RU2373887C2 - Method and device for treatment of diaphyseal fractures of clavicle - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: group of inventions relates to field of medicine, namely to traumatology and orthopedics. Pin is intramedullarily introduced into proximal bone fragment. Reposition of fragments is performed. Then pin is drawn intramedullarily in opposite direction through distal fragment. When pin goes out through skin, it is pulled until proximal pin end disappears under skin, free pin end being bent at angle of 90°. In plane of clavicle longitudinal axis, through both cortical layers at angle of 45° to each other, through each two console pins are drawn into proximal and distal fragments and fixed on device plates. Intramedullary pin is fixed on distal plate of device with possibility to perform compression and distraction of fragments. Device consists of two plates with holes, fixed on threaded rod. Plates are fastened with possibility to move by means of brackets with nuts. Intramedullary and console pins are fixed on plates by means of bolts- pin fixers. Intramedullary pin is fixed on distal plate of device.

EFFECT: inventions ensure increase of fixation rigidity, possibility of controlled fragment reposition, reduction of treatment terms.

2 cl, 2 dwg, 1 ex

Description

The present invention relates to medicine, namely to traumatology and orthopedics, and can be used to treat fractures of the clavicle.

The frequency of collarbone fractures is about 3% of the damage to all bones of the skeleton and is more common in young people. The mechanism of injury is mostly indirect - a fall on the designated arm, but a direct one is also possible - a blow to the clavicle. Due to the violation of the physiological balance of the muscles, the fragments are displaced and occupy a typical position. The central fragment is displaced up and back, the peripheral fragment down, anterior and inward. Conservative treatment in the form of various soft and gypsum dressings does not provide complete reposition and complete immobility of the fragments, which increases the period of immobilization and leads to the consolidation of the clavicle in the wrong position. Surgical treatment of fractures includes internal osteosynthesis and external transosseous osteosynthesis. However, with internal osteosynthesis, massive metal structures damage the periosteum and bone tissue, often creating a cosmetic defect in the form of a hypertrophic scar. External transosseous osteosynthesis consists in transosseous holding of spokes, rods fixed in the supports of the external fixation apparatus.

Various known methods for treating clavicle fractures.

A known method of treating collarbone fractures by transosseous osteosynthesis, including conducting through both cortical layers of 2-3 knitting needles through a central fragment and 2-3 knitting needles through a peripheral fragment, fixing the knitting needles with special fixators on 1-2 threaded rods. Spend an open reposition of the fragments and fix them with a knitting needle, hold 2-3 knitting needles at an angle of 45 ° to the axis of the clavicle, fix the knitting needles with clips directly above the skin, bend the free part of the spoke at an angle of 45 ° (see RF Patent No. 2281052, M. cl A61B 17/60).

The disadvantage of this method of treatment is that the reposition of bone fragments is carried out only at the time of surgery. Throughout the entire fixation by the apparatus during treatment, reposition and dosed compression of fragments in order to improve bone regeneration is impossible.

The closest is a method of treating collarbone fractures with a device consisting of two arched plates connected by a threaded rod, cantilever spokes with a thrust pad are conducted through the holes in the plates (see Solomin L.N. Fundamentals of transosseous osteosynthesis using G.A. Ilizarov apparatus: Monograph. - St. Petersburg, Morsar AV, 2005. - P.377).

The disadvantage of this method and device is that the cantilever needles can not create a sufficiently strong fixation of bone fragments for the treatment period, because due to the severity of the upper limb and traction of muscles attached to the clavicle, the possibility of secondary displacement of bone fragments is great.

The technical result of the proposed method and device is to increase the rigidity of fixation, providing controlled reposition, reducing treatment time.

New in the method is that first the needle is introduced intramedullary into the proximal fragment, the bone fragments are repositioned and the needle is inserted intramedullary in the opposite direction through the distal fragment, and after the exit of the needle, the free end of the needle is bent at an angle of 90 ° above the skin.

Also new is the fact that in the plane of the longitudinal axis of the clavicle, through two cortical layers at an angle of 45 ° to each other, two cantilever spokes are inserted into the proximal and distal fragments and fixed on the plates of the device with the possibility of compression of fragments.

New in the device is that the plates are mounted on a threaded rod with the ability to move through brackets with nuts.

Also new is the fact that the cantilever and intramedullary spokes are fixed on the plate with special fixing bolts, while the intramedullary spokes are fixed on the distal plate.

The ability to move the device plates along the threaded rod and securing the spokes on the plates provides strong fixation of fragments with the possibility of controlled reposition and compression of fragments. The fixation of the intramedullary spokes on the distal plate does not interfere with the function of the upper limb. The reposition of bone fragments achieved at the time of surgery under visual and palpation control is maintained for the entire period of fixation by the device, compression and distraction of bone fragments is possible along the intramedullary needle as a guide, which eliminates the possibility of secondary displacement of bone fragments. All this improves the quality of osteosynthesis and creates the conditions for better healing of bone tissue, which in turn reduces the time of treatment.

Comparative analysis with the prototype shows that the proposed method differs from the known one in that the needle is introduced intramedullary into the proximal fragment first, the bone fragments are repositioned and the needle is inserted intramedullary in the opposite direction through the distal fragment, bending the free end of the spoke at an angle of 90 ° in the longitudinal plane the axis of the clavicle through both cortical layers at an angle of 45 to each other, carry two cantilever spokes into the proximal and distal fragments and fix them on the plates of the device with the possible the ability to perform compression of fragments; the device is characterized in that the device plates are mounted on a threaded rod with the possibility of movement along it with brackets with nuts, the cantilever and intramedullary spokes are fixed on the plate with special bolts, while the intramedullary spoke is fixed on the distal plate, which meets the criterion of "novelty".

A new set of features allows to improve the healing of collarbone fractures due to stable fixation, controlled reposition of fragments, early activation of movement, while the terms of inpatient and outpatient treatment are reduced, which meets the criterion of "industrial applicability".

The proposed device is illustrated by drawings, in figure 1 (front view) and figure 2 (top view). A general view of the device is shown, front view, figure 2 is a top view, where the plates are 1 with holes 2, the threaded rod is 3, the bracket is 4, the nut is 5, the cantilever spoke is 6, the bolt-spoke is 7, the intramedullary spoke - 8, clavicle - 9. The device consists of two plates 1, on which holes 2 are made. The plates 1 are interconnected by a threaded rod 3 with the possibility of moving along it with two brackets 4, which are fixed to the rod by nuts 5. The cantilever spokes 6 are fixed on the plates 1 with the help of special fixing bolts 7. Intramedul yarnaya needle 8 is fixed bolt-on device spitsefiksatorom 7 and plate 9 in the clavicle.

The method is as follows. The patient is placed on the operating table on his back with a roller between the shoulder blades, which makes it easier to reposition. Under general anesthesia, a small surgical approach of 15–20 mm is performed, and the fracture site is exposed. Intramedullary injected into the proximal fragment of the Kirschner needle, sharpened in two directions. After the knitting needles pass through the skin under visual and palpation control, the bone fragments are repositioned and the knitting needle is intramedullary in the opposite direction through the distal fragment. After the needles exit through the skin, the needle is tightened until the proximal end of the spoke is hidden under the skin. The distal end of the spokes over the skin is bent at an angle of 90 degrees for ease of fixation. Through both cortical layers at an angle of 45 degrees to each other in the plane of the longitudinal axis of the clavicle, 2 Kirschner spokes are inserted in the proximal and distal fragments. The knitting needles are fixed on the plates with special fixing bolts. An intramedullary needle is also fixed on the distal plate. The plates are fixed with two brackets on a threaded rod with the possibility of movement along it. Compress fragments. Suture the wound. Throughout the entire treatment period, inter-fragment compression is carried out by translating the bracket nut along the threaded rod of the apparatus.

Example. Patient Peshkova O.I., born in 1985, works as a waitress. Delivered by the ambulance team, road injury (rolled over on a car), immobilization with a Deso dressing.

I was treated from 02.25.06 to 04.0306 in the trauma department of the Emergency Hospital with a diagnosis of closed comminuted fracture of the middle third of the diaphysis of the left clavicle with a shift. An operation was performed on an emergency basis: open adaptation of bone fragments, osteosynthesis with the proposed external fixation apparatus. The postoperative period is smooth, without features. On the 3rd day, the volume of active movements in the left shoulder joint was: abduction / adduction 45/0/10 °, extension / flexion 10/0/45 °, external rotation / internal rotation 10/0/20 °. During my stay in the hospital I received standard treatment: antibiotics, analgesics, vitamins, vasoactive and sedatives, a course of physiotherapy and breathing exercises. On the radiograph during discharge, the displacement was eliminated, the standing of the bone fragments is satisfactory. During treatment, maintenance compression of 1 mm was performed every 10 days.

St.licalis at discharge: the external fixation apparatus is in the fixation position, is stable, the entry points of the spokes are clean, no detachable. The postoperative scar is clean. Blood circulation, innervation in the distal extremities are preserved.

5 weeks after osteosynthesis, the apparatus was dismantled. On radiographs - fracture consolidation. The range of active movements in the left shoulder joint was: abduction / adduction 85/0/10 °, extension / flexion 30/0/85 °, external rotation / internal rotation 20/0/20 ° (almost normal). With dynamic observation for 2 months, no complaints, the range of motion in the joints of the left upper limb is full, continues to work as a waitress.

Claims (2)

1. A method of treating diaphyseal collarbone fractures by introducing knitting needles into the distal and proximal bone fragments at an angle, characterized in that the needle is introduced intramedullary into the proximal bone fragment, reposition of the fragments is carried out, then the needle is intramedullary in the opposite direction through the distal fragment, after the knitting needle through the skin, the needle is pulled to hide under the skin of the proximal end of the spoke, bending the free end of the spoke at an angle of 90 °, in the plane of the longitudinal axis of the clavicle through both cortical layers under scrap 45 ° to each other is carried by two cantilevered spokes in the proximal and distal fragments and fixed on the plates of the device and intramedullary needle plate fixed to the distal device to perform the compression and distraction of bone fragments. 2. An external fixation device for the treatment of diaphyseal fractures of the clavicle, consisting of two plates with holes fixed on a threaded rod, characterized in that the plates are mounted on a threaded rod with the ability to move by means of brackets with nuts, cantilever and intramedullary spokes are fixed on the plate with special fixing bolts while the intramedullary needle is attached to the distal plate of the device.

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