Medical reports of 124 patients with clavicular fractures treated using various variants of transosseous osteosynthesis have been studied. The main osteosynthesis variants applied to the clavicle in case of its shaft fractures have been described. The results of surgical treatment of clavicular fractures in the periods up to one year after the device removal have been followed. The errors and complications for the used variants of clavicle surgical treatment have been analyzed. Comparative evaluations for each used variant of clavicle osteosynthesis have been demonstrated. The open reposition of fragments with intramedullary wire fixation has been revealed to cause the most number of complications. The variant of closed transosseous osteosynthesis of the clavicle should be an alternative to it.

The improved technique of external transosseous osteosynthesis has been proposed for multiple long bone fractures by means of device configuration optimization for different by their character and localization injuries of lower limb bones. The use of the devices developed in patients with long tubular bone fractures doesn’t create discomfort for patients, reduces surgery time significantly avoiding additional external immobilization, prevents joint contracture development, doesn’t limit patients’ mobility. All this leads to reducing periods of treatment and disability decrease.

The roentgenomorphological specific features of regenerated bone have been studied in 42 dogs during treatment of comminuted fractures by transosseous osteosynthesis method supplemented with hirudotherapy. Hirudotherapy technique has been established to contribute to posttraumatic edema subsidence, capillary bed development and osteogenesis stimulation, that is confirmed by clinical, roentgenological and morphological data.

Comminuted leg bone fractures (B2–B3 type) were modeled in adult mongrel dogs and immobilized using a transosseous device. The details of bone tissue reparative regeneration and the condition of the femoral condyle articular cartilage were studied in the conditions produced, as well as in case of osteogenesis stimulation with fetal bone tissue extract. It was revealed that the use of fetal bone tissue extract alongside with the stimulating effect of osteogenesis, characterized by reducing the periods of involved bone consolidation, decreases the degree of histostructural articular disorders, thereby demonstrating the possibility of optimizing the adaptive-andregenerative reserves of the locomotor system tissues involved.

Blood serum content of lymphocyte-and-thrombocyte adhesion value, TGFβ1 growth factor level and microcirculatory bed values in 86 patients with fractures of long bones in the postoperative period have been studied. The technique for predicting bone tissue regeneration disorder has been developed on the basis of the data obtained. The technique proposed has been established to allow diagnosing the development of delayed consolidation of limb long bones at the stage of preclinical manifestations.

Adhesive properties of 340 clinically significant strains of the bacterii, isolated in patients of the departments of open trauma and purulent orthopedics have been studied. All the studied strains of microorganisms had adhesive properties. The distribution by adhesiveness degree is different in the groups examined. The ability to adhesion in the strains isolated from patients with chronic osteomyelitis is reliably higher in comparison with the strains isolated from open fracture wounds. The highest adhesive activity is characteristic of Pseudomonas aeruginosa and Streptococcus spp. strains.

The biochemical values of blood serum in patients with limb bone posttraumatic shortenings during their lengthening by the method of transosseous distraction osteosynthesis according to Ilizarov have been studied in the work. The sequence of osteogenesis stage change in the process of treating the patients has been revealed, the method invasiveness has been assessed.

The investigation held in the all of traumatological-and-orthopedic departments of the St. Petersburg state hospitals using transosseous osteosynthesis technique in their work has allowed to obtain the total picture of the method usability. The significant moment consists in the fact that unlike standard monolocal sample the results of which are always seriously influenced by the preference of the head and the physicians of a single department of one city hospital, the multicentre investigation has allowed to summarize the data of the technique preferred on the basis of physicians’ work of the whole megapolis in a single unit.

A group of patients below 7 years of age with unilateral chest hypoplasia and congenital scoliosis through segmentation disorder and combined vertebral failures, developmental costal defects, as well as with idiopathic, paralytic (denervation) and systemic scolioses has been analyzed. The character of initial deformity, the rate of progressing the spine and chest deformity and their correlation depending on age period have also been analyzed. The rationality of using prognostic criteria has been confirmed. The possibilities of surgical correction of the spine and chest deformity in children with severe deformities of the spinal column and chest have been evaluated. The tactics of surgical correction and management of infants and young children has been proposed.

The biomechanical substantiation of using a device for external transpedicular fixation for treatment of patients with scoliosis and deformities of the spine of traumatic genesis is presented. Osteosynthesis variants are considered depending on deformity character, curvature type and degree. The valid approach to the method use allows to treat patients effectively and prevents the errors and complications of its application.

The pains associated with the spine diseases are among the main problems of people in modern society. Most often the pain syndrome is caused by degenerative changes in intervertebral discs. Conservative therapy is the basis of the treatment. However, a conservative method of treatment does not always produce the desired effect. The work was based on the analysis of observation of 170 patients who were divided into two groups. The patients of the first group were treated by complex conservative therapy, while those of the second group underwent laser thermodiscoplasty of intervertebral discs. The data obtained demonstrate that the use of the proposed variant of surgical treatment in patients with lumbosacral osteochondrosis was more effective than traditional treatment, that was confirmed by 93% decrease of relative risk and 70.45% increase of relative benefit. The immediate and long-term results of treatment in patients with lumbosacral osteochondrosis by the surgical method of laser thermodiscoplasty evidence considerable effectiveness.

Aim of the study consists in the optimization of rehabilitation programs for primary school age children with static disorders of the locomotor system (LMS). We have performed the study of primary school age children on a scientific research center base in “Problems of childhood vertebrology” laboratory in 2008–2009. 137 primary school age children (7–10 years old) took participation in the study, there were 52 boys and 85 girls among them. All the children had functional static disorders of LMS (pelvic tilts in the frontal plane, postural disorders, planovalgus feet). The assessment of LMS initial condition, as well as the effectiveness assessment of restorative treatment was made using computer optical topography (COT) developed at the Novosibirsk Scientfic Research Institute of Traumatology and Orthopedics [7] and Dia-Sled (DS) stabilographic complex developed in FSI “The Saint Petersburg Scientific and Practical Center of Medical and Social Expertise, Prosthetics and Rehabilitation of the Disabled named after G. A. Albrecht of Federal Medical and Biological Agency of Russia” [8]. We have worked out the algorithm of therapeutic physical training (TPT) in view of static disorder type of the spine as the spine scoliotic arc and axis slope through pelvic tilt in the frontal and horizontal planes. The differentiated TPT prescribed for a patient in combination with mechanical correction using uneven orthopedic insoles contributes to prevention of the spine structural disorders. The creation of the muscular corset, as well as the skill of correct posture with the help of physical exercises in the process of TPT is considered by us to be a fundamental guideline for the outcome achievement.

Screening of 18500 children of Nizhnevartovsk has been performed for a vertebral deformity by computer optical topography method, and thereby 2115 (11.4 %) children with scoliosis have been revealed. The aim is to characterize scoliosis primary and secondary arcs. The spine deformities below 10º have been ascertained to be, as a rule, non-structural and, mainly, to be localized on the left in the lumbar and thoracolumbar spine with unmarked and little-marked upper compensatory arc on the right in the thoracic spine. On the contrary, the spine deformities above 10º, as a rule, are structural and localized mainly on the right in the thoracic spine with secondary compensatory arc in the opposite lumbar spine. In the exceptional cases, when the compensation mechanism is insufficient, an additional third curvature arc is formed.

Purulent postoperative sternomediastinitis is a severe form of surgical infection, it is characterized by sternum and anterior mediastinum involvement and is often combined with suppuration of postoperative wounds. Sternomediastinitis is a manifestation of exudative-anddestructive inflammation, and the process of lipid peroxidation is one of this inflammation components. The results of treatment of 19 patients with postoperative sternomediastinitis have been analyzed. The average duration of treatment was 25–55 days, mortality — 10.5%. The dependence of lipid peroxidation activation on the degree of exudative-and-destructive inflammation manifestation has been established, thereby suggesting the possibility of using the values of free radical oxidation as markers.

The experience of the orthopedic department the Saratov regional clinical hospital in the shoulder endoprosthetics is presented in the work. 64 surgeries of primary monopolar endoprosthetics of the shoulder have been performed using endoprostheses produced by Endoservis (Russia), the main indications and contra-indications to the surgery have been developed. The technique of surgery and postoperative rehabilitation has been described. The estimation of results was made in the periods from 9 months to 4 years after the surgery using Swanson scale for the shoulder (A.B.Swanson shoulder score 1989). The results of treatment have been studied in 43 patients in the period from 1 to 3.5 years after the shoulder endoprosthetics surgery. Good and excellent results (>20 points) have been obtained in 31 patients (72.1%); satisfactory results (15–19 points) — in 11 patients (25.6%). An unsatisfactory result was observed in one patient (2.3%) in whom deep suppuration of endoprosthesis area was developed, and in this connection the implant was removed. It has allowed to consider the experience of using the shoulder monopolar endoprotheses by Endoservis (Russia) as positive and perspective for further use.

The results of reconstructive surgical interventions on filling the defects of distal femur, proximal tibia using CITO-MATI new modular endoprosthesis. The implant made of titanium alloys according to modern technologies has been successfully tested technically and medically and has been introduced into mass production. Good functional results and low complication risk conform to the best foreign data obtained using new oncologic and modular endoprostheses.

The algorithm of examination of patients with III stage osteoarthrosis is presented in the work, being based on determining the peripheral blood neutrophile phagocytic activity (NPA) in the long-term periods (12–24 months) after the knee and the hip endoprosthetics, that can be used to predict the course of late postoperative period and to reveal the patients with implant instability development from the risk group. The most informative values in assessing the postoperative process and predicting the character of endoprosthesis instability have been revealed to be phagocytic value (PV), the value of phagocytosis completion (VPC), the number of active phagocytes (NAP).

42 patients with unilateral and bilateral coxarthrosis have been examined in standing position using roentgenography technique in order to diagnose deformities of the spinal-and-pelvic complex in the frontal plane. Among them pelvic distortions in the frontal plane have been diagnosed in 30 patients. Nine types of the spinal-and-pelvic complex deformities have been revealed by the analysis of static spine and pelvis changes. The criteria for assessment of spinal-and-pelvic relation changes have been described. The spine and pelvis roentgenography in standing position in the anteroposterior view combined with clinical examination allows to reveal various types of relation disorders in the spinal-and-pelvic complex.

Aim of the study was to investigate the plasmatic, thrombocytic, endothelial links of hemostasis in 31 patients in the dynamics after the knee endoprosthetics through the prevention with Dabigatran, a direct thrombin inhibitor. Maximal thrombin formation was determined after the surgery completion, its level didn’t differ from the initial value by Day 14. Fibrinolysis was of phased character: intensification after surgery, depression — by Day 3, re-intensification — beginning from Day 7. The increased platelet activity was observed immediately after surgery, being restored up to its initial level in a day. The coagulation index determined by thromboelastography was within the normal limits in the majority of patients examined through significant prolongation of clotting tests. Conclusions. The use of Dabigatran standard dose provides adequate correction of hypercoagulation condition in hemostasis plasmatic link in most patients undergone total endoprosthetics of the knee.

The analysis of disability has been made in 52 patients with gonarthrosis undergone outpatient treatment by an orthopedist according to the disease stages, gender, age, social status, the disease duration, the knee function, the pain syndrome nature, gait condition, disability and associated pathology. Mean age of patients amounted to 60.5±1.6) years. Positive high correlation has been revealed between age and the number of women (rs = 0.90; p = 0.037), constant pain syndrome, flexion-extension contracture of the knee and gait disorder (rs = 0.90; p = 0.037).

The use of «Voluson-730 PRO» (Austria) modern ultrasound scanner with Doppler mode and the mode of three-dimensional reconstruction has significantly expanded the notion of reparative osteogenesis process of tibial distraction regenerated bone in patients with subjectively low height. The qualitative and quantitative evaluation of reparative osteogenesis has been made (n = 67), the degree of vascularization in lengthening zone has been assessed. The criteria of osteogenesis three main types are presented on the basis of the data obtained.

Cytokine secretion, apoptosis and production of active oxygen forms in cell cultures for their in vitro contact with implants carrying microarc, magnetron or ablation calcium-phosphate coatings have been studied in the work. Mononuclear blood leukocytes have been established to be first of all cells regulating the acceptance/rejection of implants with different roughness. Implants with “smooth” calcium-phosphate coatings are less suitable for bone tissue reparative regeneration.

The experiment has been performed in vitro and in vivo in 29 adult rabbits. The influence of titanium matrix diamond-like carbon nanocoating (a-C) on the cell viability, adhesion, NADPH-oxidase activity, colony-forming ability of myelocariocytes; on the morphology and strength of neoformations in the pores of bone tissue implants was investigated. The increase of cell viability, clonogenic ability of myelocariocytes in the presence of titanium samples with a-C titanium has been revealed. The use of carbon diamond-like nanocoating leads to the formation of more mature and strong bone tissue in the implant pores. The use of the nanocoating slows the sclerosing processes of newly formed bone tissue.

The condition of bone remodeling in case of reparative osteogenesis of patients after immobilization depends on the metabolic peculiarities of osteogenic cells, as well as on the balance of bio-energy reactions. The manifestation degree of metabolic response to immobilization is associated with the degree of reduction in bone tissue mineral density.

The use of periarterial cryosympathodestruction in complex treatment of patients with complex regional pain syndrome allows to achieve positive results in 96% of observations. While using traditional methods of treatment the effectiveness doesn’t exceed 50% of cases due to the continuing decompensation of peripheral blood flow and vegetative profile.

Treatment of patients with Achilles tendon ruptures is an actual problem of modern traumatology and orthopedics. Treatment at first sight seems simple enough, but researchers invariably register high frequency of wrong diagnostics of ruptures of an Achilles tendon and complications after conservative and operative treatments, which rather essentially worsen quality of patient’s life. In the domestic literature questions of treatment of patients with Achilles tendon ruptures are in our opinion are reported insufficiently, and in many cases the information has sketchy character. These preconditions are at the bottom of insufficient knowledge of surgeons, traumatologists-orthopedists about true complexity of treatment of this category of patients that is in many respects caused by shortage of the corresponding literature. The given circumstance has induced us to generalize the historical data presented in the literature on treatment of patients with Achilles tendon ruptures. The particular interest for us has presented a historical sketch of the decision of the given problem.

The technique of surgical correction of hindfoot posttraumatic deformity with calcaneal defect-pseudoarthrosis accompanied by a trophic ulcer and soft-tissue defect of calcaneal plantar part has been published in the work.