RU2385683C1 - Method for reduction of greater displaced heel bone fracture - Google Patents

Abstract

FIELD: medicine. ^ SUBSTANCE: invention concerns medicine, namely to traumatology and orthopaedics. There is applied a compression-distraction apparatus comprising a base ring support and a closed ring frame interconnected by threaded bars whereon there are two threaded rods arranged in the lower third of shin or in the distal metaphysis of shin bone. The closed ring frame consists of jointed front and back semi-rings. Forefoot is fixed with two wires to be fixed in a vertical semi-ring and arm supports fastened to the front semi-ring of the closed frame. Two wires are X-shaped through heel bone and fixed on the semi-ring which is fastened to the back semi-ring of the closed frame. The application of the apparatus is followed with delivering auxiliary wires through calcanean tuber: six - in a sagittal plane outside of an attachment point of Achilles tendon, and one wire through heel bone in a frontal plane. The latter is fixed in the free semi-ring. These wires are used for reduction ensured by pulling the semi-ring of the distal fragment of heel bone wherein the wire is fixed, towards the sole, while six wires are bundled to turn the fragment along the frontal axis to be directed towards the sole. After the reduction is completed, 2-3 wires are delivered transarticularly through heel and ankle bones with using 1-2 wires of those six delivered before, and the other 4-5 wires and the wire delivered in the frontal plane are removed. ^ EFFECT: method provides one-stage reduction with elimination of angular displacement and length displacement of heel bone fracture, and prevention of secondary displacement. ^ 6 dwg, 1 ex

Description

The invention relates to medicine, namely to traumatology-orthopedics, and can be used in the treatment of calcaneal fractures, characterized by a large displacement.

Calcaneal fractures resulting from significant trauma, such as a fall from a great height or accident, are characterized by the presence of a significant displacement of the fragments. With such fractures, the reposition of fragments with the restoration of the forms of the longitudinal arch is shown. None of the many methods proposed in our country and abroad for the treatment of this type of damage does not provide good enough results, although in some cases it is possible to achieve quite favorable outcomes [1].

A way to restore the shape of the calcaneus is skeletal traction in two mutually perpendicular directions behind the spoke, embedded in the calcaneus according to A.V. Kaplan [2]. The method requires careful monitoring of the action of rods with loads to prevent diastasis of fragments and damage to the ligamentous apparatus.

The closest, in terms of its technical solution, the claimed invention is “A method for the surgical treatment of calcaneus fractures with a knitting-rod apparatus”, including applying a compression-distraction apparatus, reposition and fixation of the fracture. Two rods mounted in the lower third of the tibia are fixed on an annular support and on the front half ring of a closed annular frame, interconnected by two vertical and one horizontal rods. The foot is fixed to the apparatus with four knitting needles: one, drawn through the base of the metatarsal bones, to the vertical half-ring mounted on the front half-ring of the closed annular frame, the other, drawn through the front half of the calcaneus, to the front half-ring of the closed annular frame, and two cross-spoke, to the half-ring mounted under a closed annular frame. This method provides the mechanical elimination of a large angular displacement of the calcaneus and optimal restoration of the articular surfaces. However, when the Beler angle reaches negative values (-50-70) ° and there is a traumatic detachment of the skin of the foot and ankle joint on the lateral surface, there is a risk of infection and complications, up to skin necrosis in the area of the needles through the calcaneus, due to significant tension soft tissues and skin resulting from the elimination of bias.

The essence of the claimed invention is expressed by a combination of essential features sufficient to achieve the desired technical result, which consists in preventing complications that are possible when eliminating large displacements of the calcaneus using external fixation devices.

This essence lies in the fact that the method for repositioning calcaneal fractures with a large displacement of fragments involves applying a compression-distraction apparatus containing a basic annular support and a closed annular frame interconnected by threaded rods on which two threaded rods are mounted, installed in the lower third of the lower leg or in the distal metaphysis of the tibia, reposition and fixation of the forefoot and anterior calcaneus with knitting needles. After applying the apparatus, auxiliary knitting needles are drawn through the calcaneal tubercle of the fragment: six - in the sagittal plane, outside the Achilles tendon attachment point, and one spoke - through the calcaneus in the frontal plane, the latter is strengthened in the free half ring. Using these knitting needles, a reposition is performed, after which 2-3 knitting needles will be transarticularly inserted through the calcaneus and talus, using 1-2 knitting needles from six previously held auxiliary ones, and the rest, including the knit held in the frontal plane, are removed. Install two spokes in the X-shape and fix them to the device.

An auxiliary spoke drawn through the calcaneus in the frontal plane serves as an axial one around which the fragment is rotated during reposition to eliminate angular displacement. This spoke (while holding the free half-ring on which it is fixed) allows you to wedge the fragments and produce, using a bunch of knitting needles, the removal of displacement in the subtalar joint.

Six auxiliary knitting needles held through the calcaneal tuber reliably hold the fragment, and assembled together in the surgeon’s hand they create a rigid lever that allows to overcome the resistance of the lower leg muscles and manipulate the fragment, providing the best reposition of the fracture.

2-3 needles, additionally transarticular through the fracture line and the talus fix the fragment in a state of reposition.

2 spokes held X-shaped, fixed to a previously superimposed apparatus, prevent the secondary displacement of the fragment.

Holding and removing 4-5 needles, of the six mentioned, and one in the frontal plane, in the area remote from the fracture, is a less traumatic manipulation. Due to the sparing attitude to injured soft tissues, the proposed method provides reposition and fixation of fragments without tissue tension, eliminates possible serious complications.

The method is illustrated by illustrations, where figure 1 shows the layout of the compression-distraction apparatus of external fixation; figure 2 shows a diagram of the holding of auxiliary knitting needles through the calcaneus with a large displacement of the fragment (side view); Figures 3-6 are radiographs illustrating a clinical example: Figure 3 shows an injured foot before surgery; figure 4 is a snapshot of the stage 0repositions; figure 5, 6 - the final reposition.

The device includes a basic support 1 and a closed annular frame 2, consisting of a front 3 and a back 4 half rings interconnected by threaded rods 5 installed in vertical brackets 6.

In this case, the support 1 is connected by threaded rods 7 with the front half ring 3 of the frame 2 and the threaded rod 8 through brackets 9 and 10 with the rear half ring 4. At the ends of the front half ring 3, long brackets 11 are installed, and to the middle part of this half ring 3, using brackets 12 , a half-ring is vertically mounted 13. At the ends of the rear half-ring 4 of the frame 2, threaded rods 14 are mounted connected to the hinges 15 mounted on the half-ring 16. The middle parts of the half-rings 4 and 16 are connected by a threaded rod 17 with a hinge 18 at the end, while the hinge 18 is installed on the half-ring 16, and the free end of the rod 17 is inserted into the hole of the half-ring 4, opposite the hole of the half-ring 16, in which the hinge 18 is installed. On both sides of the half-ring 4, the restriction nuts 19 are installed on the rod 17, providing axial movement of the rod 17 in the hole of the half-ring 4.

The method is as follows.

After the preparation of the surgical field, two threaded rods 20 are installed in the lower third of the lower leg or distal metaphysis of the tibia 20, which are fixed: one in the base support 1, and the other on the front half ring 3 of the closed annular frame 2. Through the bases 1-11 metatarsals, In order to prevent dorsiflexion of the foot, a spoke 21 is carried out in the frontal plane and fixed on a vertical half-ring 13. The ankle joint is set at right angles to the lower leg. In the frontal plane, through the front section, a spoke 22 is held and fixed on the long brackets 11. Six auxiliary spokes are guided through the calcaneal tuber in the sagittal plane outside the place of attachment of the Achilles tendon, and one spoke through the calcaneus in the frontal plane, the latter is fixed in the free half ring (figure 2). The assistant holds the leg by the external fixation apparatus, the lower leg is located on the stand. The surgeon pulls with his left hand the distal fragment of the calcaneus by the semicircle in which the spoke is strengthened in the plantar direction. With his right hand - collects six knitting needles into a bundle and rotates the fragment along the frontal axis, directing the axis of the assembled knitting needle bundle in the plantar direction. At the end of the reposition, 2-3 knitting needles (pos. 23-25) are carried out transarticularly through the calcaneus and talus bone, of which 1-2 needles are used from the bundle, and the rest are additionally carried. An x-ray control is performed, with a good reposition result, in order to exclude a relapse displacement, another 2 spokes - 26, which are attached to the half ring 16 with fixation on the leg support, are X-shaped through the calcaneus. Clinical example.

B-naya S-va, born in 1987, was treated at the SRC “WTO” from 12/15/08 to 9/12/08.

Diagnosis: Closed comminuted fracture of the right calcaneus of the daily limitation (figure 4).

Operation December 5, 2008: Closed transosseous osteosynthesis of a fracture of the right calcaneus (Fig. 3). The patient installed the Ilizarov apparatus according to the scheme shown in figure 1, auxiliary spokes (according to the scheme of figure 2) were carried out, with the help of which the fracture was repositioned with the restoration of the heel shape (Figs. 4-6). The patient was discharged for outpatient treatment with fixations in the device for a period of 3 months, followed by x-ray control and dismantling.

Information sources

1. Traumatology and orthopedics. Manual for Doctors Ed. SOUTH. Shaposhnikova, volume 2, M., “Medicine”, 1997, p. 415.

2. Traumatology. Textbook for pre- and postgraduate training. Krasnov A.F., Miroshnichenko V.F., Kotelnikov G.P., M., 1995, p. 272.

3. RF patent No. 2321369, BIPM No. 10, 2008.

Claims (1)

A method for repositioning calcaneal fractures with a large displacement of fragments, including applying a compression-distraction apparatus containing a basic annular support and a closed annular frame, interconnected by threaded rods, on which two threaded rods are mounted, installed in the lower third of the tibia or in the distal metaphysis of the tibia , while the closed annular frame consists of interconnected front and rear half rings, the fixation of the forefoot is carried out with two knitting needles, with a fixed spokes in the vertical half-ring and brackets that are attached to the front half-ring of the closed frame, X-shaped through the heel bone two spokes and fix them on the half-ring, which is attached to the rear half-ring of the closed frame, characterized in that after applying the apparatus through the calcaneal tubercle of the fragment carry out auxiliary knitting needles: six - in the sagittal plane, outside of the Achilles tendon attachment site, and one spoke - through the calcaneus in the frontal plane, the latter is strengthened in a free half ring, with p With the help of these knitting needles, they reposition due to the fact that the distal calcaneus fragment is pulled by the semicircle in which the spoke is fixed in the plantar direction, and six knitting needles are assembled into a bundle and the fragment is rotated along the front axis, directing the axis of the assembled knitting needle bundle in the plantar direction , at the end of the reposition, 2-3 knitting needles are carried out transarticularly through the calcaneus and talus, using 1-2 knitting needles from six previously held auxiliary ones, and remove the remaining 4-5 knitting needles and the knitting needle from the front .

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