RU2331379C1 - Method for fixation of fragments of cortical bones with oblique and spiral fractures - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to veterinary surgery, namely to osteosynthesis of cortical bones in small domestic animals, application of the invention being the most effective for osteosynthesis of cortical bones with oblique and spiral fractures. Serclage stich in the form of wire circular suture is put in. Wire circular suture is tightened with rotating clockwise movement, with fracture line in inferior aperture of operation wound falling from left to right, and anticlockwise, with fracture line in inferior aperture of operation wound rising from left to right. In both cases, force of rotating movement acting on wire displaces it to the side opposite to bone fragment end.

EFFECT: increased compression of osteosynthesis at the moment of wire twisting, elimination of injury to bone fragment ends, reliable fixation, elimination of post-operative complications and reduction of treatment terms.

2 dwg, 2 ex, 1 tbl

Description

The invention relates to veterinary surgery, namely to osteosynthesis of tubular bones in small pets. Most effective is its use in osteosynthesis of tubular bones with oblique and helical fractures.

A known apparatus for applying circular wire seams for fractures of long tubular bones, which is the tension of the wire, followed by its rotation through 360 °. The twisting of the wire occurs evenly with good tension. The apparatus reduces the consumption of wire due to shortening the length of the bite of its ends [Borodin I.F. Apparatus for applying circular wire sutures for fractures of long tubular bones. // Orthopedics, traumatology and prosthetics. No. 9, State. ed. medical literature, Moscow-Kharkov, 1960. - S. 53-54].

There is also a known method of osteosynthesis, where in an oblique fracture, the fixation of fragments of the tubular bone is made by a rod and cerclage sutures. Circular seams are presented in the form of a circular wire seam [Nikitin GD, Mityunin N.K., Gryaznukhin E.G. Multiple and combined bone fractures. Leningrad. "MEDICINE", Leningrad branch, 1976, p. 97, fig. 36 (b) - prototype].

The main disadvantage of such fixation of fragments during longitudinal, oblique and helical fractures is that when tightening the wire, the direction of its twisting is not observed depending on the direction of the fracture line in the wound aperture. In the case when the rotational movements when tightening the wire will be directed in such a way that they will contribute to the displacement of the applied circular cerclage towards the end of the fragment due to the angular displacement of the wire relative to the longitudinal axis of the bone, then its displacement is possible with subsequent dropping between the fragments. For example, when the twisting of the circular wire cerclage is performed clockwise (instead of the optimal counterclockwise rotation), its upper and lower parts, visualized in the wound aperture, will shift to the edge of the bone fragments (it is possible for the wire to fall between fragments). This can lead to additional trauma to the ends of the fragments, the nourishing artery and bone marrow. In addition, such twisting promotes the separation of fragments and their microdisplacement before stable fixation is achieved. All this affects the timing of the consolidation of fragments and the occurrence of postoperative complications.

The objective of the proposed solution is to eliminate these disadvantages and increase the efficiency of fixation of fragments during osteosynthesis.

The problem is achieved due to the fact that the known method of fixing fragments of tubular bones with oblique and helical fractures, including the imposition of a cerclage seam in the form of a circular wire seam and its tightening, according to the invention, that the circular circular seam is tightened clockwise when the fracture line in the lower aperture of the surgical wound runs downward from left to right, and counterclockwise, when the fracture line in the lower aperture of the surgical wound runs along the it left to right, while in both cases, the impact force of the rotational motion of the wire displaces it in the opposite direction from the end of the bone fragments.

The invention is illustrated by drawings, where

in figure 1. - fixation of fragments of the tubular bone (oblique fracture, where the fracture line in the lower aperture of the surgical wound runs along the flowing from left to right) with a wire in compliance with the direction of its twisting clockwise. The application of rotational motion with such twisting will contribute to the angular displacement of the wire from the edge of the bone fragments and prevent the wire from dropping between them. The arrows indicate the direction of displacement of the wire;

figure 2. - fixation of fragments of the tubular bone (oblique fracture, where the fracture line in the lower aperture of the surgical wound runs along increasing from left to right) with the wire, observing the direction of twisting counterclockwise, which will also contribute to the displacement of the wire from the edge of the bone fragments and prevent the wire from dropping between them. The arrows indicate the direction of displacement of the wire.

The operation according to the proposed method is given as an example of osteosynthesis of a long tubular bone (dog and cat) with an oblique line of fracture 1 using wire 2 and observing the direction of rotational movements at the point of twisting 3 of wire 2. The operation is carried out as follows.

After combining the fragments in order to prevent them from diverging along the line of fracture 1, circular cerclage sutures from wire 2 are placed in two places and bone fragments are fixed, observing the direction of rotational movements at the twisting point 3 of wire 2 taking into account the direction of the fracture line in the wound aperture.

Example 1. A dog of the breed a dwarf poodle at the age of 4 years with a live weight of 6 kg. The diagnosis is an open oblique fracture of the tibia. An operation was performed to combine and fix bone fragments using a wire with a cross section of 1.0 mm. The wire was laid in the form of a circular seam, covering the diaphysis of the damaged bone in two places perpendicular to its long axis. Since the fracture line in the lower aperture of the surgical wound passed along the falling from left to right, the direction of twisting of the wire clockwise was observed. The initial application of rotational motion in this case contributed to the angular displacement of the wire from the edge of the bone fragments. That is, with this direction of the fracture line in the wound aperture, the upper part of the circular cerclage from the wire was shifted to the right, and the lower part to the left and, respectively, from the edge of the bone fragments. The entanglement of wire between fragments was excluded. Subsequently, rotational movements in a given direction contributed to the shortening of the wire forming a circular cerclage seam, which gradually assumed a perpendicular position relative to the long axis of the bone. In this case, the return of the circular cerclage to its initial position before twisting (perpendicular to the long axis of the bone) facilitated the movement of the fragments towards each other due to the adhesion of the wire to the periosteum of the fragments - a compression was created that was useful for stable immobilization of fragments. Complete modeling of the wire around the bone diaphysis contributed to the reliable immobilization of fragments. As a result of the operation, a complete restoration of the supporting function of the diseased limb was observed on the 26th day after the operation, which is 3 days earlier compared to the control animals (twisting the wire counterclockwise).

Example 2. A cat at the age of 2 years with a live weight of 2.5 kg. The diagnosis is a closed oblique fracture of the femur. Osteosynthesis was performed using a wire with a cross section of 0.5 mm. Since the fracture line in the lower aperture of the surgical wound ran in increasing direction from left to right, the direction of twisting the wire counterclockwise was observed, the acting force of which contributed to the angular displacement of the wire in the opposite direction from the edge of the fragments and prevented the wire from dropping between the fragments. That is, with this direction of the fracture line in the wound aperture, the upper part of the circular wire cerclage shifted to the left, and the lower part to the right and, respectively, from the edge of the bone fragments. Rotational movements in a given direction contributed to the shortening of the wire, forming a circular cerclage seam, which gradually assumed a perpendicular position relative to the long axis of the bone. As a result of the operation, a complete restoration of the supporting function of the diseased limb was observed 24 days after the operation, which is 4 days earlier compared to control animals (twisting the wire clockwise).

As a result of the application of the proposed method, it was found:

- the exception of slipping wire from fragments;

- prevention of injury to the ends of bone fragments;

- the exclusion of additional trauma to the supply artery and bone marrow;

- the elimination of microdisplacement of fragments relative to each other;

- additional advancement of fragments towards each other at the time of twisting the wire, that is, an increase in the compression of osteosynthesis;

- increase the fixing ability of the wire;

- reduction of the postoperative period and bone repair;

- reduction of the recovery time of the function of the damaged limb;

- reducing the possibility of developing postoperative complications.

This greatly improves the efficiency of the operation.

The proposed method was successfully applied on 9 dogs and 9 cats with oblique bone fractures during their surgical treatment on the basis of the medical and diagnostic veterinary center of the Federal State Educational Institution of Higher Professional Education “Orel GAU” and other clinics of the Russian Federation (see table 1).

Table 1 The method of fixation of fragments of tubular bones by circular cerclage The number of animals operated Full restoration of the supporting function of the damaged limb, day The proposed method eighteen 24-26 Known method eighteen 28-30

As can be seen from the table, the application of the proposed method is more effective than the known one and allows you to accelerate the full restoration of the supporting function of the damaged limb in animals on average 4 days earlier than when applying the generally accepted method.

Claims (1)

A method for fixing fragments of tubular bones with oblique and helical fractures, comprising applying a cerclage suture in the form of a circular wire suture and tightening it, characterized in that the circular circular suture is tightened clockwise when the fracture line in the lower aperture of the surgical wound runs along the falling left to the right and counterclockwise, when the line of fracture in the lower aperture of the surgical wound runs along increasing from left to right, while in both cases the acting force rotates The positive movement on the wire shifts it to the side opposite from the end of the bone fragment.

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