Connection of broken bones with the help of surgery has accelerated both the treatment process and the rehabilitation of patients with complex fractures. For the first time, such a procedure as osteosynthesis of bones was carried out back in the 19th century, but due to the occurrence of very serious complications of a purulent nature, doctors were forced to stop doing it. Resumed attempts after the introduction of antiseptic and aseptic treatment into practice.
What is osteosynthesis?
Many patients with complex fractures are offered osteosynthesis by doctors. What it is? This is the connection of bone fragments with the help of an operation. It is usually prescribed in the treatment of complex joints, incorrectly fused or fresh non-united fractures. With the help of osteosynthesis, the matched fragments are fixed. Thus, ideal conditions are created for their fusion, as well as restoration of the integrity of the limb.
There are two main types of osteosynthesis:
- submersible (on-osseous, intraosseous, transosseous);
- external (extrafocal).
There is also ultrasonic osteosynthesis. What it is? This is a connection of small bone fragments.
Operations are carried out with the help of different clamps. Nails and pins are used for submersible intraosseous osteosynthesis, plates with screws for extraosseous osteosynthesis, pins and screws for transosseous osteosynthesis. These retainers are made from chemically, biologically and physically neutral materials. Basically, metal structures made of vitalium, stainless steel, titanium are used, much less often - from inert plastics and bone. Metal retainers, after the fracture heals, are usually removed. The Ilizarov apparatus on the leg is used for external osteosynthesis. Thanks to him, bone fragments after comparison are firmly fixed. Patients can walk normally with a full load.
Indications
Osteosynthesis is indicated as the main recovery technique for:
- such a fracture that does not grow together without the help of a traumatologist;
- damage with the possibility of perforation of the skin (when a closed fracture is able to go into an open one);
- a fracture complicated by damage to a large artery.
Contraindications
Surgery is not recommended for the following conditions:
- if the patient feels unwell;
- there are extensive opendamage;
- when the affected area becomes infected;
- if there are pronounced pathologies of any internal organs;
- with progression of systemic bone disease;
- the patient has venous insufficiency of the limb.
Types of plates
The plates used during the operation are made from various metals. Titanium plates are recognized as the best, since this material has an interesting feature: in the air, a film instantly forms on it, which in no way will interact with body tissues. In this case, you can not be afraid of the development of metallosis. That is why many do not remove such plates, but leave them for life.
Immersion intraosseous osteosynthesis
Another name for the operation is intramedullary osteosynthesis. It is open and closed. In the first case, the fracture zone is exposed, after which the fragments are compared, and a mechanical rod is inserted into the bone marrow canal of the damaged bone. Open osteosynthesis does not require the use of special equipment for joining fragments; this technique is much simpler and more accessible than closed surgery. However, this increases the risk of soft tissue infection.
Closed intramedullary osteosynthesis is characterized by the fact that the fragments are compared, after which a small incision is made far from the fracture site. Under X-ray control, through this incision, using a special apparatus, they are introduced into the bone marrow canal of the damagedbone along the conductor is a rather long metal hollow rod of the corresponding diameter. After that, the conductor is removed, and the wound is sutured.
Internal bone osteosynthesis
What is this? This method of connecting bone fragments is used for various fractures (comminuted, helical, periarticular, oblique, transverse, intraarticular), regardless of the bend and shape of the medullary canal. The fixators that are used for such operations are presented in the form of plates of different thicknesses and shapes, connected to the bone with screws. Many modern plates have special approaching devices, including removable and non-removable ones. After the procedure, a plaster cast is often also applied.
In helical and oblique fractures, external osteosynthesis is usually performed using metal bands and wires, as well as special stainless steel rings and semi-rings. This method of bone connection, especially wire, is rarely used as an independent one due to not very strong fixation and most often serves as an addition to other types of osteosynthesis.
Soft suture material (silk, catgut, lavsan) is very rarely used for this operation, because such threads are not able to withstand muscle traction and displacement of fragments.
Internal transosseous osteosynthesis
Such a surgical reposition is carried out with the help of bolts, screws, spokes, and these fixators are carried out in an oblique or transverse directionthrough the bony walls at the site of injury. A special type of transosseous osteosynthesis is a bone suture - this is when channels are drilled in the fragments and ligatures (catgut, silk, wire) are passed through them, which are then tightened and tied. A bone suture is used for fractures of the olecranon or patella. Transosseous osteosynthesis involves the application of a plaster cast.
External osteosynthesis
Such a reposition is carried out with the help of special devices (apparatuses of Ilizarov, Volkov - Oganesyan). This allows you to compare fragments without exposing the fracture site and firmly fix them. This technique is performed without the imposition of a cast, and the Ilizarov apparatus on the leg allows the patient to walk with a full load.
Complications
Serious complications may occur after the operation. Leads to them:
- Wrong choice of technique for fixing bone fragments;
- instability of matched bone fragments;
- soft tissue roughness;
- incorrectly selected retainer;
- non-compliance with asepsis and antisepsis.
Such complications contribute to improper union of the fracture, its suppuration or complete non-union.
Since long massive plates are used for internal bone osteosynthesis, and for this the bone is exposed over a large area, its blood supply is often disturbed, which leads to slow fusion. Removing the screws leaves numerous holes that weaken the bone.
Conclusion
So, we have analyzed such a technique as osteosynthesis. What it is? This is the most modern way to connect bone fragments after a fracture. Thanks to him, the process of treatment and rehabilitation of patients is significantly accelerated. Osteosynthesis is carried out using various fixators. The most durable are titanium plates, which can not even be removed.
