Komparativna analiza rezultata lečenja trohanternih preloma

Abstract

This doctoral thesis deals with the current problem of osteoarticular system and trochanteric fracture treatment of people who are 60 or more years old. The fracture is treated by extramedular implants, DHS-YU, selfdynamizing fixator-Mitkovic and DHS-Richards. The thesis contains both experimental and clinical part of study. In the experimental part of the thesis, you can find a research carried out on biomechanic characteristics of the implants and dinamization at the axis neck under cyclic loading. Wooden femur models with virtual trochanteric fracture are used (under fracture corner of 45º) and they are fixed with a corresponding implant. At the Faculty of Engineering in Nis, a research was carried out with a specific instrument used for cyclic examination. It has been used for the implant testing since 2007. Wooden femur models are used for testing the implant resistence on the axial force. As an equipment part, we used a “twitcher” (Veb Thuringer Raunsteim). During the procedure we used power of 1000N. One hundred and fifty patients who were 60 or more years old, took part in the clinical prospective study.They all had a trochanteric fracture and were all treated with the dynamic extramedular implant, DHS-YU, self-dynamizing fixator-Mitkovic and DHS-Richards, at the orthopedic ward in Cuprija and at the orthopedic clinical ward in the Health Center in Nis. The research period lasted from January 1st 1995 to June 1st 2010. The following parameters were recorded: the patients’ sex and age, fracture type and operation duration, blood compensation, application of antibiotics, pain, range of movement, muscle power, verticalization time, curtailment of the limb operated on, patients’ walk and activity after operation. Mechanic complications, superficial and deep infections, duration of hospitalization, mortality and final functional results were also recorded. The final treatment results were estimeted with Salvati-Wilson scale modified by Todorovic and Jevtic. The author has come to conclusions which are reliable and applicable. Momčilo Todorović – Doktorska disertacija Komparativna analiza rezultata lečenja trohanternih preloma - 187 - During the test of dynamization of the neck axis with cyclic loading applied on the femur model, the dynamization happens in an early phase in the case of all the three implants. During the testing process of the continual axial force at 1000N, none of the implants’ plastic is deformed. Apart from dynamization in the neck axis, existing in all the three extramedular implants, dynamization along the axis of the femur, existing in the selfdynamizing inner fixator-Mitkovic, has an advantage when we compare it with the other extramedular implants. According to the clinical research results, in the treatment of femur trochanteric fracture with dynamic extramedular implants (DHS-YU, selfdynamizing inner fixator Mitkovic, DHS-Richards) we can say that all the implants are anatomically and functionally very efficient. The treatment of trochanteric fractures treated with DHS-YU implants compared with the treatment of trochanteric fractures treated with DHS-Richards implants, shows that better results are achieved with DHS-implants if we consider patients’ supporter,walk and activity after operation. It has been confirmed that there is no great statistic difference in the analyzed parameters between patients who are treated with DHS YU extramedular implant and patients treated with selfdynamizing inner fixator – Mitkovic. The study results are very important for trochanteric fracture treatment applied on older patients.