Fixation Of Bone Fragments Research Articles

Osteosynthesis devices in absorbable Magnesium alloy in comparison to standard ones: a Systematic Review on effectiveness and safety.

Background and aim of the work:Magnesium (Mg) is a metal physiologically present in bone tissue and essential for bone health. Mg-based alloys exhibit mechanical properties, namely density and strength, similar to human cortical bone. These features have been exploited for the development of osteosynthesis devices in biodegradable Mg-based alloys. Accordingly, the aim of this study is to rank the effectiveness and safety of Mg-based alloys applied in bone surgery in comparison to other suitable metals, focusing in particular on Mg superior biocompatibility and biodegradability.Methods:a systematic review of the literature was conducted including only primary research studies dealing with patients suffering from fractured or osteotomized bones fixed using Mg-based osteosynthesis devices.Results:literature revision suggested Mg-alloys holding comparable properties and side effects in comparison with titanium (Ti) screws, thus showing similar efficacy and safety. Particularly, the gas formation in the carpal bones was identified as the main side effect of the Mg-alloys, during the corrosion/degradation phase of Mg.Conclusions:according to the literature, the main advantages exploiting Mg-alloys for bone implants are related to their biocompatibility, bio-absorbability/-degradability, the lack of surgical removal, osteoconductivity and antibacterial activity. On the opposite, the main limitation of Mg-alloys is due to the poor mechanical resistance of small devices that lack of sufficient strength to withstand high forces. Therefore, an important future prospect could rely in the development of innovative hybrid systems aimed at fixing high load-bearing fractures, as well as in regenerative medicine by developing new Mg-based engineered scaffolds. (www.actabiomedica.it)

Replacement of Mandible Defect by a Rib Autotransplant

Aims. Improve the technique of bone plastics of the mandible with a free autogenous rib graft.Materials and methods. A retrospective analysis of 41 case histories of patients undergoing surgical treatment in connection with the replacement of the mandibular defectsacquired due to tumors, injuries, osteomyelitis at the clinic of maxillofacial surgery in 2003-2018 was carried out.
 The technique of osteoplasty of the mandible with free autogenous rib graft has been improved by expanding the technical possibility of reliable fixation of bone fragments with titanium plates and screws, as well as tight installation of autograft in the bone defect and creating favorable conditions for the primary osseointegration.
 The own method of harvesting and formation of autogenous rib graft is proposed. For 15 years, not a single complication was identified and there was no rejection of the free autogenous rib grafts.Conclusions. This technique is simple, safe, and can be effectively used to reconstruct long-span mandibular defects with minimal complications in selected patients.
 

The Influence of Severe Plastic Deformation on Microstructure and In Vitro Biocompatibility of the New Ti-Nb-Zr-Ta-Fe-O Alloy Composition.

In this work, severe plastic deformation (SPD) of the newly designed Ti-Nb-Zr-Ta-Fe-O GUM metal was successfully conducted at room temperature using high speed high pressure torsion (HSHPT) followed by cold rolling (CR) to exploit the suitability of the processed alloy for bone staples. The Ti-31.5Nb-3.1Zr-3.1Ta-0.9Fe-0.16O GUM alloy was fabricated in a levitation melting furnace using a cold crucible and argon protective atmosphere. The as-cast specimens were subjected to SPD, specifically HSHPT, and then processed by the CR method to take the advantages of both grain refinement and larger dimensions. This approach creates the opportunity to obtain temporary orthopedic implants nanostructured by SPD. The changes induced by HSHPT technology from the coarse dendrite directly into the ultrafine grained structure were examined by optical microscopy, scanning electron microscopy and X-ray diffraction. The structural investigations showed that by increasing the deformation, a high density of grain boundaries is accumulated, leading gradually to fine grain size. In addition, the in vitro biocompatibility studies were conducted in parallel on the GUM alloy specimens in the as-cast state, and after HSHPT- and HSHPT+CR- processing. For comparative purposes, in vitro behavior of the bone-derived MC3T3-E1 cells on the commercially pure titanium has also been investigated regarding the viability and proliferation, morphology and osteogenic differentiation. The results obtained support the appropriateness of the HSHPT technology for developing compression staples able to ensure a better fixation of bone fragments.

Osteogenesis and Histostructure of Femoral Muscles When Modeling a Femoral Fracture with Immediate or Delayed Osteosynthesis Using an Interlocking Intramedullary Antegrade Rod

Interlocked intramedullary osteosynthesis is the most common method for treating femoral shaft fractures. The aim — to reveal specifi c characteristics of the histostructure of canine femoral muscles when healing femoral fractures under osteosynthesis using interlocking intramedullary reinforcement with an antegrade metal rod. Femoral shaft fractures were modelled in 9 mongrel dogs. The fractures were fi xed with an intramedullary rod. In Group I (n=4), osteosynthesis was started immediately after bone injury. In Group II (n=5), osteosynthesis was started 4 days after fracture (delayed osteosynthesis). M. biceps femoris and M. quadriceps femoris were studied. In Group I and Group II, bone healing occurred following 42 and 70 days, respectively. A unifi ed bone marrow cavity and cortical layer had been formed by day 70 and day 100 in Group I and Group II, respectively. The histostructure of M. quadriceps femoris in Group I remained largely unchanged throughout the experiment, while M. biceps femoris underwent the process of structural reorganization on days 42 and 70 of the experiment. The Group of delayed osteosynthesis demonstrated changes in the histostructure of both muscles, including an increased diversity of fi bre diameters, an increased number of nuclei in myocytes, fi brosis of the interstitial space and perimysial arterial vessels. These changes were more pronounced in M. biceps femoris. Three months after injury, the histostructure of the muscles under study, even in the Group of delayed osteosynthesis, had no signifi cant differences and tended to the intact norm. In femoral fractures, the earliest possible fi xation of bone fragments with an inter locking antegrade intramedullary rod is recommended. A complete bone healing in such cases occurs a month earlier than in those with delayed osteosynthesis. The femoral muscles of the anterior group are injured to a lesser extent than those of the posterior group.

Mandibular reconstruction with free non-vascularized rib autograft

Purpose of the study. To increase the effectiveness of rehabilitation of patients with acquired bone defects of the mandible with the help of rib free non-vascularized autografts.
 Materials and methods. In the maxillofacial department of Municipal non-profit enterprise
 «City Clinical Hospital for Emergency and Medical Care, Zaporizhyzhya» Council 41 patients were treated, who underwent surgical treatment to replace the acquired bone defects of the mandible with rib free autografts on the basis of the clinic of maxillofacial surgery of the State Institution SE «Zaporizhzhya Medical Academy of Postgraduate Education of the Ministry of Health of Ukraine» 2015–2019. Most patients were of working age: from 21 to 60 years. In general, the age composition of patients was almost identical, which allowed us to assume that all studies were conducted under the same conditions and in a standard sample. Depending on etiology, surgery – replacement of mandibular defects, performed simultaneously or across a long time period.
 Results. Improved technique of mandibular bone grafting by free rib autograft due to the expansion of the technical possibility to reliably fix bone fragments with titanium plates and screws, as well as tight installation of the autograft in the bone defect and create, consequently, favorable conditions for a pseudo-temporal-mandibular joint formation. The own technique of preparation and formation of a costal autograft is offered. For 15 years, no complications were detected and no rejection of freely transplanted costal autografts was observed.
 Conclusions. The use of reliable fixation of bone fragments ensures the formation of callus and prevents autograft rejection. The proposed method of preparation of a costal autograft with a fragment of cartilage, allows to achieve reliably forming a pseudo-temporal-mandibular joint.

Miniplate osteosynthesis in fracture surgeries: Case series with review of concepts

PurposeMiniplates were initially developed as targets for foot and hand fractures, but they have been used in the treatment of fixation of small bone fragments, reduction of long bone fractures and non-union treatment, which have been difficult to treat. In this study, the authors used miniplates to treat fractures of the upper extremities, lower extremities, and pelvis obtained good outcomes. Herein, the authors report these good outcomes and review the current concept of miniplates. Patients and methodsForty-two patients treated with miniplates between March 2012 and March 2017 who attended follow-up for > 1 year were included in this retrospective study. Miniplates were selected according to purpose, which was classified into three categories: fixation, reduction, and stability enhancement. For fixation, miniplates were used to fix distal fibular fractures occurring distal to the syndesmosis and treat patellar and olecranon fractures with severe comminution. For reduction, miniplates were used to reduce the tibia during intramedullary nailing in tibiofibular shaft fractures, while reduction was performed in advance of definitive plating fixation in patients with humeral and pelvic fractures. To enhance stability, the miniplate was inserted after autobone graft for atrophic nonunion at the humeral shaft following nail insertion. The validity of a miniplate was analyzed by reviewing the published literature on the use of miniplates in orthopedic fracture surgeries. ResultsBony union was achieved in all cases. No specific postoperative complications were observed; however, mild pain and limited range of motion observed in two patients were resolved after implant removal. Sixteen studies on fracture treatment using miniplates reported clinically fair outcomes. ConclusionMiniplates are not just small metal plates. Depending on the location and treatment of the fracture, the miniplate can effectively fix small bone fragments, help the main plate to maintain the reduction of large bone fragments, and increase the fixation force for nonunion treatment.

Comparison of a novel adhesive system and plate and screw for facial fracture osteosynthesis

Background: in oral and maxillofacial fractures, plates and screws routinely fix fragments until the completion of healing process, which has its own complications in some critical fractures. To overcome this drawbacks bone adhesives are developed for the immobilization of fractured bones. Objective: In this in-vitro study we compared the bond strength obtained by immobilization of the bone fragments using plates and screw and new adhesive containing BTDMA monomer. Materials and methods: In this experimental in-vitro trial, bone fractures were simulated in bovine’s mandibular bone using an electrical saw. The bone fragments were randomly allocated in different groups and were immobilized with either plate and screws and adhesive containing 0,10, 15% BTDMA. After 24 hours tensile bond strength was calculated using universal testing machine. One-way ANOVA and Tukey post hoe test were used for statistical analysis. Results: Mean (± standard deviation) of tensile bond strength of bone fixation using adhesive containing 15% (W/W) BTDMA monomer were 176.0 (±18.89) N. These values were 149.1 (±23.88) N for adhesive containing 10% BTDMA; 102(±17.99) N for the base adhesive and 278.9 (±24.12) N for the screw and plate technique. Significant differences were found regarding bond strength of bone fixation in 4 groups using bone adhesives or plate technique (P<0.001). The highest bond strength was recorded for the plate group and the least was related to the base adhesive. Significant differences existed between all bone adhesives as declared by paired comparison (p<0.05). Conclusion: Despite the lower bond strength in adhesive groups in comparison with screw and plate, with regards to possible complications of screw and plate technique, it seems bone adhesives containing BTDMA monomer can be used for bone fragment fixation. However, bond strength is just one of the numerous properties that an adhesive should have and more studies must be done on these kinds of adhesives.

Age Features of Periostal Callus Formation in Patients with Closed Fractures Bones of the Shoulder and of the Tibia

Treatment of patients with fractures of the bones of the leg in an outpatient setting occurs under conditions of a forced increase in the axial load on the injured lower limb. The aim of the study was to determine the conditions for the formation of periosteal callus of the shoulder and lower leg and to assess the effect on its formation of the time frame for fixation of bone fragments in people of different ages under the conditions of treatment in the outpatient setting.

Surgical treatment of congenital pseudoarthrosis of the clavicle in children

Introduction. In the literature the issue of indications for surgical treatment of CPC (congenital pseudoarthrosis of the clavicle) is exposed to discussion. Also, there are no accurate age indications for surgery. The conducted research has shown that the course of CPC is accompanied by clavicle shortening as well as by bone fragments deformation in 60% of the cases, which has a significant effect on the planning of surgery.
 Purpose of study: to develop a differentiated approach to the treatment of congenital pseudoarthrosis of the clavicle in children, taking into account the clinical and radiological picture.
 Patients and methods. 27 patients with the congenital pseudoarthrosis of the clavicle (CPC) aged from 4 up to 16 years old were operated. In 6 observations bone fragments deformation of the clavicle was absent, and in 21 observations various deformations occurred. The surgery included restoration of clavicle axis, replacement of bone tissue defect with bone autograft, fixation of bone fragments with a needle.
 Results. After the first surgery, bone fragments consolidation of the false joint was reached in 82% of the cases (22 patients); the recurrence of the false joint was observed in 18% (5 patients). Repeated surgeries were successfully performed on four of them; one patient is being observed on an outpatient basis.
 Conclusion. The results of the surgical treatment have shown that for the union of a false joint it is necessary to use differentiated approach to the adoption of surgical technique with regard to bone fragments deformation. Partially eliminated deformation and clavicle sternal bone fragment high standing served as the main reason for the recurrence of pseudoarthrosis.

The importance of the quality of power supply of treating fractures of the bones of the leg according to the ilizarov method

Annotation: The aim of the work was to analyze the impact of the deterioration in the quality of nutrition of the population during the economic crisis that occurred after 1990 on the treatment of bone fractures. The technique: In the period from 1970 to 2008, the impact of the deterioration in the nutrition quality of the population in particular of the Kurgan Region of Russia, expressed in preserving the caloric component due to an increase in the consumption of vegetables and bread and a decrease in the consumption of meat products by more than 35%, was analyzed. bone fragments in Ilizarov treatment in 1923 patients with closed diaphyseal fractures of the bones of the leg. Results: The increase in the periods of fixation of bone fragments began in 1976 among a group of socially most vulnerable patients of retirement age, then among people over 50, among students, and after 1986 it became apparent in groups of patients of working age and reached by 2000 38% with helical and 111% (p≤0,001) for comminuted fractures. Keywords: Fractures of shin bones, Ilizarov method, patient age, meat consumption

Treatment of neglected, severely displaced, open malunion of the distal radius and ulna in an elderly person with Alzheimer’s disease – a case report

The case of a patient suffering from Alzheimer's disease who sustained epiphyseal, severely dislocated fractures of the distal radius and ulna is reported. As the patient was incapacitated and attempts to contact her curator failed, the decision was made on a conservative treatment of the fractures. This treatment eventually failed and resulted in malunion with exposure of bone fragments above the skin. After obtaining informed consent from her curator, a corrective osteotomy was performed using an original method, followed by fixation of bone fragments in almost anatomical position by intramedullary K wires. At a 6-month follow-up, the patient was using her hand in daily life and did not complain of any pain. An X-ray showed consolidation of the bones in the distal forearm in an acceptable position.

Femoral Diaphyseal Fractures Fixation Technique Using an Adjustable Nylon Tie in Dog (Canis lupus familiaris) and Cat (Felis catus domesticus)

Background: Adjustable nylon ties polyamide 6.6 is devices produced from the same material of surgical nylon wire and have been used in different surgical procedures in small animals and in human patient. Reports regarding the use of these devices as secondary fixation technique of femoral diaphyseal fractures in animals are rare in the literature. The aim of the present report case was to describe the use of adjustable nylon tie polyamide 6.6 as secondary fixation technique in a 3-year-old dog and 4-month-old cat, diagnosed with femoral diaphyseal fractures.Cases: Case 1. A 3-year-old female dog was presented with reluctance to support the left hind limb, with 5 days’ duration. Pain and edema on the left femoral diaphyseal region was identified. The limb was submitted to radiographic exam and revealed a closed, complete and comminuted fracture of the diaphysis of the femur, and was decided to perform a surgical stabilization by open reduction through primary fixation with intramedullary pin, and secondary fixation of bone fragments with adjustable nylon ties polyamide 6.6, as a substitute of steel cerclage wire. The bone fragments were alignment and fixated with five polyamide nylon ties. The excess was removed with a scalpel blade along the lock. Seven days after surgery the skin sutures were removed and were observed reluctance to support the left hind limb. Physiotherapy sessionswere prescribed. Forty days after the surgery was performed a radiographic exam of the left hind limb which revealed alignment of the bone axis. Six months after the surgery, the owner reported that the dog supported the left hind limb.Case 2. A 4-month-old female cat was presented with history of trauma, with 24 h’s duration, and reluctance in supporting the left hind limb. On physical examination there was identified pain on the left femoral diaphyseal region. Radiographic examination revealed a closed, complete and simple fracture of the diaphysis of the femur, and a surgical stabilization through primary fixation with intramedullary pin, and secondary fixation with three polyamide nylon ties was performed.Seven days after the surgery were observed reluctance to support the left hind limb. Three months after the surgery, the owner was contacted and he reported that the cat was supported the limb.Discussion: Adult dogs are more susceptible to diaphyseal fractures and so does the dog in the present report. On the other hand, young cats present high metaphyseal fracture rates due to the metaphyseal growth plate. However, the cat in the present report was different since it was 4-month-old and presented diaphyseal fracture. Different from steel cerclagewires, polyamide nylon ties were used as secondary fixation in diaphyseal fractures for the reason that of their stability in this kind of fracture, no tissue reaction and minimal tissue trauma. The adjustable nylon ties polyamide 6.6 were already used in different surgical procedures in human patients and animals. Complications reported in the literature due to theiruse were associated with erroneous surgical techniques. Adjustable nylon ties polyamide 6.6 proved to be efficient as bone cerclage device in diaphyseal multiple and simple fracture, as well as gave stability to the herein assessed adult dog and young cat, besides not inducing foreign body reactions.Keywords: small animals, polyamide, bones, cerclage, surgery.

The importance of quality protein food in the treatment of fractures of tibia.

The aim of the study is to analyze the reasons for the significant increase in terms of fixation of bone fragments when transferring patients to outpatient treatment. In 512 patients with closed fractures of the bones of the lower leg during Ilizarov's treatment under stationary conditions, the period of fixation of fragments was 59 ± 0.4 days, which is 42% less than in outpatient treatment (64 people). In both groups, the microscopic mobility of bone fragments was determined tensometrically in patients with limb functional loading. With the help of the SF-36 test, the quality of life was examined, and the state of autoregulation of the centers of the brain was assessed in terms of the range of changes in the rate of blood flow along the middle cerebral arteries in cases of muscle grasping. Discovered that the combination of medical and functional rehabilitation during the transition to outpatient mode with 3-weeks of treatment in patients of mature age reduced quality of life and increases the duration of the period of fixation of the bone, impairs auto-regulation of cerebral blood flow in functional muscle test.

Dependence of the Sizes of Periostal Corn from Treatment Mode, Age of Patients and Axial Load on the Limbs

It was established that the periosteal callus appears regularly after the transfer of patients to the outpatient treatment mode, its dimensions depend on the stiffness of fixation of the fragments (micromotion more than 70 μm per 10 kg of load), the duration of the fixation period and the age of the patients. The appearance of periosteal callus is a manifestation of the compensatory response of the body, contributing to the additional fixation of bone fragments and the stabilization of the age-related increase in the duration of the treatment period after 45 years. As the age of the corns of the humerus increases, the duration of the fixation period decreases. The purpose of the study was to find out what caused the appearance of periosteal corn and an increase in the length of treatment according to Ilizarov for patients with fractures of limbs when they are transferred to an outpatient regimen. Analyzed data from the study of the duration of the fixation period, micromotion of bone fragments during loading of the limb and the size of the periosteal corn in adult patients with closed fractures of the tibia during the Ilizarov treatment in the hospital and clinic (respectively 99 and 37 people), as well as in patients with diaphyseal fractures shoulder (38 people). It was established that the periosteal callus appears regularly after the transfer of patients to the outpatient treatment mode, its dimensions depend on the stiffness of fixation of the fragments (micromotion more than 70 μm per 10 kg of load), the duration of the fixation period and the age of the patients. The appearance of periosteal callus is a manifestation of the compensatory response of the body, contributing to the additional fixation of bone fragments and the stabilization of the age-related increase in the duration of the treatment period after 45 years. As the age of the corns of the humerus increases, the duration of the fixation period decreases.

The Versatile Hook Plate in Avulsion Fractures of the Hand.

In a retrospective review of our use of hook plates in hand fractures from 2008 to 2014, a total of 63 cases were identified from the hospital data base. There were 35 cases of Mallet fractures, 16 cases of proximal interphalangeal joint fracture dislocations, 5 cases of flexor digitorum profundus avulsion fractures, 5 cases of Central slip avulsions, and 2 collateral ligament avulsions. All fractures healed well with this technique with no biomechanical failures and good functional outcome. Plates needed removal in a total of 25 cases, of which 14 were in mallet fractures. Thirteen (21%) cases suffered complications, of which the majority were again related to mallet fractures. The hook plate is a simple device that can be created quite easily with readily available materials. We have extended the use of these plates to avulsion fracture fixation in the hand and found this to be a versatile technique. The risk of fragmenting the small fracture fragment is reduced because the hooks secure it and the plate is fixed in the bone. If done meticulously, joint congruence can be achieved. It has a biomechanical advantage over current methods of fracture fixation of small but important bone fragments in the hand.

A Brief History of Limb Lengthening.

In the last 35 years, orthopaedic surgeons have witnessed 3 major advances in the technique of limb lengthening: "distraction osteogenesis" facilitated by Gavriil Ilizarov method and infinitely-adaptable circular fixator with fine-wire bone fragment fixation; the introduction of the "6-strut" computer program-assisted circular fixators to effect complex deformity correction simultaneously; and the development of motorized intramedullary lengthening nails. However, the principles and associated complications of these techniques are on the basis of observations by Codivilla, Putti, and Abbott from as much as 110 years ago. This review notes the contribution of these pioneers in limb lengthening, and the contribution of Thor Heyerdahl principles of tolerance and diversity to the dissemination of Ilizarov principles to the Western world.

Nonunion of greater trochanter following total hip arthroplasty: Treated by an articulated hook plate and bone grafting.

Background:Trochanteric osteotomy still has an important role in hip arthroplasty in cases of (1) preexisting developmental hip dysplasia with superior subluxation, (2) revision arthroplasty, specifically with acetabular component revision in the face of well-fixed femoral component, and (3) recurrent dislocation without component loosening or malalignment, in treatment of complicated trochanteric fixation in osteoporotic bone and nonunions may be difficult. This study reports the clinical outcomes of trochanteric fixation following total hip arthroplasty (THA) utilizing a hook plate construct in a cohort of ten patients.Materials and Methods:The Arbeitsgemeinschaft für Osteosynthesefragen (AO) articulated hook plate was used in nine cases of established approach related nonunion following THA and in one case of osteopenic bone during primary THA. All ten patients returned for interviews and clinical examination. The average time for clinical followup was 35 months (range 5–48 months). The mean age of the study cohort was 65 years (range 56–74 years). Time to union and incidence of postoperative complications were assessed.Results:Union occurred in all ten cases at an average of 3.3 months postoperatively. One patient developed symptomatic trochanteric bursitis and required plate removal. Another patient developed a superficial infection which was successfully treated with local wound debridement and antibiotics. A third patient developed a symptomatic neuroma at the site of the iliac crest bone harvest and was successfully treated with excision of the neuroma. No catastrophic implant failures occurred.Conclusions:The articulated design of the plate allows for ease in application and functional construct stability. The articulated hook plate is an option for fixation of osteopenic bone fragments and established nonunions of the greater trochanter.

Diaphyseal fractures of the humerus. How to treat conservatively and when needed surgery?

According to the Kharkiv interdistrict MSEK (2012) using of in­ternal osteosynthesis results into high incidence of nonunion of the humeral fractures — 24 % 4 months after plating. Purpose: to justify treatment guidelines of diaphysial humeral fractures using 30-years scientific and practical experience for presenting an improved method of treatment and to present achieved re­sults. Methods: To evaluate the results of treatment in 73 patients with humeral fractures treated from 2006 to 2014. Functional conservative treatment with orthosis — 39 people, external fixa­tion device (EFD) — 16 (13 after closed reduction, open 3). In 18 patients applied internal osteosynthesis. Clinical material is analyzed since 1984 (104 cases).Results: main features that in­fluence the choice of treatment method such as the displacement of the bone fragments in the initial radiograph, fracture level, other damage, limiting the mobility of the injured, the condition of the radial nerve are distinguished and characterized. Details of functional treatment of fractures of the humerus with the cast and pin EFD are presented. Conclusion: in a case monolocal diaphyseal fractures of the humerus one should choose a con­servative functional treatment method — the safest in case of complications, providing fusion of fragments in a short time, well-tolerated by patients and requiring low material costs. For a fixed displacement of fragments greater than the diameter of the bone, and associated lesions, excluding or significantly limiting the vertical position of the patient, it is advisable to use EFD. Open reduction is required for the displacement of bone fragments in the full width, irremovable hanging shoulder posi­tion within 2–5 days. Revision of the radial nerve is indicated with considerable fixation and displacement of bone fragments.

АНАЛИЗ ОСНОВНЫХ ПРИЧИН НЕСРАЩЕНИЙ И СПОСОБОВ ОСТЕОСИНТЕЗА ПЕРЕЛОМОВ ШЕЙКИ БЕДРА

Число несращений и других осложнений при остеосинтезе переломов шейки бедра по-прежнему остается на высоком уровне и достигает 10-30% от общего числа оперативных вмешательств. Снижение числа осложнений, в первую очередь несращений отломков, является актуальной проблемой, что стимулирует исследования по данной тематике. Целью настоящей работы является критический анализ научной информации о причинах несращений и клинического опыта применения различных способов остеосинтеза как основы создания биомеханических моделей, необходимых для совершенствования методики хирургического лечения переломов шейки бедра. В представленном обзоре рассматриваются публикации за полувековой период (1965-2015-е годы). В большинстве работ этого периода исследуется остеосинтез резьбовыми фиксаторами с диафизарными накладными пластинами и без них, который обеспечивает различную жесткость системы «фиксатор-кость». Существуют различные мнения о причинах несращений. Среди них наиболее обоснованными являются: 1) недостаточное кровоснабжение отломков при идеальной или близкой к ней репозиции; 2) нестабильность фиксации отломков, возникающая вследствие перенапряжения и резорбции кости под витками резьбы при чрезмерном закручивании фиксаторов. В публикациях, посвященных способам остеосинтеза, рассматриваются в основном два вида существующих оперативных вмешательств, различающихся сроками осевой нагрузки на оперированную конечность. Согласно методике 1 система «фиксаторы-кость» подвергается нагрузкам, приближающимся к физиологическим. Методика 2 предполагает движение больного в течение всего периода сращения без опоры на оперированную конечность. При этом наблюдаются лучшие условия сращения.The number of nonunions and other complications of osteosynthesis of femoral neck fractures remains at a high level, reaching 10-30% of the total number of surgical interventions. Reducing the number of complications, primarily nonunions of bone fragments, is an urgent problem that encourages research on the subject. The purpose of this paper is a critical analysis of the scientific reasons of nonunions and clinical experience of the use of different methods of osteosynthesis as the basis for the creation of biomechanical models needed to improve methods of surgical treatment of hip fractures. This review considers publications of the past half-century (1965-2015 years). In most works of this period, osteosynthesis with locking screws with diaphyseal patch plates and without them was studied. There are different views about the causes of nonunions. Among them, the most reasonable are: 1) lack of blood supply to the bone fragments at the ideal reposition; 2) unstable fixation of bone fragments arising as a result in overstress and resorption of the bone at the threads zones. In publications devoted to osteosynthesis methods, basically two kinds of surgical interventions were considered. According to the first method,bone-implant systemare loaded under physiological conditions. Second technique involves movement of the patient during healing period without bearing on the operated limb. The second method provides apparently best healing conditions.

Surgical complications of intra-articular calcaneal fracture treatment

Introduction: The authors present complications following surgical treatment of intra-articular calcaneus fractures, in regards to the surgical technique employed, based on their own clinical material. Materials and methods: The techniques analyzed included the Westhues’ technique and its modifi cation with additional bone stabilization by Kirschner wires and the percutaneous stabilization by Rapala. The research material covered the years from 1990 to 2012 and consists of 82 operated patients - 68 men (83%) and 14 women (17%). Analyzed calcaneus fractures were divided using the Essex-Lopresti classifi cation. Results: The authors of the article indicate that the most frequently registered complications of surgical treatment of intra-articular calcaneus fractures in early observation were thromboembolic complications and local infl ammatory reactions of the skin at the point of incision and placing the stabilizing material. During the long-term follow-up, the post-thrombotic syndrome and algodystrophic disorders were the most common. Conclusions: Factors contributing to the occurrence of the complications registered were fracture morphology, fixation of bone fragments by an excessive number of stabilizing materials and prolonged immobilization of the operated limb. Cite this article as: Golec P., Tomaszewski K.A., Nowak S., Dudkiewicz Z. Surgical complications of intra-articular calcaneal fracture treatment. Med Rehabil 2016; 20(2): 25-30.