RU2812579C1 - Method of osteosynthesis of fracture of surgical neck of shoulder - Google Patents

Abstract

FIELD: medicine; traumatology; orthopaedics.

SUBSTANCE: invention can be used for osteosynthesis of oblique fractures of the surgical neck of the humerus. Reposition of fragments of the humerus is performed. In the proximal and distal fragments, four through channels are formed with a drill, so that the entry and exit points of the drill correspond to the vertices of the rectangle. Two wire cerclages are passed along the formed channels through the proximal and distal fragments to form nodes on the diaphysis; then osteosynthesis is performed with a T-plate AO, which is positioned so that it is located between two wire cerclages, and the plate is fixed with screws. The ends of the wire cerclages are pulled together and intertwined, pressing the plate against the diaphysis; the final node is formed.

EFFECT: method provides reliable fixation due to additional compression of bone fragments and the plate to the diaphysis.

1 cl, 4 dwg, 1 ex

Description

The present invention relates to medicine, namely to traumatology and orthopedics, and can be used for osteosynthesis of oblique fractures of the surgical neck of the humerus.

A fracture of the proximal humerus is a fairly common injury, with 76-82% of its occurrence occurring most often in the group of people over 40 years of age. This trend is associated with an age-related decrease in bone density due to osteoporosis. The most common methods of treating proximal humerus fractures are open reduction, intraosseous osteosynthesis, and osteosynthesis with external fixation devices. However, despite the variety of methods, the number of complications remains quite high (up to 60%). Thus, the issue of searching and developing new methods of osteosynthesis, including against the background of osteoporosis, is still relevant [Sumrein V.O., Huttunen T.T., Launonen A.R., Berg N.E., Mattila VM Proximal humeral fractures in Sweden-a registry-based study. Osteoporos Int. 2017; 28(3):901-907; Lesnyak, O.M. Epidemiology of osteoporotic fractures in the Russian Federation and the Russian FRAX model / O.M. Lesnyak, O.B. Ershova, K.Yu. Belova [et al.] // Osteoporosis and osteopathies. - 2014. - T. 17, No. 3. - P. 3-8].

One of the main methods of treating fractures and fracture-dislocations of the humeral neck is open reposition and extracortical fixation of fragments with a T-plate of the AO (Osteosynthesis Association) using cortical and cancellous screws [Egiazaryan K.A., Ratyev A.P., Gordienko D.P. ., Grigoriev A.V., Ovcharenko N.V. Medium-term results of treatment of fractures of the proximal humerus using intraosseous osteosynthesis // Traumatology and Orthopedics of Russia. 2018. No. 4. P. 81-88]. However, this method can cause difficulties in the presence of an oblique fracture of the surgical neck of the humerus, where the fracture line affects a significant part of the diaphysis. The disadvantage of this method is the high risk of developing instability of the metal structure due to osteoporosis due to the sufficient length of the fracture line. Passing cortical screws directly through the fracture zone will not provide reliable fixation of fragments due to low bone density [Court-Brown S.M., Garg A., McQueen M.M. The epidemiology of proximal humeral fractures. Acta Orthop Scand. 2001;72(4): 365-371].

The prototype of our method is patent RU 2749296 C1 - A method of surgical treatment of a fracture of the surgical neck of the humerus, which consists in repositioning fragments of the humerus, applying a T-plate AO, fixing the distal fragment with screws through the lower holes of the plate, forming two channels in the head of the humerus along the front and rear surfaces, two cerclage loops are passed through the channels formed in the head and holes in the T-shaped protrusion of the plate and the final nodes are formed.

This method has a number of disadvantages: in the presence of osteoporosis not only in the head, but also in the diaphysis of the humerus, with an oblique fracture of the surgical neck of the humerus, the risk of developing instability of the metal structure and excessive mobility of fragments, which prevents effective consolidation, remains high.

The method we propose is carried out as follows. After open access and inspection of the fracture site in the lower third of the proximal fragment, the first stage of the method is implemented (Fig. 1-2): four through channels (1) are formed with a drill in the direction from the anterior to posterior surface of the shoulder, and the drill is carried out in such a way that the entry and exit points of the drill corresponded to the vertices of the rectangle. Similar channels are carried out in the upper third of the distal fragment of the humerus (2). Next, two wire cerclages (3) are passed into the formed channels of the proximal fragment, the ends of which are passed into the corresponding channels of the distal fragment with the formation of final nodes (4) on the diaphysis. Thus, primary reposition of the fragments and additional fixation of the fragments are carried out. The osteosynthesis is completed with the second stage: application of the AO T-plate (Fig. 3) (5) with fixation with two cancellous (6) and two cortical screws (7). The plate is positioned so that it is located between two cerclages. Next, the ends of the cerclages, after fixing the plate with screws, are tightened and intertwined, additionally pressing the plate to the diaphysis. The final knot (8) is formed, the edges are bitten off and the end is bent into the hole of the plate.

Fig. 1. Anterior surface of the humerus.

Fig. 2. Lateral surface of the humerus.

Fig. 3. Application and fixation of the AO T-plate.

Fig. 4. Postoperative radiograph after osteosynthesis using the proposed method.

The technical result of the method is:

1) fixation of fragments with cerclages provides a more convenient and stable primary reduction;

2) the presence of cerclage loops provides additional compression of the fragments and plate to the diaphysis;

3) the method is inexpensive to implement and does not require additional equipment;

4) implementation of stable osteosynthesis in case of severe osteoporotic process in the humerus;

5) placement of cerclage loops leads to additional fixation of the proximal fragment, since, given the oblique type of fracture, interfragmentary diastasis often occurs with conventional fixation methods.

The novelty of the proposed invention lies in the primary reposition of fragments using cerclage loop-ties and the implementation of additional compression of bone fragments and the plate to the diaphysis, which makes it possible to use this method for complex oblique fractures of the proximal humerus.

Example of method implementation

Patient L., born in 1970, was admitted to the hospital with a diagnosis of “Closed oblique fracture of the surgical neck of the right humerus with displacement of fragments.” During open reduction and revision of the fracture site, osteoporosis was revealed in the head of the humerus. The patient underwent osteosynthesis using the method we proposed. Fixation of fragments is satisfactory. In fig. Figure 4 shows a postoperative radiograph after osteosynthesis using the proposed method.

Claims (1)

A method of surgical treatment of an oblique fracture of the surgical neck of the humerus, which consists in repositioning fragments of the humerus, then using a drill to form four through channels in the proximal and distal fragments, so that the entry and exit points of the drill correspond to the vertices of the rectangle, along the formed channels through proximal and distal fragments are carried out using two wire cerclages to form nodes on the diaphysis; then osteosynthesis is performed with a T-plate AO, which is positioned so that it is located between two wire cerclages, and the plate is fixed with screws, then the ends of the wire cerclages are pulled together and intertwined, pressing the plate to the diaphysis; form the final node.