The connection of broken bones with the help of the operation allowed to accelerate both the treatment process and the rehabilitation of patients with complex fractures. For the first time, such a procedure as bone osteosynthesis was carried out in the 19th century, but due to very serious purulent complications, doctors were forced to stop doing it. Attempts were resumed after the introduction of antiseptic and aseptic treatment into practice.
What is osteosynthesis?
Doctors suggest osteosynthesis for many patients with complex fractures. What it is? This is a compound of bone fragments through surgery. It is usually prescribed in the treatment of complex joints, improperly fused or fresh non-fused fractures. With the help of osteosynthesis, the associated fragments are fixed. Thus, ideal conditions are created for their fusion, as well as the restoration of the integrity of the limb.
There are two main varieties of osteosynthesis:
- submersible (bone, intraosseous, transosseous);
- external (extra focal).
There is also ultrasonic osteosynthesis. What it is? This is a compound of small bone fragments.
Operations are performed using different clamps. For immersion intraosseous osteosynthesis, nails and pins are used, for the osseous - plates with screws, for transosseous - knitting needles and screws. These fixatives are made from chemically, biologically and physically neutral materials. Mostly metal structures made of vitallium, stainless steel, titanium are used, much less often - from inert plastics and bone. The metal retainers, after the fracture is fused, are usually removed. Ilizarov’s apparatus on the leg is used for external osteosynthesis. Thanks to him, bone fragments are firmly fixed after matching. Patients can normally move at full load.
Indications
The operation osteosynthesis is indicated as the main recovery technique for:
- a fracture that does not grow together without the help of a traumatologist;
- damage with the probability of perforation of the skin (when a closed fracture can go into open);
- fracture complicated by damage to a large artery.
Contraindications
Surgical intervention is not recommended for the following conditions:
- if the patient is not feeling well;
- extensive open damage;
- with infection of the affected area;
- if there are pronounced pathologies of any internal organs;
- with the progression of systemic bone disease;
- the patient has venous insufficiency of the limb.
Types of plates
The plates that are used during the operation are made of various metals. Titanium plates are recognized as the best, since this material has an interesting feature: in air, a film instantly forms on it, which will in no way 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.
Submersible 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 fragments are compared, and a mechanical rod is inserted into the medullary canal of the damaged bone. Open osteosynthesis does not require the use of special equipment for connecting fragments, such a technique is much simpler and more affordable than a closed operation. However, in this case, the risk of infection of the soft tissue increases.
Closed intramedullary osteosynthesis is characterized by the fact that 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, a rather long metal hollow rod of the corresponding diameter is introduced into the bone marrow canal of the damaged bone. After this, the conductor is removed, and the wound is sutured.
Submersible bone osteosynthesis
What it is? 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 clamps 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 converging devices, including removable and non-removable ones. After the procedure, a plaster cast is often applied.
In case of helical and oblique fractures, bone osteosynthesis is usually performed using metal bands and wire, as well as special rings and half rings made of stainless steel. This method of connecting the bone, especially the wire one, is rarely used as an independent one due to not too strong fixation and most often complements other types of osteosynthesis.
Soft suture material (silk, catgut, lavsan) is rarely used for this operation, because such threads are not able to withstand muscle traction and displacement of fragments.
Submersible transosseous osteosynthesis
Such surgical reposition is carried out using bolts, screws, knitting needles, and these retainers are carried out in an oblique or transverse direction through the bone walls at the site of damage. 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 drawn through them, which are then tightened and connected. A bone suture is used for fractures of the ulnar process or patella. Transosseous osteosynthesis involves the application of a plaster cast.
External osteosynthesis
Such reposition is carried out using special apparatuses (apparatuses of Ilizarov, Volkov-Oganesyan). This allows you to compare fragments without exposing the fracture site and firmly fix them. This technique is carried out without applying gypsum, and the Ilizarov apparatus on the leg allows the patient to walk at full load.
Complications
After the operation, serious complications can occur. It leads to them:
- wrong choice of methods for fixing bone fragments;
- instability of associated bone fragments;
- rough handling of soft tissues;
- Incorrectly selected latch;
- non-compliance with asepsis and antiseptics.
Such complications contribute to improper fusion of the fracture, its suppuration or complete nonunion.
Since long massive plates are used for submersible osseous osteosynthesis, and for this a bone is exposed over a large extent, its blood supply is often disturbed, which leads to slow fusion. After removing the screws, numerous holes remain that weaken the bone.
Conclusion
So, we disassembled 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 fixatives. The most durable are titanium plates, which can not even be removed.