Lazarenko U. Surgical treatment of supracondylar fracture of distal femur

The dissertation is devoted to the orthopedics' actual issue: the improvement of treatment results of patients with supracondylar fracture of distal femur by development of an algorithm for differential use of different types of osteosynthesis using the method of biomechanical simulation. It is established that the closed antegrade locking intramedullary nailing is an effective method of treatment of patients with supracondylar fractures of a femur. The comparative analysis of intense of the deformed condition of a femur after fracture synthesis by intramedullary nailing and locking compression plate at various levels of injury of a femur is made. The obtained results proved advantages of the antegrade IM nailing for osteosynthesis of supracondylar femur fractures. The results of biomechanical modeling of femur fractures proved, that the size of Mises strain on border of "plate-bone" contacts in diaphyseal zone is most significant in case of LCP, especially for model with distance of 6.5 cm from fracture line of to a knee joint surface - 27.2 MPa, and for model with level of 8 cm from a joint surface - 40.4 MPa. Use of IM nailing provides decrease of tension level on border of "nail-bone" contacts to 11 MPa and 13 MPa respectively. At the same time, in case IM nailing and LCP at the level of fracture up to 5 cm, tension level on border "a fixation device - the bone" not significantly differ, makes 8.8 MPa and 8.0 MPa respectively. On the ground of the results of biomechanical research analysis, we developed the differentiated approach to the use of dynamic and static types the IM nailing, LCP for treatment of supracondylar fractures of a femur and their consequences, based on the size of a periarticular fragment of a femur, type and level of the fracture, existence of a systemic osteoporosis and accompanying serious damages. It is proved that use of IM nailing in case of the distance from the fracture surface to a knee joint exceeding 5 cm is optimal, in other cases LCP is more reasonable.