Osteosynthesis is a surgical procedure that helps to heal bone fragments. For this, special fixing structures are used. With their help, the bones are made motionless for a long time. This provides the necessary conditions for their proper splicing.
Definition of a treatment procedure
Osteosynthesis is an operation whose purpose is to fix the bone. This is a surgical procedure used to treat bone fractures. During its implementation, bone fragments are connected using screws, rods, plates. A broken bone is fixed using these devices, which can stably fix it in the correct position. Currently used materials are mainly made of titanium.
The most commonly diagnosed fracture of the femur. Osteosynthesis is the preferred form of treatment for multiple fragment bone fractures in patients with osteoporosis.
Hip fractures
The femur consists of the head, large and small trochanter, trochanteric fossa, as well as the lateral and medial condyles. The femoral head is articulated with the acetabulum in the pelvic bone forming the hip joint, while the distal part of the femur is connected to the tibia and the patella, forming the knee joint.
The thigh is the largest and most durable bone in the body and has good blood supply, so it requires a large or significant impact force to destroy it. There are 4 types of fracture:
- fatigue (stress) fracture;
- partial fracture;
- complete fracture without displacement;
- complete fracture with displacement;
Fractures vary in degree and complexity. They can be: transverse, inclined, spiral (due to torsional force), comminuted, open or closed.
Risk factors
There are several factors that lead to an increased risk of fracture of the femur. Elderly people (over 70) have a higher level of risk.
The risk of these fractures increases exponentially with increasing age and is most common in women.
Signs of a fracture include severe pain, inability to move or stand on a leg, restriction of hip movements, and localized swelling. Typical for hip fractures is the limitation of external rotation and a shortened lower limb. A hematoma can also be observed in the surrounding soft tissues.
Advantages and disadvantages of femoral osteosynthesis
Advantages:
- The operation allows the patient to quickly return to physical activity, prevents the development of diseases of the cardiovascular system, decreased muscle tone, the appearance of pressure sores.
- Osteosynthesis creates conditions conducive to the direct fusion of fragments, excluding the appearance of bone calluses.
- The probability of a full restoration of the normal functioning of the joints is high.
Disadvantages:
- No guarantee of final fracture fusion. Moreover, the age factor is of great importance, increasing the likelihood that after four months the fracture does not grow together. Therefore, for elderly patients, this method is considered ineffective.
- In some cases, there is the possibility that a false joint of the femoral neck is formed.
- There is a small chance of developing an infectious process with purulent discharge.
Indications for the operation
Femur osteosynthesis depends on the severity and nature of the injury. The operation can be performed by:
- For injuries of the upper end of the femur. The exception is hammered femoral neck injuries. The operation is carried out 2-4 days after receiving the fracture. When carrying out osteosynthesis, L-shaped plates, cannulated screws, and a three-blade nail are used.
- With a fracture of the body of the thigh. Osteosynthesis is carried out for 5-7 days.
- With a fracture of the lower thigh. In this case, this method is used in the presence of an isolated fracture of the femoral condyles, fragments of which are fixed with screws.
The absolute indications for osteosynthesis include:
- non-healing fractures in the absence of the effect of conservative treatment (fracture of the femoral neck or femoral condyles);
- the possibility of transforming an open fracture into a closed one;
- soft tissue implantation between fragments and complicated injuries with damage to the main blood vessels.
Relative indications include:
- secondary displacement of bone fragments during conservative treatment;
- the inability to conduct a closed comparison of debris;
- the presence of false joints or slowly healing fractures.
Types of treatment
All osteosynthesis operations are divided into two groups. Also, the time for the procedure from the moment of injury, access, and the place of application of the structure can serve as grounds for classification.
Interior
Intraosseous osteosynthesis is otherwise called intramedullary. In order to fix the correct position of the bone fragments in oblique, lateral and similar injuries in the upper part of the femur, osteosynthesis of the femur is carried out with a rod. The length of the peripheral broken off segment should be at least 15 cm. Under these conditions, reliable fixation of the fragments can be ensured.
There are two types of nail insertion: open and closed. When using the closed method, the nail is inserted through the incision above the main trochanter into the peripheral and central fragments. This method is considered less traumatic, since the fracture site does not open.
With the open method of femoral osteosynthesis with a pin, the procedure is performed after the fracture site has been opened. With direct administration, a perforator is used, with its help they penetrate into the brain cavity of the proximal type of debris. In this case, the punch is used close to the trochanteric fossa. Then the pin is inserted into the Central fragment. After combining the fragments, it is introduced into the peripheral fragment.
When using the retrograde method, they begin by introducing a pin into the brain cavity of the central fragment until it comes into contact with the skin. Then the tissues are cut, the pin is hammered to the end of the fragment, and after that, comparing the broken parts, they are hammered into the peripheral fragment.
As the indications for use expanded, intramedullary osteosynthesis of the femur began to be used more often. The reason for this was the use of lockable rods, fixed in the bone fragments with transverse type screws. This ensures reliable fixation of bone fragments with a fracture extending in the distal and proximal directions beyond the normal middle third of the bone.
Blocked osteosynthesis provides dynamic and static blockade. In the static type, the screws are inserted through the rod holes in the distal and proximal sections. In this case, the displacement of the fragments becomes impossible, as well as the shortening of the limb.
In dynamic locking, screws are inserted distally or proximal to the fracture line. In this case, the rotational force can be neutralized, but with a comminuted fracture, telescopic displacement is possible.
Femoral osteosynthesis with a proximal fracture is performed using a three-lobed nail or an angled plate.
Screw osteosynthesis
In this case, bone fragments are fixed with screws. For this purpose, a hole is drilled in the broken fragment. A thread for a screw is drilled in the opposite fragment, or a screw with a thread at the end is used directly. In both cases, the debris is joined together by tightening the screws.
Plates
During osteosynthesis of the femur with a plate, fragments of a broken bone are fixed with this device. The surgeon exposes the broken bone and screws a suitable plate along the fault line. It is fixed on all fragments with screws. In this case, the broken fragments are firmly connected to each other.
Dynamic screw
Dynamic femoral screw is used for osteosynthesis of the femoral neck. In this case, the dynamic screw is screwed into the head itself. A plate is screwed to the femur. A plate through which the free end of the screw can slide is screwed to the femur. The patient’s body weight acts in such a way that the bones are compressed at the fracture site.
External
During external osteosynthesis of the femur, specific complications may develop: contractures, additional fixation points, and damage to the vascular bundle. This method can only be used if there is evidence. As a rule, these are injuries that can lead to severe complications resulting from internal osteosynthesis. These include combined, complicated, open, gunshot, multi-fragmented, closed comminuted and segmental fractures.
What are the possible complications and risks?
Osteosynthesis is one of the standard procedures used to treat fractures, and usually proceeds without complications. This operation, like any other, can sometimes lead to infections, nerve damage, postoperative hemorrhage or the appearance of blood clots. Ankylosis, osteonecrosis, or tendon adhesions can occur in rare cases.
What happens after surgery
After surgery, during the recovery phase, the patient is under the supervision of a physician. Physiotherapeutic exercises are carried out after some time to prevent ankylosis and minimal loss of muscle tone.
The chosen osteosynthesis procedure and the individual healing process will determine if the bone can subsequently be used as usual. It takes at least six weeks to fully heal, but this process can take several months. However, partial patient mobility may occur before this point: crutches or other walking aids are allowed.
Based on various factors, it is determined whether, after complete fusion, it is possible to carry out an operation to remove fastening elements. The material used (titanium) can mainly remain in the body throughout life. As a rule, screws and plates are not removed unless there is a specific reason for this.
Recovery period
If necessary, the doctor recommends recovery methods such as physiotherapy, massage, occupational therapy and physiotherapy. All these measures are designed to quickly restore the patient, the function of the bone and its anatomical structure.
The main task of rehabilitation during osteosynthesis of the femur is to adapt the patient to his previous lifestyle. It is necessary to reduce physical activity, but its approximation to the previous level is allowed. If necessary, the patient must undergo retraining in another specialty.
After osteosynthesis of the femur with a plate, rehabilitation should begin as early as possible. All appointments must be fulfilled in a complex and without interruptions. After osteosynthesis of the femur, indications for rehabilitation depend on various factors, including age, type of surgical procedure, general condition of the patient. After bone fusion, orthopedic therapy is recommended.
During the period of immobilization, patients should actively move their legs. Using isometric exercises is also important for muscle training. After a period of immobilization, it is necessary to fix the leg manually or using a bracket. Fixation is necessary for training the hip and knee joints and ensuring the gradual verticalization of the legs and ensuring patient independence while walking or during other activities. One-way stabilization exercises and balneotherapy are also recommended. After strengthening, you need to focus on a gradual increase in pressure, re-testing the ability to walk, increasing the intensity of movements, using strength training to get rid of muscle atrophy, which is a consequence of the immobilization period, and increasing endurance.
Rehabilitation after osteosynthesis of the femur involves performing the exercises below.
Before going to bed, massage the pre-articular structures and perform hip movements. In this case, you can use all the movements, except for the rotations! It is also recommended to use passive movements to increase the mobility of the patella. After osteosynthesis, the patient’s condition is positively influenced by the use of isometric exercises for the hamstrings, quadriceps and gluteus maximus, as well as the use of active exercises with low resistance to train the muscles of the thigh and knee. The use of quadriceps massage methods is recommended immediately after verticalization without support. One-sided stabilization exercises also positively affect bone health.