Types of osteosynthesis, essence of the procedure
Osteosynthesis is a surgical intervention performed with the aim of repositioning (combining) bone fragments with ensuring their immobility until complete fusion. Various types of osteosynthesis are used in medicine, each of which has its own characteristics. Screws, needles, wire, pins and other devices made of modern biological inert material are used to fix bone fragments.
Methods of osteosynthesis
Doctors use different methods of performing this procedure:
- Transosseous (external) osteosynthesis. The doctor fixes the bone fragments externally, without dissection of the fracture area.
- Immersive synthesis. Specially selected fixators are inserted directly into the bone fragments to be connected and fixed. Nails and pins are used as fixing elements in this method.
If the fracture is complex, doctors can use two methods of osteosynthesis at once.
Indications and contraindications for osteosynthesis
Doctors distinguish between unconditional and conditional indications for the procedure. The first include:
- bone fractures that cannot heal without surgery;
- complex fractures, when there is a danger of damage by sharp bone fragments to the surrounding tissues;
- fused fractures in the wrong projection.
Conditional indications for osteosynthesis are:
- fracture that began to grow with re-displaced fragments;
- deformation of the foot of the valgus type;
- slowly growing fractures.
There are also a number of contraindications, when doctors will prefer another treatment even in the presence of unconditional indications:
- open fractures accompanied by extensive damage to soft tissues;
- previously diagnosed osteoporosis;
- infection localized in the soft tissues surrounding the fracture site;
- blood pathologies;
- diseases of the central nervous system.
Principle of osteosynthesis
The considered procedure is performed on the bones of the whole body, but there are individual features that make up the characteristics of the types of surgical manipulation:
- Osteosynthesis of hand bones. This operation is used only in the case of a closed fracture. Specialists try not to impose fixation devices, but if there are unconditional indications, they use the transosseous method. Osteosynthesis of the ankle. As a rule, fractures of this part of the lower limb are closed and are accompanied by a pronounced displacement of bone fragments. It is usually problematic to immobilize the leg. This procedure in some cases becomes the only way to restore the patient's health.
- Osteosynthesis of the tibia. Depending on the severity of the fracture, doctors can use different methods of osteosynthesis. Fixing devices can be placed on the lower leg with open fractures, even through the transosseous method, but such a "structure" is inconvenient for the patient. Intramedullary osteosynthesis is often performed for tibia fractures - a procedure that is accompanied by drilling of the bone marrow canal.
Non-hardware types of procedures are often used in medicine - for example, if it is not possible to use pins and nails as fixing elements. In particular, oblique osteosynthesis with plates is performed for fractures of the lower jaw.
There is another type of osteosynthesis - extrafocal, that is, fixation devices are installed in the bone, but not at the site of the immediate fracture. Extrafocal osteosynthesis has the same indications/contraindications as the conventional procedure.
Features of osteosynthesis
The procedure should be applied as early as possible, because wearing special devices requires a lot of time. For example, rehabilitation after osteosynthesis of the femoral neck in some cases is delayed for 6-8 months. During this period, not only the muscles of the damaged limb can atrophy, but also stagnant processes in the blood vessels can begin. Prevention of this will be complex treatment with the use of therapeutic gymnastics, massage and physiotherapy.
After osteosynthesis of the leg bones, a special program is needed for the development of the limb, so that when the patient returns to normal life, he can walk and run.
If the period of wearing fixation devices is spent illiterately, the following complications may develop:
- fat embolism;
- progressive osteomyelitis;
- nerve and blood vessel injuries;
- anaerobic infection;
- arthritis.
Complete information on the principles of osteosynthesis in different parts of the skeleton and the likelihood of complications can be obtained on our website Dobrobut.com.
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