Tactical and technological features of the treatment for damages to the distal metaepiphysis of the femur
Background. It is known that serious damage to the distal metaepiphysis of the femur often occurs in two categories of patients: in young people as a result of a high energy injury or in women of older age groups against a background of osteoporotic changes in the bone structure when falling to the knee. Despite the intensive development of traumatology and the latest development of the AO, the analysis of information sources indicates the lack of a unified concept for the treatment of injuries of the distal metaepiphysis of the femur, since recommendations regarding approaches and treatment technologies are controversial. Ideal conditions for obtaining high results when treating fractures of the distal femur can be created by internal fixation methods, provided that there is no further need for additional immobilization and the creation of conditions for early mobilization of the knee joint. However, in practice, the possibilities for performing optimal and reliable internal osteosynthesis are not always available: severe traumatic destruction of the epiphysis of the femur (type C fracture) and osteoporotic changes in the bone structure can significantly affect the quality of fixation and require the use of more flexible and adaptive treatment in each case. The purpose was to optimize approaches to the treatment of fractures of distal metaepiphysis of the femur. Materials and methods. The material for the study was the results of treatment in 44 patients with fractures of the distal femur, of both sexes and different age groups. In the treatment, internal fixation (16), external fixation (14), skeletal traction (9) and fixation method (5) were used. The results were evaluated using the score system developed by prof. S.D. Tumian. Results. Analysis of the results led to the conclusion that in a number of clinical situations (severe traumatic destruction of the distal femur and osteoporosis), there are no prospects for obtaining good anatomical and functional results when using internal fixation, with a high risk of severe irreversible complications. Methods of extrafocal osteosynthesis can largely serve as an alternative to internal fixation. Conclusions. Archaic technologies of skeletal traction and external immobilization are still in demand and find their place in the treatment of fractures of the distal femur metaepiphysis in the medical space of Ukraine.
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