The use of imitation of load bearing capacity in the case of low-invasive metal osteosynthesis of crural bone fractures in the children

Abstract

The present thesis is devoted to the problem of improving the outcomes of the treatment of crural bone fractures in the children by means of the instrumental pneumatic imitation of the load bearing capacity (PILBC). The children were previously treated with the use of the low-invasive metal osteosynthesis techniques. The objectives of the study were to adapt the PILBC method for the application in the early postoperative period with the development of indications and contraindications for its prescription, to estimate dynamics of alteration of the main clinical and functional characteristics, to evaluate the effectiveness of the use of the rehabilitative treatment being considered. The study included 102 children at the age varying from 4 to 18 years presenting with crural bone fractures; the majority of the patients were boys of the elder age group (61.8%). All the patients were allocated to two groups matched for the age and sex. They were given the identical combined treatment with the exception that the children of the study group (in contrast to those from the control one) were managed with the help of instrumental pneumatic imitation of the load bearing capacity. Analysis of the data obtained made it possible to elucidate the specific features of the PILBC method applied to assess the conditions of the children operated for the treatment of crural bone fractures. It showed that the main peculiarity of the method being discussed is the use of the differential “walking regimen” programs and the maintenance of the adequate pressure level in the pneumoortheses depending on the patients’s age, subjective complaints, severity of crural lesions, and the duration of the period following the surgical intervention. More sparing programs are available for the children under 8 years of age. An indication for the prescription of the instrumental pneumatic imitation of the load bearing capacity method is any bone fracture after the age of 4 years following the termination of low-invasive stably functional osteosynthesis. The contraindications include a severe open fracture associated with the extensive injury to the soft tissues and the presence of external fixation in the regions of the ankle joint and foot. Moreover, the PILBC method can be applied in all the children treated with the use of low-invasive technologies, i.e. practically in 30% of the patients hospitalized for the treatment of crural bone fractures.

Keywords

crural bone fractures / children / rehabilitation / imitation of load bearing capacity / pneumoortheses

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