METHOD FOR ONE-STAGE ELONGATION OF A METATARSAL BONE IN BRACHYMETATARSIA USING AN AUTOGRAFT

摘要

FIELD: medicine.;SUBSTANCE: invention refers to medicine, namely to orthopedics, and can be used in treating deformation of locomotor system and structures providing strong fixation of bones. Dorsal approach is performed longitudinally above 4th metatarsophalangeal joint in the proximal direction to the level of the prospective osteotomy. Metatarsophalangeal joint is opened, metaepiphysis and diaphysis of metatarsal bone are recovered in place of osteotomy. Performing the transverse osteotomy, the saw blade is exposed parallel to the frontal plane of 4th metatarsal bone at distance of 1.5 cm from the articular cartilage line of the metatarsophalangeal joint from the rear to the sole of the foot, wherein the saw blade is placed at angle of 90 degrees to the horizontal plane of the metatarsal bone. Stage of transplant sampling from 5th metatarsal bone is performed. External surface along 5th metatarsophalangeal joint is projected in a projection of a prospective osteotomy, a metatarsophalangeal joint is opened. First osteotomy is performed at 1 cm from the boundary of the articular cartilage proximally; the saw blade is oriented perpendicular to the metatarsal bone from the outside to the inside; a line parallel to the metatarsal bone is applied, and it is retreated proximally to the distance required for the transplant. Second osteotomy parallel to the first one is performed so that a transplant of cylindrical shape is obtained, the obtained graft is placed into physiologic saline. Head of 5th metatarsal bone is aligned with diaphysis of 5th metatarsal bone, temporary fixation of osteotomy of 5 metatarsal bone by K-wire is performed, wire is passed through proximal fragment, point of needle input is located on external side of metatarsal bone, wire is oriented into medullary canal to distal end of head of metatarsal bone, cortical layer is reamed by cannulated drill to chondral layer of head of metatarsal bone. Fragments are recorded by conducting a cannulated self-drilling compression screw that is inserted through a previously installed wire. Obtained transplant is placed in the area of osteotomy of 4th metatarsal bone, wherein head of 4th metatarsal bone is displaced until concentricity of the proximal and distal fragments of the osteotomy and transplant is restored. Osteotomy is temporarily fixed by means of a K-wire. Wire is passed through head of 4th metatarsal bone by orienting the pin in the direction of the medullary canal; the entry point is in the central part of the cartilage of head of 4th instep bone. Further, a cannulated drill is reamed on a wire through a chondral layer of the metatarsal bone head towards the medullary canal, is reamed up to 2-3 cm in a proximal fragment, after fixing head of metatarsal bone with graft to its diaphysis with cannulated self-drilling compression screw, which is carried out on previously installed K-wire. Tendon of the long extensor of 4th finger is separated; a Z-shaped elongation of the tendon is performed with a scalpel according to the distance corresponding to the distance substituted with the transplant; the ends of the tendon are sutured together by nodular bioredicated sutures. Transarticular fixation of 4th finger is carried out with a K-wire, for this purpose a pin is inserted into the fingertip through a distal phalanx in the direction of the head of the metatarsal bone, further, by bringing the tip of the wire into the projection of the metatarsophalangeal joint, the pin is aligned with the canal in the screw fixing the osteotomy, and the pin is guided through the cannulated screw channel along the medullary canal into the proximal third of 4th instep bone.;EFFECT: method provides stable fixation and effective restoration of structures by excluding external fixation and using the autograft.;1 cl, 1 ex