RU2208405C2 - Method for treating femoral cervix fracture in senile-group patients - Google Patents

Abstract

FIELD: medicine, traumatology. SUBSTANCE: the present innovation deals with treating femoral cervix ruptures at lower reparative osteogenesis. The method deals with reposition of osseous fragments, introduction of needles' bundle in different directions through fracture's region and, at least, one rod of larger diameter at fixing their ends at external support followed by stable fixation to consolidate lesion area. Moreover, during osteosynthesis one should carry out dosed longitudinal rod's replacement and, at final stage, one should, at first, remove the rod and then, successively, the needles introduced in different directions. EFFECT: shortened terms of medicinal rehabilitation, improved stimulation of reparative process in lesion area. 4 dwg, 1 ex

Description

 The invention relates to medicine, in particular to traumatology, and can be used in the treatment of femoral neck fractures in patients with weakened reparative osteogenesis.

 There is a method of treating femoral neck fractures (1, 2), which provides for stable fixation of fragments of the femur until the fracture is consolidated using a compression-distraction apparatus.

 There is also a method of treating a femoral neck fracture in the elderly and senile (3), which involves introducing knitting needles into the fragments and twisting their ends directly on the surface of the bone.

 However, this method, as well as the aforementioned methods of osteosynthesis of femoral neck fractures, does not provide the possibility of stimulating the reparative process, which leads to delayed consolidation of this type of fracture, especially in people of older age groups.

 The objective of the invention is to develop a method for the treatment of femoral neck fractures in people of older age groups, which reduces the time of medical rehabilitation of this category of patients due to directed stimulation of the reparative process in the damage zone.

 This problem is solved by the fact that in a method including reposition of bone fragments, multidirectional introduction of spokes into them through the fracture zone of the knitting needle with the free ends attached to the external support and subsequent stable fixation until the damage zone is consolidated, at least one rod of a larger diameter is additionally inserted into the bone fragments, in the process of osteosynthesis, its metered longitudinal movement is carried out, and at the final stage, the latter is first metered in and then introduced spokes in different directions.

 It is provided that at least one of the rods of a larger diameter is carried out at an angle to the axis of the femoral neck.

 The invention is illustrated by its description and an example of clinical use (figure 1-4).

 The method is as follows.

 After anesthesia and processing of the operative field under skeletal traction, based on the data of x-ray control using known methods, a closed reposition of fragments of the femoral neck is performed, achieving their exact comparison. The position of the associated fragments is stabilized by introducing into them a beam of fixing spokes with a diameter of 1.5-2.0 mm. The spokes are inserted in different directions, from the undervert region through the fracture zone to the femoral head. In addition to these spokes, also through the fracture zone at least one rod of a larger diameter, up to 4.0-6.0 mm, is inserted into the head, which may have a threaded thread at the working end. The number of introduced spokes and rods depends on the thickness of the neck: usually 6-8 spokes and 1-2 rods, one of which is carried out at an angle to the longitudinal axis of the femoral neck, taking into account the direction of the fracture line. The free ends of the spokes and rods are mounted on an external support, which can be used as a bar, arc, etc. The operation is completed by performing control radiography and the application of an aseptic dressing.

 In the postoperative period, stable fixation of fragments of the femoral neck is carried out. After the appearance of signs of fibrous fusion, for the identification of which it is advisable to regularly perform computed tomography of the damage zone, dosed movements of additional rods are performed at a rate of 1-2 mm per day. Such movements, stimulating the process of reparative osteogenesis, are performed before the appearance of pronounced signs of periosteal reaction, after which they again maintain a regime of stable fixation. At the final stage of osteosynthesis, metered removal of the fixing elements is carried out. In this case, initially, upon receipt of signs of bone consolidation, additional rods are removed, and then the spokes. If rods with a threaded thread at the working end are used to fix the fragments, they are removed until the fracture zone passes at a rate of 2-4 mm per day, after which they can be removed simultaneously. The removal of the spokes is carried out sequentially one after the other for several days, with the last of all the spokes located on the front-lower side of the neck. Additional immobilization of the limb after removal of all the fixing elements 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.

 Example 1

 Patient G., 66 years old, was admitted to the clinic of the RTC "WTO" with a diagnosis of closed fracture of the neck of the right thigh. To consolidate the fracture, the patient underwent surgery: closed osteosynthesis with an external fixation device.

 During osteosynthesis, the patient according to the proposed method, on the basis of X-ray control data, a closed reposition of fragments of the neck of the right thigh was performed. Following this, 8 smooth knitting needles with a diameter of 2.0 mm were introduced in different directions from the undertrochanteric region through the fracture head into the femoral head, the free ends of which were fixed to the external support of the apparatus. In addition to them, one rod with a threaded thread at the working end with a diameter of 5 mm was inserted obliquely-longitudinally through the fracture zone from the trochanteric region into the femoral head, which, with the possibility of axial rotation and dosed movement, was also fixed on the external support of the apparatus.

 In the postoperative period, stable fixation of bone fragments was carried out for 19 days - until the signs of fibrous adhesion appeared, and then, to stimulate reparative osteogenesis, axial rotation and dosed movement of the rod with a threaded thread of the working end were performed at a rate of 1-2 mm at a time. With the appearance of pronounced signs of a periosteal reaction in the damage zone, after 8 days, the apparatus was again transferred to the stable fixation mode, which was maintained for 25 days. After that, in the presence of a fracture consolidation pattern, an additional rod was initially dosed at a rate of 2–3 mm per day (until the threaded part of the fracture zone passed), and then the spokes were inserted in different directions for 14 days. Additional limb immobilization was not performed. As a result of treatment, the total period of which was 66 days, fracture consolidation was achieved, limb support ability was restored.

 Using the method provides a reduction in the time of medical rehabilitation of persons of older age groups with fractures of the femoral neck due to directed stimulation of the reparative process in the damage zone.

Sources of information
1. A.S. USSR 895426, publ. 01/07/82, Bull. 1.

 2. A.S. USSR 1050689, publ. 10.30.83, Bull. 40.

 3. A.S. USSR 1109140, publ. 08/23/84, Bull. 31.

Claims (1)

 A method for treating a femoral neck fracture in persons of older age groups, including reposition of bone fragments, multidirectional insertion of a knitting needle with free ends attached to them through the fracture zone and subsequent stable fixation until the damage zone is consolidated, characterized in that at least one rod is additionally inserted into the bone fragments larger diameter, the free ends of the spokes and rods are mounted on an external support, carry out the metered movement of additional rods, at the final stage, the dosage is removed first For more bars, and then spoke.

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