Limited-contact multiplanar osteosynthesis of fragments and femoral neck pseudarthrosis
Background. The results of treating the femoral neck fractures (FNF) are influenced by many objective and subjective factors, the choice of optimal modality, and compliance with the chosen treatment method. In case of unsatisfactory results of FNF treatment, usually after the osteosynthesis, hip replacement is traditionally performed. Therefore, in our opinion, there is a relevant need for the development of a biomechanically-based fixator for FNF and an effective method of its application. Materials and methods. A lot of fixators for FNF osteosynthesis have been developed. Recently, the preference is given to structures with locking screws. We analyzed 42 cases of unsatisfactory use of traditional fixators for FNF. The dependence of treatment results on the quality of reposition of bone fragments, the traumatism in surgical intervention, the beginning and the quantity of dosed and full load, their influence on the fragments’ union was analyzed. Results. Practice showed that the level of injury to the femoral neck and head are increased when using a Г-shaped plate with 16-mm blade. A good clinical effect from the using of cancellous rods is possible during the conduction of 2 rods in parallel to the Adams arch. Multidirectional insertion of rods often doesn’t have the desired effect. The using of cancellous compressive rods with a long thread rarely leads to the fragment union. The developed device for osteosynthesis of proximal femoral fractures (DOPFF) minimally injures the fragments, and also allows conducting autograft or, if necessary, anti-rotating screw in the neck above the shaped rod. To save the continuity of the fragments, directly after the patient’s hospitalization, traction with a weight of 3-5 kilograms through the hip axis is applied. With well-adjusted fragments by traction, it is possible to fix them with 2-3 Ilizarov wire, 20 cm in length, through the subtrochanteric area. X-ray monitoring is performed. The second screw is conducted in parallel to inserted first one. The best results in subcapital and diagonal FNF is providing by using cancellous screws conducted in parallel to the shaped rod of the DOPFF. In complicated cases, we use autograft up to 5-6 cm in length taken from the tibia. This is enough to overlap the fracture line. In 5 patients, the autograft is taken from the femoral subtrochanteric area. Such technique doesn’t injure the tibia, it shortens the duration of surgical intervention. Conclusions. Using DOPFF greatly simplifies performing the operation itself, provides stable fixation of fragments, good quality of life in patients in the postoperative period. Definitely, the basis of success is an anatomically correct reposition and right approach to the surgery. Practice confirms certain advantages of organ-saving interventions.