Osteosynthesis Of Long Bones Research Articles

Infectious Complications after Osteosynthesis of Long Bones of the Lower Limbs: Clinical and Nosological Aspects

Summary. The number of complications in the treatment of bone fractures, including infectious ones, remains significant. Therefore, there is a need to carry out all measures aimed at improving the treatment results for this category of patients. Objective. The objective of our study was to determine the frequency and structure of infectious complications in patients after osteosynthesis of the long bones of the lower limbs depending on the location and type of osteosynthesis. Material and Methods. For our study, 140 cases of infectious complications after osteosynthesis of long bones of the lower limbs were analyzed. Results. An integral analysis of the distribution of the retrospective array of studies based on localization in the femur revealed that the infectious process is most often localized in patients with 32B hip fractures. This type of damage was observed in 29.0% of patients of the general array, where it took the first place. Infectious complications after plate osteosynthesis also prevailed, but were detected less often, in 21.2% of cases. Among the patients after blocking intramedullary osteosynthesis, 32B was detected in more than half of the cases, which is 2.5 times more often than among the patients with plate fixation. Similar results were found in patients with damage to the shin. Conclusions. The results of the analysis indicate that in cases of infectious complications after osteosynthesis of the bones of the lower extremities, damage to the diaphyseal part of the hip was detected most often. This indicates that the development of infectious complications was significantly influenced by the patient’s condition and the intervention performed.

Метаболизм соединительной ткани у больных с гнойными осложнениями после остеосинтеза отломков длинных костей

Остеосинтез (osteosynthesis; греч. osteon (кость) + synthesis (соединение)) — это хирургическое соединение отломков костей в правильном положении с целью стабильной фиксации до полной их консолидации (костного сращения) и восстановления целости и функции кости. Обследовано 34 больных в возрасте 17–58 лет с гнойными осложнениями после остеосинтеза при переломах длинных костей, в том числе у 29 мужчин и 5 женщин. В сыворотке кpови больных определяли следующие биохимические показатели: активность коллагеназы, фpакции гидpоксипpолина, гликозаминогликаны, кальций, фосфор и электролиты (Na+, K+, Ca++).Результаты исследования показывают, что у больных с гнойными осложнениями после остеосинтеза длинных костей при рецидиве воспалительного процесса усиливается катаболическая фаза метаболизма основных компонентов органической основы костной ткани. Об этом свидетельствуют показатели, отражающие синтетическую и катаболическую фазы метаболизма основных компонентов соединительной ткани — коллагена и гликозаминогликанов. Данные, полученные при исследовании минерального обмена, отражают нарушения минерализации костной ткани, что подтверждается показателями содержания общего кальция, ионизированного кальция, фосфора и электролитов.

Complications of Intramedullary Blocking Osteosynthesis of Bones of Limbs and Ways to Prevent Them

Summary. The main condition for preventing complications of intramedullary blocking osteosynthesis of long bones is following the tactical and technical principles of osteosynthesis and conscious rejection of such surgical techniques and manipulations that can lead to disturbances of the course of reparative processes of bone tissue. Objective. On the basis of the study and summary of the identified complications of intramedullary blocking osteosynthesis of diaphyseal fractures of bones of limbs, to determine ways to prevent complications of the reparation. Materials and Methods. The results of treatment of 403 patients who underwent intramedullary blocking osteosynthesis of the femur, tibia and humerus types A1-A3, B1–B3 and C2 by AO/ASIF were studied and analyzed. Results. Analyzing the technological complications that we have divided, depending on the consequences they led to, early (up to 2 weeks after surgery), late (2 weeks after surgery) and reparative, we found that the most common technological mistakes were incorrect preoperative planning and disruption of technology and surgery, which in 21.6% of cases led to instability of bone fragments in the fracture area, and the absence or disruption of recovery and rehabilitation of patients, which occurred in 26.3% of cases. Disorders of osteosynthesis technology, namely, significant intra-operative traumatization of bone fragments and soft tissues, and non-eliminated soft tissue interposition resulted in inappropriate consolidation of bone fragments in 39% and 13%, respectively. The main cause of reparative complications was bone marrow drilling, which was performed for 56% of the patients with delayed consolidation of bone fragments, 56.3% of the patients with false joints, and 48% of the patients with bone fractures. Conclusions. Strict following the tactical and technical principles of intramedullary blocking osteosynthesis and rejection of bone marrow drilling without indications will reduce the incidence of bone dysregeneration. The study of the effect of bone marrow drilling on reparative bone regeneration in intramedullary blocking osteosynthesis is actual and needs further deep analysis.

DOES THE TERM OF DEFINITIVE OSTEOSYNTHESIS OF MULTIPLE LONG BONE FRACTURES OF LOWER EXTREMITIES IMPACT ON TREATMENT OUTCOMES IN POLYTRAUMA PATIENTS

The aim: to determine the timing impact of definitive multiple long bone fracture osteosynthesis of lower extremities on complications development, duration of Mechanical Ventilation (MV), Length of Stay in Intensive Care Unit (LOS-ICU), Hospital length of Stay (H-LOS) in patients with polytrauma treated according to Damage Control Orthopedics (DCO). Materials and methods: a prospective controlled non-randomized trial in parallel groups conducted in polytrauma department of Kyiv City Clinical Hospital No. 17 from February 2016 to January 2020, which included 107 adult patients with polytrauma, multiple long bone fractures of lower extremities, one of which femur treated according to DCO. The patients were divided into two groups: Group I included 51 patients who underwent definitive osteosynthesis of long bone fractures of lower extremities after patient condition stabilization ≥24 hours ≤5 days; Group II included 56 patients who underwent definitive osteosynthesis of long bone fractures of lower extremities during the period >5 days after injury. Results: there were no statistically significant differences between Group I and Group II patients in demographics, injury mechanism, trauma severity and general patient condition. Group I patients who underwent osteosynthesis from 2nd to 5th days after injury had lower pneumonia incidence, compared to Group II patients (17.6 % vs. 26.8 %, p=0.047), shorter MV duration (9.3±6.9 vs. 14.9±9.1, p=0.048), ICU-LOS (13.5±8.3 vs. 19.1±11.0, p=0.037), and H-LOS (30.3±13.9 vs. 38.9±15.5, p=0.046). Conclusion: performing definitive multiple fracture osteosynthesis of lower extremity long bones after polytrauma patient stabilization from 2nd to 5th days after injury allowed to reduce the frequency of pneumonia, shorten the duration of MV, LOS-ICU and H-LOS, compared with its implementation after 5th days

Нові можливості в діагностиці імплантат-асоційованої інфекції

Summary. Despite the improvement in the quality of implants, the number of complications in traumatology and orthopedics, which lead to infection, remains high. It is proved that untimely prescription of adequate antibiotic therapy for implant-associated infections can cause progression of the septic process until the development of shock and multiorgan failure and on practics leads to the development of resistance microorganisms to antibacterial drugs. An important point is to study the pathological microbial communities (bacterial film) in traumatology and orthopedics. All "classic" tests and markers of the infectious processhave low specificity and are not reliable enough for accurate diagnosis. These features are forced to development of additional microbiological diagnostics: the study of the destruction of the biofilm, which is removed from the implant surface with the help of ultrasound. The purpose of our study was to determine the effectiveness of the microbiological tests with sonication in patients with infectious process after osteosynthesis of long bones. Materials and Methods. Microbiological studies of the pathologically altered tissue biopsies directly at the implant and implant sonicates from the implant for osteosynthesis from 31 patients with chronic osteomyelitis or surgical site infection were performed. Results. As a result, the significant sonication efficiency was discovered: a 25.8% increase in positive results, 6.5% of E. aerogenes and E. faecalis cultures in association with S. aureus were isolated. Conclusions. Further improvement of the method and its application in specialized departments can give a positive diagnostic effect, which will subsequently improve the results of patient treatment.

Evaluation of Wear of Milling Cutters for Drilling of Nail Holes Used for Osteosynthesis of Long Bones of Lower Limbs

Abstract This paper deals with wear of intramedullary milling cutters for the drilling of nail holes used for osteosynthesis of lower limbs long bones. After the physician’s complaints about the increasing resistance and total change of its properties that are caused by the reuse the instrument, we have designed a suitable methodology to verify and quantify this problem. The experiment was carried out on three types of milling cutters, differing in their diameter. Using statistical tests, we compared pressure force and torque before and after wear.

Результаты спектрального анализа удаленных сломанных имплантов после остеосинтеза длинных костей конечностей

Introduction Along with expansion of the types of metal implants and indications to osteosynthesis with their application, contemporary operative traumatology continues to meet with such a complication as metal fixator breakage. The frequent cause of fixator failure is an incorrect osteosynthesis or an improperly chosen implant. Quite often, the cause of the complication remains unknown. The purpose of our study was to establish the need for spectral analysis in assessing the cases of metal fixator collapse after osteosynthesis of long bones as well as to determine the rate of the composition defects of the implants used for osteosynthesis of limb bones. Methods We performed a spectral analysis of 16 broken implants extracted from 15 patients operated on in Semashko Hospital, State Hospital No. 17 and State Hospital No. 68. The group included metal implants for both intra- and extramedullary osteosynthesis. Results Of the 16 implants studied, five (31.25 %) complied completely with the requirements of the standard, two stainless steel and three titanium metal implants among them; eleven implants (68.75 %) did not meet the international standards. Discussion In a number of cases (for example, with stainless steel implants) the deviations were significant; variability of the alloys was also noted in titanium implants. Because these deviations in composition may play a role in the destruction of metal fixators, we believe that such a study as spectrography should be recommended for the analysis of cases of implant breakage.

Principles of immune correction of infeсtious complications following osteosynthesis of long bone

The objective: was to study the state of the immune system, analyze the dynamics of the parameters of immunological defense, evaluate the effectiveness of complex treatment with the inclusion of immunomodulating drugs to correct changes in immune defense, optimize the treatment of infection after osteosynthesis due to additional differentiated pharmacological immunocorrection.Materials and methods. 157 patients (113 men and 44 women) with infectious complications after osteosynthesis of long bones were examined. 78 of them had posttraumatic, and in 79 – postoperative osteomyelitis. Osteomyelitis of the femur was noted in 50 patients, tibia osteomyelitis – in 92 and upper limb – in 15 patients.Results. Multifactorial disorders in immune defense are established. It was found out that practically all immunotropic drugs that were used to treat patients with purulent complications after osteosynthesis of long bones showed to some extent a positive effect in terms of correcting the revealed disorders.Conclusion. The presented data became the basis for recommendations on the use of immunomodulating drugs for the prevention and treatment of purulent complications in patients after osteosynthesis of long bones, as well as for stimulation of reparative processes in violation of the rates of bone tissue regeneration.

Results of limb reconstruction system in failed osteosynthesis of long bones

<p class="abstract"><strong>Background:</strong> The LRS is an excellent option treating the failed osteosynthesis in long bone fractures, because of failure in healing due to loosening of implant, infection, nonunion, poor bone quality and bone loss associated with deformities, limb length discrepancy, soft tissue problems, functional and financial issues.</p><p class="abstract"><strong>Methods:</strong> we prospectively treated 30 cases of failed osteosynthesis of long bones (7 plating, 22 nailing & 1 k-wire with plaster) between April 2009 to October 2015 with LRS. Initially we managed by implant removal, freshening of fracture site or radical debridement followed by LRS application.<strong></strong></p><p class="abstract"><strong>Results:</strong> Union occurred in 93% cases. The eradication of infection was seen in 96.5% cases. Average lengthening done was 4.2 cms. We had 93% excellent and 7 % poor bony result. Functional result was excellent in 45%, good in 48% and failure in 7% cases using ASAMI scoring system.</p><p class="abstract"><strong>Conclusions:</strong> LRS is an excellent option in the management of failed osteosynthesis especially associated with infection, nonunion, deformities, limb length discrepancy, soft tissue problems, functional and financial issues and also where re-osteosynthesis is challenging with poor bone quality and bone stock. It is simpler technically, patient friendly and short learning curve.</p>

The use of intramedullary telescopic fixateur for osteosynthesis of long bones of the lower limbs in children with osteogenesis imperfecta

Osteogenesis imperfecta (OI) is a heterogeneous pathology which is accompanied by the development of multiple fractures and deformi­ties of the long bones of the extremities. Objective: to present out­comes of surgical treatment in patients with OI using intramedullary telescopic fixateur (ITF). Methods: 9 patients with bone deformities of the extremities due to OI were operated (4 boys, 5 girls aged 1,5–11 years). Correction was performed with using of percuta­neous semi-open osteoclasia on top of deformity. Bone fragments were fixed by means of ITF developed by authors which provides bone elongation during growth. After surgery we used an orthosis for external fixation. Rehabilitation envisaged work out active and passive movements in joints of the operated extremity, exercises for increasing of muscle strength, and hydrokynesiotherapy. Control checkups (clinical and radiological examination, determination of active movements in joints and muscle strength of the lower limbs) were performed every 3–4 months. Outcomes were assessed by FAQ Ambulation Scale. In all patients there were found consolidation of fragments in the area of osteotomy, preservation of achieved axial correction of parameters in lower extremities, increasing of active movements in hip and knee joints. Bearing-kinematic function of the lower extremities grew on 5 classes, and in two cases — on 7 ones. Improvement of functional class according to FAQ Ambula­tion Scale was found in 4 patients. In 6 patients which were not able to walk before surgery an ability for vertical standing and walking appeared. Conclusion: The proposed ITF provides restoration of anatomical axis of a limb, function of walk and bearing capacity in lower extremities, early start of the rehabilitation period, reduction of the percentage of complications, and also reduces the need for repeated surgeries, prevents the progression of deformation and a nascence of secondary fractures of long bones.

Effect of therapeutic ultrasound on bone healing and blood bone markers in dogs with experimental tibial osteotomies

Experimental tibial osteotomy was performed in 24 dogs, fixed by either intramedullary (IMO; n = 12) or plate and screw osteosynthesis (PLO; n = 12). Six dogs with IMO and another six with PLO were subjected to daily therapeutic ultrasound therapy at the site of osteotomy for 10 days, starting from the first post-operative day. The other dogs served as controls. Radiological studies were performed immediately after surgery, by week 2 and months 1, 2 and 3. Blood markers of bone formation (bone alkaline phosphatase and osteocalcin) and bone resorption (tartrate-resistant acid phosphatase and C-terminal telopeptide of collagen type I) were assayed before surgery, by post-operative weeks 1 and 2 and months 1, 2 and 3. Therapeutic ultrasound had a beneficial effect on bone formation, bone union and bone resorption. Blood bone alkaline phosphatase exhibited a very high activity as early as weeks 1 and 2, statistically significant compared to controls. Osteocalcin levels were also significantly higher in periods of bone callus mineralization (month 1). From bone resorption markers, only acid phosphatase was increased in the IMO group treated with ultrasound, while C-terminal telopeptide concentrations did not change over the experimental period. It could be concluded that therapeutic ultrasound could be used as a physical adjunct to assist and stimulate early post-operative healing after osteosynthesis of long bones in dogs.

Modern approaches to anticoagulation therapy in patients after joint arthroplasty and intramedullary osteosynthesis of long bones of extremities. Clinical experience of using «Xarelto®»

The efficacy of Rivaroxaban («Xarelto®») for preventing venous thromboembolism during the early postoperative period and outpatient treatment stage in patients after hip joint (70 cases) and knee joint (30 cases) arthroplasty, as well as intramedullary osteosynthesis (150 cases) for fractures of long bones of extremities, was assessed. The drug was used at a dose of 10 mg once a day, starting from 6–10 hours after the operation and up to 35 days. A high efficacy and safety of Rivaroxaban («Xarelto®») was revealed. An allergic response was registered in one patient.

Microplacas de titânio em fraturas de tibiotarso em pombos domésticos

Entre os problemas cirúrgicos das aves, as fraturas são os de maior prevalência. Em virtude das variações no tamanho, peso, anatomia óssea peculiar, alta incidência de fraturas complicadas e das diferentes demandas funcionais entre espécies e indivíduos, não foi possível estabelecer ainda um método ideal de osteossíntese para os ossos longos das aves. Microplacas de titânio comumente utilizadas em cirurgias maxilofaciais de humanos foram empregadas recentemente na osteossíntese de aves, porém com poucos resultados disponíveis. O objetivo do presente estudo foi avaliar a utilização das microplacas de titânio no tratamento de fraturas experimentais de tibiotarso em pombos domésticos (Columba livia). Foram utilizadas 30 aves adultas, machos e fêmeas, com 7 meses de idade, pesando entre 400 a 500 gramas. Os animais foram separados em três grupos de dez, sendo que no grupo 1 foi utilizado uma microplaca de titânio com 6 furos e espaçador central; no grupo 2, com oito furos sem espaçador central; e, no grupo 3, com oito furos com espaçador central. Após avaliação clínica, as aves foram submetidas à osteotomia médio-diafisária no tibiotarso direito para colocação das diferentes configurações de microplaca de titânio, sendo fixadas com microparafusos de titânio com 7mm de comprimento. Os animais foram avaliados clínica e radiograficamente até os 90 dias de pós-operatório. Após esse período, foi realizada eutanásia em duas aves de cada grupo. Em todas elas, foi observada a consolidação óssea, sendo que, no grupo 1, o tempo médio e o desvio padrão foram 32,9±9,9; no grupo 2, 30,8±6,7 e, no grupo 3, 26,6±6,4 dias, não havendo diferença estatística entre os grupos. O envergamento do implante foi a complicação mais frequente. A configuração da microplaca resultou em diferença estatisticamente significativa em relação à deambulação e ao grau de envergamento nos diferentes grupos, sendo que, no grupo 3, houve maior precocidade no apoio do membro e menor grau de envergamento em relação aos outros grupos. Histologicamente, foi verificada a formação de calo ósseo em todos os animais e presença de tecido ósseo ao redor da microplaca e dos microparafusos. Apesar das complicações observadas, as microplacas de titânio são uma opção para osteossíntese de tibiotarso em aves de médio porte.

Morphological characteristics of the early stages of the reparative process during the replacement of skull bone defects by the method of dosed distraction (communication II)

Substitution of skull defect by transfer of vascularized or free bone grafts within the defect was investigated in 131 dogs. It was shown that distraction regenerate formed in the diastasis from both the side of fragment and the defect margin from which the fragment was transferred. On the day 7 of distraction the bone trabeculae oriented along the fragment transfer were formed. Distraction bone regenerate acquired zone structure in which two bones areas and connective tissue layer -growth zone- were distinguished. During 3 weeks observation period the areas of active osteogenesis were noted on the border of the connective layer and bone segment, and structural remodelling of the newly formed bone took place. Similar time-dependent process as well as the regenerate structure were described during distraction osteosynthesis of long bones. Regenerate process was more marked when vascularized bone fragment was transferred within skull defect.

Surgical tactics in concomitant injury of the skull and lower extremities

The treatment results of 31 patients with severe craniocerebral injury in combination with the extremity fractures (mainly femur and shin) are analysed. In 13 patients the osteosynthesis of long bones was performed within 3 days after injury and in 8 patients the fractures of the extremities were treated conservatively. Early 1-3 days osteosynthesis is shown to be performed on a more favorable metabolic level and contributes to the normalization of the disturbed correlation of the lipid peroxide oxidation and antioxidation system. Early stable osteosynthesis of the extremity fractures enables to improve the efficacy of the craniocerebral injury treatment and to prevent hypostatic complications, to shorten the terms of hospitalization (by 36% in comparison with later osteosynthesis) as well as the rehabilitation period. When no contraindications exit the osteosynthesis in this group of patients should be performed within 1 to 3 days after injury.

Study on a mechatronic tool for drilling in the osteosynthesis of long bones: Tool/bone interaction, modeling and experiments

Among the few motorized procedures used in orthopaedic surgery, drilling is surely the most common. Current drilling tools do not include any means for the control of the penetration and only radiographic control and/or a surgeon's manual skill are used to arrest the penetration of the drill when the hole is completed. Late detection of bone/soft tissue breakthroughs can cause unnecessary damage to the patient. New mechatronic drills making use of cutting force information could be used to assist the surgeon during the intervention. The goal of the experimental study reported is to develop and validate experimentally a model for the description of breakthroughs during the penetration of long bones. Such a model can be used for real-time detection of breakthroughs and be included in a mechatronic drill. Experimental results of drilling trials on fresh animal long bones are presented.