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WO2013095191A1 - Fixateur pour l'ostéosynthèse des fractures de la partie proximale du tibia - Google Patents

Fixateur pour l'ostéosynthèse des fractures de la partie proximale du tibia Download PDF

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Publication number
WO2013095191A1
WO2013095191A1 PCT/RU2012/000955 RU2012000955W WO2013095191A1 WO 2013095191 A1 WO2013095191 A1 WO 2013095191A1 RU 2012000955 W RU2012000955 W RU 2012000955W WO 2013095191 A1 WO2013095191 A1 WO 2013095191A1
Authority
WO
WIPO (PCT)
Prior art keywords
fixation
osteosynthesis
fractures
tibia
fragments
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/RU2012/000955
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English (en)
Russian (ru)
Inventor
Алексей Валерьевич БАБОВНИКОВ
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
OBSCHESTVO S OGRANICHENNOY OTVETSTVENNOSTYU "AZBUKA TEKHNOLOGY"
RUBEKIN Dmitri Nikolaevich
RUBEKINA Lyudmila Nikolaevna
VALEEV Rastam Samigullovich
Original Assignee
OBSCHESTVO S OGRANICHENNOY OTVETSTVENNOSTYU "AZBUKA TEKHNOLOGY"
RUBEKIN Dmitri Nikolaevich
RUBEKINA Lyudmila Nikolaevna
VALEEV Rastam Samigullovich
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by OBSCHESTVO S OGRANICHENNOY OTVETSTVENNOSTYU "AZBUKA TEKHNOLOGY", RUBEKIN Dmitri Nikolaevich, RUBEKINA Lyudmila Nikolaevna, VALEEV Rastam Samigullovich filed Critical OBSCHESTVO S OGRANICHENNOY OTVETSTVENNOSTYU "AZBUKA TEKHNOLOGY"
Publication of WO2013095191A1 publication Critical patent/WO2013095191A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
    • A61B17/8085—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates with pliable or malleable elements or having a mesh-like structure, e.g. small strips

Definitions

  • the proposed technical solution relates to medicine, namely to traumatology, and can be used as a device for osteosynthesis of fractures of the proximal metaepiphysis of the tibia.
  • the first group includes reposition methods in which fractures can be reduced solely by acting on the bone fragments with the hands or devices indirectly through the surrounding intact soft tissues (see, for example, Auth. USSR USSR NaNal 175474, 1409251, U.S. Patent ⁇ ° ⁇ ° 4649907, 5003969).
  • Another group includes reposition methods in which fractures are repaired with the help of knitting needles, rods, and their combinations with the application of a reponing force to the bone fragments transversely, for example, the Ilizarov, Volkov-Oganesyan, Kalnberz, Furdyuk apparatus, etc., which allows direct impact on broken and displaced bones, create conditions for early function of adjacent joints, additional correction of fragments during treatment, etc. (see, for example, ed. certificate of the USSR ⁇ ° ⁇ ° ° 1667851, 1725869, US patent 4893618) .
  • the methods of the second group are used, as a rule, in case of unsuccessful attempts to reposition the fractures by means of the first group, in the case of complex fractures, in the treatment of fractures with a long time elapsed after the injury, etc.
  • these methods are not without drawbacks: they they are invasive, require surgery and complex adjustment of the apparatus installed on the damaged segment of the limb, require significant material costs due to the fact that each patient needs a separate apparatus for treatment .
  • the most common complication when using devices of this reposition group is suppuration of soft tissues around spokes, rods.
  • the methods of the first group is easier to 'implement, does not require invasive intervention, they are based on the principle consists in the fact that the reduction of fracture should be back mechanism of displacement, when the peripheral fragments attached to the position, the response center portion.
  • the distal bone fragment of the damaged segment during extra-articular fractures or the distal bone fragment of the articulating segments during intra-articular fractures is oriented coaxially relative to the proximal until proper anatomical alignment with the response bone fragment of the damaged segment or articular surface of the articulated bone segment.
  • Osteosynthesis of the proximal tibia metaepiphysis is carried out by various designs, for example, contact fixators, which stabilize the fragments by pressing the plate to the bone.
  • contact fixators which stabilize the fragments by pressing the plate to the bone.
  • the harmful effects of plate pressure on bone are well known. Bone lysis and an early load on the limb lead to a decrease in fixation stability. Using traditional contact fixatives, it is quite problematic to perform stable osteosynthesis of comminuted fractures. There is a need to develop a latch that eliminates these shortcomings.
  • a known method of transosseous osteosynthesis of diaphyseal fractures of the lower leg according to the method of G.A. Ilizarova, according to which, at the level of the proximal metaepiphysis of the tibia, two base spokes are carried out at an angle of mutual intersection close to 60 °. At the level of the distal metaepiphysis, a second pair of base knitting needles is carried out. Then mount the external fixation apparatus on the basis of three to four ring supports (2 supports - basic, 1 or 2 - parafractory). Distraction is applied and two parafracture reposition and fixation knitting needles with thrust pads are carried out. [Shevtsov, V. I. The Ilizarov apparatus.
  • the disadvantages of this method include: 1. the bulkiness of the external fixation apparatus before performing its modular transformation; 2. the use of the proximal support, which is 2/3 of the ring, makes it impossible to reduce the legs in the external fixation apparatus, which creates inconvenience when walking, also makes it difficult to assess the shape (silhouette) of the lower limb and its biomechanical axis.
  • the ability to reduce legs during the period of fixation by devices is extremely necessary for the correction of deformities of the lower extremities, especially in aesthetic orthopedics.
  • the most widely used immersion bone fixators - knitting needles, screw rods, etc. Screws are used as a connecting element between bone fragments and bone plates. Bone osteosynthesis provides high strength surgical connection of fragments.
  • the closest analogue is the Synthes LCP-Proximal Tibial Plate 3.5 fixator for osteosynthesis of the proximal metaepiphysis of the tibia, made in the form of a plate with holes of different diameters, consisting of a posterior epiphyseal part for fixing fragments and a diaphyseal part for insertion of locking screws.
  • the problem solved by the proposed technical solution the creation of a high degree of stability of bone fragments in the treatment of multiple fractures of the metaepiphyseal zone of the upper third of the tibia, while ensuring early functional activity in the knee joint adjacent to the damage zone.
  • the aim of this proposal is more stable and accurate intraoperative fixation of repaired bone fragments in three planes.
  • a fixator for osteosynthesis of the proximal tibia metaepiphysis made in the form of a plate with holes of different diameters, consisting of a posterior epiphyseal part for fixing fragments and a diaphyseal part for insertion of locking screws, characterized in that the fixator additionally contains a metaepiphyseal branch having parallel and converging holes, and the anterior epiphyseal branch, and the metaepiphyseal part has openings for introducing Kirchner spokes to fix the subchon Dralnoy area.
  • the authors of the proposed fixator managed to simultaneously perform osteosynthesis of diaphyseal and metaepiphyseal fractures.
  • the claimed fixator is an innovative universal fixator for osteosynthesis of fractures and corrective osteotomies incorrectly fused fractures of the proximal metaepiphysis of the tibia.
  • the clamp is designed for installation on the front-inner surface of the metaepiphysis of the tibia.
  • Fig.1 shows a General view of the latch
  • Fig. 2 A - front view, B - top view (direction of screws and spokes), C - side view.
  • the fixator has a shape that anatomically repeats the contours of the tibia and 3 branches - the anterior epiphyseal (1), posterior epiphyseal (2), designed to fix epiphyseal injuries and articular cartilage and the anterior metaphysial (3), intended for osteosynthesis of fractures of the tibial tuberosity.
  • the branches of the plate have jumpers (chamfers) (4) for shortening the length (biting) in the absence of the need for their use - depending on the location of the fracture line.
  • the total plate length is from 120 to 220 mm.
  • the diaphyseal part (5) from 60 mm to 160 mm long, has openings (8) for introducing locked self-tapping screws with a diameter of 5.0 mm.
  • the 60-mm long metaepiphyseal part (6) has multidirectional (parallel and converging) holes (9) of a total of 6 pcs. for introducing screws of locked self-tapping screws with a diameter of 3.5 mm, and also holes (10) with a diameter of 1.5 mm for introducing Kirchner spokes fixing the subchondral pad. All holes in the plate have directional threads to lock the screws in a strictly defined direction. Drilling of channels for screws is carried out using a guide (7), which is screwed into the plate.
  • the main difference of the claimed fixative is the presence of 3 branches: the anterior epiphyseal, posterior epiphyseal and anterior metaphysial branches, as well as the possibility of shortening the length of the branches depending on the location of the fracture line.
  • 3D three-plane
  • the device is used as follows.
  • the fracture site is exposed, blood clots and small bone fragments are removed. Fragments of the bone are repaired, temporarily fixed with Kirschner spokes or held by the bone holder.
  • An appropriate in shape and size modeled retainer is selected.
  • the branches 1, 2, 5 of the retainer are partially straightened and give the retainer a shape suitable for placement on the bone.
  • holes are drilled for 3.5 mm screws with angular stability in the metaepiphyseal section and 5.0 mm in the diaphyseal part in the amount necessary for stable fixation and insertion of needles through 1.5 mm holes to fix the subchondral pad.
  • An intraoperative x-ray control is carried out in 2 projections.
  • the wound is sutured in layers.
  • gypsum immobilization is not used. From 2 days the patient begins a dosed load on the operated limb. After 2, 4, 6 months, a checkup is carried out. Consolidation occurs after 14 weeks.
  • the advantage of the proposed technical solution in comparison with known designs is the combination of ease of implantation with high stability of fixation while minimizing the contact surface of the fixator with the bone.
  • the design allows you to restore the integrity of the bone and allows you to preserve the natural conditions of blood supply to the bone and adjacent soft tissues, as well as to combine the period of consolidation of the fracture with the period of rehabilitation of the patient, significantly reducing the period of disability.
  • fixator can be made from materials known in the practice of orthopedics using known technology and used for its intended purpose for bone marrow osteosynthesis of the tibia.
  • Atraumatic, stable osteosynthesis, using a small number of metal structures, allows you to maintain functional activity in the knee joint, which accelerates the regeneration processes in the fracture zone, reducing the rehabilitation time of the affected limb, without stiffness in the knee joint in the treatment of multi-fragment fractures of the proximal tibia.

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  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Neurology (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)

Abstract

Le dispositif de l'invention se rapporte à la médecine, en particulier à la traumatologie, et peut être utilisé dans l'ostéosynthèse d'une fracture proximale méta-épiphysaire du tibia. Le but de cette invention est de réaliser de manière plus stable la fixation peropératoire de fragments d'os réduits dans trois plans. Pour cela, on utilise un fixateur dans l'ostéosynthèse de fractures de la partie proximale du tibia, ce fixateur se présentant sous la forme d'une plaque pourvue d'ouvertures de diamètre différent, la plaque comprenant une partie épiphysaire arrière pour la fixation de fragments et une partie diaphysaire pour l'introduction de vis de blocage, l'invention étant caractérisée en ce que le fixateur comprend également une branche méta-épiphysaire présentant des ouvertures parallèles et convergentes, et une branche épiphysaire avant, la partie méta-épiphysaire comportant des ouvertures pour l'introduction de broches de Kirschner pour la fixation de la zone sous-chondrale.
PCT/RU2012/000955 2011-12-19 2012-11-20 Fixateur pour l'ostéosynthèse des fractures de la partie proximale du tibia Ceased WO2013095191A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
RU2011151522 2011-12-19
RU2011151522 2011-12-19

Publications (1)

Publication Number Publication Date
WO2013095191A1 true WO2013095191A1 (fr) 2013-06-27

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Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/RU2012/000955 Ceased WO2013095191A1 (fr) 2011-12-19 2012-11-20 Fixateur pour l'ostéosynthèse des fractures de la partie proximale du tibia

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Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
RU2332185C1 (ru) * 2007-01-30 2008-08-27 Игорь Евгеньевич Комогорцев Устройство для остеосинтеза мыщелков большеберцовой кости
US7736365B2 (en) * 2002-12-20 2010-06-15 Zimmer Technology, Inc. Provisional bone plate
CN101856261A (zh) * 2010-07-20 2010-10-13 孙海钰 胫骨近端平台外后侧解剖型支撑锁定接骨板
US20110282393A1 (en) * 2003-09-29 2011-11-17 Smith & Nephew, Inc. Bone plate systems using provisional fixation

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US7736365B2 (en) * 2002-12-20 2010-06-15 Zimmer Technology, Inc. Provisional bone plate
US20110282393A1 (en) * 2003-09-29 2011-11-17 Smith & Nephew, Inc. Bone plate systems using provisional fixation
RU2332185C1 (ru) * 2007-01-30 2008-08-27 Игорь Евгеньевич Комогорцев Устройство для остеосинтеза мыщелков большеберцовой кости
CN101856261A (zh) * 2010-07-20 2010-10-13 孙海钰 胫骨近端平台外后侧解剖型支撑锁定接骨板

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