Science and Innovations in MedicineScience and Innovations in MedicineНаука и инновации в медицине2500-13882618-754XFSBEI of Higher Education SamSMU of Ministry of Health of the Russian Federation10968610.35693/2500-1388-2022-7-4-281-288Traumatology and OrthopedicsТравматология и ортопедияReview ArticleCurrent trends in the development of long tubular bones osteosynthesisСовременные тенденции развития накостного остеосинтеза длинных трубчатых костейhttps://orcid.org/0000-0002-6031-4824PankratovAleksandr S.ПанкратовАлександр Сергеевич
Russian Federation

PhD, Associate professor of the Department of Traumatology, orthopaedics and emergency surgery n.a. academician of RAS A.F. Krasnov

канд. мед. наук, доцент кафедры травматологии, ортопедии и экстремальной хирургии имени академика РАН А.Ф. Краснова

a.s.pankratov@samsmu.ruhttps://orcid.org/0000-0002-9004-7018RubtsovArtemii A.РубцовАртемий Алексеевич
Russian Federation

resident of the Department of Traumatology, orthopaedics and emergency surgery n.a. academician of RAS A.F. Krasnov

аспирант кафедры травматологии, ортопедии и экстремальной хирургии имени академика РАН А.Ф. Краснова

a.a.rubtsov@samsmu.ruhttps://orcid.org/0000-0003-3830-2998OgurtsovDenis A.ОгурцовДенис Александрович
Russian Federation

PhD, Associate professor of the Department of Traumatology, orthopaedics and emergency surgery n.a. academician of RAS A.F. Krasnov

канд. мед. наук, доцент кафедры травматологии, ортопедии и экстремальной хирургии имени академика РАН А.Ф. Краснова

d.a.ogurcov@samsmu.ruhttps://orcid.org/0000-0002-9300-2704KimYurii D.КимЮрий Дмитриевич
Russian Federation

PhD, assistant of the Department of Traumatology, orthopaedics and emergency surgery n.a. academician of RAS A.F. Krasnov

канд. мед. наук, ассистент кафедры травматологии, ортопедии и экстремальной хирургии имени академика РАН А.Ф. Краснова

yu.d.kim@samsmu.ruhttps://orcid.org/0000-0002-5854-0961ShitikovDmitrii S.ШитиковДмитрий Сергеевич
Russian Federation

PhD, assistant of the Department of Traumatology, orthopaedics and emergency surgery n.a. academician of RAS A.F. Krasnov

канд. мед. наук, ассистент кафедры травматологии, ортопедии и экстремальной хирургии имени академика РАН А.Ф. Краснова

d.s.shitikov@samsmu.ruhttps://orcid.org/0000-0001-6900-0824ShmelkovAndrei V.ШмельковАндрей Владимирович
Russian Federation

PhD, assistant of the Department of Traumatology, orthopaedics and emergency surgery n.a. academician of RAS A.F. Krasnov

канд. мед. наук, ассистент кафедры травматологии, ортопедии и экстремальной хирургии имени академика РАН А.Ф. Краснова

a.v.shmelkov@samsmu.ruSamara State Medical UniversityФГБОУ ВО «Самарский государственный медицинский университет» Минздрава России02122022742812881508202203102022Copyright ©; 2022, Pankratov A.S., Rubtsov A.A., Ogurtsov D.A., Kim Y.D., Shitikov D.S., Shmelkov A.V.Copyright ©; 2022, Панкратов А.С., Рубцов А.А., Огурцов Д.А., Ким Ю.Д., Шитиков Д.С., Шмельков А.В.2022Pankratov A.S., Rubtsov A.A., Ogurtsov D.A., Kim Y.D., Shitikov D.S., Shmelkov A.V.Панкратов А.С., Рубцов А.А., Огурцов Д.А., Ким Ю.Д., Шитиков Д.С., Шмельков А.В.https://creativecommons.org/licenses/by/4.0https://innoscience.ru/2500-1388/article/view/109686

We reviewed scientific literature on the problem of osteosynthesis of long tubular human bones, published during the last 10 years. The Scopus, Web of Scince, Pubmed, RSCI databases were searched for the articles reporting the results of clinical studies and biomechanical experiments using plate osteosynthesis. The advantages and disadvantages of minimally invasive plate osteosynthesis for different segments have been revealed. The articles reported a lower probability of displacement development in minimally invasive plate osteosynthesis in comparison with intramedullary osteosynthesis, good biological conditions for fracture healing, decreased rate of complications of postoperative wounds due to reduced incisions.

In the concept of biological osteosynthesis, the advantage of axial dynamization and fracture micro-mobility over absolute rigidity was noted. The study also revealed the influence of the parameters of a plate and osteosynthesis technique on the rigidity of the plate-bone system, such as: the working length of the plate, the number of screws on the plate, types of screws (cortical or locking), the plate material and its profile.

The bone osteosynthesis seemed to have new directions of evolution. These include far cortical locking screws allowing micromobility under the plate, providing a "controlled dynamization". An experimental technology of Active Locking Plates has been reported, where the screws with angular stability are locked in holes on elastic sliding elements providing micromobility of the screw relative to the plate.

In general, all the visible results differed in various studies and, sometimes, contradicted each other.

Проведен обзор литературных источников за последние 10 лет, исследующих применение накостного остеосинтеза длинных трубчатых костей человека. Поиск литературы осуществлялся по базам данных Scopus, Web of Scince, Pubmed, РИНЦ.

Были рассмотрены особенности современного остеосинтеза пластинами на основе результатов клинических исследований и биомеханических экспериментов. Выявлены преимущества и недостатки малоинвазивного остеосинтеза для разных сегментов, который имеет меньшую вероятность развития смещения в сравнении с интрамедуллярным остеосинтезом, обеспечивает хорошие биологические условия для сращения перелома, уменьшает осложнения послеоперационной раны за счет уменьшенных доступов.

В концепции биологического остеосинтеза отмечено преимущество аксиальной динамизации и межотломковой микроподвижности над абсолютной ригидностью. Определено влияние на ригидность системы «пластина – кость» и техники остеосинтеза следующих параметров пластины: рабочая длина, количество винтов, типы винтов (кортикальный или блокируемый), материал пластины, ее профиль.

Обнаружены новые направления в накостном остеосинтезе. К ним можно отнести винты с блокированием дистального кортикала (Far Cortical Locking Screw), позволяющие небольшую подвижность под пластиной и обеспечивающие «контролируемую динамизацию». Обнаружена экспериментальная технология активно блокируемых пластин (Active Locking Plates), в которых винты с угловой стабильностью блокируются в отверстиях на эластических скользящих элементах. Это дает небольшую подвижность винту относительно пластины.

В целом все видимые результаты у разных авторов отличаются, а иногда они и вовсе противоречивы.

osteosynthesisLCPbridge fixationpseudoarthrosisfar cortical lockingactive locking platesостеосинтезLCPмостовидная фиксацияпсевдоартрозFar Cortical LockingActive Locking PlatesBergdahl C, Ekholm C, Wennergren D, et al. Epidemiology and patho-anatomical pattern of 2,011 humeral fractures: data from the Swedish Fracture Register. BMC Musculoskelet Disord. 2016;17:159. doi: 10.1186/s12891-016-1009-8Mseddi MB, Manicom O, Filippini P, et al. Intramedullary pinning of diaphyseal fractures of both forearm bones in adults: 46 cases. Rev Chir Orthop Reparatrice Appar Mot. 2008;94(2):160-7. doi: 10.1016/j.rco.2007.11.006Meglic U, Szakacs N, Menozzi M, et al. Role of the interosseous membrane in post-traumatic forearm instability: instructional review. Int Orthop. 2021;45(10):2619-2633. doi: 10.1007/s00264-021-05149-4Mao Z, Wang G, Zhang L, Zhang L, et al. Intramedullary nailing versus plating for distal tibia fractures without articular involvement: a meta-analysis. J Orthop Surg Res. 2015;10:95. doi: 10.1186/s13018-015-0217-5Kwok CS, Crossman PT, Loizou CL. Plate versus nail for distal tibial fractures: a systematic review and meta-analysis. J Orthop Trauma. 2014;28(9):542-8. doi: 10.1097/BOT.0000000000000068Anneberg M, Brink O. Malalignment in plate osteosynthesis. Injury. 2018;49(1):66-71. doi: 10.1016/S0020-1383(18)30307-3Taki H, et al. Closed fractures of the tibial shaft in adults. Orthopaedics and Trauma. 2017;31(2):116-124. doi: 10.1016/j.mporth.2016.09.012Larsen P, et al. Incidence and epidemiology of tibial shaft fractures. Injury. 2015;46(4):746-750. doi: 10.1016/j.injury.2014.12.027Yang L, Sun Y, Li G. Comparison of suprapatellar and infrapatellar intramedullary nailing for tibial shaft fractures: a systematic review and meta-analysis. J Orthop Surg Res. 2018;13(1):146. doi: 10.1186/s13018-018-0846-6El-Menyar A, Muneer M, Samson D, et al. Early versus late intramedullary nailing for traumatic femur fracture management: meta-analysis. J Orthop Surg Res. 2018;13(1):160. doi: 10.1186/s13018-018-0856-4Ghouri SI, Asim M, Mustafa F, et al. Patterns, Management, and Outcome of Traumatic Femur Fracture: Exploring the Experience of the Only Level 1 Trauma Center in Qatar. Int J Environ Res Public Health. 2021;18(11):5916. doi: 10.3390/ijerph18115916Levack AE, Klinger C, Gadinsky NE, et al. Endosteal Vasculature Dominates Along the Tibial Cortical Diaphysis: A Quantitative Magnetic Resonance Imaging Analysis. J Orthop Trauma. 2020;34(12):662-668. doi: 10.1097/BOT.0000000000001853Lai TC, Fleming JJ. Minimally Invasive Plate Osteosynthesis for Distal Tibia Fractures. Clin Podiatr Med Surg. 2018;35(2):223-232. doi: 10.1016/j.cpm.2017.12.005Bondarenko AV, Guseynov RG, Plotnikov IA. Osteosynthesis of shin fractures at the second stage of damage control in polytrauma. Polytrauma. 2021;3:28-36. (In Russ.). [Бондаренко А.В., Гусейнов Р.Г., Плотников И.А. Остеосинтез переломов голени на втором этапе damage control (контроля повреждений) при политравме. Политравма. 2021;3:28-36]. doi: 10.24412/1819-1495-2021-3-28-36Semenistyi AA, Litvina EA, Mironov AN. Classification of proximal tibial fractures and algorithm of intramedullary nailing: efficacy evaluation. Traumatology and Orthopedics of Russia. 2021;27(4):42-52. (In Russ.). [Семенистый А.А., Литвина Е.А., Миронов А.Н. Классификация и алгоритм лечения переломов проксимального отдела большеберцовой кости методом интрамедуллярного остеосинтеза. Травматология и ортопедия России. 2021;27(4):42-52]. doi: 10.21823/2311-2905-1699Belokrylov NM, Belokrylov AN, Antonov DV, Schepalov AV. Stage treatment of patient with gunshot shin wound possessing bone and soft tissue defects in conditions of osteomyelitis. Perm Medical Journal. 2019;36(6):95-101. (In Russ.). [Белокрылов Н.М., Белокрылов А.Н., Антонов Д.В., Щепалов А.В. Этапное лечение больного с огнестрельным ранением голени из ружья с дефектом кости и мягких тканей в условиях остеомиелита. Пермский медицинский журнал. 2019;36(6):95-101]. doi: 10.17816/pmj36695%101Panov AA, Kopysova VA, Kaplun VA, et al. Osteosynthesis results for comminuted fractures of long tubular bones. Genij Ortop. 2015;4:10-16. (In Russ.). [Панов А.А., Копысова В.А., Каплун В.А., и др. Результаты остеосинтеза оскольчатых переломов длинных трубчатых костей. Гений ортопедии. 2015;4:10-16]. doi: 10.18019/1028-4427-2015-4-10-16Polat A, Kose O, Canbora K, et al. Intramedullary nailing versus minimally invasive plate osteosynthesis for distal extra-articular tibial fractures: a prospective randomized clinical trial. J Orthop Sci. 2015;20(4):695-701. doi: 10.1007/s00776-015-0713-9Zou J, Zhang W, Zhang CQ. Comparison of minimally invasive percutaneous plate osteosynthesis with open reduction and internal fixation for treatment of extra-articular distal tibia fractures. Injury. 2013;44(8):1102-6. doi: 10.1016/j.injury.2013.02.006Kim JW, Kim HU, Oh CW, et al. A Prospective Randomized Study on Operative Treatment for Simple Distal Tibial Fractures-Minimally Invasive Plate Osteosynthesis Versus Minimal Open Reduction and Internal Fixation. J Orthop Trauma. 2018;32(1):19-24. doi: 10.1097/BOT.0000000000001007Ahmed A Khalifal TAA-D, Tammam H, ElSayed Said, Refae H. Conventional Open Reduction and Internal Fixation (ORIF) Compared to Minimally Invasive Plate Osteosynthesis (MIPO) for Treatment of Extra-Articular Distal Tibia Fractures – A Prospective Randomized Trial. Ortho & Rheum Open Access J. 2019;13(4). doi: 10.19080/OROAJ.2019.13.555867Li A, Wei Z, Ding H, Tang H, et al. Minimally invasive percutaneous plates versus conventional fixation techniques for distal tibial fractures: A meta-analysis. Int J Surg. 2017;38:52-60. doi: 10.1016/j.ijsu.2016.12.028Bleeker NJ, van Veelen NM, van de Wall BJM, et al. MIPO vs. intra-medullary nailing for extra-articular distal tibia fractures and the efficacy of intra-operative alignment control: a retrospective cohort of 135 patients. Eur J Trauma Emerg Surg. 2022;48(5):3683-3691. doi: 10.1007/s00068-021-01836-4Beytemür O, Barış A, Albay C, et al. Comparison of intramedullary nailing and minimal invasive plate osteosynthesis in the treatment of simple intra-articular fractures of the distal tibia (AO-OTA type 43 C1-C2). Acta Orthop Traumatol Turc. 2017;51(1):12-16. doi: 10.1016/j.aott.2016.07.010Lill M, Attal R, Rudisch A, Wick MC, Blauth M, Lutz M. Does MIPO of fractures of the distal femur result in more rotational malalignment than ORIF? A retrospective study. Eur J Trauma Emerg Surg. 2016;42(6):733-740. doi: 10.1007/s00068-015-0595-8Kim JW, Oh CW, Byun YS, et al. A prospective randomized study of operative treatment for noncomminuted humeral shaft fractures: conventional open plating versus minimal invasive plate osteosynthesis. J Orthop Trauma. 2015;29(4):189-94. doi: 10.1097/BOT.0000000000000232Qiu H, Wei Z, Liu Y, et al. A Bayesian network meta-analysis of three different surgical procedures for the treatment of humeral shaft fractures. Medicine (Baltimore). 2016 Dec;95(51):e5464. doi: 10.1097/MD.0000000000005464Zhao Y, Wang J, Yao W, et al. Interventions for humeral shaft fractures: mixed treatment comparisons of clinical trials. Osteoporos Int. 2017;28(11):3229-3237. doi: 10.1007/s00198-017-4174-1Keshav K, Baghel A, Kumar V, et al. Is Minimally Invasive Plating Osteosynthesis Better Than Conventional Open Plating for Humeral Shaft Fractures? A Systematic Review and Meta-Analysis of Comparative Studies. Indian J Orthop. 2021;55(2):283-303. doi: 10.1007/s43465-021-00413-6Beeres FJ, Diwersi N, Houwert MR, et al. ORIF versus MIPO for humeral shaft fractures: a meta-analysis and systematic review of randomized clinical trials and observational studies. Injury. 2021;52(4):653-663. doi: 10.1016/j.injury.2020.11.016García-Virto V, Santiago-Maniega S, Llorente-Peris A, et al. MIPO helical pre-contoured plates in diaphyseal humeral fractures with proximal extension. Surgical technique and results. Injury. 2021;52(4):125-130. doi: 10.1016/j.injury.2021.01.049van de Wall BJM, Baumgärtner R, Houwert RM, et al. MIPO versus nailing for humeral shaft fractures: a meta-analysis and systematic review of randomised clinical trials and observational studies. Eur J Trauma Emerg Surg. 2022;48(1):47-59. doi: 10.1007/s00068-020-01585-wBel JC. Pitfalls and limits of locking plates. Orthop Traumatol Surg Res. 2019;105(1S):103-109. doi: 10.1016/j.otsr.2018.04.031Thomas PR, Richard EB, Christopher GM. AO Principles of Fracture Management. 2013: II. Germany, Berlin, 2013.Dolganova TI, Shchurov VA, Dolganov DV, et al. Rheological characteristics of tibial regenerated bone. Genij Ortop. 2016;2:64-69. (In Russ.). [Долганова Т.И., Щуров В.А., Долганов Д.В., и др. Реологические свойства дистракционного регенерата большеберцовой кости. Гений ортопедии. 2016;2:64-69]. doi: 10.18019/1028-4427-2016-2-64-69Diachkova GV, Stepanov RV, Diachkov KA, et al. Dynamics of tibial cortical bone density in patients with closed lower leg fractures at treatment stages. Genij Ortop. 2018;24(2):147-152. (In Russ.). [Дьячкова Г.В., Степанов Р.В., Дьячков К.А., и др. Динамика плотности корковой пластинки большеберцовой кости у больных с закрытым переломом костей голени на различных этапах лечения. Гений ортопедии. 2018;24(2):147-152]. doi: 10.18019/1028-4427-2018-24-2-147-152D'iachkov KA, Korabel'nikov MA, D'iachkova GV, et al. MRI-semiotics of the distraction regenerated bone. Med. Vizualizatsiia. 2011;5:99-103. (In Russ.). [Дьячков К.А., Корабельников М.А., Дьячкова Г.В., и др. МРТ-семиотика дистракционного регенерата. Мед. визуализация. 2011;5:99-103]. doi: 10.18019/1028-4427-2016-2-64-69Giannoudis PV, Giannoudis VP. Far cortical locking and active plating concepts: New revolutions of fracture fixation in the waiting? Injury. 2017;48(12):2615-2618. doi: 10.1016/j.injury.2017.11.030Bottlang M, Fitzpatrick DC, Sheerin D, et al. Dynamic fixation of distal femur fractures using far cortical locking screws: a prospective observational study. J Orthop Trauma. 2014;28(4):181-8. doi: 10.1097/01.bot.0000438368.44077.04Tsai S, Fitzpatrick DC, Madey SM, Bottlang M. Dynamic locking plates provide symmetric axial dynamization to stimulate fracture healing. J Orthop Res. 2015;33(8):1218-25. doi: 10.1002/jor.22881Ricci WM, Streubel PN, Morshed S, et al. Risk factors for failure of locked plate fixation of distal femur fractures: an analysis of 335 cases. J Orthop Trauma. 2014;28(2):83-9. doi: 10.1097/BOT.0b013e31829e6dd0Ignat'ev YuT, Nikitenko SA, Rozhkov KYu, et al. Dual-energy computed tomography in controlling reparative regeneration of leg tubular bone fractures. Luchevaia Diagnostika i Terapiia. 2016;1:64-68. (In Russ.). [Игнатьев Ю.Т., Никитенко С.А., Рожков К.Ю., и др. Двухэнергетическая компьютерная томография в контроле репаративной регенерации переломов трубчатых костей голени. Лучевая диагностика и терапия. 2016;1:64-68]. doi: 10.22328/2079-5343-2016-1-64-68Lebedev VF, Dmitrieva LA, Shurygina IA, Khaziev PN. A minimally invasive method for the treatment of posttraumatic disorders of the bone union of the tibia. Acta biomedica scientifica. 2020;5(5):107-111. (In Russ). [Лебедев В.Ф., Дмитриева Л.А., Шурыгина И.А, Хазиев П.Н. Малоинвазивный метод лечения посттравматических нарушений костного сращения большеберцовой кости. Acta biomedica scientifica. 2020;5(5):107-111]. doi: 10.29413/ABS.2020-5.5.14Heyland M, Duda GN, Haas NP, et al. Semi-rigid screws provide an auxiliary option to plate working length to control interfragmentary movement in locking plate fixation at the distal femur. Injury. 2015;46(4):24-32. doi: 10.1016/S0020-1383(15)30015-2Elkins J, Marsh JL, Lujan T, et al. Motion Predicts Clinical Callus Formation: Construct-Specific Finite Element Analysis of Supracondylar Femoral Fractures. J Bone Joint Surg Am. 2016;98(4):276-84. doi: 10.2106/JBJS.O.00684Rodriguez EK, Zurakowski D, Herder L, et al. Mechanical construct characteristics predisposing to nonunion after locked lateral plating of the distal femur fractures. J Orthop Trauma. 2016;30(8):403-408. doi: 10.1097/ BOT.0000000000000593Harvin WH, Oladeji LO, Della Rocca GJ, et al. Working length and proximal screw constructs in plate osteosynthesis of distal femur fractures. Injury. 2017;48(11):2597-2601. doi: 10.1016/j.injury.2017.08.064McLachlin S, Kreder H, Ng M, et al. Proximal Screw Configuration Alters Peak Plate Strain Without Changing Construct Stiffness in Comminuted Supracondylar Femur Fractures. J Orthop Trauma. 2017;31(12):e418-e424. doi: 10.1097/BOT.0000000000000956Röderer G, Gebhard F, Duerselen L, et al. Delayed bone healing following high tibial osteotomy related to increased implant stiffness in locked plating. Injury. 2014;45(10):1648-52. doi: 10.1016/j.injury.2014.04.018Ries Z, Hansen K, Bottlang M, Madey S, Fitzpatrick D, Marsh JL. Healing results of periprosthetic distal femur fractures treated with far cortical locking technology: a preliminary retrospective study. Iowa Orthop J. 2013;33:7-11. PMID: 24027454; PMCID: PMC3748895Li H, Yin Q, Gu S, et al. Research progress in treatment of fractures by far cortical locking technique. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2016;30(1):110-4. PMID: 27062857Wynkoop A, Ndubaku O, Charpentier PM, et al. Optimizing Hybrid Plate Fixation with a Locked, Oblique End Screw in Osteoporotic Fractures. Iowa Orthop J. 2017;37:11-17. PMID: 28852328Adams JD Jr, Tanner SL, Jeray KJ. Far cortical locking screws in distal femur fractures. Orthopedics. 2015;38(3):e153-6. doi: 10.3928/01477447-20150305-50Bottlang M, Feist F. Biomechanics of far cortical locking. J Orthop Trauma. 2011;25(1):S21-8. doi: 10.1097/BOT.0b013e318207885bHast MW, Chin M, Schmidt EC, et al. Mechanical Effects of Bone Substitute and Far-Cortical Locking Techniques in 2-Part Proximal Humerus Fracture Reconstruction: A Cadaveric Study. J Orthop Trauma. 2020;34(4):199-205. doi: 10.1097/BOT.0000000000001668Rice C, Christensen T, Bottlang M, et al. Treating Tibia Fractures With Far Cortical Locking Implants. Am J Orthop (Belle Mead NJ). 2016;45(3):E143-7.Plumarom Y, Wilkinson BG, Marsh JL, et al. Radiographic Healing of Far Cortical Locking Constructs in Distal Femur Fractures: A Comparative Study With Standard Locking Plates. J Orthop Trauma. 2019;33(6):277-283. doi: 10.1097/BOT.0000000000001464Habet N, Elkins J, Peindl R, et al. Far Cortical Locking Fixation of Distal Femur Fractures is Dominated by Shear at Clinically Relevant Bridge Spans. J Orthop Trauma. 2019;33(2):92-96. doi: 10.1097/BOT.0000000000001341Bottlang M, Tsai S, Bliven EK, et al. Dynamic Stabilization with Active Locking Plates Delivers Faster, Stronger, and More Symmetric Fracture-Healing. J Bone Joint Surg Am. 2016;98(6):466-74. doi: 10.2106/JBJS.O.00705Mitchell EJ. The Challenge of Plate-Bone Construct Stiffness: A Swinging Pendulum: Commentary on an article by Michael Bottlang, et al.: "Dynamic Stabilization with Active Locking Plates Delivers Faster, Stronger, and More Symmetric Fracture-Healing". J Bone Joint Surg Am. 2016;98(6):e24. doi: 10.2106/JBJS.15.01337Henschel J, Tsai S, Fitzpatrick DC, Madey SM, et al. Comparison of 4 Methods for Dynamization of Locking Plates: Differences in the Amount and Type of Fracture Motion. J Orthop Trauma. 2017;31(10):531-537. doi: 10.1097/BOT.0000000000000879