RU2476181C1 - Apparatus for treating people with combined injuries of shin and foot - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention relates to medicine, namely to traumatology-orthopedics. Essence of invention lies in the following: apparatus for treatment of fractures of shin and foot bones contains supports, connected by means of threaded bars, brackets, wire-fixers and intraosteal rods. Circular supports of apparatus are made composite, and consist of similar modules, representing sectoral plates in form of ring quarter with holes located along contour. One end of plate is provided with rectangular open pocket with hole on the side, parallel to plate plane, width of the other end being made equal to width of internal size of pocket. On peripheral sides of plates, closer to their end parts, made are semi-circular projections, located in such a way that holes in them are located between holes along plate contour. Plates are connected to each other by means of bolts with nuts.EFFECT: invention provides possibility of treating patients with combined injuries of shin and foot, accompanied with bone fractures, vast defects of skin and underlying soft tissues, with simultaneous stabilisation of bone fragments of injured segment, with reconstruction of its axis and possibility of collection of small bone fragments, due to restoration of periosteum tension, performing interventions on vascular-nervous bundles, covering skin defects and underlying soft tissues, with reduction of treatment time and improvement of its outcomes.7 dwg

Description

The invention relates to medicine, namely to traumatology - orthopedics, and is intended for the treatment of patients with combined injuries of the lower leg and foot, accompanied by fractures of the bones, extensive defects of the skin, and underlying soft tissues.

Known devices of rod fixation: 1) Heidelberg Fixer (Heidelberg Fixator) [1]. The one-way retainer is the Standard Central Body, which allows for compression / distraction. The Cardan Joint allows for multi-plane correction, and the Hinge Joint for single-plane correction. Special clamps make it possible to locate Shants screws perpendicularly or at an angle to the bone. 2) Hexagonal external fixation (Hex-Fix External Fixation System) [2]. Hexagonal (in section) beam with Shants screws fixed to it through special clamps. Multiplane fixation (i.e., threaded rods can be inserted into the bone at different angles.) The disadvantages of the method include the impossibility of correcting in 3 planes and the likelihood of varus deformation of the device (during physical exertion).

The closest to the proposed apparatus in its technical solution is the osteosynthesis method adopted by us as a prototype by the Ilizarov apparatus. This device differs from all previously proposed by a high degree of fixation of bone fragments and low trauma during its use. This is ensured by closed steel ring supports, the cross-location of the spokes in the bone, their small diameter (1.5 mm) and the possibility of dosed tension using a tensiator [3]. This device also has a number of disadvantages, for example, due to the presence of extensive defects of the skin and underlying soft tissues, it is not always possible to carry knitting needles; it is impossible to use annular supports and a cross spoke fixation system, which is explained by the presence of entry and exit points in the spokes. Closed annular supports and spokes make it difficult to intervene on the neurovascular bundles in the area of the defect, as well as the closure of defects in the skin and underlying soft tissues. In this case, you need to contact hybrid devices. In the absence of a defect in the proximal or distal zone, it is possible to impose an annular support with a cross spoke system and rods, and if it is present, it is necessary to use a rod fixation system on either side, depending on the integrity of the skin, and taking into account the neurovascular bundles.

The invention consists in the combination of essential features sufficient to achieve the desired technical result, which consists in the possibility of using the apparatus for the treatment of patients with combined injuries of the leg and foot, accompanied by fractures of the bones, extensive defects of the skin and underlying soft tissues, while stabilizing the bone fragments of the damaged segment, with the restoration of its axis and the ability to collect small bone fragments due to the restoration of tension of the periosteum nitsy, performing interventions on the neurovascular bundles, closing defects in the skin and underlying soft tissues, while reducing treatment time and improving its outcomes.

This essence lies in the fact that the apparatus for treating fractures of the leg and foot bones contains supports connected by threaded rods, brackets, spoke fixators, knitting needles and intraosseous rods. The annular supports of the apparatus are made integral and consist of the same modules, which are sectoral plates in the form of a quarter of a ring with holes located along the contour. One end of the plate is equipped with a rectangular open pocket with an opening on the side parallel to the plane of the plate, and the width of the other end is equal to the width of the inner size of the pocket. On the peripheral sides of the plates, closer to their end sections, there are semicircular protrusions arranged so that the holes in them are between the holes along the contour of the plate. The plates are interconnected by bolts with nuts.

The implementation of the annular supports of the apparatus with composite, consisting of the same modules, in the form of sectoral plates, provides a simple and quick application of the apparatus, allows you to stabilize the bone fragments of the damaged segment. The device allows the use of modules in the form of a quarter of a ring, half-ring or ring, depending on the location of the defect of the skin and underlying soft tissues, outside the crush area, without overlapping the defect area of the integumentary tissue, which does not prevent the interventions on the neurovascular bundles, the closure of skin defects cover and underlying soft tissue. Further installation of the device with correction ensures a complete reposition of the segment and stable osteosynthesis.

A pocket located at one end of the module is designed to install the end of the second module in it, with the possibility of connecting these modules with a bolt and nut.

Semicircular protrusions with holes located in close proximity to the end sections of sectoral plates are designed to fix these plates with threaded rods when the holes are loaded along the contour of the plate, as well as to fix brackets and spoke fixators, if the axis of the spoke or rod coincides with the axis of the hole of the semicircular protrusion . This arrangement of the holes in the protrusions eliminates the overlapping of the threaded rods with rods and spokes installed in the holes along the contour of the plate, and allows the axes of the threaded rods to be spaced apart to fix the modules in space, which ensures the stability of the apparatus.

A large number of holes in the module in the form of a sectoral plate provides free spatial orientation of the brackets with knitting needles and rods and spoke fixators with knitting needles, for complete maneuver by fixing elements.

The device for treating patients with combined injuries of the lower leg and foot is illustrated by the illustrations shown in figures 1-7, where:

figure 1 presents the module of the apparatus;

figure 2 shows the layout of the apparatus, consisting of 2 support modules and connecting from threaded rods;

figure 3 is a General view of the apparatus for the treatment of patients with combined injuries of the lower leg, consisting of two support rings made up of modules, and two repair modules;

figure 4 - layout of the apparatus, consisting of two reference modules and one reponent module;

figure 5 - layout of the apparatus, consisting of a support ring (composite) on the proximal fragment and a support module on the distal fragment of the tibia;

figure 6 - arrangement of the apparatus, consisting of a support module on the proximal fragment and a support ring (composite) on the distal fragment of the tibia;

Fig.7 - layout of the apparatus for the treatment of patients with combined injuries of the foot, accompanied by bone fractures, extensive defects of the skin and underlying soft tissues, consisting of two half rings made up of modules connected by threaded rods using L-shaped plates.

All modifications of the apparatus are composed of modules 1. Modules either independently perform the function of supporting elements (apparatus layout in FIG. 2, FIG. 4, FIG. 7), or in combination with support rings 2 composed of these modules (apparatus layout in FIG. 5, Fig. 6), or both support elements are made in the form of rings (Fig. 3) and are interconnected by threaded rods 3. The support rings 2 are composed of 4 modules 1, which are interconnected by bolts 4 and nuts (not shown ) Module 1 is a sectoral plate in the form of a quarter of a ring with holes along the contour. One end of the plate is equipped with a rectangular open pocket 5 with a hole 6 on the side parallel to the plane of the plate. The width of the other end of the plate 7 is made equal to the width of the inner size of the pocket 5. On the peripheral sides of the plates, closer to their end sections, there are made semicircular protrusions 8 arranged so that the holes 9 in them are between the holes 10 located along the radius of the plate of module 1. Intraosseous rods 11 and spokes 12 are fixed to the device using brackets 13 and spoke fixators 14.

Device use

With combined damage to the lower leg, accompanied by bone fractures, extensive defects of the skin and underlying soft tissues, the apparatus is applied in two stages as follows.

The first stage, for preliminary correction and fixation of fragments of the leg bones, outside the focus of soft tissue defects, impose an apparatus consisting of one supporting modules 1, shown in figure 2. The support modules 1 are interconnected by two threaded rods 3 located in the holes 9, semicircular protrusions 8, in the end sections of the sectoral plates of the modules. Two intraosseous rods 11 are inserted into the proximal fragment, outside the area of soft tissue damage, taking into account the neurovascular bundles so that the upper intraosseous rod 11 is located below the growth zone, and the lower one is above the line of bone fracture. Accordingly, on the distal fragment, the intraosseous rods are located: the upper one is below the fracture line, the lower one is above the growth zone. Intraosseous rods 11 are fixed to the modules using brackets 13. Fragments are preliminary corrected. The displacement of fragments along the length is eliminated by moving the nuts along the threaded rods 3 between the modules. The displacement of fragments in a direct projection (in the frontal plane) is eliminated by moving (pulling or pulling) the intraosseous rods 11 with nuts, fixing the rods 11 in the brackets 13. After stabilization of the bone fragments of the lower leg, they proceed to interventions on the neurovascular bundles, closing the skin defects and underlying soft tissue. Then, the apparatus is dismantled, transforming the support modules into support rings, i.e. the apparatus is converted in accordance with figure 3. For this, support rings 2 are formed at the level of the proximal and distal end of the modular system by attaching additional modules to the already installed support module. To do this, the end of each plate 7 is installed in a rectangular open pocket 5 next to the plate and connect them together so that the bolt passes through the hole 6 in the pocket located on the side parallel to the plane of the plate, and the hole on the end 7 of the adjacent plate installed in the pocket 5. On the healthy side of the limb, the support rings are preliminarily connected to each other by threaded rods 3. At the level of the proximal and distal fragment of the tibia, intraosseous rods 11 are inserted, which are fixed to rotating arm support arm 13. After the distal end of the proximal fragment and the proximal end of the distal fragment carried intraosseous rods 11 which are fixed to the repositioned in the support modules 15. All of the healthy side is fixed rods 3. Carry dokorrektsiyu fragments.

With combined damage to the lower leg, accompanied by bone fractures and extensive defects of the skin and underlying soft tissues on one side of the lower leg, the apparatus is composed of two base and one repair module 15 (see figure 4). To do this, through the holes 9 in the semicircular protrusions 8, three threaded rods 3 are connected with two threaded rods 1. In this case, the two outermost modules carry out the support function, and the middle module 15 is a reponent. Two intraosseous rods 11 are inserted into the proximal fragment, outside the area of soft tissue damage, taking into account the neurovascular bundles so that the upper intraosseous rod is located below the growth zone, and the lower one is above the line of bone fracture. Accordingly, intraosseous rods are located on the distal fragment: the upper one is below the fracture line, the lower one is above the growth zone. A free-lying fragment is fixed either with an intraosseous rod 11, or with a spoke (not shown), which is fixed to module 15 by an arm 13. The intraosseous rods 11 are mounted on modules 1 by an arm 13 (needles with spokes, and, if necessary, with an arm, not shown). Make a preliminary correction of fragments. After stabilization of the bone fragments, interventions are performed on the neurovascular bundles, the defect of the skin and underlying soft tissues is closed. Then, if necessary, the device is installed, increasing the supporting modules to the rings (described above).

With combined damage to the lower leg, accompanied by fractures of the bones and extensive defects of the skin and underlying soft tissues in the distal region of the lower leg, the layout of the apparatus is carried out in accordance with Fig.5. The support ring 2, consisting of 4 modules 1, is connected by threaded rods 3 to the support module 1, fixing the threaded rods 3 in the holes 9 of the semicircular protrusions 8 of the end sections of the sectoral plates. Two spokes 12 and a rod 11 or only intraosseous rods (not shown) are introduced into the proximal fragment outside the area of soft tissue damage, taking into account the neurovascular bundles, and fix them in the support ring 2. On the distal fragment, the intraosseous rods 11 are placed as follows: upper - below the fracture line, the lower one is above the growth zone, and is fixed on the support module 1. The intraosseous rods 11 are mounted on the modules 1 by brackets 13, the spokes 12 - by means of special clamps 14, and, if necessary, brackets 13. Preliminary correction Theological fragments. After stabilization of the bone fragments, interventions are performed on the neurovascular bundles, the defect of the skin and underlying soft tissues is closed. Then, if necessary, the device is installed, increasing the support module to the ring (described above).

With combined damage to the lower leg, accompanied by bone fractures and extensive defects of the skin and underlying soft tissues in the proximal lower leg, the apparatus is assembled from the support ring 2 on the distal fragment and the support module 1 on the proximal fragment of the tibia, as shown in Fig.6. The support ring 2, consisting of 4 modules 1, is connected by threaded rods 3 to the support module 1, fixing the threaded rods 3 in the holes 9 of the semicircular protrusions 8 of the end sections of the sectoral plates. Two spokes 12 and a rod 11 or only 2 intraosseous rods (not shown) are introduced into the proximal fragment, outside the area of soft tissue damage, taking into account the neurovascular bundles. On the proximal fragment, the intraosseous rods 11 are positioned so that the upper intraosseous rod is located below the growth zone, and the lower one is above the line of bone fracture. The intraosseous rods 11 are mounted on the modules with brackets 13, the spokes with the help of special clamps 14 or, if necessary, with brackets 13. A preliminary correction of the fragments is carried out. After stabilization of the bone fragments, interventions are performed on the neurovascular bundles, the defect of the skin and underlying soft tissues is closed. Then, if necessary, the device is installed, increasing the support module to the ring (described above).

With combined damage to the foot, accompanied by bone fractures, extensive defects of the skin and underlying soft tissues, use the layout shown in Fig.7. The support half rings 17 are assembled from two modules 1, for which the end of one module 7 is installed in the pocket 5 of the other module and connected with a bolt and nut, while the bolt is inserted into the hole 6 of the pocket 5, and then into the hole at the end 7 installed in the pocket. The supporting half rings 17 are connected by threaded rods 3 with the help of L-shaped plates 18. Through the metatarsal bones, the needles 12 are held and fixed on the front supporting half ring 17 with the help of fixators 14. The needles 12, drawn through the calcaneus, are fixed to the rear supporting half ring 17. To stabilize the bone fragments of the foot of the nut are moved along the threaded rods 3, thereby changing the distance between the supporting half rings 17, and the spokes are pulled in the fixators 14. After stabilization of the bone fragments, interventions are performed on the neurovascular bundle kah, close the defect of the skin and underlying soft tissues. If necessary, additional correction of fragments of the bones of the foot on the lower leg install modules, support half rings, or ring supports that connect the support half rings of the foot through threaded rods (not shown).

Information sources

1. http://www.smithnephew.com/uk/Standard.asp?NodeId=2947

2. www.jcharlestaylor.com/hexx/index.shtml

3. Lee A.D. Guide to transosseous compression-distraction osteosynthesis / A.D. Li, R.S. Bashirov. - Tomsk: Red Banner Publishing House, 2002. 307 p.

Claims (1)

An apparatus for treating fractures of the leg and foot bones, containing supports connected by threaded rods, brackets, special fixators, knitting needles and intraosseous rods, characterized in that the annular supports of the apparatus are made up of the same modules, which are sectoral plates in the form of a quarter of a ring with holes located along the contour, one end of the plate is equipped with a rectangular open pocket with a hole on the side parallel to the plane of the plate, and the width of the other end is equal to the width of the inner about the size of the pocket, on the peripheral sides of the plates, closer to their end sections, there are semicircular protrusions arranged so that the holes in them are between the holes along the contour of the plate, the plates are interconnected by bolts and nuts.

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