Plasty of shin bone defects with segmental loss using ring fixators of the wire-rod type

Abstract

The problem of segmental bone loss of the tibia after fractures is an urgent and not completely resolved problem. The use of distraction osteogenesis by bone transport according to Ilizarov is the leading method of treatment. Improving this technology is a generally accepted way of improving treatment outcomes.To propose improvements in the technology of distraction osteosynthesis with the use of ring fixators, taking into account the problematic issues of their use; analyze the results obtained.Tasks: to formulate the disadvantages and problematic issues of distraction osteogenesis in patients with segmental defects of the leg bones after fractures; to propose a solution to the existing disadvantages of the method; analyze the results.78 victims met the inclusion criteria. 36 patients were operated on according to the proposed method; they made up the core group; 42 – comparison group, treatment was carried out according to the generally accepted method. The time spent in the external fixation apparatus and the index of external fixation were used as criteria for evaluating the results; the final assessment was carried out according to the anatomical and functional scale Modified Functional Evaluation System by Karlstrom–Olerud.Our results (good and excellent 77.8 %; unsatisfactory in 2.8 % are comparable to those of most researchers. Anatomical and functional results in the main group with a high degree of probability (˃95 %) exceeded the results in the comparison group.Bearing in mind the severity of the defeat, we find this result encouraging. Given the insufficient number of observations, it is necessary to recommend the use of the proposed improvements in the use of RF in the treatment of nonunions of the shin bones after fractures and further study of their effectiveness.Thus, nonunion of the tibia requires complex treatment using osteosynthesis with ring fixators. Spoke-rod designs of the apparatus, gentle technique, optimal ways of guiding the pins, transition to final fixation using Softcast/Scotchcast systems, drug correction of regeneration disorders made it possible to avoid many complications of extrafocal fixation and obtain good results.