Analysis of the results of blocking intramedullary osteosynthesis in treatment of patients with fractures

A retrospective study of 1725 patients of Almaty City Clinical Hospital №4 between 2015 and October 2017, who sustained a diaphyseal fracture of long tubular bones.

Introduction. Every day thousands of people are injured and killed on our roads. Millions of people each year spend long weeks in hospital after severe crashes and many will never be able to live, work or play as they used to do. Accidents and trauma are one of the world's most serious health problems. The fast moving transport systems, unprecedented and unplanned urbanization and changing social patterns have contributed to the global increase in the incidence of trauma. Traffic accidents are an endemic disease, which affects mainly the young adults in the economically productive age groups, and are the leading cause of death in persons under 44 years of age [1]. According to the world literature, fractures of long tubular bones both in isolated and in multiple and combined injuries account for about 8.0-11.0% of the total number of fractures. These types of injuries often lead to severe injuries of the musculoskeletal system, and particularly to fractures of tubular bones among which: humeral fractures 7%, femur fractures 6.4%, fractures of lower leg bones 10% [2]. The blocking intramedullary osteosynthesis is the “gold standard” in the osteosynthesis of diaphyseal fractures of long tubular bones [3].

The first surgeon to begin to think about and experiment with intramedullary fixation was Nicholas Senn in 1893. Robert Danis began making nails in 1938 and used short intramedullary implants for various fractures [4]. He must be regarded as the father of modern osteosynthesis. The concept of a long metallic intramedullary device that gripped the endosteal surface of the bone - so-called elastic nailing - was the brainchild of Gerhardt Kuntscher working in collaboration with Professor Fischer and the engineer Ernst Pohl at Kiel University in Germany in the 1930s. Kuntscher originally used a V-shaped nail but then changed to a nail with cloverleaf cross section for greater strength and designed to follow any guide pin more faithfully [5]. Kuntscher's first nailing procedure in a human was in 1939 [4].

Nowadays, intramedullary osteosynthesis is definitely the most widespread approach to diaphyseal fractures.

The aim of this article is to represent the results of the BIOS implementation with the Department of Traumatology and Orthopedics based on Almaty City Clinical Hospital №4, as one of the most effective methods in treating fractures of long tubular bones.

In the Republic of Kazakhstan, the widely usage of the BIOS was started in the last 10 years since 2009. We have analyzed the BIOS implementation in the treatment of patients with fractures of long tubular bones (humeral, femoral, tibia) as a part of the Traumatology and Orthopedics Department, Almaty City Clinical Hospital №4. The BIOS implementation has begun in 2011 in Almaty City Clinical Hospital №4.

Methods and materials. A retrospective study of 1725 patients of Almaty City Clinical Hospital №4 between 2015 and October 2017, who sustained a diaphysealfracture of long tubular bones. In this study, the analysis was carried out according to the following criteria: age, gender, localization of fractures, duration of inpatient treatment, terms of the operative intervention and methods of the operative treatment.

Results. The number of patients with fractures of long tubular bones is unfortunately rapidly growing up and this type of fractures remains an actual and frequently occurring trauma in the structure of general traumatism. In Almaty City Clinical Hospital №4 were recorded 1725 cases of fractures in a period from 2015 and October 2017 (Table 1). We note a large percentage of patients with fractures of the femur by analyzing the cases of trauma in duration 2015 and October 2017. Because the femur is so strong, it usually takes a lot of force to break it. Car crashes, for example, are the number one cause of femur fractures [5].

Table 1 Localization of fractures

The BIOS, as we mentioned earlier, is young procedure for (Table 2). This fact give us a big potential to develop and speed

Kazakhstan, because of that, it needs a time for full transition. up the BIOS implementation in our country.

Nevertheless, we can see a progressive increase of this procedure

Table 2 Comparative analysis of the surgical procedure

Among the 296 cases (period of 2015 and 2017), males were predominant (Table 3). This is due to the growth of cities and the professional employment of the male in severe traumatic works.

Table 3 Distribution

to

In addition to division by gender, we have also classified fractures according to age. The age group varied from 18 to 80 years. The incidence of fracture was observed maximum between

18 and 40 years of age. The group of young people of working age (18-40 y.o) got 33% (Table 4).

Table 4 Distribution

Discussion. Intramedullary nail provide fragments stability and contributes to the process of osteogenesis. Biomechanical role of intramedullary nails is to keep the bone fragments in a good correlation, but also to prevent torsion and shear forces. It was considered that in a given moment should be provided an axial load transmission throughthe bone and fracture by the phenomenon of "dynamization", which accelerates osteogenesis by allowing micro-movements at the site of the fracture process, explanation was that the axial movements of fragments reduces fracture area, accelerates fracture callus maturation and remodeling of bone [6].Intramedullary fixation provides for short operating time, short hospital stay and early rehabilitation. Average time of hospital stay (pre- and postoperatively) was 12 days. In patients who had traditional osteosynthesis, it was 15 days whereas in patients who had nail fixation (BIOS) it was 10 days.

Conclusion. Closed blocking intramedullary osteosynthesis of diaphyseal fractures of the femur, tibia and humerus, performed according to strict indications with a static blocking of main fragments, restored support ability of extremity. The correct choice of technique and technical equipment of the operation (electro optical converter, orthopedic table, special instrumentation) as well as proper management of the patient in post-operative period avoided complications, such as poor fixation of bone fragments, locking screws break, etc. Needless of additional external immobilization in application of the method made possible the early activation of joints and shortening of hospital treatment. The results received by us testify the high efficiency of this method and further development the concept of early osteosynthesis in treatment of diaphyseal fractures of long bones in patients with a multiple trauma [7].

REFERENCES

1. World Health Organization Statistical Annex. World Report on Road Traffic Injury Prevention.
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7. R ArokiaAmalan, R Devendran, J Maheswaran, Heber Anandan Comparative Study on Fixation Techniques and Functional Outcome between Plate Osteosynthesis, Interlocking Nailing, and Titanium Elastic Nailing in both Bones of Forearm Fractures. URL: www.ijsssn.com/uploads/2/0/1/5/20153321/ijss_feb_oa02_-_2017.pdf