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Cranial osteosynthesis
Last reviewed: 06.07.2025
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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 such an operation: internal and external transosseous osteosynthesis.
In external osteosynthesis, the connection is made using special devices; in immersion osteosynthesis, various fixators (screws, pins, nails) are used to hold the bone fragments.
The purpose of this surgical method is to ensure the immobility of bone fragments until they are completely fused.
Transosseous osteosynthesis according to Ilizarov
In 1950, Gavriil Abramovich Ilizarov invented a compression-distraction device consisting of rods, rings and spokes and designed to fix bone fragments.
4 rods connected by 2 rings, into which crossed spokes are tightly stretched, not only securely fix the bones, but also control the complex biological process of bone tissue development – compression and stretching (compression and distraction).
The Ilizarov apparatus allows to some extent to preserve the functionality of muscles and the mobility of adjacent joints, which generally ensures the fastest possible fusion of bone fragments.
Transosseous osteosynthesis can be performed for fractures of the tibia and leg, but most often it is performed for closed comminuted fractures (especially with multiple fragments).
Transosseous compression-distraction osteosynthesis
After extrafocal compression-distraction osteosynthesis began to be used in surgery, doctors were able to successfully treat multiple fractures without interfering directly with the fracture area.
The advantages of this method are low trauma, the ability to maintain joint mobility and open access to the affected areas, which allows for skin care.
Transosseous osteosynthesis using external fixation devices requires organized work of all personnel, a good technical base, as well as certain knowledge and experience of medical workers (junior, mid-level personnel and doctors).
The preparation of the devices is carried out by a metal technician, who makes individual adjustments, carries out repairs, etc.
Closed transosseous osteosynthesis
Transosseous osteosynthesis is divided by method, as mentioned, into external (compression-distraction) and submersible. In turn, submersible osteosynthesis can be open or closed, in which, after matching all the fragments, a hollow metal rod is inserted into the medullary canal of the broken bone through a small incision. The rod is inserted using a guide (which is then removed), the operation is carried out under X-ray control.
[ Bilocal transosseous osteosynthesis
Bilocal osteosynthesis was developed to treat pseudoarthrosis. The main problem with this orthopedic disease was that conservative treatment did not lead to the desired effect, and after surgery, relapses occur in the vast majority of cases.
Bilocal osteosynthesis is prescribed for loose pseudoarthroses, shortening of more than 1.5 cm and thinned fragments.
A false joint is a pathological mobility in any part of the skeleton, most often, the pathology occurs in the shin area. Treatment involves two stages - bilocal transosseous osteosynthesis and bone plastic surgery.
Bilocal osteosynthesis involves removing the false joint and simultaneously lengthening and cosmetically thickening the limb. The limb is lengthened after an artificial bone fracture (osteotomy) by rupturing the epiphyseal zone.
Despite the positive results, the risk of recurrence of the pathology remains high, and the full course of treatment takes about 2 years.
Transosseous osteosynthesis shows positive results in the treatment of pseudoarthrosis and pathologies of long tubular bones; this method is also indicated for osteomyelitis (there is no exacerbation of the disease during treatment).
With the help of the device, both the false joint and bone deformation (if necessary) are eliminated.
In case of atrophic pseudoarthrosis, the open method of bone fusion is ineffective; in this case, it is recommended to expose the bone fragments and create counter-lateral compression with pins.
After the bone has healed, surgeons lengthen it using devices and osteotomies.
Like any other method, osteosynthesis has its drawbacks, among which are the possibility of damage to large vessels, nerve trunks, skin, inflammatory processes around the spokes, cosmetic defects, and inconvenience.
It takes quite a long time to apply the device, in addition, the surgeon needs to have some training, and there are also difficulties when replacing the needles.
Experts recommend this method for open fractures that are accompanied by significant tissue crushing, as well as for injuries or improperly healed fractures.