Combined osteosynthesis for tibial shaft fracture treatment
https://doi.org/10.18019/1028-4427-2023-29-6-635-639
EDN: QUVIYQ
Abstract
Introduction Widespread use of intramedullary and extramedullary implants, as well as external fixation devices, has demonstrated that current surgical methods are not always successful.
The study aimed to assess the efficiency of a combination of transosseous osteosynthesis with intramedullary reinforcement using elastic titanium hydroxyapatite-coated rods (HA-rods) in long bone fracture treatment.
Material and methods Medical records of 40 patients aged from 18 to 55 years with closed diaphyseal tibia fractures of A1-A3 type (AO/ASIF) treated with the Ilizarov transosseous osteosynthesis method combined with intramedullary elastic HA-coated wires were analysed. Result Ilizarov fixator removal was performed on average 45.3 ± 14.7 days after surgery. Radiological signs of bone union (immature callus, patterns of periosteal and endosteal stratifications overlapping the fracture line) were visible by week 3 to 4.
Discussion Соmbination of the external fixator and intramedullary elastic HA-coated wires overcomes shortcomings of both external and internal means of fixation. External osteosynthesis provides advantages of the Ilizarov method: preservation of blood supply, absence of soft tissue injury, joint function and early weightbearing. Elastic intramedullary wires do not injure a. nutricia and mechanically stimulate endosteal and periosteal bone formation.
Conclusion The advantages of combined osteosynthesis provide reduction of Ilizarov apparatus fixation time, reduction in the number of wires and half-pins in the frame assembly, stimulation of bone callus formation and prevention of secondary bone fragment displacement.
About the Authors
K. A. Klyshnikov
Ilizarov National Medical Research Centre for Traumatology and Orthopedics
Russian Federation
Russian Federation
Konstantin A. Klyshnikov – postgraduate student
N. V. Sazonova
Ilizarov National Medical Research Centre for Traumatology and Orthopedics
Russian Federation
Russian Federation
Natalia V. Sazonova – Doctor of Medical Sciences, Head of Department
A. V. Popkov
Ilizarov National Medical Research Centre for Traumatology and Orthopedics
Russian Federation
Russian Federation
Arnold V. Popkov – Doctor of Medical Sciences, Professor, traumatologist-orthopedist, Chief Researcher
References
1. Milstrey A, Baumbach SF, Pfleiderer A, et al. Trends of incidence and treatment strategies for operatively treated distal fibula fractures from 2005 to 2019: a nationwide register analysis. Arch Orthop Trauma Surg. 2022;142(12):3771-3777. doi: 10.1007/s00402-021-04232-0
2. Ylitalo AAJ, Dahl KA, Reito A, Ekman E. Changes in operative treatment of tibia fractures in Finland between 2000 and 2018: A nationwide study. Scand J Surg. 2022;111(3):65-71. doi: 10.1177/14574969221111612
3. Alhadhoud MA, Alsiri NF. The epidemiology of traumatic musculoskeletal injuries in Kuwait: Prevalence and associated risk factors. J Taibah Univ Med Sci. 2022;17(4):685-693. doi: 10.1016/j.jtumed.2022.01.006
4. Мироманов А.М., Гусев К.А., Усков С.А. и др. Современные подходы к диагностике нарушений консолидации при переломах. Гений ортопедии. 2017;23(1):12-15. doi: 10.18019/1028-4427-2017-23-1-12-15
5. Jayaraju U, Rammohan R, Awad F, et al. Tibial Intramedullary Nailing by Suprapatellar Approach: Is It Quicker and Safer? Cureus. 2022;14(10):e29915. doi: 10.7759/cureus.29915
6. Bhanushali A, Kovoor JG, Stretton B, et al. Outcomes of early versus delayed weight-bearing with intramedullary nailing of tibial shaft fractures: a systematic review and meta-analysis. Eur J Trauma Emerg Surg. 2022;48(5):3521-3527. doi: 10.1007/s00068-022-01919-w
7. Shikinami Y, Matsusue Y, Nakamura T. The complete process of bioresorption and bone replacement using devices made of forged composites of raw hydroxyapatite particles/poly l-lactide (F-u-HA/PLLA). Biomaterials. 2005;26(27):5542-5551. doi: 10.1016/j.biomaterials.2005.02.016
8. Костив Р.Э., Матвеева Н, Калиниченко СГ. Биоактивные покрытия на металлических сплавах и стимуляция восстановления костей после перелома. Тихоокеанский медицинский журнал. 2021;(2):31-36. doi: 10.34215/1609-1175-2021-2-31-36
9. Popkov AV, Popkov DA, Kononovich NA, et al. Biological activity of the implant for internal fixation. J Tissue Eng Regen Med. 2018;12(12):2248- 2255. doi: 10.1002/term.2756
10. Lascombes P, Haumont T, Journeau P. Use and abuse of flexible intramedullary nailing in children and adolescents. J Pediatr Orthop. 2006;26(6):827- 834. doi: 10.1097/01.bpo.0000235397.64783.d6
11. Bolbasov EN, Popkov AV, Popkov DA, et al. Osteoinductive composite coatings for flexible intramedullary nails. Mater Sci Eng C Mater Biol Appl. 2017;75:207-220. doi: 10.1016/j.msec.2017.02.073
12. Cao L, Han SM, Wu HZ, et al. Lower Tibial Shaft Spiral Fracture Concurrent with Distal Tibial Triplane Fracture. Curr Med Imaging. 2022;18(3):322- 326. doi: 10.2174/1573405617666210716170213
13. Hemmann P, Friederich M, Körner D, et al. Changing epidemiology of lower extremity fractures in adults over a 15-year period - a National Hospital Discharge Registry study. BMC Musculoskelet Disord. 2021;22(1):456. doi: 10.1186/s12891-021-04291-9
14. Patel I, Young J, Washington A, Vaidya R. Malunion of the Tibia: A Systematic Review. Medicina (Kaunas). 2022;58(3):389. doi: 10.3390/medicina58030389
15. Ding P, Chen Q, Zhang C, Yao C. Revision with Locking Compression Plate by Compression Technique for Diaphyseal Nonunions of the Femur and the Tibia: A Retrospective Study of 54 Cases. Biomed Res Int. 2021;2021:9905067. doi: 10.1155/2021/9905067
16. Radaideh A, Alrawashdeh MA, Al Khateeb AH, et al. Outcomes of Treating Tibial Shaft Fractures Using Intramedullary Nailing (IMN) versus Minimally Invasive Percutaneous Plate Osteosynthesis (MIPPO). Med Arch. 2022;76(1):55-61. doi: 10.5455/medarh.2022.76.55-61
17. Upfill-Brown A, Hwang R, Clarkson S, et al. Rates and timing of short-term complications following operative treatment of tibial shaft fractures. OTA Int. 2021;4(4):e158. doi: 10.1097/OI9.0000000000000158
18. Пичхадзе И.М., Кузьменков К.А., Жадин А.В. и др. Лечение переломов длинных костей конечностей методом чрескостного остеосинтеза на основе биомеханической концепции. Вестник травматологии и ортопедии им. Н.Н. Приорова, 2006;(4):12-17.
19. May JD, Paavana T, McGregor-Riley J, Royston S. Closed Tibial shaft fractures treated with the Ilizarov method: A ten year case series. Injury. 2017;48(7):1613-1615. doi: 10.1016/j.injury.2017.05.019
20. Cibura C, Ull C, Rosteius T, Lotzien S, et al. The Use of the Ilizarov Fixator for the Treatment of Open and Closed Tibial Shaft and Distal Tibial Fractures in Patients with Complex Cases. Z Orthop Unfall. 2022. English. doi: 10.1055/a-1910-3606
21. Makhdoom AU, Shaikh BJ, Baloch RA, et al. Management Of Segmental Fracture Of Tibia Treated By Ilizarov External Fixation. J Ayub Med Coll Abbottabad. 2020;32(3):291-294.
22. Popkov DA, Popkov AV, Kononovich NA, et al. Experimental study of progressive tibial lengthening in dogs using the Ilizarov technique. Comparison with and without associated intramedullary K-wires. Orthop Traumatol Surg Res. 2014;100(7):809-14. doi: 10.1016/j.otsr.2014.06.021
23. Popkov AV, Gorbach EN, Kononovich NA, et al. Bioactivity and osteointegration of hydroxyapatite-coated stainless steel and titanium wires used for intramedullary osteosynthesis. Strategies Trauma Limb Reconstr. 2017;12(2):107-113. doi: 10.1007/s11751-017-0282-x
24. Ирьянов ЮМ, Кирьянов Н.А., Попков А.В. Заживление перелома в условиях интрамедуллярного введения спиц с покрытием из гидроксиапатита. Вестник РАМН. 2014;(7-8):127-132.
25. Fini M, Cigada A, Rondelli G, et al. In vitro and in vivo behaviour of Ca- and P-enriched anodized titanium. Biomaterials. 1999;20(17):1587-1594. doi: 10.1016/s0142-9612(99)00060-5
26. Попков А.В., Попков Д.А., Кононович Н.А. и др. Остеоинтеграция биоактивных имплантатов при лечении переломов длинных трубчатых костей: учебное пособие. Томск: Изд-во Томского политехнического университета; 2017:304 с.
Review
For citations:
Klyshnikov K.A., Sazonova N.V., Popkov A.V. Combined osteosynthesis for tibial shaft fracture treatment. Genij Ortopedii. 2023;29(6):635-639. https://doi.org/10.18019/1028-4427-2023-29-6-635-639. EDN: QUVIYQ
Views:
365
Email this article 