LOW INVASIVE OSTEOSYNTHESIS FOR INJURIES TO THE MUSCULOSKELETAL SYSTEM IN POLYTRAUMA
Objective - improvement of the results of treatment of limb bone fractures in patients with polytrauma. Materials and methods. The single-plane techniques (developed and tested in the traumatology and orthopedics clinic since 1998) of transosseous osteosynthesis of fractures of humeral surgical neck, of diaphysis of the long bones of the upper and lower extremities, and the kneecap, and the device for transarticular fixation of the foot to the tibial bone with use of pins and reposition of leg fragments were used. 475 patients with polytrauma were divided into two groups. The study group included 254 patients with fractures of a surgical neck of the brachium (n = 33), the humerus (n = 49), the leg bones (n = 98), lower third of the femur (n = 17), fractures of ankles (n = 32) and patella (n = 25). The comparison group included 221 patients with similar fractures and received some various variants of the known traditional methods of osteosynthesis (Ilizarov’s devices, external and internal methods). Results. The developed set of treatment-and-prophylactic actions with experimentally and clinically substantiated supportive-functional scheme for management of patients with fractures of the long bones of the extremities, surgical neck of the humerus, the ankles and patella resulted in reduction of terms of hospital management 1.5-2.3 times, out-patient treatment - by 1.5 times, as well as reduced the amount of days of disability by 1.0-1.3 months, increased the rate of excellent and good results by 1.2-2.1 times respectively, and decreased the rate of satisfactory and unsatisfactory results. Conclusion. Low invasive transosseous methods of osteosynthesis with the use of the developed devices are the preferred methods for treatment of the fractures of the above-mentioned localizations in polytrauma. The use of internal ways of fracture treatment requires a clear definition of indications, competence, with orientation to severity of the patient’s condition, presence of damages of soft tissues and concomitant pathology.