MINIMALLY INVASIVE OSTEOSYN THES IS OF FRACTURES OF THEAN TERIOR PELVIC SEMICIRCLE

В данной работе нами был рассмотрен метод малоинвазивного остеосинтеза переломов переднего тазового полукольца. В ходе работы было выяснено, что по сравнению с классическими методами у малоинвазивного есть существенное преимущество. Малоинвазивный метод позволяет значительно снизить длительность операции, объем интраоперационной кровопотери и начать более раннюю реабилитацию пациента. In this paper, we considered the method of minimally invasive osteosynthesis of fractures of the anterior pelvic semicircle. In the course of the work, it was found that in comparison with classical methods, the minimally invasive method has a significant advantage. The minimally invasive method allows you to start the rehabilitation of the patient much earlier, the duration of the operation is reduced, blood loss during the operation is reduced. Further on, the clinical example will describe the very essence of the method.

Functional and Radiographic Outcomes for Distal Radius Fractures Treated with Volar-Locked Plates and Percutaneous K-Wires: A Comparative Study

Purpose to evaluate and to compare radiological and functional outcomes of the volar locking plate fixation using pronator-sparing approach and K-wire fixation of distal radius fractures. Materials and Methods. We retrospectively analyzed 41 patients with distal radius fractures (27 female and 14 male) treated in the period from 2016 to 2020 using minimally invasive osteosynthesis via pronator-sparing approach. The mean age was 51 years (31-74 years). The control group consists of 37 patients (19 female and 18 male, mean age 61 years (29-76 years)), who underwent minimally invasive percutaneous K-wire fixation of distal radius fractures during the same period of time. Comparative analysis of radiographic and functional outcomes in both groups of minimally invasive osteosynthesis of distal radius fractures was carried out in the period from 1 to 6 months after the surgery. Results. Primary union of distal radius fractures was confirmed in X-rays in all patients within 6 weeks after the surgery. There were no complications in patientstreated by pronator-sparing volar locking plate fixation, whereas in K-wire group we had 6 patients with complications: 4 cases (11%) superficial infection around K-wires and 2 cases (5,4%) intraoperative damage of sensitive branch of radial nerve. There were statistically significant differences in radiographic results (volar tilt, radial inclination, andradial height) between two groups: they all were better in patients treated by pronator-sparing volar locking plate fixation during the whole follow-up period (р0,01). Minimally invasive volar locking plate fixation via pronator-sparing approach also provided significantly better grip strength and range of wrist motion and forearm rotation in the early 6-month postoperative period, compared with percutaneous K-wire fixation (р0,001). Conclusion. Our study demonstrates that both techniques of minimally invasive osteosynthesis of distal radius fractures are effective and relatively safe methodsof surgical treatment, but volar plating via pronator-sparing approach leads to a better reconstruction of the distal radius and better functional outcomes compared to percutaneous K-wiring. Keywords: minimally invasive osteosynthesis, distal radius, volar locking plate, pronator-sparing approach, K-wire.

Protocol of BRICS: Brazilian multicentric pragmatic randomised trial of surgical interventions for displaced diaphyseal clavicle fracture study: MIPO versus ORIF for the treatment of displaced midshaft clavicle fractures

IntroductionFractures of the diaphysis of the clavicle are common; however, treatment guidelines for this condition are lacking. Surgery is associated with a lower risk of non-union and better functional outcomes but a higher risk of complications. Open reduction and internal fixation with plates and screws are the most commonly performed techniques, but they are associated with paraesthesia in the areas of incisions, extensive surgical exposure and high rates of implant removal. Minimally invasive techniques for treating these fractures have a lower rate of complications. The aim of this study is to evaluate which surgical treatment option (minimally invasive osteosynthesis or open reduction and internal fixation) has better prognosis in terms of complications and reoperations.Methods and analysisThe study proposed is a multicentric, pragmatic, randomised, open-label, superiority clinical trial between minimally invasive osteosynthesis and open reduction and internal fixation for surgical treatment of patients with displaced fractures of the clavicle shaft. In the proposed study, 190 individuals with displaced midshaft clavicle fractures, who require surgery as treatment, will be randomised. The assessment will occur at 2, 6, 12, 24 and 48 weeks, respectively. The primary outcome of the study will be the number of complications and reoperations. For sample size calculation, a moderate effective size between the techniques was considered in a two-tailed test, with 95% confidence and 90% power. Complications include cases of infection, hypertrophic scarring, non-union, refracture, implant failure, hypoesthesia, skin irritation and shoulder pain. Reoperations are defined as the number of surgeries for pseudoarthrosis, implant failure, infection and elective removal of the implant.Ethics and disseminationStudy approved by the institutional ethics committee (number 34249120.9.0000.5505—V.3). The results will be disseminated by publications in peer-reviewed journals and presentations in medical meetings.Trial registration numberRBR-3czz68)/UTN U1111-1257-8953.

Minimally Invasive Osteosynthesis of Isolated Coronoid Process Fracture: A Novel Technique

Isolated coronoid process fracture is not a commonly encountered injury of the elbow joint. Coronoid process is an important component in providing elbow stability. We present a case of isolated coronoid process fracture in a young male managed by minimally invasive osteosynthesis technique.

MINIMALLY INVASIVE OSTEOSYNTHESIS IN PLEVIC TRAUMA- APPROACHES AND VISIONS FROM CLINICAL PRACTICE

In this study, we intend to study general problems of plevic trauma, available treatment methods minimally invasive and some recommendations or else, visions to evaluate and select the optimal treatment for pelvic ring fractures, to improve quality of life of patients and to reduce the intraoperative risks and incidence of post-traumatic disability.

Treatment outcomes in patients with multiple and concomitant trauma managed with minimally invasive osteosynthesis technologies and electromagnetic waves of the terahertz range

Purpose To assess the effectiveness of minimally invasive technologies of osteosynthesis and electromagnetic waves of the terahertz range in patients with multiple and concomitant trauma. Materials and methods The process of rehabilitation was studied in 513 patients with polytrauma of varying severity which was more than 26 points on the ISS scale. The patients were diagnosed with 545 injuries of different organs and systems. All patients with severe concomitant and multiple trauma were divided into 3 groups: Group I of controls, treated in1995–2001, consisted of 269 patients whose treatment was conservative and aggressive (surgical, with the use of plating or intramedullary osteosynthesis); Group II was the experimental study group consisting of subgroup A of 202 patients treated in 2002–2009 in whom “damage control” concept was applied and subgroup B of 42 patients treated in 2010–2017 using the damage control tactics and new minimally invasive methods of treatment and devices (non-invasive lung ventilation in intensive care for fat embolism; rational osteosynthesis in closed chest trauma; minimally invasive guided method of transosseous osteosynthesis, including the use of fixators with hydroxyapatite coating; rational surgical approach to pelvic bones; universal guide for reaming the medullary canal) and exposure to electromagnetic waves of the terahertz range (EMWTHR)of the xiphoid process of the sternum to stimulate the immune system. Results It was revealed that the use of minimally invasive, low-traumatic methods of treating bone fractures in severe polytrauma and methods stimulating the immune system and tissue regeneration (subgroup II B) contributed to an improvement of anatomical and functional results of treatment by 1.3 times compared with the control group. The quality of life of patients in this group, in comparison with the control group, was 1.6 times higher for injuries of the upper limb and 1.9 times higher for injuries of the lower limb. An integral analysis of the effectiveness of the treatment revealed a reliable increase in the effectiveness to a satisfactory level. Conclusion The use of EMWTHR in the complex treatment of such patients is a promising method for stimulating hematological and immunological processes. The first results described in the literature are optimistic.

Experience of using an original external fixation device in the treatment of pelvic fractures in a patient with polytrauma

The article presents a clinical case of a patient being treated after a road accident in the Kaluga Regional Clinical Hospital of Emergency Medicine named after K. N. Shevchenko, delivered by an ambulance team 1,5 hours later with a diagnosis: Polytrauma. Severe closed head injury. Brain contusion of moderate severity. Fracture of the pelvic bones. Lung contusion. Respiratory failure 1-2. Traumatic shock. Taking into account the severity of the patient’s general condition, we performed minimally invasive osteosynthesis of the pelvic bones with an external fixation device of the original design of spoke arrangement and CITO screw. After 2,5 months, fracture consolidation was diagnosed and the apparatus was dismantled. Then the patient underwent a course of rehabilitation and restorative treatment. At the end of the course of rehabilitation treatment, a good recovery of the patient’s functionality was noted. Key words: polytrauma, external fixation device of the original design, treatment tactics, injury control surgery.