Теоретичні аспекти формування концепції лікування переломів кісток, що утворюють підтаранний суглоб

Abstract

The causes of unfavorable outcomes of treatment of fractures of the bones of the posterior part of the foot have a direct connection with the fundamental moments of the use of therapeutic tactics. The issues of therapeutic tactics and the choice of optimal surgical interventions in the system of treatment of fractures of bones forming a fractured joint remain insufficiently studied and poorly covered in the specialized literature, and their significance is underestimated. The regularities of the formation of factors that worsen the results of treatment of fractures of the talus and calcaneus are not systematized, and measures to prevent them are proposed mainly at the empirical level. The frequency of complications remains relatively high, and the ways to reduce it are not well defined, since they are due to the use of traditional techniques. Insufficiently studied issues of identifying risk factors for the development of adverse outcomes limit the possibilities of timely correction of therapeutic tactics. The wrong choice of treatment tactics explains the errors caused by the insufficient qualifications of medical staff and the development of complications that can lead to an unfavorable outcome of treatment in general. The variety of factors affecting the outcome of treatment also raises questions for the development and implementation of a single pathogenetically based system of preventive measures, which allows taking into account the effect of these factors and their possible mutual influence. The low efficiency of traditional approaches to the treatment of fractures of the bones of the posterior part of the foot emphasizes the expediency of searching for new ways of reposition and stable fixation of the bones forming the subtalar joint in the case of various types of injuries. Taking into account the above, measures to prevent the consequences of rammed damage will be effective only if they are comprehensively developed within a single conceptual model, which consists of two levels: organizational, diagnostic and technological. Each of these levels includes similar mechanisms aimed at eliminating the influence of factors contributing to the negative outcome of treatment. Before planning surgery and choosing the method of osteosynthesis, a systematic analysis of the factors affecting the results should be carried out in accordance with the nature of the fracture. Conclusion. The proposed conceptual model shows a natural objective relationship between the levels, so the solution of emerging problems is actually of direct scientific interest. The levels differ only in the content of the phenomena studied and the mechanisms of influence on the treatment process. Work on the improvement of these levels is at this stage the most realistic and practically significant subject of scientific research in traumatology and orthopedics, which can lead to a significant improvement in the anatomical and functional results of the treatment of foot injuries. The performed analytical study and the proposed conceptual model expand the understanding of the process of preventing adverse consequences and the choice of tactics in the treatment of bone injuries that form the subtalar joint