Fixation Of Bone Fragments Research Articles

Use of porous adhesive cement for fixation of fragments in fractures of the lower jaw

BACKGROUND:The preferred method of treating mandibular fractures is surgical, but it also has problems due to a number of complications associated with the presence of a metal structure in the surgical wound. AIM:To improve the efficiency of surgical treatment for mandibular fractures by developing and experimentally testing amethod for fixing mandibular fragments using porous adhesive cement. MATERIAL AND METHODS:The experiments were performed on 30male Agouti guinea pigs, which were divided into two groups: the main group— 20animals, the comparison group— 10guinea pigs. A mandible fracture was modeled in all animals. In the main group, the fragments were fixed with porous glue-cement “Rekost”, in the comparison group— with abone wire suture. All animals received prophylactic antibacterial therapy. All manipulations were performed under combined anesthesia. The statistical significance of the differences in the compared groups was assessed using Fisher's criterion. For all comparisons, the selected level of statistical significance was 5% (p≤0.05). RESULTS:The use of the method developed by us for fixation of bone fragments in mandible fractures allowed us to achieve a positive result in all 20laboratory animals included in the study. This was confirmed by the results of histological studies in the dynamics of observation: a reliable difference was established between the main group and the comparison group in the severity of inflammation signs on the 14th day, as well as the severity of regeneration signs. It was found that the use of porous glue-cement for fixation of mandible fragments, in contrast to bone wire suture, allows for reliable consolidation of bone fragments for the entire period of treatment (according to X-ray diagnostic data) and to stop by the 14th day (according to histological studies) signs of inflammation in the bone wound (no leukocyte infiltration and vascular congestion). In this case, the glue allows filling the fusion area with developing bone tissue by the 90th day of observation (according to histological studies) and excluding repeated surgical intervention to remove the fixing structure, since the porous adhesive cement, according to histological studies, was absorbed by the 90th day of observation, which indicates its biodegradable properties. CONCLUSION:The use of porous adhesive cement for fixation of mandibular fragments demonstrated better properties compared to bone wire suture.

СРАВНИТЕЛЬНАЯ ХАРАКТЕРИСТИКА МЕТОДОВ ИММОБИЛИЗАЦИИ ОТЛОМКОВ ПРИ ПЕРЕЛОМАХ НИЖНЕЙ ЧЕЛЮСТИ

Item. A review of the literature is presented on the current problem of maxillofacial surgery – methods of fixation of bone fragments in fractures of the lower jaw. The purpose of the study is to study publications on methods of fixation of fragments in fractures of the lower jaw in the comparative aspect of their influence on the clinical course. Methodology. The publications of domestic and foreign authors on modern methods of fixation of bone fragments in fractures of the lower jaw were studied, and a comparative analysis of their effectiveness was carried out. Results. Currently, orthopedic and surgical methods of immobilization of bone fragments are used, which are used both in isolation and in various combinations. During surgical treatment with the help of mini-plates, it is possible to perform optimal reposition and stable fixation of fragments, however, the traumatic nature of the operation, leading to bone hypoxia, slows down the processes of reparative osteogenesis and leads to the development of postoperative complications. The use of bone glue-cement makes it possible to achieve reliable fixation of bone fragments, accelerate the formation of a callus. At the same time, there is no need to remove the glue, since it is a biodegradable material. Conclusions 1. None of the currently used methods of fixation of bone fragments in clinical practice for fractures of the mandible, both orthopedic and surgical, as well as in their combination, can fully meet the optimal conditions of reparative osteogenesis. 2. A promising alternative method is the use of bone adhesives that fill the bone voids between fragments, which contributes to their stable fixation and reparative osteogenesis, biodegrading simultaneously with the formation of a callus.

A clinical case of scapula fragment fracture with dislocation of fragments

Relevance. According to statistical data, fractures of the scapula are quite rare, accounting for approximately 3-5% of all shoulder girdle fractures and less than 1% of the total number of fractures. Because of the high-energy nature of scapula fractures, 80% to 95% of cases are associated with additional traumatic injuries. The aim: to analyze the technique of performing surgical intervention in a fragment fracture of the right scapula with displacement of the fragments on the example of a clinical case. Object and methods. Patient G., 21 years old, on 12.10.2023 applied to the trauma center № 114 after a wind-driven tree fell on his right forearm area. A fracture of the right scapula with displacement of the fragments was detected, the patient was referred to the emergency room of the R.R. Vreden Research and Development Center for further examination and treatment. On admission to the department, the patient's right supraclavicular region was longer than the left one, the right supraclavicular region at the acromial end was swollen and painful, without visible deformity. Results. The study presents traumatologic pathology, namely, fractures of the articular and clavicular processes of the scapula with displacement of the fragments, as well as fracture of the acromial process of the scapula with minimal displacement of the fragments and cranial subluxation of the acromial end of the clavicle. The causes, diagnostic methods and surgical treatment of this pathology are described. Conclusions. Due to the growing amount of data on satisfactory postoperative results in patients with scapula fractures, there is still interest in surgical trends in the treatment of these patients. However, it is worth remembering that postoperative complications after repositioning and fixation of bone fragments continue to be an urgent problem.

СПОСОБ ЛЕЧЕНИЯ ЛОЖНЫХ СУСТАВОВ ЛАДЬЕВИДНОЙ КОСТИ ПУТЕМ ПРИМЕНЕНИЯ НАДКОСТНИЧНЫХ ЛОСКУТОВ НА МЕТАКАРПАЛЬНЫХ АРТЕРИЯХ

The purpose of the study: to improve the method of surgical treatment of patients with scaphoid nonunion. Material and methods: the results of treatment of 30 patients operated on for scaphoid nonunion of the hand, which arose after conservative treatment (not treatment) of fractures, surgical treatment for 2018-2021 were analyzed. The patients were divided into two groups: 15 patients with scaphoid nonunion who underwent free bone autoplasty as a surgical aid, fixation of bone fragments with a headless screw – a control group; 15 patients with fscaphoid nonunion, who underwent free bone autoplasty as surgical treatment, supplemented with non-free plastic surgery with a periosteal flap on the metacarpal artery – the main (experimental) group of patients. The possibility of using periosteal flaps isolated from the first and second metacarpal bones was evaluated. To assess the results of treatment, X-ray monitoring of scaphoid nonunion consolidation was used at 8, 12 weeks and 6 months after surgery; computed tomography of wrist joints was performed at 4 months after surgery in order to assess the degree of bone graft reconstruction. Hand function was assessed before and after surgery using the DASH Upper Limb Disability Questionnaire and the Visual Analog Pain Scale (VAS). Results of the study: in the experimental group, scaphoid nonunion consolidation was achieved in 13 out of 15 patients (86.6%) compared with the control group (10 out of 15 patients – 66.7%). According to the severity of the pain syndrome and the final functional result, comparable indicators were obtained in both groups. Discussion: given the small sample of patients who participated in the work, the study has moderate reliability. However, the data obtained allow us to hope for the effectiveness of the proposed method of surgical treatment used in patients of the main study group.

Дослідження відносних деформацій міжуламкового регенерату в моделях різних варіантів остеосинтезу кісток гомілки з переломами в середній третині у дітей з недосконалим остогенезом та незавершеним ростом

Introduction. Osteogenesis imperfecta is a genetic pathology that leads to a violation of the processes of formation of collagen fibers, formation of bone matrix and its mineralization and, as a result, to the formation of bone tissue with low strength properties. The most promising means of stabilizing bone fragments under this condition are intramedullary fixators of various designs. Aim. To investigate the relative deformations of the interfragmentary regenerate under the influence of various types of loads in models of the tibia with fractures of both bones in the middle third and their osteosynthesis using intramedullary rods of various designs in children with osteogenesis imperfecta and incomplete growth. Materials and methods. Mathematical modeling of options for osteosynthesis of tibia bones with a fracture in the middle third in children with osteogenesis imperfecta was performed. Two variants for tibial osteosynthesis were modelled: a rod without rotational stability; rod with rotational stability. Osteosynthesis of the fibula was not modelled in all variants. The stress-strain state of the model under the influence of vertical compressive, bending and torsional loads, as well as the magnitude of the relative deformations of the interstitial regenerate, were studied. The results. A “growing” intramedullary shear with rotational stability provides essential advantages in the case of torsional loads. The presence of rotational stability makes it possible to ensure two times lower values of relative deformations of interfragmentary regenerates compared to osteosynthesis with a rotationally unstable rod. Under compressive and bending loads, both rods showed almost identical results of relative deformations of bone regenerates. High rates of deformation of interfragmentary tibial regenerates are due to the lack of longitudinal axial stability of both rods, which is the basis for the possibility of increasing their length during the growth of the patient. Conclusions. The use of osteosynthesis with intramedullary rods, which increase during the treatment of tibial fractures in patients with osteogenesis imperfecta, does not ensure a sufficient level of stability for the fixation of bone fragments under compression and bending loads, which leads to the greatest deformations of bone regenerates. A rod with rotational stability provides advantages in resistance to torsional loads, which is determined by twice lower relative deformations of interfragmentary regenerates. No conflict of interests was declared by the authors.

Дослідження розподілу напружень під впливом згинаючого навантаження в моделях різних варіантів остеосинтезу кісток гомілки з переломами в середній третині при їх уродженому псевдоартрозі в дітей з незавершеним ростом

Congenital pseudoarthrosis of the bones of the lower leg is a rare disease characterized by the presence of non-union (pseudoarthrosis) of the bones of the lower leg, which does not grow independently. The majority of surgical techniques involve the removal of pathological soft tissues in the zone of pseudarthrosis followed by bone autoplasty and fixation of tibial bone fragments in external fixation devices or with the help of intramedullary fixators. Purpose - to investigate the stress-deformed state of models of the leg in the presence of pseudarthrosis in the middle third under the influence of bending load and their osteosynthesis using intramedullary rods of various designs in children with incomplete growth. Materials and methods. Mathematical modeling of 3 variants of osteosynthesis of lower leg bones with congenital pseudarthrosis in the middle third was performed: 1 - rod without rotational stability; 2 - rod with rotational stability; 3 - rod with rotational stability and blocked movement during compression. The stress-strain state of the models under the influence of a bending load of 300 N was studied. Results. When using a rotationally unstable «growing» rod, maximum stress levels of 18.5 MPa and 23.1 MPa are determined at the proximal and distal ends of the tibia, respectively. In the fracture zone, the stress level is minimal and does not exceed 0.2 MPa. In the diaphyseal part, stresses are determined at the level of 0.3 MPa and 0.4 MPa above and below the fracture zone, respectively. In the zone of the fracture of the fibula, the stress level is also not significant - 0.7 MPa and 0.8 MPa in the proximal and distal fragments. The use of a rod with rotational stability does not lead to any significant changes in the stress-strain state of the model compared to tibial osteosynthesis with a rotationally unstable rod. The use of an intramedullary rod with blocked movement during compression allows to reduce the values of stresses at the proximal and distal ends of the tibia - up to 16.9 MPa and 21.2 MPa, respectively. In all control points of the diaphyseal part of the tibia, the stresses are minimal and equal to 0.2 MPa. It should be noted that in this case the stresses in the area of the fracture of the fibula, where they do not exceed the mark of 0.1 MPa, are almost negligible. Conclusions. Under bending loads, all types of intramedullary rods provide a minimum level of stress in the tibial fracture zone. Additional rotational and longitudinal stability of the rods allow to slightly reduce the level of stress in the proximal and distal ends of the tibia. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Flistory and prospects of development of methods of osteosynthesis and osteosynthesis of the humerus diaphysis

Relevance. About 800 thousand people die every year as a result of injuries and their consequences, in the Russian Federation the frequency of injuries is 12 %. Fractures of the humerus diaphysis account for 1-5 % of the total number of traumatic injuries of the skeleton, at the same time, there is no tendency to reduce injuries in modern society, therefore, the number of surgical interventions aimed at restoring the integrity of the bone does not decrease. Among the reasons for the unsatisfactory results of osteosynthesis, iatrogenic ones are distinguished: inconsistency from a biomechanical point of view, the choice of an unsuitable metal structure, insufficiently correct comparison of the ends of bone fragments and neglect of contraindications to the use of submerged structures with increased contamination of the wound with open fractures. Non-infectious complications of primary osteosynthesis include false joints, improperly fused fractures, untenable osteosynthesis, as well as fractures and migrations of implanted metal structures. The described complications are the basis for repeated (revision) surgery, or rheosteosynthesis. The purpose of this study is to analyze the historical aspects of the development of osteosynthesis and rheosteosynthesis methods, as well as to determine the prospects for their further development.Materials and methods. In the process of writing the article, the analysis of data from literary sources published in the period from 2016 to 2023 was carried out.Results. Speaking about the choice of osteosynthesis technique, it should be noted that no recommended and maximally described techniques will be able to fully cover the variety of situations that arise during osteosynthesis operations, therefore, first of all, a positive outcome depends on the experience of the surgeon and his ability to make situational decisions. Each of the methods used has both advantages and disadvantages, and which treatment tactics the surgeon would not prefer - there is always a risk of complications and, as a result, an unsatisfactory result. In such cases, patients undergo revision operations of osteosynthesis (rheosteosynthesis), minimizing or completely eliminating bone defects. The complexity of correcting the consequences of injuries of the humerus diaphysis is due to the variety of conditions leading to the development of various kinds of bone defects or false joints, as well as in a limited number of techniques that can fully repair the damage in a short time. Taking into account the rather long periods of consolidation of fragments, rehabilitation of patients with this type of pathology implies the use of devices capable of providing stable fixation and the possibility of early restoration of upper limb functions for fastening bone fragments. As a rule, revision surgical interventions include excision of scars from the interfragmental area or corticotomy, removal of deformation (if present), rimming of the medullary cavity and intramedullary osteosynthesis, to which, in rare cases, fixation with a short plate may additionally be applied. The range of revision surgical interventions may include rheosteosynthesis in combination with: segment elongation and corrective osteotomies, bone alio- and autoplasty, with bone elongation on a nail in an external fixation device.Conclusion. The development of modern technologies of osteosynthesis and osteosynthesis of the diaphyses of long tubular bones in general, and the humerus in particular, has passed a serious evolutionary path. In recent decades, methods and technologies of osteosynthesis have been actively developing and improving. With the development of knowledge in the field of the mechanism of bone fusion, implant designs and installation technologies are changing, new modifications of operative accesses are being developed. When choosing the method of fixation of bone fragments, minimally invasive osteosynthesis techniques are becoming increasingly popular. Currently, combinations of different rheosteosynthesis methods are being actively introduced, which significantly expands their capabilities, in comparison with their application separately.

SURGICAL TREATMENT OF THE PROXIMAL HUMERUS FRACTURES IN PATIENTS WITH OSTEOPOROSIS. PROBLEMATIC ISSUES AND DEVELOPMENT PROSPECTS

Fractures of the proximal part of the humerus (FPPH) are the third most common in the elderly after fractures of the femur and radius. Objective. On the basis of analysis of the literature to identify problematic issues of surgical treatment of patients with FPPH and osteoporosis and prospects for improving implants and algorithms treatment. Methods. The material of the study was the scientific papers available in Google search engines, PubMed,Medline, published in specialized sources. Results. It is shown that are used today there are Neer and AO/OTA classifications of FPPH. Conservatively manage of FPPH in 80 % of patients with two-fragmentary fractures according to Neer or type A2/A3 according to AO/OTA. The remaining 20 % patients have threeand four-segment FPPH (types B and C according to AO/OTA), the conservative treatment of which consists of problem, especiallyin patients with osteopenia and osteoporosis. Surgical treatment of FPPH is recommended in case of fractures types 11B2-3, 11C2-3 in young patients or in the elderly age that requires significantfunctionality of the upper extremity. Positive results of treatment of FPPH types 11B3, 11C2-3 on the background of osteoporosis obtained after installation LCP-plates with allo- or autograftfrom the fibula bones, as well as support screws, filling of cavities in the humerus head fragments with bone cement, or using free bone implants are most often used. These methods achieve andsupport to enable stable repositioning of even complex type fractures 11C2-3. Blocked intramedullary nails of the third generationhave improved mechanisms for attaching proximal screws and specific fixation of bone fragments, as well as straight geometry. Primary reverse shoulder arthroplasty in case of type 11С2, 11С3fractures according to AO/OTA enables to obtain positive results in most patients. Conclusions. Surgical treatment of patients with FPPH is advisable for active patients, it is possible to improvefunctional results compared to conservative manage and avoid the most complications of it.

In vitro/ in vivo evaluation of double crosslinked bone glue with different degrees

ABSTRACT Successful bone fragment fixation is a crucial factor in bone fracture healing, the fixation of crushed bone fragments could hinder bone fracture healing. Thus, ideal bone glues to effectively adhere and splice comminuted bone fragments are needed in clinical. Herein, an osteoinductive and biodegradable double cross-linked bone glue (GelMA-oDex-AMBGN) was constructed through Schiff’s base reaction between commercial GelMA (with different substitution degrees of amino groups) and Odex mixed with amine-modified mesoporous bioactive glass nanoparticles (AMBGN), followed by crosslink with blue light irradiation. The GelMA-oDex-AMBGN bone glue successfully adhered and spliced the comminuted bone fragments of isolated rat skulls. GelMA-oDex-AMBGN promoted the proliferation of 3T3 cells and enhanced the expression of osteogenic proteins Runx2 and OCN in vitro. In rat cranial critical-sized defect models, GelMA-oDex-AMBGNs with different substitution degrees significantly increased the new bone contents at the fracture defect sites and promoted bone tissue regeneration in vivo. In conclusion, the double cross-linked bone glue (GelMA-oDex-AMBGN) was successfully constructed and can induce bone regeneration. Additionally, there was no significant difference in osteogenic activity among GelMA-oDex-AMBGNs with different substitution degrees and the equal content of AMBGN.

Persian Fixation - A Novel Surgical Method for Intra-articular Distal Radius Fractures.

Background: Intra-articular distal radius fracture treatment options include Kirschner wires (K-wire) fixation, external fixation and plate fixation, however, fixation of small bone fragments in distal radius fractures in a secure and anatomical manner was a challenging issue with several limitations. In this study, we present a novel surgical method that we have called the Persian Fixation for intra-articular distal radius fracture and describe a short-term clinical result. Methods: We described the surgical procedure and clinical result of 15 patients between 2019 and 2020 in whom the Persian Fixation technique was utilised. Through clinical examination and questionnaires, objective and subjective clinical results were determined. Results: At the final follow-up, the mean Quick Disabilities of the Arm, Shoulder and Hand (Quick-DASH) score for our patients was 17.6 ± 12.1, the mean WOrk-Related Questionnaire for UPper extremity disorders (WORQ-UP) score was 20.7 ± 4.4 and the mean Visual Analogue Scale (VAS) score was 27.8 ± 16.5, indicating a good to excellent clinical result. Conclusions: We recommended the Persian Fixation technique for intra-articular distal radius fractures, which is a low-cost and readily accessible procedure that provides stable fixation of a tiny bone piece. Level of Evidence: Level IV (Therapeutic).

The application of intramedullary nails and transmedullary support screws in surgical treatment of distal tibia fracture

Introduction. Fractures of the distal tibia are a difficult treatment problem due to the specific anatomy of this area and the soft tissue injuries resulting from trauma. A distal fracture is short, has a wide marrow cavity, and the asymmetric muscle forces acting on it can cause secondary displacements despite the originally correct positioning. Against the background of the problems presented above, the fixation with an intramedullary nail (IMN) with the use of TMS (trans medullary support) screws directional screws seems to be the best alternative for treatment. Aim. The aim of this study was to evaluate the bone fracture repositioning after surgical treatment of tibia fracture, the time of bone healing and the function of the upper ankle joint. Materials and methods. Forty patients treated surgically due to a fracture of the distal tibia with the use of an intramedullary nail and TMS screws were included in this study. The mean follow-up time was 25.3 months. The function of the ankle joint of the injured limb was evaluated using the AOFAS, VAS and SF-36 questionnaires. Radiological documentation was assessed in terms of correct bone fragment repositioning, placement of directional screws and correct union of the fibula. Post-operative X-rays as well as X-rays taken at the end of treatment in AP and lateral projection were also assessed, evaluating LDTA (lateral distal tibial angle) and ADTA (anterior distal tibial angle). Results. The function of the ankle joint after surgical treatment of a distal tibia fracture using the IMN + TMS method is as follows: AOFAS score 91.5, VAS 2.2 / 10 points. The range of motion of the ankle joint: the angles of ankle movement were significantly greater in the case of the uninjured limb compared to the injured one. Bone union was obtained in all patients. In 80% of patients, it was achieved in less than 6 months. Assessment of repositioning after surgery – mean LDTA angle after surgery was 89 and mean ADTA angle after surgery was 86 (standard LDTA 90, ADTA 85). Conclusions. The function of the ankle joint after treatment of a distal tibial fracture with an intramedullary nail and TMS screws according to the AOFAS and VAS scale was very good and allowed for the anatomical bone fragment fixation. The bone healing after fixation of the distal tibial fracture with an intramedullary nail and TMS screws was shorter than 6 month in most cases.

TREATMENT OF PURULOUS-INFLAMMATORY COMPLICATIONS OF INJURIES AND DISEASES OF PELVIC BONES

Summary. Purulent-inflammatory complications of fractures of pelvic bones represent up to currently one of the most difficult and little-studied sections of traumatology. Complexity anatomical structure and topographic relations of the pelvic region, deep location a significant part of the bones under the muscle mass create objective difficulties for surgical treatment of bone damage and later in the diagnosis of purulent processes. Osteomyelitis of the pelvis is accompanied by high mortality and is from 2.5 to 52% as in acute and in the chronic stage of the disease.
 Purpose: by analyzing clinical mistakes and the possibility of purulent-inflammatory complications during operative treatment and postoperative management of patients with fractures bones of the pelvis, as well as to determine methods of diagnosis, treatment and ways of prevention traumatic sacroiliitis.
 Materials and methods. In the period from 2017 to 2022 in the bone-purulent surgery department of Zaporizhzhia city clinical hospital №9 treated 9 patients with purulent processes in of the pelvic region, 6 (66.3%) of them were men, and 3 (33.4%) were women. With postoperative osteomyelitis, which occurred after osteosynthesis with plates of multiple pelvic bone fractures, 4 (44.5%) patients were treated. Conservative therapy with sacroiliitis, the cause of which was abortion, received by 2 (22.2%) women, 1 (11.1%) patient suffered from right-sided sacroiliitis since childhood and repeatedly operated, and 2 (22.2%) men were treated with cause of sacroiliitis, which occurred after slaughter of the sacroiliac joint area.
 Results. All patients who were treated in the bone-purulent surgery department for purulent-inflammatory processes of pelvic bones, recovered and were discharged for outpatient treatment. While treatment in the ward, patients received complex treatment, which included conservative therapy and surgical intervention. Despite the introduction of modern methods of treatment of osteomyelitis of the pelvis, a trend of steady growth in the number is noted exits of patients with disabilities, which is confirmed by world statistics.
 Conclusions. Lack of hard fixation of bone fragments by implants increases the risk of purulent complications in the postoperative period. Use of additional diagnostic methods and complex treatment, which includes radical purulent sanitation foci, creation of favorable conditions for tissue regeneration, prevention of relapses suppuration, targeted antibacterial therapy, correction of homeostasis indicators and increases the protective forces of the body during purulent processes of the bones and joints of the pelvis achieving positive results in 80.2% of patients.

Comparison of Craniosynostosis Surgery Outcomes Using Resorbable Plates and Screws versus Absorbable Sutures in Children with Craniosynostosis.

Previously, absorbable screw and plate systems were widely used in craniosynostosis surgery in Iran, but now, due to the establishment of economic sanctions, the importation of these tools into the country has become difficult. In this study, we compared the short-term complications of cranioplasty surgery in craniosynostosis using absorbable plate screws with absorbable sutures. In this cross-sectional study, 47 patients with a history of craniosynostosis who underwent cranioplasty at Tehran Mofid Hospital, Tehran, Iran from 2018 to 2021 were divided into two groups. For first group (31 patients) we used absorbable plate and screws, and for the second group (16 patients) absorbable sutures (PDS). All operations in both groups were performed by the identical surgical team. Patients followed up for consecutive post-operative examinations in the first and second weeks and 1, 3, and 6 months. Data were analyzed using SPSS software version 25. The results did not show any short-term or medium-term complications in either group. No recurrences were observed. In Whittaker classification, 63.8% were Class I, 29.8% were Class II, 6.4% were Class III, and 0% were Class IV. There was no statistically significant relationship between the type of treatment (screw and plate or absorbable suture) and higher Whitaker. There was also no statistically significant relationship between type of craniosynostosis and higher Whittaker. The absorbable sutures can be considered as valuable and cost-effective tools in the fixation of bone fragments in craniosynostosis surgeries by surgeons.

Results the use of minimally invasive surgical methods for the treatment of patients with polytrauma in the Fergana branch of the Rncemp

Retrospective analysis of the anatomical and functional outcomes of surgical treatment of 1024 patients with polytrauma was performed in the trauma department of the FBRSCEMA for the period from 2005 to 2020. High-tech methods of minimally invasive osteosynthesis have been increasingly used in recent years in order to improve the results of treatment of patients with polytrauma. 1340 operations were carried on 1024 (76.4%) patients. The share of minimally invasive surgical interventions was 83.4% (854 operations). In comparison with traditional osteosynthesis, the introduction of new minimally invasive osteosynthesis technologies provides the possibility of earlier performing of surgical fixation of bone fragments, reduces the likelihood of postoperative complications due to minimal surgical trauma, creates optimal conditions for accelerating the healing of fractures, provides early support for the limb and the ability to start an early stage development of movements in the joints of the injured limbs.

УСТРОЙСТВО ДЛЯ ЗАКРЫТОЙ РЕПОЗИЦИИ, ФИКСАЦИИ КОСТНЫХ ФРАГМЕНТОВ И ПОСЛЕДУЮЩЕГО ВЫПОЛНЕНИЯ ПОГРУЖНОГО ОСТЕОСИНТЕЗА У БОЛЬНЫХ С ПЕРЕЛОМАМИ МЫЩЕЛКА ПЛЕЧЕВОЙ КОСТИ

Background. Intra-articular fractures of the distal humerus are complex injuries that can subsequently significantly limit the function of the elbow joint. Transosseous osteosynthesis has a number of undeniable advantages: low trauma, accurate reposition of bone fragments using closed methods, stable fixation of bones, early movements in the injured joint both with and without hinges. However, this method of surgical treatment is not without a number of complications. Objective. Develop and test a device for closed reposition, fixation of bone fragments in patients with fractures of the distal humerus and subsequent ORIF. A device has been develop for closed reposition, temporary fixation of bone fragments in patients with fractures of the humerus condyle and subsequent ORIF. In 24 patients with intra-articular fractures of the distal humerus (according to the AO classification: 13 - C2 - C3), internal fixation was performed. In patients of the first group (comparison group, 14 cases), one-stage open osteosynthesis with submersible fixators was performed within 4–14 days after injury. In patients of the second group (main group, 10 cases), a two-stage treatment of fractures of the condyle of the humerus was carried out using the developed device. Results. All patients of the main group achieved good results of treatment: no complications were detected; the timing of fracture consolidation did not differ from the average.

Проблемы и успехи комбинированного применения технологий Илизарова и Masquelet

Introduction Based on the assessment of the problems and effectiveness in the use of the induced membrane and bone transport techniques, a new technological solution was proposed. It combines the methods of Masquelet and Ilizarov for restorative treatment of patients with bone defects and nonunion. Materials and methods The combination of the technologies was successfully applied for filling bone defects in the conditions of active purulent infection and its remission in 24 patients. Patients of the first group (n = 17) had bone defects in the conditions of the osteomyelitic process remission. In the second group of patients (n = 7), the osteomyelitic process was active. The combined technology of bone grafting included segment reconstruction in two stages. At the first stage of treatment, a sanitizing treatment of soft and bone tissues in the area of the defect and nonunion was performed followed by spacer implantation and transosseous fixation of bone fragments with the Ilizarov apparatus. During the second operating session, the spacer was removed, and after osteotomy (corticotomy), the fragment(s) were transported according to Ilizarov. Empirical antibiotic therapy against a wide range of pathogens was started after the verification of the microbial tests of the biomaterial and the determination of sensitivity to antibiotics, the correction of antibiotic therapy was carried out. Results The postoperative wounds in the area of the implanted spacers healed by primary intention in the first group. In two patients of the second group (29 %), purulent fistulas were formed by the time the spacers were removed, and the wounds healed by secondary intention. The duration of distraction in the first group was 45.4 ± 9.8 days. Bone transport in the patients of the second group continued 52.8 ± 5.3 days. The duration of fixation of the segments with the device was 195.1 ± 9.9 days in the first group and 181.8 ± 11.4 days in the second group. Discussion At the initial stage of the combination of the Masquelet technique and non-free Ilizarov bone grafting, the risks of the activity of a purulent process remain if the debridement of the infection nidus is not radical, implanted spacers with a prophylactic dose of antibiotics are massive, and the antibiotic therapy is empirical. The formation of an induced membrane with bactericidal activity at the second stage of surgical treatment, the creation of favorable conditions for bone transport, adequate sanitation of the purulent focus, and targeted antibiotic therapy ensure a stable suppression of the activity of the purulent process. Conclusions Surgical rehabilitation of patients with segmental infected defects results in bone defect filling with distraction regenerates undergoing complete organotypic restructuring, which eliminates the likelihood of deformities or fractures at the level of newly formed bone areas and reduces the risk of recurrence of the osteomyelitis process.

STIFFNESS PARAMETERS OF VARIOUS MODIFICATIONS OF RING FIXATOR

Relevance. To date, there is no final solution to the theoretical and practical issues of the problem of external fixation in the treatment of long bone fractures.
 Objective. To determine the rational methods of completing ring retainer (RF) in the treatment of nonunions of the shin bones after fractures of long bones on the basis of clinical and experimental substantiation of the choice, taking into account the peculiarities of the assembly of the apparatus and the implementation of the connection "apparatus-fragments of non-union".
 Materials and methods. In the experimental part, Sawbones® synthetic composite bone was used. The rigidity of fixation of bone fragments of the RF of the wire-rod type was studied. We tested and compared 5 different options for fixation of bone fragments in RF. The samples were tested in 4 modes: compression along the axis of the bone; compression on the head of the bone; twisting; bending. The strength and deformation characteristics of the materials were determined with a maximum force of up to 5 kN using the TIRATEST-2151 universal testing machine. They chose the most optimal configuration of the RF. Then, in the clinical part, the clinical effectiveness of the optimal structures was evaluated based on the analysis of their use in 12 patients with non-union of the shin bones.
 Results. Optimal structures have been determined from the point of view of integral rigidity of the structure. The greatest rigidity was the RF system No. 3, in which 3 spokes are used: 2 of them are held at an angle, 1 - in the plane of the ring. In the case of an increase in the number of spokes, the stiffness of the system increased. When tested in compression along the axis of the bone, the stiffness of System No. 3 is 6.5% greater than that of System No. 2 and 12.5 % greater than System No. 1, in which only 2 spokes are used. Fixing the spokes at an angle to the plane of the ring also increases the rigidity of the system. When tested in compression along the axis of the bone, the stiffness of System No. 3 is 6.5 % greater than that of System No. 2. The stiffening rib affects the stiffness of the entire system. But the bend became the most sensitive. Flexural stiffness decreased by 23 % and compression by 8.5 %. Debris removal during bending increased by 1.5-1.8 times.
 Conclusion. The best indicators of fixation rigidity have options for the arrangement of spokes with a cross not only in the frontal, but also in the sagittal planes. The stability of the fixation of the rod is significantly increased by mounting the "stiffness triangle". The obtained clinical data indicate the promising application of improved ring fixators.

Proximal femoral varus osteotomies in childhood-development of osteosynthesis materials

Proximal femoral osteotomies are one of the most commonly used surgical techniques and play an important role in the spatial correction of the hip joint in a number of pediatric orthopedic disorders such as Legg-Calve-Perthes disease, Slipped capital femoral epiphysis, Developmental dysplasia of the hip, osteoarthritis, etc.14,21,23,28,30,31
 The development of orthopaedic osteosynthesis for fixation of bone fragments includes the use of Kirschner wires, intraosseous nail plates, AO-plates with fixed angle, external fixators, etc. Over time, many of the techniques and osteosynthesis materials have fallen into disuse and have remained only of historical significance.
 The purpose of this study is to follow how osteosynthesis fixation devices for varus osteotomies in the proximal femur have historically evolved and developed from the beginning to the present.

Safety and Effectiveness of Using Double-Ended Allograft in the Repair of Large Defects of Bi-Epiphyseal Bones in Experiment

BACKGROUND: The repair of large defects in the long bones remains one of the most pressing problems in traumatology and orthopedics.
 AIM: To evaluate the effectiveness and technological safety of the repair of large defects of the long bi-epiphyseal bones including the use of double-ended bone allografts to demarcate the defect cavity from the surrounding tissues and fixation of bone fragments using an external fixation device.
 MATERIALS AND METHODS: Experiments were conducted on 14 adult nonpedigree male and female dogs aged 12 years. The double-ended allograft was used to demarcate the formed defect of the tibial bones at 1.5 diameter length of the shinbone. The bone fragments were fixed with Ilizarov apparatus adapted for experiments on dogs. The maximal follow-up period was 2 years after the surgery. In the dynamics of the experiment, life-time observations, X-ray examination, and laboratory control were conducted. After euthanasia, the implantation zone was examined histologically.
 RESULTS: The visual signs of the restructure of the transplants were identified starting from day 35 after surgery. The bone regenerates in the defect zone completely formed within 3 months after the surgery. This permitted the removal of the external fixation apparatus in 3 months after the surgery. The restructuring of the newly formed part of the bone continued for 2 years after the operation. No significant changes in the laboratory parameters in the dynamics of the experiment were observed. No changes could be evaluated as negative phenomena. No serious unwanted events were recorded either.
 CONCLUSION: The proposed technique for the repair of large defects of long bi-epiphyseal bones demonstrated safety and sufficient effectiveness in the speed of regeneration of the defect and quality of the bones formed.

Osteosynthesis with metal plates in operations on bones in children

The paper presents the experience of using metal plate osteosynthesis in 158 patients aged 6 to 14 years in the treatment of bone fractures of different localization, improperly fused fractures, as well as in performing corrective osteotomies for orthopedic diseases. Fixation of bone fragments with metal plates made it possible to do without external immobilization in the postoperative period. Stable osteosynthesis provided the possibility of early functional loading of the operated limb, which excluded the development of post-mobilization states (contractures, hypotrophy). The child could use the operated limb long before the onset of complete consolidation of the bone fragments. Depending on the nature of the fracture and the type of osteotomy, straight, T-shaped, apgular and derotational-compression plates were used.