Purpose. To improve the results of treatment of patients with advanced pelvic injuries using external fixation according to Ilizarov principles of transosseous osteosynthesis.
Materials and Methods. The results of treatment analyzed in 32 patients. External fixation using the Ilizarov method and fixator used in all cases for pelvic ring deformity correction and stabilization achievement. The advantages of pelvic ring external fixation versus internal one identified, osteosynthesis technologies presented depending on anatomic-and-functional disorders.
Results. The results of treatment within 1-8-year period studied in 28 patients. Good results achieved in 18 patients, satisfactory ones – in 7, unsatisfactory – in 3 patients associated with pubic bone separation recurrence and anterior pelvic instability.
Conclusion. The technique of external pelvic fixation using the Ilizarov fixator according to the principles of transosseous osteosynthesis developed in RISC “RTO” allows to restore the shape and stability of pelvic ring for its advanced injuries in a closed manner.

Purpose. To increase the effectiveness of treatment in patients with vertically instable pelvic injuries using the technique of little-invasive fixation of posterior parts.
Materials and Methods. The technique of little-invasive fixation of posterior pelvis used in treatment of 55 patients with acute vertically instable pelvic injuries. Iliosacral screw insertion to stabilize the posterior pelvis performed after definitive reposition, the technique of iliosacral blocking had its own characteristics depending on injury type.
Results. Good results achieved in 50 cases.
Conclusion. The use of the technology proposed for treatment of vertically instable pelvic injuries allows obtaining positive results in 91% of cases due to the possibility of performing reliable bloodless fixation of posterior pelvic ring complex provided adequate reposition regardless of its performance technique. A differentiated approach used to choose fixation technique depending on injury type. The proposed original way of sacral fracture fixation not involving sacroiliac joint is more physiologic, and it allows to reduce the risk of deforming osteoarthrosis and pain syndrome.

To study the long-term results of treatment of patients with proximal femoral fractures.
Materials and Methods. 379 patients with transtrochanteric fractures of AO 31-А type studied. The values of lethality, functional status, laboratory data, complication frequency studied in the early and long-term periods depending on treatment tactics.
Results. Surgical treatment revealed not to reduce lethality, but to improve the patient functional status reliably comparing with conservative treatment.
Conclusion. The comparison of different osteosynthesis technologies of proximal femur didn’t reveal significant advantages of any of them.

Purpose. To reveal the features of calcaneal fractures, to compare the results of treatment using different techniques and their effectiveness for the fractures of various types, to determine the prospects of the development of surgical treatment techniques.
Materials and Methods. The results of surgical treatment of calcaneal fractures studied in patients treated in the traumatological department for three years.
Results. The advantages and disadvantages of all the used surgical treatment techniques revealed. The algorithm made up to render care for patients with calcaneal fractures, as well as the prospects of surgical treatment techniques considered.
Conclusion. Conservative treatment indicated for type 73A fractures without displacement, and screw osteosynthesis for avulsion fractures with displacement; closed reposition according to Essex-Lopresti with wire or screw fixation is effective for type 73B fractures; plate osteosynthesis and osteoplasty – for type 73C fractures; Essex-Lopresti technique with wire fixation is a method of choice for type 73C open fractures; transosseous compression-distraction osteosynthesis according to Ilizarov indicated for infected fractures, open fractures combined with ipsilateral open fracture of the leg.

Purpose. To evaluate the effectiveness of clavicular fracture treatment by transosseous osteosynthesis at the stages of treatment and in the postoperative period neurophysiologically and dynamometrically.
Materials and Methods. 58 patients with closed clavicular fractures treated by the Ilizarov method examined in different periods after surgery. Neurophysiological and dynamometrical parameters evaluated.
Results. The greatest changes revealed to develop in m. biceps brachii. The recovery of the hand grasp strength occurred by the moment of the fixator removal, and the recovery of the shoulder girdle muscle function – within a year after treatment.
Conclusion. The neurophysiological and dynamometrical studies objectively confirm the high effectiveness of rehabilitation of patients with clavicular fractures by transosseous osteosynthesis technique thereby allowing to recommend it for wider use in clinical practice.

Introduction. Modern diagnostic techniques, USE and MRT, allowing topical diagnosis used to reveal the knee diseases and injuries.
Purpose. Complex examination performed in patients with the knee intra-articular fractures treated by fixation of fragments using the Ilizarov fixator under arthroscopic control.
Materials and Methods. On admission all the patients underwent AP and lateral views of the knee radiography, and ultrasound examination (USE). Magnetic resonance tomography (MRT) performed in 12 patients using 1.5-T magnetic-resonance tomograph.
Results. Trabecular edema of different manifestation revealed before treatment in seven patients, within a year after surgery – in five patients. The changes in medial and lateral menisci as inhomogeneity, destruction, partial or complete ruptures revealed by MRT technique in eight patients with closed intra-articular fractures of tibial upper third. The changes in ligamentous apparatus structure as inhomogeneity, swelling, thickening, partial or complete ruptures of ligaments revealed by MRT in nine patients.
Conclusion. MRT technique allowed to obtain sufficient diagnostic information about all structural components of the joint: bone, cartilage, menisci. The data also evidence sufficiently high USE effectiveness to diagnose the knee changes postoperatively, and low effectiveness – in the acute period of trauma, that confirmed by the comparative evaluation of USE and MRT data. USE for intra-articular fractures before surgical treatment not recommended. In this period MRT technique is reasonable, which allows studying not only the character of the knee element injuries, but also the severity of bone structure and cartilage injury, to determine bone marrow condition.

Purpose. To evaluate the effectiveness of total hip replacement in patients with dysplastic coxarthrosis.
Materials and Methods. The results of treatment of 103 patients with dysplastic coxarthrosis analyzed. Mean follow-up – 5.1 years.
Results. When assessing the results according to Harris 76.2% of excellent and good outcomes revealed.
Conclusion. The success of total hip replacement, especially in case of dysplasia, depends on the stability of implant acetabular and femoral components with their correct anatomical relations. The latters can only be achieved using reconstructive osteoplastic interventions in the area of acetabulum and proximal femoral end.

Purpose. To evaluate the dependence of clinical symptom manifestation on endoprosthesis fixation technique.
Materials and Methods. Patients operated for coxarthrosis and complaining during follow-ups (3-12 months after surgery) tested. 61 patients at the age of 29-78 years examined using Visual Analogue Scale, Lequesne index, WOMAC osteoarthritis questionnaire, Harris test, MacGill pain questionnaire. The assessment of pain syndrome intensity, constraint feeling and functional disorders made.
Results. The data evidence the absence of the influencing a technique of endoprosthesis fixation on the degree of functional disorders and constraint feeling. MacGill pain questionnaire established to be the most sensitive in case of the pain syndrome evaluation under these conditions. The following differences between groups revealed during the study: significantly less marked pain syndrome observed postoperatively in patients underwent the replacement using cement implant fixation (versus the cases of using cementless technology).
Conclusion. The studies demonstrated that a variant of endoprosthesis component fixation didn’t influence the functional result of treatment. The differences between groups noted for the pain syndrome scoring only.

Purpose: To develop and test the technique of unilateral epidural anesthesia and analgesia at the lumbar level for primary total replacement of the knee.
Materials and Methods. The technique of unilateral epidural anesthesia presented as a component of balanced anesthesia and multimodal analgesia for total knee replacement. The study included 14 patients at the age of 42-76 years.
Results. The unilateral insertion of an epidural catheter allowed achieving predominantly unilateral distribution of local anesthetic in the epidural space with subsequent development of selective sensory and motor nerve block.
Conclusion. The unilateral epidural anesthesia provided patient’s adequate protection from surgical stress, as well as effective postoperative analgesia during total knee replacement.

Purpose. To analyze the functional-and-ergonomic characteristics of external fixators (EF) of different types, as well as to develop the system of their evaluation and predict the effectiveness of their use in clinical practice.
Materials and Methods. The study of the functional-and-ergonomic characteristics of external fixators (EF) performed in terms of mechanics basic principles being the basis of functioning the mechanical systems for targeted and graduated movement of the bodies fixed in them.
Results. The direct dependence of the results of treatment of long bone fractures on EF functional-and-ergonomic characteristics demonstrated in clinical material. The system of their evaluation proposed which predicted the effectiveness of EF use in clinical practice.
Conclusion. Systematic work to improve the EF in order to increase their potential should be based on the principles of mechanics and ergonomics. The main ergonomic characteristic of the EF is the number of independent movements carried out by them. There is a close connection between EF ergonomic characteristics, physician productivity, periods of treatment, and the quality of the results achieved.

Purpose. Studying the effectiveness of osteoplasty using a vascularized autograft for extensive defects of forearm bones.
Materials and Methods. Surgical treatment analyzed in 25 patients with extensive segmental defects of one of forearm bones operated using a vascularized tubular bone autograft from a fibular fragment of the pool of the same-name leg vessels.
Results. Complete engraftment of the autograft occurred in 24 patients with consolidation of bone fragments and full or partial functional recovery of the limb operated. Lysis of bone flap occurred in one case.
Conclusion. The use of blood-supplied bone flaps as organ grafts in osteoplasty surgery allows to reduce the periods of surgical treatment significantly in such patients.

Purpose. To study special features of the structural state of distraction regenerated bones for polylocal lengthening of fragments in patients with long bone defects with one of the regenerated bone formation by “ischemic” type.
Materials аnd Methods. The results of ultrasound examination ("Aloka" SSD–630, Japan, Voluson 630PRO, Austria) of the special features of distraction regenerated bone structural state for polylocal lengthening of fragments in four patients with long bone defects presented in real-time mode using linear ultrasound sensors of 7.5-MHz frequency.
Results. Formation of the first regenerated bone occurred by “ischemic” type: the absence of paraosseous and endosteal reaction in the zone of distraction regenerated bone with its structure disorder and hypoechogenic foci visualization. Additional osteotomy and further distraction caused the intensification of reparative processes and the acceleration of organotypical reorganization of previously formed distraction regenerated bone in two patients (50% of cases).
Conclusion. The formation of distraction regenerated bones for consecutive multilevel lengthening of the fragment proceeds independently in patients with acquired bone tissue defects.

Purpose. To analyze the treatment results in patients with bone giant-cell tumors (GCT), evaluate the role of immunohistochemical reactions using the index of Ki-67 proliferative activity and a new device for bone tumor biopsies.
Materials and Methods. The diagnostic tactics using a device for taking bone tumor biopsies and the index of proliferative activity in immunohistochemical investigations developed by the personnel of the Department of traumatology, orthopedics and extreme surgery of the Samara State Medical University together with the personnel of the Samara Regional Clinical Oncologic Center since 2009. A technique of bone tissue preparation for surgical treatment of benign skeletal tumors, a new technique for plasty of bone tissue defect in the meta-epiphyseal zone of long tubular bones for the similar treatment implemented during treatment of patients. The presented technique of bone tissue preparing with plasma used in surgical treatment of 29 patients with skeletal bone giant-cell tumor and follow-up periods up to 4 years.
Results. Necrosis zone obtaining during resection zone preparing with argon plasma flow allowed to maintain mineral structures by their composition and form with the loss of all cellular elements including tumor ones being a cause of recurrences. Recurrences with soft-tissue component revealed in two cases within the periods below 6 months, and limb amputations performed due to this.
Conclusion. The experimental and clinical data obtained allow to use preparing the zone of bone tissue resection with a flow of low-temperature plasma in order to obtain the zone of necrosis which can contribute to increase the effectiveness of surgical treatment in patients with skeletal bone giant-cell tumors of benign variant.

Purpose. To develop optimal diagnostic and therapeutic measures aimed at improving the outcomes of treatment in patients with neuromuscular spinal deformities.
Materials and Methods. Surgical treatment for the spine correction and fixation performed in 28 patients at the age of 4-27 years, single-stage treatment – in 19 patients (using dorsal approach) and two-stage one – in 9 patients (using ventral approach at first and dorsal access further).
Results. Good and satisfactory results achieved, the correction of scoliotic deformity averaged 56.2%.
Conclusion. As a result of scoliosis surgical correction trunk balance improves, the spine and chest deformity progression prevents, and the possibility of self-service gets better in this group patients.

Purpose. To develop and introduce the algorithm of efficient diagnostics and surgical tactics into clinical practice on the basis of analyzing the results of surgical treatment of patients with true spondylolisthesis. The algorithm allows improving anatomic-and-functional results of treatment.
Materials and Methods. The results of surgical treatment of 115 patients with true spondylolisthesis analyzed. 47 patients(Group I) operated using the technique of isolated anterior interbody spondylodesis, 68 patients (Group II) – using the systems of the spine transpedicular correction and fixation. The maximum periods of follow-up for Groups I and II patients were 25 and 14 years, respectively. Most of patients had L5 Degree II displacement and operated at the age of 20-40 years.
Results. The factors identified which largely affected the outcomes of surgical treatment of patients with spondylolisthesis: compression of nerve roots; degree of vertebral body displacement; destabilization and abnormality of the spine profile line; intervertebral space height; degenerative changes in adjacent vertebral segments. The efficient tactics of surgical treatment proposed in view of the above mentioned factors, which contributed to reduce the incidence of unsatisfactory treatment outcomes from 25.5% (Group I) to 4.4% (Group II).
Conclusion. The combination of pathological factors in each specific case allows to develop an individual program of surgical treatment including different variants of spinal cord root decompression, the spine instrumental correction (alignment) and osteoplastic stabilization. It’s rational to use transpedicular systems for the spine correction and fixation in case of spondylolisthesis. The alignment of the vertebra displaced indicated for Degree II-IV displacement and can be performed using special reduction screws or instruments.

Introduction. The work involves the important problems of rotation atlas subluxation pathogenesis in children related to collagen metabolism disorder and the presence of undifferentiated connective tissue dysplasia. Purpose. To improve the effectiveness of treatment of children with rotation atlas subluxation due to the reveal of pathogenesis clinical-and-diagnostic features.
Material and Methods. Blood serum of 87 children studied. Clinical examination performed with revealing the external signs of undifferentiated connective tissue dysplasia, as well as the level of autoantibodies to I and II collagens determined in blood plasma by the method of solid-phase enzyme immunoassay (EIA).
Results. The level of autoantibodies to I and II collagens increased in blood serum of patients with rotation atlas subluxation (p less 0,05). Direct correlation revealed between dysmorphogenetic signs and collagen metabolism disorders.
Conclusion. The data reflect the conjugation of the external and clinical stigmata of undifferentiated connective tissue dysplasia for rotation atlas subluxation with immunologic shifts in pathogenesis.

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.

Purpose. A morphologic and histomorphometric study of leg bone nerves for transosseous distraction osteosynthesis of canine leg at the level of proximal meta-diaphysis.
Materials and Methods. The histomorphometric study of the leg bone nerves in 7 adult mongrel dogs which underwent leg lengthening with the Ilizarov fixator at the level of proximal meta-diaphysis for 28 days by 1 mm for 4 times.
Results. The changes of both compensatory-adaptive and destructive-reparative character revealed. The presence of combined antecurvation and valgus deformity of the leg (from 2° to 10°) was a factor which aggravated the alteration of leg bone nerves after the end of distraction. By a month after the fixator removal the proportion of destructively changed fibers increased to 5.5-6.4 % due to blood supply deterioration of nerve conductors. Dystrophic and destructive changes in microvessel epineurium, extensive subperineural and endoneural edemas evidenced nerve microcirculation disorders.
Conclusion. The neurological complications (5-30% of cases) not infrequently occurring in clinical practice for leg lengthening at the level of proximal meta-diaphysis may be a result of not only compensatory-adaptive changes in leg bone nerves, but destructive-reparative ones as well.

Purpose. Complex studying the dynamics of osteoreparative processes in patients underwent the cosmetic lengthening of lower limb bones according to Ilizarov.
Materials and Methods. The complex study of the dynamics of osteoreparative processes in patients underwent the cosmetic lengthening of the lower limb according to Ilizarov performed. The biochemical parameters of blood serum and daily urine studied in 14 somatically normal persons (at the age of 20-35 years) who underwent cosmetic lengthening of lower limb bones. Monolocal distraction osteosynthesis of leg bones, tibial osteotomy in the upper third, fibular osteotomy in the lower third performed in all the patients. Distraction started on Day 4-6 after surgery.
Results. Osteoreparative processes in patients underwent the cosmetic lengthening of lower limb bones according to Ilizarov revealed to be characterized by substantial activation of osteosynthetic processes in the first day of distraction with further increase of osteolysis; by the presence of calcium balance disorder compensation; by osteogenesis supporting inflammation reaction; by the change in skeletal muscle status as a factor limiting distraction osteosynthesis potential.
Conclusion. steoreparative activity in patients underwent the cosmetic lower limb lengthening according to Ilizarov supported through maintaining organism’s calcium balance, as well as through the development of the acute phase reaction (inflammation) fulfilling an osteogenesis supporting function.

Purpose. To study the fractionated blood plasma in patients with limb bone fractures for some biologically active substances.
Materials and Methods. Blood plasma fractionated according to an original technique studied for containing some biologically active substances in 10 patients with limb bone fractures in the postoperative period using immunoferment analysis.
Results. TGF-β1, IGF-2, Ang-1 and -2, PDGF-AA, PDGF-BB, PDGF-AB, FGF-acidic, SCF, VEGF-А, sVEGFR1/Flt-1, TGF-α, EGF and MSP revealed to be contained in the concentration ranges of 10-6 -10-12 g/ml biologically significant for these compounds. The values of TGF-β2, FGFb and SCF-sR concentrations turned up to be below the sensitivity threshold of determination methods. The mechanism of participating biologically active molecules in reparative osteogenesis program proposed.
Conclusion. More successful variant of regeneration may be determined not only by more competently made surgical manipulations, but also by the influence of biologically active components of fractionated blood plasma (growth factors, cytokines and their receptors) as participants of afferentation of bone tissue regeneration system.

Purpose. To study the changes in the system of peroxidation of lipids and proteins in blood serum of experimental animals.
Materials and Methods. The values of lipid and protein peroxidation in blood serum determined in experimental animals with the model of degenerative-and-dystrophic changes in joints.
Results. The significant increase in lipid spectrum peroxidation products demonstrated in blood for articular pathology development.
Conclusion. The results evidence that peroxidation products accumulate in blood serum of experimental animals in case of osteoarthrosis development, and a high content of free radical compounds observes as a consequence, which in its turn contributes to pathologic process development.

The publications and the materials presented in Internet on different techniques of lower limb shape correction using external fixators analyzed. The used techniques of preoperative planning, types of devices, variants of correcting osteotomies, types of bone fragment transfers, techniques of result scoring described. The shortcomings of the techniques used and the directions of their further improvement identified.

Complex study of transosseous osteosynthesis effectiveness in treatment of patients with limb intra- and peri-articular fractures presented. Optimal treatment techniques for patients proposed depending on bone and soft tissue localization and degree of their involvement on the basis of experimental, clinical, physiological, biomechanical and biochemical techniques of studying. Good and satisfactory results of treatment obtained in 96.6 % of cases, and they allow to implement the transosseous osteosynthesis method in practical health service broader. This method combined with current diagnostic techniques, introduction of arthroscopy and endoprosthetics will allow to raise this branch of our specialty to a higher level.