IMPROVEMENT OF THE TACTICS OF SURGICAL TREATMENT OF VICTIMS WITH INTRA-ARTICULAR FRACTURES OF THE DISTAL METAEPIPHYSIS OF THE TIBIA

Аннотация

According to domestic and foreign literature, a large number of unsatisfactory results (up to 40%) in the treatment of patients with intra-articular fractures of the distal metaepiphysis of the tibia are associated with massive destruction of the articular surface of the ankle joint. This leads to repeated surgical interventions aimed at correcting the orthopedicconsequences ofthetrauma. Currently, there is no clear algorithm for preoperative planning and operative technique. Thisis dueto errors made during preoperative planning and surgical treatment. For modern medicine, the problem of reducing the labor activity of patients with CRF and leading to disabilityin 26%ofcases is very important. Key words:fractures, distal metaepiphysis, catatravma, Research objective. Increasing the effectiveness of surgical treatment of patients with intra- articular fractures of thedistalmetaepiphysis ofthetibia. The relevance of the diagnosis and treatment of patients with intra-articular fractures of the distal metaepiphysis of the tibia is determined, first of all, by the large proportion of unsatisfactory anatomical and functional results in this category of patients, according to various authors, from 15to 28%. High-energy fractures of the distal metaepiphysis of the tibia are usually caused by a fall from a height (catatravma) accompanied by a fall on straightened legs and are caused by forces directed in the cranial direction along the axis of the tibia [4, 6, 9]. The second most common cause of high-energy injuries under consideration is road traffic accidents [7, 2].As a rule, during a car accident, the ankle joint is affected by a combination of forces, including compression, forced backflexion,and rotation [2.4] 98,7:ROTCAFTCAPMI.SECNEICSLACIDEM ,5202 , yluJ,5emuloV gro.srehsilbupcimedaca.www Materials and methods. On this topic, at the clinical base of the Department of Traumatology and Orthopedics of the DKTF, at the Samarkand branch of the Scientific and Practical Medical Center of Traumatology and Orthopedics, examination and treatment of patients with patellar instability are being carried out. From 2023to 2025, an analysis of 126 patients' medical histories will be conducted: The majority of patients were men (97 victims or 77%). Female individuals were significantly fewer - 29 clinical observations, which constituted23% ofthestudygroup. The ageof thepatients ranged from 19to 64years.. Table-1 Distribution ofpatients by ageandsex. Sex Total Male Female Age Number % Number % Number % 19-29 20 20,6 5 17,5 25 1 9, 8 30-39 37 38,2 3 10,3 40 3 1, 7 40-49 18 18,5 12 41,3 30 2 3, 8 50-59 16 16,5 6 20,6 22 1 7, 5 60-64 6 6,2 3 10,3 9 7, 2 Total 97 100 29 100 126 1 0 0 The injured were divided into two groups depending on the tactics of surgical treatment. The main group consisted of 64 patients, the clinical and radiological parallels of which made it possible to improve the tactics of surgical treatment. The comparison group included 62 victims,in thetreatment of whom only traditionalmodern surgical principles were applied. A clinical, radiological, and CT assessment of the presence and severity of signs of degenerative-dystrophic damage to the ankle joint was conducted, and the patient's quality of life in terms of joint function was studied. For this purpose, the following questionnaires were used: AOFAS -American Orthopaedic Foot and Ankle Society Ankle - Hindfoot Scale, FAAM - Foot and Ankle Ability Measure, FAOS - Foot and Ankle Outcome Score, SF-36 - TheSF-Health Survey. 98,7:ROTCAFTCAPMI.SECNEICSLACIDEM ,5202 , yluJ,5emuloV gro.srehsilbupcimedaca.www The developed surgical tactics were tested in the treatment of 64 patients who came for treatment in the period from 2016 to 2018. The comparison group consisted of 62 patients with similar fractures treated using traditional surgical tactics in the period from 2015 to 2016. This group was selected for the possibility of a comparative analysis of the clinical effectiveness of the improved surgical tactics for the treatment of the studied category of victims. In general, the distribution of injuries in the studied area by the type of fracture under consideration is characterized by the predominance of fractures B2 and C2 - 23.8% and 23.1%, respectively. In both the general group (8.7%) and the comparison groups (7.8% and 9.7%), themost frequent type ofinjury was atype V1 fracture. The American Orthopaedic Foot and Ankle Society Ankle - Hindfoot Scale (AOFAS) questionnaire, which was also used in this study, included 9 questions distributed among the indicators: pain (40 points), the patient's range of motion and physical capabilities (50 points), stickiness of the foot (10 points) - a general scale from 0 to 100 points (100 points correspond to the best score). This scale combines both subjective questions about the intensity of pain, the limitation of maximum range of motion activity during walking, and the results of clinical examination of the patient (walkin