The increasing number of hip replacement surgeries in the worldwide practice causes the progressive increase in revision cases. The treatment of patients with instability of the hip implants requires the individual approach, taking into account the size of the defect, the loss of bone mass and the structural state of the bone in each case. Objective. To show the technical opportunities of the revision cementless implants in combination with 3D-modeling for the treatment of acetabulum massive defects. Methods. It was shown the clinical case of hip replacement surgery of the patient with the aseptic instability of endoprosthesis components. A 3D-model of the pelvis and femur was created on the basis of the СT scan in order to make an analysis of bone tissue defects and to select the exact size of implant components for revision surgery. Results. It was suggested a standardized methodology of the preoperative examination to make the high-tech operation easier and maximally effective. It is necessary not only to take into account the results of the X- ray analysis, but also to pay attention to all changes in the damaged segments. It was shown that the real plastic model make the work of the surgeon easier during all steps of the treatment. The opportunity to use the standard revision components for the restoration of the complex geometrically shaped bone was demonstrated with the good nearest clinical and radiological and functional results. Conclusions. The success of the revision arthroplasty depends on the carefully preoperative planning, the maximum approximation of the parameters of the artificial joint to the anatomical parameters of the patient and biomechanics of the hip join. No less important is the individual recovery program during the postoperative period.
Violation of femoral fracture consolidation after blocking intramedullary osteosynthesis is a fairly common pathology, and requires the attention of physicians due to its prevalence. There are several reasons for this complication: it is the instability in the system «bone-implant», and the untimely dynamization of the locking nail. Methods. This article presents a case of fracture violated consolidation after blocking intramedullary osteosynthesis caused a nonunion due to nail failure. Results. Patient was injured on 29.12.2018, as a result of a traffic accident. 01.15.2019, the surgery was performed: closed reduction, blocking intramedullary osteosynthesis of the fracture of the middle shaft of the right thigh, static fixation of the nail. Next visit to the clinic was on 02.01.2020, because of pain in the middle third of the thigh, problems with axial weight-bearing on the right leg, limitation of the flexion in the right knee joint. Control radiographs demonstrated no signs of consolidation of the femoral shaft fracture, and migration of the distal locking screw. 08.01.2020 revision surgical treatment was performed. Given the presence of 5 mutually perpendicular holes in the distal part of the nail, two of them were locked in the anterio-posterior view by the free hand method, the migrated screw in the distal part of the nail was replaced, and the nail was dynamized in the proximal part taking into account its design features. Conclusions. To normalize the consolidation processes in patients with nonunion femoral fractures, bone physiology and the positive effect of autocompression should be considered. The described case demonstrates the necessity for timely dynamization of the blocking nail, which confirms our own observations and literature data. Despite the fact that the dynamization of the nail was performed 1 year after blocking intramedullary osteosynthesis, fracture consolidation occurred 5 months after its implementation. Key words. Femoral fracture, blocked intramedullary osteosynthesis, disorders consolidation, dynamization of the construction.
Одеський національний медичний університет, Одеса, Україна УДК 618.718.45-001.5-089.84 Д. С. Чабаненко О. М. Полівода ВИБІР ДОЦІЛЬНОІ ТОЧКИ ВВЕДЕННЯ ІНТРАМЕДУЛЛЯРНОГО СТРИЖНЯ ПРИ ОСТЕОСИНТЕЗІ СТЕГНОВОЇ КІСТКИ Одеський національний медичний університет, Одеса, Україна Антеградний інтрамедулярний остеосинтез залишається «золотим стандартом» в лікуванні діафізарних переломів стегнової кістки вже декілька десятків років. Існує багато суперечок стосовно вибору точки введення стержня з наступними ускладненнями які можуть виникнути. Вважається, що оптимальною точкою введення є грушеподібна ямка вертлюгової ділянки стегнової кістки для центромедуллярних стрижнів , та верхівка великого вертлюга для цефаломедуллярних. Дослідження післяопераційних рентгенограм даної категорії хворих показало наявність кутових зміщень осі стегнової кістки пов′язаних із невірно обраною точкою введення інтрамедулярного стержня, та напрямком відкриття каналу проксимального уламка стегнової кістки. Недооцінка цих етапів призводить до варусного викривлення осі стегнової кістки з усіма наступними ускладненнями стосовно консолідаціі перелому.
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