DOI: https://doi.org/10.15674/0030-59872019157-63
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Tactical treatment optimization for long bone distal metaepiphysis fractures based on biological principles

Iryna Bets

Abstract


The intensive development of orthopaedics and traumatology has led to the appearance of problematic issues in the treatment of fractures of distal metaepiphysis of long bones (FDM). The reason to divide them out from the whole array of intraand near-articular fractures was the commonality of classifying characteristics (according to AO classification).

Objective: to improve the results of treatment of FDM fractures based on the use of well-grounded tactical decisions in accordance with biological principles.

Material and Methods: A retrospective study was made; we analyzed medical records of 122 patients. Prospective study included — 217 patients, where we applied the optimized therapeutic fracture therapy. We have done an experimental study for 13 patients with studying of tibia fragments mobility fixed with one-side rod fixators with specially developed equipment. Another one experimental «in vivo» study was made on 28 rats, who received standardized fractures of lateral femur condyle. The physical properties of the Softcast and Scotchcast braces, the properties of these materials and external fixing devices were investigated by mathematical modeling.

Results: in the retrospective group of patients with FDM injuries methods of internal fixation were prevailed — 59 %, external fixation was used in 22 % of cases, conservative treatment — in 19 %. Failed results (32 %) were due to the development of complications, 25 % of which were infections, 7 % — regeneration disorders. In the prospective group, the proportion of conservative methods was 29 %, external fixation — 50 %, internal — 21 %. The change in the treatment method for FDM injuries has been substantiated by the results of experimental studies.

Conclusions: the tactics for treatment of FDM were optimized based on biological principles and functional remodeling, which allowed to increase the number of good results up to 58 % (against 44 % in the retrospective group) and reduced the number of unsatisfactory results to 9 % (compared to retrospective group 32 %). 


Keywords


distal metaepiphysis; fracture; treatment; functional remodeling effect; clinical-experimental study; biological principles

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References


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