Главная Тезисы Лечение диафизарных переломов длинных костей Some aspects of forming of conception about treatment of fractures in Ukraine

Some aspects of forming of conception about treatment of fractures in Ukraine

CONCEPTION - is the system of views on something.

For the present moment our country hasn't well-stated system of views on application of existent methods of fracture treatment, providing the most effective functional recovery of musculoskeletal system and working capacity.

In all advanced world countries, ideas, developed by AO, are taken as the basis of similar conception. They are international and are known by many specialists in Ukraine. They may be composed as basis and briefly presented in the following manner:

« Main aim of fracture treatment is recovery of primary function at the expense of anatomic reposition, stabile fixation, which allows precocious active Movements in joints of injured extremity and early partial or complete load J. DURST - Traumatologische Praxis/ Standards in Diagnostik und Therapie fur alle Fachgebite. 1997.

However, development of new methods of fracture treatment and improvement of existing ones considerably changes our approaches to the system of their application in treatment of injuries of different localization and severity degree. Therefore, having taken this thesis as basis, having discussed and supplemented it with best ideas, developed in our country and abroad, it is expedient for congress to accept national conception of fracture treatment and apply it in practice according to potential.

In our opinion, with the purpose of creation of such conception it is necessary to discuss the following fundamental matters:

1. Classification.

2. Recovery of anatomy and function of injured segment.

3. Stability of fixation.

4. Atraumatic operative technique.

5. Early active movements and early partial or complete load._

We will proceed from the fact, that conception is ideal fundamental scheme of fracture treatment, on which it is necessary to orientate. However, in everyday practice, anatomic reduction, atraumatic operative technique, functional recovery and, particularly, loads are not always attained simultaneously or in equal extent, and in this case, priority of purpose is determined subject to localization and severity of injury.

1. In order to form single system of views on traumatologic pathology and applied methods of treatment, first of all, it is necessary to accept single injury classification. In our opinion, it would be most expedient to accept well-known classification AO, as it is single language, unifying traumatologists of all countries. However, it must be officially included to teaching program and be obligatory in keeping of the whole medical documentation.

2. In literature of last years dominates the opinion, that functional recovery is more important than fracture consolidation!?

This opinion is confirmed by fact that at present time achievement of fracture consolidation isn't problem itself: specialists, who learn afterhistory of fracture treatment, register contractures and other functional disorders of extremities more often than false joints.

Consequently, it is possible to determine priority of function or anatomy under solution of specific practical problems, being guided by the following rules.

 

  • The principle of maximum possible recovery of anatomy of articular surface is unshakable in treatment of intra-articular fractures. It is ideally, if anatomical reduction and fixation can be fulfilled by means of arthroscopic equipment.
  • In treatment of fractures of upper extremity, the priority belongs to functional recovery.
  • In treatment of fractures of lower extremity, the priority belongs to recovery of ability to load.

 

3. In order to begin recovery of functions of joints and muscles' mobilization, it is necessary to carry out stable fixation of fracture from the first day after injury, not blocking movements.

4. From biological point of view, preservation of optimal blood supply of both bone, and tissues, which surround bone, during conducting of osteosynthesis, avoidance of intraoperative loss of blood and prevention of infection is extremely important. For that, it is necessary to use sparing surgical equipment and special implants.

5. It's important to understand, that with the purpose of recovery of complete or primary function of joints, adjacent to fracture, as well as in other joints, muscles' mobilization must be done as early as it is possible, ideally on the day of injury.

Ankin L.N., Kulazhenko E.V. Ankin N.L.
Kiev - Odessa.

 

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