RU2375978C2 - Method of treating intercondylar eminence of tibia fracture - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to traumatology and can be used for treatments of intercondylar eminence of tibia fractures. Fracture reposition and its fixation with pin are carried out by arthroscopic control. Through fragment of intercondylar eminence in top-down, front-back,outside-inside direction 2 mm pin is driven using anterior-external arthroscopic entrance. Pin is brought out in region of posterior-internal surface of medial condyle of tibia. Upper pin end is bent at angle of 90° in form of hook and is pulled until submergence into cartilaginous tissue of intercondylar eminence fragment.

EFFECT: method reduces knee joint tissues traumatising.

1 ex, 1 dwg

Description

The invention relates to medicine, namely to childhood traumatology, and can be used to treat fractures of the intercondylar elevation of the tibia.

Known methods of surgical treatment of fractures of the intercondylar elevation of the tibia using, as clamps, wire, Dacron, screws and L-shaped bone metal devices.

However, all the proposed methods for fixing the intercondylar elevation require wide operative access, which entails significant intraoperative trauma, often leading to the development of complications such as contractures and degenerative-dystrophic joint changes that lengthen the recovery time and affect the mental and physical development of the child. Open surgical interventions also increase the risk of developing an infectious process.

The technique of intra-arthroscopic fixation of the intercondylar elevation with the AO-ASIF screw [1] cannot be applied in childhood due to the insignificant thickness of the torn fragment.

All this prompted the development of a new method for fixing the fracture of the intercondylar elevation of the tibia in children, which allows to reduce intraoperative trauma, improve the cosmetic effect and, with stable fixation of the fracture, significantly reduce the treatment time.

Closest in its technical solution to the claimed method, as having the greatest number of common features, is the method of osteosynthesis of intercondylar eminence according to McLennan [2]. The method consists in reposition, under arthroscopic control, of the intercondylar elevation, and fixation of the fracture by 2-3 Kirschner spokes held in the zone of the repaired osteochondral fragment retrograde through the condyles of the tibia, in the direction from the bottom up and front to back, crosswise relative to each other.

The disadvantages of the method adopted for the prototype include the inevitable trauma to the proximal tibial growth zone with a beam of retaining spokes, as well as the long immobilization of the knee joint (from 4 to 6 weeks) due to the likelihood of secondary displacement of the fracture, due to the close alignment of the spokes and the tension vector anterior cruciate ligament.

The essence of the invention lies in the combination of distinctive features sufficient to achieve the desired technical result, which consists in improving treatment results by eliminating the disadvantages inherent in known methods. The proposed method allows to achieve stable fixation of the fracture, while reducing surgical trauma, and to reduce the period of immobilization of the knee joint.

The essence of the invention lies in the fact that a method of treating a fracture of the intercondylar elevation of the tibia involves repositioning the fracture and fixing it with a knitting needle under the control of arthroscopy. Through a fragment of the intercondylar elevation, repaired by an arthroscopic probe, from top to bottom, from front to back, from outside to inside, a 2-mm retaining needle is inserted using the anteroposterior arthroscopic portal and displayed in the posterior-inner surface of the medial condyle of the tibia. The upper end of the knitting needle bends at an angle of 90 °, in the form of a hook, and is pulled until the osteochondral fragment of the intercondylar eminence is immersed in the cartilaginous tissue.

Holding one fixing knitting needle allows to reduce the invasiveness of surgical intervention.

The formation of a hook at the end of a spoke inserted into the joint prevents its migration.

Holding the knitting needle from top to bottom, from front to back, from outside to inside, in a plane perpendicular to the plane of the anterior cruciate ligament, ensures the stability of the osteosynthesis of the intercondylar eminence.

Pulling the knitting needle until the hook is immersed in the cartilaginous tissue of the osteochondral fragment of the intercondylar elevation is carried out with the aim of carrying out the final reduction.

The location diagram of the anatomical formations of the knee joint after the operation according to the proposed method is shown in the attached illustration (front and side views, from the inside), which shows the inner condyle of the tibia 1, the intercondylar eminence of the tibia 2, the fixing knitting needle 3.

The method is as follows.

Of the two anterior arthroscopic portals of the knee joint, the probe, reposition the fracture of the intercondylar elevation of the tibia. When the knee joint is bent, at an angle of 90 °, using the front-outer portal at the lower pole of the patella, through the osteochondral fragment of the intercondylar eminence, using a drill, draw a 2-mm needle from top to bottom, front to back, from the outside inwards and transdermally in the posterior-inner surface of the medial condyle of the tibia. The upper end of the knitting needle is bent in the form of a hook, at an angle of 90 °, and lowered by pulling the knitting needle through the arthroscopic portal into the joint cavity, until the end of the spoke is immersed in the cartilaginous tissue of the intercondylar eminence. The lower end of the knitting needles bite directly above the bone tissue. The operation is indicated for non-fragmented fractures of the intercondylar elevation of the tibia of type I-III according to the Meyers-McKeever classification [3].

Clinical example

Child Alexander, 12 years old, medical history No. 1273, was admitted 7.12.2004 with a diagnosis of closed fracture of the intercondylar elevation of the right tibia with a displacement of the II degree. Hemarthrosis. Injury 2 days ago. Three days later, an arthroscopic intervention was performed on the knee joint with reposition of the probe fracture and fixation of the intercondylar elevation with a knitting needle according to the method described above. The postoperative course is smooth, the sutures were removed on day 7. The patient was discharged under outpatient observation in a plaster cast in the position of flexion of the lower leg 20 °. 2 weeks after surgery, X-ray control was performed, exercise therapy of the knee joint with dosed support on the limb 4 weeks after surgery was prescribed. Examined after 3 months. - no complaints, the range of motion in the knee joint is not limited, there are no signs of instability of the knee joint.

According to this treatment method, 6 patients aged from 8 to 15 years were operated on. Fracture fusion was obtained in all patients. Long-term results were studied within 3 months. - 1 year. The absence of complaints in patients, the stability of the operated knee joint allow us to consider the treatment outcomes satisfactory. The invention allowed to treat children in a short time, without cosmetic defects.

The considered method can be recommended in clinical practice.

Information sources

1. Samoilovich E.F. Arthropneumography in the diagnosis of meniscus diseases in children // Surgery im. N.I. Pirogova. - 1992. - No. 11-12. - S.86-92.

2. McLennan J.G. The role of arthroscopic surgery in the treatment of fractures of the intercondylar eminence of the tibia // J. Bone Joint Surg. [Br]. - 1982. - Vol. 64. - P. 477-480.

3. Meyers M., McKeever F.M. Freacture of the intercondylar eminence of the tibia // J. Bone Joint Surg. [Am]. - 1970. - 52-A. - P.1677-1684.

Claims (1)

A method of treating a fracture of the intercondylar elevation of the tibia, including reposition of the fracture and fixing it with a knitting needle under the control of arthroscopy, characterized in that a 2-mm retaining needle is inserted through a fragment of the intercondylar elevation, repaired by an arthroscopic probe, from top to bottom, from front to back, from outside to inside using the anteroposterior arthroscopic portal, and in the area of the posterior-inner surface of the medial condyle of the tibia, bend the upper end of the knitting needle at 90 ° in a hook and tighten before immersion in osteochondral cartilage fragments intercondylar eminence.

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