CLINICAL RESULTS WHEN USING THE DEVICE TO ELIMINATE FOOTSUBLUXATION, DIASTASIS OF THE TIBIOFIBULAR SYNDESMOSIS,DISPLACEMENT OF ANKLE FRAGMENTS AND TRANSARTICULARFIXATION OF THE FOOT TO THE TIBIA

Abstract

Relevance. Ankle fractures are common injuries that can occur as a result of a simple twisting injury in older, weakened
patients or in a younger population. Treatment of these fractures is aimed at restoring joint stability and alignment in order to
reduce the risk of post-traumatic ankle arthritis. Ankle fractures account for approximately 9% of all fractures, occur with a
frequency of 122 per 100,000 people and a frequency requiring hospitalization of 83 per 100,000 people. The data obtained
from a systematic review of competing surgical technologies has led to the conclusion that further evaluation is needed,
including closer attention to long-term results.
Aim. Improvement of treatment results in patients with complex ankle fractures with subluxation or dislocation of the foot,
using the developed device for reposition and trans-articular fixation of the foot (TFF) to the tibia.
Materials and methods of research. Study design a prospective clinical trial conducted in 2015-2018. In total, the study
included data from 142 patients with closed ankle fractures, with subluxation or dislocation of the foot. Among 142 patients
undergoing transarticular fixation of the foot to the tibia, there were 87 men (61.3%) and 55 women (38.7%) aged 19 to 75
years (mean age M=46.1; SD=2.5; 95% CA (33.5-74.5)).The main group of the study included 97 patients who used the
developed device during treatment. In the comparison group there were 45 people (31.7%), in whom the fixing spokes were
carried out without using a device, and the reposition was carried out manually according to A.V. Kaplan (1979).
Statistical calculations: When analyzing quantitative data, a check was carried out on the correctness of the distribution
of the trait in the sample, with a visual assessment and application of the Shapiro-Wilk criterion. Pearson's χ2 criterion was
used to compare frequency indicators.If the number of any subgroups was less than 10, then Fischer's two-sided exact
criterion was applied. The level of statistical significance p=0.05 was adopted to reject the null hypothesis.
Results. In the treatment of patients with ankle fractures, subluxation or dislocation of the foot and with rupture of the
MBS with the proposed device in patients of the study group, compared with the data of the comparison group, it was shown
that arthroarthritis in the main group, compared with the comparison group, was 3 times lower (5.2%, p=0.07 and 15.6%,
p=0.07), damage to cartilaginous tissues of joints by CT by 31.3%, (p=0.048) less, secondary displacement of ankle and foot
fragments, bending and breakdown of spokes by 12.8% (P<0.01) were less common, and inflammation of soft tissues
around the spokes decreased by 3 times, there was no spoke osteomyelitis at all. Therefore, there were 19.1% more good
treatment results in the main group (p=0.03), and 14.7% less satisfactory results (p<0.01). There were no unsatisfactory
results in the main group. The duration of treatment among patients with complications in the comparative group compared
to the main group was 10.1±0.7 (p=0.04) days (by 11.0%, p=0.03).
Conclusions. The use in clinical practice of the "Device for the elimination of foot subluxation, diastasis of interbertial
syndesmosis, displacement of ankle fragments and transarticular fixation of the foot to the tibia" (RF Patent No.2690613,
June 2019) for the treatment of severe GSS injuries allowed to reduce the frequency of complications observed among
patients of the comparison group during their treatment, thereby improving treatment results patients of the study group.