Varzar S. Surgical management of external malleolus fractures with tibiofibular syndesmosis injuries

Object: talocrual joint, fracture of external malleolus ankle with injuries of tibiofibular syndesmosis. Aim: improve the treatment results of patients with fracture of external malleolus and injuries of tibiofibular syndesmosis by development and substantiation of new treatment approach complex subject to physiological mobility rate of tibiofibular syndesmosis. Methods: clinical, X-ray, roentgenometry, mathematical modeling using method finite elements, MRI, computer tomography, laboratory, experimental, statistical. At first on basis of systematization of roentgenometrical characteristics the integrated numerical score of structural and functional state of ankle and tibiofibular syndesmosis was developed. Firstly the mobility characteristics in tibiofibular junction on level of tibiofibular syndesmosis were determined using CT investigation. New devices and surgical approach for treatment of fracture of external malleolus and injuries of tibiofibular syndesmosis with preservation of three-plane mobility on the fixing device level were developed. Biomechanically and mathematically higher stability of fixing device of shank bones to changing dynamic load in system "fixing device - bone" was explained as compared with fixation of shank bone by AO methods. It was proofed that fixation of fracture of external malleolus with injuries of tibiofibular syndesmosis by developed fixing device with preservation of the physiological mobility on the tibiofibular syndesmosis level was effective surgical approach. Developed integrated numerical score of state of talocrual joint and tibiofibular syndesmosis allows objective appraisal of the joint state in case of injuries and during treatment. Proposed indications for tibiofibular fixation in the cases of external malleolus fractures with injuries of tibiofibular syndesmosis using developed fixing device can be used by traumatologists for determination of character and volume of surgical intervention. Created device for tibiofibular syndesmosis renewal which considering anatomical and biomechanical features of this area allows make fixation of shank bones on the tibiofibular syndesmosis level and ensure optimal motion amplitude in three planes and what permits early graduated weight bearing on the operated extremity. Created device for formation of best parameters of the tibiofibular diastasis at the conditions of tibiofibular fixation on the tibiofibular syndesmosis level decreases risk of stiffness and synostosis development in this area. Risk of postoperative complications is decreased in connection with absence of need of fixing dynamic screw removal in the case of total axial load on the operated extremity. Patient's hospital stay was decreased 12-15 days. Developed complex method of treatment of patients withs traumatic fractures of external malleolus and injuries of tibiofibular syndesmosis with the use of created devices promotes earliest rehabilitation of muscle and nervous structures of extremity, prevention of contracture risk in the talocrual joint and foot joints, thereby improves treatment efficiency and quality of life. Results introduced into clinical practice at ballet and sport trauma government institution "Institute traumatology and orthopaedics, Ukrainian academy of medical sciences", traumatology department of Kyiv region clinical hospital, traumatology departments No.1, 2, 3 of utility enterprise "Minsk clinical hospital №11"; in scientific and educational process and clinical practice at traumatology and orthopaedics department of Odessa national medical university, Ukrainian ministry of education. Traumatology and orthopaedics.