METHODS OF OSTEOSYNTHESIS OF FEMUR NECK FRACTURES AND DEVICE FOR ITS REALISATION Russian patent published in 2012 - IPC A61B17/88 A61B17/90 

FIELD: medicine.

SUBSTANCE: group of inventions relates to medicine, namely to orthopedics and traumatology and can be used for treatment of femur neck fractures. Device contains supporting aiming element equipped with device for being held in subtrocanteric area of femur and provided with a set of rotating instruments. Supporting aiming element has central guiding wire with thread on the working end, intended for installation of cannulated cancellous screws. Supporting aiming element is made with possibility of being installed above patient's skin in subtrochanteric area of femur along its longitudinal axis and consists of two connected with ball joint plates. In plate located closer to greater trochanter made are central and peripheral thread holes for detachable thread bushes with through channels for installation of, respectively, central and peripheral guiding wires. Device for holding supporting aiming element in subtrochanteric area of femur is made in plate, located farther from greater trochanter in form of longitudinal slot for screwed into bone fixing screw. Head of fixing screw is made elongated and on its end made is threaded portion for locknut, installed under plate with slot, and clamping fly-nut, installed above plate. In the middle of elongated head of fixing screw made is smooth cylindrical portion, whose diameter is larger than diameter of threaded portion. Plate with slot for fixing screw has possibility of back and forth linear travel within slot length and rotation in one or another side relative to fixing screw. Plate with threaded holes for detachable threaded bushes with through channels for installation of guiding wires has possibility to rotate with respect to ball joint and change neck-diaphyseal inclination angle α. Ball joint is provided with cone screw fixer. Method includes making surgical cuts, installation of supporting aiming element, introduction of central guiding wire with thread on working end into femur neck, checking its position in two projections by means of EOC, correcting location of supporting aiming element relative to introduced central guiding wire and bone surface, introduction of peripheral guiding wires with thread on working end into femur neck for installation of cannulated cancellous screws at optimal neck-diaphyseal inclination angle, removal of supporting aiminh element and central guiding wire, installation of cannulated cancellous screws and removal of peripheral guiding wires. During installation of supporting aiming element, which consists of two plates connected with ball joint, it is placed above patient's skin in subtrochantric area of femur along its longitudinal axis, plate with threaded holes for detachable threaded bushes with through channels for installation of guiding wires is located closer to great trochanter, and plate with longitudinal slot for screwed into femur fixing screw is placed farther from great trochanter. In subtrocanteric area of femur point surgical cut is made, fixing screw is screwed into bone. Lock nut is screwed onto threaded portion of elongated head of fixing screw until it rests against cylindrical portion of screw head middle. Plate with slot of supporting aiming element is put on fixing screw above locknut, slightly fixed via washer with clamping fly-nut to locknut with possibility of travel and rotation. After that, location of supporting aiming element is corrected, for which purpose it is curved in ball joint in such a way that element copies patient's skin surface in subtrochanteric area and does not tough it. In the place of introduction of central guiding wire point surgical cut is made. Detachable threaded bush with through channel for central guiding wire is screwed into central threaded hole. After that, supporting aiming element is linearly moved and turned with respect to fixing screw and curved with respect to ball joint in such a way that through hole of detachable threaded bush was on trajectory of central guiding wire introduction into central part of femur neck at optimal neck-diaphyseal inclination angle ά. Position of through channel is fixed for central guiding wire by screwing cone screw fixer on ball joint. After that, central guiding wire is introduced. In places of introduction of peripheral guiding wires point surgical cuts are made. Detachable threaded bushes with parallel through channels for installation of peripheral guiding wires are screwed into peripheral threaded holes of supporting aiming element. Position of supporting aiming element is fixed by screwing fly-nut on fixing screw. Peripheral guiding wires for installation of cannulated cancellous screws are introduced.

EFFECT: inventions ensure optimal direction of peripheral guiding wires with cutting edges on working end, intended for installation of cannulated cancellous screws at specified neck-diaphyseal inclination angle, elimination of vast surgical cut in soft tissues for access to subtrochanteric area and diaphysis of femur, elimination of displacement of introduced into bone guiding wires, make it possible to free surgeon's hands from holding supporting aiming element, provide possibility to take into account patient's anatomical peculiaritiers, in particular, neck-diaphyseal angle, correction of location of supporting aiming element with respect to femur diaphysis by its longitudinal travel and rotation.

5 cl, 10 dwg