Biological osteosynthesis as the treatment mode for multifragmental extra-articular fractures of lower limb long bones.

The concept of stable-rigid osteosynthesis developed by AO ASIF was subjected to basical changes recently, with regard to the treatment strategy of multifragmental extra-articular fractures. The principle of biological osteosynthesis was worked out, which, in contrast to AO original concept, implies the indirect (closed) reduction and "bridge-like" (elastic) fixation, without intervening on fracture area, and additionally, with maximally preserved vascularization of intermediate fragments. The study objective implied the consideration and analysis of the results of biological osteosynthesis, performed on multifragmental extra-articular fractures of lower limb long tubular bones, also to determine the indications and advantages of different methods of biological osteosynthesis. 117 patients with 153 fractures of lower limb long bones were treated by the method of biological osteosynthesis in the Department of Traumatology and Orthopedics of the Central University Clinic, in the period of 2000-2008. In 75 cases, osteosynthesis was accomplished through an external fixator, and in remaining 78 cases - by different kinds of plates. In 143 cases (93.5%), the complete fracture consolidation was achieved, requiring the average dates of 4.4 months for tibial and 4.9 months for femoral fractures, respectively. The secondary, i.e. repeated osteosynthesis with plate was required in 10 cases (6.5%). In case of biological osteosynthesis, the consolidation process gains the maximally physiological course, without lysing the intermediate fragments, and with development of endosteal-periosteal callus having the rigid framework. The biological osteosynthesis provides the minimized invasiveness of surgical intervention.