Osteosynthesis is a surgical intervention to connect and fix the bone fragments that formed during fractures. The main purpose of this intervention is to create the necessary conditions for bone fusion.
A similar technique is used when conservative therapy does not give the desired result. The conclusion regarding the treatment failure is made on the basis of the diagnosis.
To connect bone fragments, special fixing components are used. The choice of the type of latch largely depends on the characteristics and location of the injury, as well as the nature of the damage.
What is the operation
Compression-distraction osteosynthesis is a surgical therapy technique, which is prescribed mainly for complex fractures with displacement. During the operation, fragments of bone of the lower leg, ulna or femur are fixed by the use of fixatives.
This is necessary so that all fragments of the bone can be completely immobilized until they are completely fused. The design for osteosynthesis is selected individually for each patient. This type of therapy is much more effective than other, more gentle treatment methods.
Purpose of operation
Compression-distraction osteosynthesis is used to treat fresh injuries, overgrown or incorrectly fused fractures and pseudoarthrosis. A traumatologist carries out surgical treatment using the reposition method to:
- Stable fixation of the damaged area until it is completely restored.
- Reducing the risk of injury to adjacent soft tissues.
- Return functions of the injured limb.
As fixing elements, special nails, plates, screws, wire, spokes and many other components are used.
The main types of operations
There are several types of extra focal compression-distraction osteosynthesis. Only a doctor can determine what type of surgical intervention is suitable for a particular patient. Basically, the effect of this technique is positive. In most cases, the intervention is carried out immediately after injury. Osteosynthesis can sometimes be done over time. The cause of this may be an incorrectly fused fracture. Among the main types of surgical intervention, it is necessary to distinguish the following:
- Submersible.
- Hybrid.
- Transosseous.
When performing a submersible type of operation, the doctor performs a dissection of the soft tissues, then implants are introduced, which are fixed in the bone in the places of its destruction. Extra focal compression-distraction osteosynthesis is performed using x-ray equipment, and the fixators are fixed at the required distance from the fracture area. In this form, bone fragments are fixed:
- The core.
- Spoke.
- Spokes-rod apparatus.
In the hybrid method of intervention, immersion and compression-distraction osteosynthesis are simultaneously used. A similar method is used in the most severe cases. To compare fragments, a Weber operation is often prescribed, when both the submersible and the external structure are used.
Compression-distraction osteosynthesis according to Ilizarov implies the use of the device of the same name. Thanks to him, bone particles are firmly fixed in a strictly predetermined position.
Application area
In modern surgery, osteosynthesis techniques are widely used for injuries in such departments:
- Shoulder joint.
- The pelvic bones.
- Lokteva.
- Hip.
- Ankle joint.
- Wrist.
- Hip.
- Foot.
Compression-distraction osteosynthesis provides for the full restoration of the natural integrity of bone tissue, the consolidation of individual fragments and the provision of the required conditions for a full recovery.
Indications for the operation
A similar technique is prescribed if a person risks being permanently disabled. In addition, extramedullary and intramedullary compression-distraction osteosynthesis is prescribed in the most extreme cases when conservative methods do not bring any result. Indications for surgical intervention are:
- Complex fractures.
- The likelihood of damage to large vessels and nerve endings.
- Incorrectly healed fracture.
- Repeated fracture with displacement of bone fragments.
- Hallux valgus correction.
Fresh fractures, which cannot be fused without surgery, are considered an absolute indication for osteosynthesis. This applies mainly to fractures complicated by the displacement of bone fragments, the formation of hematomas and rupture of blood vessels.
The relative indications of osteosynthesis include the requirements for the rehabilitation period.
Technique of osseous surgery
Bone extrafocal compression-distraction osteosynthesis is characterized by the fact that fixators are introduced only from the outside of the injured bone. It is used mainly for uncomplicated fractures with a slight displacement. As fixing elements, metal plates are used, which are connected with special screws. Also, fixators that a surgeon can use to join bone fragments can be:
- Corners.
- Rings.
- Wire.
- Tapes.
- Half rings.
Structural elements are made of alloys of various metals. In particular, stainless steel, titanium, and composite compositions are used.
Surgery Technique
When transosseous compression-distraction osteosynthesis is performed, the fixing elements are inserted into the bone strictly in the area of the fracture. This technique is used only if bone fragments are helical in shape.
To ensure strong fixation, screws of such a diameter are used so that the connecting part of the structure protrudes slightly beyond the borders of the bone. As a result of this, parts of the bone are pressed very tightly, thereby significantly reducing compression.
If the fractures are very complex and the fracture line is incorrect, then the bone suture technique can be used. Its essence is to connect the fragments with a special fixing tape made of stainless steel or a round wire. In the area of the damaged areas of the bone, holes are drilled through which the wire rods are stretched, used to fix the bone fragments in the place of contact. The latches are then firmly tightened and secured.
After the appearance of characteristic signs of fracture fusion, the wire is removed to prevent subsequent atrophy of bone tissue, fastened by a metal structure. Reoperation is mainly carried out 3 months after osteosynthesis of the primary.
Transosseous compression-distraction osteosynthesis according to Ilizarov is indicated for fractures of the condyle of the shoulder, elbow process and patella. It is very important to carry out the initial operation in the shortest possible time for fractures in the knee and elbow. Conservative treatment is rarely effective, subsequently leading to some restriction of the mobility of the affected joint.
The surgeon selects the most effective technique for fixing fragments based on x-rays. With a simple fracture, the Verber technique of osteosynthesis is used, that is, the bone is fixed with a wire and two titanium knitting needles. If several fragments have formed at once and a strong displacement has occurred, then metal plates with screws are used.
Technique for intraosseous surgery
In practice, two techniques for intraosseous osteosynthesis are used, since the operation can be closed and open. The closed type of surgery is carried out in two stages. Initially, individual fragments are collected using a special guiding apparatus, and then a fixing metal rod is introduced. The latch is screwed in under the control of the x-ray equipment.
When surgery is open, the fracture area is initially exposed, bone fragments are manually matched using special surgical instruments without the use of additional equipment. This technique is considered the simplest, but it is accompanied by significant blood loss, a violation of the integrity of the surrounding soft tissues and the risk of an infectious process.
Osteosynthesis in Oral and Maxillofacial Surgery
Compression-distraction osteosynthesis of the lower jaw is widely used in maxillofacial surgery. The purpose of the operation is to eliminate existing congenital or acquired over time skull abnormalities.
This method of intervention is used to eliminate the resulting deformation of the lower jaw, which was formed as a result of injuries or developmental disorders of the masticatory apparatus. Compression is created using special orthodontic structures that are fixed in the oral cavity. They exert uniform pressure on bone fragments, while guaranteeing a tight fit along the edges.
Contraindications
The operation is not performed if the patient has such diseases and disorders:
- Diseases of the nervous system.
- Blood clots.
- Osteoporosis.
- Renal failure.
- Severe condition of the patient.
- Infection and suppuration in the area of the fracture.
In order to exclude available contraindications and negative consequences, you need to undergo a full examination. If there are no contraindications, the doctor selects the method of osteosynthesis.
Possible complications
With compression-distraction osteosynthesis of the lower leg or other part of the limb, unpleasant consequences are extremely rare. When performing open operations, such complications may develop:
- Osteomyelitis.
- Embolism.
- Soft tissue infection.
- Internal bleeding.
- Arthritis.
After the operation, anticoagulants and antibiotics are prescribed for preventive purposes. Anesthetic is prescribed according to indications.
Rehabilitation process
The rehabilitation period is largely dependent on many factors. These include:
- Location of injury.
- The complexity of the operation.
- Age.
- Type of equipment used.
- Health status.
The recovery program is developed separately for each patient and includes several methods:
- Electrophoresis
- Physiotherapy.
- Balneological procedures.
After surgery on the elbow joint, patients experience severe pain for 2-3 days. Despite this, you need to develop a hand. In the early days, exercises are carried out under the supervision of a doctor. Bending, straightening the limbs, rotational movements are recommended.
Special simulators are used to develop the knee and hip joint, with the help of which the load gradually increases, tendons and muscles are strengthened. Massage is also required.
After osteosynthesis of the elbow, thigh, lower leg, the recovery period takes 3-6 months. The doctor selects rehabilitation methods individually.