RU2593230C1 - Method for surgical treatment of fracture of condyle of humerus in children and adolescents - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to traumatology and orthopaedics and can be used for surgical treatment of condyle of humerus fracture in children and adolescents. Two parallel pins with thrust areas in frontal plane, through condyles of humerus in opposite direction, are fixed by means of external support device. At a lateral external surface of lower third of shoulder one intraosseous Schanz rod is inserted and fixed to support via bracket with threaded hole.

EFFECT: method provides early rehabilitation, reduces a risk of contracture.

1 cl, 5 dwg

Description

The invention relates to medicine, in particular to traumatology and orthopedics, and can be used in the treatment of patients with fractures of the condyles of the humerus in children.

There is a method of surgical treatment of multicapillary fractures of the distal metaepiphysis of the humerus in children and adolescents [1], which provides access to fragments of the humerus from 2 sections along the inner and outer surfaces of the elbow joint, with the isolation and blocking of the ulnar nerve. The fracture is repositioned and the anatomically matched fragments of the humerus are temporarily fixed with a limited number of cross spokes, depending on the number of fragments. The imposition of the Ilizarov apparatus is carried out closed, without fixing the elbow joint. The disadvantages of this method of treatment is a large number of spokes held through the shoulder near the passage of the neurovascular bundles, which can cause damage. A spoke system of fixation, which has inlet and outlet openings, which increases the fixation of paraossal tissues to the bone, can lead to the development of contracture of the elbow joint. The three-sectional external fixation device has a large weight and volume, which makes it difficult to care for soft tissues and limits movement in the limb. Due to the complexity of holding knitting needles in this segment and the risk of damage to blood vessels and nerves, the spoke arrangement increases the time of surgical intervention.

A known method of surgical treatment of intra- and periarticular fractures of the distal end of the humerus [2]. The method consists in holding two knitting needles with thrust pads through the condyle of the shoulder, introducing the rods in different planes to the axis of the humerus into the shoulder diaphysis, fixing the rods in the apparatus, performing reposition and lateral compression of the bone fragments by tensioning the knitting needles in the spokes. The disadvantage of this method is the layout of the external fixation device, containing straps with a threaded end and a reposition unit in the form of a slider with holes. Due to the complexity of the assembly, the time of surgery is increased, which means that the dose of anesthetics is also increased. Conducting rods from this node is possible only on the back surface of the shoulder, which, due to the passage of the posterior group of shoulder muscles in this area, restricts movements in the elbow joint, leads to contractures, increases pain in the postoperative period and increases the rehabilitation time of these patients. Holding a second threaded percutaneous shaft further injures the bone and soft tissue. This leads to an increase in fracture fusion time, patient rehabilitation time, to contractures in the elbow joint and intensification of pain in the postoperative period.

The aim of the invention is to provide a method to reduce the time of surgical intervention, providing the possibility of early rehabilitation.

The invention consists in a combination of essential features sufficient to achieve the desired technical result, consisting in the implementation of stable osteosynthesis of the condyles of the humerus in children and adolescents, which allows for the prevention of contracture.

The essence of the method of surgical treatment of the condyle of the humerus in children and adolescents involves conducting two parallel knitting needles through the humerus of the humerus in the frontal plane, in the opposite direction, fixing them with the external support of the apparatus, introducing rods into the diaphysis of the humerus and fixing them to the support of the apparatus. The needles are carried out after a closed reposition of the condyle fracture, the intracostal Shantz rod is carried out along the outer-lateral surface of the lower third of the shoulder and fixed to the support through the bracket with a threaded hole.

The use of one intraosseous rod causes minimal additional trauma to the patient, increases the reliability and stability of fixation of bone fragments, allows to minimize the weight of the apparatus, eliminates the development of contractures, reduces the time required for rehabilitation.

The method is illustrated in the illustrations, where:

In FIG. 1 and FIG. 2 shows radiographs of an injured shoulder;

In FIG. 3 - radiographs of the injured limb with the apparatus installed;

In FIG. 4 - FIG. 5 shows an apparatus mounted on a patient’s shoulder.

The method is as follows.

Under general anesthesia, under aseptic conditions, a closed reposition of the condyle of the humerus is performed. Through the condyle of the humerus in the frontal plane, two spokes with thrust pads are held parallel to each other: one from the outer surface, the other from the inner surface of the shoulder, and fixed in the semicircular support from the standard parts of the Illizarov apparatus. The spokes are pulled into each other, which creates compression in the fracture zone of the condyle of the humerus. A Schantz intraosseous rod is carried out along the outer lateral surface of the lower third of the shoulder and fixed to the semicircular support through a bracket with a threaded hole.

An example of practical application.

Patient Mr. R.A., born in 2000, was admitted to the children's ward of the Traumatology Center GAUZ RKB MH RT on December 7, 2014 (I. / B. No. 43492) with a diagnosis of Closed fracture of the medial condyle of the left humerus with displacement. Injury the day before admission: fell while rolling downhill. At the place of residence in the CRH, a diagnosis was made, a plaster cast was applied. On examination: severe edema, pain. On the roentgenogram: fracture of the medial condyle of the left humerus with displacement (Fig. 1, Fig. 2). In the clinic, the operation was performed on December 9, 2014: a closed reposition of the fracture, osteosynthesis with the Ilizarov spokes (Fig. 3 - Fig. 5). The spokes are removed after applying the Ilizarov apparatus. The postoperative period was uneventful, the fracture was healed. The dismantling of the Ilizarov apparatus was carried out after 2 months. The functional result of surgical treatment is good.

According to the proposed method, 9 patients aged from 8 to 15 years were operated on. The application of the proposed method improves the reliability and stability of fixation of bone fragments, is the prevention of contracture of the elbow joint, and also significantly reduces the time required for rehabilitation.

Information sources

1. RF patent No. 2360629 A61B 17/56, July 10, 2009.

2. RF patent No. 2178273 A61B 17/56, 01/20/2002

Claims (1)

A method for the surgical treatment of a condyle of the humerus fracture in children and adolescents, including holding two parallel knitting needles with thrust pads in the frontal plane, through the humeral condyles in the opposite direction, fixing them using the external support of the apparatus, characterized in that on the outer-lateral surface of the lower Thirds of the shoulder conduct one intracostal Shantz shaft and fix it to the support through a bracket with a threaded hole.

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