There are contraindications. Specialist consultation is required.
Advantages Indications Contraindications Preparation Progress of the operation Rehabilitation
Osteosynthesis of the bones of the lower leg is a surgical operation that is performed for the purpose of repositioning (restoring in its place) and reliable fixation of bone fragments that were obtained as a result of injury to the tibia or fibula. The main goal of the procedure is to create the most physiological conditions possible for the bones to heal in their correct anatomical position. Such a radical intervention as osteosynthesis of the tibia is not recommended for all patients with fractures, but only for those in whom conservative measures have not yielded results or are inappropriate based on diagnostic results (union is impossible with casting).
For the most correct connection of bone fragments, surgeons can use frame structures or use only certain fixation options. The selection of specific devices will depend on the size of the injury, the nature of the injuries sustained and the location of the fracture, age, and additional conditions.
Advantages of tibial osteosynthesis surgery
The main advantage of such an intervention is the ability to create conditions for the fastest, full healing of a fractured leg bone. This is realized due to two conditions. The first is the reliable and most accurate fixation of all bone fragments in their places. The second is the process of early restoration of tissue functions with improved blood flow and acceleration of the regeneration process. Through the use of various structures, the bones are reliably connected, while the limb remains mobile.
Such operations are performed for complex fractures - if both bones are damaged at the same time. In addition, osteosynthesis of the left or right tibia may be recommended if the ankle area is involved in the process, if fragments are displaced and surrounding tissues are injured.
Osteosynthesis of the hip
Femur fractures are much more common in older people. However, the number of young patients with this type of fracture is increasing. In general, a reed fracture is a big blow to the body. These fractures take an extremely long time to heal and do not always heal correctly. That is why hip osteosynthesis is recommended for almost every hip fracture.
Osteosynthesis of the femur allows, through supporting devices, to ensure a reliable connection of the fractured bone. Constantly being in the correct position, the bone simply must heal correctly. After surgery, recovery and rehabilitation, the hip will no longer bother you.
Indications for tibial osteosynthesis
Before the operation, the doctor determines the indications for osteosynthesis of the shin bones or ankle joint. Key indications include:
- the presence of compartment syndrome, severe tissue compression due to damage;
- damage to nerve trunks or vascular bundles;
- open fracture of 2-3 degrees with complications;
- diaphyseal fracture in patients with polytrauma, which requires active treatment;
- the presence of an unstable fracture, where there is displacement of bone fragments, and they are displaced by more than ½ the width of the diaphyseal part;
- unstable fracture, in which there is damage to the muscles or tendons by bone fragments or an affected bone fragment;
- there is a shortening of more than 1 cm in the area of the fracture line;
- segmental fracture;
- a fracture initially treated conservatively with secondary displacement;
- fracture of the tibia only, but with a varus deformity that exceeds 10 degrees;
- ipsilateral fracture with damage to the ligamentous apparatus in the knee joint;
- a short oblique fracture, which has a fragmentary-rotational nature, and the sharp part of the bone is displaced dorsally.
Additionally, there are a number of indications for the use of percutaneous osteosynthesis using hardware structures. They are determined by a doctor based on an analysis of numerous factors and conditions. First of all, this is the nature of the fracture. If this is an uncomplicated fracture (non-fragmented), closed reduction (with plaster casting) or screw osteosynthesis or submersible (simple type) is used. If it is a comminuted fracture that cannot be resolved by repositioning with plaster, percutaneous fixation using devices is possible.
Depending on the location of the fracture, various designs are used - osteosynthesis of the tibia with a plate, rod or pin.
During osteosynthesis, the condition of the skin over the fracture site is important. If there is dermatitis or suppuration, osteosynthesis may be prohibited.
Ankle osteosynthesis
The ankle is the part of the human body that experiences perhaps the heaviest stress. The load of the whole body falls on the ankle, while it remains extremely fragile and vulnerable to fractures. For displaced fractures, osteosynthesis of the ankle is mandatory. This procedure will ensure the most effective recovery, eliminating the risk of lameness and constant pain in the leg after treatment.
Ankle osteosynthesis can be open or closed. Open is more aggressive and is used in difficult cases. Open osteosynthesis of the ankles involves making an incision in the ankle area, when the surgeon performs all manipulations manually. The bone is placed in its place, and a fixation device is also installed to ensure that the broken bone heals correctly. In turn, closed osteosynthesis of the ankles involves the installation of special wires without making incisions. These wires, together with the Ilizarov apparatus, return the fragments to their places over time, ensuring proper fusion of the bone.
Contraindications
There are a number of contraindications for performing external osteosynthesis of the tibia or its other variants. These include:
- severe lesions, disorders of the nervous system;
- severe damage to the surrounding tissues of the leg;
- osteoporosis;
- infectious diseases, fever, intoxication;
- immunodeficiency states;
- allergy to anesthetics;
- exacerbation of any chronic pathologies.
The doctor may determine other temporary or permanent contraindications that will limit the intervention.
In what cases is osteosynthesis performed?
The operation is performed as planned 6-12 months after osteosynthesis, when complete healing of the fracture has occurred. In addition, it is recommended to always remove metal structures if the patient engages in or plans to engage in sports, especially extreme sports.
In some cases, the structure has to be removed earlier. This happens rarely, and intervention is performed only for serious indications.
:
- development of a purulent process;
- intolerance to the metal from which the retaining elements are made;
- weak fixation, loosening and instability of clamps;
- breakage or displacement of structural elements;
- formation of a false joint;
- restriction of mobility of a joint located nearby, which can be caused either by the structure itself or by the formation of contracture as a result of the scarring process;
- discomfort in the limb;
- there are no signs of callus formation.
Technically, emergency surgery is performed in the same way as elective surgery.
How is the operation performed?
When it comes to a tibia fracture, specialists most often use the technique of intramedullary osteosynthesis, which involves drilling the bone marrow canal or without drilling. The latter method helps to minimize tissue trauma during surgery, which is important against the background of severe injuries or the threat of shock. But osteosynthesis with reaming helps to ensure a tight fit of all fixed fragments, which is especially important in the presence of a pseudarthrosis.
For open fractures, the technique of compression-distraction transosseous intervention is used. But subsequently it is necessary to walk with the device for a certain time. After healing, the device is removed and intramedullary osteosynthesis is performed. For complicated fractures, a periosteal osteosynthesis procedure is performed.
Removal of the rod (pin) after surgery
Intraosseous (intramedullary) rods with locking screws or, as they are also called, pins are used to fix fractures of tubular bones, and in particular transverse and helical fractures with a small number of fragments and splinters. Also, preference for intraosseous osteosynthesis is given due to the speed of the operation, minimal invasiveness and low traumatic nature of the operation. It is worth saying that the fixation with the rods is very good and dosed loads on the operated limb can be given after just a few days.
After successful surgery and healing of the fracture, as a rule, the dynamic screw is removed and the load on the limb is increased for complete healing of the fracture. 1 year after surgery, when the fracture has completely healed, the screws and rod are routinely removed.
Almost always, the operation to remove the rod does not take more than 30 minutes. Removal occurs using similar tools as during installation.
Difficulties may arise when removing the rod; it is not installed correctly. Or the threads and screw heads are torn off. In this case, you will need to drill out the screws and rod.
Rehabilitation period
After surgery, it is important to strictly follow all doctor’s recommendations for rehabilitation. This is important for normalizing blood circulation, which speeds up healing and reduces the risk of secondary complications. Physiotherapy, exercise therapy, and sets of special gymnastics exercises are indicated to prevent joint contractures and weakening of muscle tone. In addition, early activity prevents congestive pneumonia and thrombosis.
Massage courses that are carried out at certain stages of rehabilitation are useful. During treatment, it is necessary to take control images that allow you to evaluate the dynamics of bone restoration.
Our clinic performs osteosynthesis of the lower leg and you can find out the price of the operation from the doctor at a preliminary consultation. Doctors at the clinic carry out various types of interventions, even in complex cases. It is important not to delay your visit if you need surgery. In addition, in our clinic you can undergo preliminary examination, preparation for surgery and post-operative rehabilitation.
Mobilization period
From 3-5 days after surgery until the consolidation of the fracture, if the patient’s condition is satisfactory. With stable functional osteosynthesis during this period, moderately active movements are acceptable and even desirable.
Usually by 3-5 days the patient no longer experiences pain; swelling by this time is significantly reduced. Against the background of positive dynamics in the patient’s condition, his further activation is carried out, increasing the motor regime for the operated limb, including light exercises, which are performed first carefully, then more and more actively until mild pain occurs.
After 2-3 days, movements become actively free and remain so until functions are fully restored. At this time, technically competent bone osteosynthesis allows for resistance exercises (in a simplified version) that help strengthen muscle tissue.
Exercises in the pool are also shown - this is an excellent tool for improving lymph and blood flow, recovery processes, developing muscles and expanding the range of joint movements. Exercises in water are much easier to perform, since its physical properties are such that they require much less effort when moving.
You can start exercising in the pool when indicators of fracture consolidation appear; This period usually corresponds to 4-5 weeks after surgery. The optimal water temperature is 30-32 degrees, each lesson lasts 25-30 minutes. Sudden movements should not be allowed, exercises are performed slowly, repetition frequency is 10-12 times.
If the upper limbs are fractured, all exercises are performed by going into water up to the chest or neck; with an operated hip or lower leg - lying on your back or stomach, holding the handrail with your hands. If the femur or tibia was broken, walking in water is prescribed as an exercise; this takes into account the load on the legs.
The load is calculated taking into account body weight and the fullness of the pool: if the water reaches the neck, the body mass coefficient is 1/6 of the mass of the body not immersed in the water. If the water reaches the chest - 1/3, to the navel 1/1. Exercises in the pool have repeatedly proven their effectiveness, contributing to the rapid restoration of limb function, strengthening muscles and increasing the overall tone of the patient.
Postoperative period and rehabilitation:
The patient remains in the clinic after the operation for 2-3 days. Already starting from 3-4 days, you can begin active recovery measures, including physical therapy, physiotherapy and massage.
On average, the recovery time after a minimally invasive operation performed at the ABIA clinic is 2-3 times shorter than after a classic open osteosynthesis operation. The absence of the need to wear a cast, as well as the possibility of a speedy return to work and active life, significantly improves the quality of life of our patients in the postoperative period.