Extrafocal modular system for transverse-radial stabilization of hand bone fractures

Abstract

FIELD: medical equipment.SUBSTANCE: extrafocal modular system for transverse-radial stabilization of hand bone fractures. The extrafocal modular system for transverse-radial stabilization of hand bone fractures contains two supports. The first support includes two brackets with nodes for fixing the wires and the wire installed on them. The second support is made in the form of a threaded rod, on which at least one wire retainer is mounted with the possibility of movement, made in the form of washers equipped with chordal grooves for the wire, fixed at both ends with nuts. The two ends of one wire are placed in the grooves of the washers of the retainer, installed on the threaded rod. The two brackets of the first support are connected by a hinge joint formed by two ears with threaded tails. The threaded shanks of the ears are inserted into the blind threaded end holes of the brackets. The threaded ear shanks are equipped with a lock nut that can be rotated. A threaded rod passes perpendicular to the axis of the brackets through the eyelets of the ears and is fixed on both sides with clamping nuts.EFFECT: complete stability of bones at fracture sites, due to the impossibility of rotation along the axis of the bracket and the use of lock nuts, with preliminary optimal adjustment of the position of the structure, thanks to the presence of a hinge joint.1 cl, 3 dwg, 2 ex

Description

[0001] The invention relates to the field of medicine and can be used in traumatology and orthopedics for fixing fractures of the short tubular bones of the hand.

[0002] A device is known for lengthening short tubular bones, containing a threaded rod with a metric or trapezoidal thread, on which at least two spoke fixators are mounted with the possibility of movement, wherein each spoke fixator is made in the form of a bolt with a through axial hole, a support plate located on the side of the bone, a pressure plate coaxially located relative to the support plate, and in said plates grooves are made for fixing the spokes, additionally containing a set of lock washers and fasteners that ensure fixation of the spokes in the working position (SU 1715333, published 28.02.92)

[0003] The disadvantages of the analogue are the impossibility of fixing individual segments of destroyed rays to stable rays in case of comminuted fractures and bone defects, the impossibility of transferring the supporting load to two stable rays in case of comminuted fractures and bone defects.

[0004] A device is known for osteosynthesis of short tubular bones, comprising a rod, pins, pin fixators in the form of a bolt with washers mounted thereon with grooves for the pins and fastening elements, the rod is made of a radiolucent material, equipped with at least two fixing units in the form of brackets with a threaded and smooth hole, respectively, for a locking screw and a bolt shank, in the head of the latter, on the side of the shank, multidirectional grooves are made, and the shank is equipped with a longitudinal chamfer. It is envisaged that the smooth hole of the bracket can be equipped with a segmental cut corresponding to the bolt chamfer. (RU 16644, published 01 / 27 / 2001).

[0005] The disadvantages of the analogue are the impossibility of fixing individual segments of destroyed rays to stable rays in case of comminuted fractures and bone defects, the impossibility of transferring the supporting load to two stable rays in case of comminuted fractures and bone defects.

[0006] Also known is a compression-distraction apparatus comprising a threaded rod with spoke holders mounted thereon, each of which includes a bolt with radial holes, a pair of cooperating washers with tangential grooves for accommodating the spokes, and fastening elements that ensure reliable fixation of the spokes during the distraction process. (SU 1161100, published 06 / 15 / 1985)

[0007] The disadvantages of the analogue are the impossibility of fixing individual segments of destroyed rays to stable rays in case of comminuted fractures and bone defects, the impossibility of transferring the supporting load to two stable rays in case of comminuted fractures and bone defects.

[0008] A prefabricated module for fixing fractures of short tubular bones is known, which includes a bracket as a supporting element, nodes for fixing spokes placed on it, and spokes, one end of which is intended to pass through the bone and at the same time is bent at the skin level so that their direction is perpendicular to the surface of the skin, and the other end is fixed in the bracket (RU 2849689, published 10 / 28 / 2025).

[0009] The disadvantages of the analogue are the impossibility of fixing individual segments of destroyed rays to stable rays in case of comminuted fractures and bone defects, the impossibility of transferring the supporting load to stable rays in case of comminuted fractures and bone defects, and the impossibility of multi-segment fixation.

[0010] The closest to the claimed technical solution in terms of technical essence and the achievable technical result, selected as a prototype, is a device for treating syndactyly (RU 24366, published 10.08.2002), containing two supports made in the form of threaded rods, on which at least two spoke clamps are mounted with the possibility of movement, each of which is made in the form of washers provided with grooves for spokes, fixed at both ends with nuts, while the supports are connected by a unit for their spreading, characterized in that it contains an additional unit for spreading the supports, wherein the units for spreading the supports are made of a threaded rod, on which two bushings are located with the possibility of movement by means of pairs of nuts, each of which is provided with a bracket, and in each of the spoke clamps no more than two spokes are fixed.

[0011] The disadvantages of the prototype are the structural complexity due to the multitude of elements, which complicates assembly during surgery, the ability to rotate along the axis with minimal loosening of the locking element, due to the cylindrical shape of the main rod of the structure and the inability to transfer the supporting load to two stable rays of the hand in case of multi-fragmentary fractures and bone defects.

[0012] The objective of the invention is to develop a stable lightweight design that provides one-stage multi-beam extrafocal fixation of fractures of the short tubular bones of the hand in case of multi-comminuted fractures and bone defects.

[0013] This problem is solved due to the fact that in the extrafocal modular system for transverse-radial stabilization of fractures of the bones of the hand, containing two supports, the first of which includes brackets with nodes installed on them for fixing the pins and the pin, the second support is made in the form of a threaded rod on which at least one pin retainer is mounted with the possibility of movement, made in the form of washers equipped with chordal grooves for the pin, fixed at both ends with nuts, where at least one pin is fixed, a difference is provided in that the first support is made as a hinged connection of two symmetrically placed brackets, into the blind threaded end hole of each of which a threaded shank of an earring is introduced, equipped with a lock nut with the possibility of rotation, and the threaded rod passes perpendicular to the axis of the brackets through the eyes of the earrings and is fixed on both sides with clamping nuts.

[0014] The technical result is to ensure complete stability of the bones at the fracture sites, due to the impossibility of rotation along the axis of the bracket and the use of lock nuts, with preliminary optimal adjustment of the position of the structure, thanks to the presence of a hinge joint.

[0015] The invention is illustrated by drawings:

[0016] Fig. 1 shows an extrafocal modular system for transverse-radial stabilization of hand bone fractures, assembled, where 1 is a bracket, 2 is an earring, 3 is a threaded rod, 4 is a unit for fixing the pins.

[0017] Fig. 2 shows the component parts of the extrafocal modular system for transverse-radial stabilization of hand bone fractures, where 1 is a bracket, 2 is an earring, 3 is a threaded rod, 5 is unthreaded holes, 6 is a threaded end hole, 7 is threaded bolt legs, 8 is a pin fixation unit, 9 is a bolt head, 10 is a longitudinal groove, 11 is a pin, 12 is a washer, 13 is a chordal groove, 14 is a nut, 15 is a threaded shank, 16 is a lock nut, 17 is an eye.

[0018] Fig. 3 shows a control radiograph of the hand.

[0019] The extrafocal modular system for transverse-radial stabilization of hand bone fractures contains two supports, the central axes of which are perpendicular to each other.

[0020] The first support is made of two brackets 1, connected by a hinge joint formed by two earrings 2, through the eyes of which a threaded rod 3 passes, which is the second support and carries a movable unit for fixing the spokes 4.

[0021] Bracket 1 has a rectangular prism shape with rounded edges, on which there are two to five unthreaded holes 5 located perpendicular to the central axis, and one end hole with thread 6.

[0022] Through the holes without threads, the legs of the bolts with threads 7 pass, at least one unit for fixing the spokes 8, wherein the bolt has on the side of the leg on the head 9 a longitudinal groove 10 for fixing the spokes 11, on the other side of the bracket there is a washer 12, put on the leg of the bolt 7, also having on one of the sides a chordal groove 13 for fixing the spoke 11, pressed until it stops with a nut 14. Each of the spokes 11 is preliminarily passed with one of its ends through the bone.

[0023] The brackets are connected by a hinge consisting of two earrings 2 with a threaded shank 15, equipped with a lock nut with the possibility of rotation 16, and inserted into the threaded end hole 6 of the bracket 1.

[0024] The second support is made in the form of a threaded rod 3, on which a movable unit for fixing spokes 4 is placed, made in the form of two clamping nuts 14 and at least two washers 12 placed between them, provided with chordal grooves for spokes 13. In the grooves of the washers 12 of the unit for fixing the spokes to the threaded rod 3, both ends of at least one spoke 11, previously passed through the bone, are placed.

[0025] In one embodiment, in the reposition mode, the unit for fixing the spokes 4, located on the threaded rod 3, may include four washers 12 with grooves 13 for fixing the four ends of two spokes 11.

[0026] The threaded rod 3 is installed with one end perpendicular to the axis of the first support and is secured in the eyes 17 of two earrings 2 that form the hinge of the first support, using clamping nuts 14 located on both sides of the earrings 2.

[0027] The invention is used as follows.

[0028] To install an extrafocal modular system for transverse-radial stabilization of bone fractures with the ability to reliably fix individual fragments of destroyed rays, a threaded earring shank equipped with a lock nut to lock the rotation of the earring is initially inserted into the blind threaded end hole of each of the two brackets.

[0029] Then, during surgery, at least four pins are inserted in pairs into stable proximal fragments or intact bones at a 45-degree angle to the skin surface using a drill with a bicortically sharpened end. The free ends of each pin are bent in one or two places above the skin so that their axis, when intersecting with the first support, is perpendicular to its central axis. Each pair of pins is placed in its pin fixation unit on either side of the horizontally positioned brackets with a shackle, which form the basis of the first support. These pins are positioned in the grooves of the bolt head and in the chordal grooves of the washers, previously inserted into the bracket hole. Then, using a clamping nut, without tightening it completely, the pin is preliminarily secured in the unit, placing the first support above the skin surface.

[0030] The next step is connecting the supports. This is accomplished by inserting a rod into the earring eyelets perpendicular to the axis of the first support, thereby forming a hinge joint. The rods are secured with clamping nuts, each on its own side of the earring. The nuts are not fully tightened, which is necessary for further adjustment.

[0031] After installing the rod and spokes, the support's height and position are adjusted by sliding the spokes in the grooves and bending them. This is due to the loose clamping nuts and the hinged connection between the two brackets of the first support. To reduce the length of the spoke arm inserted into the phalanx and minimize the risk of uncontrolled bending, the free end of the threaded rod is installed as close as possible to the spoke insertion point.

[0032] After adjustment, all clamping nuts and locknuts are tightened, ensuring full fixation of the first support over the hand surface. The design ensures stability due to the paired pin arrangement and bicortical fixation.

[0033] To reduce the risk of damage to the skin and mucous membranes by the free ends of the spokes, the ends are shortened and bent in the opposite direction directly above the brackets along the head of the screw or clamping nut.

[0034] Then a movable unit for fixing the spokes is attached to the free end of the rod, made in the form of two clamping nuts and at least two washers placed between them, equipped with chordal grooves for the spokes.

[0035] Next, in distraction mode, at least one pin is inserted bicortically into the phalanx of the injured radial finger or its distal fragment, ensuring that it is positioned as close as possible to the fracture site while still within healthy tissue. Using a drill, the pin is inserted perpendicular to the skin surface, midway between the palmar and dorsal surfaces of the phalanx. The free ends of the pin are bent at skin level so that they point toward the nail. The two ends of one pin are placed in a sliding pin fixation unit on either side of the nail, in the chordal grooves of two washers located between two clamping nuts. These nuts are then used to pre-fix the pin ends, without fully tightening them. In this mode, stabilization of the injury is combined with distraction of the fragments.

[0036] In one embodiment, in reduction mode, two pins are inserted parallel bicortically into the phalanx of the injured radius or its distal fragment, spaced 2-3 mm apart, ensuring they are positioned as close to the fracture site as possible while remaining within healthy tissue. In this embodiment, the two ends of each pin are placed in a sliding pin fixation unit on either side of the rod, in the chordal grooves of four washers located between two clamping nuts. In this mode, in addition to stabilizing the injury and distracting the fragments, bone fragment reduction is also possible.

[0037] After installing the spokes, adjusting the height and position of the phalanx or repositioning its fragment is carried out by sliding the spokes in the grooves and bending them due to the fact that the clamping nuts are not initially tightened all the way.

[0038] The threaded rod allows for micro-adjustment of the pin-to-rod fixation unit for optimal repositioning and / or distraction. Once adjustments are complete, all clamping nuts are tightened, achieving complete stabilization of the system and bone fragments.

[0039] To reduce the risk of damage to the skin and mucous membranes by the protruding free ends of the needles, the ends are shortened and at a distance of 1.5-2 cm above the rod are bent in the opposite direction along the needle.

[0040] The extrafocal modular system for transverse radial stabilization of bone fractures allows, if necessary, for example, in the case of secondary fragment displacement, to slightly loosen the clamping nuts using a straight section of the pins, 1.5-2 cm long, from the shaft to the bend. This allows for the positioning of the pins and the bone fragments they hold, moving them along the axis of the fixation unit. Accordingly, the invention allows for adjustments throughout the patient's treatment period.

[0041] The proposed invention allows for the long-term stabilization of bone fragments in a fixed, stable and repositioned state with the possibility, if necessary, of correcting their position, which increases the chance of fracture healing without complications.

[0042] Clinical example 1. Patient L., 29 years old, was admitted with a penetrating gunshot wound to the right hand with a multi-fragmentary fracture and a bone defect of the 3rd metacarpal bone.

[0043] To install an extrafocal modular system for transverse-radial stabilization of hand bone fractures, four pins were inserted bicortically into the necks of the second and fourth metacarpal bones using a drill at a 45-degree angle to the skin surface. The free ends of each pin were bent in two places above the skin so that their axis, when intersecting with the brackets, was perpendicular to the central axis of the first support. Each pair of pins was positioned in its own pin fixation unit on either side of the horizontal surface of the hand, the brackets with the shackle, which form the basis of the first support. The pins were positioned in the grooves of the bolt head, previously inserted into the bracket hole, and in the chordal grooves of the washers. Then, using clamping nuts, without tightening them completely, the pins were preliminarily secured in the nodes, placing both parts of the first support above the skin surface.

[0044] The next step is connecting the supports. This is accomplished by inserting a rod into the earring eyelets perpendicular to the axis of the first support, forming a hinge joint. This is secured with clamping nuts, each on its own side of the earring. The nuts are not fully tightened, which is necessary for further adjustment.

[0045] After installing the rod, the height and position of the first support were adjusted by sliding the spokes in the grooves and moving the hinge joint. Then, all clamping nuts and locknuts were tightened completely, ensuring complete fixation of this part.

[0046] The next stage of the operation is to place a unit on the rod, which is the basis of the second support, for fixing the spokes to the threaded rod, in the form of two nuts and, located between them, two washers with chordal grooves.

[0047] Next, using a drill, insert one pin, sharpened end first, through the proximal phalanx of the third finger, bicortically, midway between the palmar and dorsal surfaces, strictly perpendicular to the skin surface. The free ends of the pin, 2 mm above skin level, are bent so that they point toward the rod. The resulting pair of pin ends is placed in a knot on either side of the rod located in the hole of the shackle, in the chordal grooves of washers previously threaded onto the rod and located between two clamping nuts. Using these nuts, both ends of the pin are then preliminarily secured without tightening them completely.

[0048] After the pin was installed, the proximal phalanx was repositioned and distracted by sliding the ends of the pin in the grooves and bending them, after which the final tightening of the clamping nuts was performed to completely stabilize this part of the system and bone fragments.

[0049] To reduce the risk of damage to the skin and mucous membranes by the free ends of the pins, their ends are shortened and bent back just above the brackets of the first support, following the heads of the screws and clamping nuts. Similarly, for the second support, the ends of the pins are bent back along its axis, 1.5-2 cm above the shaft.

[0050] The final stage was typical primary surgical treatment of the wound, and aseptic dressings were applied.

[0051] At the end of the operation, a control radiography was performed: the position of the fragments was satisfactory, the axes were preserved (Fig. 3).

[0052] In the early postoperative period, without complications and secondary displacements.

[0053] The patient was then scheduled for reconstructive surgery.

[0054] Thus, the proposed invention allows for a long period of time to stabilize bone fragments in a fixed, stable and repositioned state with the possibility, if necessary, of correcting their position, which increases the chance of fracture healing without complications.

[0055] Clinical example 2. Patient Yu., 36 years old, was admitted with a gunshot wound to the left hand with comminuted fractures of the proximal phalanx of the 3rd finger and 3rd metacarpal bone with soft tissue and bone defect.

[0056] To install an extrafocal modular system for transverse-radial stabilization of hand bone fractures, four pins were inserted bicortically into the necks of the second and fourth metacarpal bones using a drill at a 45-degree angle to the skin surface. The free ends of each pin were bent in two places above the skin so that their axis, when intersecting with the brackets, was perpendicular to the central axis of the first support. Each pair of pins was positioned in its own pin fixation unit on either side of the horizontal surface of the hand—the brackets with an earring, which form the basis of the first support. The pins were positioned in the grooves of the bolt head, previously inserted into the bracket hole, and in the chordal grooves of the washers. Then, using clamping nuts, without tightening them completely, the pins were preliminarily secured in the unit, positioning both parts of the first support above the skin surface.

[0057] The next step is connecting the supports. This is accomplished by inserting a rod into the earring eyelets perpendicular to the axis of the first support, forming a hinge joint. This is secured with clamping nuts, each on its own side of the earring. The nuts are not fully tightened, which is necessary for further adjustment.

[0058] After installing the rod, the height and position of the first support were adjusted by sliding the spokes in the grooves and moving the hinge joint. Then, all clamping nuts and locknuts were tightened completely, ensuring complete fixation of this part.

[0059] The next stage of the operation is to place a unit on the rod, which is the basis of the second support, for fixing the spokes to the threaded rod, in the form of two nuts and four washers with chordal grooves located between them.

[0060] Then, using a drill, two pins with the sharpened ends are inserted through the distal fragment of the proximal phalanx of the third finger bicortically, midway between the palmar and dorsal surfaces, strictly perpendicular to the skin surface. The free ends of the pins, 2 mm above skin level, are curved so that they point toward the rod. The resulting two pairs of pin ends are placed in a knot on either side of the rod located in the hole of the shackle, in the chordal grooves of washers previously threaded onto the rod and located between two clamping nuts. Using these nuts, all four ends of the two pins are then preliminarily secured without tightening them completely.

[0061] After the installation of the spokes, the proximal phalanx was repositioned and distracted by sliding the ends of the spokes in the grooves and bending them, after which the final tightening of the clamping nuts was performed to completely stabilize this part of the system and bone fragments.

[0062] To reduce the risk of damage to the skin and mucous membranes by the free ends of the spokes, their ends are shortened and bent back just above the brackets of the first support, following the heads of the screws and clamping nuts. Similarly, for the second support, the ends of the spokes are bent back along their axes, 1.5-2 cm above the rod.

[0063] The final stage was typical primary surgical treatment of the wound, and aseptic dressings were applied.

[0064] In the early postoperative period, without complications and secondary displacements.

[0065] The patient was then scheduled for reconstructive surgery.

[0066] Thus, the proposed invention makes it possible to stabilize bone fragments in a fixed, stable and repositioned state for a long period of time with the possibility, if necessary, of correcting their position, which increases the chance of fracture healing without complications.

Claims

An extrafocal modular system for transverse-radial stabilization of hand bone fractures, comprising two supports, the first of which includes two brackets with units mounted thereon for fixing pins and a pin, the second support is made in the form of a threaded rod, on which at least one pin retainer is movably mounted, made in the form of washers provided with chordal grooves for a pin, fixed at both ends with nuts, characterized in that two ends of one pin are placed in the grooves of the lock washers mounted on the threaded rod, two brackets of the first support are connected by a hinge joint formed by two earrings having threaded shanks, wherein the threaded shanks of the earrings are inserted into blind threaded end holes of the brackets, the threaded shanks of the earrings are equipped with a lock nut with the possibility of rotation, and the threaded rod passes perpendicular to the axis of the brackets through the eyes of the earrings and is fixed at both ends sides with clamping nuts.

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