RU2409327C1 - Method of osteosynthesis of olecranon fractures - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to traumatology and orthopaedics. Two extension wires are inserted at the side of olecranon top through area of fracture until ends of wires perforate opposite cortical layer of ulnar bone. Holes are made in distal direction from fracture in cortical layer of ulnar bone at medial and lateral sides. Distal part of tightening wire loop is pulled through holes so that it is located around distal sections of wires. Proximal part of tightening loop is pulled over top of olecranon around proximal ends of wires, which are bent. Wire loop is tightened due to twisting of its ends one to another.

EFFECT: method makes it possible to eliminate migration of wires, to achieve effect of blocking and stressed osteosynthesis, preserving effect of compression in area of fracture for the period of its synostosis, to start active exercise therapy with application of mechanotherapy methods at early time after operation, to reduce risk of consolidation disturbance and formation of elbow joint contracture.

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Description

The invention relates to medicine, namely to traumatology, and can be used in the treatment of fractures of the ulnar process by immersion osteosynthesis.

The analogues of our proposed method are: immersion osteosynthesis with a screw; a plate; the core. (N.V. Kornilov, E.G. Gryaznukhin, Traumatological and orthopedic care in the clinic, p. 115.)

The prototype is a method for osteosynthesis of fractures of the ulnar process by a tightening wire loop and Kirchner knitting needles (Peter Matter, Domenic Scharplatz, Operative Orthopedics, Vol.1, pp259-261), according to which the fracture is fixed with two Kirschner spokes parallel to each other, perpendicular to the fracture line near the articular surface, the ends of which perforate the opposite cortical layer of the ulna, and a tightening wire loop held under the tendon of the triceps muscle and around the Kirchner spokes and 3 cm distal to the fracture through cash made in the ulna.

The disadvantages of this method are:

1) A low degree of stability of osteosynthesis, since holding a wire loop only around the proximal ends of the Kirchner spokes leads to an uneven distribution of forces transmitted from the tightening loop to the spokes, which creates the preconditions for the migration of spokes during the early development of movements in the elbow joint.

2) A low degree of supportive compression in the fracture zone. The occurrence of resorption in the fracture zone during fixation leads to a significant weakening of the pulling force of the wire loop, which reduces the likelihood of fracture fusion due to the loss of the effect of supporting compression.

Thus, the application of the described method for the osteosynthesis of fractures of the ulnar process does not in all cases provide the necessary complex of biomechanical conditions of fixation, which leads to the occurrence of complications such as migration of metal structures, delayed fusion or formation of a false joint, contracture of the elbow joint.

We have developed a method for osteosynthesis of ulnar bone fractures, which provides higher stability of fracture fixation, elimination of spoke migration, dynamic supportive compression in the fracture zone. In addition, our proposed method allows us to reduce the risk of delayed joint fracture and the formation of a false joint, to begin active physical therapy in the early stages after surgery, which provides a good functional result and prevention of contracture of the elbow joint.

This is achieved by the fact that the tightening wire loop is carried out not only around the proximal, but also around the distal ends of the spokes. In this case, the balancing of the forces transmitted from the tightening loop to the spokes occurs, which leads to the occurrence of the blocking effect. In addition, the interaction of the distal parts of the spokes and the tightening wire loop leads to the appearance of additional force due to the bending stress of the spokes. This force provides the effect of supporting dynamic compression in the fracture zone even in the case of resorption. Thus, when using our proposed method, the effect of intense blocking osteosynthesis of the fracture of the ulnar process is achieved.

The proposed method is illustrated in figure 1, where 1 - Kirchner spokes, 2 - zone of fracture of the ulnar process, 3 - constricting wire loop, 4 - holes in the cortical layer of the ulna.

The method is as follows.

After laying the patient in the operating room on an orthopedic table in a supine position with a damaged upper limb laid on his chest, the surgical field is treated and a midline incision is made along the posterior surface of the elbow joint, shifting in the radial region of the ulnar process. Then, the fracture zone of the ulnar process (2) is exposed, through which, after open reposition, two Kirschner spokes (1) are passed from the top of the ulnar process distally at an angle to the axis of the ulnar bone until the ends of the spokes (1) perforate the opposite cortical layer of the ulnar bone . Then, at a distance of about 3 cm distal to the fracture in the cortical layer of the ulna from the medial and lateral sides, holes (4) are made with a drill through which the distal part of the tightening wire loop (3) is drawn so that it is located around the distal sections of the Kirchner spokes (1) . The proximal part of the tightening loop (3) is carried out under the tendon of the triceps muscle of the shoulder above the apex of the ulnar process around the proximal ends of the Kirchner spokes (1), which are folded 180 ° and immersed in the cortical plate of the apex of the ulnar process. Then attach the position of the extension of the elbow joint and tighten the wire loop (3) by twisting its ends one after another. Perform control radiography. The wound is sutured. Apply an aseptic dressing.

The proposed method was applied by us in the treatment of 9 patients with fractures of the ulnar process. In none of the cases was the migration of metal structures recorded, in all cases good treatment results were achieved.

Clinical example

Patient S., 45 years old. Diagnosis: closed fracture of the right ulnar process with displacement of fragments. Figure 2 presents the x-ray before surgery. An open fracture reduction was performed, in accordance with the proposed method, Kirchner spokes and a tightening wire loop were introduced (Fig. 3 shows the radiograph after the operation). 4 days after the operation, active physiotherapy exercises began. On the 10th day after the operation, the patient was discharged for outpatient treatment with the possibility of self-care of the injured limb. Four weeks after the operation, control radiography revealed a fusion of the fracture, the absence of signs of migration of metal structures (figure 4). A good functional result was achieved: muscle strength in the right hand - 4 points on a five-point system, passive movements in the right elbow joint in full.

The proposed method allows you to:

- to achieve high stability of fracture fixation,

- exclude the migration of knitting needles,

- provide dynamic supportive compression in the fracture zone,

- reduce the risk of delayed joint fracture and the formation of a false joint,

- start active physical therapy in the early stages after surgery,

- to achieve good functional results of treatment and implement effective prevention of contracture of the elbow joint.

Claims (1)

The method of osteosynthesis of the ulnar process, including the introduction of two Kirschner spokes from the apex of the ulnar process through the fracture zone until the ends of the spokes perforate the opposite cortical layer of the ulna, and holding a tightening wire loop, characterized in that distal to the fracture in the cortical layer of the ulna of the medial and lateral sides, holes are made through which the distal part of the tightening wire loop is held so that it is located around the distal sections in the spokes, the proximal part of a tension band is passed over the tip of the olecranon around the proximal ends of the spokes are bent, tighten the wire loop due to twist it all for each other.

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