In article the treatment results comparative analysis of two groups of gun wounded patients with long bone gunshot fractures has shown. In first group the casualties were treated by external ostheosynthesis on medical evacuation stages (145 cases) and in second group the last ones were treated by sequential two sets ostheosynthesis (29 cases). The investigations have shown that sequential ostheosynthesis allows to get complete consolidation in most cases and reduce the probability of fracture malunions in comparison with external ostheosynthesis. The frequency of large joints contractures was approximately in two times less for upper extremity’s injures and in three times for lower extremity’s injures. The treatment terms have also significantly reduced: for about per 43 days (36%) for gunshot injures of arms (p≤0,01) and approximately per 36 days (19%) for gunshot injures of legs (p≤0,05).

In the process of treating 180 patients with tibial shaft fractures (111 cases) and pseudoarthroses (69 cases), the procedure of osteosynthesis was combined the Ilizarov device for external fixation with interfragmental compression of bone fragments using the tightening braces with shape memory effect. For the purpose of bone fragments encircling splintage in spiral, oblique and comminuted fractures as well as for autograft fixation, ring-shaped tightening braces were used, while S-shaped braces were used in transverse fractures and pseudoarthroses. The union of bone fragments in anatomically correct position was achieved in 109 (98.2%) patients with fractures and in 65 (94,2%) patients with pseudoarthroses with good functional outcomes.

The observations were analyzed in 22 patients with complicated closed leg shaft fractures, treated within the period of 1997-2004 in the Minsk traumatological hospitals, being the bases of the traumatology and orthopaedics faculty of the Belorussia State Medical University. Infected trophic bullae were observed in 10 patients, necroses of skin and subcutaneous fat – in 6 ones, bedsores caused by sharp tibial bone fragments – in 3 ones, acute sheath syndrome – in 3 patients. The technique of extrafocal compression-distraction osteosynthesis was used for treatment of the patients.

We studied the contents of some blood serum indices of «POL-antioxidants» system and adenylic system in 84 patients with closed fractures of long tubular bones. The technique for diagnosing the development of inflammatory process in the early postoperative period was proposed on the basis of the data obtained. It allows prediction of purulent and inflammatory complications at the stage of preclinical manifestations.

The effect of local osteogenesis focus that was produced by osteoperforation in the contralateral limb on tibial fracture repair with transosseous osteosynthesis was studied experimentally in mature Wistar rats using the techniques of roentgenology, light microscopy, scanning electron microscopy and electron probe microanalysis. It was established that osteoperforation activated reparative osteogenesis, accelerated compactization and reorganization of newly formed bone tissue, increased the degree of its maturity and provided for formation of proper regenerated bone in earlier periods. Therefore this technique can be recommended to optimize osteoreparation in combination with other techniques of bone fracture conservative and surgical treatment.

The results of experimental work evidencing the involvement of the system of endogenous opioids in the processes of osteogenesis regulation in vivo have been published. Inhibition of the system of endogenous opioids with naloxone hydrochloride leads to stimulation of physiological and reparative osteogenesis.

This research studied the contents of energy metabolism substrates (creatine phosphate, glycogen, lipids) in skeletal muscles and liver of the mice after leg bone fracture modeling. It was revealed that intact animals had clear correlates between the contents of creatine phosphate and glycogen in muscles, as well as between the contents of glycogen and lipides in muscles and liver. These correlations were disordered in animals with leg bone fractures.

The possibility of ventral stabilization used in combination with regional antibacterial lymphotropic therapy was assessed for treatment of patients with spine hematogenous osteomyelitis. The data of treatment of 42 patients with spine hematogenous osteomyelitis were studied. Patients were divided into 3 groups: 11 cases of sanative and reconstructive surgeries in a traditional way (group I), 10 clinical cases subjected to the traditional procedure of surgical treatment with regional antibacterial lymphotropic therapy (group II), 20 cases – sanative and reconstructive surgeries and additional ventral stabilization with “MACS” plate in combination with lymphotropic therapy (group III). The results of treatment were estimated by the dynamics of local kyphotic deformity, complication character and pain syndrome objectification. The use of ventral stabilization in combination with regional antibacterial lymphotropic therapy in addition to radical restorative surgery for spine hematogenous osteomyelitis enables to improve treatment results, accelerate patients’ rehabilitation, and reduce the period of in-patient hospital stay.

The children who suffer from the subclinical natal injuries of the cervical spine develop delayed complications that are caused by cerebro-vascular disorders and vertebrogenic changes. The instability of the cervical spine in some children results in the development of ischemia of the cerebral structures while in other children the cervical trauma itself leads to regional hemodynamic disorders. In children, even small amounts of stretching or compression of the vertebral artery is sufficient for cerebral circulation disorders to occur. Besides, due to rich sympathetic innervation of these arteries, the spasm of the whole arterial bed in the vertebrobasilar pool takes place. Clinically, these consequences manifest themselves in cervical insufficiency or myatonic syndrome. Cerebral hemodynamics in children with natal injuries of the cervical spine has its own specific features which have not been studied properly, and therefore deserve special attention as they contribute to diagnosing the disease and provide for early adequate therapy in the period when the disease clinical signs are minimal.

The effect of microcirculatory blood flow values in the pool of posterior spinal arteries of the spinal cord on thermoesthesia-and-algesthesia state was studied in patients with spine and spinal cord trauma. It was revealed that the perfusion degree of the pool of the posterior spinal arteries after decompression procedures (post-decompression blood flow) influenced the level of thermoesthesia and algesthesia recovery. This effect is observed both in the acute and in the late periods of spinal cord traumatic disease. The materials presented allow us define more exactly the role of compensatory potentials in the vascular pool of spinal cord posterior spinal arteries in thermoesthesia and algesthesia recovery in patients with spine and spinal cord trauma.

The screening of 18,500 schoolchildren in Nizhnevartovsk (Tyumen region) was performed using the technique of optical computer topography. Posture disorders were revealed in 79.5% of the examined children. The study of posture was done in three planes: frontal, sagittal and horizontal ones. A great number of children had posture disorders in several panes simultaneously, therefore one and the same patient can represent posture disorders both in one and another plane. The posture disorder in one plane only was revealed in 27.2% of schoolchildren. There were 10,183 schoolchildren with combined posture disorders in two planes simultaneously (69.2%), and 3.6% were schoolchildren with triplanar posture disorder. Biplanar and triplanar posture disorders represent a multiplanar form and amount to 3/4 of all posture disorders.

Electroneuromyographic (ENMG) changes at the level of lumbosacral plexus were studied in patients with pelvic girdle injuries of different severity degree. Objective critera of such disorders are proposed by ENMG data on the basis of studying foot muscles, peripheral nerves and radicular responses at the level of L4-S2 segments. According to the data obtained for vertical instable fractures of pelvic bones the disorders at the level of lumbosacral plexus were registered in 100 % cases. ENMG was compared with the results of clinical neurological examination of lower limb locomotor activity in patients with pelvic trauma.

This article deals with an original approach to leg weight-bearing restoration in case of tibiofibular synostosis failure, which consists in aimed formation of tibiofibular synostosis, as well as in biomechanical axis correction of the segment. Differentiated use of the developed osteosynthesis approach allows us to reduce the probability of tibial nonunion recurrence.

The authors developed a technique for treating habitual dislocation of the shoulder in sportsmen and patients whose profession involves heavy physical work. It combines multiple closed osteoperforation of the humerus along the path of the intertubercular sulcus and the frontal edge of scapular glenoid cavity with parietal osteotomy of the medial semi-circumference of the surgical neck of the humerus. Posttraumatic hematoma transformation into fibrous tissue strengthens the damaged shoulder capsule (scar barrier), and stabilizes the joint. 15 patients with anterior posttraumatic habitual dislocation of the shoulder underwent the treatment with the technique. The patients’ age ranged from 19 to 43 years. There were 14 (93.3%) males and 1 (6,7%) female. Stability was restored in all the patients with preservation of full range of movements and cosmetics in the shoulder. There were no cases of shoulder dislocation recurrences.

The work was based on the outcomes of treatment of 134 patients with various forms of juvenile femoral head epiphysiolysis. Algorithm of surgical treatment was developed. Treatment tactics was validated in view of the character of pathological changes in the hip.

The results are presented concerning studying articular cartilage reparative regeneration under different conditions of adjacent limb segment lengthening: by the technique of ―fan-like‖ distraction (series1) and using automatic distraction with 3-mm rate (series 2). While using the modes of limb lengthening studied the structural-and-functional changes of reactive and/or destructive-and-reparative character were revealed in articular cartilage the degree of which depends on the amount of one-time lengthening, as well as on the periods of limb distraction and fixation with the device. The intensity of destructive changes was higher for "fan-like" distraction. Activation of proliferative and biosynthetic processes was the main factor which provided for the possibility of change reversibility. In series 1, by the end of the experiment (93 days) proliferation in the articular cartilage was associated with the decrease of secretory active cells in number, cartilage thickness increased to a less extent than in the comparable series. In series 2, at this stage (experiment period 75 days), though regeneration was incomplete, the dynamics of the studied parameters indicated to intensifying of both biosynthetic and proliferative activity of cells, thereby evidencing the possibility of articular cartilage subsequent restitution.

The characteristic features of bone tissue reparative regeneration in the process of limb lengthening were studied experimentally in 19 dogs during limb lengthening with the technique of combined distraction osteosynthesis using clinical, roentgenological and histological methods of study. Animals were withdrawn from the experiment after 28 days of distraction, 30 days of fixation, and 30 days after device removal. It was established that during limb lengthening with the combined technique a typical distraction regenerated bone was formed and the periosteum was the main source of its osteogenic potential.

The work deals with the indications, time periods and tactics of surgical treatment for feet equinoplanovalgus deformity in children with spastic forms of infantile cerebral paralysis in different age groups. A specific method of surgical treatment is recommended depending on the disease form, patient’s age, motor skills, severity degree of the deformity.

The incidence of longitudinal platypodia in adolescents amounts to 17-81%, according to the reported data. If platypodia is suspected in the absence of complaints during foot examination, additional methods of study should be indicated. Visual estimation has high percentage of errors and can lead to the failure of the pathology diagnosis.

The study of static and dynamic walking parameters ("DiaSled-Scan" complex, St. Petersburg) was performed in 13 patients with fractures (4 subjects) and fracture-dislocations (9 subjects) of the talus in out-patient settings after their treatment with the method of transosseous osteosynthesis. The qualitative and quantitative estimation of dynamoplantograms enabled to work out the additional criteria for evaluation of treatment results in the patients with talus fractures. Good result of treatment is the increase of anterior-posterior foot coefficient at the expense of the increase of loading on the metatarsal heads, provided the preserved or moderately decreased loading on the heel is maintained. Also, there are no local loading points on foot parts, but according to the additional measurements of local overloading the foot arch was noted to be overloaded during walking. Satisfactory result of treatment means the decrease of anterior-posterior foot coefficient both statically and during walking, and local increase of partial loading on the heel. According to the main and additional measurements of local overloading both statically and during walking, the overloading of the medial and lateral parts of the foot arch was revealed.

Both structure and density of lower limb bones in 21 patients with vitamin D-resistant rickets and in those with vitamin D-deficient rickets consequences after treatment by transosseous osteosynthesis method were studied using computed tomography (CT) technique. The dynamics of structure changes in the femoral and tibial metaepiphyses of the patients with vitamin D-resistant rickets at the age of 11-16 years manifested itself in random arrangement of bone trabeculae in the medial parts, as well as in irregular sclerosis areas as compared to the bone structure of the patients with vitamin D-deficient rickets consequences. At the age of 17-23 years in the long-term period (from one to three years after the fixator removal), the greatest sclerotic changes were noted in the proximal tibial epiphysis (180±85 НU) while the least ones were in the distal femoral metaphysis (167±84 НU). At the age of 24-40 years, the patients with vitamin D-resistant rickets had minimal density values in the proximal tibial epiphysis (181±106 НU) that was associated with the degenerative changes, being extensive cyst-like reorganization at this level.

In vitro modeling of molecular reactions of peripheral blood mononuclear leukocytes to contact with implants which are perspective for improvement of osteosynthesis techniques can be used, in our opinion, for prognostic estimation of acceptance/rejection of artificial materials and the prospective usage for surgical treatment of patients with osteogenesis imperfecta and connective tissue dysplasia.

The analysis of hemostasis indices was performed in 83 patients that had major joint arthroplasty. It showed that using molecular markers enabled to reveal preoperative coagulation and fibrinolysis dysfunction, to investigate the dynamics of hypercoagulation syndrome phase changes, to trace the intensity and variability of thrombinemia by standard antithrombotic prophylaxis with enoxaparin.

The study compares the musculofatty component mass of the lower limbs in patients with achondroplasia and in normal children at the age of 6-20 years. Soft tissue mass was determined with «Lunar» bone densitometer. To determine the changes in limb soft tissues, the coefficient of muscular/fatty tissue ratio was used. The obtained results evidence that the lower limb morphometric characteristics in patients with achondroplasia after surgical lengthening conform to the analogous values in normal children.

Electromyographic examinations of 29 patients at the age of 4-18 years with congenital developmental anomalies of the upper limb have demonstrated that the activation ability of forearm muscles in the limb involved is to greater extent decreased in the developmental disorder of radius. In case of shortening of the forearm not accompanied by defects of its bones the decrease of the ability of forearm muscle voluntary activation is minimal. EMG changes by maximal voluntary tension in patients with ulnar defects stand midway. Numerous low-amplitude EMG patterns of lengthened forearm muscles in patients with upper limb developmental anomalies reflect variety of the processes of adaptation and disadaptation of motor unit peripheral structures under the conditions of distraction osteosynthesis. The recovery of EMG-parameters within the periods of 1 year after treatment in patients with different variants of developmental anomalies also has a wave-like character and represents an oscillatory transitional process.

The aim of the work was to study the effect on bone and skin reparative regeneration of two concentrations of isolated from blood serum fraction used as part of an agent with ―Tizol‖ ointment base for outer application in 30 laboratory white mice experimentally. The animals who had closed fractures of leg bones three days before blood intake served as donors of serum components. The animals which were subjected to rib fracture were recipients of the agent. It was established that using the ointment base alone, as well as the blood plasma fraction of higher concentration, did not have a statistically significant effect on the size of cells of osteo- and chondroblastic lines, while the blood components of less concentration produce a marked osteoinducing effect. A favourable effect on kerato- and dermogenesis was noted in both experimental groups, and this effect was the most marked in the group with higher concentration of blood serum components.

Antibioticogram analyzing results are shown for S. aureus, S. epidermidis, Enterococcus spp., P. aeruginosa, isolated from patients with chronic osteomyelitis and from open fracture wounds within the period of 2005-2008. The antibiotic resistance of the strains was comparatively assessed using the coefficient of resistance. The analysis demonstrated the tendency towards decreasing of the antibiotic resistance of the strains, isolated from patients with chronic osteomyelitis. The converse results was revealed while studying the antibioticograms of bacteria, isolated from open fracture wounds with increasing resistant isolates in number. Pseudomonas aeruginosa, isolated both from open fracture wounds and osteomyelitis foci, was characterized by high proportion of the strains that were non-sensitive to the antibiotics being tested, though the resistance of this microorganism to antibiotic influence was reliably established to decrease for the period studied.

The results of the study on social and cultural adaptation of 14 foreign patients that were treated at RISC ―RTO‖ within the period from 2005 to 2008 are shown. Total periods of their individual treatment varied from 6 to 11 months. It was established that the process of their psychological and emotional adaptation occurred by stages and was complicated by prolonged information deficit, which was caused by language barrier as well. It leads to psychological intolerance, aggressiveness, and lower sociability. On the whole, the behavioural features of the treated patients can be described as ―culture shock‖ which at initial stages manifests itself in anxiety, aggressiveness and diffidence followed by gradual improvement (adaptation stages 4 and 5) in more positive spirits and confidence in the future.

New settlers of the North, men and women, adult and elderly ones, healthy and those suffering from arterial hypertension and chronic obstructive lung diseases, were examined. Age, blood circulation and breathing dysfunctions reduced their quality of life.

Potential risks of using medical equipment in medical institutions have been analyzed. Three fields of risk are singled out: personal (patients, users and the third persons exposed); associated with devices (affecting a medical product from outside, characteristic of a medical product, coming from a medical product); production and economic (expenses for purchase and use). The regulations on risk control have been formulated, based upon adherence to law principles, education of users, insurance, refinancing and operating. Specific recommendations on risk management for specialists are given.

The article deals with the author’s points of view on the main tendencies and problems concerning laboratory service. The relationship of scientific and technical progress with organizational structure of laboratory service is clearly traced. Attention is paid to the increase of the need for laboratory analyses as an integral part of the treatment process of conclusive medicine. The vital importance of laboratory service has been emphasized in the programs of public health modernization. New organization and legal forms of clinical diagnostic laboratory (CDL) have been proposed.

The results of studying the age-related changes in skeletal bone mineral density (BMD) in normal males at the age from 3 to 85 years determined with computed tomography and X-ray double-energy bone densitometry were analyzed. In immature children, BMD values in the spine were identical. Unlike adult subjects, they had the direct dependence between bone mass and body length, which disappeared as soon as puberty started. Then BMD increased to a greater extent in girls than in boys, as a result of girls’ earlier pubescence. After pubescence, the density of cortical bone significantly correlated with the anthropometric indices of the body length, mass and the volume of muscles and connective tissue. Trabecular bone density of vertebrae increased only at the later stages of pubescence.