Choice of a Method for Blocked Intramedullary Osteosynthesis in Tibial Fractures in the Context of Topographic-Anatomical Research

Abstract

Blocked intramedullary osteosynthesis has become a "gold standard" for the treatment of patients with diaphyseal fractures of the tibia. However, there is still debate about the importance and necessity of reaming the bone marrow cavity when performing intramedullary osteosynthesis.The aim is to study the individual features of the structure of the medullary cavity of the tibia in relation to intramedullary osteosynthesis, as well as to evaluate the effect of blocked intramedullary osteosynthesis with preliminary reaming and without reaming of the bone marrow cavity on the vascular supply of the tibia.Material and methods. Using morphometric and radiological methods, an experimental topographical and anatomical study was carried out on 26 dry preparations and histotopograms-plates of tibial bone cuts, as well as on 10 lower limbs of corpses with X-ray contrast injection of arterial vessels. Statistical analysis was performed using the Student's parametric test and the nonparametric MannWhitney test.Results. Particular attention was paid to the detailed study of the main parameters of the tibial bone marrow cavity that are important for the technology of blocked intramedullary osteosynthesis (size, shape and curves of the bone marrow cavity, architectonics of its narrow part, density and distribution of spongy matter in it, topography of the a. nutricia tibialis channel and distribution of its branches). To assess the invasiveness of osteosynthesis on 10 anatomical objects with preliminary injection of vessels of the lower extremity with X-ray contrast mass, blocked intramedullary osteosynthesis of the tibia with and without reaming of the bone marrow cavity was modeled.Conclusion. It was concluded that any variant of intramedullary rod insertion is accompanied by damage to a. nutricia tibialis in a narrow part of the bone marrow cavity, and reaming of the bone marrow cavity has certain advantages in view of the pronounced individual differences in the structure of the tibia.