Semi-rigid individual stage functional bandages in distraction osteosynthesis of a tibia following fractures
Existing methods for fixing fragments in fractures of long bones have different properties. Certain characteristics are indications for the preferential use of different methods in some individual situations. During the treatment, the conditions of fixation are changing. Changing requirements within the treatment of the nonunion makes the transition from one species to another optimal — the so-called conversion osteosynthesis. The duration of treatment for nonunion of the tibia with a defect of bone tissue and plastics with distractive regenerator by Ilizarov provides the basis for the application of the low-traumatic methods of fixing fragments with external bondages at the final stages. The authors present the results of the treatment of 36 patients with tibia nonunion, who have applied the Scotch system following the surgical intervention (segmental resection of the tibia and replacement with the distractive regenerator by Ilizarov) to prevent deformation of the regenerator after dismantling of the external fixation union by Ilizarov and to begin the full-fledged tibia function. The use of a semi-rigid individual Softcast/Scotchcast locking system made it possible to achieve stability and the opportunity to start functional loading at an early stage. Free knee and ankle joints made it possible for them to function fully. The muscular atrophy was prevented, blood circulation conditions — outflow through veins were improved. As a general result, the results of the rehabilitation of patients with tibia nonunions after fractures are improved. The combination of rigidity (Sсotchcast) and elasticity (Softсast) in the system of semi-rigid fixation with polymeric materials enables the circular rounds of Softcast to change its shape. given this, the authors proposed a method that provided the possibility of pneumatic massage at the immobilization stage of treatment. The results of treatment of the victims with tibia nonunion after fractures were evaluated using the Modified Functional Evaluation System by Karlstrom-Olerud. No complications caused by the proposed complex treatment were observed. The volume of the medical complex and the possible prediction of the obtained results were carried out with the use of predictors of the Non-Union Scoring System — NUSS scale. The results obtained were determined using the Karlstrom-Olerud anatomical-functional scale. Poor results account only for 5.6 % (2 observations); good and excellent — 63.8 % (23 patients). The result is considered as good, regarding the most observation characteristics (which are required by NUSS) for specialized therapies, complex specialized medical care with a possible positive result.
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