FEATURES OF THE ACETABULUM POSTERIOR WALL FRACTURES DELAYED SURGICAL TREATMENT.

OBJECTIVE: The aim: To analyse the results of the delayed acetabulum posterior wall fractures treatment and to identify the negative factors affecting the outcome. PATIENTS AND METHODS: Materials and methods: The patients' treatment results have been assessed in 5 years after the surgery. The surgery was performed in 21 to 120 days after the injury, 44±11 days on average. 23 individuals (19 men and 4 women) were included in the retrospective analysis. RESULTS: Results: Anatomical fracture reposition was achieved in 12 (52.2%) cases, imperfect but satisfactory reposition - in 7 (30.4%) cases. 4 (17.4%) cases resulted in unsatisfactory reposition. Hip arthroplasty was performed in 5 patients over the following 5 years. CONCLUSION: Conclusions: The delayed fractures of the acetabulum posterior wall (21 to 120 days after the injury) is the complicated task for a surgeon. The aseptic necrosis and deforming arthrosis were found in 1-5 years after treatment. The preparation for the anatomical reposition takes a big amount of time and effort from the orthopedic team because of technical peculiarities.

LONG-TERM RESULTS OF TREATING PATIENTS WITH OPEN FRACTURES OF LOW-LEG BONES.

OBJECTIVE: The aim: To analyse long-term results of treating patients with open fractures of low-leg bones within a specific time period and to describe concomitant problems. PATIENTS AND METHODS: Materials and methods: A retrospective study was carried out to evaluate the results of the final treatment of patients after one year and after five years. Patients were divided into two groups. Group I included 47 (61.84%) patients for whom the treatment method was changed from external fixation to internal fixation. Group II included 29 (38.16%) patients for whom the final treatment of an open fracture was performed with an external fixation device without changing the method. The study exclusion criteria were patients under 18 years old and patients with gunshot fractures of the lower leg bones. RESULTS: Results: Patient treatment included initial surgical debridement and fracture stabilization with external fixation devices. In all patients, wound healing occurred within 30 days (on average, 24 ± 4.5 days). When evaluating the treatment of patients in group I, 32 (68.09%) of them underwent a one-stage removal of an external fixation device and osteosynthesis of fragments during the first 7-10 days. In 3 (20.0%) patients, osteosynthesis was performed with an intramedullary locking nail, in 12 (80.0%) patients - with a plate. The decision to change the fixation method was made taking into account clinical and laboratory parameters. It is noted that the treatment of patients with type III open fractures of the lower leg bones according to the Gustilo-Andersen classification, provided that the method of external fixation is replaced with an internal one, gives better results compared to osteosynthesis with external fixation devices. CONCLUSION: Conclusions: Treatment of patients with high-energy injuries of the lower leg bones is a long-term process. It is possible to improve the therapy efficiency by changing the fixation method from external to internal one. In this regard, the main evaluative characteristics are such indicators as uncomplicated wound healing combined with the absence of laboratory and clinical signs of inflammation.

FEATURES OF THE FEMORAL HEAD FRACTURES COMBINED WITH ACETABULUM POSTERIOR WALL FRACTURES SURGICAL TREATMENT.

OBJECTIVE: The aim: To conduct a thorough analysis of the surgical approach features in femoral head fractures combined with acetabulum posterior wall fractures; to analyze these patients' treatment results 12-36 months after the surgery; to determine the criteria affecting the satisfactory treatment results achievement in these injuries. PATIENTS AND METHODS: Materials and methods: The surgical treatment results were evaluated 13 and 36 months after the surgery. The retrospective analysis included 21 patients (17 men and 4 women) with femoral head fractures combined with the acetabulum posterior wall fractures. Pipkin and Brumback classifications were used to classify the fractures. RESULTS: Results: The results of acetabulum posterior wall fractures delayed treatment are significantly different to the ones treated with early osteosynthesis. The reasons for that are difficulties in anatomical repositioning, femoral head malnutrition due to its displacement or chronic subluxation, reduced blood supply to the fragments due to surgical manipulations during the approach. Thus, according to Matta criteria anatomical reposition of the fragments was achieved in 19 (90.5%) cases, imperfect reposition in 1 (4.8%) case, unsatisfactory reposition - in 1 (4.8%) patient. The treatment results' improvement after 3 years occurred due to hip joint replacement in 5 (23.8%) patients. CONCLUSION: Conclusions: The treatment results of femoral head fractures with acetabulum posterior wall fractures depends on the type of fracture, concomitant injuries, the timing, and method of removing the femoral head dislocation, and the surgical treatment method.