RU2339325C2 - Atraumetic method for reposition of comminuted fractures in area of vascular fascicles - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: spin or rod-like apparatus for transosseous osteosynthesis is applied according to the standard method, reposition of proximal and distal fragments of the bone is conducted. Skin in the projection of the fracture is incised; channel is formed by blunt way intraperiosteally along the external surface of the fragment. Then standard titanium rod is manually screwed into the channel until ledges of its thread touch lateral surface of the fragment. The tail of the rod is fixed in the supporting arm arranged on the stand; control spin is fixed parallel to the inserted rod in the closest to the supporting arm opening of the pivot ring. Turning the supporting arm moves the fragment to its bed on the main fragment. If the fragment is long enough two or more rods are used, which are fixed on parafractional pivot rings.

EFFECT: would reduce traumatism of surgical elimination of comminuted fractures of bones, when fragment is located in area of vascular - nervous fascicle.

2 cl, 4 dwg, 1 ex

Description

The invention relates to medicine, namely to traumatology, and allows for a closed reposition of comminuted fractures when the fragment is located in the region of the neurovascular bundle.

All reposition methods currently used to correct bias have their drawbacks. So with a closed reposition, a puncture with a skin needle can cause damage to blood vessels and nerves, both directly at the time of passage of soft tissues, and during the rotation of the needle with a drill when it is inserted into the bone. At significant speeds, tissue burns and soft tissue “sticks” to the instrument, during which surrounding tissues are wound around the needle, i.e. a traction mechanism of iatrogenic damage occurs. Bone tissue, periosteum and soft tissues inevitably heat up in the region of entry of the needle into the splinter, which adversely affects the splinter, which has a shortage of blood supply, and subsequently manifests itself, in the best case, aseptic inflammation, and in the worst, infection may join.

When the rod is inserted into the splinter, the skin is pre-cut with a drill, which is unsafe with respect to the surrounding tissues both from the drill side, despite the presence of a conductor, and from the splinter side, since the splinter is mobile in soft tissues. When the drill rotates both at the time of penetration into the bone tissue and when passing through it, rotational-vibrational movements of the ends of the fragment occur, which are often pointed, which also increases the risk of damage to blood vessels and nerves [1].

An open reduction of the fracture entails, as a rule, the outflow of hematomas into the wound, which adversely affects the healing process of the bone wound. At the same time, a closed fracture turns into an open one, since conditions for the occurrence of purulent complications appear [2].

The invention consists in a combination of features sufficient to achieve the desired technical result, namely: reducing the morbidity of the operation to eliminate comminuted bone fractures when the fragment is located in the region of the neurovascular bundle.

The essence of the invention lies in the fact that the atraumatic method of reposition of comminuted fractures in the region of vascular bundles includes the application of a rod or spoke device for transosseous osteosynthesis, reposition of the proximal and distal fragments of the bone. The next step is to dissect the skin in the projection of the fragment and, subperiostally, bluntly form a channel in the soft tissues along the outer surface of the fragment. A titanium rod is inserted into this channel manually by translational screwing until the protrusions of its thread come into contact with the outer side surface of the fragment. The shank of the rod is fixed in the bracket mounted on the support. In parallel with the inserted rod, the control spoke is fixed in the hole closest to the bracket on the ring support. When the bracket is rotated around the axis, it moves the fragment to its bed on the main fragment and holds it in the reached position. The dosage of reposition across the width is determined by measuring the violation of the parallelism of the rod and the control needle. With a significant fragment length, it is necessary to use two or more rods, which are strengthened on parafractural ring supports. The direction of insertion of the rods is determined by the type of displacement.

The use of this method is not accompanied by significant tissue trauma, it eliminates the mechanical impact of a drill or a needle on both the fragment itself and the soft tissues around it, and excludes the traction mechanism of iatrogenic damage to the neurovascular bundle.

The simplicity of the method and its non-invasiveness allow the doctor to freely and without fear conduct an accurate closed reposition of a comminuted fracture using standard equipment.

The method is as follows.

The rod or spoke device is applied for transosseous osteosynthesis. After conducting a closed reposition of the proximal and distal fragments of the bone, a removable bracket is installed on the parafracture ring of the rods in the hole closest to the fragment. In the projection of the center of the fragment, a skin incision of 0.5-0.7 cm is made, a blunt way forms a channel in the soft tissues, going subperiosteally to its outer (cortical) plate, to exclude damage to blood vessels and nerves. A titanium transosseous rod is inserted into this channel manually, without using a drill, so that the end of the rod extends 2-3 cm further from the fragment, and the protrusions of the rod thread are as close as possible to the surface of the fragment. The shank of the rod is fixed in a removable bracket. Then, on the ring support, in the hole closest to the bracket, a control spoke, held parallel to the previously inserted shaft, is fixed with the help of a spoke fixer. The reposition is done in a dosed manner by turning the bracket in the direction of the fragment bed on the main fragment. In this case, the threaded surface of the transosseous rod exerts pressure on the lateral surface of the fragment, thereby achieving stability of its position. The sharp edges of the threads of the transosseous rod allow, in a small volume, to reposition and with the reciprocating movement of the rod. The dosage of reposition across the width is determined by measuring the violation of parallelism of the rod and the control needle at two levels: above the skin of the segment and at the level of the ring. In the presence of an external fragment, it can be repositioned by two rods and brackets mounted on both parafracture rings.

Clinical example.

Patient S.V.N., born in 1972, source.ball. No. 4059, 09.09.05 was admitted to the traumatology department of the SRC “WTO” with a diagnosis of closed comminuted fracture of the left shoulder with a displacement of 20 days ago (injury from 08.20.05) - figure 1.

09.09.05 - operation with the imposition of an apparatus for transosseous osteosynthesis - Fig.2 and 3 - given two projections of the limb with the apparatus installed.

September 16, 2006 the patient was discharged from the hospital for outpatient treatment. The device was removed on 1/16/06. The function of the left upper limb is fully restored. The control snapshot of 05.23.06 is shown in Fig.4. The patient is satisfied with the result of the operation.

Information sources

1. Osteosynthesis: A Guide for Physicians, ed. S.S. Tkachenko. L .: Medicine, 1987. P.193.

2. General Surgery, Volume 1. Guide for Physicians and Students, ed. E.R. Hesse, S.S. Girgolava and V.A.Shaak, OGIZ, 1935, p. 276, 487.

Claims (2)

1. Atraumatic method for the reduction of comminuted fractures in the region of vascular bundles, including the application of a rod or spoke device for transosseous osteosynthesis and reposition of the proximal and distal fragments of the bone, characterized in that the skin is cut through the projection of the fragment, subperiosteally, along the outer surface of the fragment, the channel is divided into the fragment soft tissues, into which manually, by progressive screwing, a standard titanium rod is inserted until the protrusions of its thread come into contact with the outer side surface fragment, the shank rod is fixed to the bracket mounted on a support rod is fixed parallel to the entered control needle closest to the bracket hole in the annular support, rotating the bracket is moved to its splinter box at the base moiety. 2. An atraumatic method for the reduction of comminuted fractures in the region of vascular bundles according to claim 1, characterized in that, with a significant fragment length, two or more rods are used that are mounted on parafracture ring supports.

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