METHOD FOR ANKLE JOINT ARTHRODESIS WITH APPLICATION OF THREE CANCELLOUS SCREWS Russian patent published in 2017 - IPC A61B17/00 

FIELD: medicine.

SUBSTANCE: ankle is accessed along the medial edge of the anterior tibial muscle tendon, starting 4-5 cm above the joint line and up to 3-4 cm below it. The proximal extensor retainer is Z-intersected, the anterior tibial artery, vein and deep branch of the peroneal nerve together with the tendons of the long extensor of the thumb and the long extensor of the fingers are laterally shifted. The anterior part of the ankle capsule and marginal osteophytes, the cartilage from the articular surfaces of the tibia and the block of the talus of all non-viable bone tissue are removed. Then, a spacer in the form of an elevator is installed, across the joint slit, consistently first in the joint center, and then along the medial and lateral margins. If there is a significant bone defect after surgical treatment of the articular surfaces, or if it is necessary to correct the talus position, bone spongy-cortical autografts, taken from the iliac wing, are installed along the limb axis, and the cavities remaining between the supporting autografts are filled with bone crumbs. The foot is set, so that the angle between the lines drawn along the long axis of the limb and the axis of the talus neck on the lateral projection is approximately 110 degrees. In this position, the ankle joint is fixed with spokes directed transarticularly from the plantar surface of the foot into the diaphysis of the tibia, and the final fixation of the position is carried out using three 6.5 mm cancellous screws with incomplete thread and threaded part length of 16 mm. The first two screws are inserted through the anterior edge of the distal tibia metaepiphysis 3 cm above the articular fissure in the talus block, in parallel, in the front to back direction and downwards. The third screw is inserted through the skin puncture along the posteromedial surface of the lower third of the shin through the posterior medial distal tibial metaepiphysis at a distance of 3 cm from the medial ankle apex in the direction of the talus neck. In the second version, arthrodesis without bone plastic is performed, and in the presence of a stable ankle joint contraction, extending Z-shaped achillotomy is performed.

EFFECT: reliable retention of grafted articular surfaces in a given position with a possibility of free bone plasty of defects, minimal risk of infectious complications, early rehabilitation.

6 cl, 1 dwg