[ON THE TREATMENT OF FRACTURES OF THE FEMORAL AND TIBIAL CONDYLE BY PINNING].
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The number of the injuries and of the open fractures is steadily increasing. These latter are regularly due to traffic accidents. Characteristics of the open fractures are the extended lesion of the soft parts and the piece-like fractures. The treatmend depends on the patient's general state, the extension of the lesion of the soft parts, the contamination and the infection of the wound, as well as on the localization and the type of the fracture. In the case of proper indication the osteosynthesis yields satisfactory results, but it is not always to be performed and its use to exposed to dangers. The conservative treatment assures good results, if the lesion of the soft parts is minimal, the reduction of the dislocation is easily accoplished and the bone ends are to be held together. On the other hand, the method is unsuitable, if extended lesion of the soft parts occurs, as well as in the treatment of multifragmental fractures. In this group of the open fractures we must try to find other, new methods.
Open leg fractures observed in 81 patients are analysed by the authors. In case of conservative treatment alone and in the group, which has been treated with primary osteosynthesis satisfactory results have been observed by the authors. False joint and osteomyelitis happened only in the group, in which the patients obtained firstly conservative treatment and in the case of the failure of this treatment osteosynthesis has been carried out. In the authors' opinion the most frequent complications are due - besides the damage of the soft parts - to the repeated and sometimes erroneous interventions.
The results of the treatment of 557 open fractures of the leg are discussed from the standpoint of healing of the fractures. According to the severity of the fracture the patients have been ranked into 3 groups. Although in 95,1% of the patients recovery was obtained, in 50% of severe injuries healing occurred only over 20 weeks. The time of recovery was influenced unfavourably by the non stable osteosyntheses. Conservative treatment performed in a great number of patients yielded satisfactory results. The number of the cases treated with stable osteosynthesis is relatively small for comparison with the former groups. In the authors' opinion, the classification of the cases according to the severity of the fracture is of great importance, since it influences the treatment, the recovery time as well as the prognosis.
The importance of the shaft of the fibula in lower leg fractures is the greater, the more unfavourable the situation of the tibia together with the surrounding soft tissue. We consider the operative stabilisation of the fibula to be a good procedure in cases of distal lower leg fractures, comminuted fractures of the tibial shaft and intramedullary nailing of the tibia, to increase overall stability of the whole lower leg system. The fibula is of still greater importance in cases of non-unions with loss of bone, with or without infection. The reconstruction of the tibial bone defect can be achieved via the stable fibula by means of several modifications of the fibula-pro-tibia operation. It can be demonstrated by various examples that the fibula and its stability should be considered more often in the therapeutic management of lower leg fractures and non-unions of the tibia.
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