Combined osteosynthesis for tibial shaft fracture treatment

Abstract

Introduction Widespread use of intramedullary and extramedullary implants, as well as external fixation devices, has demonstrated that current surgical methods are not always successful. The study aimed to assess the efficiency of a combination of transosseous osteosynthesis with intramedullary reinforcement using elastic titanium hydroxyapatite-coated rods (HA-rods) in long bone fracture treatment. Material and methods Medical records of 40 patients aged from 18 to 55 years with closed diaphyseal tibia fractures of A1-A3 type (AO/ASIF) treated with the Ilizarov transosseous osteosynthesis method combined with intramedullary elastic HA-coated wires were analysed. Result Ilizarov fixator removal was performed on average 45.3 ± 14.7 days after surgery. Radiological signs of bone union (immature callus, patterns of periosteal and endosteal stratifications overlapping the fracture line) were visible by week 3 to 4. Discussion Соmbination of the external fixator and intramedullary elastic HA-coated wires overcomes shortcomings of both external and internal means of fixation. External osteosynthesis provides advantages of the Ilizarov method: preservation of blood supply, absence of soft tissue injury, joint function and early weightbearing. Elastic intramedullary wires do not injure a. nutricia and mechanically stimulate endosteal and periosteal bone formation. Conclusion The advantages of combined osteosynthesis provide reduction of Ilizarov apparatus fixation time, reduction in the number of wires and half-pins in the frame assembly, stimulation of bone callus formation and prevention of secondary bone fragment displacement.

Keywords

• ilizarov
• flexible intramedullary nailing
• hydroxyapatite