Главная Тезисы Лечение диафизарных переломов длинных костей STAGING AND PECULIARITIES OF TREATING TACTICS IN THE CASE OF NONUNION OF DIAPHISIS OF LONG BONE

STAGING AND PECULIARITIES OF TREATING TACTICS IN THE CASE OF NONUNION OF DIAPHISIS OF LONG BONE

 

Topicality. The progress of orthopaedic science, perfecting of surgical tactics, devices and methods of osteosynthesis did not lead to the decreasing of the prevalence of nonunion that occurs up to 5% after diaphysial fractures of long bones.

The aim - to define the staging and peculiarities of treating tactics at different complications, concerned with bone healing disorders.

Materials and methods: presented work is based on the analysis of 186 patients (204 segments), that received medical treatment in Sytenko Institute for 10 years. The presence of hypertrophic nonunion was established in 81 cases, oligotrophic in 64 cases, hypotrophic in 44 cases, nonunion-defect in 15 cases. 18 patients, among 186, had nonunions on 2 segments. All patients were admitted in terms of no less than 6 moths after primary trauma and after usage of 2-5 fixation methods. The staging of treatment of analyzed patients was built taking into consideration such factors as the presence of metal fixators in nonunion zone, different types of deformation, shortening, necrotic suppurative process in the zone of nonunion, presence of skin defects or extensive scar disfiguration, and also combination of these factors, in order to reduce the terms of treatment and improve its results.

The results of own investigation. The multifactor analysis, which was carried out concerning the character and type of operative treatment and their efficacy, revealed that the number of stages, their sequence and also the extent and character of operative treatment on each stage is determined both by nonunion type and presence, severity and combination of factors, aggravating the course of bone healing and the restoration of functional ability of damaged extremity.

Conclusion. Differentiated approach that we worked out to treat patients with different pathological conditions, which developed after diaphyseal fractures of long bones (n=204), allowed to obtain positive results and restore functional ability of damaged segments in 171 cases (83,8%) and in 5 cases only (2,5%) we had to perform the amputation of lower extremity on middle third-lower third level considering the extension of the defect of soft tissues, severity and duration of necrotic suppurative process, and in 28 cases (13,7%) the treatment prolongs.

Goridova. L.D., Romanenko К.К., Prozorovskij D.V. 
Sytenko Institute of Spine and Joint Pathology AMS of Ukraine; 
Kharkov Medical Academy of Postgraduation Education; Kharkov, Ukraine

 

 

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