This analytical work is devoted to reviewing the evolutionary development, the current role and place of the Ilizarov method in orthopedics and traumatology. In order to improve transosseous osteosynthesis technologies the authors suggest promising directions of scientific studies, which are focused primarily on implementation and practical use in clinical practice.

The analysis of the basic quantitative and qualitative indicators of the work of the traumatologic-and-orthopedic service of the Ural Federal Region for the period of 2008-2011 has been presented in comparison with the Russian-wide indicators. Further prospects have been identified on the development of rendering specialized traumatological care to the region residents.

The analysis of errors and complications for treatment of patients with the hand open injury using the technique of transosseous osteosynthesis according to Ilizarov is presented in the work.

The parameter of lymphocyte-platelet adhesion (LPA) has been studied in 75 patients with the uncomplicated and complicated process of limb long bone fractures postoperatively. A technique of traumatic chronic osteomyelitis diagnostics allowing to predict the disease development at the stage of preclinical manifestations more accurately has been worked out on the basis of the data obtained

The tactical features of consecutive differentiated medical care at the pre-hospital stage and during transportation have been determined based on the analysis of rendering pre-hospital care to 1482 patients with pelvic injuries subsequently transported to a Scientific Clinical Center. The medical care for 275 patients transported in resuscitation ambulances by the standby teams of the center at a distance of up to 600 km was the most efficient taking into account the severity of trauma and general condition, within the necessary extent of injury repair.

60 subjects with leg bone fractures have been examined. 40 patients underwent plate osteosynthesis, 20 were included in the control group. Duplex scanning of vessels and rheovasography examination were used in order to study leg and feet circulation. The studies were performed on Day 5 and Day 10, one, two, three and four months after surgery. The process of leg tissue regeneration for internal osteosynthesis has been established to occur under the conditions of reduced arterial blood flow, microcirculation low level and enhanced venous outflow with their staged recovery in parallel with limb motor activity expansion. Surgical treatment of leg bone fractures leads to the decrease of the blood flow parameters of the foot and contralateral leg.

The aim of this work was to study the age-related special features of EMG parameters of the back muscles in patients at the age of 6-18 years with I-II degree scoliosis. 26 patients were at the age of 7.5±0.57 years; 39 – at the age of 12.9±0.28 years; 29 – 16.6±0.5 years. The functional condition of lumbar muscles was evaluated by EMG values of m. erector spinae. It has been established the increase of maximal EMG power, that of mean EMG frequency and EMG fast waves/slow waves ratio, as well as the decrease of mean maximal EMG amplitude and m. erector spinae EMG mean power/mean frequency ratio is observed in muscles both to the left and to the right from the spine with age in children with I-II degree scoliosis. A spurt of the change in the parameters mentioned above takes place within the age-related range of 6-10 years and that of 10-14 years. Subsequently, as far as the children tested grow older, the rate of the parameter change becomes slower. It has been established for all age-related groups, that EMG maximal amplitude and EMG mean power/mean frequency ratio is higher, while EMG mean maximal power, EMG mean frequency, EMG fast waves/slow waves ratio in m. erector spinae is lower on the spine right side with respect to the left one in patients with I-II degree scoliosis of the spine.

The results of conservative treatment of lumbar herniated intervertebral discs have been analyzed in 580 patients. CT, MRI, and MSCT examinations were performed in patients for making the diagnosis of herniated intervertebral discs. All patients were treated according to the developed scheme of conservative (orthopedic) treatment: spine traction, injections of corticosteroid preparations into the spinal canal to resolve the discoradicular conflict, performing medicamental therapy, physiotherapy and exercise therapy. The decrease of disc hernia size (regression) was determined by tomography data due to the conservative treatment performed. The use of the developed technique of conservative (orthopedic) treatment of lumbar herniated intervertebral discs allows to obtain good clinical results.

Purpose: to compare the result of using a stay stitch to bridge the nerve gaps with repair the nerve gap without using a stay stitch, to compare both ways on the length of graft, number of grafts and number of cables per graft. Methods: a comparative study between 2 groups of babies with OBPP in which each group consists of 15 infants. In all the patients in both groups, neuroma excision and nerve grafting was indicated. In group (A) the defects were measured directly after neuroma excision without any attempts to approximate the retracted ends of the nerves, this was followed by reconstruction of the gaps by cable grafts from the sural nerves using fibrin glue. Conversely, in group (B) we took measurements of the defects after using 1 or 2 bridging stay sutures through the posterior aspect of the epineurium just to overcome the retracted distance without any further tension on the nerve. This also was followed by reconstruction of the gaps by cable nerve grafts with the aid of fibrin glue. Results: in group (B), the cable grafts length can be shortened from (29.6mm to 14.2 mm) with average of (15.4 mm). The number of cables per graft increase from 2.2 to 3.2. The number of grafts used in reconstruction of the brachial plexus were more in group B than in group A. Conclusions: A simple bridging stay suture can prevent retraction of the nerve ends after repair with fibrin glue, working as an internal splintage to the repair site, decrease the length of the cable graft, increase the number of cables per graft, gives more opportunity to make more nerve grafts and the surgeon feel that his repair is more secure.

Тhe aim of this work is to search the criteria of differential diagnosis of the brain traumatic and toxic involvement. The analysis of clinical and CT data, that of biochemical parameters has been made. The reliable criteria of differential diagnosis have been revealed. A convenient and modern method of their application as a computer program has been proposed.

Echocardiography examination was performed in 77 children at the age of 4-18 years with II-III Degree funnel chest. The study was performed by standard techniques. It found the changes in heart. The shape of right ventricle was changed in 35 children. The geometry of right atrium was observed in two cases. The interventricular septum mobility was studied. Hypokinesis was revealed in 5 cases, hyperkinesis – in 6 cases, and asynchronous contraction of interventricular septum – in 6 cases. The increase in the velocity characteristics of diastolic flows through the tricuspid valve was registered in 7 children.

The results of questionnaire of 308 children (observation group – 151 children with the hip dysplasia, control group – 158 children with unchanged hips) using the cards of medicosocial studying the hip dysplasia risk are demonstrated in the work. The data were processed using the methods of statistical analysis. A number of risk factors (12 factors) significantly influencing the development of the hip dysplasia in children was revealed. Newborns with the history of 4 and more factors combined and high relative risk can constitute a group of the hip dysplasia risk. Taking it into account it’s possible to perform preventive treatment in neonatal period.

of the lower limb large joints. Material and Methods. Hemodynamic status monitoring based on the technique of impedance cardiography (ICG) has been used in 42 patients with the hip and the knee injuries during the surgeries of total endoprosthetics of the lower limb large joints. The surgeries were made under combined spinal-epidural anesthesia with sedation by propofol or midazolam hypnotics. Results. The main factors determining intraoperative hemodynamic status of surgery-undergo patients have been established to be the following: a technique of providing anesthesia, pharmacological effects of the preparations used for anesthetic protection, the performed perioperative infusion-transfusion therapy, the degree of bone cement negative effect, surgery duration and blood loss volume. No dangerous deviations of hemodynamic parameters beyond the range of permissible physiological variations were registered thereby evidencing the effectiveness and adequacy of anesthesiological and infusion-transfusion supply of the surgeries made. ICG-monitoring has made it possible to estimate the degree of hydration of lung interstitial space for invasive endoprosthetics surgeries which are often accompanied by increased intraoperative blood loss in patients with the compromised cardiopulmonary system. The use of ICG technique allows to increase the safety level of the patients operated on. Conclusions. ICG technique allows to obtain useful clinically significant information about the character of changes in systemic circulation of patients undergoing rather complex surgeries of endoprosthetics of the lower limb large joints.

The evaluation of feet support reaction has been made by podography technique in 37 patients with dysplastic coxarthrosis (at the age of 8-17 years, mean – 12.0±2.5 years). The registered types of compensatory feet reactions in patients with dysplastic coxarthrosis have no specific diagnosis and differently manifest themselves in all patients. The number of the registered types of compensatory reactions determines the decompensation degree of locomotor stereotype. Degree I – asymmetry of limb weight-bearing with respect to age-related standard, the area of center-of-pressure trajectory is increased. Degree II – additionally: the decrease of pace of walking, asymmetry of the time-related parameters of stride cycle >10%, asymmetry of back push >20% due to its decrease for the limb involved. Degree III – additionally: the decrease of the length of center-of-pressure trajectory for the limb involved, the force parameters of stride cycle are decreased with respect to age-related standard for both involved and intact limbs, there is no damper fall in the involved limb. Degree IV – additionally: the decrease of the length of center-of-pressure trajectory for involved limb and intact one with asymmetry >5 %, there is no damper fall in both involved and intact limbs, the increase of the double-support walking period duration, back/front push parameter ratio is below 1.0.

The significant scattering of the parameters of different leukocyte forms with its range exceeding the technique error has been revealed in the process of preoperative dynamic examination of 826 patients preparing for primary total hip arthroplasty and 482 ones – for revision hip arthroplasty. The blood tests of seven practically normal volunteers performed during 30 consecutive days demonstrated the same range of scattering, as well as a fluctuating character of changes in the parameters studied. The levels of total leukocyte content, stab and segmented neutrophils and lymphocytes in peripheral blood fluctuated at hemicircaseptanic intervals, and the level of monocytes – at circaseptanic intervals. The fluctuations occurred around the trend, the value of which changed with circadiseptanic and close to circavigintanic periods. The data suggest these biorhythms to be the cause of the scattering observed.

40 patients with the knee and the hip osteoarthrosis (OA) have been examined in order to study neutrophil functional-metabolic activity when preparing to perform arthroplasty procedure and in case of the development of aseptic artificial joint instability. According to the data obtained, the intensification of neutrophil functional-metabolic activity is observed in both groups, oxygen-dependent metabolism of neutrophil phagocytes begins to dominate for the development of aseptic endoprosthesis instability through phagocytosis activation and enhancement of phagocytic digesting function. Therefore, in the long-term periods after large joint arthroplasty the following parameters of neutrophil phagocytic activity become the most significant diagnostically: PI (phagocytic index), PN (phagocytic number), IPC (index of phagocytosis completeness), НСТ-test, CP (cation proteins).

The stress-strain condition which occurs due to the impact of the most critical functional loads in “femoral component of the hip endoprosthesis-bone structures” system has been analyzed by the finite element method using ANSYS software. A standard-size series of the three-dimensional models has been developed which are anatomically similar to both femoral natural shaft and femoral "CORAIL" and "TAPERLOCK" implanted stem (of appropriate sizes). The analysis made has revealed that the shifts for the friction coefficient of 100 do not significantly differ from the similar data for natural bone under the conditions of the osteointegration taken place, as well as it confirms the mechanical compatibility of "CORAIL" and "TAPERLOCK" femoral components.

All the available methods for treatment of lunate bone aseptic necrosis have been considered and their efficiency – analyzed in the review. Osteoplasty technique takes the leading positions in treatment of Kienböck's disease due to its greatest efficiency and surgeons’ and patients’ satisfaction with surgical outcomes. The best results appear to be achieved by the procedure of vascularized bone grafting. The anatomy of donor site blood supply has been described and illustrated in detail. Vascularized bone grafts by dorsal approach, obtained from distal radial epimetaphysis pedicled from the arteries passing in 4 or 5 channels of the hand extensor tendons, as well as from the distal and proximal epimetaphyses of 2-3 metacarpal bones pedicled from the second dorsal metacarpal artery, are considered to be the most easy to use and anatomically favorable.

Comparative study of the vegetative nervous system functional condition was performed in patients with the locomotor system oncological diseases (55 subjects) at the age of 37.4±17.2 years (M±ð) and in those with congenital and acquired heart diseases (51 subjects) at the age of 50.6±13.0 years. Control group included 23 normal testees at the age of 42.3±14.9 years. The sharp predominance of the vegetative nervous system sympathetic tone has been revealed in oncological patients. In cardiologic-profile patients sympathicotonia manifested less sharply. The significant increase of the vegetative nervous system sympathetic tone in oncological patients resulted in high level of vegetative dysfunctions. The revealed special features of the vegetative nervous system functional condition in the tested groups of patients should be taken into consideration for complex rehabilitation of such patients.

The concept of “metabolic mark” is proposed, which consists in the fact, that any integrity disruption in bone leads to formation of a new metabolic condition in it and in organism on the whole, and the condition reactivity in case of repeated bone damage is increased.

The aim of the present study was to determine the diagnostic information value of some biochemical synovia parameters of patients with degenerative-dystrophic changes in their joints. The work has been made using synovia samples of 46 patients with the knee osteoarthrosis. The results demonstrate the increase of synovia general lipids, as well as the high values of diagnostic sensitivity and diagnostic specificity for the parameters of general protein, uronic acids, sialic acids, and general lipids of synovia

The parameters of population examination of patients for skeletal metabolic diseases have been studied using quantitative densitometry. Bone mineral density (BMD) has been compared in different age-related groups.

The cortical plates of femoral and leg bone shaft in 6 dogs have been studied by the digital images of histological sections, X-rays, computer tomograms, as well as by 3D-reconstructions made on the basis of serial tomographic scans at the stages of distraction transosseous osteosynhesis with an external fixator. Residual deformations and foci of high porosity with active remodeling have been found in tibiae after flexion osteoclasis at distraction diastasis level, that is not characteristic of femurs after osteotomy with a Gigli saw. Cortical plate microtraumatizing for plastic deformations is considered to be a trigger of reparative remodeling process.

Aim of study – morphological analysis of the osteoplastic effectiveness of bone tissue biomineral (BTB) obtained without thermal and demineralizing processing, as well as studying the mechanisms of reparative osteogenesis for BTB implantation into bone defects. An experimental-and-morphological study was performed on 30 mature Wistar rats of control and experimental groups, in which perforation defects were produced in the proximal third of tibial shaft. In the experimental group an implant was inserted into the site of defect – granulated BTB. Surgical interventions were performed under general anesthesia. Animals were withdrawn from the experiment after 1, 2, and 3 weeks. The bones operated were fixed and embedded in paraffin and araldit. Histological sections were stained with hematoxylineosin and with picrofuchsin by Van Gieson. The chemical composition and surface microrelief of BTB granules were investigated using an electron-probe microanalyzer and a scanning electron microscope, the intensity of osteogenesis process was determined, as well as the degree of maturity of newly formed bone tissue in regenerated bone. The results of the study performed evidence the fact that early intense angiogenesis is provided, activation of reparative posttraumatic osteogenesis occurs, acceleration of both remodeling and organotypical restoration of the bone involved take place in case of BTB implantation into bone defects.

Transosseous osteosynthesis has significant potential the realization of which implies performing systematic work to improve the devices for external fixation. And in this situation the main emphasis should be aimed at improving their reposition characteristics, the possibilities for producing an optimal balance of forces at the junction of fragments and providing stable fixation. These requirements have been successfully implemented in Matsukidis-Shevtsov device, thereby allowing to achieve high anatomic and functional results of treatment.

The current concepts of physiological and reparative regeneration of the articular cartilage, its structural adaptation in case of limb adjacent segment lengthening are represented on the basis of literature analysis.

A case report is presented which demonstrates the result of the combined pathology of lumbar spine and the hip for surgical treatment of articular and vertebrogenic factors. Complex sophisticated differential diagnostics is required at the stage of preoperative preparation in treatment of patients with the hip-spine syndrome in order to determine a dominant factor in the formation of the hip-spine syndrome clinical picture, as well as prioritization and feasibility of performing surgical treatment in one of the hip-spine syndrome components.

A case report of surgical treatment of the spine fracture dislocation at ThV-VI level with anatomical spinal cord interruption has been described in a patient at the age of 21 years. The technique of shortening vertebrotomy according to Tomita for spinal cord fragment adaptation has been used.