Results of Conversion Osteosynthesis in Treatment of Patients with Long Bone Fractures
- Authors: Alsmadi Y.M.1,2, Zagorodniy N.V.1,3, Solod E.I.1,3,2, Lazarev A.F.3, Abdulkhabirov M.A.1,2, Ananyin D.A.1,2, Petrovskiy R.A.1,2
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Affiliations:
- RUDN University (Peoples’ Friendship University of Russia)
- Eramishchantsev City Clinical Hospital
- National Medical Research Center for Traumatology and Orthopedics named after N.N. Priorov
- Issue: Vol 23, No 3 (2019)
- Pages: 257-270
- Section: SURGERY. TRAUMATOLOGY
- URL: https://journals.rudn.ru/medicine/article/view/22514
- DOI: https://doi.org/10.22363/2313-0245-2019-23-3-257-270
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Abstract
Аbctract. Treatment of long bones fractures of the extremities has a particular relevance in modern traumatology due to their high frequency, as well as a large number of deaths in patients with polytrauma. It is dangerous to perform an urgent final osteosynthesis in severe patients because of the possibility of shock and the deterioration of the condition of the injured. Therefore, the principle of Damage control with urgent fixation of damaged segments by external fixation and their subsequent replacement (converse) to intramedullary osteosynthesis had a particular relevance in the treatment of patients with long bones fractures. Purpose: Improving treatment outcomes for patients with long bones fractures. Materials and methods. In the present study, a retrospective analysis of using conversion osteosynthesis in the treatment of 120 patients with long bones extremities fractures in a multidisciplinary hospital was carried out. For a better analysis of the results of treatment, we divided the patients into two groups: The first group 44 patients with fractures of the long bones with polytrauma according to the ISS severity scale> 17. The second group consists of 76 patients with closed isolated unstable comminuted fractures of the long bones with severe post-traumatic edema, who have a high risk of significant trauma of soft tissues. Results. The most optimal time for conversion osteosynthesis to patients with polytrauma was 7-12 days, which prevented the occurrence of traumatic shock; and for patients with closed isolated unstable fractures of long bones with significant of post-traumatic edema for conversion osteosynthesis, the optimal time was 3-7 days after injury, which prevented the occurrence of inflammatory complications in the postoperative period. Conclusion. The study confirmed the feasibility of conversion osteosynthesis in the treatment of patients with diaphyseal fractures. The use of the technique of transferring the fixation of fragments by the external fixation device to the internal osteosynthesis (conversion) contributed to a reduction in the duration of inpatient treatment of patients with fractures of the long bones.
Keywords
About the authors
Ya. M. Alsmadi
RUDN University (Peoples’ Friendship University of Russia); Eramishchantsev City Clinical Hospital
Author for correspondence.
Email: yaseenalsmadi@gmail.com
Moscow, Russia
N. V. Zagorodniy
RUDN University (Peoples’ Friendship University of Russia); National Medical Research Center for Traumatology and Orthopedics named after N.N. Priorov
Email: yaseenalsmadi@gmail.com
Moscow, Russia
E. I. Solod
RUDN University (Peoples’ Friendship University of Russia); National Medical Research Center for Traumatology and Orthopedics named after N.N. Priorov; Eramishchantsev City Clinical Hospital
Email: yaseenalsmadi@gmail.com
Moscow, Russia
A. F. Lazarev
National Medical Research Center for Traumatology and Orthopedics named after N.N. Priorov
Email: yaseenalsmadi@gmail.com
Moscow, Russia
M. A. Abdulkhabirov
RUDN University (Peoples’ Friendship University of Russia); Eramishchantsev City Clinical Hospital
Email: yaseenalsmadi@gmail.com
Moscow, Russia
D. A. Ananyin
RUDN University (Peoples’ Friendship University of Russia); Eramishchantsev City Clinical Hospital
Email: yaseenalsmadi@gmail.com
Moscow, Russia
R. A. Petrovskiy
RUDN University (Peoples’ Friendship University of Russia); Eramishchantsev City Clinical Hospital
Email: yaseenalsmadi@gmail.com
Moscow, Russia
References
- Yamkova A.D., Gavryushenko N.S., Zorya V.I. Stabilization capabilities of a nail with plastic deformation Fixion during fixation of simulated diaphyseal bone fractures (experimental study). Bulletin of Traumatology and Orthopedics named after NN Priorov. 2016. No. 1. S. 82—84.
- Khominets V.V., Belenky I.G., Kutyanov D.I., Pechkurov A.L. Tactics treatment of long-bone fractures in polytraumatized patients. M.: Clinical medicine “Surgery” Traumatology, Vol. 12, 53 (p. 631—645); June 2011.
- Shevyrev K.V., Yamkova A.D., Voloshin V.P., Zorya V.I., & Stepanov E.V. (2017). Osteosynthesis of limb bones with hydraulic expansive pins. Modern Problems of Science and Education, (6), 57—57.
- Pairon P. et al. Intramedullary nailing after external fixation of the femur and tibia: a review of advantages and limits. European Journal of Trauma and Emergency Surgery. 2015. Vol. 41. No. 1. P. 25—38.
- Korzh N.A., Dedukh N.V., Nikolchenko O.A. Reparative bone regeneration: a modern view of the problem. Regeneration stages. Orthopedics, Traumatology and Prosthetics. 2006. Vol. 1. S. 77—84.
- Backus J.D., Furman B.D., Swimmer T., et al. Cartilage viability and catabolism in the intact porcine knee following transarticular impact loading with and without articular fracture. J. Orthop. Res. 2011;29(4):501—10.
- Solomin L.N. The basics of transosseous osteosynthesis by G.A. Ilizarova: Monograph. SPb.: MORSAR AV LLC, 2005.
- Testa G. et al. Treatment of femoral shaft fractures with monoaxial external fixation in polytrauma patients. F1000Research. 2017. Vol. 6.
- Kobbe P., Micansky F., Lichte P., Sellei R.M., Pfeifer R., Dombroski D., et al. TraumaRegister DGU. Increased morbidity and mortality after bilateral femoral shaft fractures: myth or reality in the era of damage control. Injury 2013; 44:221—5.
- Patka Peter. Damage control and intramedullary nailing for long bone fractures in polytrauma patients. Injury 48 (2017): S7—S9.
- van Dongen T.T., Idenburg F.J., Tan E.C., Rasmussen T.E., Hamming J.F., Leenen L.P., et al. Combat related vascular injuries: dutch experiences from a role 2 MTF in Afghanistan. Injury 2016 Jan;47(1):94—8.
- Kataoka Y., Minehara H., Kashimi F., Hanajima T., Yamaya T., Nishimaki H., et al. Treatment combining emergency surgery and intraoperative interventional radiology for severe trauma. Injury 2016 Jan;47(1):59—63.
- Boutefnouchet T., Gregg R., Tidman J., Isaac J., Doughty H. Emergency red cells first: rapid response or speed bump? The evolution of a massive transfusion protocol for trauma in a single UK centre. Injury 2015 Sep;46(9):1772—8.
- Pairon P., et al. Intramedullary nailing after external fixation of the femur and tibia: a review of advantages and limits. European Journal of Trauma and Emergency Surgery 41.1 (2015): 25—38.
- Recknagel Stefan, et al. Conversion from external fixator to intramedullary nail causes a second hit and impairs fracture healing in a severe trauma model. Journal of Orthopaedic Research 31.3 (2013): 465—471.
- Matsumura Tomohiro, et al. Clinical outcome of conversion from external fixation to definitive internal fixation for open fracture of the lower limb. Journal of Orthopaedic Science (2019).
- Bertrand M.L., Andrés-Cano P., and Pascual-López F.J. Suppl 1: M9: Periarticular Fractures of the Knee in Polytrauma Patients. The open orthopaedics journal 9 (2015): 332.
- Bhandari M., Zlowodzki M., Tornetta P. 3rd., Schmidt A., D.C. Templeman Intramedullary nailing following external fixation in femoral and tibial shaft fractures. J Orthop Trauma, 19 (2005), pp. 140—144.
- Monni T., et al. Conversion of external fixation to internal fixation in a non-acute, reconstructive setting: a case series. Strategies in Trauma and Limb Reconstruction 8.1 (2013): 25—30.
- Matsubara et al. Clinical Outcomes of Conversion Surgery from an External Fixator to an Iodine-Supported Titanium Alloy Plate Journal of Microbial & Biochemical Technology. 2014. doi: 10.4172/1948-5948.1000121.
- Nicholas B. Borderline femur fracture patients: early total care or damage control orthopaedics? / B. Nicholas [et al.] ANZ J Surg. 2011. Vol. 81. P. 148—153.
- Samusenko D.V., Karasev A.G., Martel I.I., Shvedov V.V., & Boychuk S.P. (2014). Ilizarov technique in staged management of patients with concomitant injuries and multiple fractures. Polytrauma, (1).