RU2198620C2 - Method for treating shin bone fractures at the presence of extensive marginal tibial defect - Google Patents

Abstract

FIELD: medicine, traumatology. SUBSTANCE: one should develop angular deformation of damaged bone, form osseous fragment from paired bone, replace it proportionally into defect's area followed by fixation till complete accretion due to application of compression-distraction apparatus that provides osseous strength. The method provides restoration of osseous volume. EFFECT: higher efficiency of therapy. 5 dwg, 1 ex

Description

 The invention relates to medicine, in particular to traumatology, and can be used in the treatment of patients with fractures of the lower leg.

 Known methods of treating fractures of limb bones, providing for the comparison of fragments and their stable fixation using a compression-distraction apparatus. These include the “Method for the treatment of fractures of the lower leg and forearm” (1), which includes performing oblique osteotomy of the paired bone, moving the osteotomized fragment proximal or distal until a bone regenerate appears in the area of the fracture of the main bone, followed by returning the displaced fragment to its original position.

 Also known is a "Method for the treatment of a false joint with an edge fragment defect" (2). The specified method involves the creation of angular deformation of the damaged bone, the formation of a bone fragment from adjacent to the defect area of the bone area, its movement in the defect area, followed by fixation to fusion.

 However, this technique is ineffective in the treatment of patients in whom a fracture of the tibia is accompanied by a significant defect along the length and volume that captures both fragments. In these cases, the formation of an autograft from adjacent areas of the bone is difficult and the replacement of such a defect is associated with long periods of treatment, especially in the elderly.

 The objective of the invention is to develop a method of treatment that provides restoration of supporting ability of the extremity in fractures of the lower leg with an extensive regional defect of the tibia.

 This problem is solved by the fact that in the method, including the creation of angular deformation of the damaged bone, the formation of a bone fragment and its displacement into the defect zone, followed by fixation to fusion using a compression-distraction apparatus, the bone fragment is formed from the paired bone, it is metered to move to overlap the zone defect and fix in position of tight contact with the tibia with simultaneous restoration of the longitudinal axis of the latter.

 New in the proposed method is that a bone fragment is formed from the paired bone, dosed to move it to overlap the defect zone and fixed in position of tight contact with the tibia with simultaneous restoration of the longitudinal axis of the latter. The above allows us to conclude that the proposed method meets the criterion of "novelty."

 Analysis of available sources of information on the treatment of patients with fractures of the tibia shows that the proposed technical solution is not obvious and does not follow from the level of knowledge achieved in this area. This makes it possible to judge its compliance with the criterion of "inventive step".

 The applicability of the method is confirmed by the fact of its successful clinical use in the RRC "WTO" them. Acad. G.A. Ilizarova.

 The method is as follows.

 After anesthesia and treatment of the surgical field with known techniques, osteosynthesis of shin injuries is performed. In the course of its implementation, translucent, cross-held holding knitting needles through the tibia at the level of the proximal and distal metaepiphyses, as well as through the opposing ends of fragments of the tibia near the fracture. In the tensioned state, the free ends of the spokes are mounted on the supports of the apparatus installed at the appropriate level, which are interconnected by threaded rods and hinged nodes with the possibility of dosed movement and rotation relative to each other.

After the installation of the main components of the apparatus is completed, a closed reposition of fragments of the tibia is performed, their ends are compared and installed at an angle open to the side of the existing boundary defect. Following this, based on the clinical picture of the condition of the fibula perform:
- osteotomy of one of the fragments in cases where there is a fracture of the fibula;
- double osteotomy of the fibula in cases of maintaining its integrity.

 As a result of one of these manipulations, an intermediate fragment of the fibular diaphysis is formed, which in its dimensions should correspond to the longitudinal dimensions of the marginal defect of the tibia. If initially there was a double fracture of the fibula, then during the operation they are limited to its fixation by traction needles. The free ends of the spokes fixing the selected or existing fragment of the fibula diaphysis are fixed in traction units mounted on the adjacent support of the apparatus.

 The operation is completed by stabilizing the systems of the device, performing control radiography, suturing wounds, applying aseptic dressings.

 In the postoperative period, starting from 3-5 days, a metered shift of the selected (existing) fragment of the fibula in the direction of the marginal defect of the tibia is made while maintaining the angular position of the fragments of the latter. Maintaining this position creates favorable conditions for moving the fragment in the thickness of soft tissues, the tension of which on the defect side is weakened. Upon reaching the contact of the moved fragment with both ends of the fragments of the tibia, the latter are brought to the position of normal correction with the restoration of the longitudinal axis of the tibia. As a result of this, the displaced fragment of the fibula along the entire length enters into the position of tight contact with the areas of the edge defect of fragments of the tibia and simultaneously overlaps the joint zone between them. In this case, the regenerate sections formed as a result of traction of a fragment of the tibia and restoration of the axis of the tibia contribute to a strong fusion of the contacting fragments of the tibia according to the type of multiple synostoses. In the future, stable fixation of the damaged segment by the apparatus is carried out until a clinically reliable picture of the restoration of the integrity of the tibia and the formation of a single tibia block of the tibia is obtained. Additional immobilization of the limb after dismantling the apparatus, as a rule, is not required. The patient is prescribed a course of exercise therapy.

 The practical use of the method is illustrated by the following clinical observation.

 Patient P., 72 years old, was admitted to the clinic of the RTC "WTO" with a diagnosis of Closed comminuted fracture of the left tibia; double fracture of the left fibula.

 To restore limb support ability, the patient underwent surgery: Osteosynthesis of bones of the left lower leg by Ilizarov apparatus.

 During osteosynthesis, according to the proposed method, fragments of the tibia bones were fixed with transversely held knitting needles; installation of the apparatus has been carried out.

 In the postoperative period, a dosed displacement of the intermediate fragment of the fibula in the direction of the edge defect of fragments of the tibia was performed. Moreover, during the movement of the latter kept in position at an angle to each other. Upon completion of the movement of a fragment of the fibula, fragments of the tibia were dosed in a position of normal correction. At the same time, a fragment of the fibula is set in close contact with fragments of the tibia in the region of their marginal defect with overlapping joint area. The total period for moving fragments was 21 days; the period for subsequent fixation was 58 days.

 As a result of treatment, the limb support ability was restored, and the bone skeleton of the lower leg, resistant to static-dynamic loading, was created. The patient walks without additional means of support, fully loads the operated limb.

 Using the method provides restoration of limb support ability during fractures of the leg tibia with an extensive marginal defect of the tibia, including in the elderly and senile.

Sources of information
1. AS USSR 1120985, publ. 10.30.84 g. Bull. 40.

 2. AC USSR 1568991, publ. 06/07/90, Bull. 21.

Claims (1)

 A method for treating a leg fracture in the presence of an extensive regional defect of the tibia, including the creation of an angular deformation of the damaged bone, the formation of a bone fragment and its displacement into the defect zone, followed by restoration of the bone axis and fixation of fragments to fusion using a compression-distraction apparatus, characterized in that the fragment is formed from the paired bone, metered to be displaced to the tibial fragments with the overlapping of the fracture zone and fixed in the position of tight contact with the lateral surface character of these fragments throughout their marginal defect.