General tactical principles to treat the fractures of distal metaepiphysis of long bones
Fractures of distal metaepiphysis of long bones (DMELB) have a lot in common because of injury mechanisms of and classification features. This allows us to consider them as a part of the combined group and investigate tactical trends in their treatment. Some domestic traumatologists due to the dominance of AO technology during the past 10 years began to consider other methods of treating of intraarticular injuries as archaic. Undoubtedly, the AO classification is the most modern and successful aimed at the informed choice of treatment tactics, but it is limited to AO technology only. However, clinical experience of authors shows some questionable indications for plate osteosynthesis in the case of open fractures and fractures with severe soft tissue injuries, intraarticular C-type fractures.
The goal: to analyze gained clinical experience an on this ground identify common tactical trends of the use of various technologies in the treatment of intra-articular fractures of the distal metaepiphysis of long bones.
The methods: the study included a group of 115 patients with intraarticular injuries of distal metaepiphysis of humerus and femur, forearm and tibia.The results: it was revealed that in the treatment of fractures of DMELB skeletal traction was used in 31 % cases, external fixation devices — in 30 % cases, combined technologies of osteosynthesis in 11 % cases, open remodeling with on-bone osteosynthesis in 28 % cases. The application of these technologies provide in general good results in 60 % cases, satisfactory results in 31 % cases and unsatisfactory results in 9 % cases, that roughly coincides with the quality indicators for the treatment of intraarticular injuries according to specialized scientific journals. It was also proved that one of the results of priority use of low-traumatic treatment technology was the virtual absence of serious irreversible suppurative-necrotic complications. The deepening research are required for the final decision concerning the treatment strategy of DMELB fractures.
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