The work is based on the analysis of treatment of 129 patients (within the period from 2003 to 2010) with consequences of the lower limb bone fractures under instable osteosynthesis in order to prove the need for orthetics in the system of treating limb long bone fractures using individual and serial constructs. When the effectiveness of treatment was evaluated in patients, their functional activity – mobility and walking – was taken into consideration beside the results of clinical and x-ray examination. Modern orthetics should be an integral part of treatment process, and it should have the objective validity in case of treatment stage changing.

This article is devoted to the problem of complex treatment of patients with intra-articular fractures out-patiently. The algorithms presented will be useful for specialists in traumatology and orthopedics, as well as for general surgeons who supervise these patients. The problems of preventing severe posttraumatic deforming osteoarthroses and the typical errors made in treatment of such patients are emphasized. The authors hope that this work will reduce the percentage of disability for patients with intra-articular fractures in Russia.

The disadvantages and traumatic nature of open osteosynthesis of bone fragments allowed researchers to use a distraction device for closed osteosynthesis in case of metacarpal bone fractures. The principal aim of the work is to show the advantage of closed osteosynthesis consisting in prevention of mixing bone fragments after their closed reposition, as well as in firm holding the fragments until their complete union is achieved. This technique of treatment has been performed in 30 patients with metacarpal bone fractures of different types. The analysis of treatment outcomes has demonstrated that good results are obtained in 74% of cases and satisfactory ones – in 24%.

The analysis of the special features of rotator integrity arthroscopic repair by the technique of arthroscopic double-row suture using anchor retainer is presented. This surgical technique has been applied in 58 patients with different injuries of the shoulder rotator cuff elements. Follow-up amounted to 18±5.2 months. Good results by UCLA score scale were obtained in 89.6% of cases.

Traumatic injuries of acromioclavicular articulation are still a problem of current interest in traumatology. They are the most common in
subjects of working age, and in a substantial number of active sportsmen among them. The problem of treatment is quite urgent due to a great
number of poor outcomes. The technologies of the coracoclavicular ligament replacement by different synthetic implants are increasingly
used in practice. The authors have obtained the evidences of the possible use of synthetic carbon implants for surgical reconstruction of the
coracoclavicular ligament on the basis of experimental studying the dynamics of strength properties of the implants of this type.

The result of surgical treatment of 63 patients with injuries of thoracic vertebrae and the first lumbar one is presented; the surgery was performed through a thoracotomic approach (control group) in 45 patients and that through a thoracoscopic approach (study group) – in the others. The original technique has been used consisting in anteroposterior spondylodesis by performing percutaneous transpedicular fixation and video thoracoscopic spondylodesis acutely.

Aim of study. To analyze the experience of usage of VEPTR and VEPTR II instrumentation in treatment of congenital spine deformities in infants and young children. Materials and methods. The data of 6 children (aged from 1 year 5 months to 8 years old) who underwent surgical treatment of vertebral column and thorax deformities were investigated. We applied different variants of VEPTR construction set, such as «rib-rib», «rib-spine», «rib-pelvis», «spine-spine», and estimated the possibility of effective correction. Results. We elaborated an algorhythm which helps to choose different VEPTR-endocorrector sets in treatment of congenital spine deformities in infants and young children.

The incidence of soft tissue inflammation in the area of inserted half-pins, as well as the instability of the inserted half-pins of an external fixator has been studied, illustrated by an example of treating 117 patients. All the patients were divided into groups depending on using the inserted half-pins of different types.

The ultrasound examination of the urinary system state has been performed in 55 patients with spine-and-spinal cord injuries (SSCI) in the acute, intermediate and late periods of the course of spinal cord traumatic disease. It has been established by the results of examinations that diffuse changes in renal parenchyma, dilatation and deformation of the renal pelvicaliceal system (PCS), the presence of concrements, thickening and heterogeneity of the bladder wall structure, the presence of suspension in the bladder cavity, the increase of prostate volume with vesiculitis signs is observed in the patients of this category. The above-mentioned changes have been revealed mainly in the late period of SSCI in patients with the motor and sensory disorders present.

Osteoarthrosis incidence among subjects above 65 is 60-70%, and arterial hypertension in the same age-related group occurs in 50% of the subjects. But the severity of arterial hypertension is determined not only by the degree of arterial pressure increase. Early diagnostics of disordering the structure and function of target organs, and, first of all, those of the heart is one of the important moments. 50 patients at the age above 50 with the knee and the hip osteoarthrosis have been examined. All of them had associated arterial hypertension of II-III stage. The patients were divided into groups depending on their age. ECG- and EchoCG-examination was performed in all of them. Left vetricular remodeling and hypertrophy progressing with age were observed in 82 % of cases. The higher values of wall thickness, myocardium mass, and myocardium mass index of the left ventricle, as well as the decreased values of ejection fraction and fractional shortening were observed in patients with the heart geometry changed in comparison with the patients with the heart normal geometry. High percentage of revealing the diastolic function disorder of both the left and the right ventricles was observed in all the groups.

The technique of closed intramedullary osteosynthesis combined with transosseous osteosynthesis has been used in treatment of 144 patients with shaft factures of forearm bones. A distraction device is applied for reposition at the first stage; closed intramedullary osteosynthesis is performed at the second stage. Good and excellent results were obtained in 96% of cases when evaluation of clinical signs was made and that by the DASH score system.

The work deals with the results of treatment in patient K., 58 years old, in whom the Achilles tendon avulsion from the calcanean tuber has occurred through hormonal therapy due to a minor injury. The patient underwent achilloplasty with the ankle fixation using the Ilizarov device. A good clinical and functional result has been achieved.

The work deals with the early experience of cryogen technology use for treatment of patients after the locomotor system injuries with delayed consolidation. Objective measures of diagnostics have been established as factors of this pathology. High medical effectiveness of using cryogen technologies is demonstrated.

The work demonstrates the results of treatment of male patient Shch., 69 years old, with the diagnosis: posttraumatic pseudoarthrosis of the left femur neck, the pain syndrome, combined contracture of the hip, relative 7-cm shortening of the left lower limb, local osteoporosis. At the first stage, a device mounted from the Ilizarov fixator parts was applied in order to equalize the limb length using distraction by 2-3 mm per day for 17 days. At the second stage, total hybrid arthroplasty of the left hip was performed using the Ceraver prosthesis 3 days after the Ilizarov fixator dismounting. One year later the achieved anatomic-and-functional result of treatment is preserved.

The article deals with the clinical observation of male patient Z., 68 years old, with the diagnosis: right-side idiopathic gonarthrosis of Degree II, flexion contracture, frontal instability, varus deformity of the right knee. The following surgery has been performed: tibial supratrochlear osteotomy, fibular subcapitular osteotomy, osteoperforations and tunnelization of the right femur condyles, hydraulic lavage of the right knee, osteosynthesis of the right leg bones with the Ilizarov fixator. Total endoprosthetics of the right knee has been performed 8 years later. Total period of follow-up is 13 years and one month. The patient is satisfied with the results of treatment.

The work demonstrates the results of treatment of female patient B., 61 years old, with the diagnosis: posttraumatic pseudoarthrosis of the left femur neck, the pain syndrome, combined contracture of the hip, relative 4.7-cm shortening of the left lower limb, local osteoporosis. She underwent arthroplasty of the left hip using the DePuy prosthesis with cementless fixation. Due to the pathology complexity the mobilization of the capsule-and-ligamentous apparatus was additionally performed in the area of the greater and lesser trochanters up to the attachment sites of the muscles forming the hip. A good anatomic-and-functional result was obtained.

216 patients have been examined after total hip arthroplasty. Reliable parameters determining prethrombotic shifts in the thrombocytic and plasma elements of the hemostasis system in patients with thromboembolic complications (TEC) yet preoperatively were identified in the process of the study performed. The results obtained have given rise to the development of the treatment-and-diagnosis algorithm for TEC prevention in patients with dystrophic diseases of the hips subjected to arthroplasty. The clinical-amnestetic and laboratory data evidence that TEC belong to a pathological process of dystrophic nature.

The aim of the study was to investigate the influence of age on the character of changes in the hemostasis system dynamically in 77 patients underwent the large joint arthroplasty. The parameters of coagulation, fibrinolysis were analyzed, as well as anticoagulants. Slower recovery of the level of prothrombin complex factors has been revealed, as well as less marked reactive thrombocytosis, higher activity of fibrin formation and lysis, greater activity of PAI-I reflecting endothelial dysfunction in the postoperative period in elderly patients in comparison with middle-age patients. Conclusions. More intensive fibrin formation and more pronounced endothelium damage in elderly patients may increase the risk of postoperative deep-vein thrombosis in comparison with middle-age patients.

The correlation between the development of early acute postoperative cognitive disorders and the low concentration of postoperative hemoglobin level and delayed allogenic hemotransfusion has been determined retrospectively in 268 patients at the age of 60-92 years with femoral neck fractures admitted to Yekaterinburg traumatology departments within the first 24 hrs after injuries not later. Hemoglobin level of ≥100 g/l in the early postoperative period has been established to be associated with the decrease of acute postoperative cognitive disorder incidence in patients with femoral neck fractures and cardiovascular diseases undergoing the procedure of the hip endoprosthetics.

The authors have proposed an algorithm of modeling this disease development for different variants of its treatment based on the abovementioned discriminatory analysis in order to automate the selection of treatment in patients with Perthes disease. 13 clinical-andradiological patient parameters have been determined in the technique of Perthes disease outcome prediction: patient’s age at primary diagnosis, the upper subluxation of the femoral head, the angle of acetabulum opening, lateral displacement of the femoral head, change in the the acetabulum radius, the hip abduction, type of the treatment performed. The coordinate values of the canonical linear discriminatory functions have been calculated for clinical (RootF1k and RootF2k) and radiographic outcomes (Root F1r, Root F2r).

The comparative analysis of the results of single- and two-stage treatment of 45 patients (48 hips) with severe unstable forms of juvenile slipped femoral epiphysis has been made. The long-term clinical and radiographic results and the incidence of complications after performing open epiphysis reposition and intertrochanteric rotational osteotomy have been followed for the period from 2 to 18 years. The differences of the compared techniques include the reduction of rehabilitation period in case of using early surgical treatment as open reposition of the femoral head epiphysis.

Biomechanical and electromyographic studies have been performed in 28 patients with chronic juvenile slipped femoral epiphysis before surgery. The functional disorders and compensatory adaptation of the locomotor system statically and in walking have been determined on the basis of analyzing the data obtained.

The evaluation of femoral muscle contractility has been made using the dynamometric test stand developed at RISC “RTO”. Three groups of patients were singled out: Group I – 15 patients (8±1.5 years) with the hip dysplasia; Group II – 15 patients with dysplastic coxarthrosis (13.7±2.8 years); Group III – 20 patients with the hip ankylosis (17.0±3.0 years). The conservative treatment performed in patients with the hip dysplasia contributes to complete recovery of femoral flexor muscle strength. The following different behaviors of working intact limb muscles were singled out in patients with the hip ankylosis: I – the work aiming at femur spatial moving on the hip ankylosis side through pelvic position changing, II – that aiming at moving the intact limb directly. The improvement of biomechanics of the femur operated in patients with dysplastic coxarthrosis one year after surgical treatment contributed to complete recovery of femoral abductor muscles, strength recovery of the muscles responsible for flexion and extension of the operated femur in patients with the hip ankylosis amounted to 85-95% of intact limb values.

Complex physiological examination of 50 patients at the age of 10-18 years with dysplastic coxarthrosis has been performed in the immediate and long-term periods after treatment. The reconstruction of proximal femur was made in 14 cases. Correcting surgeries of both articular components were performed in the remaining cases. The improvement of limb weight-bearing, joint function, as well as shortening compensation has been achieved clinically. After the Ilizarov fixator removal the functional load of the limb operated recovers most rapidly, which in combination with correct walking stereotype allows patients to increase their motor activity. Taking the restorative period regularities into consideration the complex exercise therapy for muscle contractility should be recommended only after muscle tone normalization up to intact limb values. The observed disorders of posture and the spine deformities are predominantly the adaptation manifestations of the locomotor system to functioning biomechanical conditions thereby requiring special attention in exercise therapy complex.

The article deals with a technique of acute femoral nerve block with subsequent catheter tunneling for prolonged femoral nerve block as a part of balanced anesthesia and multicomponent analgesia in the knee surgical interventions. 23 patients were included in the study (15 patients underwent the knee endoprosthetics, 8 patients – the knee ligamentoplasty). There were no cases of migrating catheter or its entry site infection, as well as no complications or toxic reactions to local anesthetic infusion. The proposed technique decreases the risk of catheter migration and allows to provide prolonged and effective peripheral neuraxial block perioperatively

Bone tumor-like involvements have the clinical and radiological signs similar to benign and malignant tumors. 365 patients with tumorlike involvements (22.4 %) were treated in Astrakhan clinics within the period of 1970-2010. Such processes in the leg bones are unevenly distributed with some topic predisposition. We took the possible parameters of pathological focus radiation imaging (focus location and shape, destruction character, bone cortex condition) into consideration. These signs have specificity for a certain nosological form. The results obtained allow to suggest the correct diagnosis by clinical-and-radiological manifestations with a certain amount of reliability, as well as to determine a type of the surgery required which depends on the process nosology, prevalence and localization, thereby contributing to the lower limb weight-bearing recovery.

The results of treatment are presented in a young patient with giant cell tumor of proximal femur using the procedure of total endoprosthetics of the right hip. A double fracture of the right femur middle and lower thirds occurred in him 1.5 years after arthroplasty. The periprosthetic fracture was fixed using cerclage, and the Ilizarov fixator was applied to the lower third fracture. Consolidated femoral fractures, as well as a stable endoprosthesis of the hip was determined by x-ray one year after injury.

The paper deals with the results of comparative evaluation of vascular bed reaction in patients with tumorous and tumor-like diseases of the hand tubular bones depending on the clinical and radiomorphological variants of bone tissue destruction and the accordingly selected option of surgical treatment. According to USDG and PPG data, the authors have revealed no ischemic changes in tissues of the hand operated segments, thereby reflecting little invasiveness and insignificant surgical aggression of the post-resection bone defect filling techniques used by us.

The system of rehabilitative treatment of patients with congenital pseudoarthroses of leg bones is based on using the technologies providing bone mass increase in pseudoarthrosis zone through adaptation of bone fragments with their mutual descending, splitting, paired bone use, osteoplasty of different variants, intraosseous reinforcement and biocomposite material use.

A comparative physiological and biomechanical study of 19 patients with phosphate diabetes (PD) and 44 patients with the lower limb varus deformities without PD has been performed. The retardation of body longitudinal growth, the decrease in limb muscle contractility, locomotion velocity- and force-related characteristics, capacity for work was revealed in patients with PD. The moderate decrease in the muscle strength of the leg deformed, the weakening of foot balancing function and the decrease of loading foot parts in walking was observed in patients without PD.

Anterior spondylodesis is combined with transpedicular fixation in children in order to achieve maximally possible and safe correction of the spine scoliotic deformity. The degree of correction depends on the instrumentation selected, the technique and extent of manipulation making, and preoperative planning is used for this purpose. The planning is made by the results of the examination performed, including standard radiography views of the spine and computer tomography.

The spine deformity progress in children is directly related to their continued growth. The lack of full etiology understanding doesn’t allow predicting the course of scoliosis. The revealed asymmetry of vertebral arches being within the deformity arc appears to be the first sign of scoliosis development in children. The relationship has been revealed between the degree of arch asymmetry and the course of idiopathic scoliosis in children with incomplete growth.

The model of forming the spine scoliotic deformity caused by the segmental disorder of vertebral subchondral zone penetrability has been developed experimentally in dogs. It has been demonstrated that the rates of forming the scoliotic deformity are higher in animals with vertebral subchondral zone penetrability disorder, as well as the deformity is more marked in them comparing with the animals without such disorder, and this will allow to use this model for studying the formation of scoliosis and the effectiveness of its correction methods.

The work deals with treatment of patients with purulent inflammatory complications of head and neck injuries through the use of local cryotherapy. This complex treatment has been demonstrated to have a persistent positive effect. Accelerated cleansing of a purulent wound from microflora and necrotic detritus occurs, as well as normalization of humoral immunity values, phagocytosis activation, peripheral blood flow stabilization, that in its turn leads to more rapid process of wound healing and doesn’t expose patient’s organism to additional stress. The exposure of a purulent focus to cryotherapy contributes to more intensive decrease of wound microbial contamination level evidencing the bactericidal activity of this method comparing with traditional treatment. The cytogram analyses made confirm the fact that cryotherapy use in treatment of purulent complications for head and neck injuries has allowed to accelerate reparative processes in a purulent focus significantly.

A technique for correction of vegetative disorders and peripheral blood flow in patients with complex regional pain syndrome has been
developed. Two variants of its use have been proposed: periarterial sympathetic cryodestruction with medication correction of two
courses, or sympathetic destruction combined with local cryological effect. Medication treatment is represented by three courses for this
option. At the same time cryotherapy is provided before, during or after conservative or surgical treatment performance for the locomotor
system involvement. The technology proposed has been demonstrated to be of high effectiveness.

The study of the vegetative nervous system functional condition including rheovasography and thermography of the upper limbs has been performed in 12 patients with children cerebral paralysis in the periods before cryosurgical treatment and 10 days after surgery. The angiospastic-type disorder of blood flow in the distal limb parts evidencing marked sympathicotony was revealed in all the patients preoperatively. The improvement of rheography and thermography parameters evidencing the increase in tissue blood perfusion was observed in the early postoperative period.

The paper deals with the results of routine clinical practice evaluation, as well as that of the risk and prevention of venous thromboembolic complications in the Ural Scientific Research Institute of Traumatology and Orthopedics within the nationwide Safety Zone project. The comparative data on evaluation of the degree venous thromboembolic complication risk and the conformity of the preventive measures taken to the national standards recommended are presented.

The preoperative real-time examination of adult patients with degenerative-and-dystrophic involvements of the hip, who were admitted to the Institute for endoprosthetic surgery, and those of children with congenital hip dislocation and congenital club foot has been performed by the technique of polymerase chain reaction in order to reveal opportunistic infection agents. Cytomegalovirus infection was revealed to predominate in children (patients) and mycoplasmatic infection – in adults. The necessity of preoperative screening of patients for the presence of opportunistic infections has been substantiated, as well as that of performing adequate therapy, that allows to eliminate the factors prognostically unfavorable for the outcomes of surgical treatment in patients with the locomotor system diseases.

The experiment was performed in 26 adult rabbits. The enzyme activity of bone tissue in the implementation of porous titanium implants with a diamond-like coatings (a-C) saturated with autologous adherent bone marrow cells, in the area of bone defects have been investigated. When using PTi (a-C) the features of osseointegration consisted in earlier and more pronounced osteogenesis activation, which was accompanied by activation of bone-specific alkaline phosphatase, as compared with PTi. One of the mechanisms that provided the increasing energy needs of the developing bone was the activation of aerobic processes.