Stojko I. Physiological treatment technology of patients with fractures of distal metaepiphysis leg bones (fractures of the pilon)

Object: the treatment of fractures of the distal metaepiphysis of shin bones. The goal: to develop the technology of treatment of patients with injuries of the distal distal metaepiphysis of shin bones aimed at reducing of the surgery trauma and early recovery of limb function. Methods: clinical, radiological, stand tests (study of the mechanical properties of polymeric materials), mathematical modeling (finite element method), statistical. Methods of preoperative planning of surgical treatment of patients with pilon fractures has been improved. It is based on was the descriptiveness reception "Traction test". During mathematical modeling the most loaded zone of the leg and foot have been identified. There are rear edge of distal metaepiphysis of tibia, posterior portions of the heel and talus. The maximum stress in these areas reached 10-11 MPa, and use external pin apparatus can significantly reduce these stresses. The first mechanical properties of modern immobilization materials (Softcast / Scotchcast) have been investigated, the value of the elastic moduli ((656,0 ± 44,5) and (1156,2 ± 92,0) MPa, respectively) were obtained, the features of their counteraction at external loads have been established. For the first time on a model of shin at the pilon fractures the distribution of stresses in the fixing bandages under axial and flexion load was studied. Compliance of physical and technical characteristics of bandages (Softcast / Scotchcast) with goals of functional stabilization at pilon fractures was established. Using functional and stabilizing dressings Softcast / Scotchcast during early functional treatment has allowed getting the effect of a functional remodeling of the articular surface of the tibia, observed clinically and radiologically, for the first time. The practical significance of the results. Technology of treatment of patients with lesions of distal metaepiphysis of shin bones, providing a differentiated choice of minimally invasive methods for reduction and fixation of bone fragments, and early functional treatment have been developed. Application of the developed technology of treatment of fractures of the distal metaepiphysis of shin bones allows significantly reduce the amount of necrotic complications from 52-54 to 23.5 %. Using functional and stabilizing bandage based on polymer materials Softcast / Scotchcast allowed to provide conditions of early functional treatment of patients with injuries pilon, effective prevention of secondary deformation of segment and immobilization complications, functional remodeling of the articular surface of the tibia. Conducting clinical approbation of the technology has allowed to reach 79% good and excellent outcomes. All the proposed methodological and technological actions have been introduced into clinical practice KUZ "Kharkiv City Hospital №18", KUZ "Kharkiv city clinical multifield hospital №17", KUZ "Kharkiv city clinical multifield hospital №25". Traumatology and Orthopaedics