CONCEPTUAL SUBSTANTIATION OF LIMITED CONTACT MULTIPLANE OSTEOSYNTHESIS OF SHINBONE FRACTURES
DOI:
https://doi.org/10.11603/2414-4533.2025.1.15186Keywords:
shinbone fractures, concept, limited contact multiplane osteosynthesisAbstract
The aim of the work: to substantiate theoretically and optimise the technique of limited contact multiplane osteosynthesis of diaphyseal fractures of the shinbones.
Materials and Methods. Based on the systematic approach, the interaction of elements in full contact of the plate with the bone and its absence was analysed, the consequences of this interaction and the impact on the reparative regeneration were observed. The main requirements for the design of the fixator to ensure optimal conditions for fragment fusion during SF were determined. Using the theoretical laws of structural mechanics, the requirements for the spatial arrangement of screws that eliminate the disadvantages of uniplanar fixation were formulated, and the advantage of multiplane stabilisation of fragments was confirmed. Among the new devices for osteosynthesis, it is necessary to emphasise the plates with a threaded plate-screw connection (LCP) – plates with angular stability [2]. The biomechanical analysis of various designs and functional capabilities of applied methods was carried out.
Results. A very important element in the treatment of SF is the ability to adjust the tightness of fixation in relation to the nature of the fracture line, the ability to provide a certain value of micromobility of fragments, which optimises the course of reparative regeneration. In view of the above, we believe that the most optimal for the treatment of SF are the limited contact multi-plane fixators developed by P.I. Bilinskyі. We offer our concept of their use in these injuries. Stable osteosynthesis of SF should be performed with fixators of minimal volume and length, which ensure the choice of the most optimal design for a particular fracture line, as well as the place of installation in accordance with the anatomical features of the damaged segment, restoration of its bearing capacity, bone axis passing after repositioning of fragments, in the absence of pressure on the bone, multi-plane insertion of fixation screws, the presence of an element of interaction with the fixator, which creates a biomechanical structure «fixator-bone» with fragments, and allows programming the value of the micromobility of fragments, optimise the course of reparative regeneration. Reliable fixation of shinbone fragments can be ensured by the original fixator, which we have improved in accordance with the developed concept, namely the Device for Moving Fragments Fixing (MFFD), protected by the patent of Ukraine No. 17502.
Conclusions. The limited contact multiplane osteosynthesis concept developed by us on the basis of a systematic analysis of the morphological and biomechanical features of the segment, the consolidation process, the design of existing fixators, and the plate-screw interaction is suitable for osteosynthesis of the SB. It coincides with the main provisions of the current trends of the AO Association.
References
Bilinskyi PI. Teoriya i praktyka malokontaktnoho bahatoploshchynnoho osteosyntezk [Theory and practice of low-contact multi-planar osteosynthesis]. Kyyiv : Makros, 2008; 375. Ukrainian.
Anqlen J, Kyle RF. Lockable plates for limb fractures / JAAOS. 2009; 17(7):647-57.
Oksymetsʹ VM, Popandopulo AH, Chernysh VYu, ta in. Klitynni mekhanizmy porushennya reparatyvnoho osteohenezu [Cellular mechanisms of disruption of reparative osteogenesis]. Ortopediya, travmatolohiya ta protezuvannya. 2011; 2:5-16. Ukrainian.
Kopytchak IR. Kliniko-morfolohichni osoblyvosti likuvannya perelomiv homilky pry politravmi [Clinical and morphological features of treatment of fractures of the tibia in polytrauma] : dys. ... kand. med. nauk : spets. 14.01.21 «Travmatolohiya ta ortopediya». Ternopilʹ, 2011; 163. Ukrainian.
Ankinta ML, Ankin LM, Satyshchev MM, ta in. Maloinvazyvnyy zahlybnyy osteosyntez u postrazhdalykh iz diafizarnymy perelomamy kistok homilky [Minimally invasive deep osteosynthesis in victims with diaphyseal fractures of the tibia]. Travma. 2011; 12(3): 80-4. Ukrainian.
Bilinskyi PI. Prystriy dlya fiksatsiyi kistkovykh vidlamkiv: pat. № 17502 Ukrayina, MPK6 A61V 17/58, A61V 17/62 [Device for fixing bone fragments: patent No. 17502 Ukraine, MPK6 A61V 17/58, A61V 17/62]; application and patent.; zayavn. i patent. № 96051961; zayavl. 20.05.96; opubl. 31.10.97, Byul. № 5. Ukrainian.
Popsuyshapka OK, Uzhyhova OYе, Lytvishko VA. Chastota nezroshchennya ta upovilʹnenoho zroshchennya vidlamkiv pry izolʹovanykh diafizarnykh perelomakh dovhykh kistok kintsivok [The frequency of non-union and delayed union of fragments in isolated diaphyseal fractures of long bones of the limbs]. Ortopediya, travmatolohiya ta protezuvannya. 2013; 1:39-43. Ukrainian. DOI: https://doi.org/10.15674/0030-59872013139-43
Symenach BI. Frakterolohiya – deyaki aspekty teoretyzatsiyi vchennya pro perelomy kistok. Ch. 2. Upravlinnya protsesamy reparatsiyi [Fracterology – some aspects of theorizing the theory of bone fractures. Ch. 2. Management of reparation processes]. Ortopediya, travmatolohiya ta protezuvannya. 2000; 4:105-17. Ukrainian.
Shymon VM, Sherehiy AA. Perspektyvni napryamy likuvannya diafizarnykh perelomiv kistok homilky [Promising directions of treatment of diaphyseal fractures of the tibia]. Travma. 2010; 11(4):363–66. Ukrainian.
Gardner MJ, Evans JM, Dunbar RP. Failure of fracture plate fixation. J.Am. Acad Orthop. Surg. 2009; 17(10): 647-57. DOI: https://doi.org/10.5435/00124635-200910000-00007
Zimmermann G, Henle P, Kusswetter M, et al. Transforming growth factor (TGF)-β1 as a marker of delayed fracture healing. Bone. 2005; 36:779-85. DOI: https://doi.org/10.1016/j.bone.2005.02.011
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