FIELD: medicine.
SUBSTANCE: invention relates to medicine, namely to traumatology and orthopedics, and can be used for surgical treatment of improperly fused fracture-dislocations of the palmar edge of the base of the middle phalanx of the three-phalangeal fingers. In the preoperative period, spatial visualization of the affected bone anatomical structures of the fingers and structural features of malunion fracture-dislocations of the palmar edge of the base of the middle phalanx of the patient's three-phalangeal fingers are determined using multilayer spiral computed tomography. The results are saved in DICOM format and transferred to Dolphin Imaging to form DICOM files. The formation of a solid STL 3D model of the phalanx of the injured finger of the patient and the necessary bone autograft is performed with the display of the affected bone anatomical structures and anomalies of the damaged phalanx from a biologically compatible and non-toxic polymer material. Virtual planning of the stages of surgical treatment is performed using the fabricated 3D model of the phalanx of the injured finger and the bone autograft model. In the position of the patient on the back with the hand laid on the side table and with the applied pneumatic cuff, a trapezoidal incision is made in the projection of the proximal interphalangeal joint of the finger and the skin flap is retracted. The canal of the flexor tendons is accessed and dissected in a U-shape with a bend of the canal wall, the tendons of the deep and superficial flexors of the finger are isolated and retracted, the palmar plate is visualized and cut off from the place of attachment to the middle phalanx and from the additional collateral ligaments along the radial and ulnar sides of the finger. Bend proximally, additional collateral ligaments are notched proximally from the place of attachment to the proximal phalanx, the middle phalanx is dislocated to the rear with visualization of the area of damage to the articular surface of the base of the middle phalanx. An oblique osteotomy of the damaged part of the phalanx is performed and the defect of the middle phalanx is measured, using the previously made individual model of the phalanx of the injured finger and the model of the bone autograft, the necessary parameters of the autograft are determined. An additional linear incision of the skin is performed in the projection of the articulation of the IV-V metacarpal bones with the hamate bone of the hand and the capsule of the wrist joint is linearly dissected with visualization of the IV-V carpometacarpal joints. The hamate bone is marked according to the measured dimensions of the middle phalanx defect. A tangential osteotomy of the bases of the IV-V metacarpal bones is performed, an osteotomy of the selected area of the hamate bone is performed with an oscillatory saw. Using a chisel, a fragment is isolated from the wound. The isolated hamate bone autograft is corrected with a rasp to match the parameters of the defect of the middle phalanx with the repetition of the dimensions of the pre-made solid model of the phalanx of the injured finger of the patient. The autograft is fixed to the dorsal edge of the middle phalanx using fixing 1.5 mm screws. The dislocation of the phalanx is reduced and controlled using an electro-optical converter of the position of the phalanges and fixing screws. Layered suture of the wound in the projection of the carpometacarpal joint of fingers IV-V, rubber drainage, suture of the palmar plate with additional collateral ligaments, flap of the flexor tendon canal wall is carried out under the flexor tendons and sutured to its opposite wall. Seam of the skin flap with interrupted sutures, aseptic dressing and fixation of the patient's hand in the back plaster splint in the position of flexion in the metacarpophalangeal joint at an angle of 85 degrees.
EFFECT: method provides accurate reconstruction of the anatomical relationship of the articular surfaces of the phalanges of the proximal interphalangeal joint, complete restoration of the function of the injured finger, and the absence of vascularization disturbance and damage to the articular surfaces of the bones of the hand due to surgical treatment.
2 cl, 3 ex
