Complications in distal femur fractures treatment

Clinica ortopedie și traumatologie „Vitalie Bețișor”, USMF „Nicolae Testemițanu”, Chișinău, Republica Moldova, Conferința stiințifică „Nicolae Anestiadi – nume etern al chirurgiei basarabene” consacrată centenarului de la nașterea profesorului Nicolae Anestiadi 26 august 2016Scop. Prezentarea complicațiilor după tratamentul chirurgical la pacienții cu fracturi ale femurului distal trataţi în clinica Ortopedie-Traumatologie „V. Beţişor” în perioada 2010-2015. Material şi metode. Au fost analizate 120 cazuri clinice cu 123 fracturi ale femurului distal (au fost 3 pacienţi cu fracturi ale femurului distal bilateral); bărbați – 58(48,3%) și femei – 62(51,7%) cu vârsta cuprinsă între 17 și 90 ani (vârsta medie 53,4ani). Circumstanțele traumelor: accident rutier – 40 cazuri, habitual – 71, traumă prin precipitare – 7, industrial – 1, prin armă de foc – 1. Fracturile au fost clasificate după AO: tip A1 – 13 cazuri, tip A2 – 29 cazuri, tip A3 – 39 cazuri, tip B1 – 2 cazuri, tip B2 – 1 caz, tip C1 – 7 cazuri, tip C2 – 27 cazuri și tip C3 – 5 cazuri. Abordurile utilizate au fost: clasic antero-lateral – 52, MIPO – 35, MIPPO – 1, TARPO – 16 și parapatelar medial (pentru retronail) – 19 cazuri. Fixatoarele utilizate: placă condilară de susținere – 24, placălamă 95o – 11, placă cu stabilitate angulară – 65, tija centromedulară blocată (retronail) – 18, DCS – 2, șuruburi (pentru fracturile de tip B) – 3. Rezultate. Complicațiile survenite au fost 3 (2,4%) deteriorări ale fixatoarelor metalice, rezolvate prin reosteosinteza osteoplastica; 3 (2,4%) deplasări secundare cu ulterioară consolidare vicioasă; 4 (3,25%) pseudoartroze și 2 (1,6%) complicații septice. Concluzii. Abordarea individuală a fracturilor femurului distal, respectarea principiilor AO, alegerea implantului potrivit și tehnicii chirurgicale minim invazive este o tactică optimală pentru obţinerea rezultatelor funcţionale favorabile şi evitarea complicaţiilor.Purpose. Presenting the complications of surgical treatment of patients with distal femur fractures treated in Orthopaedics and Traumatology Clinic " V. Bețișor" durind 2010-2015 years. Materials and methods. There were analyzed 120 clinical cases with 123 distal femur fractures (3 patients with bilateral fractures); men - 58(48,3%) and women - 62(51,7%) aged between 17 and 90 years, (mean age 53,4 years).Trauma circumstances: traffic accident - 40 cases, habitual trauma -71, precipitation – 7, industrial – 1, by firearm - 1.Fractures were classified as AO:typeA1 – 13 cases, type A2 – 29 cases, type A3 – 39 cases, type B1 – 2 cases, type B2 – 1 case, type C1 – 7 cases, type C2 – 27 cases and type C3 – 5 cases. There were used surgical approaches: classical antero-lateral – 52, MIPO – 35, MIPPO – 1, TARPO – 16 and medial parapatelar (for retronail) – 19 cases. Fixators used: condylar butress plate–24, blade–plate 95o–11, angular stability plate – 65, locked intramedullary nail (retronail) – 18, DCS – 2, screws (for type B fractures )– 3. Results. There were 3 cases(2,4%) of deterioration of fixators, solved with osteoplastic re-osteosynthesis; 3(2,4%) secundary displacements with further vicious consolidation, 4(3,25%) pseudoarthrosis and 2(1,6%) septic complications. Conclusions. Individual approach of the distal femur fractures, respecting the AO principles, the right choice of implant and minimally invasive surgical techniques is a optimal tactics to obtain favorable functional results and avoid complications

Эволюция хирургических методов лечения переломов дистального отдела бедренной кости

This article makes a comparative analysis of implants and techniques used in the treatment of distal femur fractures in Orthopedics and Traumatology Clinic “V. Beţişor” of National Scientific and Practical Centre of Preventive Medicine. In the period 2008-2009 were applied: plate-blade 95º – 44, condylar buttress plate – 15, DCS – 4, intramedullary locked nail – 10, condylar plate with angular stability – 1, osteoplasty is indicated in 10 cases. In the period 2010-2011 were applied: plate-blade 95º – 8, condylar buttress plate – 13, DCS – 1, intramedullary locked nail – 13, condylar plate with angular stable – 30, the need of osteoplasty is only in 3 cases. In 20 cases we have applied the techniques of minimally invasive plate osteosynthesis.Эта статья дает сравнительный анализ имплантатов и методов, используемых при лечении переломов дистального отдела бедренной кости в клинике ортопедии и травматологии «В. Бецишор» Национального Научно-Практического Центра Превентивной Медицины. В период 2008-2009 годов были применены: мыщелковые пластины под углом 95° – 44, ложкообразные пластины – 15, DCS – 4, интрамедуллярные стержни – 10, мыщелковые пластиныс угловой стабильностью – 1, костная пластика была показына в 10 случаях. В период 2010-2011 годов были применены: мыщелковые пластины под углом 95° – 8, ложкообразные пластины – 13, DCS – 1, интрамедуллярные стержни – 13, мыщелковые пластины с угловой стабильностью – 30, костная пластика была показына только в 3 случаях. В 20 случаях были применены методы малоинвазивного остеосинтеза с пластинами

Наш опыт хирургического лечения переломов вертлужной впадины

Fractures of acetabulum are considered unstudied very well so far, with an unfavorable prognosis and increased frequency lately. Men are more frequently affected – age group between 20-40 years. Injuries associated with fractures of the acetabulum are from 40% to 44.8%, traumatic shock of different grades up to 59.7% of cases. Despite progress in the treatment of these fractures, the overall bad consequences are high – osteonecrosis and osteoarthritis being 44% after conservativ treatment and 22.2% after surgery, heterotopic ossifi cation is developing between 14 to 50% of cases, and sciatic nerve injure constituting 10-15% as a result of primary injury and 2-6% are iatrogenic - after Kocher-Langenbeck approach.Переломы вертлужной впадины считаются среди переломов не до конца изученных, с неблагоприятным прогнозом и которые в последние десятилетия участились особенно среди молодых (20-40 лет) мужчин. Сочетанные повреждения при переломах вертлужной впадины составляют 40-45%, травматический шок регистрируется в 59,7% таких случаев. Несмотря на явные успехи в лечении этих больных, доля последствий этих травм еще высока: коксартроз и асептический некроз головки бедра до 44% после консервативного лечения и 22,2% после хирургического лечения, развитие параартикулярных осификатов в 14-50% случаев