Microcirculation parameters of the damaged segment of the lower extremity after treatment of diaphyseal fractures using a locked intramedullary nail

Abstract

Background. An in-depth analysis of the scientific works of scientists and medical practitioners allows us to conclude that locked nail intramedullary osteosynthesis is  the optimal and the most effective method of treating closed diaphyseal fractures of the lower leg bones, which is caused by the high stability of osteosynthesis and minimal damage to soft tissues during surgery. The processes of microcirculation changes in the early postoperative period by various metal structures, including a locked intramedullary nail, still remain unexplored. In particular, there is insufficient data on the use of a locked intramedullary nail. The aim of the study. To identify the features of changes in microcirculation indices of injured lower leg bones during fixation of fragments with a locked intramedullary nail in the early postoperative period. Materials and methods. The microcirculation of the lower limb segment was studied in 25 patients using laser Doppler flowmetry. Data from 25 healthy volunteers were used as a comparison group. Results. It was found that in the early postoperative period, from day 1 to day 10, in patients with diaphyseal fractures of the lower leg bones operated with locked nail intramedullary osteosynthesis, there is a decrease in the cardiac range, an increase in the share of the shunt component of microcirculation compared to the nutritional share, as well as an increase in more than 1 ratio of the cardiac and respiratory range amplitude, which indicates an ischemia type of local circulatory disorder. Compensation of ischemia is done by anastomoses, since the bypass rate is increased. Conclusion. In case of surgical treatment with locked nail intramedullary osteosynthesis, in the early postoperative period, an ischemic type of compensated local circulatory disorder develops. The regeneration process takes place under conditions of reduced arterial microcirculation blood flow and stable venous outflow, as well as the inclusion of anastomoses to compensate for destroyed vessels, which is associated with nail damage to the internal blood flow of the bone endosteum and intraosseous nutrient artery during the surgery.