Treatment of diaphyseal fractures of the humerus using locking intramedullary nailing in the conditions of regional intensive care hospital of Mariupol
Background. Fractures of the diaphysis of the humerus are very common in the structure of trauma, they makes up from 3 to 7 % of cases in the structure of all fractures. Currently, one of the most effective techniques of osteosynthesis corresponding to modern requirements is a method of intramedullary nailing, which ensures the stability of bone fragments, minimally invasive procedures and capacity to provide an early load that significantly affects the processes of reparative regeneration and restoration the function of the injured limb in the shortest time. Materials and methods. The analysis of treatment of 38 patients with diaphyseal fractures of the humerus and their consequences was carried out. Thirty two of them were operated by the locking intramedullary nailing. The intramedullary constructions, such as Charfix ChM (Poland), IRENE Osteonano (China), Medimetal (Hungary), XERONG Best (China), were used. The average age of patients was 36 years old (22–67 years). There were 17 men and 21 women. Localization of the shoulder fractures: in the upper third — 9 patients, the middle third — 12, the bottom third — 17. Current closed fractures of the humerus were operated using the locking intramedullary nailing in 30 (79.95 %) patients, with the help of the external fixsacion — in 3 (7.89 %) persons. Surgical intervention was carried out in the period from 3 to 17 days from the date of injury in fractures and between 5 and 8 months — in the presence of disorders of reparative osteogenesis. The open reduction was used in 9 (28.12 %) patients, closed — in 23 (71.88 %). The antegrade method of introduction of the intramedullary fixator was used in 23 (71.86 %) cases and retrograde — in 9 (28.14 %) cases. Results. In 2 patients in the post-operative period after osteosynthesis for acute humerus fractures, the neuritis of the radial nerve appeared that was completely eliminated after conservative treatment. Complications in the process of technical implementation of the locking intramedullary nailing: difficulties in the distal block; difficulties with the introduction of the rod (often through the narrow channel of the humerus); complexity of closed reduction (usually using bone interposition); fixing the limb with a rotary displacement. The fixation on the slight squint bandage was performed. On day 2–3 after surgery the active and passive motions started in joints of the operated limb. Full load was allowed from weeks 12–14 after surgery. Removal of the metal structures was recommended in 14–18 months. In all 33 (91.10 %) treated patients, the results of treatment were regarded as good, 5 patients reported contractures in the adjecent joints and local neurotrophic disorders in a long-term presence of edema. Conclusions. The use of locking intramedullary osteosynthesis allows to optimize the timing of consolidation, to improve outcomes and quality of the patients’ life during treatment and is the method of choice in surgical treatment of diaphyseal fractures of the humerus. To achieve good results of treatment, it is necessary to observe clear indications for the use of the method; to properly select the steel constructions and follow the recommendations of the specific manufacturer of the implant. The use of locking intramedullary nailing has proven to be highly effective in the surgical treatment of patients with diaphyseal fractures of humeral bone and allowed to obtain positive results of the treatment in 91 % of patients.
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