Efficient cure of inveterate dislocations and wrist bone fracture

In general damage traumatism variety the brushes put together 24% all of damages of supporting-motive vehicle (Volkova, 1993). Dislocations and fracture dislocations (11% all of wrist bone damages) deserve attention in tie with expressed brush function disorders and cure peculiarities (Ashkenasi, 1990). Complication of anatomic structure of wrist bones jont, good number of unsatisfactory cure results and mistakes, which admit attached to diagnostics, determine a medical and social meaningfulness of select theme.

After period 1995 - 2005 years in clinic microsurgery of brush in Donetsk was on cure 32 of patient with inveterate dislocations and wrist bone fracture dislocations. From them with inveterate interscaphoidal perilunar dislocation 19 of patients (59,3%); with inveterate dislocation of lunate - 7 of patients (21,9%), with inveterate perilunar hand dislocation 5 (15,6%); with inveterate dislocation of polygonal bone -1 (3,1%).

Males put together 27 (84,8%), womenfolks -5(15,2%). Patients age varied from 18 to 65, middle age put together 39. The Traumas production were in 15 patients, domestic - in 5. Trauma because of car were by trauma causes in 8 cases.

Attached to decision of question of nature of efficient interference took into account such factors, as trauma remoteness, patient age, his profession, thomographic picture.

Valuing a thomographic picture attention spared to fracture line of scaphoid bone, to character of her direction, to dimension of central fragment, to destruction and to bone fragmentation, arthrosis to changes around them.

By victim with inveterate dislocation lunate of bone (ILD), inveterate interscaphoidal perilunar dislocation (IISPD) dislocation, inveterate perilunar dislocation (IPLD) dislocation by first stage done superposition distraction of vehicle of external fixing.

Over 2,5-3 weeks by sick with ILD for facilitation of consequent setting by first stage was done an open setting lunate.

By Victim with IPLD is done an open setting lunate bone, transarthicular fixing by needles.

To Patients with IISPD in 4 cases was done wrist arthrodesis.

Ablation proximal of row of wrist bone was done because of neurotrophic disorders, destruction of scaphoid and trihedral bone.

In 10 patients attached to IISPD (27,8%) was laid distraction vehicle of external fixing by date to 2,5 - 3 weeks with consequent open setting and fixing by needles.

The Remote cure results in dates from 1 year to 7 spied in 21 sick (67,4%). By cure results estimation criterion served motions volume in wrist jont, force and brush function, presence of pain syndrome and neurotrophic disorders.

In 17 patients (52,4%) is got a good result, in 4 (13,3%) - satisfactory.

Like so: clinical research properly to take into account motions volume in jont, state neurotrophic of cloths, research of force and brush function. A closed setting in inveterate cases impossible, twostage efficient interference, including a superposition diaphis of vehicle of external fixing on first stage and open setting on second, is less traumatic and technically more simple. Partial or full arthrodesis does attached to expressed pain syndrome, definite thomographic signs (wrist bone fragmentation, arthrosis change). Enucleation or excision does attached to sclerosis osseous cloth, expressed neurotrophic disorders.

Kovalchuk D.U., Trufanov I.M., Pasternak V.V., Kirjakulova T.G., Shakalov U.B.
The Scientific Research Institute of Traumatology and Orthopaedy of M.Gorky Donetsk State Medical University, 
Regional clinical traumatologikal hospital, Donetsk,Ukraine

 

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