Intramedullary Osteosynthesis Research Articles

Intramedullary stabilization of dislocated clavicle fractures with a compression rod

Despite the favorable prognosis of conservative treatment for clavicle fractures, unsatisfactory consequences reach 10–30 % cases. Surgical methods of treatment for dislocated clavicle fractures, such as osteosynthesis with a plate or an elastic titanium rod, are mostly used in practice. The disadvantage of the latter is the possible migration of the implant with perforation of the skin. The purpose was to study the effectiveness of an intramedullary rod, improved by us, for osteosynthesis of dislocated clavicle fractures type OTA 15A and OTA 15B according to the AO/ASIF classification. The essence of the improvement was the possibility of closed minimally invasive intramedullary osteosynthesis of the clavicle body, with a simplified technique of the surgical intervention itself, prevention of implant migration. The latter was achieved by the fact that one of the ends of the rod had a drill, which eliminated the need for predrilling the medullary cavity of the clavicle to insert the rod, and its opposite end had a thread onto which a nut is screwed to achieve compression between the clavicular fragments. Forty-two patients with closed dislocated clavicle fractures were under supervision in the clinic of traumatology and orthopedics of Kyiv City Clinical Hospital 6. They underwent intramedullary osteosynthesis for clavicle fractures with an improved compressing rod (closed in 28 cases, open in 14) under regional anesthesia. In dyna-mics of the postoperative period, a clinical and radiological examination was performed, the severity of the pain syndrome and the function of the upper limb were assessed according to the visual analog scale (VAS), Disability of Arm, Shoulder and Hand (DASH). As shown by the results of X-ray examinations, the average period of clavicle fracture union was 10.1 ± 1.4 weeks (range 8–12 weeks). During the observation of the patients, favorable dynamics on the VAS and DASH were noted; by the end of the study (12 months after the operation), the functional capabilities of the upper limb on the DASH corresponded to 1.54 ± 0.84 points, VAS score was 9.60 ± 2.11 points. The improved construction of the intramedullary rod for osteosynthesis of dislocated clavicle fractures of the OTA 15A and OTA 15B type can be recommended for use in practice, as it has demonstrated favorable clinical, radiological, and functional outcomes.

Intramedullary osteosynthesis for ankle fractures and distal tibiofibular syndesmotic disruption

Introduction The optimal surgical approach for malleolar fractures and distal tibiofibular syndesmotic (DTFS) disruption remains controversial. There is no uniform treatment protocol for this type of injury.The objective was to review modern surgical treatments of the pathology and determine the optimal option.Material and methods Articles of French, English, Uzbek, Kazakh, German, Danish, Japanese and Chinese authors were retrospectively reviewed. An internet search of MedLine; PubMed; Scopus; Web of Science, CINAHL, the Cochrane Central Register of Controlled Trials databases was performed.Results Comparative studies of dynamic fixation and static fixation of the DTFS showed advantages of the dynamic methods enabling precise, anatomical syndesmotic fixation and faster healing. Dynamic fixation methods would require no implant removal, while syndesmotic screw woul be taken off to reduce compression in the ankle joint and minimize a risk of malreduction facilitating mobility of the ankle joint. Dynamic methods are associated with greater stability and less complication rate. However, static methods have the advantages of being more accessible and less expensive, which can be an important factor choosing a treatment method. Static methods are a wide application and can be used in a wide range of clinical cases. Long-term results show no statistically significant differences between dynamic fixation and static fixation.Discussion Literature review indicates the dynamic method with suture-button, a combined method and titanium cable isotonic annular fixation system as the preferred technique for surgical stabilization of distal syndesmosis associated with ankle fractures with a lower risk of postoperative complications and the possibility of short-term rehabilitation.Conclusion The choice between dynamic and static methods of distal syndesmosis fixation depends on many factors, including the complexity of the injury, the availability and cost of implants and the experience of the surgeon.

Percutaneous treatment of radial neck fractures in adult patients.

Radial neck fractures in adults are rare, but outcomes are often poor. Closed reduction and internal fixation (CRIF) technique has been advocated for the treatment of minimally displaced fractures in children, with a few reports on adult subjects. The aim of the present paper is to investigate mid-term results of a CRIF technique in adults with retrograde intramedullary K-wires in Mason's type II and III fractures. The proposed technique yields to good anatomical reduction of displaced neck fractures, faster rehabilitation, and easier hardware removal after fracture consolidation. A consecutive series of 17 patients were treated with closed reduction and intramedullary osteosynthesis, and outcomes were retrospectively evaluated. Elbow X-ray (XR) and CT scan were obtained preoperatively. Objective assessment before surgery and at an average 36-month follow-up included active and passive elbow range of motion (ROM). Functional evaluation was carried out through the collection of the Mayo Elbow Performance Score (MEPS), the Disabilities of the Arm, Shoulder, and Hand (DASH) score, and Elbow Self-Assessment Score (ESAS). XR at last follow-up was evaluated. The cohort included 10 males and seven females, with a mean age of 32 years. Patients returned for a follow-up evaluation at a mean of 36 months (range 6-43 m) form the surgery. The DASH score revealed good to excellent outcomes with a mean of 6.32 ± 10.24 points at last follow-up. The ESAS was 98.35 ± 1.89, indicating a non-restricted elbow function. Acceptable radiographic healing was achieved in all patients. The advocated technique is promising for obtaining good reduction and stabilization, and good to excellent satisfaction for patients. Given the challenging technique, the learning curve could be long and initial results unsatisfactory. More research with larger cohorts and improved study design could be carried out, comparing the technique with the current choice of treatment (ORIF, radial head resection).

Methodological principles of diagnosis verification and treatment tactics determination in combat limb injuries with bone defects

Objective. To develop a classification system for long bone defects resulting from combat limb injuries, establish criteria for predicting pathological fractures, and determine indicators for assessing the feasibility of converting the fixation method in combat-related injuries. Methods. The modern literature regarding the treatment of combat-related long bone defects resulting was analyzed in three databases: PubMed, Scopus, and Web of Science. The analysis was conducted using keywords such as combat injuries, bone defect, non-union, auto- and allograft transplantation, Ilizarov method — bone transport, Masquelet method — induced membrane, and fixation method replacement. The clinical material used for this study was derived from the evaluation and treatment of 457 patients with long bone defects at the III–IV medical intervention stage. Results. The determination of modern perspectives on the fundamental issues of combat injuries, combined with the analysis of treatment outcomes for such patients, enabled the development and validation of a classification of bone defects that incorporates the volume of bone tissue loss. Furthermore, a prognostic table for the risk of pathological fractures in cases of bone defects and a scoring scale for assessing the feasibility of fixation method conversion have been introduced and applied. Conclusions. The proposed classification allows the verification of all types of long bone defects. Its application in clinical practice offers the possibility of obtaining optimal and standardized treatment methods for different types of bone defects, thus improving outcomes by choice of appropriate technologies for their replacement. The objectification of fracture risk factors identification for bone defects enables the choice of the method and means of segment stabilization. The assessment of the feasibility of the fixation method change allows the evaluation of the patientʼs condition and the local status, facilitating the determination of the potential for method conversion — transition from external fixation devices to intramedullary osteosynthesis, significantly reducing complications during this stage.

Исторические аспекты и тенденции в развитии хирургического лечения переломов

Annotation: We consider trends in the development of traumatology from the 19th century to the present. The prerequisites for the development of intramedullary osteosynthesis appeared in the late – early 20th centuries. But the rapid development of traumatology begins with the discovery of the principles of asepsis and antiseptics and X-rays, which allows doctors to resort to surgical treatment of fractures more often. The research purpose is to determine the historical aspects and the main directions of the development of traumatology in the treatment of bone fractures. Materials and methods. The search was conducted in the open electronic scientific databases PubMed and databases of the Russian scientific electronic library eLibrary with keywords and phrases: traumatology, osteosynthesis, history of osteosynthesis, transosseous osteosynthesis, intramedullary osteosynthesis. Results. The end of the 20th century marked the appearance of a large number of different plates for osteosynthesis (dynamic compression plate – DCP, locking compression plate – LCP, point-contact fixator – PC-Fix), widely used in modern surgical practice, and methods of application (minimally invasive osteosynthesis, the use of biodegradable materials). Conclusion. The main trends in the development of modern traumatology are based on minimizing surgical intervention with maximum preservation of the biological integrity of tissues and the earliest activation of the patient.

The results of treatment of femoral diaphysis fractures using locked intramedullary osteosynthesis and extramedullary osteosynthesis (results for 10 years)

Background. Femoral diaphysis fractures are one of the most common and significant injuries to the bones of the limbs. Locked intramedullary osteosynthesis makes it possible to reduce the injury rate of the surgery and its length, as well as to carry out early rehabilitation of patients. The aim of the study. To conduct a continuous retrospective single-purpose comparative study of the results of treatment of patients with femoral diaphysis fractures treated with locked intramedullary osteosynthesis and extramedullary osteosynthesis for 10 years. This study did not include patients with double femoral fractures treated by osteosynthesis using a combination of two implants – locked intramedullary implant and extramedullary implant. Material and methods. We conducted a retrospective study of the results of treatment of patients from 2011 to 2020. During this period, we treated 794 patients aged from 16 to 77 years with femoral diaphysis fractures. The share of people of working age was 75 %. The patients were divided into two groups depending on the method of surgical treatment. Group 1 included 500 patients who had surgical treatment using locked intramedullary osteosynthesis. Group 2 included 294 patients who had surgical treatment using extramedullary osteosynthesis. Results. In patients of group 1 treated with locked intramedullary osteosynthesis, good anatomical and functional treatment results were achieved in 70 % of cases; satisfactory treatment results – in 25.2 % of cases, unsatisfactory results – in 4.8 %. In the group 2, good results were achieved in 61.9 % of cases, satisfactory – in 29.6 %, unsatisfactory – in 8.5 %. Conclusion. The obtained results of treatment of femoral diaphysis fractures show the undeniable advantage of using locked intramedullary osteosynthesis compared to extramedullary osteosynthesis.

Dynamics of lipoperoxidation and amino acid spectrum in patients with delirium after intramedullary osteosynthesis with ropivocaine epidural anesthesia

Introduction The pathogenesis of postoperative delirium, its causes, and factors contributing to its development remain a subject of debate. We consider it promising to study the dynamics of lipoperoxidation, cortisol levels and amino acid metabolism in patients with postoperative delirium. Such studies will reveal diagnostic and prognostic markers.The aim was to identify differences in the dynamics of lipoperoxidation, amino acid balance and cortisol levels in patients with and without delirium.Materials and methods A total of 41 patients who underwent surgery for a femoral fracture under epidural anaesthesia were included in the study. All patients underwent a daily test, the Confused Consciousness Assessment Method. If it was positive, delirium was diagnosed; thus, two groups were identified: with postoperative delirium (n = 12) and without delirium (n = 29).Results In the preoperative delirium group, there was a relative lack of glucocorticosteroids as measured by reduced cortisol levels (pU < 0.01) and inhibition of lipid peroxidation as reduced Schiff bases (pU = 0.01). There were no significant differences in amino acid metabolism of the major amino acid pools. The intraoperative period in both groups had similar characteristics and no significant differences. In the postoperative period inhibition of lipoperoxidation in the delirium group changed into its greater activation, which was revealed by increased levels of ketodienes and conjugated trienes in isopropanol phase (pU < 0.01). There was also an increase in the aromatic pool (pU < 0.01) due to an increase in large neutral amino acids (phenialanine, pU = 0.0, tryptophan, pU = 0.02, tyrosine, pU < 0.01) and a decrease in the aliphatic pool (pU < 0.01). Cortisol levels remained significantly lower in the delirium group (pU < 0.01).Discussion The preoperative decrease in the studied indices in the delirium group may indicate initial reductive stress. In the postoperative period, patients with and without delirium differ in their metabolic activity with respect to lipoperoxidation and amino acid metabolism, and cortisol levels remain significantly lower in the delirium group.Conclusion The development of delirium is facilitated by initial reductive stress and a tolerant adaptation strategy.

Bado III Monteggia in children - treatment options and outcome: an ultrasound control study.

The Bado III Monteggia lesion is an uncommon fracture in children. Radial head dislocation can occur due to intra- or extra-articular fractures of the olecranon. In extra-articular ulnar fractures, heterogeneous operative methods are proposed in different case reports. The objective of this study is to determine if closed reduction of the ulnar fracture, either without osteosynthesis or by using TEN, is a safe treatment option. In a multicenter study, we retrospectively analyzed 26 children who were treated for an extra-articular proximal metaphyseal ulnar fracture with dislocation of the radial head. These patients underwent a follow-up examination after an average of four years. The investigation included a physical examination, visualization of the elbow anatomy, and specifically, the radial head retention in the joint by ultrasound. Of the 26 patients, 18 were treated by closed reduction and intramedullary osteosynthesis (TEN), 7 were treated by closed reduction and cast immobilization without osteosynthesis, and 1 child was treated by open reduction of the ulna and plate osteosynthesis. In the follow-up examination, 25 children showed an excellent outcome, as well as inapparent sonography. Although this is a retrospective study with different types of treatment, closed reduction of the ulna with or without osteosynthesis appears to be effective. We believe that the correct primary reduction is the key to an excellent long-term outcome. Regarding the invasiveness of the treatment, reduction without or with TEN osteosynthesis should be the preferred approach in extra-articular pediatric Bado III fractures.

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.

Development of a camera-marker system (CMS) for locking nails during intramedullary osteosynthesis in large animals – First results

Abstract In large animals, fractures of the upper long tubular bones such as forearm and humerus as well as lower and upper leg, continue to represent a major surgical challenge. An implant and a corresponding surgical procedure for intramedullary osteosynthesis in fractures of long bones were developed at fzmb GmbH. Fixation of the implanted nail to the distal drill holes has proven to be difficult and requires a high level of X-ray monitoring. Therefore, a camera-marker system (CMS) was developed without the need for X-ray monitoring during drilling. The test was performed on 10 equine femora. The results showed that 8 of 10 implants could be securely fixed and no complications occurred in the experimental procedure. For the first two implants, the distal drill holes could not be hit in the first attempt. This is due to the circumstance, that the handling of the CMS needs to be practiced to hit the distal drill holes accurately and appropriately, resulting in a hit rate of 80 %. However, the described method has great potential and does not require X-ray exposure.

Analysis of the treatment of comminuted fractures of tubular bones of the extremities in cats and dogs

Surgical resolution of comminuted fractures of tubular bones is an urgent issue for practicing veterinarians. Comminuted fractures account for 52%, transverse fractures for 8.7%, oblique fractures for 26.1%, and compression fractures for 13.0% of total canine fractures. Thus, comminuted fractures of the tubular bones of the extremities are the most frequent. There are several types of bone fixation in comminuted fractures. Many authors do not recommend using of intramedullary osteosynthesis in the treatment of this type of fracture since it is not possible to connect all bone fractures. The aim of this study was to compare the methods of surgical treatment of comminuted fractures in dogs and cats admitted to the clinics and to choose the most optimal ways of treatment. In total, 4,396 cats and dogs were admitted to the clinic, excluding those admitted for vaccination. The surgical department received 35% of the total number of animals. Patients with bone and joint pathology accounted for 19% of all surgical causes and to 7% of all animals admitted to the clinic. In the group of 9 cats and 9 dogs three main types of fracture were diagnosed: transverse fracture in 6 animals (4 dogs and 2 cats), oblique fracture in 4 animals (3 dogs and 1 cat) and comminuted fracture in 8 animals (2 dogs and 6 cats). The article is illustrated with X-rays images of the clinical cases presented. In order to perform osteosynthesis using a single-plane bilateral external fixator, the authors injected 2-3 Kirchner spokes each into the proximal and distal bone fragments by drilling through the bone while perforating soft tissue on both sides. The ends of the spokes on both sides were bent towards the opposite fragment, parallel to the bone axis, at a distance of 1.0 to 3.0 cm from the skin surface. The ends of the spokes form the rods of a bilateral single-plane fixator. The rod-forming spokes are tightened with wire serrations on 3-4 levels and additionally fixed with fast hardening plastic (turbocast) or bone cement (Palacos, GMW, Osteobond) while controlling the fracture reposition. Combination with wire serclages, sutures, compression screw or intramedullary Kirschner wire osteosynthesis is possible.

Diagnostic Technique and Prevention of Compartment Syndrome in Closed Interlocking Intramedullary Osteosynthesis of Tibia

Diagnostic Technique and Prevention of Compartment Syndrome in Closed Interlocking Intramedullary Osteosynthesis of Tibia

Consolidation of experimental fractures during intramedullary osteosynthesis in rats using Collapan-L and Thymogen

The article presents the results of treatment of experimental femur fractures of laboratory animals (outbred rats) against the background of the use of a biocomposite material based on synthetic hydroxyapatite, collagen and lincomycin hydrochloride (collapan-L) and an immunotropic drug from the group of synthetic dipeptides (thymogen).During the experiment, biochemical, radiological and histological studies were carried out. It was shown that during the first week after the fracture, there were no significant changes in the groups. While for the period from 7 to 21 days (according to X-ray data), processes of reparative osteogenesis proceeded more intensively (on the 14th day) in the 1st, 4th, and 5th groups than it did in the control, and 2nd and 3rd experimental groups. These changes are consistent with biochemical blood tests. The radiographs obtained on the 28th day had no significant differences.On the 45th day after the surgery, the fibrocartilage callus forming in the group where both drugs were used simultaneously (thymogen ‒ immediately after the surgery) proceeded more pronouncedly compared to other groups. Thus, on radiographs, the fracture line was barely noticeable, which indicates more actively occurring processes of osteogenesis. These assumptions are also consistent with the level of calcium in the blood serum, as well as with histological studies. Thus, on the 45th day after the surgery, the fibrocartilage callus consisted of 60.2 ± 2.1% of bone tissue, which was 4.9% higher than in the control group and 9.39% higher than the impact of the mechanical factor (rupture resistance).Thus, the results of the studies on rats with experimental femoral fractures made it possible to establish that the combined use of the tested drugs contributes to a more intensive process of reparative osteogenesis (in the 4th experimental group).

Surgical treatment of elderly and senile patients with transtrochanteric fractures of the femur

+ The aim of the work was to analyze the functional results of surgical treatment in elderly and senile patients with transcavitary fractures depending on the method of osteosynthesis. Materials and methods. 134 elderly and senile patients with transtrochanteric fractures of the femur type 31A1.1-A1.3 according to AO/ASIF were examined (average age - 72.4±9.3 years). The patient underwent osteosynthesis with a DHS fixator, a PFNA rod and a Gamma nail according to indications. The functional result of the treatment was determined by radiographic signs of fusion, the Harris scale, and complications detected during the period of 1, 3, 6, and 12 months of examination. Results and their discussion. The functional result according to the Harris scale dramatically prevailed in the first six months after surgical treatment with intramedullary osteosynthesis. For the DHS fixator, the indicator improved from 29.8 points in the first month to 57.7 at the sixth month, for the PFNA rod - from 50.7 points to 76.9, and for the Gamma nail from 50.1 to 76.7, respectively. Consolidation of a transtrochanteric fracture in treated elderly and senile patients was observed in 83.33 % of cases after extramedullary osteosynthesis, and in 90.22 % of cases after intramedullary osteosynthesis. Complications of extramedullary osteosynthesis included instability of the fixator with migration and fracture of the fixator, during intramedullary osteosynthesis – migration of the cervical blade "cut-out" and fracture of the rod. Conclusions. The functional result in elderly and senile patients with transtrochanteric fractures after intramedullary osteosynthesis has advantages over extramedullary osteosynthesis. The results of the calculation of the Harris scale indicators, among which the evaluation of the restoration of gait, movements and resistance of the injured limb were decisive, are significantly higher in osteosynthesis with a Gamma nail and a PFNA rod in comparison with a DHS fixator. Complications that occurred in the three groups of the study coincide with the average international indicators and are not significantly low with intramedullary osteosynthesis. Improvement of surgical treatment methods is urgent and requires the search for complex treatment approaches in elderly and senile patients with transtrochanteric fractures

ANALYSIS OF SURGICAL TREATMENT RESULTS IN PATIENTS WITH FRACTURES OF THE TIBIAL BONES

Relevance: By frequency, tibial bone fractures rank second, accounting for 13% to 21.4% of all musculoskeletal injuries or 64.3%-70% of lower limb bone fractures. The nature of the injury is the result of high-energy trauma and is accompanied by severe soft tissue damage and a comminuted type of fracture. Temporary disability of patients with tibial fractures varies from 8-10 weeks to 5-7 months, and for complex fractures, it can reach 10-12 months. The purpose of the study was to conduct a comparative analysis of the treatment results of patients with tibial bone fractures and to evaluate the effectiveness of different methods of osteosynthesis. Material and methods: Depending on the method of operative treatment, the patients were divided into two groups. The experimental group included 113 patients, mostly with diaphyseal fractures of the tibial bones, who underwent surgery with the use of blocking intramedullary osteosynthesis. The control group consisted of 166 patients with tibial bone fractures who underwent intracortical or trans-cortical osteosynthesis. Results: The use of low-traumatic methods of stable fixation for the patients of the main group, the possibility of early functional rehabilitation, measures to prevent joint contractures since the first days, the possibility of early dosed loading on the operated limb ultimately led to faster healing of tibial fracture and a shorter overall treatment time. In the main group of patients, fusion was observed from 8 to 22 (11.56 ± 2.56) weeks, in the control group - from 12 to 36 (18.68 ± 4.70) weeks. The general treatment period for patients in the main group ranged from 8 to 22 (14.44 ± 2.85) weeks, while for the control group, it was from 13 to 43 (21.23 ± 5.38) weeks. Conclusion: The use of blocking intramedullary osteosynthesis has demonstrated its high effectiveness in the surgical treatment of patients with metadiaphyseal fractures of the tibia, allowing for positive treatment results in 96.66% of patients. The advantage of blocking intramedullary osteosynthesis is the biomechanically justified high stability of fixation and minimal invasiveness, which enables early mobilization in patients with fractures of the tibia bones (FTB) often experience a reduced quality of life and temporary disability, which can last from 8-10 weeks to 5-7 months or even up to 10-12 months for complex fractures. FTBs account for 13%-21.4% of all musculoskeletal injuries or 64.3%-70% of all lower limb fractures. The frequency of diaphyseal tibia bone fractures is 26-32 cases per 100,000 population. The injuries are typically the result of high-energy trauma and are often accompanied by severe soft tissue damage and comminuted fractures. The use of blocking intramedullary osteosynthesis has been shown to be highly effective in the surgical treatment of patients with meta-diaphyseal fractures of the tibia bones, with positive treatment outcomes in 96.66% of patients, providing biomechanically justified high stability of fixation and minimal trauma, allowing for early mobility and reducing the frequency of early and late postoperative complications.

Proximal femoral fracture with bony ankylosis of the hip joint : Case report of difficult surgical treatment

A78-year-old female patient sustained aleft-sided proximal femoral fracture due to a fall. Since childhood the patient had suffered from ankylosis of unknown origin in the ipsilateral hip joint. The recommended intramedullary osteosynthesis could restore the original status quo before the fracture. It needs less time in the operating room (OR) and includes a lower risk for intraoperative complications than a hip joint endoprosthesis. Arthroplasty can lead to asignificant improvement in mobility of the hip joint but requires more time in the OR for the surgical procedure and anesthesia time and includes ahigher risk for intraoperative and postoperative complications. The antetorsion angle of76° in this patient deviated extremely from the standard and made the intramedullary osteosynthesis for this type of fracture achallenge. Using improvised techniques led to aload-stable fracture treatment that ultimately led to asatisfactory result.

BIOMECHANICAL SUBSTANTIATION OF THE CHOICE OF THE METHOD FOR FIXING UNSTABLE FRACTURES OF THE PROXIMAL TIBIA

Aim: To justify the choice of a method for fixing unstable proximal tibial fractures (PTF), to conduct computer simulation of stresses on various metal fixators. Materials and Methods: at the initial stage, a solid 3D model of the lower leg has been created using Solid Works, on the background of anatomical models and CT scans. The model contained the following elements: tibia and fibula, interosseous membrane, ligaments of the proximal and distal tibia syndesmosis, and a modeled proximal tibial fracture. We have subsequently studied 4 models of bone fragments’ fixation with LCP plates and an intramedullary blocking metal rod. Further calculations were performed using the finite element method. Results: computer simulations of stresses on various metal fixators applied to fix a PTF convincingly proved that blocked intramedullary osteosynthesis (BIOS) and LCP plates placed bilaterally are feasible for this category of patients. Conclusions: Deformities and loads observed in the metal fixator, bone tissue and ligamentous apparatus run within normal limits. They are statistically significantly (p ≤ 0.05) lower in models of bone fragments’ fixation with IM nailing and bilaterally placed LCP plates. This evidences the adequate stability of bone fragments’ and these methods of osteosynthesis as a whole, compared to the stains in the same elements of modelled fixation using only one plate – medially or laterally. The results of the study may serve as the background for the development of an algorithm for surgical treatment and rehabilitation of patients with PTF.

Comparative characteristics of the regeneration of the femur bone of rats at intramedullary osteosynthesis using medical steel and carbon-carbon composite material

The aim of this study was to compare the morphological features of rat femoral bone regeneration during intramedullary osteosynthesis using medical steel and carbon-carbon composite material. Materials and methods. All animals were divided into two groups. A fracture of the thighbone was simulated by surgical intervention. In the first group, medical steel was used for intramedullary fixation of fragments; in the second group, fragments were fixed using a carbon-carbon composite material. The morphological, morphometric, histological, histochemical, immunohistochemical and X-ray methods was used, the bone regenerate was studied on the 30th day, 6 and 12 months after the surgical intervention. There were established expression of immunohistochemical markers CD-34 and Ki-67 using the ImageJ program. The statistical analysis of the obtained results was performed by the methods of variational statistics using the program Statistica 13.0. Results. In the group of animals where composite material was used, on the 30th day after surgery, a statistically significant increase in the expression of the relative area occupied by CD-34+ structures compared to the second group of animals was established (4.80 ± 0.40 in the group in which the composite material was used and 2.80 ± 0.30 in group in which the medical steel was used). Also a statistically significant increase in the expression of the Ki-67+ marker was established (5.20 ± 0.36 in the group in which the composite material was used and 2.48 ± 0.32 in group in which the medical steel was used). With inspection microscopy, faster rates of osseointegration and regeneration of the fracture site were observed in the group of animals in which the composite material had been used compared to the other group of animals due to the stimulation of vascular endothelium growth. The data of the histological examination coincide with the data of the X-ray examination at all the periods of observation. Conclusions. The use of carbon-carbon composite material during intramedullary osteosynthesis accelerates bone regeneration pace due to the angiogenic effect, which is confirmed by increase in the expression of markers of proliferative activity Ki-67+ and the marker of vascular endothelium CD-34+ in the group of experimental animals in 30 days.

Results of the surgical treatment of intra-articular fractures of the distal femur using a retrograde intramedullary technique

Background: Distal femoral fractures are a widely spread problem in traumatology, which can be caused by both a high-energy trauma and a low-energy trauma in senile patients with osteoporosis. The conservative treatment shows little promise. The surgical treatment of patients is still a challenge for orthopedic surgeons regarding both the technical aspect and a high risk of complications. There are several surgical methods with the use of plates and nails, but there is still no universal conception of the surgical treatment.
 Aim: comparative analysis of methods of intramedullary retrograde osteosynthesis and bone osteosynthesis in the treatment of fractures of the distal femur.
 Methods: In this study, we evaluated the treatment results of 46 patients who underwent osteosynthesis for intraarticular fractures of the distal femur using an intramedullary retrograde nail. The evaluation was carried out based on such parameters as the duration of the operation and the time from the moment of injury to the operation, the intraoperative blood loss and the function of the knee joint. On average, the operation time using a retrograde femoral nail was 45 minutes. Reducing the duration of the operation improved the functional results of the treatment. Reducing the operation time when installing a retrograde intramedullary nail was achieved with a relatively simple technique for installing this type of a fixator and the use of minimally invasive approaches.
 Results: On average, the operation time using a retrograde femoral nail was 45 minutes. Reducing the duration of the operation improved the functional results of treatment. Reducing the operation time when installing a retrograde intramedullary nail was due to a relatively simple technique for installing this type of fixator and the use of minimally invasive approaches. One year after the surgery, the following mean values were achieved: 78 (6485) points according to the KSS knee score, 85 (6889) points according to the KSS function score, 3.1 (1.34.2) cm for the severity of pain syndrome according to the VAS scale, 105 (88120) degrees for the flexion in the knee joint. However, a number of post-op complications were observed: deep vein thrombosis of lower extremities was found in 6 (13.1%) patients, formation of a false-joint was seen in 3 (6.5%) patients, 1st grade arthritis of the knee joint was detected in 36 patients (78.2%), 2nd grade arthritis was observed in 10 patients (21.8%). 3rd grade arthritis was not detected. 3.5 years after the operation, none of the patients needed a knee joint replacement.
 Conclusion: Retrograde intramedullary osteosynthesis in type C distal femoral fractures promotes early rehabilitation, a complete recovery of the knee joint function and healing of the fracture, and represents an effective method of treatment.

Comparison of the use of intramedullary telescopic system and titanium elastic rods in children with osteogenesis imperfecta I and III types

Comparison of the use of intramedullary telescopic system and titanium elastic rods in children with osteogenesis imperfecta I and III types