Complications of Intramedullary Blocking Osteosynthesis of Bones of Limbs and Ways to Prevent Them
ARTICLE PDF (Українська)

Keywords

intramedullary blocking osteosynthesis, reparative complications, long bones, bone marrow drilling.

How to Cite

Mansyrov, A., Lytovchenko, V., & Gariachyi, Y. (2020). Complications of Intramedullary Blocking Osteosynthesis of Bones of Limbs and Ways to Prevent Them. Visnyk Ortopedii Travmatologii Protezuvannia, (2(105), 35-42. https://doi.org/10.37647/0132-2486-2020-105-2-35-42

Abstract

Summary. The main condition for preventing complications of intramedullary blocking osteosynthesis of long bones is following the tactical and technical principles of osteosynthesis and conscious rejection of such surgical techniques and manipulations that can lead to disturbances of the course of reparative processes of bone tissue. Objective. On the basis of the study and summary of the identified complications of intramedullary blocking osteosynthesis of diaphyseal fractures of bones of limbs, to determine ways to prevent complications of the reparation. Materials and Methods. The results of treatment of 403 patients who underwent intramedullary blocking osteosynthesis of the femur, tibia and humerus types A1-A3, B1–B3 and C2 by AO/ASIF were studied and analyzed. Results. Analyzing the technological complications that we have divided, depending on the consequences they led to, early (up to 2 weeks after surgery), late (2 weeks after surgery) and reparative, we found that the most common technological mistakes were incorrect preoperative planning and disruption of technology and surgery, which in 21.6% of cases led to instability of bone fragments in the fracture area, and the absence or disruption of recovery and rehabilitation of patients, which occurred in 26.3% of cases. Disorders of osteosynthesis technology, namely, significant intra-operative traumatization of bone fragments and soft tissues, and non-eliminated soft tissue interposition resulted in inappropriate consolidation of bone fragments in 39% and 13%, respectively. The main cause of reparative complications was bone marrow drilling, which was performed for 56% of the patients with delayed consolidation of bone fragments, 56.3% of the patients with false joints, and 48% of the patients with bone fractures. Conclusions. Strict following the tactical and technical principles of intramedullary blocking osteosynthesis and rejection of bone marrow drilling without indications will reduce the incidence of bone dysregeneration. The study of the effect of bone marrow drilling on reparative bone regeneration in intramedullary blocking osteosynthesis is actual and needs further deep analysis.

https://doi.org/10.37647/0132-2486-2020-105-2-35-42
ARTICLE PDF (Українська)

References

Pugely AJ, Martin CT, Gao Y, Klocke NF, Callaghan JJ, Marsh JL. A risk calculator for short-term morbidity and mortality after hip fracture surgery. J. Orthop. Trauma. 2014;28(2): 63-9. DOI: 10.1097/BOT.0b013e3182a22744.

Колов Г.Б., Грицай М.П. Залежність перебігу інфекційного процесу у хворих з дефектами кісткової тканини після застосування фіксаторів для остеосинтезу на нижній кінцівці. Проблеми травматології та остеосинтезу. 2017;3-4:5-16.

Kolov G.B., Grytsay M.P Dependance of infectious process in patients with bone tissue defects after use of fixators for osteosynthesis of lower limbs. The problems of traumatology and osteosynthesis. 2017;3-4:5-16.

Hak DJ, Fitzpatrick D, Bishop JA, Lawrence JM, Susanne T, Reinhard S, et al. Delayed union and nonunions: epidemiology, clinical issues, and financial aspects. Injury. 2014;45 (2):3-7. DOI: 10.1016/j.injury.2014.04.002.

Yin P, Zhang L, Li T, Licheng Z, Guoqi W, Jiantao L, et al. Infected nonunion of tibia and femur treated by bone transport. J. Orthop. Surg. Res. 2015;10:49. DOI: 10.1186/s13018-015-0189-5.

Кузнецова ЕИ, Шепелева МВ, Карасёв АГ. Показатели врождённого иммунитета у пациентов с замедленным сращением костной ткани после закрытой травмы длинных трубчатых костей. Международный журнал прикладных и фундаментальных исследований. 2015;11:652-4.

Kuznetsova EI, Chepeleva MV, Karasev AG. Congenital immunity parameters in patients with delayed bone tissue union after a closed injury of long tubular bones. International journal of applied and fundamental research. 2015;11:652-4.

Westgeest J, Weber D, Dulai SK, Joseph WB, Richard B, Lauren AB. Factors associated with development of nonunion or delayed healing after an open long bone fracture: a prospective cohort study of 736 subjects. J. Orthop. Trauma. 2016;30(3):149-55. DOI: 10.1097/BOT.0000000000000488.

Литовченко В.О., Гарячий Є.В., Березка М.І., та ін. Найпоширеніші помилки при використанні інтрамедулярного блокуючого остеосинтезу. Травма. 2012;13(4):145-148.

Litovchenko V, Garyachiy E, Berezka M, et al. Common mistakes in using intramedullar loocking osteosynthesis. Trauma. 2012;13(4):145-8.

Meeuwis MA, de Jongh MA, Roukema JA, van der Heijden FH, Verhofstad MH. Technical errors and complications in orthopaedic trauma surgery. Arch. Orthop. Trauma. Surg. 2016;136 (2):185-93. DOI: 10.1007/s00402-015-2377-5.

Shapovalov VM, Khominets VV, Mikhaĭlov SV, Shakun DA, Foos IV. Mistakes and complications in internal osteosynthesis in patients with fractures of long bones. Voen. Med. Zh. 2014;335 (1):25-30.

Bucholz RW, Heckman JD, Court-Brown CM, Paul T. Rockwood and Green’s fractures in adults. 8-th ed. Philadelphia: Lippincott Williams & Wilkins; 2010. 2296 p.

Aslan AA, Uysal E, Ozmeriç A. A staged surgical treatment outcome of type 3 open tibial fractures. ISRN Orthop [internet]. 2014 Apr; 721041. Available from: DOI: 10.1155/2014/721041.

Kumar MN, Ravishankar MR, Manur R. Single locking compression plate fixation of extra-articular distal humeral fractures. J. Orthop. Traumatol. 2015;16 (2):99-104. DOI: 10.1007/s10195-014-0325-8.

Omerovic D, Lazovic F, Hadzimehmedagic A. Static or dynamic intramedullary nailing of femur and tibia. Med. Arch. 2015;69(2):110-3. DOI: 10.5455/medarh.2015.69.110-113.

Yoshino O, Brady J, Young K, Hardy B, Matthys R, Buxton T, et al. Reamed locked intramedullary nailing for studying femur fracture and its complications. Eur. Cell. Mater. 2017;34:99-107. DOI: 10.22203/eCM.v034a07.

Jiang-Jun Z, Min Z, Yan Y, Lei W, Lv R, Zhu Z, et al. Finite element analysis of a bone healing model: 1-year follow-up after internal fixation surgery for femoral fracture. Pak. J. Med. Sci. 2014;30(2):343-7. PMID: 24772140.

Maher SA, Meyers K, Borens O, Suk M, Grose A, Wright TM, et al. Biomechanical evaluation of an expandable nail for the fixation of midshaft fractures. J. Trauma. 2007;63(1):103-7. DOI: 10.1097/01.TA.0000243205.24809.3f.

Buciu G. Studies about virtual behavior of tibia fractures and nails during the fixation process. Journal of Industrial Design and Engineering Graphics. 2013;8 (2):5-10.

Liu B, Xiong Y, Deng H, Gu S, Jia F, Li Q, et al. Comparison of our self-designed rotary self-locking intramedullary nail and interlocking intramedullary nail in the treatment of long bone fractures. J. Orthop. Surg. Res. 2014;9 (47):1-9. DOI: 10.1186/1749-799X-9-47.

Грицай НП, Цокало ВР, Колов ГБ, та ін. Септические осложнения после хирургического лечения переломов костей голени. Вісник ортопедії, травматології та протезування. 2015;2(85):59-64.

Grytsay NP, Zokalo VN, Kolov GB, et al. Septic complications after surgical treatment of leg fractures. Visnyk Orthop. Traum. Protez. 2015;2(85):59-64.

Сулбатанаев ТЖ, Алходжаев СС, Тусупов ДМ. Ошибки и осложнения при лечении переломов бедра. Вестник КазНМУ. 2016;3(1):315-6.

Sultanbayev TZh, Alhodzhaev SS, Tusupov DM. Mistakes and complications in the treatment of hip fractures. Vestnik KazNMU. 2016;3(1):315-6.

Sagalovsky S, Schonert M. The cell and molecular biology of bone fracture repair: role of the transforming growth factor-ß1 in activation reparative osteogenesis (review). Orthopaedics, Traumatology and Prosthetics. 2014;3:136-143. DOI: 10.15674/0030-598720143136-143.

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