Year 2021 Vol. 29 No 1

SCIENTIFIC PUBLICATIONS
EXPERIMENTAL SURGERY

A.A. EMANOV, M.V. STOGOV, E.A. KIREEVA, N.V. TUSHINA

CONSOLIDATION OF FEMORAL FRACTURES AT APPLICATION OF DIFFERENT TREATMENT METHODS TAKING INTO CONSIDERATION DURATION OF THE PERIOD FROM TRAUMA TO OSTEOSYNTHESIS

National Ilizarov Scientific Center for Traumatology and Orthopedics, Kurgan,
The Russian Federation

Objective. To study the characteristics and healing duration of the diaphyseal femoral fractures, depending on the technologies used for osteosynthesis and the time between trauma and osteosynthesis.
Methods. The study was performed on bred dogs (n=24). In the operating theatre all animals were modeled the transverse fracture of the femoral diaphysis in the middle third using a chisel. The animals were divided into 4 groups (6 per group). Animals of group 1 (one hour after the fracture) underwent transosseousosteosynthesis with a pin-rod external fixation device (PREF). In group 2, PREF was performed on the fourth day after the injury. In group 3 (one hour after the injury) blockable intramedullary osteosynthesis (BIOS) was performed. In group 4, the similar BIOS was performed on the fourth day after the fracture. To assess the results of treatment, the clinical, radiological and laboratory research methods were used. The duration of post-operative observation of the animals was 100 days.
Results. It has been found out that the dynamics of osteoreparative processes in the studied groups was similar and did not depend on the time between trauma and osteosynthesis.
The median time for the femoral shaft fracture healing in animals of group 1 was 46 days (Q1-Q3: 38-57), in group 2 – 73 days (Q1-Q3: 71-78) (differences between groups are significant at p=0.004); in group 3 – 49 days (Q1-Q3: 44-60), in group 4 – 72 days (Q1-Q3: 70-93) (differences between groups are significant at p=0.008). It is shown that the reason for the increase in fixation terms in dogs with the delayed osteosynthesis is the long-term persistence of the acute phase reaction caused by trauma (using the growth of C-reactive protein as an example).
Conclusion. The healing terms of a femoral shaft fracture with the use of PREF technology and BIOS technology are comparable, both in the conditions of urgent and delayed osteosynthesis.

Keywords: femoral fracture, osteosynthesis, fracture fixation, external fixators
p. 5-12 of the original issue
References
  1. Dagneaux L, Allal R, Pithioux M, Chabrand P, Ollivier M, Argenson JN. Femoral malrotation from diaphyseal fractures results in changes in patellofemoral alignment and higher patellofemoral stress from a finite element model study. Knee. 2018 Oct;25(5):807-13. doi: 10.1016/j.knee.2018.06.008
  2. Gelalis ID, Politis AN, Arnaoutoglou CM, Korompilias AV, Pakos EE, Vekris MD, Karageorgos A, Xenakis TA. Diagnostic and treatment modalities in nonunions of the femoral shaft: a review. Injury. 2012 Jul;43(7):980-98. doi: 10.1016/j.injury.2011.06.030
  3. Ng AC, Drake MT, Clarke BL, Sems SA, Atkinson EJ, Achenbach SJ, Melton LJ 3rd. Trends in subtrochanteric, diaphyseal, and distal femur fractures, 1984-2007. Osteoporos Int. 2012 Jun;23(6):1721-26. doi: 10.1007/s00198-011-1777-9
  4. Rupp M, Biehl C, Budak M, Thormann U, Heiss C, Alt V. Diaphyseal long bone nonunions - types, aetiology, economics, and treatment recommendations. Int Orthop. 2018 Feb;42(2):247-58. doi: 10.1007/s00264-017-3734-5
  5. Sipahioglu S, Zehir S, Sarikaya B, Isikan UE. Comparision of the expandable nail with locked nail in the treatment of closed diaphyseal fractures of femur. Niger J Clin Pract. 2017 Jul;20(7):792-98. doi: 10.4103/1119-3077.212452
  6. Vicenti G, Bizzoca D, Carrozzo M, Nappi V, Rifino F, Solarino G, Moretti B. The ideal timing for nail dynamization in femoral shaft delayed union and non-union. Int Orthop. 2019 Jan;43(1):217-22. doi: 10.1007/s00264-018-4129-y
  7. Wolinsky PR, Lucas JF. Reduction Techniques for Diaphyseal Femur Fractures. J Am Acad Orthop Surg. 2017 Nov;25(11):e251-e260. doi: 10.5435/JAAOS-D-17-00021
  8. Bondarenko AV, Gerasimova OA, Goncharenko AG. For the question about optimal terms of «general fracture» osteosynthesis in patients with multitrauma. Travmatologiia i Ortopediia Rossii. 2006;(1):4-9. https://cyberleninka.ru/article/n/k-voprosu-ob-optimalnyh-srokah-osteosinteza-osnovnyh-perelomov-pri-sochetannoy-travme (In Russ.)
  9. Polat G, Balci HI, Ergin ON, Asma A, Şen C, Kiliçoğlu Ö. A comparison of external fixation and locked intramedullary nailing in the treatment of femoral diaphysis fractures from gunshot injuries. Eur J Trauma Emerg Surg. 2018 Jun;44(3):451-55. doi: 10.1007/s00068-017-0814-6
  10. Shapkin Y G, Seliverstov PA. Risk factors of fracture nonunion in polytrauma. Kuban Nauch Med Vestn. 2017;24(6):168-76. doi: 10.25207 / 1608-6228-2017-24-6-168-176 (In Russ.)
  11. Medda S, Unger T, Halvorson J. Diaphyseal Femur Fracture. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan. 2020 Jun 30. https://www.ncbi.nlm.nih.gov/books/NBK493169/
  12. Denisiuk M, Afsari A. Femoral Shaft Fractures. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan.2020 Mar 14. https://www.ncbi.nlm.nih.gov/books/NBK556057/
  13. Litvishko VA. Treatment of long bones comminuted fractures using external fixation device. Ortopediia, Travmatologiia i Protezirovanie. 2016;(4):40-46. http://otpjournal.com.ua/article/view/88542/84389 (In Russ.)
  14. Koso RE, Terhoeve C, Steen RG, Zura R. Healing, nonunion, and re-operation after internal fixation of diaphyseal and distal femoral fractures: a systematic review and meta-analysis. Int Orthop. 2018 Nov;42(11):2675-83. doi: 10.1007/s00264-018-3864-4
  15. Zuev PP. Comparative analysis of surgical outcomes for patients with femural ununited midshaft fractures. Sarat Nauch-Med Zhurn. 2019;15(3):641-43. http://ssmj.ru/system/files/2019_03_641-643.pdf (In Russ.)
  16. Barabash AP, Shpinyak SP, Barabash JA.. Comparative characteristics of osteosynthesis techniques in patients with comminuted diaphyseal femoral fractures. Traumatology and Orthopedics of Russia. 2013;(2):116-24. doi: 10.21823/2311-2905-2013--2-116-124 (In Russ.)
Address for correspondence:
640014, Russian Federation,
Kurgan, M.Ulyanova Str., 6
National Ilizarov Scientific Center
for Traumatology and Orthopedics,
Ministry of Health of Russia,
tel. +7 352 245-05-38,
e-mail: stogo_off@list.ru,
Stogov Maxim V.
Information about the authors:
Emanov Andrei A., PhD(Vet) Leading Researcher of the Experimental Laboratory, National Ilizarov Scientific Center for Traumatology and Orthopedics, Kurgan. Russian Federation.
https://orcid.org/0000-0003-2890-3597
Stogov Maxim V., DS(Biol) Associate Professor, Leading Researcher of the Biochemistry Laboratory, National Ilizarov Scientific Center for Traumatology and Orthopedics, Kurgan. Russian Federation.
https://orcid.org/0000-0001-8516-8571
Kireeva Elena A., PhD(Biol), Senior Researcher of the Biochemistry Laboratory, National Ilizarov Scientific Center for Traumatology and Orthopedics, Kurgan. Russian Federation.
https://orcid.org/0000-0002-1006-5217
Tushina Natalya V., PhD(Biol), Researcher of the Biochemistry Laboratory, National Ilizarov Scientific Center for Traumatology and Orthopedics, Kurgan. Russian Federation.
https://orcid.org/0000-0002-1322-608X
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