THE SEMI-RIGID INDIVIDUAL FUNCTIONAL BANDAGES AS A FINAL STAGE IN THE TREATMENT OF THE TIBIAL BONE NONUNIONS AFTER TREATMENT WITH RING FIXATORS
Authors: Rushay A.K. , Martynchuk O.O. , Baida M.V. , Jaghdal A.A. 
Published: December 2020

Summary. The tibia non-unions after fractures require complex and durable treatment. One of the most common methods of variable osteosynthesis is the Ilizarov method. The long period of treatment causes the development of bone reaction to the immersion parts of the ring fixation (RF), osteoporosis, and as a result - reduction of the rigidity of the "fixator - bone fragments" system. All this is the basis for the application of the final stage of low-traumatic methods of fragments fixation with external bandages. Objective. The task of the study is to improve the results of tibial bone non-unions treatment after changeable osteosynthesis with ring fixators, based on the application of external individual fixation with semi-rigid bandages at the final stage of treatment. Material and methods. In our study, we had 36 patients with tibial bone non-unions under observation which have been treated with changeable osteosynthesis with RF. For the sake of prevention of displacement of the fragments, deformation of the regenerate, treatment of tissues inflammation in the area of pins implantation after disassembly of the Ilizarov device; and for the early rehabilitation of the calf functions - used individual semi-rigid fixation system Scotchcast/Softcast. The system allowed to create atraumatic conditions for regeneration and consolidation, full loading of the limb, its full usage during walking. The combination of rigidity (Sotshstast) and elasticity (Softstast) in the system of semi-rigid fixation with polymeric materials allowed the circular rounds of Softstast to change the shape of the bandage. In point of this, we were offered a method of pneumatic massage, which provided massage during the immobilization stage of treatment. Conducting kinesiotherapy and massage therapy was supplemented by medicament therapy. Results. The assessment also took into consideration the structure of non-unions with the Non-Union Scoring System - NUSS scale. The distribution of patients according to the total NUSS score indicated a very complex contingent of victims with a low probability of obtaining good results. Patients who needed standard methods of treatment, with a high probability of obtaining a positive result, were not observed; all required specialized treatments with the likelihood of achieving a positive result. In 20 cases, there was a need for complex specialized medical care with a possible positive result. 2 observation cases showed that even complex specialized medical care did not guarantee a positive result. Evaluation of the results of treatment of the victims with tibial bone non-unions after fractures were performed using the Modified Functional Evaluation System by Karlstrom-Olerud. Good results were obtained in 20 patients (30.45 ± 0.88 points, p <0.001) - 55.6%. Satisfactory results were observed in 7 patients (28.0 ± 0.125 points, p <0.001) - 19.4%. Moderate function impairment (4 patients - 13.9%) was 22.0 ± 1.323 p p <0.001. Poor, unsatisfactory results were observed in 1 case (2.8%); excellent functional status - 3 (8.3%). Conclusions. The usage of semi-rigid fixation systems at the final stage of treatment of tibial non-unions after osteosynthesis with ring fixators should be considered reasonable and safe. The results of the treatment of 36 patients with tibial bone non-unions with preliminary fixation by ring fixators according to the Ilizarov method, using semi-rigid fixation systems at the final stage of treatment -indicate high efficiency.