METHOD FOR SURGICAL TREATMENT OF PELVIC RING PUBIC BONES FRACTURES BY OSTEOSYNTHESIS WITH FIXING PINS WITH THREAD Russian patent published in 2020 - IPC A61B17/58 A61B6/02 

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to traumatology and orthopedics, and can be used for surgical management of pubic bone fractures. In the preoperative period prior to the surgical management, spatial visualization of involved pelvic bones is determined by multilayer helical computed tomography. Method of magnetic resonance tomography is used to evaluate the condition of surrounding soft tissues, vascular and nerve structures that are not visualized when performing multilayer spiral computed tomography. Bladder catheterisation is performed with Foley catheter to control diuresis and intraoperative monitoring of bladder injury. Patient is placed on an X-ray transparent surgical table to get a full X-ray projection of an entry into the pelvis, an exit from the pelvis, blocking and combined exit-and-block correction with correction of cranial inclination of C-arch taking into account individual value of lumbosacral transition of patient. Based on the results of preliminary localization of pubic tubercle on the side of the injury, access is made to it by skin incision 1 cm long medially 1–2 cm from the pubic tubercle and bluntly splitting the underlying tissues using a Mosquito-type clamp. Performing all subsequent surgical actions under control of image intensifier tube (IIT) throughout the entire surgical intervention. Protective bushing is placed and retrograde inserted through it into the upper branch of pubic bone at the point near the lower edge of the pubic tubercle by fixing the fixing pin with diameter of 2.5 mm and length of 300 mm with a self-tapping threaded tip with length of 20 mm to the moment of intersection of the fracture plane using the cannulated low-speed drill. Using the dynamic IIT control in the X-ray projections, the entry and exit of the pelvis is used to insert the fixing pin into the proximal segment in the direction of the roof of the acetabulum until the end of the penetration point of the fixing pin of the sursil – X-ray display of the roof of the acetabulum – is achieved. It is followed by IIT control of fixation pin position in the blocking and combined outlet-obstructive X-ray projections. Protective bushing is removed and snapped with wire cutters fixing pin with indentation of 10–11 mm from the mouth. Portion of the fixing pin located outside the pubic bone is bent in the distal direction and placed in the plane of the pubic bone body with tight fit of the fixing pin end to the pubic bone. Wound is layer-by-layer wound closure. In 12–14 months after surgical intervention incision of skin and subcutaneous fat 1 cm in projection of postoperative scar is performed based on results of X-ray confirmation of fracture consolidation. Distal end of the fixing pin is extracted with blunt layering of the underlying tissues using a Mosquito-type clamp and the fixing pin is twisted.

EFFECT: method provides reliable fixation of pubic bone fragments, reduced intraoperative radiation load on the operated patient, minimizing blood circulation disorders in the soft tissue area with simultaneous reduction of blood loss, reducing the length of the surgical intervention and rehabilitation of the patient with simultaneous sufficient improvement of the quality of life ensured by the IIT control of the fixation pin position.

1 cl, 3 ex