MECHANICAL AND CLINICAL CHARACTERISTICS OF THE «ROD – BONE» CONNECTION IN TREATMENT OF GUNSHOT FRACTURES WITH EXTERNAL ROD DEVICES FROM VARIOUS MANUFACTURERS
DOI:
https://doi.org/10.15674/0030-59872023110-17Keywords:
Gunshot fractures, treatment, long bones of the limbs, external fixation, rod, stability of fixationAbstract
Objective. To find out the state of the bone threading under the conditions of inserting the rods of different manufacturers and to establish the duration of a stable «rod – bone» connection in treatment of diaphyseal fractures of the bones of the limbs. Methods. An experiment was conducted using tibia bones of calves. Rods used in external fixators of Biomet (France), Stryker (USA), LLC H B Orto (Ukraine), ORTOPAK (Ukraine) manufacturers were selected. The shape of the bone threading and its contact with the surface of the rod were studied at 2‒5X magnification. Devices from the specified manufacturers were used to fix bone fragments during the treatment of gunshot fractures in 91 patients. The stability of the rod in the bone was checked. Results. The experiment showed that in order to obtain the appropriate bone threading, it is necessary to first pass through both layers of the compact bone of the diaphysis using a drill with a diameter that corresponds to the inner diameter of the threaded part of the rod. Without this, bone coils in the first cortical layer are destroyed or bone fragments in the second are chipped off, reducing the strength of fixation. In the case of screwing the rods into the drilled channel in the second layer of the cortical bone, the quality of the «rod – bone» connection was worse in all cases. Under the conditions of installing the rods in the cancellous bone, a larger number of defective turns was formed in it compared to the compact one. The lowest frequency of rod instability in patients was found when using the ORTOPAK device (18 %); it was much more frequent (35– 51 %) when using devices from other manufacturers. The incidence of the unstable state of the rods was almost 4 times greater in their location in the epimetaphysis than in the diaphysis. Conclusions. For the most effective connection of the rod with the bone, it is necessary to screw it into the prepared channel with a diameter that corresponds to the inner diameter of the threaded part of the rod. The quality and duration of the stable state of the rod in the bone depends on the technical characteristics of its threading, localization and state of fusion of the fragments.
References
- Kazmirchuk, A., Yarmoliuk, Y., Lurin, I., Gybalo, R., Burianov, O., Derkach, S., & Karpenko, K. (2022). Ukraine's experience with management of combat casualties using NATO's four-tier "Changing as needed" Healthcare system. World Journal of Surgery, 46(12), 2858-2862. doi:10.1007/s00268-022-06718-3
- Holt, E. (2022). Ukraine invasion: 6 months on. The Lancet, 400(10353), 649-650. doi:10.1016/s0140-6736(22)01635-x
- Dar , G. N., Tak, S. R., Kangoo, Kh. A., Dar, F. A., Ahmed, (2009.) External fixation followed by delayed interlocking intramedul¬lary nailing in high velocity gunshot wounds of the femur. Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery, 15 (6), 553–558.
- Gustilo, R. B., Mendoza, R. M., & Williams, D. N. (1984). Problems in the management of type III (Severe) open fractures. The Journal of Trauma: Injury, Infection, and Critical Care, 24(8), 742-746. doi:10.1097/00005373-198408000-00009
- Litvishko, V. (2017). Тreatment of long bones comminuted fractures using external fixation device. ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS, 0(4), 40-46. doi:10.15674/0030-59872016440-46 (in russian)
- Litvishko, V., & Popsuishapka, O. (2015). The functional treatment of the diaphyseal tibial fractures using Plaster cast or external fixator. ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS, 0(4), 91-102. doi:10.15674/0030-59872015491-102 (in Ukrainian)
- Popsuishapka O. K., Lytvyshko, V. O., Borobyk, I. M. (2014). Functional treatment of diaphyseal fractures of limbs using rod devices for elastically stable connection of fragments (methodological recommendations). Kyiv: Ministry of Health of Ukraine, Ukrainian Center for Scientific Infor¬mation and Patent and Licensing Work. (in Ukrainian)
- Lytvyshko V. O. (2018). Regularities of formation of osseous regenerate after shaft fracture under the conditions of functional therapy using elastic-stable connection of fragments (Doctor med. Sci.), Kharkiv (in Ukrainian)
- Kouassi, K. J., Cartiaux, O., Fonkoué, L., Detrembleur, C., & Cornu, O. (2020). Biomechanical study of a low-cost external fixator for diaphyseal fractures of long bones. Journal of Orthopaedic Surgery and Research, 15(1). doi:10.1186/s13018-020-01777-5
- Popsuishapka, O., Pobel, Ye., Shevtsova, M., Beloguova, L. (2006). Research and evaluation of the biomechanical structure "frag¬ments-fixator" created in the surgical treatment of fractures of the femoral neck. Orthopaedics, traumatology and prosthetics, 4, 56–62. (in russian)
- Borovyk I. M. (2010). Treatment of diaphyseal fractures of the fe¬mur in children with an external rod apparatus [Lecheniye diafizarnykh perelomov bedrennoy kosti u detey vneshnim sterzhnevym apparatom] (Candidat of med. Sci.) Kharkiv (in russian).
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