Treatment results were analyzed for 78 patients (2001-2008) with pyo-inflammatory complications after hip joint replacement. Implants were preserved in 7 patients. In the rest of patients implants were removed followed by sequestrnecrectomy of articular ends and neoarthrosis formation. Treatment tactics and principles of surgical intervention were described. Good and satisfactory results were achieved in 75.44% and 24.56% of cases, respectively. Presented methods enabled to achieve weight bearing ability of the extremity and contributed to the adequate rehabilitation of patients.
Aim. To study the results of treatment of patients with fractures of the humerus and their consequences, including those complicated by chronic osteomyelitis, by the method of biomechanically grounded transosseous osteosynthesis.
Materials and methods. A retrospective analysis of the results of treatment of fractures and pseudarthrosis of the humerus, including those complicated by chronic osteomyelitis, was carried out by the method of biomechanically substantiated transosseous osteosynthesis in 74 patients who were in the N.I. N.N. Priorov in the period from 2011 to 2019. Osteosynthesis with a rod-based apparatus was performed in 36 (48.6%) patients, with a spoke-rod in 38 (51.4%) patients.
Results. Complete consolidation of bone fragments of the humerus and relief of the purulent-inflammatory process were achieved in all cases studied. Excellent treatment results were achieved in 25 (34%) cases, good results were obtained in 44 (60%) patients, satisfactory results were stated in 4 (6%) patients. No unsatisfactory outcomes were registered.
Conclusion. The use of biomechanically based transosseous osteosynthesis in the treatment of fractures of the humerus and their consequences, including those complicated by chronic osteomyelitis, provided up to 94% of excellent and good results.
During the period from 2001 through 2012 one hundred forty eight patients (mean age 49 years) underwent surgical intervention for periprosthetic pyo-inflammatory complications. Removal of joint implant was performed in terms from 1 month to 25 years after total hip replacement. In 105 (72.4%) patients Girdlestone operation was performed after primary and in 43 (27.6%) — after revision arthroplasty. Removal of joint implant, hip fistulosequestrnecrectomy and weight bearing neoarthrosis formation was performed. For neoarthrosis formation in acetabular dysplasia and vast resection of proximal femur an external fixation device was used. Good results were achieved in 68 (70.8%) patients: inflammatory process was arrested and weight bearing ability of the limb was restored. Satisfactory result was observed in 28 (29.2%) patients. In 15 (15.6%) out of them inflammatory process was cupped off but no adequate weight bearing neoarthrosis was formed. Girdlestone operation is the last possibility to restore the weight bearing ability of the limb and is used in patients in whom revision arthroplasty cannot be performed.
Basing on the results of theoretical analysis and experimental studies, biomechanical characteristics (resistance to displacement) of clavicle fragments of various length were determined. With regard for obtained data the requirements and indications to the application of various osteosynthesis techniques (transosseous, epiosseous, intramedullar) in different types of fractures were formulated. Treatment of clavicular fractures and their sequelae in accordance with biomecha-nical conception of fragments fixation was performed in 223 patients. Long term results were evaluated in 178 patients. Excellent results were achieved in 135 (75.9%) cases, good - in 26 (14.6%), satisfactory - in 10 (5.6%) and unsatisfactory - in 7 (3.9%) of cases. The results of the study showed that at observance of all biomechanical principles of bone fragments fixation it was possible to improve the outcomes of clavicular fractures treatment and to reduce the rate of complications considerably.
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