After a person has a bone fracture, most often in the lower or upper extremities, fusion may not be correct. In this case, the bone changes its correct anatomical position. Quite often, the reason that the fracture has grown together incorrectly is insufficient fixation of fragments in plaster. But that's not the only reason.
How bone heals
A fracture in any part of the body can heal incorrectly. More often this occurs with fractures of the jaw, hands and fingers. An ill-healed leg fracture is much less common.
Immediately after an accident occurs, the human body begins to repair the damage. This process consists of two stages. At the first stage, the tissues that died during the injury are resorbed, and during the second stage, the bone itself is restored.
In order for the bone to grow together, it is necessarycertain time. During the first week, a special tissue is formed, which is called granulation tissue. This tissue attracts minerals to itself, which leads to the loss of excess fibrin strands. Later, collagen fibers appear, thanks to which the bone is formed in the form in which it should be. Every day, an increasing amount of mineral s alts accumulate at the fracture site, which helps the formation of new bone tissue.
If you take an x-ray in three weeks, then you can see a callus at the site of fusion. The fact that the fracture grows together incorrectly can be detected using an x-ray at this stage. What to do with an improperly healed fracture is decided in each individual case differently.
Causes of improper healing of fractures
Fractures can be of two types - closed and open. Closed is not as dangerous as open. It grows together quickly, and the reason that the fracture has grown together incorrectly can only be the wrong treatment. It is bad when the fracture is open, there are cases when osteomyelitis develops. Or the wound becomes infected.
What went wrong when the arm was broken? Why did it happen? The reasons may be as follows:
- Mistakes were made in the treatment.
- There was a displacement of the bones in the cast.
- The hinges that set the bone were not installed.
- During the surgical intervention, fixators were installed not according to morphology.
Most often, the fracture has healedwrong, occurs due to any mistakes made during the treatment period. If something bothers the person in the area where the injury occurred, and he suspects that the bones are fused incorrectly, you should contact a traumatologist to confirm or refute this fact.
The most common problem is an improperly healed fracture of the radius of the arm. Therefore, with such an injury during bone restoration, one must be especially careful so that there are no problems later.
If it happened that the fracture of the radius did not grow together correctly, then this pathology is treated in the same way as fractures in other places.
Surgical treatments
If abnormal bone fusion occurs, it is usually treated with surgery. There are three types of orthopedic surgeries:
- corrective osteotomy,
- osteosynthesis,
- marginal bone resection.
Corrective osteotomy
This operation is performed under general anesthesia. Its ultimate goal is to eliminate bone deformity. To achieve this, you have to break the bone again, which has grown together incorrectly. It is broken with surgical instruments, dissected with radio waves or a laser.
Bone fragments are again connected to each other in the correct position and fixed using special screws, spokes, plates and more. During such an operation, the principle of traction can be used. A load is suspended from the needle, which is in the bone, which pulls the bone, and it takes the positionrequired for normal splicing.
Types of osteotomy
Osteotomy according to the type of conduction can be open and closed. In the process of open intervention, a skin incision of 10-12 centimeters is made, which opens the bone. The surgeon then separates the bone from the periosteum and dissects it. Sometimes this is done through specially drilled holes.
With the closed method of this operation, the skin integuments are cut by only 2-3 centimeters at the site of injury. After that, the surgeon cuts the bone with a surgical instrument only ¾, and the rest is broken. During such an intervention, large vessels and nerves are sometimes seriously damaged, so open-type osteotomy is still more often performed.
Corrective osteotomy is most commonly used to correct an malunion fracture in the lower or upper extremities. Thanks to this operation, the patient's legs move, and the arms perform all the movements that are inherent in them.
Contraindications for osteotomy
This type of operation is prohibited if the patient has the following diseases:
- Severe diseases of the kidneys, liver, and other internal organs.
- Pathologies of the heart and blood vessels.
- If at the time of surgery the patient has an acute or exacerbation of a chronic disease.
- Purulent infection of organs or tissues.
Complications after surgery
As with any other surgical intervention, there may be complications after osteotomy, namely:
- Entering an infection into the wound, which can cause suppuration.
- The appearance of a false joint.
- Deceleration of fracture healing.
- Displacement of bone fragments.
Operation osteosynthesis
This is a very popular treatment for fractures that have healed incorrectly. The essence of this operation is that fragments of a broken bone are attached to one another using various fixators. They can be in the form of special screws, screws, knitting needles, etc. Fixators are made of strong non-oxidizing material, it can be bone tissue, special plastic, stainless steel, titanium and other materials.
Implants are used for a long time, which allows the bone at the fracture site to fully recover.
Osteosynthesis can be of two types:
- External, it is also called transosseous. During such an operation, bone fragments are connected. Outside, everything is fixed using the Ilizarov apparatus or other similar devices.
- Internal (submersible). This method differs from the previous one in that the implants fix the bones inside the body, and not outside. After this operation, additional fixation is often performed with a plaster cast.
Osteosynthesis is usually used in cases where it is necessary to connect the long tubular bones of the legs (thigh, lower leg) and arms (shoulder, forearm), as well as fractures of the joints and small bones of the hand and foot.
Fixation during osteosynthesis keeps broken bones immobile and therefore they grow togetherright.
Contraindications for this operation
Such a surgical intervention as osteosynthesis, despite many positive aspects, also has some contraindications. For example:
- The patient is in serious condition.
- The wound is infected or contaminated.
- Large area of damage if the fracture is open.
- The patient has an ailment that is accompanied by convulsions.
- Having osteoporosis, in which bones become very brittle.
Possible Complications
To fix the bone, the surgeon has to expose a large area of the bone. At the same time, she loses the tissues surrounding her, in which blood vessels are located, and this leads to a violation of her blood supply.
During the operation, nearby tissues and bones are damaged. Also, a large number of holes, which are necessary for screws and screws, weaken the bone.
If antiseptic precautions are not followed, infection can enter the wound.
Partial bone resection
During this operation, the damaged area of the bone is removed. Resection can be performed as a separate operation, or it can be only a certain stage of another surgical intervention.
Partial resection can be of two types:
- Subperiosteal. With this method, the surgeon, using a scalpel, cuts the periosteum in two places - above and below the lesion. And this should be done inwhere he althy and damaged tissues meet. After that, the periosteum is separated from the bone and sawn from above and below.
- Extraperiosteal. The operation is done in the same way as the previous one, the only difference is that the periosteum exfoliates towards the affected area, not the he althy one.
Resection is performed under general or conduction anesthesia.
