RU2324448C2 - Method of transosseous ostheosynthesis of monteggia fracture-disclocation of forearm bones and device - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method consists in the transosseous osteosynthesis with use of the externally fixating device. For this purpose, four screw-rods are inserted sequentially into the ulnar bone fragments, two - into the proximal fragment and two - into the distal fragment. Tow screw-rods are fixed in the proximal support and 1/3 ring sector for the distal support of the ulnar bone, two other screw-rods are fixed in the apertures of components installed at the projecting rods, which are connected to the intermediate support. Then, the screw-rod is inserted into the proximal part of the ulnar bone and fixed in the reposing unit installed at the proximal support of the device; after that, the 1/3 ring sector for the distal support of the ulnar bone and the screw-rod are replaced from the ulnar bone, the dislocation of the ulnar bone head in sagittal and frontal planes is repaired by use of the reposing unit installed in the proximal support, and the device is set to the fixating regimen. The device used for this method, contains the proximal and distal supports. It also has the screw-rods for bone, intermediate support for the ulnar bone in shape of 1/3 ring sector, threaded rod to connect the supports. The proximal support has the shape of 3/4 ring sector, the distal support is made of 1/3 ring sector for the radial bone and of 1/3 ring sector for the ulnar bone. On proximal and distal supports, the brackets for fixation of bone screw-rods are installed; on the projecting supports for the ulnar bone, the reposing units are installed, which contain the threaded rod fixed to the intermediate supports with use of brackets. On the projecting threaded rod, the component with the mutually perpendicular holes is installed; in one of the holes, the bone screw-rod is fixed perpendicularly to the projecting threaded rod; the ends of the proximal support are connected to the threaded rod by brackets. On the threaded rod, the reposing unit for the radial bone with the component containing the mutually perpendicular holes is fixed; in one of the hole, the threaded rod is fixed where the bone screw-rod is adjusted by means of the revolving bracket. The intermediate supports for the ulnar bone can be distracted between each other, and the 1/3 ring sector for the radial bone of the distal support with the bone screw-rod can be separately distracted and disassembled.

EFFECT: treatment efficiency is increased due to prevention of contracture in distal radioulnar joint and possibility of adjustment of radial bone head with any displacement.

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Description

The present invention relates to medicine, namely to traumatology, and can be used in the treatment of fresh and chronic injuries of the bones of the forearm of the Montage type.

Closest to the proposed method is transosseous osteosynthesis of fractures of the forearm bones, the essence of which is that transosseous osteosynthesis begins by holding the distal base needle through both bones of the forearm at an angle of 90 degrees to the longitudinal axis of the segment in the sagittal plane. Then, through the proximal metaphysis of the ulnar bone, the proximal base spoke is drawn at an angle of 60 degrees to the frontal plane. Set the proximal base support on the basis of 3/4 of the ring and fix the base spoke in the support. Install the intermediate ring supports and the distal base support. After the apparatus is installed, a distraction force is created that is sufficient to establish the radial head exactly opposite the ulna incisura radialis, and the restoration of the anatomical length of the ulna serves as a guide. Radiographs are performed in two standard projections. In the event of a violation of the relationship in the distal radiolar joint through the proximal metaphysis of the ulnar bone, the proximal base spoke is inserted.

The supports of the apparatus are connected by solid rods. A needle is passed through the radius in the anteroposterior direction at an angle of 60 degrees to the sagittal plane and fix it after tensioning to the intermediate support using brackets. A distraction force is applied between the proximal base and repositional-fixative supports by an amount sufficient to lower the radius head. For the final reduction and fixation of the radial head, a screw-rod or cantilever spoke with a thrust pad at an angle of 90 degrees to the longitudinal axis in the frontal plane is introduced into the proximal metaphysis of the radial bone. If the displacement of the head of the radial bone is preserved, then a repairing needle is inserted with a thrust pad, which is bent back and forth, and simultaneous traction over both ends of the spoke eliminates the dislocation. After manipulation, the replacement spoke is replaced by a screw-rod or a cantilever spoke with a thrust pad. Through the distal metaphysis of the ulnar bone, a distal base spoke is drawn at an angle of 30 degrees to the sagittal plane, which is fixed after tension in the support of the apparatus. Then a distraction is applied between reposition-fixation and distal base supports to create diastasis between the fragments of the ulnar bone by 3-4 mm. To reposition bone fragments of the ulna, use needles with emphasis. However, to ensure the function of rotation, after reposition, they should be replaced by cantilevered transosseous elements. After eliminating the displacement of the fragments in width and at an angle, the supports are brought together to eliminate diastasis [1].

However, the well-known technology for the treatment of fractures of the forearm bones of the Montage type excludes the possibility of rotational movements in the forearm at the treatment stages, which subsequently leads to persistent contracture in the distal radiolactic joint and retraction of the interosseous membrane. The use of transsegmental fixation elements through the radius and ulna fixes muscle tissue, which contributes to the development of forearm contractures.

Closest to the proposed is a device for the treatment of fractures of the bones of the forearm of the Montage type, containing support elements connected by threaded rods and transosseous fixators. The supporting element of the proximal part is made in the form of a sector 3/4 of the ring. Intermediate and distal support elements are made in the form of rings. The fragments are fixed on the proximal support by two spokes, one of them is cantilevered with a supporting platform. Spokes are installed on the distal support, and bone fragments of the forearm are fixed on the intermediate supports by a threaded rod and a spoke [2].

However, the known apparatus has significant drawbacks, namely: when using it, the distal radiolar joint is fixed, which causes the development of its contracture.

Based on the current level of technologies for the treatment of fractures of the forearm bones of the Montage type and apparatus designs for its implementation, as well as eliminating the disadvantages of known technologies and devices, the task is to increase the effectiveness of treatment by preventing the development of contractures in the distal radiolar joint with the possibility of adaptation of the radial head with any displacement .

The problem is solved as follows.

The method of transosseous osteosynthesis of fractures of the forearm bones of the Montage type involves the fixation and reposition of fragments of the ulna, fixation and reduction of the radius in the external fixation apparatus. At the same time, four rod-screws are successively carried out into fragments of the ulnar bone, two of them to the proximal fragment and two to the distal fragment. Two rods-screws are fixed in the proximal support and sector 1/3 of the ring for the ulnar bone of the distal support, two - in the holes of the elements mounted on the outer rods connected to the intermediate supports. Then, a screw rod is introduced into the distal radius of the radius and fixed to the sector 1/3 of the ring for the radius of the distal support. Then carry out an isolated distraction of the ulna until the adaptation of the radial head to the radial notch of the ulna. A screw rod is inserted into the proximal radius of the radius and fixed in a repositional node mounted on the proximal support of the apparatus. The 1/3 sector of the radius bone ring of the distal support and the screw shaft from the radius bone are removed, the displacement of the radial head in the sagittal and frontal planes is eliminated with the help of the reposition unit installed in the proximal support, and the device is put into fixation mode.

To implement the method of transosseous osteosynthesis of fractures of the bones of the forearm of the Montage type, an apparatus was developed containing proximal and distal supports. New in the proposed device is that it is equipped with rods-screws for bone, intermediate supports for the ulna, having the shape of a sector 1/3 of the ring, threaded rods for connecting the supports. The proximal support has the shape of a sector 3/4 of the ring, the distal support is made of sector 1/3 of the ring for the radius and of the sector 1/3 of the ring for the ulna. Brackets are mounted on the proximal and distal supports for fixing the bone rods. On the intermediate supports for the ulnar, repositional nodes are fixed, containing an external threaded rod fixed to the intermediate supports using brackets. An element with mutually perpendicular openings is installed on the remote threaded rod, in one of which a rod-screw for bone is fixed perpendicular to the remote threaded rod. The ends of the proximal support are connected by a threaded rod using brackets. A repositional node for the radius is fixed on the threaded rod, including an element with mutually perpendicular holes, in one of them a threaded rod is fixed, on which a bone screw is fixed by means of a rotating bracket. Intermediate supports for the ulna have the possibility of distraction between themselves, and the sector 1/3 of the ring for the radial bone of the distal support with a shaft-screw for bone has the possibility of isolated distraction and subsequent dismantling.

We explain the essential distinguishing features of the proposed method for transosseous osteosynthesis of fractures of the forearm bones of the Montage type and apparatus for its implementation.

The introduction of screw rods into the proximal and distal fragments of the ulna, their fixation in the external supports of the apparatus, as well as the introduction of a screw rod into the distal radius and adaptation of the radial head to the radial notch of the ulna provide the ability to perform simultaneous and isolated distraction and restoration of length ulnar bone.

The introduction of a screw rod into the proximal radius and its fixation in the reposition unit mounted on the external support of the apparatus allows the radius head to be adjusted at all possible displacements, as well as separately fix fragments of the ulna.

Dismantling the distal support base and the screw shaft from the radius, eliminating the displacement of the radial head in the sagittal and frontal planes with the help of the reposition unit allows the earlier development of rotational movements in the forearm and preventing the development of contractures in the distal radial joint.

The subsequent transfer of the device to the fixation mode is necessary for the healing of forearm bone fractures.

We explain the essential distinguishing features of the apparatus for performing transosseous osteosynthesis of fractures of the forearm bones of the Montage type:

The implementation of the supporting element of the proximal part of the apparatus in the form of a sector 3/4 of the ring, the intermediate supports in the form of a sector 1/3 of the ring and the distal part, consisting of two supports in the form of a sector 1/3 of the ring, provides the possibility of separate fixation of the bones of the forearm, as well as facilitating the design .

The installation of brackets with a threaded hole on the proximal and distal supports, in which the screw rods are fixed, allows isolated distraction of fragments of the ulna and reposition of the radius.

Strengthening on the intermediate supports of the reposition units containing an external threaded rod fixed to the intermediate supports using brackets with a threaded hole, and installation of an element with mutually perpendicular holes on one of the external threaded rods, in one of which a screw rod is fixed perpendicular to the external threaded rod, provides reposition of the pieces ulna in the frontal and sagittal planes.

The connection of the ends of the proximal support with a threaded rod using brackets with a threaded hole and fastening on the threaded rod in the projection of the radial bone of the repositional unit, which includes an element with mutually perpendicular holes, in one of which the threaded rod is fixed, the rod-screw is strengthened on the latter by means of a rotating bracket, ensures a stable fixation, as well as the ability to control the proximal radius at the stage of reduction.

The patent studies on subclasses А61В 17/58, 17/60, as well as the analysis of scientific and medical information reflecting the current level of technologies for transosseous osteosynthesis of fractures of the forearm bones of the Montage type and designs for its implementation, did not reveal identical developments. Thus, the proposed method of treatment and apparatus for its implementation are new.

The relationship and interaction of the essential methods of the method of transosseous osteosynthesis of fractures of the forearm of the Montage type and the apparatus for its implementation provide a new medical result in solving the problem, namely: to increase the effectiveness of treatment by preventing the development of contractures in the distal radial joint, since it is possible to adapt the radial head at any displacements. And also the possibility of repositioning the dislocation with chronic injuries of the forearm over time. Thus, the proposed technical solution has an inventive step.

The proposed method for transosseous osteosynthesis of fractures of the forearm bones of the Montage type and apparatus for its implementation can be widely used in the clinical practice of trauma and surgical departments.

The essence of the proposed "Method of transosseous osteosynthesis of fractures of the forearm bones of the type of Montage" is as follows.

Fixation and reposition of fragments of the ulna are carried out, as well as fixation and reduction of the radius in the external fixation apparatus. In this case, the screw rods are inserted into the proximal and distal fragments of the ulna and fixed in the external supports of the apparatus: two of them into the proximal fragment and two into the distal fragment, two screw rods are fixed in the proximal support and sector 1/3 of the ulnar ring distal supports, two in the holes of the elements mounted on the remote rods connected to the intermediate supports. Then, a screw rod is introduced into the distal radius of the radius and fixed to the sector 1/3 of the ring for the radius of the distal support. An isolated distraction is carried out, restoring the length of the ulna, until the head of the radius is adapted to the radial notch of the ulna. After that, a screw-rod is inserted into the proximal radius and fix it in a repositional unit mounted on the proximal support of the apparatus. Sector 1/3 of the ring for the radial bone of the distal support and the screw rod from the radial bone are removed, the displacement of the radial head in the sagittal and frontal planes is eliminated with the help of the reposition unit installed in the proximal support. The device is put into fix mode.

To implement the method, an apparatus was developed for transosseous osteosynthesis of fractures of the forearm bones of the Montage type, the essence of which is illustrated by drawings, where:

- figure 1 General view of the apparatus of external fixation;

- figure 2 - reposition node with a rod-screw for the ulnar bone;

- figure 3 - reposition node for repositioning the dislocation of the radius

- figure 4 is an x-ray of the left forearm of patient K. before treatment (direct and lateral projection);

- figure 5 is an x-ray of the left forearm of patient K. at the stage of treatment (direct and lateral projection);

- Fig.6 is an x-ray of the left forearm of patient K. at the stage of treatment (apparatus in fixation mode);

- Fig.7 - x-ray of the patient K. after treatment (direct and lateral projection).

The apparatus for transosseous osteosynthesis of fractures of the Montage type consists of external supporting elements 1, 2, 3, 4 and 5 connected by threaded rods 6. The proximal support 1 of the apparatus is made in the form of a 3/4 ring sector. The distal supports 4 and 5 are made in the form of a sector 1/3 of the ring. On the proximal 1 and distal 4 and 5 supports, brackets 7 are installed with a threaded hole 8, in which rods-screws 9 for bone are fixed. On the intermediate supports 2 and 3 for the ulna, the reposition units 10 and 11 are fixed. The reposition units 10 and 11 contain an external threaded rod 12 fixed to the intermediate supports 2 and 3 using brackets 7 with a threaded hole 8. An element is installed on the external threaded rod 12 13 with mutually perpendicular holes, in one of which a rod-screw 9 for bone is fixed perpendicular to the external threaded rod 12. The ends of the proximal support 1 are connected by a threaded rod 14 with brackets 7 with a threaded hole 8 On the threaded rod 14, a repositional node 15 for the radius is fixed, including an element 13 with mutually perpendicular holes, in one of which a threaded rod is fixed 16. On the threaded rod 16, a bone screw 9 is fixed to the threaded rod 17. Intermediate supports for the ulna have the possibility of distraction between themselves, and the sector 1/3 of the ring for the radial bone of the distal support with a shaft-screw for bone has the possibility of isolated distraction and subsequent dismantling. The rotating bracket 17 is fixed on the threaded rod 16 with nuts 18. The reposition units 10, 11 are moved and fixed on the remote threaded rod 12 with nuts 19.

The proposed method of osteosynthesis of fractures of the forearm bones of the type of Montage and apparatus for its implementation as follows.

After carrying out skeletal traction over the 2-5-metacarpal bones and the ulnar process of the ulna, four screw rods 9 are sequentially carried out in the ulna bone fragments (two into the proximal fragment and two into the distal fragment) at an angle of 90 degrees to the longitudinal axis of the bone in the sagittal the plane. Two rod-screws 9 using brackets 7 are fixed to the external supports 1 and 4, the apparatus (distal and proximal). The remaining rods-screws 9 are fixed in the holes of the elements 13 mounted on the external threaded rods 12 connected by means of brackets 7 to the intermediate supports 2 and 3 of the apparatus. The screw-rod 9 and the element 13 are moved and fixed with the help of nuts 19 on the external threaded rod 12. The external supports 1, 2, 3, 4 and 5 of the apparatus are connected in series by threaded rods 6. Distraction between the fragments of the ulnar bone is performed using threaded rods 6, located between the intermediate supports 2 and 3, due to the movement of nuts 19 over them at a distance of 10-15 mm (depending on the displacement of fragments of the ulnar bone along the length, for chronic injuries, discrete 1 mm per day). Then, using reposition nodes 10 and 11 (for chronic injuries, discrete 1 mm per day), reposition of ulna fragments in the sagittal and frontal planes is performed. To do this, the screw rod 9 is moved in the element 13 with the help of nuts 19 - in the frontal plane along the external threaded rod 12, and in the sagittal plane along the screw rod 9. Then, the screw rod 9 is carried into the distal radius and fix it with brackets 7 to the distal support 5 and conduct simultaneously and in isolation distraction to the required distance - 10-15 mm After that, the proximal shaft-screw 9 is inserted and fixed with the rotating bracket 17 to the threaded rod 16 by means of the element 13. The threaded rod 16 is fixed on the threaded rod 14 connecting the extreme holes of the external support 1. Then, the distal support 5 and the screw-shaft 9 are dismantled. Using the reposition unit 15, the head of the radius is adapted to the radial notch of the ulna by moving the nuts 19 on the threaded rod 14, while relaxing the nut 18. If the displacement in the frontal plane is not eliminated, the rod-screw 9 in the rotating bracket 17 is moved using the nuts 19 , after this, the dislocation of the radial head dislocation is performed by moving the nuts 19 on the threaded rod 16. After the reposition maneuver, the apparatus is put into fixation mode. After 4 weeks (with chronic injuries after 5-6 weeks), the base from the radial bone is dismantled. After fusion of fragments of the ulna, the apparatus is dismantled.

The essence of the proposed "Method of transosseous osteosynthesis of fractures of the forearm bones and apparatus for its implementation" is illustrated by a clinical example.

Patient K., 20 years old, was admitted to the clinic GU SC RVH VSNTS SB RAMS 2 months after the injury (at the place of residence he was diagnosed with a fracture of the upper third of the left ulnar diaphysis, the treatment is conservative) with complaints of pain in the left elbow joint, restriction of movements in left elbow and wrist joints, inability to fully use the left upper limb.

Objectively: Asymmetry of the forearms due to atrophy of soft tissues on the left throughout. The axis of the limb is changed - in the upper third of the forearm along the ulnar surface, the angle is open to the back surface of the forearm. Relative shortening of the limb - 1.0 cm. Movements in adjacent joints are limited: in the elbow - 90 ° / 75 ° / 0 °, in the wrist - 30 ° / 0 ° / 30 °, rotation of the forearm - 10 ° / 0 ° / 10 ° . There are no vascular, motor, sensory disorders in the distal extremities.

On the roentgenogram of the left forearm, dislocation of the radial head anteriorly and laterally is determined, violation of the integrity of the ulna, at the level of the upper third of the diaphysis. The contours of the ends of the fragments acquired uneven, fuzzy outlines. Recurrence 160 °. Displacement anteriorly by the width of the diaphysis, upward by 1 cm (Fig. 4).

Diagnosis: Injured Montage damage to the left. Combined contracture of the left elbow and wrist joints, rotational contracture of the forearm.

An operation was performed according to the proposed technology using an apparatus for its implementation.

After carrying out skeletal traction for 2-5 metacarpal bones and the ulnar process of the ulna, four screw rods 9 (two into the proximal fragment and two into the distal fragment) were successively carried out at the angle of 90 ° to the longitudinal axis of the bone in the sagittal plane. Each rod-screw 9 using brackets 7 and reposition units 10, 11 is fixed to external supports 1, 2, 3, 4 (distal to sectors 1/3, proximal sectors 3/4, intermediate to sectors 1/3 of the circumference of the apparatus ring Ilizarova). External supports are connected in series with each other by threaded rods 6.

The device is stabilized.

Then, a rod-screw 9 was drawn into the distal radius of the radius at an angle of 90 ° to the longitudinal axis of the bone in the sagittal plane. The distal shaft-screw 9 is fixed with brackets 7 with a threaded hole 8 to the external support 5, (sector 1/3 of the circumference of the ring of the Ilizarov apparatus). External supports are connected in series with each other by threaded rods 6.

The device is stabilized (figure 5).

The residual displacement of the bony fragments of the ulnar bone was corrected, the dislocation of the radial head of the left forearm in the external fixation apparatus was reversed in time as follows: using threaded rods 6 by moving nuts 19 between intermediate external supports 2 and 3 on the ulnar and 5 and 1 on the radius bones, 10 mm were discretely performed at a rate of 1 mm per day until the head of the radius was adapted opposite the radius cut of the ulna. Then, in the apparatus on the ulnar bone with the help of the reposition unit 10 fixed in the distal intermediate support 3, discrete reposition of the distal fragment in the sagittal plane was performed discretely at 1 mm per day. The screw-rod 9 was brought nearer to the element 13 by moving the nuts 19. In parallel, the dislocation of the radial head dislocation was performed in this way: the screw-rod 9 in the frontal plane was drawn into the proximal third of the radius and fixed with the help of the repositional node 15 of the radius, including an external threaded a rod 14, at the ends of which two brackets 7 are fixed with an internal threaded hole 8. Using the brackets 7, the reposition unit 15 is fixed to the outer proximal support 1 at the extreme holes. An element 13 with mutually perpendicular holes is fixed on the inner part of the remote threaded rod 14, in one of them a threaded rod 16 is fixed, to which, through the bracket 7, a rotating bracket 17 with a fixing nut 18 is attached. The rod-screw 9 is fixed to the rotating bracket 17 with nuts 19 The distal screw-rod 9 and the external support 5 are dismantled.

Using the reposition unit 15 for the radius, the radius head was adapted in the projection of the capitate head elevation, eliminating displacement in the sagittal plane due to the movement of the threaded rod 16 in the element 13 with the help of nuts 19 mounted on the threaded rod 16. Then, the displacement of the radial head in the frontal the plane by moving the element 13 along the threaded rod 14 with the help of nuts 19. To eliminate residual displacements of the radial head, the rod-screw 9 was moved in the rotating bracket 17, moving ha ki relaxing the nut 19 and 18.

After performing the reposition maneuver, the apparatus is put into fixation mode. On the roentgenogram, the deformity is eliminated, the dislocation of the radial head is corrected, the standing of the bone fragments is satisfactory, the bones of the forearm are fixed by an external fixation device (Fig.6).

The postoperative period is without complications. Movements in the elbow, wrist joints, fingers of the hand are allowed from the first day, from 3 days after the operation of exercise therapy. On the 12th day after the operation in satisfactory condition, the patient was discharged for outpatient treatment. 30 days after the operation, the external support and the screw rod 9 from the proximal radius were dismantled. The development of rotational movements of the forearm has begun. 82 days after the operation, the external fixation apparatus was dismantled. The patient freely uses the left hind limb, no complaints, range of motion in adjacent joints: elbow - 160/5/0, wrist - 40/0/40, rotation of the forearm 50/0/60; the patient's ability to work is fully restored. The anatomical and functional result of treatment according to the Mattis-Luboschitz-Schwarzberg system (3) is regarded as good (see Fig. 7).

Thus, the proposed "Method of transosseous osteosynthesis of fractures of the forearm bones of the Montage type and apparatus for its implementation" in comparison with known technologies and designs for their implementation provided the ability to adapt the radial head with any displacement, allowed to increase the effectiveness of treatment by preventing the development of contractures in the distal radial joint.

Information sources:

1. Combined transosseous osteosynthesis of diaphyseal fractures of the forearm bones. Manual for doctors. - SPb .: NIITO them. P.P. Vredena, 2004, from 16-20.

2. Solomin L.N. Fundamentals of transosseous osteosynthesis apparatus G.A. Ilizarov: Monograph. - SPb .: MORSAR AV LLC, 2005. - from 192-193.

3. Shvetsov V.I., Shved S.I., Sysenko Yu.M. Transosseous osteosynthesis in the treatment of comminuted fractures. - Kurgan - 2002, s - 137.

Claims (2)

1. The method of transosseous osteosynthesis of fractures of the bones of the forearm of the Montage type, characterized in that they use an external fixation apparatus, four screw rods are successively carried out in the fragments of the ulnar bone, two of them into the proximal fragment and two into the distal fragment, two screw rods are fixed in the proximal support and sector 1/3 of the ring for the ulnar bone of the distal support, two in the holes of the elements mounted on the extension rods connected to the intermediate supports, then the screw rod is inserted into the distal section the humerus and fix to the sector 1/3 of the radius for the radial bone of the distal support, then carry out an isolated distraction of the ulna until the radial head adapts to the radial notch of the ulna, after which a screw rod is inserted into the proximal radius and fix it in repositional the node mounted on the proximal support of the apparatus, the sector 1/3 of the ring for the radial bone of the distal support and the screw rod from the radial bone are dismantled, eliminate the displacement of the radial head in the sagittal and frontal using knock reposition assembly mounted in the proximal support, and translate in the apparatus fixation mode. 2. Apparatus for transosseous osteosynthesis of fractures of bones of the forearm of the Montage type, containing proximal, distal supports, characterized in that it is provided with rods-screws for bone, intermediate supports for the ulna, having the shape of a sector 1/3 of the ring, threaded rods for connecting the supports, the proximal support is in the form of a sector 3/4 of the ring, the distal support is made of sector 1/3 of the ring for the radius and the sector 1/3 of the ring for the ulna, brackets for fixation are installed on the proximal and distal supports of the rods of bone screws, on the intermediate supports for the ulnar, repositional nodes are fixed, containing a remote threaded rod fixed to the intermediate supports with brackets, an element with mutually perpendicular holes is installed on the external threaded rod, in one of which a bone screw shaft is fixed perpendicular to the remote threaded rod, the ends of the proximal support are connected by a threaded rod using brackets, a reposition unit for the beam is mounted on the threaded rod bones, including an element with mutually perpendicular openings, a threaded rod is fixed in one of them, on which a screw-screw for the bone is fixed by means of a rotating arm, intermediate supports for the ulna have the ability to distract between each other, and a sector 1/3 of the ring for the radius of the distal support with a shaft-screw for bone has the ability to isolated distraction and subsequent dismantling.

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