Dynamics of regional blood flow and neuromuscular function restoration after intramedullaru osteosynthesis of the distal tibia fracture

Electromyography, ultrasonography and rheography have been used to evaluate restoration of muscle activity, peripheral nerve conduction and regional bloodflow in 15 patients (24–65 years old) with the distal tibia fractures after intramedullary osteosynthesis. An assessment of muscle motor function indicator was carried out in consequtive stages of osteoregeneration (8–10 days, 1.5–2, 3–4 and 6–12 months). The degree of muscles function impairment, the degree of vascularization of the injured leg segment, the degree of compensation of the initial and secondary disturbances of blood supply were assessed quantitatively. Functional indicators were compared with radiological sings of callus formation, consolidation and remodeling of bone tissue, clinical date on the restoration of weight bearing and movement in the ankle joint. It has been shown that period of rehabilitation treatment are characterized by adaptive redistribuition recirculatory processes that correspond to the metabolic needs of developing bone tissue and varying degrees of impairment of a motor function of muscles and peripheral nerves. Muscle adaptation after intramedullary fixation of the distal tibia fractures has different restoration potency and is not finished after complete fracture union and restoration of full weight-bearing capacity. EMG-signs of subclinical axonopathy of peripheral nerves were revealed, mostly involving distal parts of fibular nerve. These changes may comprise the need to raise the question about feasibility of neurotropic therapy as a measure to improve the results of surgical treatment. The use intramedullary osteosynthesis for complex fractures creates favorable conditions for the implementation of one's own mehanizms of osteogenesis, providing full compensation for disturbances in tissue blood flow, gradual restoration of muscle activity and weight-bearing ability.