The work deals with the preliminary results of studying articular cartilage reparative regeneration under osteoarthrosis experimental modeling with subsequent tunneling subchondral zone and autologous bone marrow transplantation. Under such experimental conditions the proper regeneration potentials of cartilage were manifested in the increase of chondrocyte proliferative and biosynthetic activity. The cellular accumulations, surrounded by intercellular substance, which were found in the foci of cartilage remodeling, indicated to actively proceeding reparative process.

The effect of blood plasma component injections on maturing limb distraction regenerate bone of recipients during fixation has been studied while performing osteosynthesis according to Ilizarov. Blood plasma components were isolated in dogs during distraction of leg bones. Clinical evaluation was made in 16 patients during orthopaedic pathology correction by the technique of polyfocal multisegmental transosseous osteosynthesis; autoplasma components were infused into distal tibial regenerate bone. Numbering and computer analysis of x-ray pictures were performed. Blood plasma component injections have been demonstrated to induce acceleration of the processes of distraction regenerate bone mineralization, that is reflected by changing the architectonics of regenerate bone’s tissue complex towards breaking mineralization foci up into smaller units and higher rates of its maturing. The results obtained evidence the worth-while use of blood plasma components for the purposes of reparative osteogenesis stimulation.

In the experiments on 10 adult mongrel dogs in 5 days after closed flexion osteoclasia graduated leg lengthening was started by 1.0 mm per day: by the technique of day-and-night autodistraction – in the I series, and with 4-fold divisibility – in the II one. The animals were removed from the experiment after 28 days of distraction and 30 days of fixation. The transverse ultra-thin sections of the anterior tibial muscle were contrasted according to Reynolds, investigated using JEM-100B transmission electron microscope with 11800x magnification. Ultrastructural-and-stereological analysis was made: image projections of capillaries in their nuclear-free zone with total х44840 magnification were superposed with an open test grid of short segments (1-cm pace), the validity of differences was determined on the basis of Wilcoxon tests and randomization of components for independent samples. In addition, information analysis was made, which characterized the organization level of biological object as an integrated system. The values of information and relative entropy were calculated, as well as the coefficient of redundancy and organization. It has been shown that under the conditions of distraction of little divisibility the signs of increased metabolic activity and intensification of reductive-oxidative processes are characteristic of capillary endothelium, and at the same time the minimal values of the coefficient of redundancy and absolute organization – the indicators of system reliability are noted, as well as the maximal values of information and relative entropy. The undoubted advantage of day-and-night autodistraction has been demonstrated, especially on completion of lengthening period, when the coefficient of redundancy and the absolute organization are 2.4-fold higher in comparison with the technique of 4-fold divisibility, and on completion of fixation period the difference has amounted to 1.2, respectively, the values of information and relative entropy under autodistraction are minimal.

The histomorphometrical study of sciatic nerves in 27 dogs has revealed the advantage and expediency of treatment of ischial bone fractures surgically using an external fixator in comparison with conservative treatment. Due to early reposition of fragments and to stable fixation the possibility of sciatic nerve recompression is avoided, thereby leading to less damage of the nerve, less manifestation of destructive-and-reparative process, as well as to more successful recovery.

The relationship of some intraoperatively measured values of regional blood flow in different vascular pools of lumbar enlargement and those of the mean amplitude of total lower limb muscle EMG in patients with spine-and-spinal cord injury of thoracolumbar spine has been analyzed. Ten patients (3 females, 7 males) with thoracolumbar spine-and-spinal cord injury at the age from 24 to 58 years who underwent surgical treatment in the department of neurosurgery at RISC "RTO" were examined. The values of maximal systolic (Vs) and volumetric (Qs) blood flow velocity in the pool of the anterior spinal artery of the lumbar enlargement registered intraoperatively both in pre- and post-decompression periods in the patients mentioned have been demonstrated to correlate with the basic quantitative parameter of MVA-pattern of voluntary EMG (mean amplitude) of lower limb muscles. The critical value Qs that corresponds to "bioelectrical silence" of the muscles examined amounts to 2.5 ml/min.

Comparison of the values of spinal muscle EMG statistic characteristics and those of EEG wave structure in patients with scoliosis of I-II degree for prolonged static muscle tension was the main purpose of our study. Examination of m. erector spinae EMG power while isotonic maintaining 50% of the maximal force of voluntary contraction made by the muscle during 30 sec in patients with scoliosis of I–II degree demonstrated that the values of maximal electric activity, frequency, amplitude, amplitude-frequency ratio, high-low frequency ratio were registered in patients with high plasticity of CNS neurodynamic processes and minimal values of the parameters mentioned above – in patients with CNS mean plasticity.

We have gained the experience of treating 42 patients, who, for different reasons, were subjected to endoprosthetic surgeries of large joints (surgeries of the hip in 26 patients, those of the knee – 16 patientsв). All the patients were treated by the technique of transosseous osteosynthesis after implant removal and sequestrenecrectomy performance. After the fixator removal purulent process stopping and weight-bearing recovery were observed in 100% of patients. Arthrodesis was achieved in 34 patients, nearthrosis – in 8 ones. By the data of long-term results, 98,5% of positive outcomes of treatment were revealed, that was manifested in persistent remission of inflammatory process.

The intramedullary system of fragmental fixation for long bone fractures has been advancing in correspondence with technical progress. The introduction of the intramedullary blocking osteosynthesis into practice for treatment of long bone fractures, pseudoarthroses, which has been recently called «the gold standard» in traumatology, competes with Fixion intramedullary fixation system (Disc-o-Tech, Tel Aviv, Israel). This work deals with rarely used in the RF new system of self-locking an intramedullarily inserted nail throughout the intramedullary canal extent. Technical scopes for the nail are described, as well as those for osteosynthesis of long bones in femoral, humeral, leg segments in case of different pathology and fractures. Indications are designated, treatment results in 15 patients are demonstrated. Obvious advantages of this method have been reported in comparison with the intramedullary blocking osteosynthesis, and the authors’ first impressions have been stated.

The clinical-and-roentgenological analysis of examination results has been made in 181 patients with tibial shaft defect of different genesis, admitted to the Centre clinic for treatment. Defect filling was performed according to the techniques of RISC ―RTO‖ with tibiofibular synostoses formation.

We have gained the experience of managing 23 subjects with active solitary bone cysts of long tubular bones. Good outcomes of treatment were achieved in a group of 16 patients, who were subjected to puncture medicamentous therapy simultaneously with transosseous osteosynthesis. Recurrences of the disease occurred in three patients out of seven ones, who were subjected to transosseous osteosynthesis alone.

The aerobic microflora of gunshot bullet-induced femoral and lower leg fractures has been studied in a group of 47 wounded persons. Severe wounds were predominating with the presence of foreign metal bodies in the wound. The interval duration between the wounding and the onset of specialized care rendering varied from 2 to 70 hours. Primary stabilization of gunshot fractures after debridement was performed with external fixators in 34 wounded persons. The wounds were not sutured, they were treated with antiseptic dressings. Inoculation from the wound was made before debridement and 72 hours after it. The primary prevailing flora was represented by Staph. Aureus, which further was replaced by saprophytic flora (Staph. epidermidis, E. coli, P. aeruginosa), having become the cause of complications (osteomyelitis, wire tract infection) in 6 wounded persons out of 8 ones. There were no strong correlations between the duration of the period from injury to debridement, the degree of wound bacterial contamination and the purulent complications of gunshot fracture.

The analysis of surgical treatment of 48 patients with bilateral pelvic injuries was performed. The problems specific for bilateral pelvic injuries were evaluated, and on the basis of these problems the rational ways of such injury surgical treatment were developed depending on injury type and the period of time elapsed after injury. The external fixator of the authors’ original design was used for reposition in most patients (40/48). Immediate and long-term results were studied in 48 patients, follow-up varied from 1 to 5 years. Excellent anatomical results were obtained for class В3 injuries in 86.7% of cases, for С2 in 80%, С3 37.5%. Excellent and good functional results according to Mageed at 1 year after surgical treatment amounted to 77 % (37/48). In the group of rotationally instable injuries positive results amounted to 87% (26/30), in that of vertically instable injuries 61% (11/18). Thus, the technique proposed and the ways of surgical treatment have allowed to obtain comparable results in comparison with unilateral injuries despite the greater severity of injuries.

The original external fixator was used for deformity correction and stabilization of the bone position achieved in all cases. The details of design of the fixator are described, as well as the technique of its application, the technique of osteotomies of pelvic bones, and internal fixation techniques for them and pelvic articulations. The features of stage-by-stage correcting pelvic deformities of different types by the techniques developed according to the working classification proposed are presented.

Within the period of 2005-2009 112 patients with humeral distal segment fractures were treated. When conservative treatment was used, excellent and good results were achieved in 46,66%, as for patients with type A without displacement – in 100%. When surgical treatment was used, excellent and good results were achieved in 90,41%. Satisfactory results were obtained in 9,58%. Early prevention of edema and hematoma of the elbow and soft tissues, adequate rigid fixation of fractures with maximal restoration of the elbow congruence free of additional immobilization, and its early active movements – these are important elements of the elbow contracture prevention and positive outcome achievement.

The wire-and-rod device for osteosynthesis of intra- and periarticular fractures of the knee has been described in the article. In the process of treatment this device decreases the traumatic effect, fixes bone fragments in a stable way, expands the approach of observation, contributes to patient’s early activation.

Chronic instability of the ankle as a result of damaging distal tibiofibular syndesmosis ligaments is a frequently occurred complication of this joint injuries and requires surgical treatment. Case histories of 45 patients with chronic ankle instability of 5 months-20 years duration have been studied. Allotendografting of distal tibiofibular syndesmosis and its fixation with the Ilizarov device were performed in all the patients. The results of treatment were considered as excellent and good ones in 90 % of cases, as satisfactory ones – in 10%.

In the review the authors have analyzed the interrelation between skeletal mineral density and fracture incidence in detail. Risk factors, predictors of fractures have been considered, threshold values of mineral density have been established in the sites of the greatest trabecular bone content.

Using CT and MRI techniques, the quantitative parameters of the hip soft-tissue component normal picture have been studied in 50 adult patients examined for the pathology of small pelvis organs without complaints and changes in the hip area in three age groups: the first group from 18 to 35 years, the second one – from 36 to 55 years, and the third – 56 years and more. The dependencies of density values on tissue structure features for CT have been determined. The average density values for separate muscles normally are closely connected with the features of each muscle belly structure, high figures conform to the muscles with the low content of fatty and connective layers, and low ones evidence the higher content of layers. Age-related variations of densities and sizes allow to evaluate the involvement of each muscle in pathological process more exactly.

MRT and US studies have been performed before and after arthroscopy in 26 patients at the age of 14-63 years with closed injuries of the knee. To compare the results and to determine US effectiveness during the knee structure evaluation the parameters were used, included in the standard protocols of studying patients with closed injuries. The results of the work demonstrated rather high US effectiveness for intra-articular injury diagnostics. As for comparative analysis, US use turned out to be the most advantageous for diagnosing the exudation into the articular cavity, for the assessment of the intactness of ligamentous apparatus, menisci, and Baker’s popliteal cysts.

The results of roentgenological examination of 250 patients with the hip congenital dysplasia at the age of 2.5-16 years have been analyzed. The roentgenographic measurements of articular components and the character of their relations corresponded to their age norm in 47 joints. As for the remaining joints, the underdevelopment of acetabulum and proximal femur of different degree had place in them. The roentgenological classification of the hip dysplasia has been developed on the basis of the character of proximal femur deformity and the orientation of femoral head with regard to acetabulum. The use of this classification enables to approach the selection of optimal rehabilitative measures in children with the hip underdevelopment of different degree individually.

The aim of this study was to analyze the dynamics of the structural state of distraction tibial regenerate bone using ultrasonography in patients with achondroplasia in the process of treatment. Patients with achondroplasia at the age of 9-18 years (n=25) were examined. Leg bone lengthening was performed using the techniques of mono- and bifocal distraction osteosynthesis. Regenerate bones were evaluated by ultrasonography technique in the periods of 10, 20, 30 and 60 days after distraction onset and in the period of fixation with linear and sector sensors of 7.5 mHz using the modes of 2D and energy Doppler. Sonometric sizes, echo-density value, vascularization of distraction regenerate bone were measured. It was demonstrated that only dynamical examination allows to diagnose and predict the process of reparative osteogenesis with high accuracy.

The article deals with a clinical case, when there are certain difficulties to determine the degree of flatfoot by the data of x-ray studying. The substantiation is analyzed concerning decision-making in such cases.

Aim: to determine the potentials of I. Ponseti technique in treatment of clubfoot typical and non-typical forms of severe degree depending patient’s age. 28 patients were included into the study: 12 boys, 16 girls (totally 36 clinical cases: 1 deformed foot – 1 clinical case, 1 patient with bilateral clubfoot – 2 clinical cases) with foot deformities of severe degree for congenital clubfoot, who were treated in the period from June 2009 in the Novosibirsk Scientific Research Institute: in 19 clinical cases I. Ponseti classic technique was used, in 16 treatment was performed according to the technique described by the authors using a transosseous fixator, in 1 clinical case correcting cuboid bone osteotomy was made additionally with wedge movement onto the medial sphenoid bone. Right-sided deformity occurred in 12 patients, left-sided one in 8, bilateral one – in 8. В возрастных The patients in age-related groups were distributed as follows: from 0 months to 1 year – 12 clinical cases (in overwhelming majority of cases in this group treatment started before the age of 3 months), from 1 year to 2 years – 13 clinical cases, 2 years and above – 11 clinical cases. On the average, in all the patients after performing 3-5 plastering stages according to I. Ponseti classic technique practically complete correction of all clubfoot elements was achieved (including 22 clinical cases, in which комплексе surgical interventions were made in the complex of treating measures). Currently all the children treated are undergoing the stages of rehabilitation with obligatory brace application. The observations demonstrate stable results, the functional preservation of feet joints and roentgenological intactness of intraarticular formations. Feet deformity treatment according to I. Ponseti technique is effective for patients below 2-year age, and at the above age I. Ponseti technique should be combined with surgical correction of feet deformities.

The authors have proposed a diagram of radial nerve projection at humeral level on the basis of the data, obtained from the anatomical, ultrasonic and intraoperative studies, performed earlier. The diagram description is given, as well as the examples of its clinical use. The diagram of radial nerve projection proposed is attached to conventional humeral length, that is why it is more universal and predictable comparing with well-known techniques.

The original techniques for express determination of urine calcium and phosphate ions are described, and the basis of them is formed by the capacity to form the insoluble salts of calcium ions with oxalic acid and those of phosphate ions with ferrum chloride (3).

Aseptic (avascular) necrosis of the femoral head (ANFH) remains a subject of close attention of specialists. Mainly affecting young, able-bodied persons, the disease leads to severe disability. Active use of arthroplasty has relieved stresses in definitive rehabilitation of patients, however, possible long-term consequences of early endoprosthetics in these patients make ponder over alternative methods of treatment at the early stages of the process. Based on studying the current aspects of etiopathogenesis evaluation, the authors consider the possibilities of influencing the mechanisms of ANFH development and working out the variants of its conservative treatment.

The article deals with a rare complication developed during bladder catheterization with Foley permanent soft (rubber) catheter for sharp urine retention in the acute period of traumatic spinal cord disease. The difficulty of clinical diagnosis is caused by the disorder of conducting function of the spinal cord after its injury. Ureteral orifice occlusion occurred after the manipulation led to renal carbunculosis and required nephrectomy performance.

Surgical treatment was performed in a patient with second lumbar (LII) vertebra body fracture suffering from idiopathic osteoporosis. The height of the vertebra body involved was restored, and vertebral-and-medullary conflict was eliminated using metal structures. Drug therapy (Myocalcic, calcium preparations and vitamin D3) was continued.

The article deals with a clinical case of successful treatment in a patient with skeletal bone injury combined with diaphragm rupture. It was demonstrated that the diagnostics of this injury is difficult due to the absence of clinical symptoms in the early days after injury. In these cases treatment tactics should include the measures of patient status stabilization followed by acute surgical intervention to relieve the patient of all injuries. Transosseous osteosynthesis which allows to stabilize the limb segments injured and activate a patient within the early periods is the main antishock measure.