RU2187269C1 - Method for treating the rupture of distal intertibial syndesmosis - Google Patents

Abstract

FIELD: medicine, orthopedics, traumatology. SUBSTANCE: it is formed a posterior tibial channel from inside outwards with an outlet behind external ankle. The second osseous channel is formed in external ankle from behind frontwards sagittally. It is formed an anterior tibial channel from outside inwards with a hole in front of external ankle. Transplant is introduced in posterior channel up to blocking up the larger osseous fragment. Transplant is directed to come through in the second channel and introduced into anterior one. At the outlet of anterior channel transplant is maximally pulled up and sutured to the tibia. The method enables to prevent instability of intertibial articulation. EFFECT: higher efficiency of therapy. 3 dwg

Description

 The invention relates to medicine, namely to traumatology, and is intended for the treatment of injuries of the tibiofibular syndesmosis in pronational-eversion injuries of the ankle joint.

 A known method of treating damage to the tibiofibular syndesmosis using a screed bolt: Traumatology and orthopedics. G.S. Yumashev, S.Z. Gorshkov, L. L. Silin et al. Edited by G.S. Yumasheva, 3rd ed., Rev. and add. - M., Medicine, 1990, p. 322.

 Its disadvantage is that the restoration of the anterior and posterior tibial ligaments is not carried out, which leads to the development of instability of the tibial joint and can lead to the development of residual subluxations of the talus outward.

 EFFECT: improved functional results of treatment of pronational-eversion injuries of the ankle joint due to plastic surgery of the anterior and posterior tibial ligaments, restoration of the structural integrity of the tibiofibular syndesmosis, normalization of the structure of the dense fibrous connective tissue of the tibiofibular joint.

 Figure 1 shows the implementation of the bone-tendon block and osteosynthesis of fractures. In FIG. 2 - the site of the fence of the bone-tendon block. Figure 3 - bone-tendon block.

 The proposed method is as follows. Two side cuts inside and outside the ankle joint expose the inner and outer ankles. A bone channel 1 is formed with a drill with a diameter of 4.5 mm in the distal metaphysis of the tibia from the inside outwards with the exit behind the external ankle. The inlet of the bone channel 1 at the inner ankle is drilled with a cone-shaped drill with a diameter of 5.0 mm to a depth of 2.0 cm. The second bone channel 2 is formed in the outer ankle from back to front in the sagittal plane with a drill with a diameter of 4.5 mm. The anterior bone channel 3 is formed in the distal metaphysis of the tibia from the outside to the inside with a hole in front of the outer ankle. From the lower pole of the patella 4, the ligament of the patella 5 and the tuberosity of the tibia 6 (Fig. 1, 2), a bone-tendon graft is formed, which is a tendon part 0.5 cm wide, 4.0 cm long with two bone fragments at the ends of size 1 , 0 • 0.7 cm and 0.4 • 0.5 cm (Fig. 3). From the base to the apex, the smaller bone fragment is U-shaped stitched with a thread with the removal of the free ends for conducting a bone-tendon graft in the bone canals. Using these threads, a smaller bone fragment of the bone-tendon graft is carried out in the posterior bone channel 1 until the larger bone fragment is jammed in a cone-shaped extension. A smaller bone fragment is passed through through the canal of the outer ankle 2 and is inserted into the anterior bone canal 3 of the tibia without leaving it, with the formation of the anterior and posterior tibial ligaments. The anatomical restoration of the distal tibial joint is achieved by a positional screw 7 held in the supradermal zone in the frontal plane through both tibia. The free end of the bone-tendon graft stitched with lavsan thread is removed from the anterior bone channel 3. At the exit from the bone channel, the bone-tendon block is pulled as much as possible and sutured to the tibia. In this way, bone fragments are adapted with the bone tissue of the tibia. Layered stitches for surgical wounds.

 Recommended: 1. Immobilization up to 12 weeks; 2. Insoles arch support from 6 months. up to 1 year. 3. Active development of movements in the joints of the toes from 4-5 days. The development of movements in the ankle joint from 12 weeks. 4. Dosed load on the operated limb after 12 weeks.

 This method treated 5 patients.

 Example. Patient X. (03.03.1969), 30 years old, works as a policeman in one of the departments of the internal affairs of Ufa. He was hospitalized on an emergency basis after an injury received in everyday life (he slipped in the garden with his foot tucked up) in the orthopedic and traumatology department of the medical and medical department of UMPO State Clinical Hospital No. 13, Ufa (hospital patient record 02680/706) with a diagnosis of Closed pronation-eversion fracture of both ankles with subluxation of the foot outward and rupture of the tibiofibular syndesmosis.

 Date of receipt of September 10, 1999

 Clinical data: On admission, the patient complained of severe pain in the left ankle joint, inability to step on the left lower limb. On examination, bilateral edema, hemorrhage and deformation in the region of the left ankle joint and the lower third of the leg were found. The foot is displaced and turned outward, the axis of the lower leg extends inwards, the skin in the area of the medial ankle is sharply tense. On palpation, pain, crepitation of bone fragments in the ankle joint and in the projection of the lower third of the fibula and inner ankle. Movement in the ankle joint is severely limited. The axial load on the foot is sharply painful. An x-ray of the ankle joint and foot in 2 projections shows a fracture of the inner ankle and lower third of the fibula with displacement of fragments in width and subluxation of the talus outward. On a comparative radiograph with laying on the distal tibiofibular syndesmosis, the discrepancy of the “fork” of the left ankle joint. Immediately after admission, closed manual reduction and plaster immobilization were performed. On the control x-ray remains the displacement of the inner ankle to the width of the cortical and subluxation of the foot outward.

 To normalize the trophic 22.On 09.1999, surgical treatment was performed: open reposition of fragments and osteosynthesis of the fibula with a bone plate, and the inner ankle using the needle method. Alloplasty of the tibiofibular syndesmosis with a bone-tendon block was performed. After processing and isolation of the surgical field with two cuts in the area of the external and internal ankles with a length of 10-12 cm, access to the distal tibia was made. Fracture zones were freed from interponate (scraps of fibrous tissue and bone fragments) and an open reduction was performed. Osteosynthesis of the outer ankle was performed with a 6-hole osseous plate, and spoke-loop osteosynthesis of the inner ankle. Anatomical restoration of the distal tibial joint was achieved by holding a positional screw in the supradermal area in the frontal plane through both tibia. Then the plastic of the distal tibiofibular syndesmosis was made with a drill with a diameter of 4.5 mm, a bone channel was formed in the distal metaphysis of the tibia from the inside outwards with the exit behind the outer ankle. The inlet of the bony canal at the inner ankle is drilled with a cone-shaped drill with a diameter of 5.0 mm to a depth of 2.0 cm. The second bone canal is formed in the outer ankle from back to front in the sagittal plane with a drill with a diameter of 4.5 mm. The anterior bone canal is formed in the distal metaphysis of the tibia from the outside to the inside with a hole in front of the external ankle. The bone-tendon allograft is a tendon part 0.5 cm wide, 4.0 cm long with two bone fragments at the ends measuring 1.0 • 0.7 cm and 0.4 • 0.5 cm. From the base to the apex, the smaller bone the fragment is U-shaped stitched with lavsan thread with the removed free ends for conducting a bone-tendon graft in the bone canals. Using these threads, a smaller bone fragment of the bone-tendon graft was carried out in the posterior bone canal until the larger bone fragment is jammed in a cone-shaped extension. A smaller bone fragment was inserted through the canal of the external ankle and inserted into the anterior bone canal of the tibia without leaving it, with the formation of the anterior and posterior tibial ligaments. The free end of the bone-tendon graft stitched with lavsan thread was removed from the anterior bone canal. At the exit of the bone canal, the bone-tendon block is maximally stretched and hemmed to the tibia. Layered stitches for surgical wounds. A plaster cast was applied to the upper third of the leg, external immobilization was carried out for 12 weeks. Active development of movements in the fingers of the left foot was carried out from 4-5 days. The development of movements in the ankle joint started from 12 weeks. Dosed load started from 12 weeks. The patient used insoles arch support from 6 months. up to 1 year. Position screw removed after 4 weeks. After 6 months an operation was performed to remove the remaining metal structures. A follow-up examination after 1 year achieved a satisfactory outcome.

Claims (1)

 A method for the treatment of distal tibiofibular syndesmosis, including the formation of channels in the distal metaphysis of the tibia and the outer ankle, passing through the canals of the bone-tendon graft with a bone fragment of the graft jammed in one of the channels, characterized in that the posterior canal is formed in the tibia from the inside outward with the exit behind the outer ankle, form the second canal in the outer ankle back to front in the sagittal plane, form the anterior canal in the tibia from the outside of the whip and with an opening in front of the outer ankle carried graft to the rear channel jamming more bone fragments is carried out through the graft in the second channel and is introduced into the front, the output of the forward passage maximally tensioned graft and sutured to the tibia.

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