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Diaphyseal fractures of the third metacarpal bone (MC III – metacarpus III) are a major challenge for the veterinarian. Because these bones have minimal soft-tissue coverage, there is a high risk of open fracture and subsequent infection. Among all methods of osteosynthesis used for the treatment of diaphyseal fractures of the MC III in horses, the most popular uses metal plates attached to the bone surface. Unfortunately, there is a fundamental problem associated with plate osteosynthesis, since the attachment of two such plates requires the use of 20-24 screws, which involves substantial tissue trauma and wound closing difficulties. Another important issue is the fact that the fixation is too stiff, which prolongs the time of new bone formation and therefore healing. The most serious complications that occur after this type of surgery are infections and the screws loosening in the bone. They are also the common cause of failure in bone fracture treatment in horses. The duration of surgery is another problem in horses, because osteosynthesis prolongs general anesthesia, which may result in postanaesthetic myositis and circulation disorders. There is also the risk of osteosynthesis break-up when the horse manages to stand up after the first (main) or second (screw removing) surgery. Moreover, plates cannot be applied in the case of open or infected fractures. These difficulties make it necessary to search for better solutions, including the use of external fixators. Their main advantages are the quick insertion of implants and limited tissue trauma associated with it. The removal of implants is easy and does not require general anesthesia. Because of the lack of direct contact with the fixators (except for the pins), the blood supply to bone is not obstructed, which is beneficial for healing. External fixators can be used in the treatment of open fractures, which are often contaminated and infected. So far, no dedicated fixator for the treatment of diaphyseal fractures of MC III in horses is available on the market. The authors of this article have developed a fixator designed specifically for the treatment of diaphyseal fractures of MC III, which has successfully passed strength tests.
The most popular method of repairing diaphyseal fractures of the third metacarpal bone is the use of two plates attached directly to the bone. However, the closing of tissue over the plates may be difficult. Moreover, many such fractures are open and therefore contaminated and infected. In such situations, plates cannot be applied. The use of implants fixed in the bone with polymer-coated dressing (cast transfixation) is promising, but the stabilization of bone fragments is insufficient, which can lead to the loosening of the connection between the implant and the dressing. The use of external fixators in the treatment of bone fractures, although quite common in human medicine, is still very rare in horses, No solution for diaphyseal fractures of the third metacarpal bone is currently available on the veterinary market. One possible option might be the use of an external fixator developed by the authors of the present study. The main part of the fixator consists of three metal rods with a diameter of 8 mm and a length of 23 cm, parallel to each other and placed along the long axis of the bone. In the proximal and distal parts of the device, the rods are connected by crescent-shaped plates. On these three metal rods, arms with implant connectors are mounted, attaching the fixator to the bone. It is attached to the third metacarpal bone by 6-8 self-tapping Apex pins with a diameter of 6 mm. The device was designed to meet the following requirements: ease of application and removal, small tissue trauma associated with these operations, adjustable flexibility of fixation and possible correction during treatment, low weight, easy access to the operated area and the possibility of treating an existing wound, good stabilization of bone fragments, and suitability for different types of fractures. The new fixator fully satisfies all these requirements The fixation achieved by means of the device has successfully passed strength tests, and this solution is planned to be implemented in the treatment of selected fractures in horses, especially transverse diaphyseal fractures of the third metacarpal bone.
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