Comparative characteristics of osteosynthesis techniques in patients with comminuted diaphyseal femoral fractures

Objective. To study the characteristics and healing duration of the diaphyseal femoral fractures, depending on the technologies used for osteosynthesis and the time between trauma and osteosynthesis. Methods. The study was performed on bred dogs (n=24). In the operating theatre all animals were modeled the transverse fracture of the femoral diaphysis in the middle third using a chisel. The animals were divided into 4 groups (6 per group). Animals of group 1 (one hour after the fracture) underwent transosseousosteosynthesis with a pin-rod external fixation device (PREF). In group 2, PREF was performed on the fourth day after the injury. In group 3 (one hour after the injury) blockable intramedullary osteosynthesis (BIOS) was performed. In group 4, the similar BIOS was performed on the fourth day after the fracture. To assess the results of treatment, the clinical, radiological and laboratory research methods were used. The duration of post-operative observation of the animals was 100 days. Results. It has been found out that the dynamics of osteoreparative processes in the studied groups was similar and did not depend on the time between trauma and osteosynthesis. The median time for the femoral shaft fracture healing in animals of group 1 was 46 days (Q1-Q3: 38-57), in group 2 - 73 days (Q1-Q3: 71-78) (differences between groups are significant at p=0.004); in group 3 - 49 days (Q1-Q3: 44-60), in group 4 - 72 days (Q1-Q3: 70-93) (differences between groups are significant at p=0.008). It is shown that the reason for the increase in fixation terms in dogs with the delayed osteosynthesis is the long-term persistence of the acute phase reaction caused by trauma (using the growth of C-reactive protein as an example). Conclusion. The healing terms of a femoral shaft fracture with the use of PREF technology and BIOS technology are comparable, both in the conditions of urgent and delayed osteosynthesis. What this paper adds It has been determined the similarity of the osteoreparation dynamics in the healing of diaphyseal femoral fractures: under conditions of osteosynthesis with a pin-rod external fixation device (PREF) and blocked intramedullary osteosynthesis (BIOS). For the first time it has been shown that healing terms of a diaphyseal femoral fractures when osteosynthesis performed in 4 days after injury is 1.5 fold longer in comparison with the performance of osteosynthesis within 1 hour after the injury. For the first time it has been shown that in the case of delayed osteosynthesis, the effectiveness of PREF and BIOS is comparable in terms of the duration of the consolidation of the diaphyseal femoral fractures.

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Section: Discussionunclassified

Consolidation of Femoral Fractures at Application of Different Treatment Methods Taking Into Consideration Duration of the Period From Trauma to Osteosynthesis

Еманов¹,

Stogov²,

Kireeva³

et al. 2021

Novosti Khirurgii

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Section: Discussionunclassified

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2021

Novosti Khirurgii

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Национальный медицинский исследовательский центр травматологии и ортопедии имени академика Г.А. Илизарова, г. Курган, Российская ФедерацияЦель. Изучить особенности и длительность заживления переломов диафиза бедренной кости в зависимости от используемых технологий остеосинтеза и сроков его выполнения после травмы.Материал и методы. Исследование выполнено на 24 беспородных собаках. Всем животным в условиях операционной моделировали поперечный перелом диафиза бедренной кости в средней трети с помощью долота. Животных разделили на 4 группы по 6 животных в каждой. Животным группы 1 через час после перелома проводили чрескостный остеосинтез спице-стержневым аппаратом внешней фиксации (ССА). В группе 2 ССА применяли на четвертые сутки после травмы. В группе 3 через час после травмы производили блокируемый интрамедуллярный остеосинтез (БИОС). В группе 4 аналогичный БИОС выполняли на четвертые сутки после перелома. Для оценки результатов лечения использовали клинико-рентгенологические и лабораторные методы исследования. Длительность наблюдения за животными после операции составила 100 суток.Результаты. Обнаружено, что динамика остеорепаративных процессов в исследованных группах была схожа и не зависела от продолжительности периода от травмы до начала остеосинтеза. Срок сращения перелома диафиза бедренной кости у животных группы 1 по медиане составил 46 (38; 57) суток, в группе 2 -73 (71; 78) суток (различия между группами достоверны при р=0,004); в группе 3 -49 (44; 60) суток, в группе 4 -72 (70; 93) суток, Me (Q1; Q3) (различия между группами достоверны при р=0,008). Показано, что причиной увеличения длительности фиксации у собак с отсроченным остеосинтезом являлось длительное сохранение острофазной реакции, вызванной травмой (на примере роста С-реактивного белка).Заключение. Длительность заживления перелома диафиза бедренной кости при применении технологии чрескостного остеосинтеза ССА и технологии БИОС сопоставима как в условиях ургентного, так и отсроченного остеосинтеза.Ключевые слова: перелом бедренной кости, остеосинтез, фиксация перелома, внешняя фиксация, внутренняя фиксация, репаративный остеогенез Objective. To study the characteristics and healing duration of the diaphyseal femoral fractures, depending on the technologies used for osteosynthesis and the time between trauma and osteosynthesis.Methods. The study was performed on bred dogs (n=24). In the operating theatre all animals were modeled the transverse fracture of the femoral diaphysis in the middle third using a chisel. The animals were divided into 4 groups (6 per group). Animals of group 1 (one hour after the fracture) underwent transosseousosteosynthesis with a pin-rod external fixation device (PREF). In group 2, PREF was performed on the fourth day after the injury. In group 3 (one hour after the injury) blockable intramedullary osteosynthesis (BIOS) was performed. In group 4, the similar BIOS was performed on the fourth day after the fracture. To assess the results of treatment, the clinical, radiological and laboratory research methods were used....

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Effect of Exogenous and Endogenous Factors on the Rate of Consolidation of Fractures of the Long Bones in Osteosynthesis

Popov

2015

Bûll. sib. med.

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Purpose. Determine endogenous and exogenous factors influencing the pace of consolidation in osteosynthesis implants with different types of coatings. Based on the characteristics of the selected offer the best conditions for the application of bioactive structures.Material and methods. The work is based on an analysis of surgical treatment of 1265 patients with hip fractures, tibial and shoulder. Take into account the influence of age, gender, thе timing of the operation, quality reposition, comorbidities, location and severity of the fracture, implant сoating violation bone repair.Results. Received consolidation using bioactive plates in 99.3 % of patients. Well executed reposition 4.5 times reduced cases of delayed consolidation. The main reason for delayed fracture healing in patients older than 60 years is osteoporosis. Males under 40 years compared with women of the same age often observed slow formation of callus, which is associated with frequent presence in them of comminuted fractures. The most frequently observed sustained fusion in patients with tibial fractures, which is primarily due to the prevalence of lesions in this segment. The main mechanism of action of bioactive positive plates can be explained by the peculiarities microarchitectonics coverage closer to the physiological structure of bone, increasing the concentration of osteogenic cells around the implant and stimulation of their function. Application of bioactive plates most appropriate for osteoporosis, type C lesions, pseudoarthrosis, reoperations during migration and metal fracture, in multiple and combined injuries.

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Comparative characteristics of osteosynthesis techniques in patients with comminuted diaphyseal femoral fractures

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Consolidation of Femoral Fractures at Application of Different Treatment Methods Taking Into Consideration Duration of the Period From Trauma to Osteosynthesis

Consolidation of Femoral Fractures at Application of Different Treatment Methods Taking Into Consideration Duration of the Period From Trauma to Osteosynthesis

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Effect of Exogenous and Endogenous Factors on the Rate of Consolidation of Fractures of the Long Bones in Osteosynthesis

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