RU2483688C1 - Method of surgical treatment of fracture-dislocations of proximal part of humeral bone with strained pins - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to traumatology and orthopedics, and can be applied in operative treatment of patients with fracture-dislocations of proximal part of humeral bone. Essence of method lies in open elimination of dislocation and reposition of fragments. Osteosynthesis with strained pins is performed. Cortical holes in humeral bone are drilled with 2 mm drill from humeral bone head into intramedullar canal, pin is brought 1.8 mm beyond fracture line through cortical hole. After that, one more hole is drilled from top downward in humeral bone head into intramedullar canal. Projecting pin end is bent and introduced through humeral bone head into hole. Pin is hammered up to the stop. Other pins, required for rigid fixation, are introduced in the way similar to the first pin. Minimum two pins are required for rigid fixation. After that, additional immobilisation of injured extremity is performed in diverting splint.

EFFECT: application of claimed invention makes it possible to carry out stable osteosynthesis of fracture-dislocations of proximal part of humeral bone in open way by means of strained pins, provide early therapeutic exercise in the joints of the injured extremity.

10 dwg, 1 ex

Description

The invention relates to medicine, namely to traumatology and orthopedics, and can be used for surgical treatment of patients with fracture dislocation of the proximal humerus.

There is a method of transosseous osteosynthesis of fracture-dislocation of the proximal humerus in the external fixation apparatus according to G.A. Ilizarov (L.N. Solomin, basics of transosseous osteosynthesis by G.A. Ilizarov apparatus, 2005).

The disadvantages of this method are: the bulkiness of the structure, there is no motor activity in the joints of the damaged limb.

A known method of performing osteosynthesis of fractures-dislocations of the proximal humerus using the Philos plate (M.E. Muller, M. Algover, R. Schneider, X. Willinger, Guide to Internal Osteosynthesis, 2005).

The disadvantages of this method are: high invasiveness of the operation, wide exposure of the humerus is required, aseptic necrosis of the humeral head is highly likely, the presence of osteoporosis can lead to the migration of screws, plates.

The closest is the last way of fixing fractures of the proximal humerus. It is taken as a prototype.

The aim of the proposed "Method for the surgical treatment of fractures of the proximal humerus" is to eliminate the above disadvantages, which allows for stable osteosynthesis of fractures of the proximal humerus openly using strained knitting needles.

To achieve the medical-technical result of the proposed method, open reduction of dislocation is performed. After an open reposition of the fracture, fixation is performed with tight knitting needles. Stable osteosynthesis is carried out under visual control, stability between fragments occurs due to bending of the needle and its tension in this case, and reduces the likelihood of secondary displacements of fragments. In this case, the skin incision is much smaller than with osteosynthesis with a plate, which reduces the time of wound healing and, therefore, inpatient treatment. Then, additional immobilization of the damaged limb in the abduction splint is performed, which allows an early start of physiotherapy exercises in the joints of the damaged limb.

The claimed method is illustrated in Figure 1.

The method is as follows: the position of the patient on the back. An open dislocation elimination is performed, then the fracture is repositioned. Cortical holes (2) are drilled in the bone (1) with a 2 mm drill from the head of the humerus into the intramedullary canal. A 1.8 mm needle is inserted per fracture line (3) through the cortical opening. Drill another hole (6) from top to bottom in the head of the humerus in the intramedullary canal (4). The protruding end of the knitting needle is bent and inserted through the head of the humerus into the hole. The needle is hammered all the way. Similarly to the first spoke, other knitting needles (5) are introduced, which are necessary for rigid fixation. The minimum of knitting needles for rigid fixation is two. Under the control of an electron-optical transducer (EOP), movements are made in the shoulder joint. Capetonization (suturing) of the wound is performed.

Practical example

Patient G., 57 years old. I / B No. 4176. Diagnosis: fracture-dislocation of the head of the left humerus (Fig. No. 1). According to the patient, the trauma dated 03/13/09 at the dacha in the home fell with an emphasis on the left upper limb. At the place of injury, radiographs of an attempt to eliminate the dislocation were made, the dislocation of the head was not eliminated, a plaster cast was applied. Later he was hospitalized in department No. 1 for examination and preparation for surgery. Upon admission, the left upper limb is fixed by the discharge tire. Swelling of the left upper limb, extensive hemorrhage along the external surface of the left shoulder. Gross disturbances of innervation and blood circulation were not detected. On radiographs, a fracture-dislocation of the head of the left humerus is noted. Computed tomography (CT) scan of the left shoulder joint (Fig. No. 2) was performed, on which there was a comminuted fracture-dislocation of the head of the humerus with anterior displacement. On angiograms (Fig. No. 3) there is no blood supply to the head. 03/18/09 the operation was performed: elimination of dislocation of the head of the left humerus, open reduction, osteosynthesis with strained knitting needles (Fig. No. 4). Additionally, the fixation was carried out by the discharge bus (Fig. No. 5). The postoperative period without features, the sutures were removed on day 14, primary healing. In connection with the end of the course of treatment in satisfactory condition, the patient is discharged at the place of residence. 05/17/09 (2 months after the operation) was hospitalized in the department where physiotherapy exercises (LFK) was carried out - the development of movements in the left shoulder joint and rehabilitation. An angiography was performed, according to which blood circulation was restored (Fig. No. 6).

The range of motion in the left shoulder joint is almost in full (Fig. No. 7). Achieved complete medical and social rehabilitation of the patient. 10/07/09 after preoperative preparation, the operation was performed: removal of the spokes from the left humerus (Fig. No. 8). The volume of movements on the second day slightly decreased (Fig. No. 9). Postoperative course without features. Sutures were removed on the 13th day. When discharge, movements in the shoulder joint were fully restored (Fig. No. 10).

The list of figures for the description of the method:

Figure 1

1 - humerus

2 - cortical opening

3 - spoke number 1

4 - intramedullary canal of the humerus

5 - spoke number 2

6 - cortical opening in the head

Fig.№1. Fracture dislocation of the head of the left humerus

Fig.№2. CT of the shoulder joint

Fig.№3. Shoulder angiography

Fig. No. 4. Spoke Osteosynthesis

Fig.№5. The appearance of the patient

Fig. No. 6. Angiography of the shoulder joint after 2 months

Fig. No. 7. Appearance before removal

Fig.№8. Knitting needles

Fig. No. 9. Appearance, the first day after removal

Fig.№10. Appearance before discharge

Claims (1)

A method of surgical treatment of fractures-dislocations of the proximal humerus with strained knitting needles, including open removal of the dislocation and reposition of fragments, characterized in that osteosynthesis is performed by strained knitting needles with open fracture reposition, drilling cortical holes in the humerus with a 2 mm drill from the humeral head into the intramedullary canal , insert a 1.8 mm needle behind the fracture line through the cortical opening, drill another hole from top to bottom in the head of the humerus in the intramedullary the first channel, the protruding end of the spoke is bent and inserted through the head of the humerus into the hole, the needle is hammered to the stop, similarly to the first spoke, other knitting needles are needed for rigid fixation, a minimum of knitting needles for rigid fixation, two, then additional immobilization of the injured limb in drive bus.

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