Pyrohov Y. Surgical treatment of medial femoral neck fractures by minimally invasive osteosynthesis

Object: surgical treatment of medial femoral neck fractures. Aim: improve the results of surgical treatment of patients with medial fractures of the femoral neck by biomechanical substantiation, development and clinical application of a new method of minimally invasive osteosynthesis. Methods: comprehensive clinical examination; X-ray (X-ray) - to determine the type of fracture, the dynamics of marginal resorption of bone fragments and the process of consolidation; biomechanical analysis - to justify the fixing device; statistical - to establish the reliability of the results obtained. For the first time new knowledge about the dynamics and time limits of the resorption process in the fracture area of the femoral neck in different clinical groups of patients was obtained. A direct correlation was found between the quantitative value of bone loss in the fracture area and the patient's age, the duration of the preoperative period and the loss of interfragmental compression. The need for a unidirectional telescopic effect and secondary interfragmental compression in the early postoperative period after the osteosynthesis of medial fractures of the femoral neck was proved. An effective minimally invasive method for the surgical treatment of medial fractures of the femoral neck was developed and biomechanically was justified. On the basis of the results of biomechanical studies the spring-loaded device was validated and developed. The device allows provide a stable fixation of fragments of the femoral neck with a minimum sufficient value of the secondary interfragmental compression with a force of 100 N. The use of the proposed device allowed to improve the results of surgical treatment of patients with medial fractures of the femoral neck by 39 %. Results of the study of marginal bone resorption in the process of consolidation of femoral neck medial fractures in clinical groups of patients, different in age and duration of the preoperative period, allowed to prove a minimally invasive osteosynthesis technique and to achieve 89% of positive results of treatment of this category of patients. The results of the study were applied in clinical practice in SI "Sytenkо Institute of Spine and Joints Pathology National Academy of Medical Sciences of Ukraine", KU "Zaporozhye Regional Clinical Hospital" of the Zaporozhye Regional Council, KU "TMO" Multiprofile hospital of intensive methods of treatment and emergency medical care" Melitopol City Council of Zaporozhye region. Traumatology and Orthopaedic.