19.04.2019

Removal of a titanium plate from the clavicle. Osteosynthesis from absorbable materials. Emergency removal of metal structures

How justified are plates for fractures, which are increasingly being installed by doctors after injury? Recently, there has been a tendency among doctors that any fracture must be operated on, which in most cases involves the placement of plates. There are certain contraindications to the operation, and specific implants have been developed for each area. After metal osteosynthesis, some rehabilitation is required.

A fracture, especially a displaced one, leaves a person exhausted for a very long time, depriving him of all the joys of life. Significant displacement and the presence of a large number of fragments are indications that titanium plates are used for fractures, since normal healing with plaster is impossible in such conditions. The most optimal treatment method in such a situation is osteosynthesis, in which the fragments are fastened together with plates.

After surgery, a person is able to rehabilitate faster by placing early load on the injured limb. With the help of plates, the fracture is compared most correctly, then the most favorable conditions for fusion are created. Conditions for movement in the joints are created early, thereby reducing the conditions for the formation of osteoarthritis and contractures.

What it is

On modern stage in traumatology the most different variants plates They can have different shapes, depending on the area of the bone where they should be installed. There are significant differences in the holes in which the screw, due to the head, reliably fixes the fracture.

All plates have certain functions:

restoration of normal bone anatomy;
acceleration of fusion;

But in order to install the plate on the bone, a large number of tools are required. And they have been developed, making the operation faster.

All fracture plates are designed based on the fracture and its location, as well as the functions they are intended to perform. Highlight:

protective (neutralization);
supporting (supporting);
compression (tightening);
with partial contact;
with full contact;
microplates.

The process of applying a plate to a bone is called metal osteosynthesis. All implantable plates are designed for lifelong use after surgery.

Many injuries are an indication for surgical intervention, but surgery cannot always be performed. Regardless of which plates are placed for fractures, there are certain indications for surgery. The doctor will suggest intervention in certain cases, namely:

Significant displacement of fragments after a fracture.
The presence of several fragments.
The absence of concomitant pathology that is a contraindication to surgery.
Returning a person to active image life.
There are no contraindications to general anesthesia.
Persons with osteoporosis.
Elderly patients with no contraindications, for whom bed rest is undesirable.
Restoration of normal anatomy of articular surfaces.

But sometimes placing the plate leads to undesirable consequences. There are situations when the plate is rejected after a fracture. Under such conditions, intervention can do more harm than good. Contraindications are:

A wound, abrasions at the fracture site, intervention is possible only after it has healed.
Purulent processes or inflammation at the site of injury.
Osteomyelitis.
Tuberculosis of bones.
If the patient did not move before the injury (paralysis).
Severe forms of mental illness.
Failure of the heart, kidneys, liver in the stage of decompensation.
Severe, decompensated diabetes mellitus (postoperative wound takes a long time to heal).

In what areas are they installed?

Each bone has its own plates, some are applied for skull defects, and separate fixators exist for pertrochanteric fractures or hip injuries. The industry offers plates for the synthesis of bone fractures that make up the knee joint. Their variants are designed for the synthesis of fractures of the bones of the lower leg, shoulder, pelvis, collarbone, on the dorsal or palmar surface of the hand or foot, and even for fixing the spine.

On the bones of the skull

The bones on the head are particularly strong and can be very difficult to damage. Most often this occurs as a result of a direct blow to the head with a heavy, sharp or blunt object. The result is depressed or comminuted fractures requiring surgical intervention. The result of the operation is most often a life saved, however, a defect in the skull bones is formed, which must subsequently be closed.

Titanium plates are used for these purposes; by covering the defect, they protect the brain and its membranes. Subsequently, the plate is not removed after a fracture, and it remains in place for the rest of life. If the bones of the facial skull are damaged, then it makes no sense to install plates due to their impracticality. The bone is aligned using a cerclage wire, which performs the same function as the plates.

Upper limbs

Plates installed for fractures of the upper extremities have different shapes and sizes. Microscopic plates have been developed that can be installed on the phalanges of the fingers if there is displacement. On the palm, the plate is placed only on the back surface, this is due to the proximity of the bones to the surface of the skin. A large number of vessels, nerves, and tendons pass along the palmar surface, which are easily injured.

Of particular interest are fixators implanted for injuries in the area of the elbow and wrist joints. This type of plate takes into account the anatomy of the articular surfaces of the bone. Often, ligaments are torn off along with bone fragments in the joint area; they can be fixed in place using anchors.

Implants are installed for about a year, after which they must be removed during repeated surgery. But sometimes the question arises whether it is necessary to remove the plate after a fracture; in general, it is designed for constant use. The doctor resorts to removal only when it interferes or causes certain inconvenience. If a person intends to remove the implant, then there must be complete confidence that a callus has formed and the bone does not need fixation.

If the collarbone is damaged, a titanium or nickel plate is applied, which has a curved shape and completely follows the normal anatomy of the bone. If it is necessary to impart a certain curvature, the plate is bent at the discretion of the doctor. When damage to the ligaments of the acromioclavicular joint occurs, plates with special protrusions are selected. One part of them enters the acromion process of the scapula, and the other is fixed with screws to the collarbone.

Plates used for damage to the acromioclavicular joint.

Pelvis and lower limbs

Injuries to the pelvis and lower extremities are classified as severe and sometimes require immediate surgical intervention. A specialist will help you choose which ones are best after an examination, since the price (in dollars) can reach several thousand.

For displaced pelvic fractures, various modifications are used. The most commonly operated areas are the wings of the ilium, the acetabulum, pubic bones. It is these bones and components that provide the supporting function of the pelvis. Plates are used not only for fractures, but also for rupture of the pubic symphysis, including after childbirth. Tears larger than a centimeter require surgical intervention.

Damage to the hip also requires the placement of various plates. Very often, surgery requires fractures in the femoral neck and transtrochanteric region. The last option shows the use of the DHS design, consisting of a plate from which a screw extends at a certain angle, which is fixed in the thickness of the neck. The plate is fixed to the body of the femur using screws.

In the area of the bone body, plates with full or partial contact are used. Quite often, interlocking plates are used, in which the holes are angled or threaded. The screw head in such plates is tightly fixed in the hole or clamped with a thread. Also, when tightening the screw, the plates help to compress the fracture site, so healing occurs faster.

In the lower thigh, damage affects the condyle area. In this department, it is very important to restore the articular surfaces of the femoral condyles. To achieve anatomical integrity, special curved plates and screws are used. When fixing any screw into the bone, it is important that the end section extends slightly from the opposite edge of the bone. Under this condition, the most durable fixation of the screw in the bone is achieved.

In the lower leg area, fractures occur in the upper, middle or lower sections. For each area, the use of a different plate is indicated; special attention, of course, requires the articular surfaces in the upper and lower sections. If a fracture occurs, the plate should remain in the leg for about a year, after which it can be removed.

In the condylar area, the use of angular stability plates is indicated. It allows not only to fix the fracture, but also to prevent damage to the articular area. For a fracture of the middle third of the tibia, the use of simple plates with partial or complete contact with the bone surface is indicated.

A separate approach is required for the lower third of the shin bones, when it is necessary to restore not only the articular platform, but also to fix the damaged ligament, called syndesmosis. Before installation, the titanium implant is given an individual shape that follows the curve of the bone.

Plates are also used for injuries to the bones of the foot, especially the metatarsals. For this purpose, microplates are used for splintered or oblique injuries. Plates are widely used for heel fractures; in this case, the plate allows the anatomical integrity of the bone to be restored. Such plates cannot provide support, but with their help the bone heals correctly. When the fracture has consolidated, there is full support on the bone, there is no pain when walking, and flat feet do not develop.

Recovery

It’s not enough to just put a plate and fix the fracture; it’s important that the person can then live and work fully. Held rehabilitation only under the supervision of an experienced specialist. Approximate time the time required for full recovery is approximately a month, and can last longer a long period time. If the fracture is matched correctly, the desire of the patient himself is required and the result will not be long in coming.

Simple movements in the joints are indicated after the wound has healed, but provided that displacement does not threaten. As the fracture consolidates, weight bearing on the limb is indicated, first using crutches, then a cane or walker. After surgery on the upper extremities, the load on the operated segment is performed using expanders, weights, and dumbbells. The use of therapeutic exercises in a lying or sitting position is indicated.

Each type of fracture requires its own set of exercises. A rehabilitation doctor or traumatologist will help you choose them. After each operation, a different complex is shown. After some operations, recovery is carried out only in the form of movements in the joints without supporting the limb. If you neglect this rule, the result will be lost and the fracture will move.

Removing plates after a fracture

Many people who have undergone surgery are interested in the question of whether it is necessary to remove the plate after a fracture. In general, implants are designed to last a lifetime. It can be removed when there is good bone callus or the implant interferes with normal movements. It is also possible to remove the plate if a cyst develops at the site of the screw placement. In general, the issue of removing the plate is decided in each individual case jointly by the traumatologist and the patient.

Should I delete or not?

Today we will talk about indications and contraindications for the removal of metal structures.

Last year, and maybe earlier, you or your loved one underwent osteosynthesis surgery for a bone fracture, a metal structure was installed, and now the question arose: “To remove or not?” This article will help you take a more balanced approach to this issue.

On the one hand, this is another operation, and on the other hand, it is a foreign body that causes certain reactions in the body.
So, let’s consider the necessary conditions and indications for removing metal structures:

- Healing of the fracture for which surgery was performed.

If healing of the fracture has not occurred, of course, the metal structure should not be removed. An X-ray examination, which is mandatory for everyone before surgery, will help answer this question. Non-union of a fracture for 6 months or more is called a false joint and requires contact with an orthopedic traumatologist. In most cases, the formation of a false joint requires repeated surgery with removal of the old and installation of a new metal structure.

- Limitation of mobility of the joint next to which the metal structure is installed.

The metal structure can conflict with the joint structures, limiting movement in the joint. Also, an intense scarring process caused by primary trauma, surgery and metal structures (which is a foreign body) can cause the formation of joint contracture. In such a situation, when removing the metal structure, it is possible to mobilize (release) the muscles and tendons, which, with proper subsequent rehabilitation, will significantly improve the function of the joint.

- Low quality metal structures installed.

The plate and screws must be made of special alloys and have the same chemical composition to reduce the likelihood metallose. This process involves corrosion of metal fasteners. In the surrounding tissues, the concentration of iron, chromium, nickel, and titanium increases. The combination of different grades of steel in the structure enhances the metallosis process; the combination of chromium and cobalt, vanadium and titanium in metal alloys is very unfavorable, high concentrations nickel in stainless steel.

The dependence of the degree of corrosion of metal implants under conditions of a decrease in the pH environment, which is typical for purulent-inflammatory complications, osteomyelitis, and also during a long stay in the body, has been established. Electrochemical corrosion in metal implants occurs due to the presence of dissolved metal salts (Fe, Na, K, Cb, etc.), which are electrolytes, in tissue fluids.

A certificate from medical institution and an implant passport, which is issued upon discharge.

- Migration, fracture of the implant or its elements.

If control radiographs reveal that the metal structure has begun to migrate or has fractured, contact the doctor who performed your operation to coordinate treatment tactics. This situation is possible due to non-fusion of the bone and/or an infectious process.

- Infectious process in the postoperative period.

If after the operation there were problems with wound healing, fistulas and purulent discharge, the doctor prescribed you additional course antibacterial therapy. Despite the fact that nothing may bother you now, remove the metal structure as planned. Scars in such a situation are a source of chronic infection. A decrease in immune status and trauma to this area can provoke inflammatory process, which will require emergency removal of the structure.

- The need for cosmetic correction of the scar.

A hypertrophic, keloid scar can be located on an area of the body subject to mechanical stress. Constant traumatization causes discomfort and limitations. For example, after osteosynthesis of the clavicle with a plate, the backpack strap presses on postoperative scar and a person cannot engage in any hobby - tourism.

Removal of the metal structure, in contrast to the primary operation, is a planned intervention, in which full-fledged aesthetic correction of the scar is possible.

- It is mandatory to carry out staged removal of metal structures included in the treatment method.

The most common situations: dynamization of a tibia fracture after intramedullary osteosynthesis with a locking pin and removal of a positioning screw after an ankle fracture. Dynamization of the fracture allows you to provide the necessary load on the callus, accelerating fracture healing and reducing the risk of pseudarthrosis formation. Removal of the position screw 6-8 weeks after osteosynthesis of a fracture of the ankle of the leg with damage to the distal tibiofibular syndesmosis (ligament stabilizing the joint) makes it easier to restore the full range of motion in ankle joint, reduce the likelihood of developing deforming osteoarthritis of the ankle joint and the formation of tibiofibular synostosis (bone fusion of the tibia and fibula with each other, disrupting the physiological functioning of the joint).

- Remove the metal structure if you play sports or plan to start doing so.

This especially applies to game, contact and extreme sports. With repeated trauma, there is a higher probability of a fracture along the edge of the plate and the presence of an old implant will create technical difficulties during surgery, especially if the fixator has been installed for more than 2 years.

- Consult an orthopedic traumatologist if the metal structure is located near the joint.

Any joint that has been injured is at risk for the earlier development of deforming arthrosis. The presence of a plate or pin during endoprosthetics surgery (replacing a joint with an artificial one) will significantly complicate surgery, especially if the metal structure was installed 5 years ago or more.

- Osteoporosis (decreased bone mineral density) and the presence of a brace on the lower limb.

Patients with osteoporosis require a special approach in choosing metal structures, rehabilitation, and deciding whether to remove the fixator. The installed plate after healing of the fracture prevents plastic deformation of the bone during movement, during which blood flow in the bone increases. It also splints the load through the plate and creates a stress concentration at the bone-implant interface, which also increases the likelihood of re-fracture. This situation requires a balanced approach and comprehensive examination patient.

Now let's look at the contraindications.

Except general contraindications For planned operations and anesthesiological benefits, which are determined by the therapist, a specialist in your specialized pathology (if you have one), the anesthesiologist should note the following points:

When the metal structure is located in close proximity to the neurovascular bundle, the scarring process caused by trauma and primary surgery makes it difficult to identify it during surgical access. In such situation possible risks may outweigh the benefits of removing the metal structure and surgical intervention should be avoided.

In the presence of neurological disorders, such as a decrease or disappearance of skin sensitivity, muscle weakness or lack of active movements, may be an indication for neurolysis (freeing the nerve from scars) and removal of the implant, of course, provided that the fracture heals. In such a situation, it is optimal to perform the operation by an orthopedic traumatologist together with a microsurgeon.

A correctly installed, modern fixator that does not cause subjective complaints and is installed on the upper limb of a patient with low motor demands in most cases does not require removal. In other cases, the decision to remove the plate, pin, pins and other implants is made jointly with an orthopedic traumatologist during a face-to-face consultation with the obligatory X-ray examination.

If for some reason you do not have the opportunity or desire to have the metal structure removed by the doctor who performed the initial operation, we suggest having this operation performed at the XXI Century clinic.

In most cases, removal of the metal structure is a less traumatic intervention than the primary operation and can be performed without hospitalization. Clinic "XXI Century" is equipped with the necessary modern equipment for safe anesthesia, solving possible non-standard situations with implants of unknown origin. It is possible to perform the operation by a multidisciplinary team together with a microsurgeon or plastic surgeon.

The cost of removing metal structures in our center is 12,000 rubles. + cost of anesthesia from 3500 rubles/hour depending on the type of anesthesia.

Memo for patients “Preparation for anesthesia” - , . You can print and fill out at home or preview the questions and fill out at the clinic before surgery.

IMPORTANT! When asking a question in this thread, please write:

- Patient's age
- Date of injury and/or surgery
- What is the diagnosis in the extract?
- What treatment did you receive?

Hello. I am 27 years old. Athlete. Displaced fracture of the fibula; there is a titanium plate; the screw correcting the displacement was removed. surgeons installed the plate permanently, based on the fact that I play sports and put heavy loads on the foot. Now, working with sports doctors, massage therapists, undergoing a rehabilitation course, they insist that the plate must be removed, since the bone will not fully function and, accordingly, in the future it may there may be consequences. They also write on the Internet that there are many reasons for removing foreign bodies after surgery, but they don’t indicate them. In principle, nothing bothers me, it’s just that when you find yourself in the middle of those who are for and against removing the plate, the question arises, what’s all this? do?!

Hello. In general like this:

Titanium plates are indeed more biologically inert and can cause metallosis to a lesser extent + it is possible to do MRI with them (unlike steel plates, although the titanium there is usually not pure, but an alloy, so there is potentially some risk that this alloy cannot be placed in a tomograph, but in general it is usually possible, although you need to warn the MRI doctor and be sure that one or two steel screws have not been accidentally installed). The ability to do MRI is a big plus, because... In the future and during the treatment process, injuries or diseases for which MRI is extremely necessary cannot be ruled out.

Indeed, high-quality plates do not need to be removed, but it is still better for young ones to remove them. In old age, every operation is a risk, so sometimes we do not remove the fixators. At a young age, the risk of surgery is much lower.

Reasons why it is better to remove the plate:

1) bacteria can settle and attach to a foreign body, which is difficult for the body to reach and destroy. These bacteria can cause suppuration if the immune system is weakened (illness, hypothermia, certain medications, etc.). This could happen in 20 or 30 years. Not necessarily, of course, but the risk with a fixative is significantly higher.

2) If the latch is located close to the skin, in case of injury you can easily damage the skin right up to the latch, which is much more dangerous than just a laceration.

3) In some areas of the body (not in all!!!) the fixator, screws may rub against the tendons or the plate may press slightly with its edge on the anatomical structures (for example, a high plate on the shoulder can sometimes, with maximum range of motion, rest against the acromion or into the subacromial bursa). The retainer, of course, becomes overgrown with scars and actually becomes smoother because of this, but in some places it is still better to remove it. The tendon may not rupture, but it may become inflamed due to this - tendinitis or tenosynovitis.

4) The plate and bone have different degrees of elasticity. Because of this, when overloaded, a fracture can occur, often at the screw. For normal loads this is less important, but in sports large and sudden loads are possible.

In general, everything is decided with you individually. There is also a risk when removing the plate. But in the long term, the risks of not removing it accumulate more. In some hard to reach places Sometimes it’s really better not to remove the retainers, because... It is easy to damage the nerve or other structures.

10.04.2011, 17:59

I really ask for help and advice. On January 5, 2011, my husband underwent surgery after breaking his ankle. A titanium plate was installed (plate seller NPO Deost). On April 9, 2011, a planned visit to the emergency room and after an X-ray, the diagnosis was “Incorrectly healed fracture of both bones of the left leg in conditions of MOS. Plate fracture.” (approx. the plate broke at the site of the ankle fracture). A traumatologist from the regional trauma center said that the plate must be removed, the bone must be broken again, a new plate must be installed, and another 3 months of lying without any load. And everything needs to be done as quickly as possible.

In city hospital No. 79 today (04/10/2011) they refused hospitalization, citing the fact that we were having a planned operation and it was necessary to collect tests at the district clinic and only then contact them at the hospital to the head of the department for hospitalization. The doctor on duty from the trauma department, after my requests to examine my husband’s leg, nevertheless examined the leg and said that the situation was not critical, the pulse in the leg was good and there was time to collect tests. And the fact that the leg was very swollen and turned brown at the site of the fracture plate, according to him, is a normal process in our situation.

Which doctor should you trust?

TELL US what to do in our situation in the best way for the health of your spouse:

10.04.2011, 18:56

They refused to admit us to hospitalization, citing the fact that we were having a planned operation and it was necessary to collect tests at the district clinic and only then contact them at the hospital to the head of the department for hospitalization.

1) do bones actually heal incorrectly?

2) When should the operation be performed?

The timing doesn’t play a special role here, there’s no point in putting it off for months, but there’s no need to rush, measure it seven times...

10.04.2011, 19:52

A plate fracture indicates a lack of fusion. So there is no talk of either correct or incorrect fusion.

Tell me what is your forecast for possible further actions: plate removal; a new bone fracture with the installation of a new plate and another 3 months of lying down + 1 month of rehabilitation, or is the broken plate simply removed and you can stay in a cast until complete healing?

10.04.2011, 19:54

They did not refuse, but invited me to hospitalization after an outpatient examination.

Yes you are right.

10.04.2011, 21:13

Tell me what is your forecast for possible further actions: removal of the plate

There are many options - a device, a plate with bone grafting, an intraosseous rod. Which one will be chosen by those who will perform the operation - they know best.
There is nothing to break here, there is no fusion. Simply removing the plate and waiting in plaster has too little chance of success.

10.04.2011, 21:28

There are many options - a device, a plate with bone grafting, an intraosseous rod....

Thanks for the comprehensive answers. Please clarify “device, plate with bone grafting, intraosseous rod” is this purchased by patients or installed under a medical policy? Don't get me wrong, we bought the titanium plate ourselves from a company recommended to us by the operating surgeon. I want to prepare financially. Sorry, this is not a medical issue, but very relevant for our family.

13.04.2011, 19:25

First of all, it is necessary to exclude an infectious complication

13.04.2011, 20:21

In any case, you need to find out about the specific conditions of hospitalization where you will place the patient for further treatment.

The operating doctor prescribed the husband a course of physical therapy to heal the bones; the broken plate was left in place for now. They don’t give information about what they will do after finishing the course and when it ends:ac:

Please advise what pills I can take to help the bone heal faster. My husband drinks only mumiyo and mountain calcium and only on his own initiative. Not a single doctor gave us any recommendations. There are no contraindications, my husband has no allergies.

And do you think there is a curvature of the bone? The third surgeon who looked at this picture in the hospital said that the bone was curved. Do you think there is a curvature?

14.04.2011, 14:55

The operating doctor prescribed a course of physical therapy for the spouse to heal the bones; the broken plate is still

This serious reason change medical institution.
A “course of physical therapy” in this situation is a way to waste a lot of time and achieve nonunion against the background of stiffness of adjacent joints.
It is necessary to do reosteosynthesis. What technical option is the third matter.

Please advise what pills I can take to help the bone heal faster. My husband drinks only mumiyo and mountain calcium and only on his own initiative.

There are no such pills. This “own initiative” is meaningless and useless. The patient only develops unjustified hopes for the best, thereby reducing the motivation to achieve a real solution to the problem.

And do you think there is a curvature?

The fragments are movable. And the broken plate indicates that nothing is going to grow together there yet.

I never thought I'd break anything.

And even more so, I could not imagine that fractures received at home could require surgical treatment.

However, there is a first time for everything.

If you found this article, you have probably also experienced a fracture or are about to undergo surgery. I found practically no useful information before the operation, although I intensively scoured the Internet.

I sincerely hope that this article will help someone find answers to their questions, will calm someone down and will not be so scary.

How I broke my arm

A slippery country porch after the rain, my hands full of things - I couldn’t hold on to the railing. A split second - and I was already sitting on the steps. It hurts somewhere in the hip area. I try to get up, but I realize that left hand doesn't listen to me. I hear some kind of grinding sound inside (the edges of a broken bone are rubbing against each other). There is no pain in my arm, it's because I'm in shock. Almost lost consciousness. When they lifted me up and sat me down on a chair, I noticed that I was intuitively supporting my sore arm with my healthy one. The hope of a dislocated joint quickly disappeared when I tried to move my left arm and bend it - it hung like a whip, and fragments were shaking inside, unnaturally inflating the arm from one side to the other. This sight made me feel sick, my head was spinning, and my legs were weak.

As I realized later, I fell on my hip, but during my inglorious flight my arms went to the sides, and one of them hit the railing with all its strength, which is why it broke.

An hour later I was at the emergency room in Solnechnogorsk. On a first-come, first-served basis, they took pictures and put me in a plaster cast. The pictures showed a helical fracture of the humerus in the lower third (closer to the elbow) with displacement. The local traumatologist immediately told me that surgery would be required and asked which hospital to refer me to. Thus, that same evening I was taken to the hospital at my place of residence, where at 11 pm I was hospitalized, and I fell asleep almost exhausted on the newly acquired bed 36 of the Moscow hospital.

picture immediately after the fracture (without plaster)

First hospital

I got to the hospital on Saturday night, and, of course, no one began to urgently attend to me, they just took new pictures. On Sunday they took tests and injected me with analgin a couple of times. I couldn’t understand where my doctor was, whether there would be an operation and when, how long I would be stuck in this institution where I was supposedly being treated. When they came to do an ECG, I was almost sure that it was sure sign preparation for surgery. But everything turned out differently: my attending physician came in the afternoon and doubted the advisability of the operation. He said that he would discuss this situation with the head of the department and get back to me.

The manager came in a little later and was also full of doubts. According to him, “the bone in the cast stood up straight and will heal on its own,” so surgery is not necessary in my case. However, the doctors themselves could not make such a decision; they began to wait for the professor. The professor called a consultation and all these people came to my room. They examined me, checked whether my fingers were working and informed me that they would not operate, saying I was lucky and it should heal that way. And the next day I was discharged home. So I spent 4 days in the hospital without any treatment.

It is clear that nothing is clear

Then I was recommended to be observed at the emergency room at my place of residence. The first time I came there without photographs, only with an epicrisis. When the time came to redo the picture, 2 weeks had already passed since the fracture, and the traumatologist, seeing a fresh picture, said that I needed surgery and would do it quickly. I was at a loss: some traumatologist against the opinion of the whole council? However, the latest photo seemed scary to me too.

picture 10 days after the fracture in a cast

A couple more days passed, out of fear, I redid the picture again, but in a different projection, and what I saw there scared me wildly. Because SUCH a bone will definitely not heal.

It was clear that the bone was not standing as it was before; the fragments were moving despite the plaster splint. And I began to collect the opinions of other doctors. They all said one thing: an operation is needed, don’t delay, the longer the time passes, the harder it will be for the surgeon.

I had to take all the tests again, take an X-ray of my lungs and an ECG. At that time, I already knew that I would go to have surgery in. Through friends and acquaintances I was recommended to see Dr. Gorelov. During the consultation, he seemed reasonable and even somewhat pessimistic to me (in fact, he just honestly warned about the risks), but a qualified doctor. I couldn't find any reason not to trust him.

I liked the inpatient facility in the hospital - two and single clean rooms with TV, Wi-Fi and even air conditioning. In general, I was satisfied with everything.

I was operated on on September 14, and 2 days after the operation I was discharged, making me promise to come for dressings. In general, I liked all the staff in this hospital - the doctors, my anesthesiologist and attentive nurses. I want to express my gratitude to everyone for their professionalism and help.

I.V. Gorelov is a very kind, competent, calm and patient doctor, answers all questions in detail, calms and encourages. No familiarity or attempts to tease the patient, make a bad joke, etc. Such qualities of a doctor are very important to me, because you listen to every word and, to some extent, the doctor is an authority for the patient, whom you need to completely trust and follow all instructions. And if the person himself or communication with him is unpleasant to you, then this complicates everything and there is no trace of any positive attitude.

Displaced humerus fracture and treatment options

Doctors say that breaking the humerus is not so easy - it is one of the largest and strongest human bones. Displaced fractures are extremely rarely treated conservatively. This also takes a rather long time for the bone to heal and there is a high probability that after a couple of months in plaster the bone will heal crookedly. But the most unpleasant thing is that it may not heal at all, and a false joint may form at the site of the fracture, which is very, very bad.

Surgery can be risky because the radial nerve runs along the humerus to the elbow. If we talk in simple language, then this nerve is responsible for the work of the hand. If it is damaged during surgery, the hand may simply “hang” for a long time. But doctors do not give guarantees, each person is individual, some may be unlucky.

The operation itself involves the installation of a titanium periosteal plate, which is secured to the bone with screws screwed into the bone. The difficulty is that the radial nerve runs straight through the bone, so in order to get to it, you need to isolate the nerve and place a “shock-absorbing” material under it (between it and the plate). muscle tissue. This operation is not considered simple; personally, it took me about 2.5 hours to do it. What a relief it was to see that the fingers were moving, that the nerve was not damaged. After the operation, the doctor said that the muscle began to wrap around a fragment of bone, which made it impossible for it to heal. Therefore, the decision to undergo surgery was correct.

In my case (the operation was complicated by the age of the fracture), general anesthesia with a mask and tube was suggested. And fresh fractures of this type can be operated on under local anesthesia(anesthesia in the neck, turning off the sensitivity of the arm). Personally, I think that general anesthesia is better because you don’t see your blood and don’t hear your bones being drilled. Not every person can handle this. And I liked mask anesthesia much more than intravenous anesthesia (I had such experience) - it was easier to recover from.

Preparation for osteosynthesis with a titanium plate and the first days after it

Discuss treatment options with your surgeon. If the fracture occurred recently and the bone did not break at the joint itself, you may be offered to install a pin - a metal rod that is driven into the bone, which will fix it from the inside. Less risk to the radial nerve and small scars on the arm. Installing the plate means a big scar, preceded by a big seam (I'm already slowly thinking about a tattoo). In my case it was too late and difficult to use the pin, so we agreed on a plate.

The patient purchases this accessory himself, through a doctor, or looks for it on his own. My German plate cost 103 thousand rubles. No matter how you buy the plate, ask for receipts and documents for it. We bought from the supplier company. No one showed us the plate itself, arguing that it would be delivered directly to the doctor, and it is not recommended for mere mortals to touch this sterile device. But a bunch of certificates were handed out. Yes, the price was high, and it depends on the length of the plate. Mine covers almost the entire humerus. Someone may be luckier and find it cheaper.

Before the operation, you must undergo a standard medical examination. examination by a therapist, have a fresh fluorography on hand, as well as an ECG, blood and urine tests. With this heap of papers you come to the hospital, and the longest day of your life begins. After lunch they will no longer feed you, and in the evening they will completely cleanse your intestines and prohibit you from drinking after midnight. In the morning, on an empty stomach, you will be stripped naked, given an antibiotic injection into a vein, and taken to the operating room.

I was taken to surgery straight away with a cast on my arm. I have no idea how they filmed it - it was already under anesthesia. In the operating room, a catheter is placed in the arm and a mask is applied. I passed out after 15 seconds to the music of the band Spleen, sounding relaxed in the cold operating room.

When I woke up, I saw people in dressing gowns, they calmly talked to me, they said that I had only lost half a liter of blood, that this was not much. Then they took me to the ward. A stonehenge of ice in bags was laid out around the operated arm, taped with a bandage, and an IV was connected to the healthy arm. At this point the worst was over.

For the first 2 days, blood leaked from the stitches, so I had to put special diapers on the bed. This is absolutely normal, although it looks creepy. Also normal after surgery elevated temperature(up to 37.5 within a week) and severe swelling of the arm. My hand has become 2 times larger, the sight is unsightly and scary. However, this is normal given the damage to the muscles and tissues of the arm - the blood supply needs time to recover, and this is not a couple of days.

While the stitches are bleeding, dressings are done daily, then as directed by the doctor. It is better not to disturb dry seams again. They are removed on the 12th day after surgery.

You should try to bend the operated arm (slowly develop it), massage the hand to remove swelling and wear the arm in such a position that the hand is above the elbow - this will reduce swelling. In my sleep, I put my hand on my stomach - in the morning the swelling is much less than in the evenings.

Upon discharge, I was prescribed a course of antibiotics and painkillers (if necessary).

All the bandages-scarves-splints from pharmacies seemed uncomfortable to me, they put pressure on the seams, so I wear my arm loosely, slightly bending it at the elbow. It's not difficult, don't be afraid to not support it. For the first 2 days I tied my arm with a Pavloposad scarf, but now I’m just walking (a week after the operation) without holding it in any way. I use my hand minimally - open the lid, take the mug. There is almost no strength in the arm yet, but it will return with the development and restoration of the injured muscles.

With this I want to finish the first part of my story. will be devoted to the rehabilitation and development of arm muscles.

If you have questions, be sure to ask in the comments. I know from myself that in such a difficult situation you cling to every review, collect information literally bit by bit, and this ignorance is frightening and disorienting.

Health to all our readers!

Patients who had a fixator installed during the treatment of a fracture have the osteosynthesis plate removed after a year. This is also done in the event of the development of complications associated with a negative reaction of the body to the presence of a foreign body, or if the patient himself does not want to live with the plate. The operation involves certain difficulties, and the rehabilitation period subsequently lengthens. Often, removal is carried out when the fixator is installed on the lower leg, that is, as accessible as possible.

Timing of plate removal after osteosynthesis

If there are no indications for removing metal structures, they do not need to be removed.

Metal plates should be removed 8-12 months after osteosynthesis. Indications for the operation to remove the structure are as follows:

purulent process in the area of the plate;
unsatisfactory fixation;
patient intolerance to the metal from which it is made;
damage to ligaments and muscles by the structure during movement of the limb;
inability to fully carry out movements in the joint;
breakage of a screw or plate;
formation of osteophytes in the area of damage;
likelihood of re-fracture;
the need for the absence of foreign bodies due to the type of activity;
psychological intolerance to the presence of the plate in the body;
location of the structure on the tibia of the leg;
discomfort while wearing shoes.

How is it carried out?

Before the operation, the patient undergoes a CT examination.

Operations of this kind are carried out as planned after a series of studies (X-ray and CT) and after preoperative preparation. It is recommended to remove the plates after 12 months, when a full callus has formed and the fracture site has hardened. Emergency cases of interventions include migration of screws into internal organs, which often occurs when fixing the head of the humerus. To perform the manipulations, anesthesia will be required. The incision is made along the primary scar. Difficulties in carrying out the procedure may arise due to the use of low-quality materials in the manufacture of metal structures and screws. The slots on the head may be damaged, which will require the use of a specific tool.

Postoperative period

As a rule, the metal structure is easily separated from the bone. But due to the presence of stitches, when the operation to remove the osteosynthesis plate is performed, the patient needs to stay in the hospital for about 2 weeks until the postoperative scar gets stronger. Wherein painful sensations weakly expressed during this period. After removing the plate, plaster immobilization of a previously injured area on the leg or arm is not required, as are specific rehabilitation techniques. But you will still need to stop putting loads on the injured bone for a while.

Classification

First of all, operations are classified according to the time of implementation - primary or delayed. This is followed by classification according to the method of installation of fixators, which can be transosseous or submersible.

Loading operations, in turn, are divided into:

bone;
intraosseous, or intramedullary;
transosseous.

Medical scientific circles offer a very special, innovative way connection of bone fragments - ultrasonic osteosynthesis.

With its help, mechanical vibrations are created; the surgeon, observing the process of joining the edge of the inert fracture on the computer screen, achieves the most accurate connection of bone fragments. At the junction, under the influence of ultrasound, a polymer conglomerate is formed, firmly connecting the edges of the bone fracture.

Transosseous osteosynthesis is considered the most difficult. It is called compression-distraction, external or internal, according to the method of installing the attachment for the bone edges.

Such osteosynthesis operations are performed using special compression-distraction devices, which allow reliable fixation of bone fragments without opening the soft tissue at the fracture site.

Here the doctor sees his actions on the screen of the X-ray machine and gradually achieves an accurate connection of bone fragments. Fixes the connected bones with metal knitting needles or nails, passing them through the bone.

The operation using the method of immersion osteosynthesis requires precise movements from the doctor, strong and confident hands, because he has to insert fastening elements into the bone fragments at the fracture site. Intraosseous osteosynthesis involves the use of rods different types– nails, pins. This is an operation of osteosynthesis of the tibia with a pin.

Bone osteosynthesis involves the use of plates that are fixed with screws and screws. Transosseous immersion osteosynthesis involves the use of screws and wires.

When starting an operation, surgeons prepare several sets of fasteners, since during the operation it may turn out that a different type of fastening is required if the bone fragments are not straight, but spirally twisted and need to be returned to their original position in order to align with the bone fragments on the other side of the fracture.

Operations of this type are considered combined for several methods of osteosynthesis.

The second operation, to remove the shin plate, usually takes place without complications, and the patient immediately stands on the operated leg after it. However, you still have to walk for a long time with a cane, which helps relieve motor tension from the sore leg.

The type of surgery chosen depends on the complexity of the injury. A complex double fracture, when the fibula and tibia are simultaneously damaged, requires osteosynthesis using the intramedullary method, with drilling out the bone canal. If the operation is performed without drilling canals, this reduces the traumatic nature of the surgical intervention.

The method of osteosynthesis with reaming guarantees the most reliable fixation of fragments. This technique is used in the formation of false joints.

For open fractures, transosseous osteosynthesis of the tibia using compression-distraction technologies is used.

This technique is used in the most complex cases of injury, when bone fragments are difficult to connect, and additional adjustments, which such devices allow, may be required.

In addition, the devices allow you to fix a fracture without using plaster.

The external fixation device makes walking difficult, especially since the patient can only move on crutches. Such devices are usually installed for six months. During the fusion process, control X-rays are taken to check the rate of bone healing and callus formation.

Follow-up x-rays indicate when the plates can be removed after a tibia fracture to continue treatment of the injury.

Before performing surgery for metal osteosynthesis of the tibia, it is recommended to keep the victim in skeletal traction for several days. The design of skeletal traction involves passing an Ilizarov wire through the heel bone, with a load of several kilograms attached to a fishing line.

Surgery with a plate for a displaced tibia fracture is carried out in several stages:

hiding the fracture site;
cleaning the fracture site from blood clots, soft tissues and bone fragments that interfere with bone realignment;
metal osteosynthesis (installation of a plate and fixing it with screws);
X-ray for control;
layer-by-layer suturing of the wound;
application of a plaster splint.

This traction is performed under local anesthesia and allows you to gradually reduce the fracture.

The operation itself is performed under general anesthesia either with the help spinal anesthesia. The choice of type of anesthesia depends on the complexity of the operation, its expected duration, general condition health of the patient.

During the operation, the surgical field is washed several times to prevent infection from entering the exposed tissue. A rubber or tubular drainage is placed along the plate, which allows accumulated blood to be removed from the wound (preventing the formation of a hematoma). On surgical wound a sterile bandage is applied.

The price of the operation depends on the complexity of the fracture, the anesthesia chosen, and the type of plate that will be used.

If there are no indications for removing metal structures, they do not need to be removed.

Metal plates should be removed 8-12 months after osteosynthesis. Indications for the operation to remove the structure are as follows:

purulent process in the area of the plate;
unsatisfactory fixation;
patient intolerance to the metal from which it is made;
damage to ligaments and muscles by the structure during movement of the limb;
inability to fully carry out movements in the joint;
breakage of a screw or plate;
formation of osteophytes in the area of damage;
likelihood of re-fracture;
the need for the absence of foreign bodies due to the type of activity;
psychological intolerance to the presence of the plate in the body;
location of the structure on the tibia of the leg;
discomfort while wearing shoes.

The use of specific biosoluble materials minimizes side effects from the use of plates.

The most acceptable and harmless method of osteosynthesis is to carry it out using special materials that, over time, can completely dissolve and be removed from the human body.

Most often, this technique is used for fractures of the tibia of the leg. The main advantage of such an operation is the elimination of repeated intervention, which reduces the degree of trauma to soft tissues, avoids temporary disability and the need for dressings.

Metal osteosynthesis of a tibia fracture with a plate

A shin fracture is a fairly common injury, which can be caused by a car accident, fall, or sports injury.

Trauma to the tibia is sometimes complicated by displacement, fragments, and skin damage ( open fracture), as well as a fracture of the fibula.

Depending on the type of fracture (with or without displacement, with or without fragments), one of the treatment methods is to install a plate for a tibia fracture.

The fibula, most often, is not subject to targeted treatment, since the supporting bone is the tibia of the leg. After tibial reduction, the fibula is realigned and secured in a cast following tibial surgery.

Anesthesia during surgery

Before performing surgery for metal osteosynthesis of the tibia, it is recommended to keep the victim in skeletal traction for several days.

The design of skeletal traction involves passing an Ilizarov wire through the heel bone, with a load of several kilograms attached to a fishing line.

This traction is performed under local anesthesia and allows you to gradually reduce the fracture.

How to choose a plate

Synthesis of a fracture of the tibia and knee joint with a plate

When choosing a shin plate for a fracture, the traumatologist takes into account the location of the fracture.

The thickness of the plate, its type and length will depend on this.

If the fracture of the tibia is in the middle third, then the plate can be taken thick and straight.

A fracture that extends into the articular part of the tibia requires the choice of a plate with one wide end. At the same time, the thickness of the plate is slightly thinner, so that it is possible to adjust its shape for a tight fit to the bone.

Surgery with a plate for a displaced tibia fracture is carried out in several stages: Carrying out metal osteosynthesis

During the operation, the surgical field is washed several times to prevent infection from entering the exposed tissue.

A rubber or tubular drainage is placed along the plate, which allows accumulated blood to be removed from the wound (preventing the formation of a hematoma).

A sterile bandage is applied to the surgical wound.

Postoperative care

But the leg should not be constantly immobilized, as bedsores may form - the leg can be slightly turned and its position changed.

A slight rotation of the ankle joint can help relieve contracture.

While the patient is lying, from the first day it is prescribed breathing exercises to prevent pneumonia from developing.

From 2-3 days the massage therapist conducts restorative massage and development of the joints of a healthy limb, as well as gentle development of the joints of the operated limb.

For speedy recovery muscle tone and limb performance, 4-5 weeks after surgery, limb development in the pool is prescribed.

With stable consolidation of the fracture, it is allowed to walk without crutches, but the leg should not be heavily loaded. Full recovery limbs occurs after 10-12 months.

Removing the Plate

How long does it take to remove the plate?

At normal course healing, it is recommended to remove the plates after a tibia fracture about a year after its installation, but there are certain nuances that force the removal of the metal structure earlier:

rejection of the metal from which the plate is made;
formation of a false joint;
improper healing of the fracture;
callus does not form;
plate or screw fracture;
suppuration of the fracture site;
screw migration;
unreliable fixation.

These reasons are not only an indication for surgery to remove the plate. Also, with suppuration, a long course of treatment of damaged soft tissues or even bones is also expected.

Removing the plate after a tibia fracture

When is the plate not removed?

If more than 3 years have passed since the installation of the plate, and the patient has not contacted a traumatologist, then the following options are possible for leaving the plate in the lower leg:

too deep ingrowth of the metal structure into the thickness of the bone;
the age of the patient (after 80 years, repeated operations are not recommended);
close placement of the neurovascular bundle to the fracture site.

Rehabilitation after plate removal

Removing a plate after a tibia fracture is less traumatic than installing it. But this is still an operation, during which the bone can also be damaged (cleaning the place where the plate and screws are attached from callus). This means that the fracture site is weakened again.

Rehabilitation after a tibia fracture

A cast will not be needed, but it is recommended to reduce physical activity on the affected leg. You need to gradually resume the usual loads on your leg. For example, you don’t need to run a 10-kilometer cross-country race right away.

The ankle is the most fragile part of the human legs. The ankles of slender girls with a graceful bone structure are especially susceptible to various types of injuries.

A jump from a height with an unsuccessful landing, a sharp twist of the foot, an unexpected turn of a joint, or a sharp blow can result in fractures. Given the traction of the ends of several bones, fractures often result in displacement of the damaged bone.

Therefore, the operation is performed using a titanium plate, with which the surgeon fixes the connected parts of the bones.

Fracture picture and plate placement

Displaced ankle fracture

The processes from below the tibia bones enter the internal structure of the ankle group. From the outside they are attached to the fibula, from the inside to the tibia, thus forming a “fork” of the ankle, limiting and protecting it on both sides.

The medial joint plays a significant protective role; it bears a triple load - from the person’s weight, from the dynamics of movements, from prolonged stress.

Therefore, the injury causes a double fracture of the ankle with displacement, which leads to the need for a rather complex operation.

An ankle fracture is a serious matter. The joints of bones and tendons grow together for a long time, painfully. The doctor decides to operate on the injured leg.

This is a mandatory surgical element, a real installation of the bone, if there is a tear from the top of the ankle from the inside. The patient walks with the plate for several weeks or months until the bones are completely fused, which is visible on control X-rays.

After this, the plate is removed and the second rehabilitation period begins.

How long the sick leave lasts after surgery for a displaced ankle fracture is decided first by the doctor, who extends the sick leave, and then by the medical advisory commission, which determines the degree of disability.

Symptoms of a displaced fracture

Closed fracture with displacement

Characteristic symptoms appear immediately at the minute of injury. They are very expressive: unbearable pain in the limb, loss of control of movements, lack of support on the foot, visible deformation of the bones.

Palpation at the site of injury causes an audible crunch of bone fragments. It is impossible not only to step on the foot, but also to simply control its movement. Such symptoms allow the doctor to make a preliminary diagnosis: a displaced fracture.

When the ligaments are damaged, the fracture is accompanied by a dislocation, and the foot is noticeably displaced, turned inward or turned outward.

The activities of the person providing first aid must be practiced and clear. The victim urgently needs to provide first aid for injury, give an injection of pain medication, wipe his temples ammonia, half diluted with water.

Diagnosis includes x-ray examination, in which pictures are taken in several projections. This helps to visualize all bone fragments, their location, and the direction of shift.

Clearly and most accurately shows the picture of the fracture modern views examinations - CT, MRI, 3D ultrasound scanning.

Detailed examination is required to select the surgical technique and decide, together with osteosynthesis, to perform plastic alignment of the damaged ligaments.

After a double fracture of the ankle with displacement, the operation is performed in accordance with the complexity of the patient’s condition, based on this, anesthesia is selected - general or spinal.

Regardless of the general condition of the patient, the treatment and postoperative period takes a long time in the hospital - the patient must lie for as long as the attending physician says until the bones heal.

Types of Ankle Fractures

A variety of ankle injuries cause fractures, which are classified according to specific criteria:

closed, secure skin;
open, with skin damage.

Both types of fractures occur on both the outer and inner ankles, or a bilateral fracture is diagnosed.

Injuries are also classified by type of injury:

with bone fragmentation;
occurring in a helical direction;
with fragments;
torn;
fractures combined with dislocation and subluxation of the foot, with damage to the ligaments.

All types of fractures are severe injuries, accompanied by visible external changes in the ankle and severe pain. This requires the help of a surgeon who will compare the bone fragments and, if necessary, perform osteosynthesis.

Using titanium plate

A greater number of fractures in the ankle area occur with displacement of fragments, injury to ligaments and tendons.

The surgeon’s task is to carry out an effective surgical treatment, restore the anatomy of bones and their joints.

To do this, the doctor reliably fixes the connected fragments using osteosynthesis, that is, restores the integrity of the bones by installing a titanium plate to help the bones heal correctly.

Methods of osteosynthesis are:

closed, extrafocal;
open.

The closed method involves the use of metal knitting needles. They must be installed without opening the injury site, above and below the injury.

Then the needles go to the staples of the Ilizarov apparatus, designed for long-term fixation of bone fragments. The device is adjusted using screws and bolts, after the surgeon displaces the bone fragments under X-rays.

The device must be worn until the bones heal, which X-rays show by the formation of a callus at the site of injury.

Much more often, open osteosynthesis is performed, when the surgeon compares fragments, removes fragments, and releases pinched soft tissues.

Bone fragments must be removed carefully, without leaving even the slightest - this is a prerequisite for performing an operation using any method. The doctor rigidly fixes the combined bones with a plate equipped with several holes and screws.

The healing time of the bone depends on how accurately the surgeon aligns the broken fragments.

The price of the operation is determined by the use of the fixation device: if the Ilizarov apparatus is used repeatedly, only the consumable material – the knitting needles – is changed; then titanium plates are used only once. The cost of the entire operating complex includes the sum of prices only for consumables.

Over time, the latest methods of osteosynthesis operations are being introduced into the practice of traumatology. Intra-articular injuries are combined during surgery using the arthroscopy method.

It does not open the joints, but makes small incisions to insert a probe with a video camera and special instruments.

Small fragments are removed through the incisions, the camera illuminates the areas where soft tissues are pinched to release them, and the fragments are fixed. All the surgeon’s actions are precise, neat, and correct.

Old bone fractures in the ankle area after their improper healing are accompanied by the development of irreversible deformities of the ankle joint.

Arthrosis and contracture develop, and complete immobility of the ankle appears.

Any changes in the structure of the bone joint of the ankle are accompanied by severe pain.

In this case, patients are offered surgical intervention aimed at restoring mobility and physiological structure ankle

Recovery should begin immediately after surgery, even when the plate is in place.

Recovery period

Ankle replacement

Rehabilitation after a displaced ankle fracture after surgery lasts individually, the period depends on the body’s ability to recover, on the age of the victim, and continues after the plate is removed.

Fixation of the ankle when installing a plate on a displaced ankle fracture is carried out for a long time, for 1.5-3 months. Therefore, movements are activated in the knee and hip joint. This is necessary so that the circulation of lymph and physiological fluid does not stagnate.

The exercises are performed lying down and sitting; it is important to walk in doses with crutches, without leaning on the operated leg.

It is necessary to perform a complex of breathing exercises that activate blood circulation and oxygen supply to cells. A thigh massage is included for the same purpose - to improve blood flow to all parts of the leg.

You should carefully and conscientiously do everything that the attending physician prescribes in order to achieve an effective rehabilitation result.

When the plaster cast is removed, development of the ankle joint begins with a gradual increase in load. Physiotherapeutic procedures are carried out - ozokerite, baths, acupuncture.

After the doctor allows you to step on the operated leg, you must use orthopedic insoles to absorb the load on the joint.

Complex professional treatment after surgery for displaced ankle fractures, it leads to restoration of the functions of the ankle joint, prevents complications and re-injuries. At the end of rehabilitation, the doctor appoints a day for removing the plate.

The home recovery period includes continued treatment and following the trainer’s recommendations physical therapy so that the injured leg can heal peacefully good conditions care and rehabilitation measures.

Ankle injuries are becoming more frequent due to the fact that many new miracle devices are appearing - roller skates with low boots, skateboards with a movable board mount, snowboards, longboards, freeboards, hoverboards, hoverboards, scooters... Rotational movements to control such a mobile device increase the possibility of ankle injury .

This operation revolutionized traumatology because it made it possible to halve the period of disability of patients. Think about it - after osteosynthesis surgery, the patient can move the joints within a week.

And compare with the usual casting - several weeks of limb immobility in a cast, swelling after removal of the cast, a long rehabilitation process. (restoration of leg functions).

Of course, osteosynthesis is not indicated for everyone; for example, for a common ankle fracture, plaster casting is most often used. But if both bones of the lower leg, ankle are broken, and there are also bone fragments, osteosynthesis cannot be done without it.

Many people are afraid of a second operation, and they procrastinate, which is absolutely not allowed. The fact is that after 10-12 months the metal begins to become overgrown with periosteum, and it will no longer be possible to remove it easily and simply.

Repeated surgery is not at all as scary as many people think. This is simply removing the metal through a small incision.

In a week or two, when the stitches on the skin are healed, you will forget about it. It has nothing in common with the first operation, when the metal was just installed and the doctors assembled the leg “in parts.”

Despite the fact that there are special titanium-based alloys that can be left in the leg forever, many traumatologists still recommend removing metal structures from the leg. They explain this by saying that the pin can eventually move into the ankle joint and injure it.

In addition, metal is still a foreign body in your body, and it can cause suppuration and osteoporosis. In any case, the issue of removal is decided individually with each patient.

Yes, yes, this miracle has already happened - our doctors work with such materials that, after a year and a half, they themselves dissolve in the human body, having first done their job - properly fastening the bones after a fracture.

Such materials are called biodegradable (that is, biosoluble).

In case of a hip fracture, for example, a pin made of such material allows a person to quickly get back on his feet after surgery and not have to think about removing the osteosynthesis...

Fracture and its varieties

The use of titanium plates for fractures allows you to count on:

restoration of the anatomical integrity of the damaged bone;
the fastest possible healing of the fracture;
return of motor activity.

There are various techniques for installing titanium plates. They have many types, each of which is designed for use on certain parts of the body. Also, structures are classified taking into account the functions assigned to them.

There are protective, support, compression and tension plates. Today developed special devices, maximally facilitating the process of implanting plates into the damaged bone.

Bones can break in isolation - only the tibia or only the fibula. A combined fracture of both bones may occur. Violation of integrity can be localized in the area of the epiphysis, diaphysis, and condyles of the bone. The fracture line can be transverse or oblique.

Damage to the fibula

Basically, this bone breaks under the influence of a direct blow to it. The peculiarities of its location are such that it is located, as it were, in the depths of the lower leg. It is difficult to notice this fracture externally - there will be no deformation of the limb.

Even with palpation, it is not always possible to detect fragments and fracture lines. Displacement of fragments is also rare.

Symptoms of a fibula fracture:

There is only some pain at the fracture site, which may intensify when walking.
Local changes are observed - slight swelling of the lower leg.
There may be a hematoma at the site of injury.

Tibia injury

The injury occurs by the same mechanism as in the case of the fibula. However, the clinical manifestations will be different.

Since the bone is very close to the skin, the likelihood of open fractures is high and the diagnosis in this case will not be in doubt. If the fracture is closed, bone fragments will still be palpable and their displacement can be detected.

Displacement will occur when the ligaments connecting the shin bones are torn. It can be suspected if the length of the injured limb changes slightly in relation to the healthy one. Displaced fragments can also be palpated.

The lower leg will be bent, a hematoma will appear on the skin, and swelling will increase. The supporting function of the tibia is impaired - the victim will not be able to step on his leg.

When falling from a height onto straight legs, or when jumping in sports, fractures of the condyle of the bone are possible. The large bone has two condyles - internal and external.

Such injuries are characterized by impaction or depression of the condyles. If the fragments are displaced, the function of the joint is impaired.

Movement in the joint becomes impossible due to severe pain. The supporting function of the limb is also impaired. Swelling in the joint area increases rapidly.

The shape of the tibia roller be stable (when the ankle bones are slightly displaced, but occurred next to each other) edema with displacement (bone fragments swelling at a distance from each other), sometimes or open.

When a part of the bone is fractured in the lower leg, the hematomas of tissue and blood vessels, as well as the covering, may come out.

In addition, there is a classification according to the type of bone separation:

several (perpendicular to the axis of the presence of bone);
oblique;
comminuted (in a foot injury, small parts may break off).

A fracture of the tibia, depending on the part of the damage, is divided into types:

partial – there is no harm to health in this case;
complete - the bone structure breaks completely, affecting the internal structure;
closed – the fracture is isolated;
open - displaced fracture of the tibia, fragments affect muscles, fibers and ligaments;
stable - the crushed parts retain their previous position without causing ruptures of other tissues;
oblique - the breakdown passes under an inclined vector;
longitudinal – the line of damage is clearly visible;
helical - the rarest injury, a bone fragment wraps around an axis, while the foot can be rotated 180 degrees from its original position.

The plate itself comes in several types. This is the one that performs a protective function (neutralization), support (support), compression, and when constricting broken bones. Four species in the classification section.

Metal osteosynthesis is a prescription for placing titanium plates on the bone.

There are indications for any disease. This case is no exception. Indications

Symptoms of a fracture of a large soft bone

pathological mobility and unnatural position of the leg;
pain, swelling and hematoma;
violation motor function limbs - the patient cannot stand on the injured leg, there is a violation of innervation in the area of the suspected bone damage;
shortening of the limb;
bone fragments are visible that come out (with an open fracture).

severe pain in a favorable place, when trying to support the tissues, the pain intensifies, in the state of the nerves the pain is dull and aching;
tendon swelling in the area of the leg, although the vessels are damaged, a hematoma (bruise) forms at the site of the vessels;
complex deformity of the lower leg, unnatural long-term part of the leg below, often fracture;
numbness of the limb, the prognosis of the foot is pale in color, indicating vascular injury and also, therefore health care in a minor case it is required immediately;
The bone is an open fracture, then the vessels and tissues are visible, as well as the injury itself or its fragments can be seen.

Regardless of how accurately you or people have identified the symptoms of the tibia, in case of pain in the damaged area, you should undergo a consultation to spread.

Surgery with a plate for a displaced tibia fracture: rehabilitation

It is important to begin rehabilitation as early as possible, as soon as the patient is able to stand up and walk to the physiotherapy department on crutches. Principle recovery period– rehabilitation is carried out continuously and comprehensively.

The basis of rehabilitation is special gymnastics. Special exercises improve blood circulation, this accelerates bone fusion and restoration of joint motion. It is necessary to prevent physical inactivity, against which contractures develop: pneumonia, thromboembolism, etc.

Patients are also prescribed:

exposure to weak currents;
applications with paraffin, therapeutic mud;
massage.

How to choose a plate

What plates are used for tibia fractures? Metal implants used for metal osteosynthesis in traumatology are made of titanium, which does not cause allergic reactions. It is extremely rare for an allergy to develop, the process of implant rejection begins to develop, and it has to be removed.

A small callus has already grown on the bone, which holds the fracture site. Further treatment should be carried out in a cast until complete consolidation (fusion) of the fracture.

When choosing a shin plate for a fracture, the traumatologist takes into account the location of the fracture. The thickness of the plate, its type and length will depend on this. If the fracture of the tibia is in the middle third, then the plate can be taken thick and straight.

Even a titanium hypoallergenic structure is still considered a foreign body. A foreign bodies subject to removal. As soon as a strong bone callus has formed at the fracture site, the traumatologist prescribes planned surgery for plate removal for tibia fractures.

When to remove the plate after a tibia fracture?

These reasons are not only an indication for surgery to remove the plate. Also, with suppuration, a long course of treatment of damaged soft tissues or even bones is also expected.

The last reason listed may cause more harm than good. If a doctor accidentally damages this bundle, it can cause excessive bleeding and loss of sensation in the limb.

Removing a plate after a tibia fracture is less traumatic than installing it. But this is still an operation, during which the bone can also be damaged (cleaning the place where the plate and screws are attached from callus). This means that the fracture site is weakened again.

A cast will not be needed, but it is recommended to reduce physical activity on the affected leg. You need to gradually resume the usual loads on your leg.

For example, you don’t need to run a 10-kilometer cross-country race right away. If a runner needs to quickly return to the usual rhythm of training, it is better to start with warm-ups and short runs.

And also you should not neglect massage and exercise therapy (see also: For what purpose and how is rehabilitation carried out after a tibia fracture.).

Postoperative care

The patient must be placed on a horizontal surface and quickly free the injured limb from clothing and shoes. Then the limb must be immobilized using Dieterichs or Kramer splints. You can use available means - boards, branches, fittings, ropes.

The victim should be given an analgesic, such as Nurofen, Nimesil or Ketanov. For more information about the medications that doctors recommend using to relieve pain after a broken leg, read the article “Painkillers and tablets for joint pain.”

In the presence of heavy bleeding from the limb, a tourniquet must be immediately applied above the site of injury (with the obligatory indication of the time of application). If more than two hours have passed since this moment, then it is necessary to loosen the tourniquet for a few minutes to prevent tissue death.

Just a few days after fixing the structure, the doctor allows the patient to engage in some physical activity. The rehabilitation process begins, which can take from one to several months depending on the characteristics of the injury and the complexity of the operation.

During recovery, the use of physical therapy methods is recommended. The patient also needs to do exercises specially designed for one or another part of the body. The instructions must be strictly followed. It is advisable to carry out exercise therapy under the supervision of a specialist, at least at first.

It is important to adhere to a certain diet that will not allow you to gain overweight, but will provide the body with all the substances necessary for full recovery. The diet should include more fish, lean meat, dairy products.

Food, rich in calcium- in priority. Deficiency of vitamins and minerals (especially D, A, PP; calcium, phosphorus) should not be allowed. Therefore, the patient is prescribed special vitamin and mineral complexes and supplements.

While the patient is lying down, breathing exercises are prescribed from the first day to prevent pneumonia from developing. From 2-3 days, the massage therapist performs a general strengthening massage and development of the joints of the healthy limb, as well as gentle development of the joints of the operated limb.

In a normal, uncomplicated course of the healing process, you can get up for 2-3 days, but you cannot load the limb.

Sutures are removed 12-14 days after surgery. Moving is allowed only with the help of crutches.

With stable consolidation of the fracture, it is allowed to walk without crutches, but the leg should not be heavily loaded. Complete recovery of the limb occurs in 10-12 months.

Traumatologist Victor Kotyuk recommends applying dry cold to the injured limb (3-7 times a day) for the first 2-3 days, both through the soft part of the splint, plaster, and directly to the skin. To avoid frostbite, exposure time on the skin should not exceed 5-7 minutes. If you cool it through a plaster cast, it can take more than an hour.

Thermal procedures for any injuries are used no earlier than after 10-14 days. For fractures - later.

In case of heel fractures (intra-articular fractures of the calcaneus), in order to avoid further deformation of the foot, the doctor must correctly set the bone fragments and model the plaster accordingly. This is done with the surface of the damaged area closed, but more often through surgery.

When any bones are extremely small, it is correct to render the first bone. So, a person needs rest in order to avoid the first bones.

Help is needed. To do this, you need to apply a board to the injury and numb it with bandages (carefully).

This can be done with ice and a medicinal pain reliever if the pain is very strong.

Types required: a - without displacement; b - with offset; in - give; g - splintered

But the leg should not be constantly immobilized, as bedsores may form - the leg can be slightly turned and its position changed. A slight rotation of the ankle joint can help relieve contracture.

In a normal, uncomplicated course of the healing process, you can get up for 2-3 days, but you cannot load the limb.

To quickly restore muscle tone and limb performance, limb development in the pool is prescribed 4-5 weeks after surgery. This helps restore blood and lymph flow in the operated limb, as well as gently increase the range of motion in the joints (physiotherapy instructions are individual for each patient).

At the same time, pain is weakly expressed during this period. After removing the plate, plaster immobilization of a previously injured area on the leg or arm is not required, as are specific rehabilitation techniques.

But you will still need to stop putting loads on the injured bone for a while.

Titanium plates provide beneficial influence on bone integrity. They contribute to their recovery.

Also, these components help the bones perform their functions in a short period of time. If we talk about mechanical functions, then this is support, movement and protection of internal organs.

Orthopedists and surgical specialists use different methods on their application. Moreover, each section has suitable options.

When installing and fastening, special devices and tools are used. They simplify this process and make the final result more effective.

Depending on where the bone is broken, the type of plate and its further function depend.

Diagnostics

Put correct diagnosis can only be done by a qualified specialist. If the victim can move independently after an injury, it is impossible to reliably refute the presence of a fracture without examination by a traumatologist.

The most accessible and informative diagnostic technique is radiography of the injured limb, which reveals a fracture or crack, the type of pathology (with or without displacement), possible complications. IN severe cases doctors resort to computed tomography.

Treatment tactics are selected depending on the diagnostic results. If a fracture of the tubular bones of the lower limb has been identified without obvious displacement of the fragments, then the patient is recommended to undergo skeletal traction or closed reduction followed by the application of a plaster cast.

Skeletal traction carried out by passing metal wires through fragments of damaged bone, which are located in the correct anatomical position. The knitting needles are secured to a medical splint, to which a load is tied (see figure).

Open reduction is carried out when there is significant displacement, it is impossible to carry out reposition using a closed method, or there are multiple fragments.

In case of a displaced leg fracture, doctors perform surgery using special plates, with which the patient, under general or local anesthesia, fixes the bone fragments in the correct anatomical position.

After 12 months, the plate is removed. This method is rarely used, since this method of treatment is less tolerated by patients and is accompanied by significant damage to soft tissues.

For older patients, the wire or plate is often left in place for the rest of their lives.

In the diagnosis of any fractures, the collection of complaints to determine the cause of injury to the limb is of great importance.

Next stage - visual inspection areas of damage and conduction x-ray examination. Based on all of the above, the final diagnosis is established.

The basis of treatment for fractures in the lower leg consists of anesthesia, reposition and fixation of bone fragments, followed by immobilization by applying a plaster cast.

Treatment is carried out exclusively by a traumatologist or surgeon. Often, fractures in the shin area require surgical treatment, and in some cases, multivitamin complexes or chondroprotectors are prescribed.

After completing all the activities, all efforts must be directed toward recovering from a fracture of the tibia and returning mobility to the leg. You need to realize that a fracture is a serious physical and psychological trauma which requires serious rehabilitation.

In case of fractures, the victim should present symptoms to a medical facility; in the area, it is advisable to immobilize the injured person by applying a splint. For or you can use improvised elements: attach two sticks or injuries to the injured leg and apply a painful scarf.

Immobilization is necessary; the knee should not be aggravated by displacement of the joint. You can also apply the volume to the affected leg and give the sensation a pain reliever.

Doctor possible diagnostics, based on the external irradiation of the injury and asking the victim about the localization of its receipt. What matters is the location of the impact and its direction.

The injury is usually performed by x-ray swelling of the injured part of the leg in where projections. Usually it provides more information about the injury, and there is no need for predominantly examinations.

In case of fractures of the tibia, emergency care is required for the victim:

It consists of immobilizing the injured limb using a splint - ladder, wooden or pneumatic. You can also use improvised materials.
No anesthesia is required for a fibula fracture.
The tibia when injured causes pain syndrome, therefore, the administration of analgesics will be required.
The patient must be transported in a supine position.

Depending on the appearance of the fracture and its specificity, it can immediately be non-surgical, with the deformation of a special plaster and other watches to immobilize the limb.

Later, in the case of this damage, most of the leg occurred, inside at a certain angle on if it ends on the femoral part. More precisely, the location of the displacement of the plaster cast is determined based on the location of the fracture.

Individual bone healing is noticeable; fragments take an average of 2 months. Do not step on the injured limb; move the limb with the help of crutches.

If there is a significant displacement or significant number of fragments, then a tightening intervention will be required to connect the bone muscles into one whole. A special pin is screwed in to hold the bone in place.

The application is contraindicated for children and fragments whose skeleton, all legs, is at the stage of formation.

So, the immobilizer must be taken to the hospital. A suitable one will certainly order an x-ray to find out the nature and extent of the fracture.

Minor fractures (for displacement and separation of a large primary fragment) do not require surgical immobilization. A cast will be applied.

Afterwards, the bandage should completely fit the leg, fix the heel at the right angle and cover approximately a third of the thigh. The fusion of the leg can take more than two months, for the bones are quite different.

You can move around on crutches; wooden ones are used on the injured limb.

If there has been a displacement of the slats, then surgical intervention is necessary, during which the surgeon will first compare all the fragments and fix them in this position with the beam of a special device.

4.Rehabilitation after relatively fibula fracture

In medicine, among the most common injuries in the lower area, fractures can be identified, which include fractures of the poll and tibia.

In cases with a certain X-ray impact and a certain type of clarification, a fracture of the fibula is combined with a fracture in a big way bones.

Depending on the nature of the injury, it is divided into a straight line and a fracture is obtained. A straight (bumper-like) fracture is more observable and easier to treat.

There was that for the given fracture is missing great character fragments that remain similar to crushing bone.

For a fracture of the tibia, depending on the nature of the injury and the number of fragments, different therapeutic methods are prescribed; this also affects how long to walk in a cast. The following will describe the course of treatment for fractures with and without displacement.

Without complications, full leg function is restored in the fourth month.

Treatment of a displaced fracture of the tibia:

Local anesthesia.
Purpose of the skeletal retraction procedure. Surgical knitting needles with attached staples are inserted into the heel bone, through which a weight is tied to the leg. In this position, the muscles are stretched and it becomes possible to reposition the fragments and displacements. He who breaks his leg remains in this position until the bone growth(calluses).
To monitor the formation of callus, x-rays are used; if the traction is positive, it is removed after 5 weeks.
After the needles are removed, the patient is given a splint or plaster for a period of 2 to 4 months.
Course of rehabilitation procedures.

If traction does not bring the desired result, then in order to reduce the severity of harm to a person’s health, surgical intervention is prescribed. During the operation, an incision is made at the site of injury and bone fragments are fixed with metal or titanium staples or pins (for oblique fractures).

The use of the Ilizarov apparatus is also effective; in this case, the design used helps to achieve rigid fixation and regulate the position of the fused fragments.

Prevention

Preventive measures to prevent fractures in the lower leg area are very simple and understandable. Absolutely everyone can follow them.

These include:

nutritious diet including foods containing large amounts of calcium;
performing a warm-up before intense physical activity;
refusal bad habits;
balanced ratio of work and rest;
wearing comfortable shoes, for women - with or without low heels (especially in winter);
compliance with safety measures when crossing the street, skiing or skating.

At home, the bathroom must have an anti-slip mat, and all wires in the rooms are hidden to prevent accidental falls.

A shin fracture is a fairly common and very unpleasant occurrence. His treatment will require a large investment of personal time and a huge amount of physical and mental strength.

Often for a long time The fear of repeated fractures persists, which disrupts the daily course of life. Carrying out proper rehabilitation will allow you to return not only your former mobility, but also your self-confidence.

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What it is

In what areas are they installed?

On the bones of the skull

Upper limbs

Pelvis and lower limbs

Recovery

Removing plates after a fracture

How I broke my arm

First hospital

It is clear that nothing is clear

Displaced humerus fracture and treatment options

Timing of plate removal after osteosynthesis

How is it carried out?

Postoperative period

Classification

Anesthesia during surgery

How to choose a plate

Surgery with a plate for a displaced tibia fracture is carried out in several stages: Carrying out metal osteosynthesis

Postoperative care

Removing the Plate

How long does it take to remove the plate?

When is the plate not removed?

Rehabilitation after plate removal

Fracture picture and plate placement

Symptoms of a displaced fracture

Types of Ankle Fractures

Using titanium plate

Methods of osteosynthesis are:

Recovery period

Fracture and its varieties

Damage to the fibula

Tibia injury

Symptoms of a fracture of a large soft bone

Surgery with a plate for a displaced tibia fracture: rehabilitation

How to choose a plate

Postoperative care

Diagnostics

Prevention

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