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The Surgical Functional Treatment of the Malleolar Fractures


Author: Andrei Homa
Degree:doctor of medicine
Speciality: 14.00.22 - Orthopedics and Traumatology
Year:2006
Scientific adviser: Filip Gornea
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution:
Scientific council:

Status

The thesis was presented on the 15 November, 2006
Approved by NCAA on the 21 December, 2006

Abstract

Adobe PDF document0.33 Mb / in romanian

Thesis

CZU 616.718.66 - 001.5 – 089 + 617.585.1

Adobe PDF document 3.90 Mb / in romanian
143 pages


Keywords

malleolar fracture, the injury of distal tibiofibular joint, the internal fixation

Summary

The malleolar fractures consists 20–22% of all skeletal injuries and 60% of all shin fractures. The aim of modern treatment of the malleolar fractures includes the minimum discomfort, minimal terms of hospitalization, immobilization and crutch-locomotion, good anatomical and functional restitution.

The actual research include 124 patients with the malleolar fractures treated surgically during the 1999-2004, using the type AO adjustments and technology (78 patients) and some new adjustments (46 patients) proposed and introduced by us. During the preclinical stage whithin the cadaveric experimental research we determined that the “be-toothed plate”, proposed by us, reinforces the fixation of the malleolar fragment about 16,2–23,6% in fractures of the lateral malleola type A and type B (low), according to the Danis-Weber classification in comparison with the type AO 1/3 tubular plate and provides necessary stability for the early recuperation and consolidation of the fracture. It is determined by fixation of the distal malleolar fragment by 2 theeths + screw introduced through the plate, which formes the triangular system of fixation. This adjustment was used for the treatment of 41 patients with the fracture of lateral malleola type A(6 patients), type B(29 patients) and type C(6 patients). The plate can be situated on the lateral or posterior fibular surface. There were achived excellent and good results in 84,85±4,3% cases shows that the plate can be used in all types of the fracture of the lateral malleola.

The cadaveric experimental research determined that the Muller’s technique of the fixation fractures of the medial malleola was supplemented by us with „8-form plate”, wich reinforces the fixation of the malleolar fragment in about 24,04–36,03%. This technique was realised in 19 fractures of the medial malleola.

Especially for the patients with severe osteoporosis in addition to „8-form plate”, we supplemented this technique with a screw, sagital introduced in the distal tibial methafiz for the anchoring of the tensioned band wire. Thus we prevent the cut of the wire through the methafizar osteoporotic bone.

Surgical treatment of the malleolar fractures using the AO techniques and adjustments, supplemented with some new adjustments proposed and introduced by us, insures good and excellent anatomical and functional results in about 84,85% cases.