SURGICAL ACCESS TO THE LATERAL CURVE OF THE LARGE-CURVED BONE FASSIOPLASTIC WITH OSTEOTOMY OF ZHERDI TUBERCULE Russian patent published in 2018 - IPC A61B17/00 

FIELD: medicine.

SUBSTANCE: invention relates to the field of medicine, namely to surgery, in particular to traumatology and orthopedics, and is intended for use in the treatment of fractures in the region of the lateral condyle of the tibia. In surgical access, an incision is made on the lateral surface of the knee joint area from the lateral epicondyle of the femur distally towards the tuberosity of the tibia, not reaching the last 2 cm. Next, the cutaneous subcutaneous flap is pulled out sharply, which is retracted posteriorly, fascia and the fascia of Zherdi, which extends through the fascia. Further, an L-shaped incision of the intrinsic fascia is made, which begins 3 cm proximal to the joint gap from the level of the lateral collateral ligament. Incision is conducted parallel to the joint slit to the patellar ligament, after which it is rotated perpendicular and leads in the distal direction to the level of tuberosity of the tibia. Produced fascial flap is exfoliated in an acute way from the underlying joint capsule, then performing an osteotomy of the Zherdi hillock, which greatly facilitates the separation of the flap. Formed flap is removed in the dorsal direction. Conducting a substitutive arthrotomy of the knee joint, performing a fracture reposition and osteoplasty. Final fixation is carried out by the support plate. After osteosynthesis of the fracture in its correct position, the continuity of the fascial-ligamentous apparatus of the knee joint is restored by applying a single encircling continuous stitch to the fascial flap first in the proximal part (to prevent tissue deficit), then in the distal, an active drainage is installed under the fascia. Skin-subcutaneous flap is sutured with separate nodular sutures.

EFFECT: method makes it possible to improve the conditions for surgery on the knee joint, to create a sufficiently spacious and safe access to the external condyle of the knee joint, which makes it possible to cover the metal fixator with a deep fascia of the shin, while not breaking the fascial-ligamentous apparatus of the knee joint in its lateral section.

1 cl, 13 dwg, 1 ex