DE102015121123A1 - reduction device - Google Patents

Abstract

The invention relates to a reduction device for treating a forearm fracture comprising a central part with two elements which are interconnected by a spring joint, wherein the two elements each have two or more struts, each having one or more outbreaks and wherein on the top of one of the two Elements is attached to a rope tensioning device and wherein on the other of the two elements at least one hook on the top is present and wherein a rope outside the arm longitudinal axis is guided over hook and rope tensioning device.

Description

The invention relates to a reduction device for the treatment of dislocated forearm fractures.

Forearm fracture is one of the most common injuries, especially in childhood. Falling on the forearm often results in a fracture of the radius and / or ulna. Depending on the age of the patients and thus on the correction potential of the fractured bone and the degree of dislocation, various treatment options are available.

Especially in the distal forearm fracture of the younger child, there are good prospects of recovery in conservative therapy. Operative reduction and Kirschner wire osteosynthesis in general anesthesia can be dispensed with if the degree of dislocation is low. In contrast, severely dislocated, shortened or open fractures need to be timely treated to provide good conditions for fracture healing and good functional outcome.

• – Ruhigstellung des betroffenen Armes im Gips und radiologische Verlaufskontrolle nach einer Woche, um dann abhängig von der aktuellen Stellung der Fraktur über die Fortführung der konservativen Ausheilung zu entscheiden.
• – Unmittelbare sichere Reposition in einer Form der Betäubung/Narkose und Ruhigstellung im Gips mit dem Restrisiko einer Sekundärdislokation.
• – Direkte geplante Osteosynthese in Narkose.

Whether reduction is required depends on the degree of dislocation and the age of the patient, because there may be pure correction growth until growth is complete. In the management of the distal forearm fracture in a radiologically and / or sonographically secured tilting of about 15-20 ° and young age (up to 10 years) have established three different approaches in current practice:

• - Immobilization of the affected arm in plaster and radiological follow-up after one week, and then decide on the continuation of conservative healing depending on the current position of the fracture.
• - Immediate safe reduction in a form of anesthesia / anesthesia and immobilization in plaster with the residual risk of secondary dislocation.
• - Direct planned osteosynthesis under general anesthesia.

Accordingly, there is the risk of overtreatment and, in contrast, there is an overall extended therapy period for purely wait-and-see behavior. This is achieved when, after radiological control, the indication for the operation is made, which is typically followed by an immobilization of the operated limb of four weeks.

During callus formation, the bone is still soft and permanently remodeled at the fractured site.

It would therefore be desirable, in particular in the period of days one to five after the fracture, to achieve a marked improvement in the fracture position by stepwise reduction in targeted minimal movements.

With such an intended improvement in fracture position in such an early and short phase immediately after the fracture, it is extremely important that the correction be done with exactly the right orientation by focusing on the one major axis and not disturbing further therapy.

Forearm fracture is one of the most common injuries, especially in childhood. Falling on the forearm often results in a fracture of the radius and / or ulna. Depending on the age of the patients and thus on the correction potential of the fractured bone and the degree of dislocation, various treatment options are available.

Especially in the distal forearm fracture of the younger child, there are good prospects of recovery in conservative therapy. Operative reduction and Kirschner wire osteosynthesis in general anesthesia can be dispensed with if the degree of dislocation is low. In contrast, severely dislocated, shortened or open fractures need to be timely treated to provide good conditions for fracture healing and good functional outcome.

• – Ruhigstellung des betroffenen Armes im Gips und radiologische Verlaufskontrolle nach einer Woche, um dann abhängig von der aktuellen Stellung der Fraktur über die Fortführung der konservativen Ausheilung zu entscheiden.
• – Unmittelbare sichere Reposition in einer Form der Betäubung/Narkose und Ruhigstellung im Gips mit dem Restrisiko einer Sekundärdislokation.
• – Direkte geplante Osteosynthese in Narkose.

Whether a reduction is necessary depends on the degree of dislocation and the age of the patient because it can lead to pure correction growth until the completion of growth. In the management of the distal forearm fracture in a radiologically and / or sonographically secured tilting of about 15-20 ° and young age (up to 10 years) have established three different approaches in current practice:

• - Immobilization of the affected arm in plaster and radiological follow-up after one week, and then decide on the continuation of conservative healing depending on the current position of the fracture.
• - Immediate safe reduction in a form of anesthesia / anesthesia and immobilization in plaster with the residual risk of secondary dislocation.
• - Direct planned osteosynthesis under general anesthesia.

Accordingly, there is the risk of overtreatment and, in contrast, there is an overall extended therapy period for purely wait-and-see behavior. This comes about when, after radiological control, the indication for surgery is made, to which typically one Immobilization of the operated limb of four weeks adjoins.

During callus formation, the bone is still soft and permanently remodeled at the fractured site.

It would therefore be desirable, in particular in the period of days one to five after the fracture, to achieve a marked improvement in the fracture position by stepwise reduction in targeted minimal movements.

With such an intended improvement in fracture position in such an early and short phase immediately after the fracture, it is extremely important that the correction be done with exactly the right orientation by focusing on the one major axis and not disturbing further therapy.

The DE 10 2008 022 952 A1 describes a non-invasive re-adjustable extension, reduction and retention device for treating inter alia forearm fractures, which aligns a fracture with three rotational and three translational degrees of freedom.

The device is not suitable for improving the fracture position immediately after the fracture and before the subsequent treatment, because of its high complexity and its expenditure on equipment. Another disadvantage of this device is that all fastening steps on hardened gypsum, a solid material with non-predefined outer contours must be performed. This is laborious and can lead to minor errors in alignment, which should be avoided in the period immediately after the fracture and before the subsequent treatment.

It is therefore an object of the invention to provide a reduction device for forearm fractures, which is particularly suitable for improving the fracture position in the first days after the fracture.

Furthermore, it is the object of the invention to provide a reduction device for forearm fractures, which specifically enables the correction of the fracture position in the one essential axis and avoids errors due to too many degrees of freedom of alignment or incorrect positioning relative to the fracture.

In addition, it is an object of the invention to provide a reduction device for forearm fractures, which can be integrated when plastering in the plaster and must not be subsequently installed inside or outside of the plaster.

Furthermore, it is an object of the invention to provide a reduction device for forearm fractures, which is compact and easy to handle and does not interfere with other therapeutic steps by clearly emerging from the gypsum components.

The object of the invention is achieved by a reduction device (by way of example by reference to the figures, in particular indicated) for the treatment of a forearm fracture comprising:
a central part with two elements ( 1A and 1B ), which by a spring joint ( 2 ), wherein the two elements each have two struts ( 4 ) with one or more outbreaks ( 3 ) and being on top of one of the two elements ( 1B ) a rope tensioning device ( 5 ) and being on the other of the two elements ( 1B . 1A ) at least one hook ( 6 ) is mounted on the top and being a rope ( 7 ) outside the arm's longitudinal axis via hooks ( 6 ) and rope tensioning device ( 5 ) to be led.

The reduction aid according to the invention in this case connects in an articulated manner two sections of a plaster cast in an axis which lies in the fracture site. This allows these sections to perform a relative bending movement relative to each other.

A simple mechanism allows a controlled transfer of force to the two connected elements and thus a predefined movement in the fracture area.

The Elements ( 1A and 1B ) are made of a material that has sufficient rigidity and elasticity at the same time. The elements are preferably made of organic polymers, more preferably of thermoplastically produced polymers (thermoplastics). Thermoplastics are among those skilled in the art, among others Standard DIN 7724 , Polymer materials grouping of polymeric materials known due to their mechanical behavior. Particularly preferably, the elements are made of polyamide.

Due to the structural design, a simple production of the central part made of plastic by injection molding is possible. The advantages of this method can be used in the production of large series. The spring joint ( 2 ) is made with the two elements of a material. In the VDI / VDE Guideline 2252, m. 9 "Guides / spring joints" lists both metals (spring steels, spring bronzes) and thermoplastics as possible materials. Here is the use of a thermoplastic makes sense, because thereby the simple and cost-effective production of the spring joint with the two above-mentioned elements in a manufacturing step is possible.

The joint allows the defined movement of the two elements by exactly one axis, which passes through the fracture site, and thus the backlash-free adjustment of the reduction angle.

The aspiration ( 4 ) are made of the same material with the same characteristics as 1, but can be made radiopaque by means of inserts. Thus, the reduction aid can be positioned before the plaster process so that the film hinges force the movement in the fracture axis at the right place.

The Elements ( 1A and 1B ) have at least one outbreak ( 3 ) is preferably provided with more than one eruption. As a result, during the curing of the gypsum, the strength of the connection is increased by additional positive engagement between the gypsum and the elements.

The hooks, which are made of identical material as the elements. redirect the tension cable.

The ones with outbreaks ( 3 ) ( 1A and 1B ), the spring joint ( 2 ), also with outbreak struts ( 4 ), which optionally have radiopaque inserts (eg pins) ( 11 ) and the hook (s) ( 6 ) and the fixture of the clamping device form the central component, which is integrated into the plaster.

Rope tensioning device ( 5 ) and ropes ( 7 ) are well known to those skilled in the art, they form the adjustment mechanism. Rope tensioning device ( 5 ) and ropes ( 7 ) can be purchased for example from the company Boa under the name Boa-closure system. These components of the device according to the invention are attached only after the creation of the gypsum sections, for example by simple snap connections on the central part.

In a preferred embodiment of the reduction device is also on the element ( 1B ), the rope tensioning device ( 5 ), at least one hook ( 6 ) and the rope ( 7 ) will also use this hook ( 6 ) guided. This embodiment has the advantage that by the multiple deflection of the rope ( 7 ) attached to the rope tensioning device ( 5 ) for the purpose of changing the angular position of the spring joint ( 2 ) force is reduced according to the skilled person generally known laws.

This simple pulling mechanism loaded eccentrically and parallel to the arm longitudinal axis, the two by the spring joint ( 2 ) connected portions of the cured gypsum with a defined tensile force and thus generates a predefined rotational movement about the axis lying in the fracture area.

During the plastering of the central component of the reduction device, it is advantageous to insert parts ( 8th ) to protect the contours of Repositionsvorrichtung to use, which should not be plastered with. They are removed after the casting. Particularly suitable here are inserts made of an elastic, deformable, compressible material, which itself does not enter into a firm connection with the gypsum. Particularly suitable materials here are generally known by the term foam, these are generally foamed plastics with a cellular structure and low density. Foams are those skilled in the art, for example from the Standard DIN 7724 , Foam terms and classification known.

In a preferred embodiment, rope ( 7 ), Hooks ( 6 ) and rope tensioning device with a cap ( 9 ), which protects against erroneous operation. Such caps are preferably made of plastic.

In a preferred embodiment of the reduction device according to the invention, above the spring joint ( 2 ) a contour is provided, which allows the display of the bending angle ( 10 ).

For the exact radiological positional control of the reduction device according to the invention relative to the fracture, it is advantageous to apply to the film joints ( 4 ) X-ray opaque parts (eg pins ( 11 ) or to provide the struts with radiopaque fillers. Such radiopaque fillers are known to the expert, inter alia, from DE 20201000032 U1 and the DE 102014003037 A1 ,

• i. Radiologische Kontrolle der Fraktur
• ii. Anlegen des zentralen Bauteils an der Fraktur
• iii. Lagekontrolle und gegebenenfalls Lagekorrektur des zentralen Bauteils der Repositionsvorrichtung
• iv. Optional: Anbringen der Einlegeteile, sofern diese nicht bereits vorher am zentralen Bauteil befestigt wurden
• v. Erstellung der beiden Gips-Abschnitte unter Integration des zentralen Bauteils der Repositionsvorrichtung
• vi. Aushärten der Gips-Abschnitte
• vii. Entfernung der Einlegeteile
• viii. Anbringung des Verstellmechanismus´ bestehend aus Seilzugvorrichtung (5) und Seil (7)
• ix. Betätigung des Verstellmechanismus´ (evtl. unter radiologischer Kontrolle)
• x. Optional: Anbringen und Befestigen der Abdeckkappe (9), z.B. mit einem Klebestreifen

The inventive method for treating a fracture of a forearm comprises the steps:

• i. Radiological control of the fracture
• ii. Applying the central component to the fracture
• iii. Position control and, if appropriate, position correction of the central component of the reduction device
• iv. Optional: Attach the inserts, if they have not been previously attached to the central component
• v. Creation of the two gypsum sections with integration of the central component of the reduction device
• vi. Curing the plaster sections
• vii. Removal of the inserts
• viii. Attachment of the adjustment mechanism consisting of cable pulling device ( 5 ) and rope ( 7 )
• ix. Actuation of the adjustment mechanism (possibly under radiological control)
• x. Optional: attaching and fixing the cap ( 9 ), eg with an adhesive strip

The reduction device contains a central component, which is integrated into the forearm plaster during the initial restoration of the fracture after radiological control of the fracture area (Figs. 2, 3). Struts anchor the central component in the plaster by their structure with bursting out.

During the engagement of the forearm, the central component is integrated. The two elements are by a spring joint ( 2 ), so that their relative position to each other can be adjusted and their relative position to each other (bending angle) by suitable contours ( 10 ) can be displayed.

The spring joint connecting the elements is positioned at the level of the fracture. At each of the two areas are struts ( 4 ) with outbreaks ( 3 ), which ensure the firm connection with the plaster by the plastering. This allows a defined angular adjustment of the two sections.

Inserts ( 8th ) protect the contours of the reduction aid, which should not be plastered over. They are removed after the casting. The articulated connection is made by a spring joint ( 2 ), which can be easily integrated in the construction by injection molding. As a result, all the necessary functions can be combined in one part, which can be placed on the fracture site before casting on and does not hinder the plastering of the fracture.

During plastering, the support member can be handled easily and does not hinder the process. The broken out contour allows a reliable connection of the central component with the plaster. The adjustment mechanism is only attached after the gypsum has hardened. As a result, on the one hand, it is not itself damaged or restricted in its mode of action and, on the other hand, does not hinder the plastering.

The mechanism consists of a rope. The correction of the angular position in the plastered state can therefore very easily with a rope tensioning device ( 5 ), a display can be realized by a simple pointer with a scale.

In order to ensure the flexibility of the reduction aid after the plastering and fasten the adjustment mechanism, certain contours can be covered and protected by inserts that can be easily removed after casting.

After the plastering, the adjustment mechanism can be protected with a cover cap from the erroneous operation by the patient or a third party. To secure the cap, adhesive strips such as e.g. Adhesive plaster can be used.

The presented reduction aid is easy to handle and enables a modern form of gradual reduction without invasive measures, increased radiation exposure or negative effects on the healing process. Radiological posture control is maintained and surgery can continue to be scheduled in the event of missed reduction or non-toleration of the procedure. The reduction aid closes the gap between conservative and minimally invasive traumatology.

Embodiments of the invention may be taken by way of example from the accompanying drawings, which are intended to illustrate the invention and are not intended to be limiting:

Show it:

1 Inventive reduction device;

2 Inventive Reduction Device, CAD Model;

3 Spring joint, detail

4 Functional pattern of the reduction device according to the invention with adjusting mechanism applied to an arm.

LIST OF REFERENCE NUMBERS

1A

Element with at least one hook

1B

Element with rope tensioning device on the top

2

 spring joint

3

 outbreak

4

 strut

5

 Rope tensioner

6

 hook

8th

 insert

9

 cap

10

 Angle display contour

11

 X-ray opaque inserts

QUOTES INCLUDE IN THE DESCRIPTION

This list of the documents listed by the applicant has been generated automatically and is included solely for the better information of the reader. The list is not part of the German patent or utility model application. The DPMA assumes no liability for any errors or omissions.

Cited patent literature

• DE 102008022952 A1 [0016]
• DE 20201000032 U1 [0038]
• DE 102014003037 A1 [0038]

Cited non-patent literature

• Standard DIN 7724 [0025]
• VDI / VDE Guideline 2252, T. 9 [0026]
• Standard DIN 7724 [0035]

Claims (10)

A forearm fracture treatment reduction device comprising: a central part having two elements ( 1A and 1B ), which by a spring joint ( 2 ), the two elements ( 1A and 1B ) each have two or more struts ( 4 ) with one or more outbreaks ( 3 ) and being on top of one of the two elements ( 1A . 1B ) a rope tensioning device ( 5 ) and being on the other of the two elements ( 1B . 1A ) at least one hook ( 6 ) is present on the top and where a rope ( 7 ) outside the arm's longitudinal axis via hooks ( 6 ) and a rope tensioning device ( 5 ) is guided. Reduction device according to claim 1, characterized in that also on the element ( 1B . 1A ), the rope tensioning device ( 5 ), at least one hook ( 6 ) and the rope ( 7 ) also over this hook ( 6 ) to be led. Reduction device according to one of the two preceding claims, characterized in that, during a plastering, inserts ( 8th ) are provided for the protection of the reduction device, which are removed after curing of the plaster again. Reduction device according to one or more of the preceding claims, characterized in that a cap ( 9 ) is provided. Reduction device according to one or more of the preceding claims, characterized in that above the spring joint ( 2 ) Angle display contours ( 10 ) are provided. Reduction device according to one or more of the preceding claims, characterized in that at the connecting film joints radiopaque pens ( 11 ) are provided to identify the bending axis Reduction device according to one or more of the preceding claims, characterized in that radiopaque fillers for identifying the bending axis are included in the connecting film joints Reduction device according to one or more of the preceding claims, characterized in that on the struts ( 4 ) radiopaque pens ( 11 ) are provided. Reduction device according to one or more of the preceding claims, characterized in that the struts ( 4 ) contain radiopaque fillers. A forearm fracture treatment method comprising a forearm fracture treatment reduction device according to any one of the preceding claims comprising the steps of: i. Radiological control of the fracture ii. Applying the central component to the fracture iii. Position control and, if appropriate, position correction of the central component of the reduction device iv. optional installation of the inserts, if they have not been previously attached to the central component v. Creation of the two gypsum sections with integration of the central component of the reduction device vi. Curing the gypsum sections vii. Removal of inserts viii. Attachment of Verstellmechanismusses consisting of cable pulling device ( 5 ) and rope ( 7 ix. Actuation of the adjustment mechanism x. optional attachment and fixing of the cap ( 9 ).

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