The data of the development of the transosseous osteeosynthesis method according to Ilizarov are presented from historical point of view. To substantiate the potentials of the fixator use in treatment of traumatologic-and-orthopaedic patients the author (G.A. Ilizarov) had performed six series of the experiments allowing to determine the effects of the rigidity of bone fragment fixation, blood supply, preservation of osteogenic elements – periosteum, endosteum, bone marrow – on osteogenesis process and consolidation periods. New medical technologies of treatment of patients with pseudoarthroses and bone defects, limb lengthening and limb deformity correction had been developed on the basis of the data obtained. Further studies demonstrated that the transosseous osteosynthesis method could be used in the allied medical disciplines: neurosurgery, stomatology, oncology, angiology, the hand surgery and others.

The tactics and techniques of polysegmental lengthening of segments according to Ilizarov in patients with achondroplasia and in those of subjectively low height (750 patients with achondroplasia, 287 – cosmetic lengthening) are described. Errors and complications have been analyzed, as well as results of treatment.

The analytical review of foreign literature and that of our country dealing with evolution of non-free bone grafting according to G.A. Ilizarov in the problem of rehabilitative treatment of patients with long bone defects and pseudoarthroses is presented in the work.

The great clinical experience (more than 8,000 patients) of treatment of the the locomotor system pathology (defects, pseudoarthroses, deformities, shortenings, endoprosthetics consequences), complicated by chronic osteomyelitis, has been generalized. The main principles are presented, including pathologic process diagnostics, surgical elimination of osteomyelitic focus, limb weight-bearing restoration. The technology of osteosynthesis performance is described for different localization of destruction focus and disease stage, as well as the algorithm of treatment-and-rehabilitation measures. The developed methodology of chronic osteomyelitis treatment has allowed to achieve positive outcomes in 97.1% of cases.

The main experimental scientific developments of the workers of the Experimental Department in the field of vertebrology, surgery of pelvis and the hip are presented from historical point of view.

The work deals with the main fields of using the controlled transosseous osteosynthesis according to G.A. Ilizarov in the hand surgery. The Ilizarov method has been shown to play a principal role in the variety of specialized medical care for patients with injuries and orthopaedic diseases of the hand. The use of the principle of stable fixation of bone fragments, as well as the use different variants of compression and distraction osteosynthesis allows to solve the problems of syndactyly, shortenings, deformities and defects of the hand bones for congenital and acquired pathology successfully. The rational combination of the Ilizarov method with microsurgical technologies significantly increases the potentials of reconstructive-and-restorative surgery of the hand in case of its severe injuries, including multiple injuries of tendons, neurovascular bundles, abjunctions and extensive defects of soft tissues.

The experience of treatment of 3156 patients with open limb fractures has been analyzed, the techniques of transosseous osteosynthesis according to Ilizarov for filling "acute" tissue defects and anatomical restoration and rehabilitation of patients with the abovementioned injuries have been determined and substantiated. The osteosynthesis techniques proposed have been proved to provide the conditions for tissue regeneration, prevent pyo-necrotic processes and, thereby, reduce treatment periods and improve treatment outcomes in these patients.

The work deals with the outcomes of the experimental studies on the skull and brain pathology elimination, which have been performing at RISC "RTO" for 33 years, as well as with the results of introduction of the techniques developed into clinical practice.

The work deals with the problems of forefoot bone lengthening in patients congenital developmental anomalies and posttraumatic defects of the foot. Lengthening was performed using the transosseous osteosynthesis method according to Ilizarov. Different configurations of the fixator optimally appropriated for specific clinical situation were used depending on shortening localization, the number of pathologically changed foot rays and patient’s age. The lengthening required was performed in all the patients. The immediate and long-term results of treatment have been analyzed.

According to our data, posttraumatic gonarthrosis accounts for 47.9% of cases among degenerative-and-dystrophic diseases of the knee. The process of rehabilitation of 178 patients (188 joints) at the age of 19-70 years (51.6±0.8 years) with posttraumatic gonarthrosis of all stages has been studied in the Center clinic. The decompression-draining and decompression-correcting surgeries developed at the Center have been performed in patients depending on their anatomic-and-functional disorders. Studying isolated results demonstrated that positive results of treatment were obtained in 96.7% of cases owing to differentiated approach to surgical treatment of patients with posttraumatic gonarthrosis in complex with adequate conservative therapy.

The results of treatment of 54 children (69 joints) at the age of 2.5-6 years with congenital dislocation of the hip have been analyzed. The technology of closed dislocation reposition using the Ilizarov fixator with reconstruction of articular components has been applied. The relations in 67 joints have been restored by closed technique. Dislocation recurrence was observed in four cases (5.9%), aseptic necrosis of the femoral head – in five cases (7.4%). Clinicoradiographic evaluation was carried out according to McKey and Severin criteria: the proportion of good results made up 82 % and the poor ones – 10.5%.

Formation and development of neurosurgery in RISC “RTO” is reflected in the work. The method of distraction osteosynthesis developed by G.A. Ilizarov has found its application in spine surgery as well. The department of neurosurgery was organized in 1993 for the method clinical evaluation. At present patients with diseases and injuries of the spine, with those of the peripheral nervous system and brain are treated in this department using different techniques.

We have gained the experience of treatment of 46 patients with primary tumors of leg bones using transosseous osteosynthesis. In patients with bone sarcoma transosseous osteosynthesis techniques were used after the preliminary stage of treatment measures including radical and ablastic tumor resection with the appropriate complex of neoadjuvant chemotherapy. In the group of patients with benign tumors the rehabilitation measures for anatomic-and-functional recovery of the limb operated were made in a single-stage fashion. The use of the transosseous osteosynthesis technologies according to Ilizarov has allowed to fill post-resection bone defects, as well as to achieve optimal limb reconstruction not only in adults, but also in children with incomplete skeletal formation.

1310 patients with different injuries and diseases of the locomotor system were examined using roentgenography, USE, CT, MRT for the development and improvement of new radial diagnostics techniques in traumatology and orthopaedics. As a result of the work made, new techniques of chronic osteomyelitis diagnostics have been developed, as well as quantitative evaluation of reparative osteogenesis for limb lengthening and fracture treatment, the techniques of distraction regenerated bone evaluation, new techniques of quantitative and qualitative diagnostics of soft tissue condition for lengthening, the techniques of bone state evaluation for systemic skeletal diseases, arthrosis deformans, which are protected by 23 patents of the RF, and 6 computer programs registered in Russian Agency for patents and trade marks have been created. The diagnostics techniques proposed are widely used in clinical work to choose methods of treatment, to control the course of treatment process, to develop rehabilitation measures.

Secondary feet deformities develop as a result of inadequately performed treatment of congenital club-foot, besides, one or more components of deformity have the opposite direction comparing with the initial pathology and therefore require supplementary treatment. Both technical intraoperative errors and tactical details of patient first-year postoperative management play a role in the development of secondary feet deformities after club-foot surgical treatment. The experience of treatment of 66 patients at the age from 3 to 18 years with secondary feet deformities after congenital club-foot treatment by both conservative and operative techniques has been analyzed. Correction of secondary feet deformities requires individualized approach and strict indications for each option of deformity elimination.

The results of treatment of 55 patients with different deformities of the lower extremity have been studied. Among them 18 patients were treated conservatively, 37 patients – surgically. Operative correction of the deformities of lower limb axis was performed in 37 patients. The closed perforative method of osteotomy using the Ilizarov fixator was used in 34 patients among them to correct axial deformities and limb shortenings, and osteotomy with triangular regenerated bone augmentation was performed in 3 patients. The perforative method of osteotomy with the Ilizarov fixator application in children is an effective method of little damage.

The authors describe a technique of intramedullary osteosynthesis with a wire distractor based on the Ilizarov fixator for treatment of proximal tibial fractures in 53 patients. The original osteosynthesis technique is presented, as well as its high effectiveness is demonstrated in treatment of high tibial fractures.

Profound analysis and mathematical processing of the data have been made on the basis of 1800 medical histories of the injured subjects from the archives of the Military and Medical Museum for the purpose of evaluation of the essence and extent of specialized orthopaedic-and-traumatologic care at the stages of medical evacuation during battle operations in the Northern Caucasia in the injured subjects with gunshot wounds of limb long bones, and for that of determination of the main directions of its optimization. And the first experience of the staff members from the department of military traumatology and orthopaedics of the Military Medical Academy, who moved to the battle area as members of the specialized teams of medical reinforcement, was used as well. On the basis of the analysis made the recommendations have been given for optimization of specialized traumatologic care, the most severe and the most numerous groups of the injured subjects have been revealed, as well as the factors influencing the outcomes of their treatment to the greatest extent.

Rendering of vertebrological care for children at the age from 0 to 10 years have been analyzed in the work. The causes are enumerated which, in the authors’ opinion, have led to relative backwardness of this branch of spine surgery through successful development of adolescent and adult vertebrology. Groups of patients are presented for whom untimely surgical care is rendered very often. Some organization measures have been proposed which allow to improve the rendering of care for small patients with spine pathology.

Clinical use of a new technique for surgical treatment of patients with lumbar osteochondrosis is described. The technique consists in prosthetics of the disk changed with a combined prosthesis. 47 patients with the decrease of vertebral bone mineral density to 67-72 % of age-related norm have been operated on, and their condition was an absolute contraindication for using routine disk endoprostheses in case of the segment instability revealed. Good clinical results were achieved in all the patients when the new combined prosthesis was used, this was evidenced by the fact that all of them started their professional activity within the first year after surgery.

Most patients hospitalized for the hip or knee replacement have 1-3 additional risk factors of venous thrombosis and embolism. The age (above 40 years old), obesity, chronic non-specific lung diseases, varicose disease of the lower limbs are the most frequent factors. The routine use of anticoagulant prevention of thromboembolic complications combined with regional anesthesia is safe and allows to reduce the lethality caused by pulmonary thromboembolism significantly (0.007 %) after the planned replacement of the hip or knee.

The characteristic features of thinking of the dysplastic pathology, “the diseases of joints caused by hereditary predisposition”, have been revealed by the authors on “syndromogenesis” principle.

The work deals with modeling of the hip closed dislocation in 12 hamsters, in whom at their age of 10 days the formation of Stage I of the disease was started as epiphyseal dysplasia by daily laser irradiation of the hip for 20 days with radiating power 10 mw, exposition 10 min., wave-length 0.9 μm, pulse rate 2500 Hz. After that under general anesthesia with ketamine Stages II and III of the hip dislocation were produced with mechanical vibrations made by a vibrator and transmitted to the ends of joint bones with simultaneous manual strain of ligaments and joint capsule by 1-kg force, for vibration frequency – 100 Hz and amplitude – 0.3 mm. The study of the joint preparations has shown that 7 days after displacement the volume of cavities decreases due to their deformity and hypoplasia for faster growth of the heads forming new cavities behind the external surface of the wall of previous cavities.

A new complex technique for prediction of sustained injury outcomes has been proposed on the basis of studying medical documents of 762 injured and 339 lost subjects in traffic accidents in the city of Cheliabinsk within the period of 2005-2009; not only severity of the injury sustained, its type and characteristic has been taken into consideration in this technique, but also background pathology presence, the role of victim’s participation in the traffic, the season when injury occurred, severity degree, health harmful consequences. The developed by us technique enhances the accuracy of injury outcome prediction evaluation, thereby enabling to choose adequate medical management. Moreover, the prediction of traffic accident injury consequences can serve as one of the criteria for evaluation of rendering medical care quality

The literature review on the role and significance of multiphase bone scanning in the diagnostics of the locomotor system diseases in children and adolescents is presented. The fundamentals of pharmacokinetics of the radiopharmaceutical preparations used for bone scanning (BSc) are described in detail. The modern concepts of the mechanism of their fixation in bone tissue are presented. The theoretical, methodological and clinical aspects of BSc using for diagnostics of the locomotor system diseases in children are elucidated. The results of bone scanning for different nosologic forms of this pathology are analyzed critically, as well as the criteria for effectiveness evaluation of therapeutic measures. The practical significance and prospects of using multiphase bone scanning in pediatric orthopedic practice are shown.

The three-fold, five-fold change of unified repositional hinges is necessary for correction of complex multicomponental multiplanar deformities using the Ilizarov fixator. Transosseous devices the work of which is based on computer navigation (so-called hexapods) allow to move bone fragments in a single-stage manner along the “integral” trajectory. The length of each of connecting telescopic rods – struts – conforms to the initial position of bone fragments. The software calculates the change of each strut length to achieve the required bone fragment position. The made comparative analysis of the hexapods used nowadays (Taylor Spatial Frame, Ilizarov Hexapod System and Ortho-SUV Frame) has demonstrated the advantages of Ortho-SUV frame in the potentials of reposition, osteosynthesis rigidity, comfort of hardware and software use. Ortho-SUV Frame has been evaluated in treatment of 93 patients (109 cases of the frame appliance). Deformity correction (fracture reposition) was achieved by single stage without the necessity of partial remounting of the frame. Complications were observed in 14 cases (12.8 %), and they were mainly of inflammatory character.