Novosti
Khirurgii
This journal is
indexed in Scopus



Year 2019 Vol. 27 No 2

REVIEWS

DOI: https://dx.doi.org/10.18484/2305-0047.2019.2.204   |  

V.S. KOZOPAS

TREATMENT OF MULTI-FRAGMENT DIAPHYSEAL BONE FRACTURES BY BLOCKING INTRAMEDULLARY OSTEOSYNTHESIS TECHNIQUE (ANALYSIS OF ERRORS AND COMPLICATIONS)

Danylo Halytsky Lviv National Medical University, Lviv,
Ukraine

The growth of the level of traumatism and the prevalence of orthopedic pathology determine the necessity to advance diagnostics and treatment of injuries and diseases of the musculoskeletal system as a priority trend in the development of health care. Improvement of diagnostic capabilities of modern methods of visualizing conditions of bones, joints and soft tissues, expansion of the scope of high-tech minimally invasive osteosynthesis techniques will change the concept for implementation of orthopedic trauma care.
The proposed literature review is dedicated to the urgency of the problem and analysis of the structure of traumatic injuries, as well as the fundamental advantages of their treatment by the method of intraosseous osteosynthesis, which, due to the closed reposition of fragments and low surgical access outside the damage zone, doesnt cause any additional injury to the tissues in the fracture zone.
The main errors of surgeons when performing intramedullary blocking osteosynthesis have been studied and analyzed. It has been shown that treatment of patients with diaphyseal multi-fragment fractures of the long tubular bones should include measures to restore the anatomical structures of the injured segment and the function of the injured limb. The determination of clear indications and consistent preoperative planning of surgical intervention with careful selection of parameters of fixing structures are the main factors affecting the quality of fixation of fragments and they ensure the final result.

Keywords: trauma, bone fractures, intramedullary osteosynthesis, surgical errors, complications
p. 204-2011 of the original issue
References
  1. Gaiko GV, Derkach RV. Cause analysis and study of the reasons that influence the mortality rate in a car accident victims with the injuries to the musculoskeletal system. Nauka Praktika. 2014;(1):82-86. http://nbuv.gov.ua/UJRN/nauipr_2014_1_13 (in Ukr.)
  2. Gur’v SO, Satsik SP, vdoshenko VP, Natsevich RO. Lkuvannia perelomv dovgikh kstok u postrazhdalikh unasldok dorozhn’o-transportnikh prigod. Travma. 2015;16(3):94-97. http://www.mif-ua.com/archive/article/40906 (in Ukr.)
  3. Lacombe J, Cairns BJ, Green J, Reeves GK, Beral V, Armstrong MEG. Million women study collaborators. The effects of age, adiposity, and physical activity on the risk of seven site-specific fractures in postmenopausal women. J Bone Miner Res. 2016 Aug;31(8):1559-68. doi: 10.1002/jbmr.2826
  4. Scholes S, Panesar S, Shelton NJ, Francis RM, Mirza S, Mindell JS, Donaldson LJ. Epidemiology of lifetime fracture prevalence in England: a population study of adults aged 55 years and over. Age and Ageing. 2014;43(2):234-40. doi: 10.1093/ageing/aft167
  5. Zarutsky J, Trutiak I, Laksha A. Surgical tactics in injuries of the locomotor apparatus in patients with multiple injuries. Ltopis Travmatolog ta Ortoped. 2011;(1-2):98-101. http://nbuv.gov.ua/UJRN/Lto_2011_1-2_24 (in Ukr.)
  6. Global Burden of Disease [Electronic resource]. WHO. [cited 2018 Dec 29]. Available from: http://www.who.int/healthinfo/global_burden_disease/en/
  7. Grygorieva NV, Zubach OB. Risk factors of proximal hip fractures in older patients. Travma. 2016;17(6):53-61. doi: 10.22141/1608-1706.6.17.2016.88618 (in Ukr.)
  8. Korzh NA, Gerasimenko SI, Klimovitskii VG, Loskutov AE, Romanenko KK, Gerasimenko AS, Kolomiets EN. Rasprostranennost’ perelomov kostei i rezul’taty ikh lecheniia v Ukraine (kliniko-epidemiologicheskoe issledovanie). Ortopediia, Travmatologiia i Protezirovanie. 2010;(3):5-14. https://cyberleninka.ru/article/n/rasprostranennost-perelomov-kostey-i-rezultaty (in Ukr.)
  9. Hettrich CM, Browner B. High-energy trauma. Best Pract Res Clin Rheumatol. 2012 Apr;26(2):281-88. doi: 10.1016/j.berh.2012.03.007
  10. Borzykh AV, Klimovitsky VG, Oprischenko AA, Borzykh NA, Basiy RV. Epidemiology of polystructural trauma of the extremities in the Donbass region. Travma. 2013;14(6):61-63. http://www.mif-ua.com/archive/article/37720 (in Russ.)
  11. Benirschke SK, elder I, Henley MB, Routt ML, Smith DG, Chapman JR, Swiontkowski MF. Closed interlocking nailing of femoral shaft fractures: assessment of technical complcations and functional outcomes by comparison of a prospective database with retrospective review. J Ortop Trauma. 1993;7(2):118-22. https://www.ncbi.nlm.nih.gov/pubmed/8459295
  12. Chan R, Taylor BC, Gentile J. Optimal Management of High-Energy Pilon Fractures. Orthopedics. 2015 Aug;38(8):e708-14. doi: 10.3928/01477447-20150804-59
  13. Ditillo M, Pandit V, Rhee P, Aziz H, Hadeed S, Bhattacharya B, Friese RS, Davis K, Joseph B. Morbid obesity predisposes trauma patients to worse outcomes: a National Trauma Data Bank analysis. J Trauma Acute Care Surg. 2014 Jan;76(1):176-79. doi: 10.1097/TA.0b013e3182ab0d7c
  14. Korzh MO, Tan’kut VO. Medichn aspekti dorozhn’o-transportno pol travmi, iak osnovno prichini smertnost molodikh liudei v Ukran [Electronic resource]. [cited 2018 Dec 29]. Avialable from: http://eprints.kname.edu.ua/29868/1/4.pdf (in Ukr.)
  15. Korzh MO, Iaremenko DO, Gordova LD, Romanenko KK. Pomilki ta uskladnennia v ortopedo-travmatologchni praktits. Ortopediia, Travmatologiia i Protezirovanie. 2010;(2):5-10. (in Ukr.)
  16. Zarutskyi YL, Kosevtsov VO, Tkachenko AE. Traumatism in the system of threats to the ukrainian national security. Nauka Praktika. 2014;(1):50-56. http://opb.org.ua/3053/1(in Ukr.)
  17. Vallier HA, Wang X, Moore TA, Wilber JH, Como JJ. Timing of orthopaedic surgery in multiple trauma patients: development of a protocol for early appropriate care. J Orthop Trauma. 2013 Oct;27(10):543-51. doi: 10.1097/BOT.0b013e31829efda1
  18. Faddeev DI. Oslozhneniia pri lechenii mnozhestvennykh i sochetannykh perelomov dlinnykh trubchastykh kostei metodami rannego stabil’nogo pogruzhnogo i chreskostnogo osteosinteza. Vestn Travmatologii i Ortopedii. 2013;(1):18-23 (in Russ.)
  19. Brodauf L, Heßing K, Hoffmann R, Friemert B. Current state of medical care of polytrauma and mass casualty ncidents in Germany: are we well-prepared? Unfallchirurg. 2015 Sep 1;118(10):890-900. doi: 10.1007/s00113-015-0063-2
  20. Gur’ev SE, Tsviakh AI. Skeletnaia travma v strukture politravmy. Travma. 2014;15(6):7-10. http://www.mif-ua.com/archive/article/39982 (in Russ.)
  21. Malisano LP, Stevens D, Hunter GA. The management of long bone fractures in the head-injured polytrauma patient. J Orthop Trauma. 1994;8(1):1-5. https://www.ncbi.nlm.nih.gov/pubmed/8169687
  22. Shimon VM, Sheregi AA, Geleta MM, Boldizhar MM. Pogliadi na lkuvannia perelomv kstok gomlki metodom cherezkstkovogo osteosintezu v umovakh endemchnikh regonv. Ltopis Travmatolog ta Ortoped. 2011;(21-22):180-82. http://nbuv.gov.ua/UJRN/Lto_2011_1-2_46 (in Ukr.)
  23. Shimon VM, Sheregi AA. Perspektivn napriamki lkuvannia dafzarnikh perelomv kstok gomlki. Travma. 2010;11(4):363-66. http://www.mif-ua.com/archive/article/20004 (in Ukr.)
  24. Brusko AT, Gaiko GV. Modern concepts of stages of bone tissue fractures reparative regeneration. Vsnik Ortoped, Travmatolog. 2014;(2):5-8. http://www.irbis-nbuv.gov.ua/cgi-bin/irbis_nbuv/cgiirbis_64.exe?C21COM=2&I21DBN=UJRN&P21DBN=UJRN&IMAGE_FILE_DOWNLOAD=1&Image_file_name=PDF/Votip_2014_2_3.pdf (in Ukr.)
  25. Klimovitskii VG, Chernysh VIu. Chastota zamedlennoi konsolidatsii perelomov u postradavshikh raznykh vozrastnykh grupp i vliianie na nee osteotropnoi terapii. Travma. 2011;12(3):129-35. http://www.mif-ua.com/archive/article/23297 (in Russ.)
  26. Anuar-Ramdhan IM, Azahari IM, Med M. Minimally invasive plate osteosynthesis with conventional compression plate for diaphyseal tibia fracture. Malays Orthop J. 2014;8(3):33-36. doi: 10.5704/MOJ.1411.008
  27. Maru N, Mandaliya D, Parmar R. Two stage reconstruction protocol in management of high-energy proximal tibia fractures (Schatzker, type IV-VI). J Evol Med Dent Sci. 2012;1(4):639-45. doi: 10.14260/jemds/100
  28. Butcher NE, Enninghorst N, Sisak K, Balogh ZJ. Definition of polytrauma: variable interrater versus intrarater agreement – a prospective international study among trauma surgeons. J Trauma Acute Care Surg. 2013;74(3):884-89. doi: 10.1097/TA.0b013e31827e1bad.
  29. Champion HR, Copes WS, Sacco WJ, Lawnick MM, Bain LW, Gann DS, Gennarelli T, Mackenzie E, Schwaitzberg S. A new characterization of injury severity. J Trauma. 1990 May;30(5):539-45.
  30. Hoegel FW, Hoffmann S, Weninger P, Bühren V, Augat P. Biomechanical comparison of locked plate osteosynthesis, reamed and unreamed nailing in conventional interlocking technique, and unreamed angle stable nailing in distal tibia fractures. J Trauma Acute Care Surg. 2012 Oct;73(4):933-38. doi: 10.1097/TA.0b013e318251683f
  31. Kalashnikov AV, Stavinsky YuA. Treatment algorithm for reparative osteogenesis disorders after femoral and tibia diaphyseal fractures with blocking intramedullary osteosynthesis. Travma. 2011;12(1):69-66. http://www.mif-ua.com/archive/article/17224 (in Ukr.)
  32. Henderson CE, Lujan TJ, Kuhl LL, Bottlang M, Fitzpatrick DC, Marsh JL. 2010 mid-America Orthopaedic Association Physician in Training Award: healing complications are common after locked plating for distal femur fractures. Clin Orthop Relat Res. 2011 Jun;469(6):1757-65. doi: 10.1007/s11999-011-1870-6
  33. Pankov IO, Safarov RR, Sirazitdinov SD. Modern method of the surgical treatment of patient with polyfractures of extremyties. Sovrem Problemy Nauki i Obrazovaniia. 2015;(5):243. https://www.science-education.ru/ru/article/view?id=22352 (in Russ.)
  34. Paller DJ, Frenzen SW, Bartlett CS 3rd, Beardsley CL, Beynnon BD. A three-dimensional comparison of intramedullary nail constructs for osteopenic supracondylar femur fractures. J Orthop Trauma. 2013 Feb;27(2):93-99. doi: 10.1097/BOT.0b013e31825199c9
  35. Lee YK, Chung CY, Park MS, Lee KM, Koo KH. Intramedullary nail versus extramedullary plate fixation for unstable intertrochanteric fractures: decision analysis. Arch Orthop Trauma Surg. 2013 Jul;133(7):961-68. doi: 10.1007/s00402-013-1764-z
  36. Kreb DL, Blokhuis TJ, van Wessem KJ, Bemelman M, Lansink KW, Leenen LP. Intramedullary nailing without interlocking screws for femoral and tibial shaft fractures. Arch Orthop Trauma Surg. 2013 Aug;133(8):1109-13. doi: 10.1007/s00402-013-1775-9
  37. Sokolov VA, Bondarenko AV, Byalik EI, Fain AM, Ivanov PA. Comparative assessment of osteosynthesis techniques in polysegmental fractures of lower extremities. Vestn Travmatologii i Ortopedii im NN Priorova. 2006;(4):3-8. (in Russ.)
  38. Dergachov VV, Aleksandrov N, Vankhaisky SB, Onatsky YuV, Kotenko RS, Kolesnikov AM. Locking intramedullary nailing-modern method, new difficulties, complications .Travma. 2011;12(4):20-23. https://cyberleninka.ru/article/n/intramedullyarnyy-blokiruyuschiy-osteosintez-sovremennaya-metodika-novye-slozhnosti-oslozhneniya (in Ukr.)
  39. Berezka MI, Litovchenko VO, Garyachiy VO, Rami AF, Al-Masri. Surgical technology for closed intramedullary osteosynthesis during the treatment of patients with multifragmental fractures of limb bones. Problemi Ekolog ta Meditsini. 2011;15(5-6):3-8. https://cyberleninka.ru/article/n/hirurgichna-tehnologiya-zakritogo-intramedulyarnogo-blokuyuchogo-osteosintezu-pri-likuvanni-postrazhdalih-z-bagatoulamkovimi (in Ukr.)
  40. Pven’ IuM, Litvin IuP. Peredoperatsine planuvannia ta vibr metodu osteosintezu pri bagatofragmentarnikh perelomakh proksimal’nogo vddlu plechovo kstki. Problemi Travmatolog ta Osteosintezu. 2015;(1):75-76. http://nbuv.gov.ua/UJRN/pto_2015_1_38 (in Ukr.)
  41. Litovchenko VO, Vlasenko DV, Vlasenko VG, Jaryachiy EV, Galabuts,ka TM, Fadev OG. nrameduliarnii osteosintez blokovanimi tsviakhami v lkuvann perelomv stegnovo kstki v rznikh anatomo-funktsonal’nikh utvorenniakh pri odnochasnomu poshkodzhenn. Travma. 2011;12(4):63-66. http://www.mif-ua.com/archive/article/25610 (in Ukr.)
  42. Chelnokov AN, Bekreyev DA. Intramedullary osteosynthesis for fractures of the upper tibial third - a technique based on transosseous osteosynthesis Genii Ortopedii. 2011;(2):112-16. https://cyberleninka.ru/article/n/intramedullyarnyy-osteosintez-pri-perelomah-verhney-treti-bolshebertsovoy-kosti-tehnika-na-osnove-chreskostnogo-osteosinteza (in Russ.)
  43. Litovchenko VO, Berezka MI, Garyachiy EV, Rami AF, Al Masri, Vlasenko DV. Mistakes during treatment of multi-fragment fractures of limbs’ bones by implementation of intramedullar blocking ostheosynthesis. Eksperimental’na Klnchna Meditsina. 2012; 4(57):132-135. http://nbuv.gov.ua/UJRN/eikm_2012_4_31 (in Russ.)
  44. Litovchenko VA, Garyachiy EV, Berezka MI, Spesiviy II. Intramedullary locking osteosynthesis: errors which should not be. Meditsina S’ogodn Zavtra. 2012;(1):113-19. https://msz.knmu.edu.ua/?journal=pub&page=article&op=viewFile&path%5B%5D=223&path%5B%5D=209 (in Ukr.)
  45. Lytovchenko VA, Jaryachiy YeV, Berezka MI, Spesiviy II. Most common mistakes while using locked intramedullary nailing. Travma. 2012;13(4):145-48. http://www.mif-ua.com/archive/article/34672 (in Ukr.)
  46. Klimovitsky VH, Chernysh VYu, Klimovitsky FV. External transosseous osteosynthesis in treatment of tibia extraarticular fracture: indications, complications, results. Travma. 2016;17(2):26-30. http://www.mif-ua.com/archive/article/42580 (in Russ.)
  47. Rusyn VI, Popovych YM, Korsak VV, Boldizhar PO. Radioisotope diagnosis deep venous thrombosis. Naukovii Vsnik Uzhgorods’kogo Unversitetu. Ser Meditsina. 2013;1(46):114-17. http://nbuv.gov.ua/UJRN/UNUMED_2013_1_26 (in Ukr.)
Address for correspondence:
79010, Ukraine,
Lviv, Pekarskaya Str., 69,
Danylo Halytsky Lviv National
Medical University,
Department of Disaster Medicine
And Military Medicine.
Tel. +38 (032) 260-08-28,
e-mail: kozopas@ukr.net,
Viktor S. Kozopas
Information about the authors:
Kozopas Viktor S., PhD, Assistant of the Department of Disaster Medicine and Military Medicine, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
https://orcid.org/0000-0003-3451-6016
Contacts | ©Vitebsk State Medical University, 2007