Osteosynthesis complications and failures in children with closed locomotor monofracture

Abstract

Introduction. There is not any surgical method of treatment without failures and complications. The main cause of their increase is placement of massive metal fixators in the child, which are similar to those used in adults. Material and methods. The failure of surgical technique was recorded in 12 children, including one with the fracture of the clavicle fixed with screwed plate and pins–with pin fracture and migration of the distal end forward into mediastinum. The Ilizarov apparatus was incorrectly fixed in 2 patients with diaphyseal humeral fracture; wrong technique in osteosynthesis of intraarticular fractures of the elbow was recorded in 6 patients. Some mistakes in diagnosis were recorded in 3 children with forearm fractures-dislocations. Postoperative osteitis was present in 11 children at various sites after osteosynthesis (clavicle, humerus, femur, leg, astragalus). Pseudoarthrosis following osteosynthesis developed in 38 patients, in the majority after diaphyseal fractures and osteosynthesis with screwed plates, intramedullary rods, and bolts. There was found fracture of the metal fixator at the level of the primary fracture in 8 cases, which certainly proves the presence of post-traumatic pseudoarthrosis. Discussions. All cases of pseudoarthrosis developed after performing metal osteosynthesis. Also, purulent complications occur after osteosynthesis, being life-threatening complications (damage to subclavian vessels during surgery with a fatal outcome, migration of the pin end into the mediastinum, aorta and pericardium, etc.). In this regard, the indications for surgical treatment should be strictly selected and surgery has to be performed by the specialist who will avoid possible complications. In diaphyseal fractures of the humerus, forearm, femur and leg, it is necessary to comply with osteosynthesis requirements in order to avoid major removal of periosteum from the bone, endosteal trauma, therefore osteosynthesis has to be performed with fine and relatively stable devices. Osteosynthesis of elbow fractures must be made through an anatomical-functional approach, neither muscles and tendons sections, nor olecranon osteotomy. Delicate surgical technique, protection of the tissues adjacent to the joint, maximum possible limitation of wound exposure are among the factors of preventing complications.