Extrafocal transosseous osteosynthesis in the comprehensive treatment of patients with false joints of the tibia
The choice of the osteosynthesis method in the treatment of false joints of the shin bone remains unsolved problem. One of the possible options for stabilizing the fragments is the use of extrafocal locking rings of wire-rod type. Indications for their use were: the presence of a focus of inflammation (even in the past medical history); large, coarse cicatricial changes of the soft tissues of the lower leg (more often as consequences of open fractures or previous multiple interventions); multiple ineffective interventions using other immersible fixation methods; localization of the false joint in the lower third of the shin; osteoporosis. In all 47 cases, positive results were obtained. But the false joints of the tibia were a heterogeneous group and had individual characteristics, so the treatment time in the different groups were different. In the group of hypertrophic joints, distraction was performed 4 months before the appearance of a radiographic evidence of consolidation (4 and 4.5 months). In 2 cases of bilocal osteosynthesis, the distraction regenerate matured at a rate of 1 mm per month, after fragment reposition, 4.5 and 5 months passed. The total duration of treatment was 8 and 8.5 months. The largest one was the group of patients with atrophic false joints of the tibia (43 observations). The fixing time was 149.0 ± 12.4 days. Luboshits-Mattis-Schwarzberg system was used for determining the anatomical and functional results of treatment in patients with shin fractures. This system allowed to take into account the anatomical and functional results and the degree of restoration of performance. The evaluation period was 1.5 years after the reconstructive intervention, 38 patients were followed up. A good result of treatment (3.5-4 points) was obtained in 29 patients (76.3 %), satisfactory (2.5-3.5 points) - in 8 cases (21.1 %), unsatisfactory - in 1 case (2.6 %). Surgical intervention on the false joint had the following components. The separation of fragments was performed atraumatically, the bone marrow canal was restored. Planes of bone reposition were treated with gouge or burs before the appearance of pinpoint bleeding. From a small incision, a resection of the fibula was performed. In the zone of the false joint, a previously prepared mixture for plasty was placed, which consisted of the following components. It was based on the autospongiosis of the iliac wing with the addition of processed fragments (“chips”, “bundle of brushwood”, pins) of the resected fibula, with the addition of the prepared platelet-rich plasma, collapan, tranexamic acid and haemostatic sponge for prolonged fixation in the clot of enriched platelet concentrate (growth factor). A mixture for the plasty of a false joint was easily formed, all the components which activate regeneration were securely fixed for the required time. The obtained results indicate a high efficiency of the used way of fixation of false joints of the tibia in their comprehensive treatment.