TACTICS AND TREATMENT OF FRACTURES OF THE PROXIMAL TIBIA
About the author:
Isaev I. I.
METHODS AND METHODOLOGIES
Type of article:
Goal. Development of specific treatment tactics for maximum improvement of treatment results for fractures of the proximal tibia. Methods. 87 patients aged 17-19 years were examined during the last 5 years. 72.4% (63 people) of patients were men, 27.6% (24 people) were women. As a result of road accidents, 25.2% of patients (22 people) and 10.3% (9 people) were injured with various pathologies during sports. Most of the patients being able-bodied people aged 17-50 years were 66.6% (58 people). The above-mentioned injuries were observed in 33.4% of patients (29 people) aged 51-79 years. 70.1% (61 people) of fractures observed in patients were closed, 29.9% (26 people) – open. Patients who had dislocated fragments accounted for 74.7% (65 people), patients with observed non – displaced fractures – 25.3% (22 people). 86.3% of patients (75 people) in the study material were patients with fractures of both bones of the lower leg. 13.7% (12 people) were patients with a fracture of the proximal tibia only. 82.7% of patients (12 people) went to the hospital for help within the first 1-3 days after the injury. 17.3% of patients (15 people) went to a doctor 3 days after the injury. Conservative and operative methods of treatment were used in the treatment of patients. 77.2% of the observed patients (17 people) with non-displaced fractures were treated with plaster bandages. 22.8% (5 people) had surgery, although they had non-displaced fractures. 12.3% of patients (8 people) out of 65 people who had displacement received conservative treatment. These patients were treated with skeletal traction and conservative treatment with plaster bandages. During surgery, the treatment tactics based on the classification of AO– Mueller (1982) and Schatzker (1979), the most widespread in fractures of the proximal tibia, were chosen. According to the classification, osteosynthesis with metal screws for type I fractures was used in 7.7% (11 people), osteosynthesis with grafts for type II and III fractures – in 21.1% (13 people), osteosynthesis with metal plates for type IV and V fractures – in 33.8% (21 people), for type VI fractures in 27.4% of patients (17 people), mainly osteosynthesis with metal plates and external fixation devices. Due to the onset of plateau subsidence in type II and III fractures, the use of a graft and osteosynthesis with metal plates was performed. In General, suppuration was observed in 8% of patients (5 people) receiving surgical treatment, in 4.8% (3 people) – non-joined fracture, in 4.8 (3 people) secondary displacement, in 3.2% (2 people) thromboembolism, in 9.6% (6 people) knee contracture. In 8% of patients (2 people) receiving conservative treatment, there was an uncompressed fracture, in 16% – a secondary displacement, and in 20% (5 people) knee contracture.Long-term results of treatment of patients receiving conservative treatment on the KSS scale showed excellent results of 52.1%, good results of 14.6%, satisfactory results of 20.8%, and unsatisfactory results of 12.5%. When evaluating the results of treatment of patients who received surgical treatment, the results were excellent 54.2%, good 22.4%, satisfactory 4.1%, unsatisfactory 4.1%. Conclusions. In any case, if the treatment of fractures of the proximal tibia was performed surgically, excellent and good results were maximum, and unsatisfactory results were minimal.
fractures of the tibia, osteosynthesis, complications.
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Publication of the article:
«Bulletin of problems biology and medicine» Issue 2 (156), 2020 year, 208-211 pages, index UDK 616.718.51-001.513-089