Removal of metal structures after osteosynthesis. Stable and functional osteosynthesis of the diaphysis of long bones of the lower extremities - errors and complications. What influences the decision to remove the fixator

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Altai State Medical University

Department of Traumatology and Orthopedics

Head Department: doctor medical sciences, Professor Raspopova E.A.

Teacher: Candidate of Medical Sciences, Associate Professor A.V. Chantsev

CLINICAL HISTORY OF THE DISEASE

Sick:______

Clinical diagnosis:

Healed pertrochanteric fracture of the right femur in conditions of MOS SSA, complicated by inflammation of the spoke and rod tracts

Curators: students of 422 groups

Rozhkov I.A., Chapyeva M.V.

Supervision date 06/21/06

BARNAUL 2006

FULL NAME.________

Location________

Place of work: unemployed

Date of admission: 06/19/06

Date of supervision: 06/21/06

ANDCOMPLAINTS for impaired mobility in the hip and knee joints on the right.

ANAMNESISMORBI

He considers himself sick from 7:30 a.m. On March 4, 2006, when he suffered a domestic injury, he slipped in the yard of his house, fell, and felt sharp pain V right leg, could hardly get up. He called a paramedic, who administered an anesthetic, applied a splint from scrap materials, and sent him to the Central District Hospital in a passing car. There he was diagnosed with a pertrochanteric fracture of the right femur based on clinical signs and radiography. For 5 days he was in the Central District Hospital in skeletal traction. 03/10/06 was delivered to trauma department AKB, where he was in skeletal traction for 2 weeks. On March 23, 2006, an operation was performed (metal osteosynthesis with the application of a pin-rod apparatus). On May 14, 2006 he was discharged from the hospital. On June 13, 2006, I got caught in the rain, the bandages got wet, on the same day I felt pain, burning, itching in the area where the metal structure was applied, the skin around the places where the needles exited turned red, and by the evening swelling appeared in the thigh area. From the Central District Hospital he was sent to the trauma department of the Regional Clinical Hospital. For 6 days I was at home due to lack of transport, I took ketones 3 times a day, one tablet. On June 19, 2006, he was admitted to the Regional Clinical Hospital with a diagnosis of a pertrochanteric fracture of the right femur in the conditions of MOS SSA, complicated by inflammation of the pin tracts. On the same day, an operation was performed to dismantle the SSA, dressings and anti-inflammatory therapy were prescribed.

ANAMNESISVITAE

Patient ______, born September 29, 1958. suffered: Botkin's disease, tuberculosis, venous diseases denies. Injuries suffered: fracture of the bones of the right forearm - 1967, fracture of the left clavicle - 1980, multiple fractures of the ribs - 1979, broken fingers right foot- 1996 Heredity is not burdened. Allergic reactions there was no response to previously taken medications. No blood transfusions were performed.

STATUSPRESENSCOMMUNIS

The general condition of the patient is satisfactory, consciousness is clear, position is active. The physique is proportional, the constitution is normosthenic. Posture is straight. Height 170 cm, weight 67 kg. Color skin flesh-colored, skin elasticity is not reduced, the skin is dry. The subcutaneous fat layer is poorly developed. The corners of the mouth are symmetrical, the color of the lips is pink. The mucous membrane of the oral cavity is pink and moist. The tongue is pink, moist, the root is covered with a white coating. The tonsils do not protrude from behind the arches. The act of swallowing is not impaired.

Degree of development muscular system moderate. There is no bone curvature.

The shape of the chest is normosthenic, symmetrical. The chest is symmetrically involved in the act of breathing. Mixed breathing type. Frequency breathing movements 18 per minute, vesicular breathing, rhythmic, no wheezing. No pathological pulsation was detected in the cardiac or extracardiac region.

The pulse is synchronous in both arms, the pulse rate is 75 beats per minute, rhythmic, soft, full. Heart rate 75 per minute, normocardia, correct rhythm. Heart sounds are clear and rhythmic. On the arms: blood pressure s = 120\90 mm Hg; Blood pressure d =120\90mm Hg.

The abdomen is of the correct configuration, symmetrical, participates in the act of breathing, and is not swollen. No visible peristalsis or antiperistalsis was detected. The development of subcutaneous venous anastomoses was not detected. The abdomen is soft, muscle tone is preserved, muscle tension No.

The act of defecation and urination is not impaired.

STATUSORTOPEDICUS

In an upright position it stands independently, straight. Moves with the help of crutches with partial support on the affected limb.

The head is located in the midline.

The shoulder girdles are located at the same level, length 19 cm on the right and left.

The chest is symmetrical, normosthenic in constitution, both halves of the chest equally take part in the act of breathing.

Waist triangles 6 cm on the right and left.

The wings of the ilium are at the same level.

Plumb the navel along the midline.

The physiological curves of the spine are moderately expressed.

The line of the spinous processes corresponds to the plumb line, the plumb line passes through the intergluteal fold.

The angles of the shoulder blades are at the same level.

Measurements	Right (cm)	Left (cm)
Relative length of the upper limb
Relative length of the lower limb
Absolute length: shoulder
Forearms


Shoulder circumference: Upper third
Middle third
Lower third
Forearm circumference: Upper third
Middle third
Lower third
Thigh circumference: Upper third
Middle third
Lower third
Calf circumference: Upper third
Middle third
Lower third

Range of motion measurements in large joints


Shoulder joint: flexion/extension
Abduction/adduction
External/internal rotation
Elbow joint: flexion/extension
Wrist joint: flexion/extension
Pronation/supination
Radial/ulnar deviation
Hip joint: flexion/extension
Abduction/adduction
External/internal rotation
Knee joint: flexion/extension
Ankle: dorsi/plantar flexion

STATUSLOKALIS

When examined in the area of the right thigh, the skin is of normal color. There is moderate swelling of the soft tissues of the thigh, spreading to the knee joint and partially to the distal parts of the right lower limb. In places where the rods pass, local hyperemia of the skin is noted. Movement in the hip and knee joints on the right is limited, in the right ankle joint full movement. Sensitivity is not impaired.

ADDITIONAL RESEARCH METHODS

General blood analysis

Red blood cells - 3.8 * 10 12 / l

Platelets - 380 * 10 9 /l

Sugar - 5.1 mmol/l

Description of the radiograph dated June 19, 2006

On a targeted radiograph of the area hip joint and the proximal diaphysis of the femur in the direct projection, a healed pertrochanteric fracture of the femur is visible in the conditions of MOS SSA with displacement of fragments along the length. The neck-shaft angle is 133 0, which corresponds to the norm.

CLINICAL DIAGNOSIS AND ITS RATIONALE

Based on: the patient’s complaints about limited mobility in the hip and knee joints on the right; data from the medical history that the patient felt a sharp pain in the area of the right hip after a fall, was taken to the Central District Hospital, where he was diagnosed with a pertrochanteric fracture of the right femur, which was later confirmed in the Regional Clinical Hospital, where he underwent MOS SSA surgery; also medical history data about the wetting of the bandages and the subsequent appearance of pain, burning and itching in the area where the rods exit; objective examination data (impaired mobility in the hip and knee joints on the right, swelling of the soft tissues of the thigh with transfer to the knee joint and distal parts of the right lower limb, hyperemia of the skin in the places where the rods pass), data x-ray examination from 06/19/06 - healed pertrochanteric fracture of the right femur in the conditions of MOS, SSA, we make a diagnosis: healed pertrochanteric fracture of the right femur in the conditions of MOS, SSA, complicated by inflammation of the pin and rod tracts.

DIFFERENTIAL DIAGNOSIS

This fracture should be differentiated from a pathological fracture. The fact that the cause of this fracture was a trauma is supported by the fact that the patient felt a sharp pain after a fall, which, as a rule, does not happen with pathological fractures; as well as the absence in the anamnesis of indications that the patient has osteomyelitis. This lesion differs from a dislocation in the presence characteristic features fracture on radiographs (the fracture line and displacement of fragments are visible).

PLANTREATMENTS

1. anti-inflammatory therapy

Local application of Levomekol ointment

Taking oral antibiotics to prevent osteomyelitis

REHABILITATION PLAN

1. walking on crutches with a moderate, increasing load for 1 month;

2. after 1 month, X-ray control, deciding on the issue of reaching full load;

3. gradual access to full load within 1-1.5 months;

4. during this entire time:

Exercise therapy aimed at developing joints,

Physiotherapy aimed at developing joints and relieving edema syndrome,

Massage aimed at developing joints and relieving swelling;

See what "MOS" is in other dictionaries:

Mosoy- Norwegian Måsøy municipality of Norway ... Wikipedia

Mos- (German Moos; Spanish Mos) ambiguous term. Moos (Bodensee) is a commune in Germany, in the state of Baden Württemberg. Moos (Lower Bavaria) is a commune in Germany, in the state of Bavaria. Mos (Pontevedra) is a city and municipality in Spain. MOS organometallic compounds ... Wikipedia

mosel- oils Dictionary of Russian synonyms. mosel noun, number of synonyms: 1 mosel (2) ASIS Dictionary of Synonyms. V.N. Trishin. 2013… Synonym dictionary

Mos. Moscow Moscow Moscow Moscow Dictionary: S. Fadeev. Dictionary of abbreviations of the modern Russian language. St. Petersburg: Politekhnika, 1997. 527 pp.... Dictionary of abbreviations and abbreviations

mosel- (BSRZH) ... Dictionary of the use of the letter E

MOS- International Organization for Standardization: an international body whose members are national standardization bodies and which approves, develops and publishes international standards. [Glossary of terms used in... ... Technical Translator's Guide

Multi-user operating system with virtual memory Dictionary: S. Fadeev. Dictionary of abbreviations of the modern Russian language. St. Petersburg: Politekhnika, 1997. 527 pp.... Dictionary of abbreviations and abbreviations

mosel- MASYOL, sla (or village), MOSYOL, sla (or village), m. 1. Bolshoy, strong man. 2. Well done, well done. 3. Arm, leg, limb. From “moslak”, “mosla”, “mosol” a large, protruding bone; Wed ug. "masel" military, policeman... Dictionary of Russian argot

Mos- Mosya, Moska, Mos, Mosyara, Mosyanya, (rare, but cool), Mosenegro - Mosenergo. (Dictionary of proper names - company names) ... Dictionary of business slang

MOS- International Standards Organization... Universal additional practical Dictionary I. Mostitsky

Books

Mos Angeles. Favorites, Paperny Vladimir. This collection is a continuation of the previous onesMos Angeles andMos Angeles Two (UFO, 2004, 2009). Here are collected the best articles, memories, notes and stories from…

) and provides the most accurate and complete removal tumors. This microsurgical procedure is usually used for malignant cells located on the head or neck, as well as for recurrent lesions. There are several main cases in which it is necessary to perform the MOS operation:

The tumor is localized in those areas of the body where it is important to preserve maximum amount healthy tissue - eyes, ears, nose, mouth, hairline, legs or genitals.
Exists high risk re-development cancer, or a relapse has already occurred.
MOS surgery is necessary if it is difficult for the surgeon to determine the boundaries of the affected tissue.
The tumor has big sizes or is aggressive.

Oncology treatment using modern capabilities Medicine, with the involvement of highly professional specialists, in most cases saves a person’s life.

Our company Tlv.Hospital is a medical provider in Israel and offers treatment for skin cancer in the best clinics countries. We successfully operate in the services market medical tourism more than 10 years and will be able to provide you with high-quality treatment results.

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Doctors in Israel, when performing MOS, have one main goal - to remove as many cancer cells as possible while causing minimal damage to surrounding healthy tissue. One of the specialists in the treatment of skin cancer in Israel is. Contact us to make an appointment with him. Micrographic surgery, or MOS, is an improvement over standard surgery (partial excision). It involves removing visible tumor and a small supply of healthy cells, and allows surgeons to check the removed tissue for cancer during the procedure and, if necessary, excise a larger area. Thus, MOS surgery increases the chances of recovery for patients and reduces the need for additional treatment and performing repeated surgery.

Advantages of MOS operation in Israel

The procedure involves removing skin cancer layer by layer and then examining the tissue under a microscope until “clean edges” are achieved. It has the highest success rate (up to 99%) in treating skin cancer compared to other methods.

Advantages of micrographic surgery (MOS):

Removal of a minimal amount of healthy tissue.
Short term rehabilitation.
MOS surgery almost completely eliminates the likelihood of cancer recurrence.
The ability to cure a disease after other treatments have not brought the desired results.
Maximum functional and cosmetic results.

Other surgical methods involve blind removal of large amounts of tissue, which can lead to unnecessary excision of healthy cells or regrowth of the tumor.

Preparing for MOS surgery

Before the procedure, the patient must follow several general rules:

Stop smoking at least 2 weeks before MOS surgery. Smoking can slow down the healing process and cause infection in the wound area.
Seven days before the procedure, it is recommended to stop or reduce consumption. alcoholic drinks, since alcohol abuse can cause bleeding.
For patients who do not have heart problems, the doctor may prohibit taking blood thinning medications - Ibuprofen, Alka-Seltzer, vitamin E, aspirin - 14 days before MOS surgery.

The use of medications is discussed with the attending physician. The patient should neither continue to take prescribed medications nor stop taking them without preliminary consultation doctors (patients who have had a heart attack, stroke, or have heart pain are more likely to continue taking medications).

Ask a Question

Operation MOS – carried out in Israel

Surgery is performed under local anesthesia. Herself MOS operation(tumor removal) is performed in the operating room, and histological examination of the obtained tissue samples is carried out in a neighboring laboratory.

There are several main stages of the MOS operation:

Stage 1. A map of the affected one is made cancer cells areas. Surgeon studying visible part tumor and determines its clinical boundaries.

Stage 2. The cancerous tumor is removed, after which the doctor removes a deeper layer of tissue, which includes fragments of skin closest to the tumor and the layer located underneath it.

Stage 3. During MOS surgery, the surgeon makes marks on the skin and divides the resulting sample into parts, which are then painted in specific colors. This is necessary to determine the source of the deleted fragments. According to the labeling of the obtained samples, they are plotted on the tumor map.

Stage 4. The laboratory conducts a histological examination of each piece of tissue, its surface and edges to confirm the presence or absence of cancer cells in the resulting fragment.

Stage 5. If the surgeon finds tumor cells under the microscope, he marks their location on a map and returns to the operating room to remove the next, deeper layer of skin. And the procedure is repeated again.

Stage 6. The MOS operation is completed after the surgeon is sure that there are no cancer cells left in the resulting layer.

Stage 7. Reconstruction of the damaged area. Both suturing and transplantation of skin flaps from other parts of the patient’s body can be performed.

The procedure usually takes several hours. The time for MOS surgery depends on the depth of tissue damage by cancer cells and the number of additional layers that the surgeon will have to examine.

Postoperative risks

Complications after MOS surgery are rare, but they are still possible:

bleeding or hematoma formation;
infection;
pain and sensitivity in the wound area;
temporary or permanent numbness around surgical field;
itching or shooting pain in the affected area.

The MOS operation is an improved technique of standard surgery, more complex, labor-intensive and expensive. Meanwhile, after it there is a minimal risk of relapse and the smallest aesthetic defect. Operation MOC is the best method skin cancer treatment. Thanks to the timely assistance of our medical service"Tlv.Hospital" you can get rid of malignant tumor in the shortest possible time.

Key words: diaphyseal fractures, lower limbs, stable functional osteosynthesis, complications of osteosynthesis, impaired osteogenesis

Introduction. Choosing a treatment method for diaphyseal fractures long bones lower limbs is one of the pressing problems of modern traumatology. The relevance is due to both the frequency of these injuries, reaching up to 40% of injuries to the musculoskeletal system, and the large percentage of complications and unsatisfactory treatment outcomes for the above injuries.

The most common method of treating diaphyseal fractures of the long bones of the lower extremities is stable functional osteosynthesis according to AO (intraosseous and extraosseous).

Fundamental Principles stable functional osteosynthesis are: anatomical reposition, stable fixation of bone fragments, early active movements in the joints of the operated limb, which expands the possibilities of early functional treatment and rehabilitation. However, a number of authors believe that stable functional osteosynthesis using AO has its drawbacks, which sometimes lead to complications such as non-union of fractures, delayed consolidation, aseptic necrosis, myelitis, etc. . With stable functional osteosynthesis, anatomical reposition and tight fixation are achieved due to excessive trauma bone tissue: drilling out the medullary canal using massive nails (with intramedullary osteosynthesis) or large soft tissue incisions with exposure of the fracture site and skeletonization of the bone (with external osteosynthesis). This leads to a worsening of already impaired blood flow in the fracture area, disruption normal process osteogenesis, resulting in a number of complications.

In the last decade, a new direction in improving osteosynthesis has emerged, designated as biological or minimally invasive osteosynthesis, the purpose of which is to avoid the above complications.

The purpose of this work is to study the results, identify errors and complications in the treatment of fractures of the long bones of the lower extremities using the method of stable functional osteosynthesis, carried out at the Center for Orthopedic Orthopedics over the past 17 years.

Material and methods. In 1989-2006. in the Center for Orthopedic Orthopedics (Armenia, Yerevan), stable functional osteosynthesis was performed on 1484 patients with fractures of the diaphyses of the long bones of the lower extremities - 1305 (88%) with closed and 179 (12%) with open fractures.

Domestic injuries were registered in 39%, industrial - 30, sports - 0.5, falls from a height - 3, injuries from road traffic accidents - 27.5%.

51% of the victims were hospitalized in satisfactory condition, 42% in serious condition, 7% in very serious condition.

The age of the patients ranged from 17 to 76 years, of which 626 (42.2%) were aged 17-37 years, 688 (46.4%) - 37 - 57 years, 170 (11.4%) - 57-76 years .

Multiple fractures occurred in 208 (14%) patients, with fractures of two segments recorded in 158 patients, three segments in 50 patients, and 1276 (86%) patients had a fracture of one segment.

Patients were hospitalized at the Center for Emergency Hospital on the first day of injury - 1451 (97.8%), and 33 (2.2%) - from the second to seventh day after injury. 955(64.4%) patients had femoral fractures, 529(35.6%) had fractures tibia, 834(56.2%) - comminuted fractures, 352(23.7%) - oblique and oblique-spiral, 298(20.1%) - transverse fractures. In 669 (45.1%) patients, the fracture was located in the middle third of the diaphysis, 460 (31%) - in the lower third, 355 (23.9%) - in the upper third.

Intramedullary nail osteosynthesis was performed in 608 (41%) patients, of which 438 (72.1%) cases were intraosseous osteosynthesis of the femur, 170 (27.9%) - tibia.

Intramedullary osteosynthesis was performed in 326 (53.6%) patients using the closed anterograde method, and in 282 (46.4%) patients using the open retrograde method. In all cases of intramedullary osteosynthesis of the tibia, osteosynthesis was performed using a closed (anterograde) method.

In 876(59%) patients, extramedullary osteosynthesis plate. Of these, 517(45.3%) had femoral fractures and 359(44.7%) had tibial fractures.

The distribution of patients according to the method of osteosynthesis performed and according to the damaged segment is given in Table. 1.

Table 1. Distribution of patients according to the method of osteosynthesis performed and according to the damaged segment

Osteosynthesis operations were performed in the first 7 days after injury in 688 (46.4%) patients, within 30 days - in 635 (42.8%), in the remaining 161 (10.8%) - more late dates. In our opinion, the most optimal timing the operation is carried out on the 5-7th day from the moment of injury, when the swelling begins to decrease and the trophism of the injured limb is restored.

In the preoperative period, in mandatory, skeletal traction was applied to the injured limb for the purpose of immobilization. We also consider it mandatory to prescribe exercise therapy and breathing exercises from the first day.

Most patients were operated on under spinal anesthesia. In the preoperative period, all patients received a course of prophylactic antibiotic therapy.

The choice of fixator (rod, plate) was determined depending on the nature and level of the fracture. I should note that, in our opinion, for diaphyseal fractures of the bones of the lower extremities, intraosseous osteosynthesis is more appropriate.

The immediate results of treatment were studied in all cases.

Of the 1484 patients who underwent stable functional osteosynthesis, the surgical wound healed in 93% primary intention, and in 7% (104 patients) inflammation occurred surgical wound. Of all cases of inflammation, 30 (31.2%) inflammatory process stopped without serious complications, in the rest - the wound festered. Of the 74 cases of wound suppuration, 41 (55.4%) were with hip fractures, 33 (44.6%) were with tibia fractures. During wound suppuration, 21 (28.4%) underwent intramedullary osteosynthesis with a nail: 14 (66.7%) of them - open retrograde, 7 (33.3%) - closed anterograde osteosynthesis, 53 (71.6%) patients bone osteosynthesis was performed with a plate. Of all the cases of wound suppuration, in 22 patients the wound closed during treatment, and in 52 cases a fistula formed, of which in 13 myelitis was detected by x-ray, in 39 there was destruction in the fracture area and bone sequestration. These patients developed osteomyelitis, for which they were reoperated and received appropriate treatment.

Control examination of patients was carried out 2-4 and 10-12 months after surgery. All patients attended the first follow-up examination. Radiologically, by this time, 585 (96.2%) patients, out of 608 operated on with intramedullary osteosynthesis, showed signs of callus formation, and in 23 (3.8%) these signs were absent. During the first control examination, 804 (91.8%) patients, out of 876 patients operated on with external osteosynthesis, had radiographic signs of consolidation, while 72 (8.2%) had no signs of consolidation. 27 (1.8%) patients had persistent pain (18 of them were operated on with intramedullary osteosynthesis, 9 with bone osteosynthesis). In 11(40.7%) of them, these pains subsequently decreased, and in 16(59.3%) they remained, and 7 of them developed ankle or foot contracture due to this. knee joint. During the first follow-up examination, 52 (3.5%) patients had active fistulas with purulent discharge. From total number Of the patients who came for the first follow-up, 21 (1.4%) were found to have fractures and deformations of the structure.

80% of the operated patients came for the second control examination, the rest came at a later date. In 594 (97.7%) patients operated on with intramedullary osteosynthesis, consolidation was noted radiographically, and in 14 (2.3%) callus was not detected. In 824 (94.1%) patients operated on with external osteosynthesis, during the second control examination, radiographic signs of consolidation were noted, and in 52 (5.9%) there was no callus. Of the 52 patients who had purulent fistulas during the first follow-up examination, 39 (75%) had an osteomyelitic process determined radiologically. We give two clinical examples.

1. Patient A.M., 39 years old. She had surgery in 1998. in the Russian Federation regarding a secondary open oblique fracture of both bones of the middle third of the leg, where a stable, functional extraosseous osteosynthesis with a plate was performed. A year later, I went to the Center for Emergency Hospital, where the diagnosis was made : ununited fracture of the middle third of the bones of the left leg, condition after MOS, postoperative osteomyelitis .

Rice. 1. An x-ray of the leg bones shows that the fracture is fixed with a plate and screws; foci of destruction and large bone sequesters are visible

2. Patient A.L., 33 years old. In 1995, she underwent surgery at the Central Orthopedic Hospital for a closed comminuted fracture of the upper third of the femur. Stable and functional intramedullary osteosynthesis with a nail and cerclage was performed. After 10 months, the patient was re-admitted to the Center for Emergency Hospital, where the diagnosis was made: non-united fracture of the upper third of the left femur, complicated by osteomyelitis, condition after MOS .

Rice. 2. An x-ray of the femur reveals an ununited fracture of the upper third of the femur, a gap between the bone fragment, large cortical sequesters, and foci of destruction are visible

Both patients were re-operated; the structure was removed, sequesternecrectomy, and extrafocal osteosynthesis were performed.

Of the total number of patients who came for the second control, 26 had fractures and structural deformations. We give two clinical examples.

3. Patient B.A., 36 years old. She was operated on at the Center for OR in 2000. for a closed transverse fracture of the middle third of the femur. Stable and functional intramedullary nail osteosynthesis was performed. In 2002 contacted the Center for Orthopedic Hospital, where the diagnosis was made: refracture of the middle third of the left femur, condition after MOS, fracture of a metal nail.

Rice. 3. An X-ray of the hip reveals a refracture of the middle third of the femur, a fracture of a metal nail

4. Patient G.G., 50 years old. In 1999, she received a fracture in the middle third of her right shin. She was operated on at the Center for Orthopedic Orthopedics, where they performed stable and functional osteosynthesis of the tibia with a metal plate and screws. After 9 months, the patient contacted the Center for Emergency Hospital, where the diagnosis was made: refracture of both bones of the middle third of the right leg, condition after MOS, fracture of a metal plate.

Rice. 4. An x-ray of the lower leg shows refracture of both lower leg bones and a fracture of the metal plate

Both patients were re-operated, the structure was removed and reosteosynthesis was performed.

Results and discussion. The results of treatment were studied in 1484 patients with fractures of the diaphysis of the long bones of the lower extremities operated on with stable functional osteosynthesis. Treatment results were assessed based on restoration of the anatomical and functional integrity of the limb. Good results were recorded in 76.4% (1134), satisfactory - 13.1% (194), bad - 10.5% (156).

Of the total number of observed patients, complications were identified in 233 (15.7%), of which in 159 (68.2%) cases extramedullary osteosynthesis with a plate was performed, in 74 (31.8%) - intramedullary osteosynthesis with a nail (of which 53 (71.4%) - open, 21 (28.6%) - closed osteosynthesis).

Complications of osteosynthesis depending on its method are given in Table. 2.

table 2. Complications during stable functional osteosynthesis of diaphyseal fractures of long bones of the lower extremities

Type of metal structure	Complications during stable functional osteosynthesis
Type of metal structure	structural fracture	design deficiency	osteomyelitis	aseptic bone necrosis	slow consolidation	false joint	express. pain syndrome	Total
Plate

Total (% of total observations)								233 (15,7%)

The above complications were associated both with errors made during the operation and with the basic principles of stable functional osteosynthesis (rigid fixation, large surgical approaches, skeletonization of bone tissue, use of massive nails, etc.).

Literature

Abbasi B.R., Ayvazyan V.P., Manasyan M.M., Vardevanyan G.G. Surgical treatment diaphyseal fractures of the tibia. Abstract. report II Congress of Traumatologists and Orthopedists of the Republic of Armenia, Anniversary Conference dedicated to the 50th anniversary of the founding of the Center for Traumatology, Orthopedics and Rehabilitation of the Ministry of Health of the Republic of Armenia, Yerevan, 1996, p. 3-4.
Ayvazyan V.P., Tumyan G.A., Sokhakyan A.R., Abbasi B.R. Method for blocking fractures of long bones during osteosynthesis with standard pins. There, p. 6-8.
Baskevich M.Ya. Current aspects of closed intramedullary osteosynthesis, Russian Biomedical Journal, 2005, vol. 6, p. 30-36.
Betsisor V., Darchuk M., Kroitor G., Goyan V., Gergelejui A. Combined osteosynthesis in the treatment of diaphyseal fractures of long bones and their consequences, Mat. Congress of Traumatologists and Orthopedists of Russia with international participation, Yaroslavl, 1999, p. 65-67.
Gaiko G.V., Ankin L.N., Polyachenko Yu.V., Ankin N.L., Kostrub A.A., Laksha A.M. Traditional and minimally invasive osteosynthesis in traumatology, J. orthopedics, traumatology and prosthetics, 2000, 2, p. 73-76.
Grigoryan A.S., Tumyan G.A., Sanagyan A.A., Poghosyan K.J. Complications during intramedullary functionally stable osteosynthesis of long bones of the lower extremities, Sat. materials of the I International Medical Congress of Armenia, Yerevan, 2003, p. 98-99.
Mironov S.P., Gorodnichenko A.I. Treatment of long bone fractures with a new universal external fixation device. Mat. Congress of Traumatologists and Orthopedists of Russia with international participation, Yaroslavl, 1999, p. 265-266.