The technology of syndactylia treatment is presented, which consists in graduated controlled and coordinated transferring phalanges and hand metacarpal bones with an external fixator to make a soft tissue reserve in interdigital spaces with their further plasty. Unlike conventional methods of treatment, formation of the interdigital spaces is performed only at the expense of local tissues, skin grafts should not be used, because their taking damages the donor site and results in appearing disfiguring scars in the place of taking.

The skin integument of interdigital spaces has been studied in 9 patients with skin syndactylia and in 10 patients with finger posttraumatic stumps before and after reconstructive surgeries using the technique of transosseous distraction osteosynthesis. In spite of skin different histological picture in patients with different pathology of the hand before treatment start, the general tendency towards the active growth and thickening of epidermis proliferating layers, as well as to dermal normal structure recovery has been revealed in the stress-deformed state of skin integument under graduated tension.

The ways of anatomical restoration of the hand first ray, those being at RISC ―RTO‖ disposal and those improved by the authors on the basis of controlled transosseous osteosynthesis are presented in this article. The mean periods of distraction, fixation for lengthening of the first ray stumps at different levels are given in the work as well. The complications occurred in the process of treatment have been analyzed.

The authors present the main techniques for hand tubular bone lengthening worked out at FSI «RISC» RTO», as well as their use depending on clinical picture on the basis of extended clinical material − 394 subjects with congenital and acquired pathology. 566 segments were lengthened and, in addition, deformity was corrected in 24 patients, dermatoplasty was performed – in 46. The analysis of results revealed that positive results were achieved in all the patients treated – the lengthening obtained was preserved completely. The strength of the grasps available increased; grasps appeared, which were absent before; cosmetic picture of the hand improved. The complications, developed in the process of treatment, accounted for 18%, they didn’t influence the results and periods of treatment significantly.

The work deals with the high-priority problem of treatment of patients with posttraumatic deformities of the hand bones, the advantages and short-comings of currently used methods of treating such deformities have been determined by literature data. . The special features of different transosseous osteosynthesis techniques using the Ilizarov mini-fixator have been shown depending on the localization, type of hand tubular bone deformity. The analysis of outcomes has been made in patients with posttraumatic deformities of the hand bones, treated by transosseous osteosynthesis method.

The authors present their experience of making the procedures of filling post-resection defects with free autografts in 19 patients for tumoral and tumor-like diseases of hand tubular bones. Depending on clinical-and-roentgenological semiotics of the involvement of hand short tubular bones, segmental and intraosseous resection of destruction foci was performed with fixation of fragments and grafts using the Ilizarov mini-fixator. The configurations of mini-fixators proposed allowed to preserve the function of adjacent joints at the stage of transosseous osteosynthesis without limitation of socioenvironmental and, in some cases, working adaptation at the stages of treatment-and-rehabilitation process.

The high priority of the problem of treating patients with the fractures of distal epimetaphysis of the hand metacarpal bones has been demonstrated, as well as advantages and short-comings of currently used methods of treating such fractures have been revealed by literature data. The special features of different transosseous osteosynthesis techniques have been shown depending on injury level and severity for the closed fractures of distal epimetaphysis of the hand metacarpal bones. The outcomes of treatment by transosseous osteosynthesis method have been analyzed in patients with the closed fractures of distal epimetaphysis of the hand metacarpal bones.

Irrespective of wide preventive use of different antibiotics, in case of inadequate primary debridement wound infection complicates the course of hand and finger open injuries in 4-21% of patients, this value reaches 65% for severe cases. We have proposed a complex of surgical measures for operative treatment of hand and finger open soft-tissue injuries using vacuumation and “Cyteal” antiseptic solution. The material is based on the treatment results of 127 patients with open soft-tissue injuries of hand and fingers. The results obtained demonstrated that after performing debridement microflora growth in the first group of patients was noted in 33,3% of cases, in the second one – 8% of cases and in the third group – in 3,3% of cases only.

Histological study of operation material from 14 patients with forearm and hand injuries by a circular saw was performed, that made it possible to revise the insight into injury mechanisms, «no-reflow» phenomenon, as well as to determine the histological correlates of artery traction and avulsion injuries.

According to the authors’ data, radial nerve injuries account for 13-25% of peripheral nerve injuries. All the methods of reconstructive surgeries for hand and finger neurogenic deformities are divided into two groups: dynamic and stabilizing. Dynamic surgeries are intended to restore the active function of fingers, achieved at the expense of tendinomuscular transpositions. The aim of stabilizing surgeries is to produce a functionally favourable position to make grasp function available for fingers.

The work is based on analyzing the data of studying temperature-and-pain sense and hand grasp strength in patients with traumatic brachiplexopathy. Both significant regress of sense disorders and recovery of forearm and hand muscle strength were a success after performing a course of direct electrical stimulation of brachial plexus trunks in combination with pharmacotherapy.

The analysis of the dynamics of integumentary tissue mechanic-and-acoustic state has been made under the conditions of forearm congenital stump surgical lengthening using a skin analyzer (ASA-4) for the purpose of preparation to upper limb prosthetics. Osteosynthesis of forearm stump and osteotomy of one or both bones were performed in RISC ―RTO‖ clinic in 19 patients at the age of 4-18 years using the Ilizarov fixator. The increase of stump length amounted to 4,3±1,1 cm (range: from 3 to 6 cm), and the amount of lengthening reached 12 cm by several stages (2 subjects). Heterogeneity coefficient А(z,x) for integument tissue testing in all the periods of lengthening was established to be below the similar parameter of intact forearm. Its minimal values amounted to 1,1; maximal value didn’t exceed 1,3. A narrow range of changes was noted for acoustic heterogeneity degree in the skin of stump front surface. As for stump face skin in making measurements in different directions, it was revealed that the greatest increase of this value took place in distraction period in case of transverse and oblique diagonal orientation. On the basis of the non-invasive express-diagnostics of stump skin structural-and-mechanical adaptation for lengthening the approaches have been determined to predicting possible soft tissue overextension, stump face perforation with lengthened bone and development of trophic disorders.

97 x-ray images of 19 patients with posttraumatic defects of forearm bones have been analyzed using ―DiaMorph‖ computer-assisted complex. Mean optical density of regenerated bone shadows has been evaluated for the purpose of studying the dynamics of osteogenesis and mineralization of newly formed bone tissue during osteosynthesis. By planimetry of distraction regenerated bones it was established that osteogenesis developed by normoplastic type. Typical distraction regenerated bones were formed while filling defect-diastases; the regenerated bones lost their zonal structure at the end of fixation period. During formation of wedge-shaped regenerated bones clear zonal structure of newly formed tissue was not traced, the area of interlayer occupied significantly less part than it was in case of filling the defects of forearm bones by fragment lengthening and formation of typical distraction regenerated bone.

Surgical treatment is indicated for fractures of radius head and neck with displacement. Surgery was performed in 42 patients. Osteosynthesis with «Aesculap» mini-fixators or screws by AO technique was made in 40 cases. Endoprosthetics of radial head was performed using «Liverpool» endoprothesis (Biomet) in 2 patients. Only one negative result took place due to aceptic necrosis of radial head. The detailed classification of these injuries according to AO type has been proposed, which allows to choose a method for osteosynthesis or endoprosthetics properly.

A differential approach to the choice of optimal configurations of a transosseous osteosynthesis device is required for treatment of forearm bone injuries depending on the level of ulna diaphysis damage. The types of configurations proposed for external fixators in treatment of forearm bone injuries provide the rigidity of bone fragment fixation, preserving the function of adjacent joints and rotation of the segment damaged.

Results of treatment of 25 patients with posttraumatic contractures of the elbow are demonstrated, among them the limitation of forearm supination-pronation function was observed in 8 patients. When restorative treatment was performed using an electromechanical device, good results were obtained in 84,0% of patients and satisfactory ones – in 16,0% depending on the degree of pathological process manifestation in the elbow.

While 20 anatomical objects were studied, the location of radial nerve was determined with respect to the middle of humeral back surface, clavicular acromial process, olecranon. The point of radial nerve intersection with humeral axis was 1,5±0,5 cm (0,5-2 cm) proximal with respect to the middle of humerus, thereby dividing «acromion – olecranon» distance into 2 parts, amounting to 45,6% and 54,4% of conventional humeral length, respectively. The data obtained can be used for radial nerve identification during surgical interventions and different manipulations in the humerus.

The article deals with the results of treatment in 40 patients with double humeral fractures. Consolidation of fragments was achieved in 36 patients. Immediate results were unsatisfactory in four cases; that is why it was required to perform reosteosynthesis in two cases, cast immobilization – in one case, and one patient rejected surgical treatment. In addition, patients’ x-rays have been analyzed and compared with the plan of humeral blood supply to reveal failure causes. It was found that three unsatisfactory results out of four ones were noted in the group of patients in whom the intermediate fragment and both fracture lines were located over the middle third of humeral shaft. The suggestion has been substantiated that this is connected with the site of intermediate fragment location, as well as with the entrance level and bone localization of nutrition artery and its branches. On the basis of significant number of cases, the groups of patients with humeral double fractures were singled out; the form and degree of vascularization disorder in the intermediate fragment have been proposed. It should contribute to predict the character of fracture consolidation process in patients of this category.

The work illustrates a clinical example of successful treatment in a patient with closed intraarticular transcondylar fracture of humerus. The special feature of operative treatment consisted in simultaneous use of the internal osteosynthesis with reconstructive and tubular for one-third plates and the transosseous osteosynthesis of humerus and forearm with the Ilizarov fixator. The aim of both technique use was to create the conditions for accurate reposition of articular surface, and to provide the stable fixation of fragments in the early postoperative period, as well as the graduated training of the elbow movements.

The authors have revealed the advantages of using an external fixator with a ball-and-socket hinge for treatment of complete intraarticular fractures of distal humeral meta-epiphysis on the basis of the results of biomechanical and clinical studies. The method proposed has been used in 12 patients at the age of 18-64 years (mean age 39,5 years). Mean follow-up was 26,9 months (with the range from 12 to 36 months) after surgery. The indications for open reposition and internal fixation with reconstruction or congruent plates were intraarticular fractures of distal humeral met-epiphysis (C2-C3 type by AO classification). The external fixator with a bal-and-socket hinge was used in all the patients for the purpose of early passive mobilization in the elbow. The elbow stability was preserved as a result of treatment, as well as physiological range of movements was recovered in all the patients. Mean range of movements in the elbow amounted to: extension/flexion – 0°/0°/130°±10°; pronation/supination – 70°±10°/0°/70°±10°. Mean score according to the Mayo clinic scale – 95 points (from 85 to 100 points).

74 patients with closed distal humeral fractures have been treated. Mean age was 39,2±1,4 years. Closed transosseous osteosynthesis method was used for operative treatment according to the techniques developed at RISC ―RTO‖. It has been demonstrated that reparative processes of the same type for different fractures of humeral condyle can be obtained at the expense of versatility of the major techniques used. The details of transosseous osteosynthesis technology using the Ilizarov fixatior are described depending on fracture type, character, time from the injury.

The authors have studied MR-tomography anatomy of the shoulder in 40 patients with posttraumatic habitual dislocation of the shoulder and in 6 normal subjects. The traditional IMR-tomography of the shoulder had no necessary level of effectiveness. Therefore, an original technique of MR-arthrography has been worked out for the shoulder instability diagnostics using contrasting the shoulder cavity with 0,5 % solution of Novocain as 30 ml 3 hours before examination. The technique of the shoulder MR-arthrography proposed by the authors has allowed to expand the scopes for radial diagnostics of the shoulder posttraumatic habitual dislocations. Characteristic MR-tomography signs of the shoulder habitual dislocation have been established: deepening and volume increase of axillary sinovial pocket along humeral anterior-internal surface from surgical neck level and lower; widening of the shoulder slit; increased extensibility of the shoulder capsule along the shoulder front and back surfaces.

The technique of directed ligamento-capsular-tenodesis, developed by the authors, provides for multiple closed osteoperforation of humeral bone along the intertubercular sulcus and the inside semi-circumference of humeral surgical neck, as well as along the frontal edge of scapular articular cavity for reinforcement of the shoulder capsule damaged (making a scarry barrier) in patients with the shoulder habitual dislocation under x-ray control (electrooptical transducer). 78 patients with posttraumatic anterior habitual dislocation of the shoulder have been treated. The patients’ age varied within the interval of 18-67 years. There were 47 men (60,2%) and 31 women (39,8%). The shoulder stability was restored in most patients with preservation of full range of movements and cosmetic picture. Recurrent dislocation of the shoulder occurred in 2 (2,6%) patients due to heavy load lifting.

The results of treatment have been analyzed in patients (60 joints) with habitual dislocation of the shoulder after soft tissue surgeries, as well as osteoplastic ones. Positive outcomes of treatment amounted to 80%. Taking into consideration the fact of 20% cases with unsatisfactory results of treatment, which occurred after soft tissue surgeries, the standardized technique of evaluating the shoulder instability degree has been developed and integrated into clinical practice to determine differentiated indications for different technique use to manage the shoulder instability.

The work deals with the results of surgical treatment of the shoulder advanced dislocation in 51 patients. The technique of open elimination of the shoulder advanced dislocation and the shoulder plasty. A surgical approach is demonstrated for the shoulder advanced dislocation with performance of greater tubercle osteotomy. The best results of the elbow movement recovery were obtained in the patients, subjected to the shoulder plasty.

We have studied the anatomical structure of femoral intercondylar fossa and tibial intercondylar eminence with determination of their linear and angular sizes, counting the indices, allowing to make screening diagnostics of dysplastic syndrome. The method of geometrical construction has been used for this purpose. Our study is based on the knee x-rays in standard frontal view in 2 groups of adult subjects (36 normal joints and 36 joints of patients with gonarthrosis of dysplastic genesis).

The quantitative parameters of acetabulum and femoral head normal picture have been studied by computer (CT) and magnetic-resonance tomography (MRI) techniques in 50 adult patients examined for pathology of small pelvis organs without complaints and change signs of the hip in three age groups: the first one from 18 to 35 years, the second one – from 36 to 55 years, and the third one – 56 years and more. The dependences of density measurements on tissue structure features have been determined for CT. Mean density values for normal bone parts are in close connection with structure features, high figures are consistent with subchondral bone and with the zones of force line location, low figures of cancellous bone tissue are beyond the location of force lines. Age-related variations of densities allow to evaluate the involvement of bone zones in pathological process more accurately.