METHOD OF SURGICAL TREATMENT OF MALUNION FRACTURE OF THE DISTAL METAEPIPHYSIS OF THE RADIUS WITH RUPTURE OF THE NAVICULAR SEMILUNAR LIGAMENT Russian patent published in 2023 - IPC A61B17/56 

FIELD: medicine, traumatology and orthopedics.

SUBSTANCE: invention can be used to treat an improperly healed fracture of the distal metaepiphysis of the radius with a rupture of the navicular semilunar ligament. A linear longitudinal incision of the skin 6–7 cm long is performed with the location of the distal end of the incision at the level of the proximal fold of the wrist and continues in a zigzag manner to the level of the tubercle of the navicular bone. Then, an osteotomy of the distal metaepiphysis is performed, a T-shaped fixing metal plate is placed on the palmar surface of the epiphysis and pressed against the diaphysis of the radius with the distal epiphysis removed from the dorsal inclination. An open reposition of the distal epiphysis is performed and osteosynthesis with a plate is performed. The tendon of the radial flexor of the hand is isolated, one third of the thickness of the bundle of the tendon of the radial flexor of the hand is cut off and peeled off from the main tendon bundle and carried distally to the point of the intended attachment in the scaphoid bone. Access to the carpal joint, to the scaphoid and lunate bones, as well as to the navicular-trapezoid-trapezoid joint is provided. From the radial side in the projection of the navicular bone, Kirschner wires are inserted into the navicular bone, the scaphoid bone is brought into the correct position relative to the lunate bone, and Kirschner wires are passed from the scaphoid bone into the lunate bone. A channel is marked for passing the autograft of the tendon of the radial flexor of the hand, and through the created channel, the free end of the tendon of the radial flexor of the hand is brought out from the palmar surface of the hand to the back surface. The free end of the tendon of the radial flexor of the hand is positioned between two threads of the anchor fixator, the tendon is tied with the threads of the anchor fixator into a knot around the tendon. The free end of the tendon of the radial flexor of the hand is wrapped in the opposite direction from the lunate to the scaphoid and sutured with two knots from the distal and proximal edges of the tendon cross section with cutting off the free portion of the tendon of the radial flexor of the hand. The wires are shortened, immersed subcutaneously along the radial edge of the wrist joint, the square pronator is refixed with interrupted sutures to the radius in the attachment zone, the wounds are sutured with interrupted sutures.

EFFECT: method provides anatomical restoration of the shape and anatomical function of the distal metaepiphysis of the radius with simultaneous restoration of the function of the navicular-lunate ligament in case of its ruptures, stabilization of the navicular-lunate joint in the anatomically and biomechanically correct relative position of the navicular and lunate bones, preservation of the patient's motor activity in the early postoperative period, reduction of surgical aggression and tissue injury, and also provides early social rehabilitation of the patient while improving the quality of his life due to the combination of techniques of the claimed invention.

2 cl, 3 ex