RU-2861318-C1 - METHOD FOR TREATING FRACTURE OF MEDIAL EPICONDYLE OF HUMERUS IN CHILDREN

Abstract

FIELD: medicine. SUBSTANCE: invention relates to traumatology and orthopaedics, and can be used in the treatment of a fracture of the medial epicondyle of the humerus in children. The method includes open reduction of the fragments, insertion of wires in the projection area of the epicondyle, reduction of the fragment to the correct position, insertion of wires into the humerus and shortening of their ends to 1 cm above the bone. Two Kirschner wires with a diameter of 1.5 mm, equipped with cone-shaped thrust plates, the bases of which face the bone and the diameter of which is at least 4 mm, are inserted at an angle of 90° to each other, avoiding the fossa of the distal metaphysis of the humerus. The ends of the wires are brought out outside the incision area, aseptic dressings are applied to them and fixed to the skin using rubber stoppers. EFFECT: stable osteosynthesis, early functional activity, prevention of the development of contractures in the elbow joint, reduction of rehabilitation time and simplification of the removal of osteofixators by inserting wires with a thrust plate at an angle of 90°, avoiding the fossa of the distal metaphysis of the humerus. 1 cl, 6 dwg, 1 ex

Inventors

• SKVORTSOV ALEKSEJ PETROVICH
• KHABIBYANOV RAVIL YARKHAMOVICH
• Amairi Omar Nael Ali
• ANDREEV PETR STEPANOVICH

Dates

Publication Date

20260504

Application Date

20250331

Claims (1)

1. A method for treating a fracture of the medial epicondyle of the humerus in children, which includes open repositioning of fragments, inserting pins in the area of the epicondyle projection, repositioning the fragment in the correct position, inserting pins into the humerus and shortening their ends to 1 cm above the bone, characterized in that two Kirschner pins with a diameter of 1.5 mm, equipped with stop pads in the shape of a cone, the bases of which are facing the bone, and the diameter is not less than 4 mm, are inserted at an angle of 90° to each other, avoiding the fossa of the distal metaphysis of the humerus, the ends of the pins are brought out of the incision zone, aseptic dressings are applied to them and fixed to the skin with rubber stoppers.

Description

The invention relates to medicine, namely to traumatology, and can be used in the treatment of fractures and avulsions of the humeral epicondyles using various metal structures for osteosynthesis. A humeral epicondyle fracture is considered unstable. Because the distal humeral fragment experiences significant forces exerted by the epicondylar muscles, maintaining it in the desired position throughout the healing process is extremely difficult. The search for a reliable osteosynthesis method and metal structures for this type of fracture has led to the development of numerous techniques and metal structures. If osteosynthesis techniques are not followed correctly, pseudoarthrosis may develop at the fracture site due to the pull of the wrist flexor muscles. According to our data, such complications occur when inserting only one pin, or two pins parallel to each other without an angle, or when using intramedullary needles to fix the fragment. In all cases, rotational displacement of the fragment, or longitudinal displacement, occurs. This is explained by the fact that the wrist flexor muscles, which exert compressive and rotational forces, attach to the medial epicondyle. Foreign and domestic traumatologists widely utilize various osteosynthesis techniques for humeral epicondyle fractures, such as fixation with a cancellous screw or fixation with multiple Kirschner wires. The most commonly used technique is fixation with Kirschner wires with smooth, straight shafts and wires with L-shaped stops at the ends [Shaposhnikov Yu.G. Traumatology and Orthopedics. A Manual for Physicians in Three Volumes. Vol. 2. Moscow: Meditsina, 1997, p. 403]. Osteosynthesis for humeral epicondyle fractures using Kirschner wires with L-shaped stops at the ends involves making a longitudinal incision 6-8 cm long in the epicondyle projection area. After removing blood clots and small bone fragments with a single-pronged hook, the fragments are repositioned in the correct position. Two Kirschner wires are drilled through the epicondyles into the humerus, the ends of which are shortened above the bone, leaving 1 cm each, and bent in an L-shape in opposite directions. The wound is sutured, and the limb is immobilized with a plaster cast for four weeks. A disadvantage of this method is that Kirschner wires, due to their small diameter and smooth surface, often migrate postoperatively, especially in children, who have morphostructural differences that contribute to these complications if the immobilization regimen is not followed. Long-term external immobilization with a plaster cast leads to difficult-to-remove, and if the callus that fills the cubital fossa of the humerus develops, it can lead to persistent contracture of the elbow joint. The closest, in its technical solution, to the proposed invention is the method of "pinning" a displaced epicondyle, proposed by G.A. Bairov, using a pin with a stop pad [Traumatology of Childhood. Edited by Corresponding Member of the USSR Academy of Medical Sciences, Professor G.A. Bairov, Leningrad, "Medicine", Leningrad Branch, 1970. pp. 223-224]. The method is as follows: the surgeon makes a puncture of the skin with a sharp scalpel above the normal location of the epicondyle. A pin with a stop pad is passed through the punctured skin to the fracture site. Gently pressing on the fragment with the fingers, the fragment is moved toward its facet on the shoulder. Monitoring the fragment with an X-ray screen, the fragment is positioned in the most correct position and fixed with two fingers of the surgeon's free hand. The epicondyle is then pierced with a pin, ensuring it passes through the bony portion (the ulnar nerve remains behind). Using the pin as a lever, the fragment is finally positioned correctly, and the needle is advanced into the humeral condyle, "pinning" the epicondyle. The stop on the pin, passing through the skin incision, rests on the epicondyle, pressing it against its socket on the humerus. The wound is covered with an aseptic dressing over the pin. However, the described method is not without its drawbacks: using only one pin for osteosynthesis will inevitably lead to the formation of a diastasis between the torn epicondyle and its bed, leading to nonunion of the bone and the formation of a pseudoarthrosis; rotation of the fragment is possible during flexion and extension of the elbow joint, which occurs when removing and putting on a plaster splint during dressing changes, and this negatively impacts the time and potential for fragment consolidation. The essence of the proposed invention lies in a set of essential features sufficient to achieve the desired technical result, and consists in the creation of a method that ensures stable osteosynthesis in the treatment of fractures of the epicondyles of the humerus, allows early functional activity, prevents the development of contractures in the elbow joint, reduces the rehabilitation period of the operated limb and simplifies the re