Organization of specialized surgical help to patients with peri- and intraarticular lover limb’s fractures

Antoniadi Y.V.

Abstract


The aim of this work is to develop a system of surgical treatment of intra- and periarticular fractures of lower limb bones for improving the results and reducing the number of postoperative complications.
Material and methods
Short- and long term results of surgical treatment of 390 patients with periand intraarticular lower limb fractures treated at a trauma department 1 of hospital # 24 in the period between 2010 and 2014 were analyzed according to a similar schedule of requirements to recovery of anatomic and functional parameters of the hip, knee and ankle joint. There were 198 men (50.8 %) and192women (49.2 %). Radiological, clinical and statistical research methods were used. Statistical methods included estimation of significance of differences for parametric and non-parametric criteria, assessment of the relationship signs on the Pearson’s coefficient of linear correlation. To study the results of hip treatment the Harris Hip Score (H. W. Harris, 1969) was used, in the region of the knee – P. S. Rasmussen scale (1973), and in the ankle – of E. Mazur (2006) which include subjective and objective criteria.
Results
Good functional outcomes were obtained in 87.1 % of femoral neck fractures, in extra-articular fractures of the proximal femur– in 76.2 %, in intra-articular fractures of the distal femur – in 75.0 %, intra-articular fractures of the proximal tibia - in 78.3 %, intra-articular fractures of the distal tibia in 96.6 % of cases.
Conclusion
Implementation in the clinical practice of the system of surgical treatment of peri- and intraarticular fractures, including improved diagnostics, practical orientation of injury systematization, algorithms for clinical diagnostic search, consecutive use of external and internal osteosynthesis, rational technique of joint arthroplasty, new technologies of osteosynthesis with a differentiated choice of metal fixators, a modified proximal femoral metal fixator, approaches to joints, methods for bone defect plasty; all these factors combined with the method of perioperative management of patients and early active rehabilitation achieved the prevalence of excellent and good anatomical and functional results for each studied location of injurie in main subgroups in comparison with the control ones.

Keywords


lower limbs, intra-articular fracture, periarticular fracture, osteosynthesis, surgical treatment

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DOI: http://dx.doi.org/10.18019/1028-4427-2018-24-2-126-133

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