RU2842928C1 - Method for osteosynthesis of fracture of lateral condyle of humerus - Google Patents

Abstract

FIELD: medical science.

SUBSTANCE: invention refers to medicine, namely to traumatology and orthopaedics, and can be used for osteosynthesis of comminuted fractures of lateral condyle of humerus. That is followed by open reposition and screw fixation of the splinter of the lateral condyle of humerus. After reposition and screw fixation of each of the fragments, an additional screw is inserted into the humeral bone in the proximal direction from the fracture line. A cerclage loop is delivered under heads of all three screws. Twisting the loop provides compression of the fragments and a final knot is formed.

EFFECT: method provides simplifying the operation and enables performing the osteosynthesis even in the case of small bone fragments.

1 cl, 7 dwg, 1 ex

Description

The proposed invention relates to medicine, namely to traumatology and orthopedics, and can be used for osteosynthesis of two-comminuted fractures of the lateral condyle of the humerus.

Fractures in the lower third of the shoulder account for about 15% of all musculoskeletal injuries. Surgical treatment is one of the leading methods of treatment at the moment.

One of the most common methods of surgical treatment is the method for treating fractures of the humeral condyle (patent RU 2466693 C2, IPC A61B 17/76, published on 20.11.2012), which includes the use of a plate and screws with angular stability, each of the fragments of the humeral condyles is fixed with screws that form a triangle with the plate with an angle inside the bone of at least 20 °, with one of the screws inserted into the ventral part of the condyle, and the other into the dorsal. The disadvantage of this method is the risk of rotational instability, loosening and migration of screws during the functional rehabilitation of the operated limb with small fragments that are not held by the plate in the case of fixing each of them with one screw, as well as the high trauma of the operation due to the need to install the plate.

There is also a method of fixing bone fragments of the humerus using pins (Resell H., Povacz P., Frohlich R., Wambacher M. Percutaneous Fixation of three- and four-part fractures of the proximal humerus // J. Bone Joint Surg. - 1997. - Vol.79 - P. 295-300). This method is easy to implement, less traumatic, but has a number of disadvantages: the small cross-section of the pins and their smooth surface creates a risk of rotational instability of fragments and migration of the metal structure. In addition, this method requires long-term plaster immobilization, which leads to the formation of contracture of the elbow joint.

We have proposed the following method of osteosynthesis of a two-fragment fracture of the lateral condyle of the humerus, consisting of open reposition and fixation of the fragments of the lateral condyle of the humerus with screws, characterized in that after reposition and fixation of each of the fragments with screws, an additional screw is installed in the humerus proximal to the fracture line and the fracture is additionally fixed with a cerclage-wire loop passed under the screw heads. The method is carried out as follows. After anesthesia and treatment of the surgical field with an antiseptic, surgical access is performed to the fracture of the lateral condyle (2) of the humerus (1) (Fig. 1). Fracture reposition (matching of bone fragments). A channel is formed with a drill through the distal fragment of the medial condyle of the humerus and the humeral block, the first screw (3) is installed, thereby fixing the condyle fragment to the humerus. Then, a second channel is formed above the first screw inserted with a drill through the second fragment of the lateral condyle of the humerus and the humeral block, a second screw is installed, thereby fixing the second fragment of the condyle to the humerus (Fig. 2). The fragments are additionally fixed with a cerclage-wire loop (4) passed under the screw heads (Fig. 3). To fix and compress the fragments, a channel is formed above the fracture line in the humerus with a drill and a screw is installed, to which a cerclage-wire loop passed under the heads of two distal screws is fixed (Fig. 4). By twisting the loop, compression of the fragments is produced and the final knot is formed.

The technical result of the method is:

1. Installation of screws and further fixation of the cerclage-wire loop, which leads to additional compression and elimination of migration of the metal structure due to fixation of bone fragments;

2. The possibility of performing osteosynthesis of each fragment with only one screw in the presence of a small bone fragment that does not allow fixation with two or more screws;

3. Providing stable compression without its subsequent reduction by fixing the fracture fragments with a wire loop on both sides of the fracture zone.

The novelty of the proposed invention consists in simplifying the operation during osteosynthesis of fractures of the lateral condyle of the humerus, creating additional compression, the possibility of performing osteosynthesis in cases where another method of osteosynthesis is impossible due to the presence of small bone fragments and reducing the trauma of the operation compared to bone osteosynthesis with a plate.

As an example of the invention implementation, we present the radiographic results of surgical treatment of a fracture of the lateral condyle of the right humerus with displacement of fragments in patient Sh., born in 1993, admitted with the diagnosis: Closed comminuted fracture of the lateral condyle of the right humerus, (Fig. 5). Osteosynthesis of the lateral condyle of the right humerus was performed with screws and a cerclage-wire loop (Fig. 6). As a result, the next day after the operation, control radiography was taken (Fig. 7), confirming the possibility of achieving the declared technical result.

Fig. 1 shows a fracture of the lateral condyle of the humerus.

Fig. 2 shows the reposition of the fracture and fixation of small fragments with two screws.

Fig. 3 shows the fixation of the fracture with screws and a cerclage-wire loop.

Fig. 4 shows the fixation of fragments to the proximal part of the humerus using a screw and a cerclage-wire loop.

Fig. 5 shows radiographic images of a patient with a closed comminuted fracture of the lateral condyle of the right humerus.

Fig. 6 shows osteosynthesis of the lateral condyle of the right humerus with screws and a cerclage-wire loop.

Fig. 7 shows X-ray control images after surgery.

Claims (1)

A method of osteosynthesis of a two-fragment fracture of the lateral condyle of the humerus, consisting of open reposition and fixation of the fragments of the lateral condyle of the humerus with screws, characterized in that after reposition and fixation of each of the fragments with screws, an additional screw is installed in the humerus proximal to the fracture line, a cerclage-wire loop is passed under the heads of all three screws, compression of the fragments is created by twisting the loop and the final knot is formed.