LIMITED-CONTACT MULTIPLANE OSTEOSYNTHESIS OF FEMORAL NECK FRACTURES
DOI:
https://doi.org/10.11603/2414-4533.2024.2.14857Keywords:
femoral neck, fracture, osteosynthesisAbstract
The aim of the work - to improve the treatment results of patients with FNF with limited-contact multiplane osteosynthesis with bone plastics.
Materials and Methods. We analyzed 32 cases of unsatisfactory use of traditional fixators for outdated femoral fractures (FF).
The dependence of the treatment results on the quality of the repositioning of the chips, the traumaticity of the surgical intervention, the beginning and the quantity of dosed and full load, their influence on the fragments’ concrescence, were analyzed.
After FNF, osteosynthesis was performed by the device for osteosynthesis of the proximal thigh fractures (DOPF - Ukrainian Patent № 22283) [5]. The fixation of fragments by this device is performed by a T-shaped rod, which is fixed in a short plate with a through groove. This rod minimally injures the fragments, its width is 9 millimeters. It has a vertical shelf, which gives it an anti-rotating effect with minimal volume. Developed DOPF, designed by us, was used with a positive result in 128 patients with medial FNF.
Results. With well-adjusted fragments by traction, it is possible to fix them with 2-3 Ilizarov’s wire, 20 cm in length conducted, through the subtrochanteric area. With the correct conduction of the needles through the Adams’ arc, a T-shaped rod is inserted into the canal, drilled by the canal drill. Stability is reached by a bolt and a groove of a short inserted plate with half-circle.
The best results in subcapital and diagonal FNF is providing by using a spongy screw conducted in parallel to the shaped rod of the DOPF. Definitely, the basis of success is an anatomically-correct reposition and right chosen tactic of operative intervention.
In complicated cases, we use autotransplant up to 5-6 cm in length taken from the tibia. This is enough to overlap the fracture line. In 5 patients, the autotransplant is taken from the femur’s subtrochanteric area. Such technique does not injure the tibia, it shortens the duration of surgical intervention.
We recommend full load for 5-6 months after the moment of operation. After bone autoplasty – after 10-12 months.
Conclusions. Using of DOPF greatly simplifies performing the operation itself, provides a stable fixation of fragments, patients’ life quality in the postoperative period. Definitely, the basis of success is an anatomically-correct reposition and right chosen tactic of operative intervention. Practice confirms certain advantages of organ-saving interventions.
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