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International Medical Scientific Journal        Issue-3 

10.5281/zenodo.5633974 

1 

    



Art of Medicine           Volume-1 

International Medical Scientific Journal        Issue-3 

10.5281/zenodo.5633974 

2 

 

Art of Medicine International Medical Scientific journal 

 

Founder and Publisher Pascual Izquierdo-Egea 

Published science may 2021 year. Issued Quarterly. 

Internet address: http://artofmedicineimsj.us 

E-mail: info@artofmedicineimsj.us 

11931 Barlow Pl Philadelphia, PA 19116, USA +1 (929) 266-0862 

 

 
  



Art of Medicine           Volume-1 

International Medical Scientific Journal        Issue-3 

10.5281/zenodo.5633974 

3 

ANALYSIS OF REPARATIVE AFTER SURGICAL TREATMENT OF 

DIAPHYSEAL FRACTURES OF THE SHIN BONES  

1
Gafforov A.U., 

2
Asilova S.U., 

3
Teshaev A.A. 

1, 3
Department of Traumatology and Orthopedics and Pediatric Surgery, BSMI, 

Bukhara, Uzbekistan 

2
 Department of Traumatology and Orthopedics, TMA, Tashkent, Uzbekistan 

Abstract. Complications of reparative osteogenesis in long bone fractures 

remain a major problem in traumatology, despite significant advances in their 

treatment. As shown by numerous observations, the disability rate of patients with 

fractures is still high, amounting to 19–37.9%, so it is obvious that it is necessary to 

study the causes of such conditions. Based on the analysis of radiographs of 122 

patients with diaphyseal fractures of the leg bones at the age of 18 to 60 years with 

dynamic observation for 8 months. up to 3 years, the timing of fusion, types of callus 

and the frequency of complications of reparative osteogenesis were established. 

Complications during fracture healing were noted in 46 (37.7%) injured patients. 

Key words: bones, shin, diaphyseal fractures, callus, radiography, reparative 

ostegenesis, complications. 

Introduction 

Reparative osteogenesis in fractures is a complex, multi-stage process, the 

course of which is influenced by many factors, including local, peripheral circulation, 

immune status, and so on [1]. Its essence is the restoration of damaged tissues, 

anatomical shape, function of the damaged bone and the segment of the limb as a 

whole [2]. Fracture healing can take different paths. It largely depends on the quality 

of bone fragments immobilization (complete immobility and good reduction) [3, 4]. 

Morphologically, the following types of callus are distinguished: endosteal, 

periosteal, intermediate, and paraossal [5]. Intermediate callus forms between the 

cortical layers, while the periosteal and endosteal layers are almost absent. With such 

fusion, the absence of periosteal callus is not a sign of poor regeneration [6]. The 

presence of a large periosteal callus indicates not so much the favorable processes of 



Art of Medicine           Volume-1 

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regeneration as the mobility of bone fragments during the formation of the regenerate 

[7]. In addition, the size of the callus is influenced by the volume of the hematoma 

and the nature of soft tissue damage. In healing fractures, they describe mainly the 

periosteal callus, since the endosteal and intermediate calluses, as a rule, are not 

visible behind the general shadow [5]. 

Standard radiography in two projections is the main method for diagnosing 

fractures at the present time, since, according to many authors, up to 85% of primary 

diagnoses are made with its help [8]. However, the assessment of the course of the 

reparative process during the primary healing of fractures (which often occurs during 

transosseous osteosynthesis) may not always be objective [2]. 

Complications of reparative osteogenesis in long bone fractures remain a major 

problem in traumatology, despite significant advances in their treatment [3, 6]. As 

shown by numerous observations, the disability rate of patients with fractures is still 

high, amounting to 19–37.9%, so it is obvious that it is necessary to study the causes 

of such conditions. 

Purpose of the study 

To study the features of reparative osteogenesis in diaphyseal fractures of the leg 

bones in young and middle-aged patients. 

Materials and methods 

The analysis of radiographs of 122 patients with diaphyseal fractures of the leg 

bones aged 18 to 60 years (men - 54.2%; women - 45.8%) in standard projections 

with dynamic observation for 8 months. up to 3 years old. All patients were divided 

into 2 groups in terms of age: group 1 - age from 18 to 35 years (44 patients - 36.1%, 

average age - 28.4 ± 4.3 years); Group 2 - from 35 to 60 years old (78 patients - 

63.9%; average age - 48.7 ± 9.4 years). 

According to VI Gongalsky (1987), the timing of the fusion of diaphyseal 

fractures of the tibial bones is the longest among all fractures of the long bones and is 

2.5–3.5 months for fractures of the tibial diaphysis; with fractures of the diaphysis of 

the fibula - 1.0–1.5 months; with fractures of the diaphysis of both bones of the lower 



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5 

leg - 3.0-4.0 months [9]. It was these terms that were taken into account in the 

analysis; an increase in the duration of fusion up to 2 weeks was not considered a 

delay in regeneration. 

When conducting statistical analysis, the data obtained were expressed in 

absolute values and percentages, to compare the indicators in the groups, the χ2 

criterion was used; discrepancies in the values of individual signs were considered 

reliable if the level of significance was less than 0.05 (p <0.05). 

Research results 

In the study, combined damage to the tibia and fibula was found in 85.2 ± 3.2% 

of cases. In 61.5 ± 4.4% of cases, patients were treated with external fixation devices; 

in 22.9 ± 3.8% - by the method of external osteosynthesis, in 15.6 ± 3.3% - with 

plaster casts. 

Complete union of fractures within 4 months was noted only in 28.7 ± 4.1% of 

cases (35 patients), within 6 months - in 33.6 ± 4.3% (41 patients), up to 8 months - 

in another 16.4 ± 3.3% (20 patients). In 26 patients (21.3 ± 3.7%), the fusion of 

diaphyseal fractures of the tibia was formed over 1.5–2 years, among them, in 9 

patients (7.3 ± 2.4%), the formation of callus took place over 6 months was 

completely absent. 

The most common (p <0.001) when fractures were healed was periosteal callus - 

102 (83.6 ± 3.4%) patients (Fig. 1), less often - intermediate - 14 (11.4 ± 2.9%) (Fig. . 

2) and paraossal - 6 (4.9 ± 1.9%). X-ray signs of endosteal callus (sclerosis at the 

level of the bone marrow cavity) were determined only in combination with 

periosteal and paraosseal bone formations. Intermediate fusion was observed in 

isolated oblique fractures of the middle and distal third of the tibial diaphysis at 2.5–3 

months. Paraosseous fusion was observed during long-term formation of callus in 

patients with complications of comminuted fractures of the tibia. The formation of 

periosteal callus did not depend on the type and location of the fracture. 



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Fig. 1. Patient I., 32 years old: a - on radiographs of the lower leg in frontal and 

lateral projections with the presence of wire splints, a helical fracture of the distal 

third of the tibial diaphysis is determined with a transverse displacement by ½ of the 

diaphysis outward, fragments overlapping up to 1.5 cm and angular displacement, 

open to the inside; oblique fracture of the middle third of the diaphysis of the fibula; 

b - on control radiographs of the lower leg after 7 months. from the start of treatment 

- healed fracture of the tibia due to the formation of circular periosteal and endosteal 

callus 

 

Fig. 2. Formation of intermediate bone callus in patient K., 24 years old at a 

control study 2.5 months after surgical treatment 

Complications during fracture healing were noted in 46 (37.7 ± 7.2%) injured, 

among them delayed fracture union - 60.9 ± 7.2% (p <0.01), pseudarthrosis formation 

- 21.7 ± 6 ,1 %; the development of post-traumatic osteomyelitis - in 26.1 ± 6.5%; 

fused fractures with preserved deformation of the bone axis - 13.0 ± 5.0%; non-union 



Art of Medicine           Volume-1 

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of a fracture with the presence of a bone defect - 6.5 ± 3.6%. Several complications 

were observed in 18 patients (39.1 ± 7.2%). Slowing down of the fusion of 

diaphyseal tibial fractures up to 6 months was not included in the group of patients 

with complications. 

In 43.4 ± 7.3% of patients with complications, their radiological signs were 

determined from 2 to 3 months; in 21.7 ± 6.1% - from 3 to 5 months from the start of 

treatment, that is, in 65.1 ± 7.0% of patients, the treatment tactics could be changed at 

an earlier stage of impaired development of the reparative process. 

The proportion of complications in the groups was: in the 1st group - 25.0 ± 

6.5% (11 patients); in group 2 - 44.9 ± 5.6% (35 patients) (p <0.01). 

Discussion of research results 

According to [3], during the initial examination of patients of working age with 

diaphyseal fractures of long bones, their localization at the level of the lower leg was 

the highest frequency - 54.6%; all the rest (thigh, shoulder, forearm) are only 46.4%. 

The authors noted that the most frequent complication of diaphyseal fractures of the 

shin was slow-healing fractures (62.7%), which coincides with the data obtained in 

the study. 

Slowly healing fractures according to the MSEC characteristics were those 

when, after 4 months. and more after it, the persisting clinical and radiological 

indicators did not allow predicting the patient's recovery in the next 2–4 months, at 

the same time, the existing signs did not give grounds to raise the question of 

changing the treatment tactics. The diagnosis of a pseudarthrosis was made after 6–8 

months. from the start of treatment and was considered as a variant of non-union of 

fragments [3]. At the same time, the term “nonunited fracture” was used to describe a 

condition when, after 4 months of treatment, there were clear clinical and radiological 

signs of the absence of regenerative osteogenesis, indicating the need for a radical 

change in treatment tactics [3]. Such disagreements in the assessment of fracture 

fusion in terms of callus formation, as well as in terms of diagnosis of complications 

of reparative osteogenesis, their interpretation and related changes in treatment tactics 



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require additional research. Until now, the methods of directed drug management of 

reparative osteogenesis have been insufficiently studied, although there are 

publications on the use, for example, of growth factors for its stimulation [10]. 

According to [6], it is possible to determine the timing of dismantling the 

external fixation apparatus, as well as to plan the nature and duration of rehabilitation 

measures for closed diaphyseal fractures of the tibial bones, based on a complex of 

modern methods of radiation diagnostics (including X-ray, computed and magnetic 

resonance imaging), with the help of which it is possible to evaluate the features of 

the formation of contact regenerate and bone remodeling with their quantitative 

assessment. In our opinion, in all patients 2-4 months after the start of treatment, on 

the basis of X-ray indicators (type of fracture, formation of callus, degree of its 

severity), it is possible to predict the duration of maturation of a full-fledged bone 

regenerate, and the use of magnetic resonance imaging in the presence of metal 

structures in such patients are not indicated. 

The reasons for the high frequency of delayed formation of reparative 

osteogenesis in diaphyseal fractures of the lower leg bones in young and middle age 

require further study. 

Conclusions 

1. In most cases, diaphyseal fractures of the leg bones healed for more than 4 

months, with complications in every third patient. 

2. It was found that the incidence of complications of reparative osteogenesis in 

diaphyseal fractures of the shin bones increases with age. 

  



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