The idea of connecting the broken bones surgically greatly accelerated the process of treatment and rehabilitation of patients with open fractures and complicated. The first operations on the connection of bone fragments have been started in the 19th century, but then they stopped doing because of the emergence of serious suppurative complications. These operations were resumed only after the introduction of the practice aseptic and antiseptic.
What is the fixation and its species
Osteosynthesis task force called bone fragments. It is used in the treatment of fresh ununited wrong accrete fracture and pseudoarthrosis
False joints - when the mobility of broken bones
. The purpose of osteosynthesis - to provide fixation of bone fragments mapped, creating conditions for their bone fusion, restore the integrity and function of a limb.
There are two basic types of osteosynthesis - immersion (injection directly into bone fastener fracture zone) and outer (extrafocal) - by means of spokes conducted in fragments through the skin and fixed to any apparatus. For the connection of small bone fragments, and more to connect the transplant of bone grafts, used ultrasound osteosynthesis.
Osteosynthesis is intraosseous, and extramedullary transosseus. To perform osteosynthesis use different tabs for intraosseous - pins and nails for extramedullary - plate with screws to transosseous - bolts and spokes. Often used a combination of several kinds of osteosynthesis. All clamps for osteosynthesis should be made of biologically, chemically and physically inert (neutral) materials. As a rule, used metal structures made of stainless steel, vitalliya, titanium, sometimes made of bone and inert plastics. Metal clamps after fracture healing is usually removed. Some locks are a combination of extramedullary and intraosseous structures.
Submersible intraosseous osteosynthesis
Submersible intramedullary fixation can be open and closed. When closed osteosynthesis after comparing fragments with the help of special devices in the medullary canal of the fractured bone through a wire through a small incision away from the fracture site is administered under the control of the X-diameter long metal hollow rod. The conductor is removed and the wound was sutured.
With an open osteosynthesis, which is used more often expose the fracture zone, fragments are compared in the medullary canal of the fractured bone is introduced mechanical rod. Outdoor fixation does not require special equipment to map the fragments, it is technically easier and more affordable closed, however, with the closed method of fracture zone is not exposed, reducing the risk of infection, less damaged soft tissue around the bone fragments.
Submersible osteosynthesis used in fractures of various localization and type (comminuted, oblique, helical, lateral, periarticular, intraarticular), regardless of the shape and bend the medullary canal. Most of the catches for osteosynthesis are of different shapes and thickness of the plate is connected to the bone with screws. Many modern plate have special bringing together the device, including fixed and removable. After osteosynthesis often impose additional plaster cast.
Osteosynthesis with helical oblique fractures and may be formed by a metal wire, metal strips, the special half-rings and rings of stainless steel. This type of osteosynthesis, particularly the wire, as an independent method is rarely used because of inadequate solid fixation, usually it is in addition to other types of osteosynthesis.
Osteosynthesis soft suture material (catgut, silk, polyester) is rarely used, as the thread can not withstand the thrust and muscle re-displacement of fragments.
Submersible transosseous osteosynthesis
Submersible transosseous osteosynthesis is carried out by means of screws, bolts, spokes. When this is carried out in the transverse clamps or kosopoperechnom direction through the wall of the tube in the area of bone fracture. A special kind of transosseous osteosynthesis is a bone joint. In the fragments of drilled channels and through them spend ligatures (silk, catgut, wire), which are then tightened and tie. Bone suture used for fractures of the patella, olecranon. When transosseous osteosynthesis, usually impose a plaster cast.
External fixation is carried out by means of special devices (by Ilizarov, Volkov-Oganesyan). It allows you to not exposing the fracture site, and compare the fragments firmly to fix them. The method does not require plaster immobilization, patients with the devices in the lower extremities can go with a full load.
Complications of osteosynthesis
Complications during osteosynthesis can cause the wrong choice of method of fixation of bone fragments, wrongly chosen type of fastener failure to stability mapped fragments, lack of respect for aseptic and antiseptic, ill-treatment of soft tissue. All of these can cause abnormal fracture healing, nonunion, or it fester.
Submersible osteosynthesis long massive plates accompanied by the exposure of the bone over a large area, which violates its food (blood flow), and may be the cause of slow accretion. Remaining after the removal of screws numerous holes weaken bone.
Nailing - is the most modern method of treatment of fractures.