RU-2861516-C2 - METHOD FOR SIMULTANEOUS NON-FREE BONE AUTOPLASTY FOR POST-FIREARM DEFECT OF PROXIMAL THIRD OF ULNA DURING ELBOW ARTHROPLASTY

RU2861516C2RU 2861516 C2RU2861516 C2RU 2861516C2RU-2861516-C2

Abstract

FIELD: medicine; traumatology; orthopaedics. SUBSTANCE: invention can be used for non-free bone autoplasty for a post-firearm defect of the proximal third of the ulna during elbow arthroplasty. Performing virtual preoperative planning with the creation of a three-dimensional model of the upper limbs, performing virtual bone reposition and determining bone deficiency, creating a computer three-dimensional model of the upper limb. Manufacturing a polymer prototype of a prosthesis with a copy of the elbow joint, manufacturing an individual elbow endoprosthesis and templates for resection; manufacturing an individual elbow endoprosthesis based on the results of virtual surgical modelling based on CT data of the patient. Using the prepared templates, performing resection of the humerus and ulna within the unaffected bone tissue. Using reamers, drilling the bone marrow canal of the humerus to the size determined during the virtual operation planning. Isolating the proximal part of the radius while preserving the attachment point of the forearm supinator muscle. Performing resection of the head and osteotomy of the radius at the level determined during virtual preoperative planning, obtaining a radial bone autograft with the muscle mass of the forearm supinator, preserving the attachment point of the supinator, preserving the blood supply to the superficial layers of the muscles, the recurrent radial artery, preserving the blood supply from the interosseous recurrent artery to the deep layers of the muscles and the periosteum, which preserves the blood circulation of the bone segment. Treating the intramedullary canals of the radius and ulna using reamers to the size determined during the virtual operation planning. Moving the radial bone autograft into the defect of the upper third of the ulna while simultaneously installing the individually modelled elbow endoprosthesis, implanting the humeral component of the endoprosthesis using the press-fit technique. Placing the non-free radial graft with the muscle mass of the forearm supinator on the stem of the ulnar component of the endoprosthesis and implanting the resulting complex into the ulna using the press-fit technique until cortical contact of the osteotomised fragments of the ulna and radius is achieved. Suturing the triceps brachii tendon to the openings of the implant designed according to the patient's anatomical features. EFFECT: reducing the likelihood of post-firearm chronic osteomyelitis of the ulna due to careful handling of the soft tissues of the radial region, maximising bone circulation preservation and complete cortical contact between the graft and the ulna. 5 cl, 14 dwg, 2 ex

Inventors

Krainov Nikolai Nikolaevich
Naida Daria Aleksandrovna
Murzin Evgenii Andreevich
Kucherenko Anna Aleksandrovna
Maksimov Andrei Andreevich
Kazanbaeva Alena Aleksandrovna
Sinegubov Oleg Nikolaevich
Ableev Ruslan
DAVYDOV DENIS VLADIMIROVICH
BRIZHAN LEONID KARLOVICH
KERIMOV ARTUR ASLANOVICH
Kukushko Evgenii Anatolevich
Khominets Igor Vladimirovich

Dates

Publication Date: 20260505
Application Date: 20240902

Claims (5)

1. A method of non-free bone autografting for a post-gunshot defect of the proximal third of the ulna during elbow joint endoprosthetics, characterized in that virtual preoperative planning is carried out with the creation of a three-dimensional model of the upper limbs with the performance of virtual repositioning of bones and the determination of bone deficiency, a computer three-dimensional model of the upper limb is created, a polymer prototype of the prosthesis with a copy of the elbow joint is manufactured, an individual endoprosthesis of the elbow joint and templates for performing resection are manufactured; a custom elbow joint endoprosthesis is manufactured based on the results of virtual surgical modeling using the patient's CT data; a surgical intervention is performed during which, using prepared templates, the humerus and ulna are resected within the unchanged bone tissue; using reamers, the medullary canal of the humerus is drilled to the size determined during virtual planning of the operation; the proximal part of the radius is isolated while preserving the attachment site of the supinator muscle of the forearm; resection of the head and osteotomy of the radius are performed at the level determined during virtual preoperative planning, obtaining an autograft of the radius with the muscle mass of the supinator of the forearm, preserving the attachment site of the supinator, preserving the blood supply to the superficial layers of the muscles, the recurrent radial artery, preserving the blood supply from the interosseous recurrent artery to the deep layers of the muscles and the periosteum, which preserves the blood circulation of the bone area; The intramedullary canals of the radius and ulna are processed using reamers to the size determined during virtual planning of the surgery; the radial autograft is transferred to the defect in the upper third of the ulna with the simultaneous installation of an individually modeled elbow joint endoprosthesis; the humeral component of the endoprosthesis is implanted using the "press fit" technology; a non-free radial graft with the muscle mass of the forearm instep is placed on the stem of the ulnar component of the endoprosthesis and the resulting complex is implanted into the ulna using the "press fit" technology until cortical contact is achieved between the osteotomized fragments of the ulna and radius; the triceps tendon is sutured to the implant holes designed in accordance with the anatomical features of the patient.
2. The method according to paragraph 1, characterized in that preoperative planning is carried out on the basis of comparative computed tomography of both upper limbs from the head of the humerus to the wrist joint with the creation of a three-dimensional computer model of the patient’s upper limbs.
3. The method according to paragraph 1, characterized in that the individual elbow joint endoprosthesis is manufactured from titanium alloy powder using additive technologies based on the results of virtual surgical modeling based on the patient’s CT data.
4. The method according to paragraph 1, characterized in that during virtual surgical modeling, the length of the limb is restored relative to the length of the patient’s healthy limb, taking into account the possibility of restoration due to a pronounced cicatricial process.
5. The method according to paragraph 1, characterized in that during the surgical intervention the tendon of the triceps brachii muscle is sutured to specially designed holes in the implant.

Description

The invention relates to medicine, namely to orthopedics and traumatology, and can be used in the treatment of the consequences of gunshot wounds to the elbow joint. The proposed surgical technique is aimed at eliminating the defect of the proximal third of the ulna in order to create a stable elbow joint, preserve the anatomical length of the forearm and establish the correct relationship of the bone, capsular-ligamentous and muscular apparatus of the limb to recreate full function of the upper limb. The elbow joint is a complex composite joint consisting of three simple articulations: the humeroulontal, humeroradial, and proximal radioulnar. All are united by a common capsule and joint capsule. The structure of the elbow joint reflects a balance between the functional requirements for the spatial positioning of the upper limb and the need for sufficient stability to allow the manipulation of heavy objects, throwing movements, and carrying heavy objects [1]. The osseous component plays a primary role in elbow joint stability. The trochlear notch of the ulna surrounds the trochlea of the humerus by almost 180 degrees, contributing to its innate stability. The shape and contour of the humeroulontal articular surface further enhance the stability of the elbow joint. The trochlea is described as having a spool shape—that is, wide in the coronal plane with a deep groove in the middle. Correct alignment of this central groove with the corresponding ridge of the trochlear notch of the olecranon adds stability to the joint [2, 3]. The ulna-humeral joint contributes to anteroposterior stability, varus, valgus, and rotational stability. Gunshot wounds differ significantly from peacetime injuries. The characteristics of a gunshot wound include: a complex wound channel configuration, the presence of necrotic tissue around the wound channel and the formation of new foci of necrosis soon after injury; uneven extent of necrotic and necrotic tissue around the wound channel; frequent presence of foreign bodies in the wound channel and surrounding tissues; rapid development of traumatic edema, which impairs tissue perfusion and contributes to the development of infectious complications [13]. When a patient is injured by a high-velocity projectile, not only soft tissues but also the axial skeleton are often damaged. At the same time, a gunshot fracture of a tubular bone is characterized by significant damage to the contents of the medullary cavity and its own nutrient arteries, which leads to tissue hypoxia and is often a trigger for the development of gunshot osteomyelitis [14]. These characteristics of the injury significantly affect not only the treatment aimed at wound closure, but also subsequent reconstructive interventions. After all, further treatment of such patients is traditionally carried out according to protocols for the treatment of chronic osteomyelitis. During combat operations, a soldier carries a firearm (machine gun) in his hands, which affects the position of the upper limb at the moment of injury, most often resulting in destruction of the superficial ulna while preserving the radius. Gunshot wounds associated with a significant bone defect in the upper third of the ulna result in significant polyaxial instability of the joint. Total elbow arthroplasty is one treatment option. This technique restores stability and function to the elbow joint. However, with significant bone loss, standard semi-constrained elbow prostheses are subject to cyclic, uneven, excessive loads in the implant-bone interface, which subsequently leads to micromobility, bone resorption, and aseptic loosening of the structure [4]. In cases of combined defects of the bones that form the elbow joint (the humerus, ulna, or radius), elbow arthroplasty may be performed with a general shortening of the upper limb. This leads to improper functioning of the capsular-ligamentous and muscular systems, ultimately resulting in poor function. Restoring full elbow function after gunshot wounds and the consequences of severe trauma is one of the most challenging tasks in modern traumatology and orthopedics due to its anatomical features, complex biomechanics, the rapid development of persistent contractures, ankylosis, and a predisposition to periarticular ossification. Currently, there is no universally accepted method for solving this problem, requiring further research and long-term observation. In the majority of available publications on elbow arthroplasty, authors propose using tubular and/or cancellous allografts to replace the defect in the ulna [5, 6, 7]. A common technique is presented in a patent (RU 2662899 C1), in which a group of authors, during elbow arthroplasty, correct a significant ulna defect using a tubular, cancellous allograft taken from a bone bank, which is fixed to the stem of the ulnar component of the endoprosthesis using cement and additional fixation with a reconstructive plate and monocortical screws (Figure 1). There