Combined fine osteosynthesis of complicated diaphyseal fractures in children

Abstract

Objective of study. To implement the method of osteosynthesis in children in order to protect the bone regeneration structures. Material and methods. In the last five years combined fine osteosynthesis was performed in 29 children aged between 3 and 15 years. The following fractures were determined: complicated humeral fractures - 5 children, femoral fractures –18 patients, leg fractures – 4 patients, and clavicle fractures - 2 patients. In diaphyseal forearm fractures with indications for surgical treatment, osteosynthesis was performed with pins or elastic Bogdanov rods. Combined osteosynthesis was performed in children with diaphyseal humeral fractures (spiral, oblique, comminuted with major fragments and displacement) with pins inserted from the distal (lateral and medial) metaphyseal side through the bone canal, across the fracture level and up to the upper part of the humerus. Thus pins have three support points (introduction, crossing and the inner part opposite to the upper one). The stability was ensured by osteosynthesis performed with with cerclage wiring. In complicated diaphyseal femoral fractures, combined osteosynthesis was performed with antegrade elastic intramedullary rod and cerclage wiring. In diaphyseal distal femoral fractures, osteosynthesis was performed analogously to that in humeral fractures. In complicated diaphyseal fractures of the leg, combined osteosynthesis was performed with pins inserted distally and cerclage wiring. Results. Fragments were consolidate din all operated children. No cases of pseudoarthrosis or post-traumatic deformity were recorded. The usual treatment for recovery allowed to restore the movements in the immobilized joints. Discussions. The method of combined osteosynthesis in complicated diaphyseal fractures in children has a major priority, protecting periosteal and endosteal tissues that are severely affected in osteosynthesis with screwed plates or massive locked intramedullary rods. Biomechanical researches (Muleret al., 2011) have objectified the priorities of cerclage wiring. Intramedullary osteosynthesis with thin elastic rods or thick pins protects the endosteum; the pins are crossed through the bone canal mechanically but not electrically. Conclusion. Combined osteosynthesis of comminuted complicated diaphyseal fractures of the humerus, femur and tibia in children have led to good results, with absence of complications. There were used modern, fine and elastic fixators associated with cerclage wiring, thus protecting the periosteum, endosteum and cortical bone.