RU2226993C2 - Reposition plate for carrying out distal metaphyseal radial bone fracture osteosynthesis in children and teenagers - Google Patents

Abstract

FIELD: medical engineering. SUBSTANCE: device is rectangular plate having superposable part with holes. The rectangular plate has stiletto on the side laid on distal epiphysis that is inclined towards plate center at an angle of 70 deg relative to surface laid on distal epiphysis. Three holes are available in the plate. The distal one and the central one are of round shape having 3.5 mm diameter. The proximal one is oval having dimensions of 3.5x7 mm. The distal hole is 12 mm far from the central one; the proximal one is 15 mm far from the central one; the distal hole is 13 mm far from stiletto base in the case of reposition plate usable for treating 7-11 years old children. The sizes are 15 mm, 20 mm and 20 mm for treating 12-15 years old children, respectively. The superposable part of the plate applicable for treating 7-11 years old children is 9 mm wide, 1.5 mm thick and 40 mm long. One applicable for treating 12-15 years old children is 60 mm long. EFFECT: enhanced effectiveness of fractured bone fragment compression and exact juxtaposition. 4 dwg

Description

The invention relates to surgery, in particular to traumatology and orthopedics for the treatment of fractures of the distal metaphysis of the radius in children and adolescents.

In fractures of the distal metaphysis of the radius in children and adolescents, an accurate comparison of fragments is required, due to the presence of a growth zone and the need to restore the physiological function of the wrist joint.

The need for surgical correction arises when the fragments are displaced into the interosseous space by more than half the diameter, with any displacement along the length and with angular deformations of more than 30 °. The above-mentioned displacements cause a cosmetic defect and significantly disrupt the rotational movements of the forearm or the function of the wrist joint (Pediatric traumatology. / Ed. By G.A. Bairov. - L .: Medicine, 1976, p. 390). The closest analogue prototype for the reposition of such fractures is a T-shaped plate of AO (LN Ankin, NL Ankin. The practice of osteosynthesis and endoprosthetics. - Kiev, 1994, p.144-146). However, when using this T-shaped plate, certain drawbacks were revealed: when fixing this plate to bone fragments, 2-3 screws are drawn through the metaphysis, which can destroy the sprout zone adjacent to children, the use of this plate does not allow for stable compression of the fragments when installing it it is necessary to widely dissect the capsule of the wrist joint and to skeletonize the radial bone over a large extent.

The task is stable compression of fragments, their exact comparison by applying a special plate.

The drawings show: FIG. 1 is a general view of a replacement plate for osteosynthesis of distal metaphysial radial bone fractures in children and adolescents; position 1 - overhead part, position 2 - stylet, position 3 - distal hole, position 4 - middle hole, position 5 - proximal hole; figure 2 - phase overlay plate; position 1 - introduction of the stylet into the distal pineal gland, position 2 - screwing in the cortical screw; figure 3 - stage reposition and compression of fragments; position 1 - screwing the cortical screw through the middle hole of the plate; 4 is a step of fixing the plate; position 1 - tightening the screw passed through the oval hole, position 2 - holding the screw through the round hole of the plate.

The specified task is implemented as follows. For an accurate comparison of fragments of the radius, stable fixation and compression of fragments without damaging the physical zone (growth zone), a special plate is used for osteosynthesis of distal metaphysial fractures of the radius in children and adolescents, a rectangular shape, on one end of which is superimposed on the distal pineal gland, there is a stylet inclined to the center of the plate at an angle of 70 °. The plate has two sizes, corresponding to the ages of 7-11 and 12-15 years:

- for the age of 7-11 years - the invoice part with a length of 40 mm, a thickness of 1.5 mm, a width of 9 mm (Fig. 1, Item 1), has a pointed stylet located on one edge of the invoice part, directed at an angle of 70 ° to the plane of the plate so that the pointed end faces the center of the plate. The length of the stylet is 8 mm, a thickness of 1.5 mm, a width of 2 mm (Fig. 1, item 2). On the surface of the plate there are 3 holes: the distal (figure 1, position 3) and the middle (figure 1, position 4) round, 3.5 mm in diameter, proximal oval 3.5 × 7 mm (figure 1 , item 5). The distance between the round holes is 12 mm, between the middle round and oval 15 mm. The distance from the distal opening to the base of the stylet is 13 mm;

- for the age of 12-15 years - the invoice part with a length of 60 mm, a thickness of 1.5 mm, a width of 9 mm (Fig. 1, Item 1), has a pointed stylet located on one edge of the invoice part, directed at an angle of 70 ° to the plane the plate so that the pointed end faces the center of the plate. The length of the stylet is 12 mm, a thickness of 1.5 mm, a width of 2 mm (Fig. 1, item 2). On the surface of the plate there are 3 holes: the distal (figure 1, position 3) and the middle (figure 1, position 4) round, 3.5 mm in diameter, proximal oval 3.5 × 7 mm (figure 1 , item 5). The distance between the distal and middle holes is 15 mm, between the middle and proximal 20 mm. The distance from the distal opening to the base of the stylet is 20 mm.

After the site of the fracture of the radial bone has been identified, the stylet of the plate is inserted into the distal pineal gland (Fig. 2, item 1), after which a 1/2 length cortical screw is screwed through the oval hole of the plate at the proximal edge (Fig. 2, item 2). The next step is the cortical screw is screwed through the middle hole of the plate, and the fragments are repositioned and compressed (Fig. 3, item 1), the proximal fixation block is stabilized by tightening the screw through the oval hole (Fig. 4, item 1); the last stage stabilize the distal fixation unit by holding the screw through the round hole of the plate (figure 4, item 2).

Advantages of a replacement plate for osteosynthesis of distal metaphysial radial bone fractures in children and adolescents:

- eliminates the possibility of damage to the distal radius of the radius;

- an opportunity is created to carry out a targeted dynamic, controlled reposition of fragments of the radial bone with their exact comparison along the growth zone, along the fracture plane, which ensures full restoration of the physiological function of the wrist joint;

- stable compression of fragments is achieved;

- the terms of external immobilization are reduced, since the stable position of the fragments fixed by this plate allows them to be reduced and early functional treatment to begin;

- eliminates the risk of damage to the articular cartilage of the wrist joint and the development of deforming arthrosis.

Example 1. Stepan V., 15 years old (IS No. 3303), was admitted to the Children's Traumatology Department of Children's Clinical Hospital No. 2 of Khabarovsk on 06/26/01 with a diagnosis of an incorrectly consolidating fracture of the distal metaphysis of the right radius with displacement of fragments. The operation was performed - open osteoclasia, reposition, metal osteosynthesis of fragments of the radial bone with a repair plate for osteosynthesis of distal metaphysial fractures of the radial bone in children and adolescents. The postoperative period was uneventful, wound healing occurred by primary intention. The child was discharged from the hospital on the 15th day under the supervision of a traumatologist at the place of residence. Examined 2 months after surgery: no complaints, range of motion in the wrist joint is complete, the anatomical axis of the limb is correct. Radiologically marked fusion of fragments of the radius, the ratios of the bone anatomical formations of the wrist joint are correct.

Example 2. Ilya B., 15 years old (IS No. 4533), was admitted to the Children's Traumatology Department of Children's Clinical Hospital No. 2 of Khabarovsk on August 30, 01 with a diagnosis of closed fracture of distal metaphyses of both bones of the right forearm with fragment displacement. An operation was performed - open reduction, metal osteosynthesis of bone fragments of the right forearm with a repair plate for osteosynthesis of distal metaphysial radial bone fractures in children and adolescents. The postoperative period was uneventful, wound healing occurred by primary intention. The child was discharged from the hospital on the 12th day after the operation under the supervision of a traumatologist at the place of residence. Examined 3.5 months after surgery: no complaints, range of motion in the wrist joint is complete, the anatomical axis of the limb is correct. Radiologically, a complete fusion of bone fragments was noted, the ratios of the bone anatomical formations of the wrist joint are correct.

Claims (1)

A reponomy plate for osteosynthesis of distal metaphysical radial bone fractures in children and adolescents, consisting of an overlay with holes made in it, characterized in that the plate has a rectangular shape, at one end of which from the side superimposed on the distal epiphysis, a stylet is made, inclined to the center of the plate at an angle of 70 ° to the surface superimposed on the distal pineal gland; there are three holes on the plate: a distal and an average circular shape with a diameter of 3.5 mm and an oval proximal opening with dimensions of 3.5 × 7 mm, while the distance between the distal and middle holes is 12 mm, between the middle and proximal 15 mm, and the distance from the distal opening to the base of the stylet is 13 mm for the replacement plate for children 7-11 years old, and for the replacement plate for children 12-15 years old these distances are 15, 20 and 20 mm, respectively; the size of the stylet: width 2 mm, thickness 1.5 mm, and length 8 mm for children 7-11 years old and 12 mm for children 12-15 years old; the overlay of the replacement plate has a width of 9 mm, a thickness of 1.5 mm, a length of 40 mm for children 7-11 years old and a length of 60 mm for children 12-15 years old.

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