Comparative evaluation of methods for osteosynthesis of diaphyseal radial fractures by the method of mathematical modeling

Abstract

RELEVANCE. The surgical treatment of patients with diaphyseal forearm fractures has a variety of methods and requires a precision technique. The need for postoperative immobilization after osteosynthesis of diaphyseal fractures remains a controversial issue, since osteosynthesis failure and the formation of a pseudoarthrosis are sometimes observed.In addition, very little information about the role of the interosseous membrane in the rotational function of the forearm during osteosynthesis is available in the literature.The OBJECTIVE was to determine the forces occurring during rotational movements of the forearm that lead to the above complications.METHODS AND MATERIALS. The clinical part included the results of surgical treatment of 330 patients with diaphyseal fractures of the forearm; it consisted of the main group (170 - interlocking osteosynthesis) and the comparison group (138 - plate osteosynthesis). The third group consisted of 22 patients with complications of surgical treatment of diaphyseal fractures of the forearm. We performed a comparative assessment of plate and interlocking osteosynthesis of radial bone fractures by mathematical modelling to determine the forces occurring during forearm rotation that lead to nonunion, instability and plate fractures.RESULTS. In the main group, healing was achieved in all (170 patients), in the comparison group, healing was achieved in 128 (92.8 %), consolidation was achieved in all 22 patients with fracture complications who underwent reconstruction. A comparative assessment revealed that during plate osteosynthesis, zones of high stress concentration were located around the plate opening above the area of fracture and the nearest to it holes from both sides. In interlocking osteosynthesis of the radius, the stresses are evenly distributed around the nail. Pronation-supination movements with an amplitude of (±90)°, according to the experimental results, should lead to the destruction of the cortical plate fairly soon after implantation, while the nail made of ultra-fine Ti-6Al-7Nb alloy will maintain its integrity.CONCLUSION. Based on these findings, external immobilization is advisable to avoid complications such as osteosynthesis instability or plate fracture.