METHOD OF MINIMALLY INVASIVE PERCUTANEOUS OSTEOSYNTHESIS OF FRACTURES OF PROXIMAL UNIT OF HUMERUS WITH B LOCKABLE SPOKE CONSTRUCTIONS Russian patent published in 2018 - IPC A61B17/00 

FIELD: medicine.

SUBSTANCE: invention relates to the field of medicine, namely to traumatology and orthopedics, and is intended for use in the treatment of patients with intra-articular fractures of the humerus in conditions of trauma and orthopedic, surgical and other hospitals. Before performing the surgical treatment using standard radiography, as well as multilayer spiral computed tomography with volumetric image reconstruction, the character and localization of fractures of the proximal humerus are determined. Perform surgery in the patient's position on the back with the abduction of the injured upper limb to the side at an angle of 30–45°. Under the control of the electron-optical converter, two punctures of the skin and subcutaneous fat are performed 7–8 cm below the fracture level using 1.8 mm diameter spokes, one on the lateral surface of the shoulder and the second on the anterolateral surface of the shoulder. At the site of punctures, expansion cuts of 0.8–1.0 cm long are made and a defender of soft tissues is installed. Two perforation holes 5–6 mm in diameter in the cortical layer of the proximal fragment of the humerus with their axes displaced relative to each other by 1–2 cm along the height of the bone are performed perpendicular to the axis of the bone along the guide spokes with a cannulated drill, the axis of the perforations have an angle of 30–45° in relation to each other. Then, after removing the guide pins, a closed manual reposition of the fracture is performed by introducing the pre-fixation spokes with a diameter of 1.8 mm through each perforation hole intramedullary proximally with their movement beyond the fracture line. Then, each previously prepared Y-shaped elastically tight fixation spoke with the formation of elastically flattened ends and with a ring-shaped intersection in the form of ring-shaped ears with a diameter of 7–8 mm, passes alternately through each perforation hole and is intramedullary hammered through the proximal fragment of the humerus into its head up to the stop of the annular ear of an elastically tense fixation spoke along a pre-set pre-fixation spoke, with the eye jammed in the perforation hole, each annular eye of an elastically strained fixation spoke is bent to the surface of the cortical layer of the proximal fragment of the humerus, fixed to the surface of the cortical layer of the proximal fragment of the humerus with cortical metal screws with washers in previously made holes with a diameter of 3.2 mm, monitoring of stability of the osteosynthesis is carried out, along with control the amount of movement in the shoulder joint and suture wounds. In this case, cortical metal screws with washers are made of titanium or its alloys, and the guide spokes and tense fixation spokes are made of stainless steel for medical purposes.

EFFECT: method allows to ensure reliable stability of fixation of the proximal fragment, reliable "dynamization" of osteosynthesis as the fracture consolidates to ensure the strength and structural adjustment of the bone, and also provides reliable lateral stability of the operated joint in a fixed position and provides prevention of postoperative contractures and arthrosis of the joint.

1 cl, 3 ex