Limited-contact multiplanar osteosynthesis of the periprosthetic femoral fractures

P.I. Bilinsky, V.A. Andreychyn, O.V. Drobotun

Abstract


Background. The number of hip joint endoprosthesis is constantly increasing, and accordingly, the growth of periprosthetic femoral fractures (PFF) is noted. The last ones occur during the arthroplasty (up to 11.2 %), in the postoperative period (3–5 %), and also in the revisional prosthesis (0.8–2.3 %). The purpose of the work was to analyze the existing methods of complicated PFF treatment, and also the means for their implementation, the development of biomechanically based fixator, the identification of its functional capabilities. Materials and methods. We had modified the design of the universal device for fixation of bone fragments (DFBF) developed by us (Patent of Ukraine No. 17502). This fixator with a positive result was applied in 140 cases of PFF. And in fractures of osteoporotic femur, the DFBF that we developed is a tool of choice. DFBF ensures the stable fixation of fragments, eliminates the pressure of the plate on the bone, provides certain micromotion of the fragments that optimizes the course of reparative regeneration. Osteosynthesis with our device allows you to carry out the full load of the postoperative limb in 3.5–4 months. Results. There are 7 interesting clinical observations of the successful use of DFBF in PFF complicated by osteoporosis with somatic pathology. In oblique femoral fractures, when it is possible, repositional osteosynthesis with screws is performed. Such osteosynthesis contributes to restoring the bearing capacity of the damaged segment. The management of patients with osteoporotic fractures in the postoperative period requires special attention. The load of the damaged limb should not be a criterion for the effectiveness of treatment. It is necessary to pay attention to joints, they mainly provide mobi-lity of patients with a sufficiently stable fixation of fragments. In the absence of cement in the bone marrow channel, surgical intervention may be much easier. For stable osteosynthesis at the level of the prosthetic leg, you need to place 4 semicircles. The final stabilization of the DFBF segment on 13–14 holes ­using 5–6 semicircles will ensure the stable fixation of the fragments. Practice has shown that a stable osteosynthesis of osteoporotic bone fragments with contact fixators is difficult enough. Pressing the plate to the bone when tightening the screws often leads to new fractures. The DFBF developed by us, due to the absence of plate pressure on the bone, conduction of screws in different planes can provide stable fixation of osteoporotic fragments, optimum course of reparative regeneration. Conclusions. So, for complicated femoral fractures, it is necessary to restore the stability of the prosthetic leg, to create conditions for the union of bone fragments. This can be provided by our DFBF. It allows choosing the most optimal design for a particular biomechanical situation. Successful use of the device in 140 cases of PFF makes it a method of choice, even with complicated fractures.


Keywords


limited-contact multiplanar osteosynthesis; complica-ted periprosthetic fractures; femoral bone; surgical treatment

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DOI: https://doi.org/10.22141/1608-1706.1.19.2018.126666

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