Traumatology
doi: 10.25005/2074-0581-2021-23-1-60-66
AUTO-DYNAMIC INTRAMEDULLARY OSTEOSYNTHESIS FOR FEMUR FRACTURES AND CONSEQUENCES OF INJURIES

P.P. Zuev, Yu.A. Barabash, I.A. Norkin, D.V. Ivanov, O.A. Kauts, K.A. Grazhdanov, A.P. Barabash

Scientific Research Institute of Traumatology, Orthopedics and Neurosurgery, V.I. Razumovsky Saratov State Medical University, Saratov, Russian Federation

Objective: The assessment of clinical testing results of the new intramedullary rod which design features neutralize the disadvantages of conventional blocking devices.

Methods: The research involved 15 patients with ununited femoral shafts fractures underwent intramedullary revision osteosynthesis with BNB rods. The analysis of surgical management was performed using the standardized system of bone fractures outcomes and their consequences (Standardized Outcome Assessment-1, SOA-1) as well as the modified Radiographic Union Score (mRUS).

Results: The examination reveals positive dynamics 2 months after the revision osteosynthesis with BNB rods. The mean rehabilitation rate by the SOA1 was 75.3±0.6 percent, it was 84.0±1.2 percent (p<0.001) in 6 months after the surgery and 90.8±2.7 percent (p>0.05) by the 12th month. Considering mRUS scores, the degree of consolidation of the femoral fracture in patients 2 months after surgery using the BNB rod corresponded to 5.0±0.2 points, to 13.3±0.8 points (p<0.001) in 6 months and to 14.8±1.0 points (p>0.05) by the 12th month. In 1 case (6.7%) out of 15, no union of the fractured fragments was observed.

Conclusion: The technical solutions implemented in the BNB intramedullary rod contribute to the autodynamization of the bone-implant system under the action of a controlled load and muscle power on the limb without additional surgical interventions, which makes it possible to shorten the rehabilitation period for patients, resulting in the reduction of treatment expenses for this cohort of patients.

Keywords: Ununited fructure, femoral bone, intramedullary osteosynthesis, false joint.

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References
  1. Ankin LN. Politravma: organizatsionnyye, takticheskiye i metodologicheskiye problemy [Polytrauma: organizational, tactical and methodological issues]. Moscow, RF: MEDpress-inform; 2004. 173 p.
  2. Kotelnikov GP, Mironov SP. (eds.) Travmatologiya: natsional’noe rukovodstvo [Traumatology: national guide]. Moscow, RF: GEOTAR-Media; 2008. 820 p.
  3. Kotelnikov GP, Mironov SP, Miroshnichenko VF. Travmatologiya i ortopediya: uchebnik [Traumatology and orthopedics: student book]. Moscow, RF: GEOTAR-Media; 2009. 400 p
  4. Tikhilov RM, Vorontsova TN, Luchaninov SS. Dinamika osnovnykh pokazateley vremennoy utraty trudosposobnosti pri travmakh i boleznyakh kostno-myshechnoy sistemy u naseleniya Leningrada – Sankt-Peterburga (itogi tridtsatiletnego monitoringa, provedлnnogo s 1976 po 2008 g.) [Dynamics of basic levels of temporary labor disability due to injuries and musculoskeletal diseases in population of Leningrad – St. Petersburg (overall results of 30-year monitoring held since 1976 to 2008)]. Travmatologiya i ortopediya Rossii. 2009;3:70-7.
  5. Norkin IA, Baratov AV, Akimova TN, Yushina BS, Vegele LS. Travmatologo-ortopedicheskaya sluzhba regiona: problemy i zadachi [The traumatological orthopedic service of Region: problems and goals]. Zdravookhraneniye Rossiyskoy Federatsii. 2014;4:12-7.
  6. Sitnik AA. Intramedullyarnyy blokiruyemyy osteosintez dlinnykh trubchatykh kostey. Obshchaya tekhnika vypolneniya, rezul’taty i perspektivy. [Blocked intramedullary osteosynthesis of long tubular bones. Technique, results and prospects]. Meditsinskiy zhurnal. 2007;4:22-5.
  7. Sokolov VA. Mnozhestvennyye i sochetannyye travmy [Multiple and concomitant injuries].Moscow, RF: GEOTAR-Media; 2006. 483 p.
  8. Klyuchevskiy VV. Osteosintez sterzhnyami pryamougol’nogo secheniya [Osteosynthesis with rectangular-sectioned rods]. Yaroslavl, RF: Ortopro; 1993. 329 p
  9. Rublenik IM, Vasyuk VL, Koval’chuk PE. 30-letniy opyt primeneniya blokiruyushchego intramedullyarnogo metallopolimernogo osteosinteza v lechenii perelomov dlinnykh kostey u 1200 patsiyentov [30-years experience of use of blocking intramedullary metalopolymer osteosynthesis in treatment of 1200 patients with fractures of long bones]. Klinicheskaya meditsina. Byulleten’ VSNTS SO RAMN. 2011;4:161-7.
  10. Mironov SP, Mattis ER, Trotsenko VV. Standartizovannyye issledovaniya v travmatologii i ortopedii [Standardized researches in traumatology and orthopedics]. Moscow, RF: FGU «TSITO im. N.N. Priorova Roszdrava», nauchno-issledovatel’skiy i uchebno-metodicheskiy tsentr biomeditsinskikh tekhnologiy; 2008. 87 p.
  11. Litrenta J, Tornetta P, Mehta S, Jones C, O’Toole RV, Bhandari M et al. Determination of radiographic healing: an assessment of consistency using RUST and Modified RUST in metadiaphyseal fractures. J Orthop Trauma. 2015;29(11):516-520. Available from: https://doi.org/10.1097/ BOT.0000000000000390
  12. Yamschikov O.N. Lechenie perelomov bedrennykh kostey u patsientov s mnozhestvennoy travmoy i travmaticheskim shokom [Treatment of patients with fractures of femurs, with multiple trauma and traumatic shock]. Vestnik Tambovskogo universiteta: Seriya Estestvennye i tekhnicheskie nauki. 2015;20(4):817-20.
  13. Bagheri F, Sharifi SR, Mirzadeh NR, Hootkani A, Ebrahimzadeh MH, Hami Ashraf H. Clinical outcome of ream versus unream intramedullary nailing for femoral shaft fractures. Iran Red Crescent Med J. 2013;15(5):432-5.
  14. Metsemakers W-J, Roels N, Belmans A, Reynders P, Nijs S. Risk factors for nonunion after intramedullary nailing of femoral shaft fractures: Remaining controversies. Injury. 2015;46(8):1601-7.
  15. Bell A, Templeman D, Weinlein JC. Nonunion of the femur and tibia: an update. Orthop Clin North Am. 2016;47(2):365-75.
  16. Hierholzer C, Glowalla C, Herrler M, von Ruden C, Hungerer S, Buhren V, Friederichs J. Reamed intramedullary exchange nailing: treatment of choice of aseptic femoral shaft nonunion. J Orthop Surg Res. 2014;9:88-90
  17. Sokolov VA, Byalik EI, Fayn AM, Ivanov PA, Vorontsov YuA. Profilaktika i lechenie oslozhneniy zakrytogo blokiruemogo osteosinteza perelomov dlinnykh kostey u postradavshikh s politravmoy [Prevention and treatment of complications of closed blocking osteosynthesis for long bone fractures in patients with polytrauma]. Vestnik travmatologii i ortopedii im. N.N. Priorova. 2008;2:29-32.
  18. Khominets VV, Foos IV, Mikhaylov SV, Shakun DA. Khirurgicheskaya taktika pri lechenii bol’nykh s neinfektsionnymi oslozhneniyami vnutrennego osteosinteza diafiza bedrennoy kosti [The analysis of noninfectious complications after an internal osteosynthesis at the changes of a diaphysis of a femur]. Kafedra travmatologii i ortopedii. 2016;2:34-41.
  19. Dergachyov VV, Aleksandrov AN, Vankhalskiy SB, Onatskiy YuV, Kotenko RS, Kolesnikov AM. Intramedullyarnyy blokiruyushchiy osteosintez – sovremennaya metodika, novyye slozhnosti, oslozhneniya [Locking intramedullary nailing-modern method, new difficulties, complications]. Travma. 2011;12(4):20- 3.
  20. Shapovalov VM, Khominets VV, Mikhaylov SV, Shakun DA, Foos IV. Oshibki i oslozhneniya pri vypolnenii vnutrennego osteosinteza u bol’nykh s perelomami dlinnykh kostey konechnostey [Mistakes and complications in internal osteosynthesis in patients with fractures of long bones]. Voyenno-meditsinskiy zhurnal. 2014;335(1):25-30.

Authors' information:

Zuev Pavel Pavlovich
Candidate of Medical Sciences, Junior Researcher, Department of Innovative Management Technologies for Treatment and Rehabilitation; Trauma Orthopedist, Scientific Research Institute of Traumatology, Orthopedics and Neurosurgery, V.I. Razumovsky Saratov State Medical University
Researcher ID: G-7101-2018
ORCID ID: 0000-0002-0324-6503
Author ID: 916590
SPIN: 1521-7718
E-mail: pasha.zuiev@mail.ru`

Barabash Yuriy Anatolievich
Doctor of Medical Sciences, Chief Researcher, Department of Innovative Projects for Traumatology and Orthopedics, Scientific Research Institute of Traumatology, Orthopedics and Neurosurgery, V.I. Razumovsky Saratov State Medical University
Researcher ID: H-2368-2018
Scopus ID: 57191888834
ORCID ID:0000-0002-8602-2715
Author ID: 639074
SPIN: 2479-2371
E-mail: yubarabash@yandex.ru

Norkin Igor Alekseevich
Doctor of Medical Sciences, Full Professor, Head of the Department of Traumatology and Orthopedics, V.I. Razumovsky Saratov State Medical University; Deputy Director for Development, Scientific Research Institute of Traumatology, Orthopedics and Neurosurgery, V.I. Razumovsky Saratov State Medical University
Researcher ID: B-1958-2017
Scopus ID: 6602239365
ORCID ID: 0000-0002-6770-3398
Author ID: 638852
SPIN: 9253-7993
E-mail: sarniito@yandex.ru

Ivanov Dmitriy Valerievich
Candidate of Physical and Mathematical Sciences, Analyst, Department of Intellectual Property and Technology Transfer, Scientific Research Institute of Traumatology, Orthopedics and Neurosurgery, V.I. Razumovsky Saratov State Medical University
Researcher ID: D-4750-2013
Scopus ID: 57214204189
ORCID ID: 0000-0003-1640-6091
Author ID: 201794
SPIN: 4459-1094
E-mail: ivanovdv@gmail.com

Kauts Oleg Andreevich
Candidate of Medical Sciences, Senior Researcher, Department of Innovative Projects for Traumatology and Orthopedics, Trauma Orthopedist in the Trauma Orthopedics Department № 3, Scientific Research Institute of Traumatology, Orthopedics and Neurosurgery, V.I. Razumovsky Saratov State Medical University
Researcher ID: A-7998-2018
Scopus ID: 57201429811
ORCID ID: 0000-0003-1822-1939
Author ID: 632695
SPIN: 1305-6629
E-mail: оandreevich2009@yandex.ru

Grazhdanov Konstantin Aleksandrovich
Candidate of Medical Sciences, Senior Researcher, Department of Innovative Projects for Traumatology and Orthopedics, Trauma Orthopedist in the Trauma Orthopedics Department № 1, Scientific Research Institute of Traumatology, Orthopedics and Neurosurgery, V.I. Razumovsky Saratov State Medical University
Researcher ID: G-7094-2018
Scopus ID: 57201431887
ORCID ID: 0000-0002-3523-4494
Author ID: 633499
SPIN: 3651-9306
E-mail: koctas1976@mail.ru

Barabash Anatoliy Petrovich
Doctor of Medical Sciences, Professor of the Department of Traumatology and Orthopedics, V.I. Razumovsky Saratov State Medical University
Researcher ID: G-6976-2018
Scopus ID: 7007134570
ORCID: 0000-0002-1877-7315
Author ID: 104282
SPIN: 7174-5184
E-mail: yubarabash@yandex.ru

Information about support in the form of grants, equipment, medications

The work was carried out according to the plan of scientific research works of Scientific Research Institute of Traumatology, Orthopedics and Neurosurgery, V.I. Razumovsky Saratov State Medical University (registration number – АААА-А18‑118060790019‑0). The authors did not receive financial support from manufacturers of medicines and medical equipment

Conflicts of interest: No conflict

Address for correspondence:

Zuev Pavel Pavlovich
Candidate of Medical Sciences, Junior Researcher, Department of Innovative Management Technologies for Treatment and Rehabilitation; Trauma Orthopedist, Scientific Research Institute of Traumatology, Orthopedics and Neurosurgery, V.I. Razumovsky Saratov State Medical University

410002, Russian Federation, Saratov, Chernyshevskogo Str., 148

Tel.: +7 (927) 1295080

E-mail: bib@sarniito.com

Materials on the topic:
  1. RISK FACTORS ASSOCIATED WITH IN-HOSPITAL MORTALITY AND PREDICTING OUTCOMES IN SEVERE ACUTE COMPOSITE TISSUE INJURIES
  2. COMPARATIVE EVALUATION OF THE RESULTS OF TREATMENT OF UNSTABLE UNCOMPLICATED SPINAL FRACTURES
  3. PREVENTION OF POSTOPERATIVE COMPLICATIONS OF CALCANEUS FRACTURES
  4. COMPREHENSIVE PREVENTION OF INSTABILITY IN HIP REPLACEMENT FOR HIP FRACTURES AND THEIR CONSEQUENCES IN POSTMENOPAUSAL OSTEOPOROSIS IN MULTIPAROUS WOMEN
  5. HIP REPLACEMENT FOR HIP FRACTURES AND THEIR CONSEQUENCES IN POSTMENOPAUSAL OSTEOPOROSIS IN MULTIPAROUS WOMEN
  6. EVALUATION OF THE EFFICIENCY OF ANTIRESORPTIVE THERAPY FOR OSTEOPOROSIS IN MULTIPAROUS WOMEN
  7. INVESTIGATION OF CALCIUM-PHOSPHORIC EXCHANGE IN WOMEN WITH THE MENOPAUSE STATE SUFFERING FROM OSTEOARTHROSIS AND CONCOMITANT OSTEOPENIC SYNDROME
  8. THE RESULTS OF TOTAL HIP JOINT ENDOPROSTHESIS FOR CONGENITAL HIP DISLOCATION
  9. COMPLICATIONS OF HIP JOINT ENDOPROSTHESIS
  10. OPTIMIZING MEDICAL REHABILITATION IN TRAUMAS OF LOCOMOTORIUM IN CONDITIONS OF POLYCLINIC

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