Osteosynthesis

Osteosynthesis is a surgical method for the treatment of complex fractures, which involves the connection of bone fragments and their fixation in an anatomically correct position until complete fusion. For stable fixation of fragments, fixators made of biologically inert metals and alloys that do not cause allergies are used. Metal osteosynthesis (MOS) is considered one of the most effective methods of fracture treatment. It allows you to reduce the risk of bone deformation and accelerate the process of its fusion. In the medical center Ladisten Clinic in Kyiv, osteosynthesis operations are performed by experienced specialists, including the author’s minimally invasive technique of Dr. Veklich V.V.

Indications and contraindications for osteosynthesis operation

The main indications for bone osteosynthesis are:

• fractures with the formation of fragments that can damage muscle tissue, nerve endings and blood vessels;
• complex fractures, the union of which is impossible without surgical intervention to fasten the fragments;
• impossibility of repositioning broken bone fragments without incision of soft tissues;
• secondary displacement of bone fragments during regeneration;
• fractures, fused incorrectly, with growing callus;
• slow fusion of the bone.

Modern osteosynthesis is used not only in traumatology for bone fractures, but also in orthopedics for the treatment of valgus deformity of the feet and hands or the correction of flat feet.

The surgical operation of metal osteosynthesis is contraindicated if the patient has:

• open fracture with extensive injury or infected wound;
• severe soft tissue contamination or deep necrosis;
• blood clotting problems;
• severe osteoporosis;
• epilepsy or other disease of the central nervous system accompanied by convulsions;
• decompensated pathology of blood vessels, with circulatory disorders in the limbs;
• severe pathology of internal organs and general health.

Types of osteosynthesis

All types of metal osteosynthesis used in modern surgical practice can be divided into two main types:

• internal osteosynthesis (submersible), involving the use of implants inside the patient’s body. This type includes the following types of osteosynthesis, which differ in the technology of fixing bone fragments and the degree of fixation stability:
  – extramedullary or extramedullary;
  – intraosseous or intramedullary;
• external (extrafocal) osteosynthesis, which does not provide for incisions for direct access to bone fragments. In this method, bone fragments are connected using external fixation devices (EFF) – the most famous of them is the Ilizarov apparatus.

In addition to the main types of MOS, ultrasonic osteosynthesis can be distinguished separately, in which the bonding of bone fragments is performed using ultrasound.

Extramedullary osteosynthesis

This type of MOS provides for the fixation of fragments using plates of various configurations and sizes, applied to the bone and attached to it with screws. Bone osteosynthesis can be carried out not only using plates, but also semi-rings, rings, tapes or wires made from materials such as:

• titanium alloy;
• an alloy of molybdenum, chromium and nickel;
• medical grade stainless steel

The plates are applied for fractures of the clavicle, legs and bones of the upper limbs. They are used for osteosynthesis of the calcaneus and humerus (shoulder neck), as well as for fractures of the forearm, jaw and femoral neck.

Intramedullary osteosynthesis

This type of MOS is also called intraosseous, since the reposition and fixation of fragments during the operation by this method is performed using pins inserted into the medullary canals of both fragments. Intraosseous osteosynthesis can be divided into the following types:

• Intramedullary open osteosynthesis, which involves incision of soft tissues and exposure of the fracture zone;
• closed osteosynthesis, with the introduction of a pin under X-ray control through a small incision;
• Lockable intramedullary osteosynthesis (BIOS) with stronger fixation of fragments, which uses pins with holes for locking screws at both ends, or self-locking pins.

Intramedullary osteosynthesis is used for fractures of the tibia, femur and humerus, which are long and have a bone marrow cavity of sufficient diameter for the insertion of a pin.

Osteosynthesis of the metatarsal bones of the hand or foot, as well as other small tubular bones, can also be performed by the intramedullary method. Only instead of pins, knitting needles are used to connect the fragments.

The medical center Ladisten Clinic does not use extramedullary and intramedullary osteosynthesis, but only a minimally invasive method of transosseous osteosynthesis is used.
Steosynthesis using external fixation devices.

Extrafocal osteosynthesis using AVF

Transosseous minimally invasive osteosynthesis using compression-distraction AVF is performed without exposing the fracture zone. Fixation of bone fragments in the correct position is provided by the spokes. They are introduced through soft tissues, passed through the bone outside the fracture zone, and their ends, which are outside the body, are fixed in the external fixation apparatus. With the help of AVF, the wires subject the bone fragments to compression (compression) or stretching (distraction). The device allows you to change the force of impact on the bone, since during the operation, during the period of fusion, healing and recovery, it is required to exert different forces on bone fragments.

The advantages of transosseous osteosynthesis using AVF include:

• stable and reliable fixation of bone fragments without tissue injury in the fracture area;
• preservation of blood supply to tissues adjacent to the bone;
• Possibility of dynamic loading on the broken bone in the process of fusion, depending on the patient’s condition.

An external fixation device and titanium wires are used for ankle fractures, as well as for osteosynthesis of the lower leg, radius, ulna, humerus, femur (femoral neck), foot and collarbone.

Preparation for osteosynthesis

Preparing a patient for metal osteosynthesis includes the following studies:

• laboratory analyzes standard for any surgical operation
  – general blood and urine tests, blood tests for syphilis, hepatitis, COVID19 and HIV;
• blood clotting test.
• electrocardiogram or Holter monitoring;
• CT or MRI of the fracture zone (necessary intervention for orthopedic correction);

If necessary, consultation with specialized specialists and bone scintigraphy may be required if osteoporosis is suspected.

Features of metal osteosynthesis

The operation of osteosynthesis includes two stages:

1. joining bone fragments and fixing them in an anatomically correct position with an external fixation device;
2. AVF removal after complete fusion of bone fragments.

The period of time between these stages depends on the complexity and location of the fracture, and takes 2-7 months.

Improved osteosynthesis technique at Ladisten Clinic

In our medical center, for a minimally invasive operation of external metal osteosynthesis, a patented external fixation device developed by Dr. V. V. Veklich is used. It is an improved Ilizarov apparatus, in which fragments are fixed not with knitting needles, but with titanium rods inserted from one side only, which makes its installation less traumatic. The Veklich apparatus provides reliable retention of bone fragments and significantly reduces the risk of osteomyelitis.

Doctor Veklich’s method can be used to treat:

• fractures of limbs, including fingers and toes;
• periarticular and intraarticular fractures;
• displaced fractures;
• open and closed fractures when it is impossible to apply a plaster cast;
• Fractures complicated by co-infection.

Cost of osteosynthesis operation

The price of osteosynthesis is calculated individually in each case. It depends on the volume of the operation, the area of ​​intervention, the complexity of the fixed structure, its dimensions and the material of manufacture.
If you want to treat a complex fracture or congenital orthopedic pathology using osteosynthesis, sign up for a consultation with Ladisten Clinic specialists at the numbers listed on the website, or write to us in Viber and WhatsApp messengers!