The results of combined intramedullary osteosynthesis and plating in the cases of intraarticular impression proximal tibial fractures in conjunction with tibial shaft ones are presented. Together with exact reduction and stable fixation of an intraarticular fracture, the technique allows to perform shaft fracture osteosynthesis by closed reduction and minimally invasive fixation. It reduces the probability of postoperative complication development at the expense of minimal surgical damage, as well as provides early limb weight-bearing and the possibility to start the training of limb joint movements in the early periods of time.

168 patients with fractures of tibial condyles are included in the study. Conservative treatment was performed in 64 patients. For surgical treatment used in 104 cases two techniques were used: extrafocal osteosynthesis with the Ilizarov fixator (42 patients) and internal fixation with support plate or without it (the remaining cases). The study excluded the use of bone plate (bone grafting). Long-term results were analyzed in 108 cases including 37 patients after conservative treatment and 71 patients after surgical one. In the immediate rehabilitation period the loss of reposition correction caused by impression changes was observed in 56,5 % cases. As a result valgus or varus deformity of limb axis developed. The results obtained emphasize the necessity bone grafting for treatment of these fractures.

The work deals with the problems of diagnostics and treatment of the patellar dislocation of posttraumatic etiology, which has been revealed for the first time after femoral fracture healing. Seven patients with patellar dislocation of slight degree after femoral fracture treatment were observed. Both the persistent patellar dislocation formed and the knee extension contracture were eliminated by cutting the patellar external supporting ligament, fibrous capsule and by quadriceps mobilization from adhesions. Patellar recurrent dislocation with the knee range of motions not less than 90° was eliminated by cutting the fibrous capsule, the patellar external supporting ligament and by strengthening those structures from the patella inside. Both the correction of femoral distal third deformities and deformed patellar modeling were performed simultaneously if indicated.

Repeated bone fractures in children are one of the main problems in traumatology. This problem is interpreted rather rarely in literature: there is no enough information concerning the use of modern diagnostic methods (MSCT, USE, Dopplerography, Densitometry) for examination of refractures in children. The necessity to solve the problem of treatment for such patients is evident due to high frequency of cases of fracture non-union and pseudoarthroses development. The analysis of treatment of 17 patients was made over the last year in the department of children’s traumatology of Scientific Research Institute of Traumatology and Orthopaedics. By the results of the study one can see that conservative treatment of repeated fractures yields satisfactory results. The indicators of good outcomes for surgical methods of treatment are higher. The use of current diagnostic methods (MSCT, USE, Dopplerography, Densitometry) has given the possibility to select an optimal method of treatment, which gives good results.

An ultrasonic study of contact regenerated bones has been performed in 14 patients at the age from 27 to 53 years with open fractures of leg bones. Reposition of bone fragments was made using the Ilizarov fixator. Sonography technique use allowed to single out two main types of consolidation for open fractures of leg bones. In case of normal process some isolated vessels were visualized in the zone of regeneration. The increased number of block-like formations in the zone of regenerated bone, as well as the presence of «circumflex» artery evidenced an unfavorable process of consolidation.

The effectiveness estimation of both femoral quadriceps and leg gastrocnemius muscle electrical stimulation has been studied with sinusoidal modulated currents in the complex of rehabilitative measures after the knee injuries. The parameters of lower limb regional blood flow have been analyzed, as well as the electrical activity of muscles in the patients of the main group in comparison with the analogous parameters in the patients subjected to the course of traditional rehabilitation.

The authors demonstrate the results of experimental study of the technique of skull osteoplastic trepanation in the projection of ischemia focus using an external fixator, as well as the results of its clinical use in 30 patients. The improvement of muscle strength measurements, those of motor and speech activity, as well as that of social adaptation has been observed even at the stage of distraction regenerated bone formation. The most active recovery of function was observed within the period from 14-th to 42-nd day of distraction. The technique proposed has advantages compared to well-known techniques owing to its use functionality and combined solution of treatment and rehabilitation problems.

The work deals with the results of morphological sciatic nerve study experimentally in 10 dogs with modeling a combined injury of pelvis and femur and its treatment by transosseous osteosynthesis method. The closed injury of sciatic nerve has been revealed with neurapraxia and axonotmesis: the damage of nerve fiber myelin sheathes and axons with further Wallerian degeneration without nerve sheath involvement. The recovery of sciatic nerve morphological structure was of incomplete character by 6 months after device removal (215 days).

The histological study of surgical material from 14 patients with forearm and hand injuries, induced with a circular saw and milling machine, has been performed thereby giving the possibility to define more exactly the insights into specific mechanisms of the injury, which leads to the nerve fiber degeneration of particular type, which differs significantly from Wallerian one and reduces the chances of nerve morphofunctional recovery.

The results of treatment of 213 patients with chronic osteomyelitis of upper limb long tubular bones are demonstrated in the work. The differentiated use of transosseous osteosynthesis techniques depending on purulent process localization and prevalence, accompanying orthopaedic pathology presence (non-union, bone defect, deformity, etc.) allowed to eliminate the disease symptom-complex present at a single stage of treatment within the relatively short periods of time. It turned out well to restore or improve limb function in all the cases, that evidences the properly selected tactics and technique for treatment of chronic osteomyelitis of upper limb long tubular bones.

105 patients with pseudoarthroses and defects of long bones for chronic osteomyelitis were subjected to free autoplasty. Among them the morphological investigation of the tissue fragments obtained from the sites of pseudoarthroses and defects with different duration of pyogenic process and characterized by various pathomorphological changes was made in 54 cases. The results of morphological studying the materials from the patients suffering within the period from three to 12 months demonstrated that reparative regeneration of connective-tissue callus was characterized by the development of inflammatory granulation tissue in it, as well as that of pathological metaplasia of connective tissue with focuses of purulent inflammation. When the disease duration was from one year to three years, fibrous or fibrocartilaginous tissue of heterogenous thickness, structure and maturity degree was observed in the zone of bone fragment union, as well as the sites of edema and mixomatosis, focal lymphocytic, macrophagal-and-plasmacytic infiltrates with formation of microabscesses of round or fissural shape. In patients with pathological process duration of above three years the investigations showed that in some cases the formation of cartilage with margins of fibrillar fibrous tissue was observed in the center of fibrocartilaginous tissue.

The results of microbiological studying the wound diskharge from 24 patients with upper limb chronic osteomyelitis and 131 patients with lower limb chronic osteomyelitis have been analyzed. The specific composition of chronic osteomyelitis causative agents has been demonstrated to depend on the process localization. The segments involved by their degree of infection load can be arranged in ascending order: forearm-arm-leg-femur. In patients with lower limb chronic osteomyelitis the structure of microcenosis was characterized by the increase of bacterial specific variety comparing with the upper limb, and it was remarkable for a lot of isolated Gram-negative bacteria of high persistent potential, that, thereby, led to a prolonged course of pyogenic infection. Nevertheless, S. aureus, which is isolated in monoculture in 75,7% and 44,4%, respectively, is the main causative agent of pyogenic process for both the upper limb and the lower one. The persistent properties of the causative agents revealed in patients with chronic lower limb osteomyelitis are also confirmed by high frequency of the methicillin-resistant staphylococci determined in comparison with upper limb involvement.

The main risk factors of the systemic inflammatory response syndrome development, as well as sepsis different forms for pyonecrotic diseases of soft tissues and postoperative wound infection have been shown, and the rational principles of surgical and conservative treatment of local and generalized forms of soft tissue infection have been described.

The immediate and long-term results of treatment have been analyzed in 282 patients with degenerative diseases of the spine, who were treated using minimally invasive methods of treatment of intervertebral disks, such as dereception (94 cases), laser nucleoplasty (96 cases), as well as dereception combined with nucleoplasty (92 cases). As it was found, a manipulation complication such as diskitis developed with equal frequency in all the 3 groups of patients (within the limits of 3-4%, and it did not require special treatment. For dereception the frequency of pain syndrome regression was 8-9% more, and it was of particular importance, that the regression occurred in the first three days after the manipulation in 94% of the patients. The regression of compression syndrome and hernial protrusion was observed for laser nucleoplasty only within the period of 1 week to 3 months. The resumption of previous work by the patient groups analyzed amounted to 76%, 83%, and 87%, respectively, showing the higher effectiveness of simultaneous use of dereception and laser nucleoplasty of intervertebral disks.

Titanium cages in combination with autobone can be successfully used for interbody spondylodesis of different types together with other known implants. Owing to the holes in the titanium cage body, bone tissue of adjacent vertebrae sprouts into the cage. Favourable conditions are for bone-metal spondylodesis formation. The use of the titanium cage reduces surgery damage and does not require the additional use of iliac crest autograft.

Background: Congenital pseudoarthrosis of the tibia (CPT) is one of the most difficult problems in paediatric orthopaedic surgery. This is a rare condition, which is mostly associated with neurofibromatosis. Treatment options have varied greatly. Successful surgical treatment of tibial pseudoarthrosis is possible by the Ilizarov method. Patients and methods: 7 patients with CPT treated using the Ilizarov technique within the period from 1998 to 2008. RESULTS: Bone healing was achieved in all cases except one. (Union rate – 85,7%). Conclsion: The Ilizarov technique is a comprehensive approach to all CPT aspects. Its use can end with very good results

Blood serum biochemical values were analyzed in children with congenital shortenings of lower limb bones. Lengthening procedure was performed by the technique of monofocal distraction osteosynthesis using intramedullary wires with hydroxylapatite coating or without them. It has been established by us that the presence of hydroxylapatite coating appears to be a factor which changes the dynamics of reparative process. Besides, the changes in blood serum biochemical values, evidencing a maximal stimulating effect in case of using the wires with hydroxylapatite coating, were observed in patients subjected to leg bone lengthening.

The histological, stereological and morphometric analysis of structural changes of the anterior tibial muscle subjected to reinnervation has been made experimentally in 7 dogs at an early stage of canine sciatic nerve posttraumatic regeneration under the influence of therapy using «Myoritm» device, which was performed within the period from 4 to 11 weeks after nerve cutting and primary suturing. It has been established that the vascularization of the muscle being reinnervized by the end of stimulation course exceeds not only the non-stimulated control, but even the value of intact muscle, creating the conditions for survival of muscle fibers in atrophic and normotrophic state, as well as for secondary myogenesis activation.

The results of studying the functional condition of neuromuscular structures have been demonstrated in 49 patients with defects and pseudoarthroses of forearm bones at the stages of transosseous osteosynthesis. The dynamics of neurophysiological condition of forearm and hand muscles in patients with acquired defects and pseudoarthroses of forearm bones was studied in the process of treatment-and-rehabilitation measures using transosseous osteosynthesis. It has been revealed that both localization and size of the forearm bone defect formed (defect-pseudoarthrosis, defect-diastasis) do not have a reliable and significant effect on the condition of limb neuromotor system. The formation of acquired defects of forearm bone framework as a result of injuries and repeated surgical interventions was usually combined with the changes of forearm muscle structure of organic character, and at the same time the disorders of segmental nerve structures were of functional character. The use of transosseous osteosynthesis technologies in treatment of patients with acquired defects and pseudoarthroses of forearm bones did not aggravate the functional condition of limb neuromuscular structures.

The effect of original implantation calcium-phosphate materials on metabolism values of experimental animals has been studied. It has been established that these materials do not have a negative effect on metabolic processes.

The first experience of tomography use for the hip examination in 16 children with congenital and acquired pathology is presented. Comparative analysis of the data obtained by X-ray as well as by tomography examination has been made. Multispiral computer tomography has allowed to obtain more exact image of structural changes and anatomic relations in the hips. It contributed to the selection of surgery optimal scope, as well as to the assessment of change dynamics in different time periods after its performance.

The authors have studied the role of reproducibility error of Lunar Prodigy (version Encore) (Prodigy) apparatus-programming complex in solution of the problems of osteoporosis diagnostics (screening) with projection mineral bone density (PBMD) estimation at T-scale and those of individual quantitative BMD dynamics monitoring. It has been demonstrated that the error depends not only upon the object studied, but upon the area of interest as well. In clinical conditions a single measurement is sufficient for screening. For the purpose of PBMD monitoring in order to minimize the reproducibility error up to clinically negligible values five consequent measurements should be done without placement change, and the results should be expressed as an average meaning for each area of interest. To evaluate the complex clinical potentials it is recommended to test it for bone objects, that supplements, but not excludes, its testing for a phantom.

The drawbacks of the current system of rendering medical care to patients with foot and ankle pathology have been considered, the analysis of the revealed drawbacks of such approach to medical care organization has been made, and a prospective organization-and-functional model for rendering a specialized podiatric care to this category of patients has been proposed.

The work deals with the effect of a single session of neuromuscular relaxation on the change in the values of the systems, responsible for adaptation, as well as on that in collagen metabolism in students’ oral fluid. A positive effect of relaxation technique has been revealed on the subjective assessment of general condition and mood, on the decrease of situational anxiety after relaxation procedure. The functional activity of both sympathoadrenal and hypothalamo-hypophyseo-adrenal systems decreased due to the application of neuromuscular relaxation. Moreover, neuromuscular relaxation influenced collagen metabolism, decreasing the level of free oxyproline in oral fluid. Possible mechanisms of the relaxation technique effect on collagen metabolism are diskussed.

A study of functional state using GcAM (General condition, Activity, Mood) test has been performed to assess the diagnostic potentials of psychophysiological testing in 61 patients during treatment of leg bone closed fractures according to the Ilizarov technique. Moreover, the procedure of psychophysiological testing has been made in 71 pregnant women and those in labor with SF-36 questionnaire. It has been found that GcAM test results allow to obtain an objective pattern of the improvement of general condition, activity and mood in patients as far as the weight-bearing function of the limb injured is recovered. The absolute values of estimations reflect the dynamics of organism’s functional state comparing with the previous level of its decrease. The duration of recovery transition period during leg fixation amounts to more than a month, and after an additional course of hyperbaric oxygenation use – about 2 weeks. SF-36 test use to assess quality of life reflects the dynamics of female patients’ functional state as well, but it’s orientated towards work ability determination in subjects under the test, it doesn’t take account of the details of women’s attitude to reproductive function realization. In addition, some factors also leave a mark upon the results of testing: age of the persons examined, social-and-economic status of their families.

Transcutaneous transpedicular fixation is one of the most modern techniques of surgical treatment of thoracic and lumbar vertebral fractures, allowing to reduce the damage of surgical intervention significantly with preservation of all the advantages of open transpedicular fixation. The exclusion of spine muscular system damage and that of hemorrhage during surgery, reduction of surgical intervention duration – these are the main positive aspects of the technique proposed. 18 patients with thoracic and lumbar vertebral fractures of B and C types (according to AO) were operated, and excellent and good results were achieved in all of them.

A rare clinical case of foreign body removal from ala ossis ilii is diskussed in the work. It was a surgical drape left four years ago during extraarticular surgery in the zone of ala ossis ilii, that further simulated bone cyst.

New models of «Fixart» device are presented for treatment of the hip pathology in children’s practice. The device advantages are demonstrated over the standard Ilizarov fixator. New osteosynthesis technologies are substantiated.