International Medical Journal, Vol. 20., Iss. 3, 2014, P. 76−80.
Problems of theory of diaphysis fractures treatment
Kharkov Medical Academy of Postgraduate Education, Ukraine
M. I. Kononenko Chuguev Central District Hospital, Ukraine
The literature data and the original epidemiological studies demonstrated that the greatest percentage of nonunions which were reoperated was observed after plate and intramedullary osteosynthesis (20.5−26 % depending on the segment). Malunions were observed in 46−68 % of patients. It testifies that the quality of fixation constructions and the method of its setting cannot provide a high efficiency of treatment. The success of the treatment depends on the ability of the structure created by the surgeon to create the conditions for natural formation of regenerate. Fibrin carries out mechanical function (resistance to blood pressure) and it can transfer power influence to the cell membrane. The effect of mechanical action of external and internal tensions can explain the vectors direction of collagen and bone structure. Fibrin−blood clot possesses elastic features and it is located in the closed space, surrounded by nonextesible tissues. At such conditions fibrin−blood clot is under deformations and internal tensions initiated by functional load. Thus, previously to the appearance of internal tension inside of the clot due to external loading its deformation must occur. External loading exceeds in several times those ones appointed by osteosynthesis theoreticians. We consider that linear fragment displacements by 2−10 % from the initial level at plate ostheosynthesis cannot cause effective level of internal tensions. These are the conditions limiting structural self−organization of the callus and leading to a high level of nonunions. The data obtained during the experimental and clinical investigations show that at functional method of diaphysar fracture treatment with apparatus of external fixation the level of fragments displacement several times exceeds the 10 %−limit. We also observe very low percentage of nonunions at external fixation 3.1−6.8 %. The obtained findings allow to formulate the theory of primary fibrin tension with adaptive positional cells activation of interfragments regenerate. It assumes another principles of diaphysar fracture treatment different from apparatus osteosynthesis.
Key words: diaphysis fractures, regeneration, nonunion, tension of regenerative tissues, fragments displacement.