Treatment of diaphyseal fractures of the bones of the lower extremity by using BIOS method in polytrauma
Keywords:tibial fracture, femoral fracture, blocking intramedullary osteosynthesis
Background. Fractures of the diaphysis of the tibia and femur are quite common. Their share reaches 15.3 % among injuries of the musculoskeletal system with polytrauma. Treatment of patients with polytrauma requires the use of minimally invasive methods for stabilization of bone fragments with the aim of early activation of the victims and the creation of convenience in conducting additional examinations if it necessary. The purposе was to study the results of surgical treatment for diaphyseal fractures of the tibia and femur in patients with polytrauma by using blocking intramedullary osteosynthesis. Materials and methods. Analysis of treatment outcomes was performed in 51 patients with fractures of the femur and tibia when using blocking intramedullary osteosynthesis. Femoral fractures were detected in 25 people, tibial fractures — in 26. The average age of patients was 34 years. According to the AO classification, 5 individuals had type A femoral fractures, 15 — type B, and 5 — type C. Type A tibial fractures were detected in 6 patients, type B — in 16, type C — in 4. Surgery using blocking intramedullary osteosynthesis was carried out in the period from 1 to 7 days after the injury and was guided by damage control. All operations were performed using Philips image intensifier. Antegrade method of introducing an intramedullary rod was used. External immobilization was not used after surgery. Activation of patients with femoral fractures was started from days 4–7, and with tibial fracture — on days 2–3 after surgery. Full load has been allowed 10–12 weeks after surgery. Removal of metal structures was carried out no earlier than 14–18 months after surgery in the presence of X-ray signs of fracture consolidation. Results. The criteria for evaluating treatment outcomes were: timely fracture healing, segment deformation, segment shortening, fracture or migration of metal structures, limitation of joint movements, neurotrophic disorders, infectious complications. Treatment results had been observed up to 24 months after surgery. Good results were obtained in 47 patients. In 5 individuals, the treatment outcomes were considered satisfactory. In 3 patients, the results of treatment were unsatisfactory. Changing the methods of treatment for transosseous osteosynthesis by G.A. Ilizarov technique made it possible to achieve fracture healing, to eliminate the deformation of the segment. The purulent-infectious complications were eliminated after removal of the metal structure and fistulonecrectomy. Conclusions. Using the method of blocking intramedullary osteosynthesis allows optimizing the timing of the rehabilitation of patients with polytrauma and achieving good and satisfactory results in up to 94 % of cases.
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