RU71874U1 - DEVICE FOR OSTEOSYNTHESIS OF Fractures and Fracture-Dislocations of the Cervix of the Shoulder - Google Patents

Abstract

A device for osteosynthesis of fractures and fractures of the neck of the shoulder, characterized in that it is made of bioinert metal in the form of a U-shaped hairpin 10 cm long with a distance between the sides of 1 cm, concave over the entire length along the radius of 9 cm and having a rectangular cross section 0, 2-0.3 cm.

Description

- A useful model - a device for osteosynthesis of fractures and fractures of the neck of the shoulder - relates to medicine, namely to orthopedics and traumatology, and can be used in the surgical treatment of neck fractures and fractures of the shoulder of various options, in accordance with the universal classification of AO / fractures ASIF M.E. Muller. Guide to internal osteosynthesis. Methodology recommended by the AO group (Switzerland) Springer - Veriag, 2001. 650 pp. Pp. 156-159.

An urgent problem of modern traumatology - orthopedics is the further development of effective metal structures for the surgical treatment of fractures and fractures of the shoulder for all three types of fractures according to the international classification. Fractures of the proximal end of the humerus accounted for about 5% - in relation to all fractures. With surgical treatment, the best possible functional result is always planned, with the use of existing well-known metal structures after surgical treatment, there is always the possibility of secondary displacement of fracture fragments and other complications. The development of new metal structures involves eliminating the shortcomings of existing metal structures. The use of plates of various modifications does not always completely eliminate the displacement of fragments. Patients are concerned about pain and impaired function of the shoulder joint. When using well-known metal structures, accompanied by extensive, traumatic, non-anatomical access, it is always possible in that

- or, to some extent, trauma to muscles, blood vessels and nerves, which in turn leads to later complications, post-traumatic deforming arthrosis of the shoulder joint, and in some cases, avascular osteonecrosis, severe atrophy of the shoulder girdle, severe contractures, which are difficult to treat. The use of more advanced designs allows you to avoid these complications, to achieve the earliest and most accurate reposition of bone fragments with reliable and non-traumatic internal osteosynthesis. Based on the data of domestic and foreign literature on the surgical treatment of neck and shoulder fractures, it can be noted that open reduction and internal metal osteosynthesis are one of the most common and effective methods for their treatment. However, among the variety of metal structures available, there is not one that is simple, not bulky, and less traumatic, providing reliable fixation.

A device is known for metal osteosynthesis of neck fractures, fracture - dislocations of the shoulder with displacement (M.E. Muller. Guidelines for internal osteosynthesis. Method recommended by the AO group. (Switzerland) Springer - Veriag 2001, 650 pp. 165-159.), which is a T-shaped plate with three or four holes. The plate is used as follows. The best access to the proximal part of the humerus is through an incision along the groove between m.pectoralis and m.deltoideus. Access can be enhanced by cutting off the deltoid muscle from the clavicle and brachial process.

Stable fixation is achieved by open reduction and internal fixation with a T-plate located so as not to disturb the function of the m.biceps long tendon. 6.5 mm spongy screws with a thread along the entire length are usually well suited to fix the head fragment. With subcapital fractures, the diaphysis almost always lies

subcutaneously and can be placed back under the head using a small bone retractor.

After the operation, the arm is placed in the abduction position on the splint and all physiotherapeutic treatment begins from this position. It is necessary to avoid prolonged immobilization of the shoulder joint.

Disadvantages of extracortical osteosynthesis with a T-shaped plate of AO.

1) The application of the plate requires extensive operational access and exposure of the bone over a large extent. This increases the risk of developing infectious complications compared with intramedullary osteosynthesis or external extra focal osteosynthesis.

2) A massive plate laid on the periosteum even without its exfoliation leads to a violation of periosteal blood supply. The plate in contact with the bone with its entire surface causes its necrosis and widespread osteoporosis. This is a natural biological response of the bone, expressed in accelerated remodeling of its havers systems.

3) Osteoporosis-related disturbance in bone strength may result in refracture at the screw insertion sites if the plate is removed before completion of the remodeling process.

4) High probability of damage to the axillary nerve (n.axsilaris) during osteosynthesis.

The T-plate with a hook-shaped end of K.M. Klimov (Kaplan A.V. Closed injuries of bones and joints. “Medicine”, Moscow, 1967, 512 pages, 156-157 pages) - fixation of fragments at fracture of the neck of the shoulder with the help of a T-plate with a hook-shaped end. The operation is as follows. After matching the fragments, the shoulder is rotated inward. Then, a groove 5-6 cm long is cut out in the humerus with a circular electric saw through the entire thickness of the cortical layer, down from the fracture site, outwards and parallel to the large tendon

pectoral muscle and long biceps head. Through it, the coracoid end of the T-plate is hammered into the head of the humerus. Then the T-plate is hammered into the sawn groove of the humerus. The plate is fixed using two cotter pins, which are hammered into the slots of the plate.

Deficiencies of metal osteosynthesis by the K-plate of K.M. Klimov.

1) Plate metal osteosynthesis requires extensive surgical access in which there is a clipping of the deltoid muscle from the clavicle and extensive preparation of the periosteum of the shoulder.

2) Traumatic access and in itself traumatic plate osteosynthesis has the risk of developing infectious postoperative complications.

3) Due to the extensive access and traumatic metal osteosynthesis of the T-plate, a high probability of injury to the axillary nerve is assumed.

Kaplan A.V. Closed injuries to bones and joints. "Medicine", Moscow, 1967, 512 pp., 156-157 pp.

- Tasks:

1) To reduce soft tissue trauma, as well as extensive preparation of the periosteum of the shoulder.

2) Prevent the development of infectious postoperative complications.

3) Avoid postoperative damage to the axillary nerve.

4) Eliminate after metal osteosynthesis the probability of displacement of bone fragments along the axis, lateral and rotational displacements in the fracture zone.

- The invention is a device for osteosynthesis of fractures and fractures-dislocations of the neck of the shoulder, characterized in that it is made of bioinert metal in the form of a U-shaped hairpin with a length of 10 cm, with a distance between the legs of 1 cm, concave along the entire length with a radius of 9 cm, and having a rectangular section of 0.2-0.3 cm.

The technical result of the proposal is:

1) Internal osteosynthesis with a U-shaped hairpin does not require extensive surgical access and exposure of the bone over a large extent. This reduces the risk of developing infectious complications in comparison with osteosynthesis of the T-plate Klimova K.M. or T-shaped plate AO.

2) The U-shaped hairpin inserted intramedullary due to the small cross section does not lead to a violation of blood supply, does not cause bone necrosis.

3) Osteosynthesis with a U-shaped hairpin during fractures and fractures-dislocations of the neck of the shoulder avoids rotational displacements, as well as displacements along the axis and lateral displacements.

The results are achieved due to the small size of the stud, the original shape, sufficient strength and rigidity. The available parameters of the stud allow you to go through the holes for osteosynthesis in the marrow canal. The existing cross-section of the stud gives strength and rigidity sufficient to reliably fix the fracture site. The length of the metal structure is justified by the ratio of the size of the shoulder head and the location of the holes for introducing the stud. A hairpin with a large cross section does not fit in the medullary canal, and with a smaller cross section does not have sufficient strength and rigidity. The existing bend angle of the stud allows you to enter the stud through the holes in the bone, as well as its distal part, resting against the back wall of the bone marrow canal, “slip” with the ends of the stud into the head of the shoulder, fixing it with the ends in the head, the middle part on the back of the canal and two points in holes for osteosynthesis. After osteosynthesis, due to the original shape of the stud, its strength and rigidity, secondary displacement in the fracture zone is unlikely.

The device is depicted in general form in Fig. 1 (view in the frontal plane) and Fig. 2 (view in the horizontal plane). The stud is equilateral. In figure 1:

1 - fixation points of the middle part of the stud;

2 - the proximal end of the stud, protruding above the bone up to 1 cm, after osteosynthesis;

3 - fixation points of the proximal part of the stud;

4 - fixation points of the distal part of the stud.

A hairpin is used as follows.

The operation is performed under intravenous anesthesia, anterolateral access in the upper third of the shoulder to the humerus in the position of the patient lying on his back, with the arm brought to the body and bent at the elbow joint to 90 degrees, and laid on a side table. Depending on the size of the shoulder, the average access size is up to 12 cm, formed in the direction of the fibers of the deltoid muscle (m.deltoidea) by dissecting layers of skin, subcutaneous tissue, superficial (intrinsic) fascia, aponeurosis (fascia brachii) of the shoulder overlook the deltoid muscle. In the course of the fibers of the deltoid muscle, with a soft preparation clamp, extend the muscle up to 3 cm, and then with two fingers of both hands disconnect the muscle along the entire length of the access to the subdeltoid space (bursa subdeltoidea). Go to the fracture zone. A place is prepared for the introduction of the hairpin: the bone is prepared from the periosteum, moving away from the fracture line of the surgical neck of the shoulder along the lateral surface of the humerus to the point of attachment of the deltoid muscle. A “triangle” is formed on the bone with the base — the fracture site, and the sides are on the right — the medial margin (margo medialis) on the left — the lateral margin (margo melialis). Using a single-tooth retractor, traction is carried out along the axis of the shoulder with the elbow joint bent at 90 degrees, and the fracture is repositioned by rotational movements. Closer to the top of the "triangle" of the upper third of the anterior lateral zone of the shoulder

(corpus humeri) form transversely at a distance of 1 cm 2 holes in the direction of the head of the shoulder (caput humeri) at an acute angle to the bone to the medullary canal and enter into the holes a U-shaped hairpin with a rectangular section of 0.2-0.3 cm, congruent to the humerus. At the same time, the existing angle of bend of the stud allows you to enter the stud through the holes in the bone (Fig.1-3), and due to bending it slides along the back wall of the medullary canal (Fig.1-1) and enters, being fixed by both sides into the head (Fig. 1-4). A hairpin is inserted into the shoulder head under R-control. After osteosynthesis, the proximal end of the hairpin stands above the bone up to 1 cm (Fig.1-2). Sutures were laid in layers on the wound, leaving subcutaneous rubber graduates. Aseptic dressing. Immobilization in a Deso plaster cast for a month. Then, after removing the plaster cast, the development of contracture with the help of physical therapy is prescribed until the function is restored within 2-3 weeks. The treatment result is satisfactory. Limb function restored almost completely.

Claims (1)

A device for osteosynthesis of fractures and fractures of the neck of the shoulder, characterized in that it is made of bioinert metal in the form of a U-shaped hairpin 10 cm long with a distance between the sides of 1 cm, concave over the entire length along the radius of 9 cm and having a rectangular cross section 0, 2-0.3 cm.