RU2270625C2 - Method for removing talocrural instability in case of chronic damage of anterior fibular-ankle and fibular-heel ligaments - Google Patents

Abstract

FIELD: medicine, traumatology, orthopedics.

SUBSTANCE: one should fix an osseous-tendinous allotransplant out of patellar own ligament with osseous terminal fragments in foramens upon heel bone and ankle bone's collum. It is necessary to locate a transplant's tendinous part in a groove developed obliquely from outwards inwards and from the top downwards in external ankle. The innovation increases reliability of transplant's fixation.

EFFECT: higher efficiency.

3 dwg

Description

The invention relates to medicine, namely to arthrology, and is applicable for the surgical treatment of post-traumatic instability of the ankle joint.

The most common cause of the development of chronic post-traumatic instability of the ankle joint is untimely diagnosed and, as a result, untreated or insufficiently treated injuries of the anterior fibular-ram and fibular-calcaneal ligaments.

With an increase in the length of these ligaments, walking on rough terrain is accompanied by instability in the joint, multiple subluxations in the ankle joint, which ultimately leads to the development of deforming arthrosis.

To eliminate instability, the method described by G.D. Nikitin (1) is used, in which a suitably treated allotissue of the long fibular muscle or allotendin of the long flexor of the first toe (depending on the thickness of the limb) is carried out with the bone from the inside through the calcaneus, the outer ankle, tibia and talus on the outside, where as a result of tension and fixation of the tendon by a loop creates a strong duplicate (external ligaments). This operation requires special care, as is carried out through small incisions in the zone of passage of blood vessels, nerves and tendons, a significant allograft, which takes a long time to rebuild, is required.

The prototype was an operation of restoration of the fibula-calcaneum and fibula-talus anterior ligaments of the ankle joint according to Seeburger (2), when a horizontal channel was drilled in the external ankle in the sagittal plane. An autograft from the tendon of the fibular muscle is passed through it and one end of the tendon graft is fixed to the talus and the other to the calcaneus is fixed.

Screw fixation of the tendon tissue to the bone is unreliable, moreover, a second operation is required to remove the metal structures.

We have proposed a method for alloplasty of the external lateral ligaments of the ankle joint, the technical result of which is achieved due to the fact that a short allograft from its own ligament of the patella is fixed with end bone fragments in pre-prepared holes on the neck of the talus and on the lateral surface of the calcaneus, and the tendon part of the graft is located in a groove formed obliquely from the outside inward and from top to bottom in the outer ankle (FIGS. 1-3).

The posterolateral access of Kocher (the incision is 6-8 cm higher than the outer ankle and 1.5 cm posterior to the fibula, i.e., in the middle of the distance between the fibula and the Achilles tendon) continue downward, curving around the outer ankle, and end at the rear feet at the outer edge of the tendon of the common extensor of the fingers, exposing the outer ankle, the neck of the talus and the middle of the lateral surface of the calcaneus. In the outer ankle, a groove is formed according to the size of the allotope tendon, going obliquely from the outside inwards and from top to bottom. One end of the allograft with its terminal bone fragment is tightly hammered into a hole in the neck of the talus made previously by a drill of the corresponding diameter. The tendon portion of the graft fits into a groove formed in the outer ankle. The other end of the allotendin, leaving the groove of the external ankle at the back, goes along its back surface for 10 mm in the hollow of the tendons of the long and short fibula and, reaching the calcaneus, with its bone fragment is tightly hammered into the calcaneal opening, previously made with a drill of the corresponding diameter. The bone crumb closes the groove above the tendon passing in the outer ankle. After hemostasis, the wound is sutured in layers, drained. A sterile dressing and a plaster cast are applied in the position of foot overcorrection for 6-8 weeks.

BIBLIOGRAPHY

1. Nikitin G. D., Kornilov N. V., Linnik S. A., Efimov V. N. Allotendoplasty in the treatment of damage to muscles, tendons and ligaments. SPb. 1994. S. 181-182.

2. Michael Perlman, D.P.M., Chronic ankle conditions. Chapter 40, Comprehensive textbook of foot surgery. Second edition, V.1, S.989-1023.

Claims (1)

A method for eliminating instability in the ankle joint with chronic damage to the anterior fibular-talus and fibular-calcaneal ligaments, including fixing one end of the tendon graft to the talus, and the other to the calcaneus, characterized in that the bone-tendon allograft from the patellar ligament with the patella fragments are fixed in the holes on the calcaneus and the neck of the talus, and the tendon portion of the graft is placed in a groove formed obliquely from the outside inward and over rhu down at the outer ankle.

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