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34. Osteosynthesis and its principles

34. Osteosynthesis and its principles Osteosynthesis (OS) is the most common method of surgical fracture treatment, involving fragment reposition and fixation by implants (plates, screws). Principles of Stability: • Stable Osteosynthesis: Provides firm fixation and enables immediate functional treatment and mobilization after surgery. Examples include Plates, Nails, and Screws (with the lag screw being a basic element). • Unstable Osteosynthesis: Retains fragment position but requires additional fixation (cast, brace) and does not enable immediate mobilization. Examples include K-wires and Tension bands. Types of Fixation: • Intramedullary (IM OS): Implants placed inside the bone canal, such as intramedullary nails (standard for diaphyseal long bones like the femur, tibia, and humerus). Nails can be locked with screws on both ends, and dynamisation (a telescopic effect) can be utilized in comminuted fractures to stimulate healing. • Extramedullary OS: Implants placed on the surface, such as plates, screws, and tension bands. Plates: • Compression Plate: Used for transverse or short oblique fractures, employing a compressarium to achieve compression between fragments. • Neutralization Plate: Used after fragments are initially stabilized (e.g., by a lag screw) to increase overall stability. • Buttress Plate: Designed to rigidly stabilize fractures at the ends of long bones (e.g., around the knee or ankle).