Osteosynthesis results for comminuted fractures of long tubular bones

Abstract

Purpose of the work was to study the effectiveness of intramedullary and extrafocal osteosynthesis in combination with additional fixation of bone fragments using tightening clamps with thermomechanical shape memory. Material and Methods. The results of osteosynthesis analyzed in 133 injured persons with comminuted shaft fractures of long tubular bones. Little-invasive intramedullary osteosynthesis with a locking rod performed in 19 (14.3 %) patients, and an additional fixation of bone fragments with tightening clamps – in 45 (33.8%) ones. Extramedullary plates used for osteosynthesis in 39 (29.3%) patients including those combined with tightening clamps in 10 cases. Extrafocal osteosynthesis used for proximal and distal shaft fractures in 30 (22.6%) patients and in 19 among them the osteosynthesis was combined with tightening clamps having thermomechanical shape memory. Results. Statistically significant differences revealed when making a comparative analysis of the results of performing closed intramedullary osteosynthesis using locking rods, extramedullary fixation using plates and those of performing intramedullary osteosynthesis and extramedullary fixation combined with tightening thermomechanical clamps in patients with comminuted humeral fractures (χ2=3.881; р=0.049). An additional stabilization of bone fragments with tightening clamps during intramedullary osteosynthesis allowed improving treatment results in patients with femoral fractures (χ2=4.756; р=0.029, a statistically significant result). The effectiveness of tibial extrafocal osteosynthesis increases when using external fixators combined with extramedullary shape-memory tightening clamps (χ2=6.058; р=0.014, a statistically significant result). Conclusion. The adaptation of bone fragments and their fixation in anatomically correct position using shape-memory clamps combined with intramedullary rods, extramedullary plates and external fixators in patients with comminuted shaft fractures of long tubular bones allows reducing rehabilitation periods, obtaining good functional results of treatment in 90.5 % of cases.