The stabilizing potentials of modern intramedullary and internal metalworks, and those of biomechanically reasonable osteosynthesis
with the Ilizarov device have been studied for fixation of typical simple /two-lever/ femoral fractures according to the biomechanical
classification of long bone fractures, as well as the strength characteristics of the descending constructions, in 42 cadaveric femoral
non-fixed preparations under the conditions of experimental modeling using w+b (walter + bai ag) «LFV-10-T50» universal testing machine (Switzerland). The clinical analysis of the effectiveness of the techniques of descending and transosseous fixation has been made based on the results of treatment of 57 patients with femoral metadiaphyseal and diaphyseal fractures, treated in TsITO in the period of 2003–2009. As a result of the experimental studies performed, we have demonstrated that fixation with modern intramedullary and internal metalworks for simple femoral fractures doesn’t not always meet the requirements of the biomechanical
conception of fragment fixation.

The algorithm of using little-invasive methods of osteosynthesis based on the Ilizarov method and the principle of ligamentotaxis has been developed and introduced into practice; the saving tactics of treatment in the presence of the limited defects of articular surface of distal tibial meta-epiphysis, as well as the possibility of proper tissue using for articular surface defect filling has been substantiated. The authors have come to the conclusion that osteosynthesis with the Ilizarov fixator has significant advantages over osteosynthesis of other types in treatment of complex fractures of distal tibial meta-epiphysis, especially in the early periods after trauma. It has been revealed that in cases of complex comminuted fractures of distal tibial meta-epiphysis the satisfactory position of fragments achieved by minimally traumatic way is optimal, and not the ideal reposition achieved by open intervention.

The aim of this work consisted in increasing the effectiveness of treatment of femoral fractures in patients with polytrauma by using modern principles and little-invasive methods. There were following tasks of the study: the substantiation of the criteria of treatment method selection depending on fracture localization, displacement of fragments, soft-tissue component condition, injury of adjacent segments, as well as the assessment of treatment results in this group of patients. Treatment of 65 patients with polytrauma, femoral fractures of different localization for the period of 2006-2009 has been analyzed. Current tactical approaches, the advantages of using modern little-invasive techniques in treatment of patients with polytrauma have been demonstrated with clinical examples, and the algorithm of rendering care for the subjects injured has been formulated. The use of this approach provided the restoration of anatomic-and-functional values with minimal number of complications within short periods of in-patient treatment, and allowed
to achieve positive results of treatment in 97 % of the subjects injured.

The review of the foreign literature and that of CIS countries, devoted to treatment of proximal humeral fractures is presented in the work. Based on the literature review and their clinical experience the authors have come to the conclusion, that there is no universal factor for osteosynthesis of proximal humeral fractures of different character. Proceeding from this, the authors propose a wire-rod device for osteosynthesis of the fractures of humerus anatomic neck and head, as well as a device for treatment of surgical neck fractures.

Chronic calcaneus osteomyelitis makes up 7-8% of the all cases of bone osteomyelitis, and there are its special forms, which are difficult from correction point of view. The problems related to development and substantiation of the original reconstructive-and-plastic method of surgical treatment which increase its effectiveness in case of the risk of irreversible scarry corrugation of integumentary tissues above calcaneus bone defect are considered in the work.

Surgery of craniofacial injuries is one of dynamically developing sections of neurosurgery. Definition of the timing of facial bone fracture treatment has been shifted towards earlier interventions in the world medicine in the past two decades. The analysis of
patients treated for craniofacial injuries in the period of 2007–2010 has been made. Surgical treatment of the fractures of the upper and middle facial zone bones has led to deterioration of the brain injury process in no patients. Good esthetic and functional results have been achieved postoperatively in all the patients. Reconstructive surgical interventions for the fractures of the upper and middle facial zones can be performed as early as it is possible.

The techniques of surgical posttraumatic flat foot correction are demonstrated in the work, as well as the results of these surgeries for the analysis of which additional methods of studying have been used (radiography, computer tomography and plantography) apart from clinical evaluation.

The article deals with the result of medical rehabilitation of a female patient with a calcaneal neurotrophic ulcer for treatment of which the combined procedure of grafting the rotation flap with axial blood supply and transosseous osteosynthesis according to Ilizarov has been used.

The authors have studied the dynamics of bone tissue remodeling for post-resection hand bone defect filling under transosseous osteosynthesis for the purpose of quantitative evaluation of restorative processes in rehabilitation of patients with primary hand bone tumors under transosseous osteosynthesis by indirect computer densitometry using “DiaMorph” hardware-software complex. The analysis of 90 hand x-ray images has been made in 11 patients (6 — males, 5 — females) at the age of 12-42 years, for whom cancellous and cortical autografts, as well as biocompatible Collapan material was used to fill the defect. The results of treatment have been followed preoperatively, postoperatively, 1, 2 months after transosseous osteosynthesis, 1, 3, 6 months and one year after the fixator dismounting.

Background: correct corticotomy is essential in limb lengthening and deformity correction by distraction osteogenesis. Currently a variety of corticotomy /osteotomy techniques are used but do not make enough confidence about preserving endosteal circulation and avoidance of periosteal damage. We introduce a new simple and efficient corticotomy method in this paper.
Methods: This study was undertaken in Mashhad Medical University-Iran from June 1995 till September 2009. In 22 patients (24 limbs) who was candidate for limb lengthening with or without correction of deformity, simultaneous corticotomy was performed by a new method which we explain it descriptively in this paper.
Results: There was not any premature consolidation. 19 limbs had radiologic callus formation at the end of 3rd week and in all of our patients at the End of 4th week. Patient functional scores and analogue satisfaction scores were better in post traumatic limb shortening and deformities in comparison to congenital disorders.
Conclusion: Corticotomy with this new method is a simple, more confident and predictable one which can prevent undesirable bone cracks and preserve both periosteum and endosteum.

The results of trials for the resistance of a modified transpedicular screw to axial elongation were evaluated in comparison with series-production specimens. Anatomical samples of human vertebrae and monoaxial transpedicular screws were prepared for the experiment, and they constituted one main group and two control ones. The screws were implanted according to the generally accepted technique with x-ray controlling the screw position in the vertebra. The study was performed on the basis of the laboratory of the Institute of Metal Superplasticity Problems of Russian Academy of Sciences (the town of Ufa) using INSTRON 1185 (England) testing machine. The values of maximal resistance of the transpedicular screws to axial elongation were within the limits of 1100-1250 Newtons, but after reaching the peak values the resistance of the main group screws was more statically reliable than that in control groups. The construction modification of the transpedicular screw positively influenced its fixation potentials (resistance to axial elongation) in the vertebra.

The authors have performed 114 surgeries of primary total endoprosthetics of the elbow using the endoprostheses produced by Endoservis (Russia) and Konrad-Mоrrey prostheses by Zimmer (USA); the main indications and contraindications for the surgery have been developed. The technique of surgery and postoperative rehabilitation is described. Assessment of the results was made according to American elbow surgeons assessment and ASES (Richards R. R. et al., 1994). The results have been analyzed for the period of 1-4 years after surgery. Good and excellent results were achieved in 70.4% of all the subjects treated; satisfactory results were registered in 22.2% of all the subjects treated. Unsatisfactory оutcomes of endoprosthetics was noted in 6 patients (7.4% from the total number of the subjects operated). This has allowed to concider the experience of using the elbow associated prostheses by Endoservis (Russia) and Kоnrad-Mоrrey ones by Zimmer (USA) as positive and perspective for further application.

85 patients at the age of 17–61 years with various traumatic injuries of the ankle have been examined. There were 44 male patients and 41 — female ones. The examination was made using SIEMENS Magnetom Symphony 1.5 T magnetic-resonance tomograph. Comparative AP x-rays of the ankle were also made in all the patients. Based on the Bristol classification, avascular necrosis was revealed in thirteen patients (15.3%) among those examined with the ankle pathology. The first, pre-x-ray, stage (according to Hepple et al, 1999) was revealed in 9 of 13 patients by MRT data, being characterized by cartilage involvement, the second stage was determined in three patients (a subchondral fracture with perifocal edema or without it), the third stage was revealed in one patient (the non-displaced fragment separated). The results of the work have demonstrated that magnetic-resonance tomography is the only method which allows to reveal avascular necrosis of talus block at an early, pre-x-ray, stage, as well as to assess the involvement stage and size in hyaline cartilage, that will make it possible to determine the tactics of treatment.

Morphoradiometric diagnostics of the knee osteoarthrosis in elderly patients is described in the article. Quantitative and qualitative evaluation of articular anatomical structures is discussed. The role of diagnostic criteria for determining the treatment tactics of heterogenic gonarthrosis depending on degenerative-and-dystrophic process severity is substantiated.

105 ultrasound examination procedures of the hips have been performed in patients with coxarthrosis of different stages. All the patients underwent radiography of the hips to determine coxarthrosis stage, the hip complex ultrasound study by standard technique, and the regional hemodynamics was assessed in them in the lateral femoral circumflex arteries using color Doppler mapping. Radioand- sonographic parallels and ultrasound semiotics have been revealed for dystrophic processes in the hip.

The age-related special features of osteoarthrosis course for the disease different stages have been revealed using ultrasonography technique. The technique used has been demonstrated to be the most informative for the disease early stage diagnosing.

Echocardiography was performed in 30 children at the age of 4-18 years with II and III Degree cobbler’s chest. The study was made according to standard techniques. Heart changes were revealed in the process of examination. The shape of the right ventricle. was changed in 12 children. The geometry of the right atrium was noted in two cases. The kinetics of the interventricular septum was studied. Hypokinesis was revealed in 5 cases, hyperkinesis — in 2 cases, asynchronic interventricular septum contraction — in 2 cases. The increase of velocity characteristics of the diastolic ducts through the tricuspid valve was registered in 7 children.

Competitive relations between lateral phenotypic and pathological asymmetries have been found while studying stabilometrically the balancing activity of feet support reactions in 56 normal subjects and 39 orthopedic patients with minimal static disorders of locomotor system biomechanics before and after surgical treatment in the different periods of functional rehabilitation. Due to the competitive manifestations in the activity of support reactions the phenotypic and pathological asymmetries weakened the informative controlling of functional rehabilitation processes, impeded the diagnostics and comparative estimations between selective populations.

Comparative evaluation of the biological criteria of the limb functional condition for tibial defect-pseudoarthrosis and defectdiastasis has been made by the data of dynamometry, sonography, tonometry, walking statical and dynamical parameters.

Seven patients with growth retardation of one of the limbs have been examined before and after their surgical equalization according to Ilizarov using “Diasled-scan” hardware-software complex. The time parameters of walking before treatment and within the first year after its completion have been revealed to be increased in comparison with the values of the healthy subjects examined (n=14). At the same time, the loading of feet supporting surface has been increased reliably both for standing and for walking.

The content of low-molecular and mean-molecular weight substances, energy-metabolism products, and protein spectrum in blood serum has been studied in the dynamics of rehabilitation of patients with the brain ischemic insult using the technique of controlled transosseous osteosynthesis.

The study of the effect of repeated lower limb bone tunnelization procedures on the changes in oxygen and carbon dioxide transcutaneous tension has been performed in 26 patients with lower limb obliterating atherosclerosis with 2B Stage peripheral circulation insufficiency. Re-tunnelization procedures in such patients have been determined to contribute to tissue respiration normalization: the increase of oxygen transcutaneous tension and the tendency towards carbon dioxide decrease, that is accompanied by the improvement of patients’ clinical and functional condition. In most cases the changes in oxygen transosseous tension coincided with the dynamics of the malleolar-and-shoulder index.

In our opinion, determination of the levels of RANTES-CCR5 system expression on blood mononuclear leucocytes in vitro can be used for individual evaluation of the perspective of implant material as inflammatory/osteoinductive reaction trigger in patients with osteogenesis imperfecta (OI). Besides, RANTES gene expression on blood mononuclear leucocytes may be effective in the development of the methods to predict the degree of inflammatory (osteolytic) response, while CCR5 gene expression — in the development of the methods to predict the process of reparative bone tissue remodeling in response to using different implants.

The purpose of this work was to assess the relationship between different electroneuromyographical characteristics of the spasticityparetic syndrome in patients with central hemiparesis of different genesis (stroke or brain injury consequence). 70 patients (53 males and 17 females) at the age of 13-64 years with clinical signs of spastic hemiparesis (stroke and craniocerebral injury consequence) underwent complex neurophysiological testing, based on the combination of global and stimulation (H-reflexes, M-responses, transcranially evoked potentials, electrophysiological analogue of the Babinski reflex) EMG. It has been demonstrated that all the ENMG-values used in the work are complementary. Polysynaptic response duration has been found to be the most informative parameter of the electrophysiological analogue of the Babinski reflex.

The frequency of isolating the causative agents of the urinary system inflammatory processes in patients with spinal cord injuries in the acute and late periods has been revealed, as well as their antibiotic sensitivity. In the acute period infection complications made up 60%, in the late one — 47,8%. 108 bacterial strains have been determined (in the acute period — 53, in the late one — 55). Gramnegative bacteria (P. aeruginosa, P. mirabilis, E. coli) and coagulase-negative staphylococci appeared to be the main uropathogens. Ceftazidim has shown the maximal activity against the microorganism strains isolated.

The work deals with the algorithm developed for the first time and intended for examination of patients with Stage III osteoarthrosis using the method of laser flowing cytometry (typing of peripheral blood lymphocytes) at different stages of the knee or the hip endoprosthetics (before implantation, after 5-7, 18-21 days, 4-7, 10-14, 22-24 months after surgery). The investigation of cellular immunity values (CD3+, CD3+CD4+, CD3+CD8+, CD3-CD19+, CD3-CD16+CD56+, CD3+CD16+CD56+, CD3+CD25+, CD3+HLA-DR) in these periods allows to predict the course of postoperative period, as well as to reveal patients from the group of risk of developing the sluggish pyo-inflammatory process in the zone of instable artificial joint implantation.

A complex study of the content and distribution of different glycosaminoglycane classes in the skin integument tissues of the leg being lengthened by the Ilizarov method has been performed. It has been revealed that fibrillogenesis signs appear in derma in the period of distraction, and the fibrillogenesis peak takes place in the period of fixation. The content of glycosaminoglycanes in epidermis and skin derivatives varies that is associated with the changes in the proliferative and biosynthetic activity of these structures in different experimental periods.

Morphological study of the hemomicrocirculatory bed of canine leg muscle proper fasciae has been performed using myosin ATPase histochemical reaction in treatment of shaft fractures by transosseous osteosynthesis technique and hirudotherapy addition. The hemomicrocirculatory bed of leg muscle proper fasciae was intensified under the influence of biologically active substances of leech saliva, as well as under the draining effect, and, accordingly, blood supply of injury zone was improved, being accompanied by a complex of positive clinical changes — more rapid reduction of posttraumatic edemas and fracture consolidation acceleration.

The ability of skeletal muscles to produce the growth factors regulating the proper muscle metabolism according to the system of auto- and paracrine regulation is demonstrated in the work, as well as the metabolism and functional state of the organs surrounding the muscles (bone, nerves).

The immediate result of surgical treatment of a patient with the combined degenerative-and-dystrophic involvement of the hips and spine is presented. The analysis of clinical observation evidences the compensation of the changes in sagittal spine-pelvis relations in the patient with bilateral coxarthrosis at the expense of pelvis tilting anteriorly and lumbar hyperlordosis formation. Leading clinical symptoms were the following: pain and movement limitation in the hips and lumbar spine, as well as bilateral limping. The performance of total endoprosthetics of the hips has allowed not only stopping the pain, eliminating the combined persistent contracture, increasing the range of movements in the hips, but restoring normal spine-pelvis relations, elimination the pain syndrome of lumbar spine as well.

The correction of static deformities of the locomotor system (LMS) using exercise therapy facilities was performed in a differentiated manner depending on the character of the functional disorders revealed in the frontal, sagittal and horizontal planes. The analysis of the results of complex functional disorder correction has demonstrated the necessity of differentiated approach to determination of the aims and methods of correction for each patient. Non-invasive instrumented monitoring gives the possibility to evaluate the skeletal-and-muscular system condition objectively, including that in dynamics, as well as to optimize the selection of optimal technique for correction.

The experimental studies have been performed in 154 adult dogs; the following problems have been investigated in them: regeneration of bone after its integrity interruption of different types; the influence of different modes of distraction on bone regeneration and morphofunctional condition of the limb being lengthened; osteogenesis after distraction regenerated bone break; the possibility of distraction osteogenesis stimulation using a complex of biomechanical facilities. It has been shown, that the creation of optimal conditions for bone tissue regeneration and limb functional state at each stage of limb lengthening process is a prerequisite of good result obtaining in standardly short periods of time.