Chip Y. Surgical treatment of proximal tibial fractures

The dissertation is devoted to the current scientific problem of traumatology and orthopedics – how to improve the effectiveness of surgical treatment of proximal tibial fractures. To study the treatment efficiency, we carried out retrospective and prospective analyses of 125 patients with fractures of the proximal tibia (FPT). Patients split into three groups according to the method of treatment: an experimental group (patients treated with BIOS and LCP), where we used the developed differentiated approach to FPT surgery; a control group (patients treated with DCP, external fixation devices, and screws); the 2nd control group (patients treated conservatively). The efficiency of surgery has been evaluated after fracture consolidation (1 year after the treatment started) on the Oxford and Neer-Grantham-Shelton scales. The research found IM nailing and LCP the most efficient methods for proximal tibial fracture management. The share of its goods and excellent results was 88.33 %, while negative results stayed within 3,34 %. This difference is statistically significant (p≤0.01) compared to the outcomes of patients after conservative treatment and the traditional metal osteosynthesis. Mathematical modeling of the elastic deformations in the bone-fixator system in proximal tibial fractures; and the extent of bone fragments displacement enabled us to determine the optimal placement of a metal fixing device in FPT. 4 elaborated models simulated bone fragments’ fixation systems, involving LCP and IM nailing with a metal nail: model 1 with an LCP along the medial tibial surface; model 2 with an LCP on the lateral tibial surface; model 3 with two LCP on medial and lateral surfaces of the tibia; model 4 with an intramedullary locking nail. The patients with proximal tibial fractures who waived surgical treatment had poor outcomes (in 45.16% of cases according to the Oxford scale and 58.06% according to Neer-Grantham-Shelton). Based on our comprehensive clinical and biomechanical studies, literature data, a differentiated approach to surgical treatment and rehabilitation of patients with proximal tibial fractures, we have elaborated a differentiated approach to the surgery and rehabilitation after proximal tibial fractures. The schemes for surgery consider a patient's general health conditions; soft tissues of the damaged extremity; existence and severity of a fracture to a fibular bone; the size of the proximal tibial fragment and the possibility to fix fibular bone; AO fracture type; the presence of severe concomitant injuries and system osteoporosis. The mentioned matters determine the choice of surgical approach for LCP and IM nailing; method for bone fragments' reposition and specificity of the post-surgical rehabilitation, namely the recommended load on the extremity in question depending on the methods of bone fragments' fixation. According to the Neer-Grantham-Shelton scale, the experimental group of IM nailing and LCP showed excellent and good outcomes in 38.33 % and 50 %, respectively. The difference is statistically significant (р≤0.01) contrasted to the first control group (20.59 % of excellent and 29.41 % of good results) with a traditional osteosynthesis. Significant statistically (р≤0.01) was the decrease in poor outcomes in the experimental group, namely 3.34 % compared to 14.71 % in the first control group and 58.06 % in the second one. The implementation of the differentiated approach to osteosynthesis improved the efficiency of the surgical treatment by 30.39 %.