinged compression-distraction apparatus supports. Fractured calcaneus fragments reposition is carried out by making movements in support members along hinged rods. EFFECT: enhanced effectiveness of treatment; repaired foot shape and structure; created longitudinal foot vault. 1 dwg

Description

 The invention relates to medicine, namely to traumatology and orthopedics, and can be used in the treatment of fresh and old intraarticular compression calcaneal fractures.

 Known methods for the treatment of calcaneus fractures, as well as devices for their implementation [1, 2], which provide reposition by passing the knitting needles through the bones of the lower leg, one spoke through the tubercle of the calcaneus and its anterior section or the base of the metatarsal bones, with the free ends of the spokes fixed in the distraction nodes of the external fixation apparatus.

 However, these methods have limited repositional capabilities and therefore cannot always be used to treat compression intraarticular calcaneal fractures.

 Closest in technical solution to the claimed one is a method of treating intra-articular compression heel bone fractures [3], which provides for the crossing of knitting needles through the bones of the lower leg, at least two crossing knitting needles through the calcaneus and one spoke through the base of the metatarsal bones, the free ends of which are fixed in the supports apparatus, distraction, followed by the formation of calcaneus regenerate.

 However, this method has several disadvantages.

 First, the hinge-free connection of distal semi-ring supports located on the calcaneus and bones of the forefoot prevents the formation of the longitudinal arch of the foot during distraction along the rods between the supports.

 Secondly, passing only one spoke through the metatarsal bones and fixing them in the support of the apparatus helps to “flatten” the foot, reduce its transverse arch and, thus, further disrupt the shape and stress state of the foot.

 Thirdly, crossed knitting needles, drawn through the calcaneus and fixed in the support of the apparatus, have limited repositional capabilities and do not provide sufficient stability of fixation.

 The essence of the invention lies in the combination of distinctive features sufficient to achieve the desired technical result, namely, to reduce the time and improve treatment outcomes.

 The essence of the invention lies in the fact that at least two knitting needles are perpendicular to the sagittal plane through the tuber and a large fragment of the calcaneus, fixing them on the back half ring of a closed hinged frame, two crossing needles are held through the bones of the middle part of the foot, which are fixed on the front half ring of that the same frame, connected through threaded rods with hinges with an annular support on the bones of the lower leg and after eliminating all types of displacement carry out stabilization.

 Holding at least two spokes perpendicular to the sagittal cavity through the tubercle and a large fragment of the calcaneus provides the reposition of a fracture of the calcaneus and subsequent stable fixation of the fragments.

 Carrying the crossing needles through the bones of the midfoot ensures the preservation of the transverse arch of the foot.

 The connection of all the supports of the compression-distraction apparatus by means of threaded rods with hinges provides multi-plane reposition with the subsequent preservation of the shape and structure of the foot.

 The layout of the compression-distraction apparatus, ensuring the implementation of the proposed method, is shown in the drawing.

 The arrangement of the device includes a support 1 of a compression-distraction apparatus, connected by threaded rods 2 with hinges 3 with a closed hinged frame. The closed hinged frame, in turn, consists of a rear 4 and a front 5 half rings, interconnected using threaded rods 6 with brackets 7 and hinges 8.

 The method is as follows.

 Through the lower third or distal metaphysis of the tibia, two crossed needles 9 are held, which are fixed in the support 1 of the apparatus. At least two knitting needles 10 and 11 perpendicular to the sagittal plane are held through the tubercle and a large fragment of the calcaneus, which are fixed in the rear half ring 4 of the closed hinge frame, and through the bones of the middle part of the foot, two crossing needles 12 are made, which fixed in the front half ring 5 of the same frame, while the hinges 3 and 8 are relaxed. Dosed distraction is performed on the threaded rods 2 and 6 with hinges 3 and 8, due to which reposition of fragments and restoration of the anatomical length of the calcaneus are achieved. In this case, the spoke 11 is axial, around which the heel bone is rotated and the talus-heel angle is restored. The connection of all the apparatus supports by means of articulated-threaded systems provides restoration and preservation of the arches, shape and structure of the foot.

 Clinical example.

 Patient Z., born in 1960, medical history 1495, was admitted to the traumatology department of the SRC "WTO" on 05/02/1999.

 Diagnosis: closed intraarticular compression fracture of the calcaneus with displacement of fragments. Closed transosseous osteosynthesis operation with Ilizarov apparatus 05/02/1999.

 Under conduction anesthesia through the distal metaphysis of the tibia, two crossed needles are held, which are fixed on an annular support. Two spokes were drawn through the fragments of the calcaneus and the bone of the middle part of the foot, which are fixed on the half rings of a closed hinged frame connected to a support on the bones of the lower leg by means of threaded rods with hinges. Reposition. Discharged from the hospital on 05/07/1999. Dismantling and removal of the Ilizarov apparatus followed by a course of reconstructive conservative treatment in the conditions of the SRC "WTO". Full recovery. He returned to his previous work.

Sources of information
1. A. D. Pilyak. Device for the treatment of calcaneus fractures. A.S. 606579. Discoveries and inventions. -1978, - bull. 18.

 2. V. M. Sergeev. Distraction-compression method in the treatment of patients with calcaneus fractures. Orthopedics, traumatology. - 6. - 1979. - S. 45-46.

 3. S. I. Shved, Yu. M. Sysenko, V. G. Shilov. A method for the treatment of intraarticular compression calcaneal fractures. The genius of orthopedics. - 4 - 1997. - S. 51-53.

Claims (1)

 A method for treating intra-articular compression calcaneal fractures, comprising applying an articulated compression-distraction apparatus, reposition and fixation of the fracture, characterized in that at least two spokes perpendicular to the sagittal plane are carried out through the tubercle and a large fragment of the calcaneus, securing them to the posterior semicircular closed ring frames, through the bones of the middle part of the foot, two crossing needles are held, which are fixed on the front half ring of the same frame, connected by means of threaded terzhney hinged with the support ring on the bones of the leg and after removal of all kinds of displacement performed stabilization.