FIELD: medicine.
SUBSTANCE: invention relates medicine, namely to traumatology and orthopedics and can be used for minimally invasive combined osteosynthesis of intra-articular fractures of the humerus block distal to the epiepicondyle. Before performing surgical treatment, the nature and localization of intra-articular fractures of the humerus block distal to the epiepicondyle are determined by standard radiography, as well as multilayer spiral computed tomography with volumetric image reconstruction. Surgical treatment is performed when the patient is on his stomach with the removal of the affected arm. Under the control of an electron-optical converter, a closed reposition of the fracture site is performed with the help of percutaneously inserted spokes into the fragments and the subsequent holding of the guide spokes perpendicular to the fracture lines with the channels re-drilled along them, the fracture is fixed by introducing cannulated screws or pins into the channels in the form of implants with their immersion to the subchondral plate with ensuring a complete intraosseous arrangement. In this case, the cannulated screws and pins are made of biodegradable synthetic biopolymers based on polyglycolic acid (PGA) or polylactic acid (PLA), and the surface of the pins is grooved. The Oganesyan articular-distraction apparatus modeled on it is applied to the elbow joint and along the axis of movement of the elbow joint in the frontal plane, through the fixing fittings of the articular-distraction apparatus, the spokes are passed through the epicondyle of the humerus along the axis of movement of the elbow joint, through the middle third of the humerus, as well as through the upper third and middle third of the ulna. Spokes in the fixing devices of the hinge-distraction device are fixed; pulling and removing their ends are performed. The articular-distraction apparatus is fixed with a posterior barbell with moderate distraction of the elbow joint in the mid-physiological position, ensuring the creation of an enlarged joint gap. Active development of movements in the elbow joint in the conditions of the articular-distraction apparatus begins from the third day from the moment of surgery, dismantling of the articular-distraction apparatus after 4-9 weeks.
EFFECT: said method provides possibility of starting early active development of movements in the operated joint with minimizing the risk of secondary displacement of fragments, reliable control of the position of the articular surfaces of the ulnar process, lateral stability of the operated joint in a fixed position, prevention of postoperative contractures and arthrosis of the joint, as well as reducing the period of hospitalization of the patient due to low invasiveness, effective use of the Oganesyan hinge-distraction device, as well as cannulated screws and pins made of biodegradable synthetic biopolymers.
1 cl, 3 ex
