DOI: https://doi.org/10.15674/0030-59872016231-40

Bone fragments displacement in the treatment of diaphyseal fractures and their importance to the process of bone regeneration

Olexii Popsuishapka, Valeriy Litvishko, Nataliya Ashukina, Svetlana Іakovenko

Abstract


Methods of fixation are used for the treatment of diaphyseal fractures, which produce structure «fragments – fixation device» with various mechanical properties and the displacement range of fragments.

Purpose: to justify the concept of the effect of the displacement of bone fragments in the process of formation of the regenerate in the treatment of diaphyseal fractures with orthosis or external rod device (ARD).

Methods: dislocation of the bone fragments using ultrasonography studied in 18 patients with diaphyseal fractures of humerus (9), femur (5) and tibia (5). Eight patients out of them with acute humeral fractures were treated conservatively with orthosis, in 5 patients with acute femoral and tibial fractures ARD was used, 6 patients had nonunion after osteosynthesis.

Results:it is found that bone fragments have a multidirectional path of movement in space. In patients with acute humeral fractures treated with orthosis, linear displacement of the fragments end ranged 1.1–6 mm (10–40 % of initial distance), angular amplitude was 2°–8°. In ARD fixation linear fragment displacement (2 mm — 13 %) found only in patients with femoral fractures. In a cases of nonunion angular skeletal deformation appeared and increased under the axial load (apical deformity angel 13–40 %). The mobility of bone fragments in the first three weeks after diaphyseal fracture causes deformation and strain blastema, which results in the future structure of the high-grade periosteal bone regenerate. Nonunion of diaphyseal fracture fragments mobility does not provide a stimulating and shaping effect.


Keywords


diaphysial fracture; ultrasonography; fragment displacement; fibrin blood clot; isometric and axial load; regenerate deformity

References


Bets GV. Osteosynthesis using external fixing devises in urgent trauma [in Russian]. Thesis Doctor of Medical Sciences. Kharkov, 1991. 286p.

Bilinskiy PI, Chaplynskiy VP, Andreychin VA. Sravnitelniy teoreticheskii analiz biomekhanicheskikh aspectov osteosinreza pri poperechnom perelome tibia kontaktnimi I malokontaktnimi plastinami. Trauma. 2013;14(2):63–71.

Volna A, Panin M, Zagorodny N. Removal of metal implants: A solved problem? Orthopaedics, Traumatology and Prosthetics. 2009;(4):84–7. doi: 10.15674/0030-59872009484-87.

Volna A. The evolution of the principles and philosophy АО/ASIF. The path of 50 years. Orthopaedics, Traumatology and Prosthetics. 2008;(2):89–96.

Popsuishapka O, Litvishko V, Grigoryev V, Ashukina N. Treatment of bone fragments nonunion after dyaphiseal fracture. Orthopaedics, Traumatology and Prosthetics. 2014;(1):34–41. doi: 10.15674/0030-59872014134-41.

Marks VO. open fracture healing [in Russian]. Minsk: Izd-vo Akademii yauk BSSP, 1962. 275 p.

Kobelev AV, Smolyuk LN, Kobeleva PM, Protsenko IuL. Nonlinear viscoelastic properties of biological tissues [Web source]. Ekaterinburg: UrRAN, 2011: www.imp.uran.ru./lib/monografy/Kobelev1.pdf.

Popsuishapka O, Litvishko V, Ashukina N, Danishchuk Z. Peculiarities in the formation, structural-mechanical properties of a fibrin-blood clot and its importance for bone regeneration in fractures. Orthopaedics, Traumatology and Prosthetics. 2011;(4):5–12. doi: 10.15674/0030-5987201345-12.

Popsuishapka O, Litvishko V. Treatment of diaphyseal humeral fractures using trunk-cloth orthosis. Orthopaedics, Traumatology and Prosthetics. 1998;(3):90–3.

Popsuishapka O. Functional treatment of diaphyseal bone fractures (clinical and experimental study): thesis for the degree of Doctor of Medical Sciences. Kharkov, 1991. 271 p.

Popsuishapka O, Uzhigova O, Litvishko V. Rate of nonunion and delayed union of fragments in isolated diaphyseal fractures of long bones of the extremities. Orthopaedics, Traumatology and Prosthetics. 2013;(1):39–43. doi: 10.15674/0030-59872013139-43.

Popsuishapka O, Litvishko V, Ashukina N. Clinical and morphological stages of bone fragments fusion. Orthopaedics, Traumatology and Prosthetics. 2015;(1):12–20. doi: 10.15674/0030-59872015112-20.

Popsuishapka O, Dubas V. Mobility of bone fragments at the functional treatment of fractures of the tibia by external device. Orthopaedics, Traumatology and Prosthetics. 2001;(1):36–9.

Popsuishapka O, Litvishko V, Borovik I. Functional treatment of diaphyseal fractures of limbs using a rod device for the elastic-resistant fragments connections. Guidelines [in Ukrainian]. Kiyv, 2014. 46 p.

Popsuishapka O, Litvishko V, Ashukina N, Podgayskaya O. The part played by a fibrin clot and mechanical stresses in it in the process of the primary bone regenerate formation in bone fractures. Orthopaedics, Traumatology and Prosthetics. 2010;(3):22–7. doi: 10.15674/0030-59872010322-27.

Romanenko K, Bilostotskiy A, Prozorovsky D. The absolute and relative stability in the osteosynthesis of long tubular bones. Orthopaedics, Traumatology and Prosthetics. 2009;(1):97–100. doi: 10.15674/0030-59872009197-100.

Serov VV, Shekhter AB. Connective tissue [in Russian]. Moskow: Medicine, 1981. 312 p.

Figurskaya M. Structure of compact bone. Rossiiskii jurnal biomekhaniki. 2007:11(3):28–38.

Khelimskii ОК. On osteoplastic properties of fibrin blood streamed. Trudi Leningradskogo institute travmatologii i ortopedii. 1956;(5):64.

Evans SF. Top down bottom up approaches to elucidating multiscale periosteal mechanobiology: Tissue level and cell scale studies [web source]. Department of Biomedical Engineering Case Western Reserve University, 2012. 104 p. https://etd.ohiolink.edu/!etd.send_file?accession=case1331646902&disposition=inline.

Falvo MR, Gorkun OV, Lord ST. The molecular origins of the mechanical properties of fibrin. Biophys Chem. 2010;152(1–3):15–20, doi: 10.1016/j.bpc.2010.08.009.

https://ru.wikipedia.org/wiki/ Механическое напряжение

Janmey PA, Winer JP, Weisel JW. Fibrin gels and their clinical and bioengineering applications. J R Soc Interface. 2009;6(30):1–10.

McBride SH, Evans SF, Knothe Tate ML. Anisotropic mechanical properties of ovine femoral periosteum and the effects of cryopreservation. J Biomech. 2011;44(10): 1954–59. doi: 10.1016/j.jbiomech.2011.04.036.

Perren SM, Cordey J. The concept of interfragmentary strain. In: Current concepts of internal fixation of fractures. Ed. Uhthoff HK. Berlin-Heidelberg-NY: Springer-Verlag, 1980. pp. 63–77.

Sarmiento A, Latta LL. Closed functional treatment of fractures. Berlin-Heidelberg-NY: Springer-Verlag, 1981. 687 p.




Copyright (c) 2016 Olexey Popsuishapka, Valeriy Litvishkо, Nataliya Ashukina, Svetlana Іakovenko

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.