Possibilities of the treatment for small-contact multiplanar osteosynthesis of lower leg fractures and methods of its implementation

Authors

  • P.I. Bilinskyi Bogomolets National Medical University, Kyiv, Ukraine,
  • Yu.P. Tsiura Bogomolets National Medical University, Kyiv, Ukraine,
  • O.P. Stetsenko Bogomolets National Medical University, Kyiv, Ukraine,
  • V.R. Antoniv Bogomolets National Medical University, Kyiv, Ukraine,
  • O.T. Sokolenko Bogomolets National Medical University, Kyiv, Ukraine,

DOI:

https://doi.org/10.22141/1608-1706.4.21.2020.212533

Keywords:

lower leg fractures, means of small-contact multiplanar osteosynthesis

Abstract

Background. Lower leg fracture is one of the most common injuries of the musculoskeletal system. Disability period during these injuries usually continues from 5 to 9 months, and results are unsatisfactory in the 22–45 % of cases. Important point of treating fractures of lower leg bones is osteosynthesis with biomechanically suitable devices. Objective: to optimize the means of small-contact multiplanar osteosynthesis for the treatment of lower leg fractures, to study the fixing capabilities of these fixators, to develop methods for their use. Materials and methods. We have improved the device for the fixation of bone fragments (patent of Ukraine No. 17502) in accordance with the anatomical features of the lower leg. Theoretical calculations using the finite element method were performed to determine the micromobility of fragments stabilized by a full-contact bone plate and the device for fixing bone fragments. The magnitude of micromobility of tibial fragments in transverse, oblique, and comminuted fractures was studied. Fixation of the fragment was simulated by putting 3–4 screws. In comminuted fracture, the fragments were additionally stabilized by 1–2 reposition screws. To study the elastic deformation of a three-dimensional body, three-dimensional models were created that reflected the most significant features of the geometry of the tibia, the device for fixing bone fragments, and the full-contact bone plate. Results. The treatment of tibial fractures is strictly individual. It was developed taking into account the obtained results of studying the micromobility of fragments, stress of structural elements of fixators and bone. This affected the formation of the structure of the device for fixing bone fragments, postoperative management of patients. In transverse and oblique fractures, we mainly use a design of the device with a plate on 8 apertures. Postoperative immobilization was not performed in the majority of patients. The time and magnitude of the dosed load on the operated segment was determined individually. If patient weighed up to 80 kilograms, the dosed load is allowed 1.5 months after surgery, and full, respectively, after 2.5–3 months. The criterion for the beginning of full load is sufficient development of the bone callus. At present, more than 460 patients with a fracture of the lower leg have been operated with a positive result. Conclusions. The results of studies on the size of the micromobility of fragments, the stresses of the structures of the fixators and the tibia confirm the significant functionality of the proposed tools for small-contact multiplane osteosynthesis of fractures of the lower leg, allowed developing effective methods of their application. They provide a good clinical result in diaphyseal fractures of the lower leg bones, improve the quality of life of patients, made it possible to avoid many complications typical of traditional osteosynthesis.

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Published

2020-08-01

Issue

Section

Original Researches