Treatment results have been analyzed in 57 patients suffered from the shoulder habitual dislocation with shoulder rotator cuff (SRC) rupture. Clinical-and-diagnostic criteria of the pathology are shown, as well as the technique of treatment including the plasty of the shoulder anterior part and tendon suturing. The treatment performed allowed to eliminate the symptom-complex characteristic of this pathology or level the disease symptoms to a considerable extent: pain and limitation of the shoulder movements.

Improvement of the results of surgical treatment of proximal humeral fractures in children and adolescents using the osteosynthesis technique proposed by us. The study was performed in 71 children and adolescents at the age of 7 -14 years admitted for the diagnosis of proximal humeral fracture. Among them the traditional conservative treatment was performed in 8 (11.27%) patients, the procedure by the proposed technique of intra- and extramedullary compression osteosynthesis using a device based on the Ilizarov fixator was performed in 63 (88.73%) patients. As a result of using this technique in 63 children our study demonstrated that excellent results were achieved in 12 (19.05%) patients, good – in 46 (73.01%) and satisfactory – in 5 (7.94%) patients. There were no unsatisfactory results. The analysis of the immediate and long-term results of treatment allows to conclude that both correct determination of indications and precise technical performance is the guarantee of good anatomic-and-functional results in children and adolescents with difficult fractures of proximal humerus.

Difficulties in treatment of bone fractures of the forearm are caused by its anatomic structure complexity and its function variety. Transosseous osteosynthesis with rod devices as a little invasive and functional method of treatment can be a method of choice for shaft fractures of the forearm bones. We have developed and use rod devices with reposition units for surgical treatment of forearm shaft bone fractures. The work deals with the results of treatment of the forearm shaft bone fractures in 22 patients subjected to transosseous osteosynthesis with rod devices. Long-term results have been studied in 22 patients within the period of 2006-2009. Good results were obtained in 20 (91%) patients, satisfactory ones – in 2 (9%) patients.

Diagnostic algorithm has been developed and introduced in patients with injuries of pelvic bones and acetabulum, the use of which allows to reduce the number of diagnostic errors at pre-hospital and hospital stages, to objectivize the severity and character of pelvic trauma. The scheme to predict the types of functional disorders has been proposed at the expense of objective analyzing patient’s clinical-and-biomechanical status for the purpose of rational selecting the tactics patient management and an estimating the expected results of restoration of the locomotor system function. Immunological monitoring has been applied to predict the development of inflammatory complications, periods of reparative regeneration and to take them into account when planning an individual program for treatment of such patients.

Primary endoprosthetics was performed in 88 patients with extra-articular fractures of femoral neck, as well as with intertrochanteric and transtrochanteric fractures. There were the following indications to surgery: advanced age of patients, accompanying osteoporosis, pathology of the hip on the side of involvement and that of the adjacent one, the history of the hip trauma and some others. The revision endoprostheses of ESI (Russia) and Zimmer (USA) firms were used. Excellent and good results within the periods of 1-6 years were observed in 69.2% of patients, satisfactory results – in 15.3%. Unsatisfactory results took place in 4 patients (5.6%) due to the development of complications in the late period - from 4 months to 5.5 years. Purulent complications were diagnosed in 2 patients and instability of endoprosthesis components – in 2 patients more. In this connection revision interventions were performed with satisfactory result. It has been established that the use of modern revision implants for endoprosthetics of the hip in case of extra-articular fractures of proximal femur and individual selection of the implants allows to obtain good functional and anatomic results for long terms.

A new device for osteosynthesis of proximal femoral fractures has been developed and introduced in clinical practice. 96 patients with femoral trochanteric fractures were operated on using the new device. Satisfactory and good results were obtained in 97.9% of the patients operated, unsatisfactory results – in 2.1% of them.

The study deals with the analysis of treatment results in 360 patients with malleolar fractures. Conservative treatment was performed in 81 cases, surgical one – in 279 cases. Bone grafting was not used in the study. Long-term results were studied in 199 cases. In the immediate rehabilitation period the loss of reposition correction caused by impression changes was observed in 36.8% cases of pronation fractures. Valgus deformity of limb axis developed as a result. The results of the study emphasize the necessity of bone grafting use for treatment of such fractures.

This technique is trained on the restoration of weight-bearing and anatomically proper contours of the hindfoot in combination with purulent-and-inflammatory process stopping in patients with osteomyelitic calcaneus. The goal is achieved by removal of osteomyelitic calcaneus, the ankle and talonavicular arthrodesis, anterior talar osteotomy, as well as graduated transporting the tibial ana talar fragments synostosed and their turning downwards and backwards in combination with tibiocuboidal synostosis formation.

The use of external transpedicular fixator for treatment of patients with scoliosis has the advantages of gradual graduated deformity correction, which allows to avoid neurological and vascular complications related to the spine traction and that of spinal canal contents. However, the use of any invasive technical device is dangerous because of potential errors or complications. The analysis of errors and complications of the method made in treatment of patients with scoliosis has allowed to complete their distribution and classification.

The number of victims with posttraumatic bone defects is constantly growing due to the increase of severe craniocerebral trauma incidence and due to surgical activity. The analysis has been made in 35 patients operated on within the period of 2004-2009 and subjected to the procedure of early cranioplasty due to the development of an extensive skull vault defect after decompression cranial trepanation. Good aesthetic and functional results were achieved in all the patients operated, as well as general condition improvement and the absence of purulent-and-septic complications. Early cranioplasty appears to be a safe and important surgical intervention.

The results of hallux valgus treatment in 63 patients have been studied using the technique of multipositional roentgenography, which was performed before and after surgery, as well as at different stages of device fixation and in the long-term period. Roentgenometric investigations were made in all patients. Depending on the degree of the first ray deformity the patients were subjected to different types of osteotomies with osteotomized fragment fixation using an external fixator. After deformity correction a prolonged reorganization process was observed in the first metatarsal bone, which can be divided into two periods: the immediate two months and one year after the end of treatment. The reorganization process of the first metatarsal bone was close to completion in 48 patients 1 year after the end of treatment, well marked cortical plates were formed, meshy structure was traced in the zone of bone base, the shape of the first metatarsal bone was nearly normal. In the rest patients the reorganization process was incomplete, there were compaction parts in the zones of osteotomies, the cortical plate was of different thickness and density, the meshy structure in the zone of bone head and base alternated with compaction and rarefaction parts.

The main principles and technology of using the external fixators intended for correcting congenital and acquired deformities of hand tubular bones are demonstrated.

The authors have summed up the experience of treatment of 98 patients with benign giant-cell tumors of distal femur and proximal tibia. The diagnostics was based on clinical and morphological data, as well as on those of radiation methods (roentgenography, CT, and MRT). Operative treatment consisted in making organ-saving surgeries. Low incidence of relapses allows to consider tumor resection as a basic method for treatment of giant-cell bone tumors. Resection of segment and its replacement with oncologic endoprosthesis is indicated in case of lytic tumor process.

The work deals with the results of comparison of x-ray and ultrasound data in 136 children (272 joints). The modified scheme of marking, when the line of bone rim was drawn through the center of wide echo signal from the lower edge of iliac bone, was used in the joints with insufficiently clear visualization of the lower edge of iliac bone (102 joints). Reliable distinctions have been revealed between the amount of roentgenographic acetabular angle and that of bone rim angle reduced to the x-ray scheme in all the children, as well as the increase of these distinctions for unclear signal from the lower edge of iliac bone and ossification center absence. The use of the ultrasonographic scheme proposed allows to achieve the angle amounts not differed from the roentgen ones reliably.

The changes in calcium-phosphorus balance have been studied in children with phosphate diabetes in the process of lower limb deformity correction using the Ilizarov fixator. The details of calcium and phosphorus metabolism have been revealed in patients, subjected to deformity correction without intramedullary reinforcement, but using intramedullary wires with hydroxylapatite coating.

The quantitative parameters of acetabulum and femoral head have been studied in 11 patients at the age of 5-11 years with the hip dysplasia using computer tomography technique. Patients were divided into two groups depending on dislocation degree: those with the hip congenital dislocation and subluxation. The mean density values of different structures of the hip, closely connected with its structural details, have been evaluated using computer tomography.

The article deals with the comparative evaluation of consolidation rates according to the data of ultrasound study in patients with long tubular bone fractures treated using bioactive and bioinert metal constructions. 47 patients (30 males and 17 females) with femoral (n=19; 40.4%) and leg bone (n=28; 59.6%) fractures were studied. Surgery was performed using plates with bioactive coating of calcium-phosphate in 24 (51.1%) patients. The surgery for fixation of fragments using bioinert plates of titanium or stainless steel was performed in 23 patients (48.9%). The dynamic of consolidation was traced by ultrasound examination in the periods of 2, 4, 6, and 9-12 months after surgery. Reliable difference in the study results was determined during the first three stages with significance level of p less 0.05, thereby evidencing the advantage of bioactive plates in the process of fracture consolidation.

18 patients with leg fractures have been examined at different stages of treatment using MRT technique. The study was performed with a magnetic resonance tomograph, MAGNETOM Symphony syngo MR SIEMENS (Germany) of magnetic field strength – 1.5 Tc, with postprocessor processing the data obtained using ―Leonardo‖ multimodal station of expert class. MRT-image of intact a. nutricia has been studied, as well as its changes for damage in the long-term period, muscular status of the limb damaged and that of intact one. The cross-section diameter of nutrient artery of the limb injured was more both in the immediate and long-term periods after treatment in comparison with the intact limb (its values amounted to 0.26±0.02 and 0.18±0.02 cm, respectively). While studying the cross-section area of the anterior and posterior groups of leg muscles, it has been revealed that the values of the limb injured were somewhat less, both at the expense of the anterior group and at the expense of the posterior one.

The endoprosthetics influence on the values of phagocytic activity of peripheral blood neutrophiles has been studied in 23 patients with osteoarthrosis of large joints. The changes characteristic of the immediate postoperative period are presented: the increase of blood phagocytic capacity and number of active neutrophiles through the rise of absorptive and digestive capability of phagocytes. Phagocytic index (percentage), phagocytic number, index of phagocytosis completeness, percentage of phagocytosis completeness, number of active phagocytes, blood phagocytic capacity (absolute phagocytic index) – all these values have been demonstrated not extend beyond the statutory limits 12-24 months after implantation in case of infection complication absence, that can be used as a prognostic test for postoperative process assessment.

The change in the content of blood serum proteoglycane components has been studied experimentally after peroral and intraarticular infusion of a preparation possessing insulin-like properties during healing of acetabular fractures. Based on the data obtained, comparative characteristic of two ways of the preparation infusion was done. The action mechanism of the preparation with insulin-like properties in case of intraarticular infusion differed from the peroral way of infusion, that was confirmed by different dynamics of changes in serum sulfate and uronic acid concentration.

The roentgen-and-histological dynamics of healing transverse intraarticular acetabular fractures with femoral head subluxation has been studied. The data of histomorphometric study evidence high activity of reparative osteogenesis under the conditions of bone fragment stabilization. The effectiveness of using transosseous osteosynthesis method has been demonstrated, being manifested itself in the structural-and-functional restoration of the anatomical site injured, as well as in the reduction of periods of this pathology treatment.

The effect of laser impulse infrared radiation of therapeutic mode on the granulation tissue formed in the medullary cavity during tibial fracture healing under transosseous osteosynthesis has been studied experimentally in mature linear rats by the methods of light and electron microscopy and morphometry. The reduction of inflammation, the increase of granulation tissue volume, the activation of fibrillogenesis and reparative intramural angiogenesis have been noted. Under laser influence the proliferation of endotheliocytes and pericytes increases, growth vascular buds are formed, as well as endothelial growths and endovasal spreads are formed, localizing in vascular lumens and intramural canals. The characteristic superficial microrelief of endovasal spreads, formed by pericytes of tiled-like arrangement, has been revealed for the first time. As a result of intense formation of capillaries the number of vessels per unit of granulation tissue section area in the experiment increases significantly, while the diameter of vascular lumen decreases in comparison with control. The data obtained are a reason to perform further studies of this kind for the purpose of developing the clinical guidelines on angiogenesis stimulation and using the progenitor cells of medullary cavity granulation tissue for cell technologies.

The influence of highlands on the hemostasis system values has been studied under the conditions of using the neutral and distraction transosseous osteosynthesis according to Ilizarov. The changes towards hypercoagulation with fibrinolytic activity suppression have been shown to occur at all the stages.

The pain of constant character in the area of sacrum and pubic articulation prevails in the clinical picture of the pregnant with pubic articulation dysfunction. The decrease in progesterone and general calcium levels has been revealed in different time periods of gestation. In case of full-term pregnancy the inflammatory reaction in the area of pubic articulation has been observed manifested itself in the increase of interleukin value level. The use of the combined bandage proposed reduces clinical symptomatology: pregnancy, labor and postnatal period proceed favourably.

The paper deals with the main elements of the conceptual model of rendering specialized medical care to patients with the ankle and foot pathology, the analysis of limitations of the existing current approaches to organization of diagnostic and treatment process is made, and the ways of upgrading the existing system of specialized medical care for this category of patients are outlined.

A current view of the diagnostic capabilities of the transcutaneous determination of oxygen and carbon dioxide tensions in traumatologic and orthopaedic patients has been demonstrated based on the analysis of native and foreign scientific publications. The informative potential of this method has been analyzed for the assessment of condition of patients with multiple (combined) injuries, open wounds, that of blood flow and tissue flap healing, tissue metabolic reactions to distraction effects in orthopaedic patients, HBO therapy results in traumatologic and orthopaedic patients.

The review of the literature which has been published for the last 10 years and devoted to the hip revision endoprosthetics is presented in the work. Based on the analysis of the data obtained the authors have come to the conclusions, that in cases of aseptic complications leading to revision endoprosthetics it is necessary to continue searching the optimal variant of surgery technique and plastic material providing the maximal rate of bone tissue biotransformation for elimination of its existing defect. Moreover, there is the tendency towards not using bone cement for fixation of the construction in case of its re-implantation.

The aim of the work – to improve the effectiveness of treatment in patients with pelvic trauma, complicated by urogenital tract injuries, using modern techniques depending on the type, severity and localization of pelvic injury and that of urogenital system organs. Retrospective analysis is presented concerning treatment of 58 patients with pelvic bone fractures and the injuries of urogenital system organs within the period of 2005-2009. Current tactical approaches, advantages of modern technique use for treatment of patients with trauma of the kind have been shown by clinical examples, the algorithm of rendering medical care for the victims has been developed. The use of this approach has ensured the restoration of anatomic-and-functional parameters with minimal complications and has allowed to achieve positive results of treatment in 81% of the victims.

24 patients with closed patellar fractures have been treated within the period of 2004-2009 using the combined method of treatment consisting in arthroscopy to diagnose the degree of the knee soft-tissue structure damage, arthroscopically controlled correction of patellar fragments and subsequent application of the Ilizarov fixator different modules. Long-term results have been traced in 18 (75 %) patients, good and satisfactory results of treatment have been observed in 100 % of cases.

A new approach to psychological preparation of the women for labor is presented in the work. It is based on the principles of synergetics. Within the limits of this theory, a woman is considered as an open system, being driven towards which a psychologist-psychotherapist has the possibility to influence it, changing its configuration. The key moment of the preparation consists in creating a positive attitude towards «happy labor», birth of a healthy child regardless of potential complications during pregnancy. A psychologist, interacting with a pregnant woman, forms a certain structure, an attractor «birth of a healthy child», which has a powerful supporting effect. The only important problem of a woman is reduced to give birth to a healthy child. The first results obtained by preparing women according to «happy labor» are presented.