Transosseous osteosynthesis
Last reviewed: 23.04.2024
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Osteosynthesis is an operation in which the surgeon restores the integrity of the bone (connects the fragments). There are two types of this operation: submerged and external transosseous ostiesynthesis.
When external osteosynthesis, the connection occurs with the help of special devices, while submersible - to use bone fragments, use various fixators (screws, pins, nails).
The purpose of this surgical method is to ensure the immobility of bone fragments until they are fully fused.
Transosseous osteosynthesis according to Ilizarov
In 1950, Gabriel Abramovich Ilizarov invented a compression-distraction apparatus consisting of rods, rings and spokes and intended for fixing fragments of bones.
4 rods joined by 2 rings, into which the crossed spokes are tightly tied, not only reliably fix the bones, but also control the complex biological process of bone tissue development - compression and stretching (compression and distraction).
Ilizarov's apparatus allows to maintain to some extent the working capacity of muscles and the mobility of adjacent joints, which as a whole ensures an early union of bone fragments.
Transosseous osteosynthesis can be performed with fractures of the tibia, tibia, but most often it is performed with closed comminuted fractures (especially with multiple fragments).
Transosseous compression-distraction osteosynthesis
After surgery began to use extra-osseous compression-distraction osteosynthesis, doctors could successfully treat multiple fractures without intervention directly into the fracture region.
Advantages of this method are low traumatism, the ability to maintain mobility in the joints and open access to the affected areas, which allows you to care for the skin.
Transosseous osteosynthesis with the help of external fixation devices requires the organized work of all personnel, a good technical base, as well as certain knowledge and experience of health workers (junior, middle staff and doctors).
Preparation of devices is carried out by the technician on metal which does individual adjustment, spends repair, etc.
Closed transosseous osteosynthesis
Transosseous osteosynthesis is divided according to the method, as mentioned, into the outer (compression-distractive) and submerged. In turn, the submerged osteosynthesis can be open or closed, in which after comparing all the fragments, a hollow metal rod is inserted through the small incision into the brain channel of the broken bone. The introduction of the rod is carried out using a conductor (which is then removed), the operation is under the control of the X-ray.
[Bilocal transosseous osteosynthesis
Bilocal osteosynthesis was developed to treat a false joint. The main problem of this orthopedic disease was that conservative treatment did not lead to the desired effect, and after surgery in the vast majority of cases, relapses occur.
Bilocal osteosynthesis is prescribed with dangling false joints, with a shortening of more than 1.5 cm and thinned fragments.
A false joint is called pathological mobility in any part of the skeleton, most often, pathology occurs in the region of the shin. Treatment involves two stages - bilocal transosseous otiosynthesis and bone-plastic surgery.
With bilocal osteosynthesis, the removal of the false joint and simultaneous elongation and cosmetic thickening of the limb. Elongation of the limb is carried out after an artificial bone fracture (osteotomy), by rupturing the epiphyseal zone.
Despite the positive results, the risk of re-development of pathology remains high, and the full course of treatment takes about 2 years.
Transosseous ostysynthesis shows positive results in the treatment of false joints and pathologies of long tubular bones, also this method is indicated in osteomyelitis (against the background of treatment there is no exacerbation of the disease).
With the help of the apparatus, both the false joint and bone deformation are eliminated (if necessary).
With atrophic false joints, the open method of bone adhesion is ineffective, in this case it is recommended that the fragments of the bones be exposed and that the collision-lateral compression be made with spokes.
After the bone has grown together, the surgeons perform lengthening with the help of apparatuses and osteotomy.
Like any other method, osteosynthesis has drawbacks, among which one can distinguish the possibility of damage to large vessels, nerve trunks, skin, inflammation around the spokes, cosmetic defects, inconvenience.
It takes a lot of time to apply the device, in addition, a certain surgeon's training is necessary, and there are also difficulties in replacing the spokes.
Experts recommend this method with open fractures, which are accompanied by a significant crushing of the tissues, as well as with trauma or improperly fused fractures.