Purpose. To substantiate biomechanically the increase in long bone osteosynthesis stability, and the possibility of significant reducing the periods of bone fragment consolidation.
Materials and Methods. A new technique described for treatment of fractures of the upper and lower limb bones based on performing intramedullary osteosynthesis using wires with bioactive coating of organic hydroxyapatite (HA). The dynamics of bone formation around the implant traced, the biomechanical calculations of osteosynthesis stability demonstrated.
Results. The technique allows reducing the periods of shaft fracture consolidation 2-4-fold.
Conclusion. The calculations evidence the fact that a traumatologist really may well expect the strength of leg consolidation in a patient in case of early disassembling the Ilizarov fixator for the longitudinal load of 180 kgf and shear load (above 100 kgf). The bending loads with the force close to 39 kgf can result in refracture, that is why further preventive immobilization of the injured segment as orthosis is required; and the orthosis will allow increasing the permissible load of the limb, providing resistance to bending.

Purpose. To perfect the biomechanical conditions of treating oblique and obliquely spiral leg fractures which allow improving the effectiveness of treatment in such patients.
Materials and Methods. A technique of tibial combined osteosynthesis proposed using cortical screws and an external fixator which optimizes the biomechanical conditions of fracture healing thereby allowing active functional treatment in the early periods. The technique used in 64 patients.
Results. The performed biomechanical studies demonstrated sufficient reliability of this kind of fixation. Good functional results achieved in 94% of cases. The periods of restorative treatment 1.5-1.8-fold reduced in comparison with average rates.
Conclusion. The technique of combined osteosynthesis for leg shaft fractures most fully meets the main principles of reposition biomechanical optimality, fixation, and functional treatment for the injuries of the kind. The use of external fixator modulus as additional immobilization allows recovering limb motor and weight-bearing function immediately after surgery

Purpose. To study the prevalence of anemic syndrome in orthopedic patients hospitalized for proximal femoral fractures.
Materials and Methods. Peripheral blood parameters studied in 74 patients with proximal femoral fractures. The parameter dynamics analyzed in different age-related groups.
Results. The syndrome of hemic hypoxia demonstrated to be quite common in orthopedic patients. The anemic syndrome of moderate severity revealed in more than 60% of elder and senile males and 70% females of the same age is of the greatest risk.
Conclusion. All the patients admitted for proximal femoral fracture should be thoroughly examined in order to identify the risk factors of the anemic syndrome. The process of examination should be regulated by certain standards followed by developing the plan of correcting the existing or potential disorders.

Introduction. Ultrasound study has recently become one of the most rapidly increasing trends in the diagnostics of posttraumatic changes in the ankle. The simplicity and accessibility, as well as high information potential of new information technologies has provided priority for the method of ultrasound examination (USE) when choosing among other instrumental methods of studying joints and soft tissues. Moreover, economic practicability of USE has made it more attractive in comparison with CT and MRI.
Methods. USE performed in 131 patients with the ankle injury. The patients were examined clinically and by X-ray before. USE performed using SIEMENS SONOLINE LM and ALOKA 500, GE Vivid 7 devices with linear 7.5-MHz transducers and 5-MHz convex transducer.
Results. Malleolar fractures revealed in ten patients, talus fracture – in five ones. Injury (tears) and posttraumatic changes (ligamentites) in the ankle ligamentous apparatus occurred in 101 patients (78%). There were 252 ligamentous injuries in total. Ligamentous tears observed in 131 cases (52%). Single ligament involved in 24 patients (19%), two and more ligaments – in 77 patients (60%). Single-ligament tear usually accompanied by inflammation of the nearby ligament. Inflammatory changes in ligaments observed in 121 cases, and they amounted to 48 % of the total number of the revealed ligamentous changes.
Conclusion. The studies contributed to establish the fact that only complex radiation examination using X-ray, USE allows to make a definitive diagnostic conclusion about posttraumatic changes in the ankle area in view of the pathology of bones, tendoligamentous apparatus, as well as to plan the scope of conservative and surgical treatment, and medical rehabilitation more accurately.

Purpose. To study epidemiology of chronic osteomyelitic processes by the Omsk Region exemplifying, to substantiate the effectiveness of the proposed organ-saving surgical treatment on the basis of using reinforcing local extended carrier.
Materials and Methods. The case histories of 178 adult patients with different etiologic forms of chronic osteomyelitis of long tubular bones analyzed. The spectrum of pathogenic microflora studied, the details of the disease process demonstrated for each etiologic group. The variants of traditional treatment presented depending on the degree of bone structure involvement and the pyogenic process prevalence, a new algorithm of organ-saving surgical treatment proposed on the basis of using reinforcing local extended antibacterial carrier.
Results. While analyzing the long-term functional results of treatment the use of the proposed new technology of surgical treatment of patients with osteomyelitis revealed to result in complete relief of the disease symptoms in 67.2% of cases, in solution of orthopedic problems and, as a consequence, in significant improvement of patients’ quality of life and social adaptation.
Conclusion. The use of local antibacterial carriers in combination with surgical treatment of patients with osteomyelitis one-third increases the number of good long-term functional results in comparison with traditional treatment variants, and in this case unsatisfactory results almost six-fold decrease, thereby evidencing the effectiveness and promises of the developed trend.

Purpose. To develop the algorithm of early diagnostics of the hip congenital dislocation in premature born infants in order to improve treatment results.
Material and Methods. The results of examination of 64 premature infants and 68 full-term ones by the technique of ultrasound Dopplerography of magistral vessels in the hip area presented in the work together with common methods of congenital hip dislocation diagnostics, as well as the details of exchanging different oxyproline fractions studied in biological fluids of these children depending on gestation age.
Results. The algorithm of diagnosing congenital hip dislocation in neonatal infants developed on the basis of “complex approach” principle thereby making it possible to start treatment in the earliest periods and achieve good results of treatment.
Conclusion. The use of the hip ultrasonography in addition to ultrasound Dopplerography, and biochemical methods of studying allows to determine the predisposition to congenital dislocation development in newborns, and, of course, it is important in neonatal orthopaedics.

Objective. To compare the results of 80 patients undergoing total knee replacement and to see the benefit of using of close suction drain and compare it with no drain group.
Methods. A randomized prospective study conducted during 2011 group A (40 patients ) without drains ,and group B (40 patients with drains .The
total blood loss was significantly greater in those with a drain (400 ml versus 200 ml of non-drain group although hidden amount of blood lost cannot be accurately determined.
Results. There was no statistical difference in the postoperative pain, ecchymosis, or in the incidence of infection in the postoperative period in both groups.
Conclusions. There were no clear evidence to support the use of drains in total knee arthroplasty, even so still there are a lot of surgeon prefer to use it.

Purpose. The introduction of the technology of the transtibial arthroscopic reconstruction of the anterior cruciate ligament (ACL) using RigidFix and Biointrafix systems of fixation, and the development of rehabilitation system of patients postoperatively.
Materials and Methods. 182 patients with ACL injury (tear) treated within the period from 2008 to 2012, they underwent arthroscopic transtibial ST-reconstruction of ACL according to Mitek Rigid-Fix endoscopic technology.
Results. Long-term results traced in 73 (40.1%) patients, and good results of treatment registered in 93% of cases.
Conclusion. The introduction of the modern technology of ACL transtibial arthroscopic reconstruction using RigidFix and Biointrafix systems of fixation, as well as the development of the system of complex postoperative rehabilitation of patients demonstrated high efficiency of the technique thereby allowing us to recommend using this technology as the most effective one providing complete rehabilitation.

Purpose. To compare the functional status in patients with different etiopathogenetic variants of Stage III coxarthrosis using various rating scales, questionnaires, and tests.
Materials and Methods. The results of testing 48 patients at the age of 20-79 years with Stage III coxarthrosis analyzed in order to determine their functional status. The disease primary form identified in 19 patients, dysplastic one – in 14, and secondary form – in 15. Testing performed using Visual Analogue Scale, Leken’s algo-functional index, McGill Pain Questionnaire modified by V.V. Kuz’menko, Harris test, WOMAC questionnaire.
Results. Less marked pain and stiffness of movements established to be experienced by persons with secondary coxarthrosis. Female patients determine pain severity higher than male ones. The emotional component dominates for the pain syndrome in women. While, as for “stiffness sensation” criterion, no substantial differences between the two categories of patients observed. Moreover, the distinctions in the manifestation degree of functional disorders depending on gender and the disease duration not revealed. The maximum level of functional disorders observed for the disease primary form, as well as in patients above 50 years old.
Conclusion. The assessment complex applied may be recommended for use in orthopaedic clinics to make additional diagnostics of the functional status in patients with different variants of Stage III coxarthrosis. This complex allows analyzing some parameters impracticable to be studied by other clinical techniques, and that is important in the assessment of the performed treatment effectiveness.

Purpose. To study the clinical-and-stabilometric characteristics of orthograde standing in patients with posttraumatic osteoarthrosis of the ankle and talocalcaneal joints.
Materials and Methods. Clinical-and-stabilometric examination performed in 26 patients with posttraumatic osteoarthrosis of the ankle (n=14) and talocalcaneal (n=12) joints.
Results. The differences revealed in the formation of compensatory-and-adaptive mechanisms of providing orthograde position functionality under these pathological conditions.
Conclusions. The results of computer stabilometry may be used when choosing treatment technique for patients with arthrosis deformans of the ankle and talocalcaneal joints, for objective assessment of the results of treatment, as well as to be considered as an additional argument for disability examination.

Introduction. The modern concept of surgical orthopedic treatment of children with cerebral palsy involves performing multilevel orthopedic interventions.
Purpose. To study the results of acute multilevel orthopedic interventions in the lower limbs of patients with children cerebral palsy (CCP) within 8-12 months after surgery.
Material and Methods. The results of surgical orthopedic treatment studied in 108 patients (11.3±1.7 years). The gait analysis by Edinburgh Gait Assesement criteria made in addition to clinical and X-ray methods of studying. Changes in motor activity studied according to Gillette scale. 141 surgical intervention performed in our series, and it included 647 surgical elements on the whole, that is 4.59 ones per surgery on the average.
Results. The gait analysis demonstrated the improvement in most parameters of the support and swing step phase in patients capable of independent ambulation. According to Gillette scale, no increase in functional motor abilities observed in 32 cases (39.02%), one-level increase observed in 47 cases (57.32%), two-level one – in three patients (3.66%).
Conclusion. Performing acute multilevel orthopedic surgeries in patients with CCP means interventions on the limb musculotendinous system and/or bones of two or more anatomical areas during one surgical procedure, or the surgeries on the limbs, due to their significant volume, performed with a short interval (3-6 weeks) during one and the same period of hospitalization further accompanied by a single period of rehabilitation. This approach requires using the adapted methods of surgical intervention (aponeurotomy, primary stable osteosynthesis), adequate procedures of anesthesia, and pain syndrome control postoperatively in order to start rehabilitative measures early. The compliance with the above principles allowed to achieve the required correction of palsy orthopedic complications in all the cases. Herewith the increase in functional abilities one year after the surgery observed in 49 of 81 patients.

Purpose. To develop original technology for treatment of congenital brachymetatarsy cases.
Materials and Methods. The results of using the modified technique of controlled transosseous osteosynthesis according to Ilizarov for treatment of congenital brachymetatarsy cases presented by exemplifying of 10 patients (18 feet).
Results. The proposed technique allows controlling distraction direction, and it is very important for metatarsalgy treatment. The wire inserted antegradely used in this technique precludes dislocation in the metatarsophalangeal in case of lengthening more than by 40% of initial length.
Conclusion. The developed complex of the technique approaches allows providing high effectiveness of the Ilizarov fixator in lengthening of brachymetatarsy. The technique accessibility and simplicity allow to recommend it for widespread use.

Purpose. To analyze the technologies of surgical treatment of the hand pathology in children with acrocephalosyndactyly aimed at grasping function recovery, as well as at the upper limb habitus improvement.
Materials and Methods. The results of surgical treatment were analyzed in 19 children with acrocephalosyndactyly who underwent 62 surgeries within the age from 6 months to 18 years. A working classification of the first ray deformities was proposed, as well as the ways of surgical correction for each variant in order to systematize the surgical interventions performed to eliminate syndactyly of 1-2 fingers. The International Classification of Functioning (ICF) and DASH Questionnaire were used to assess the hand function before and after surgery.
Results. According to the evaluation of the results of surgical treatment, positive outcomes were achieved in 15 (88 %) patients, only mild (47 %) and moderate (41 %) dysfunctions of the hand preserved.
Conclusion. Surgical treatment allows to improve the cosmetic condition significantly, and to recover the hand functional potential in relation to the main types of grasping thereby facilitating child’s social adaptation greatly.

Purpose. To study the effectiveness of derotation and correction technique for typical and atypical deformities of the spine involving three arches (Lenke type III-IV) in growing children – an independent double derotation maneuver.
Materials and Methods. A technique of derotation and correction proposed for severe combined scoliosis of Lenke type III-IV in growing children. The procedure of instrumentation described, as well as the sequence of mechanical forces to correct differently directed torsion component in one step – an independent double derotation maneuver. The analysis of using the technique in four patients made.
Results. The use of the technique allowed performing the deformity correction with 71% improvement of scoliotic component and 51% improvement of apical torsion angle, on the average. Frontal and sagittal balance restored in all the patients.
Conclusion. The proposed technique allows not only to correct the spine deformity, but it preserves the distraction potential as the patient grows, and that gives the possibility to use it in actively growing children.

Purpose. To study the effect of the technique of transosseous distraction cranial osteosynthesis on the functional condition of the neuromotor system in patients with the consequences of hemispheric insult and those of severe craniocerebral injury.
Materials and Methods. The analysis of the dynamics of some electroneuromyographic values made; the values obtained by testing limb muscles in 28 subjects in the residual period of the disease.
Results. During the study this surgical treatment has been revealed to provoke the destabilization of the motor system functional condition the signs of which observed up to the control periods of examination. The analysis of the data obtained within the control periods evidences that positive dynamics of cerebrospinal indexes is the most marked in the long-term postoperative period and by the leads in the paretic upper limb. In this case significant variability is observed concerning the degree of reactive changes induced by cranial osteoplasty.
Conclusion. The increase in effectiveness of the motor controlling the paretic limb muscles has been determined electrophysiologically in patients with cerebral alteration consequences while being treated by the technique of transosseous distraction cranial osteosynthesis.

Purpose. Comparative studying the changes in blood composition of experimental animals when using the implants of medical steel and medical steel with coating of titanium and hafnium nitrides.
Materials and Methods. The comparative study of the effect of titanium and hafnium nitride coating on the rabbit blood condition experimentally. The animals undergone osteoclasia and further osteosynthesis with a wire of bioinert medical steel served as a comparison group.
Results. In the experimental group of animals such acute phase markers of response as the level of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), relative growth of granulocyte number in blood normalized in shorter periods than in the comparison group. The postoperative inflammation providing systemic and local regulation of humoral and cellular mechanisms involved in restoration of the damaged bone tissue not accompanied by complications in case of implanting steel with titanium and hafnium nitride coating.
Conclusion. The study revealed that the reactive phase after osteotomy and osteosynthesis was of short-term character, and its manifestations were somewhat less marked in case of using implants of steel with titanium and hafnium nitride coating comparing with implantation using bioinert medical steel.

Purpose. To study the peculiar properties of regeneration process for distraction osteosynthesis of rabbit forearm bones depending on the local features of their structure using densitometry during MSCT.
Materials and Methods. Formation and remodeling of the distraction regenerated bone studied in Chinchilla rabbits. One of rabbit’s forearms 10 mm lengthened by the Ilizarov method. The density of distraction regenerated bone measured with MSCT.
Results. The distraction regenerated bone established to go through a series of stages, and its reorganization is not completed by 20 days of fixation with an external fixator. There are initial signs of medullary canal formation in the central interlayer part as evidenced by a significant decrease in its optical density in the center comparing to the anterior and posterior surfaces.
Conclusion. Densitometry during MSCT performance is an objective method for bone tissue regeneration assessment.

Purpose. To improve the results of surgical treatment of patients with chronic ischemia of the lower limbs caused by arterial bed distal involvement due to differentiated using the techniques of indirect revascularization.
Materials and Methods. The study performed in 63 patients (89 ischemic limbs). Treatment performed using three types of surgical interventions: revascularization of bone split by distraction, repeated osteoperforation, the technique of prolonged tunnelization of lower limb bones with the Ilizarov fixator applied and simultaneous wire insertion into the medullary canal. 155 surgical interventions performed in total. The following methods used: clinical, transcutaneous polarography, ultrasound dopplerography, laser flowmetry, highfrequency ultrasound dopplerography.
Results. The use of indirect revascularization techniques led to the increase of capillary blood flow, the development of collateral blood supply with the humeromalleolar index increase or stabilization, the improvement of tissue respiration. Differentiated approach to using indirect revascularization techniques allowed to obtain positive results in 76.9-85.5% of cases.
Conclusion. As the results have confirmed, the character of surgical impact should be adequate to the nosologic form and pathologic process severity in order to achieve a positive effect of treatment. The differentiated approach to surgical impact on bone and soft tissues results in ischemia compensation and contributes to lower limb saving.

The role of genetic and non-genetic factors in the process of skeleton growth, maturation and involution considered from clinical-and-pathogenetic positions. Two main paradigms of skeletal architecture development and formation analyzed according to the mechanical demands emerging during performing locomotor functions. According to the first one, genetic factors are dominating (C.O. Lovejoy et al.). And according to the other (H. Frost), genetics creates only the initial conditions. One of the most important biological problems to be solved by the organism during realization of the genetic program of its growth and maturation, as demonstrated, is achieving the maximally possible (under specific conditions) skeletal mass with the architecture providing the highest level of strength reserve in every point of the skeleton.

Current concept of protein metabolism condition demonstrated in patients after skeletal trauma. The character (depth) of metabolic changes has some dependence on trauma type as shown by the analysis of the literature available.

A result of the hip replacement presented in a patient after successful elimination of extensive pyo-inflammatory process in the hip, femur in the presence of pseudoarthrosis with shortening and combined contracture. It can be suggested by the result analysis that transosseous osteosynthesis technique promotes the persistent elimination of chronic purulent process, as well as the creation of favorable conditions for subsequent replacement of the joint. This approach has allowed to achieve a positive result of treatment.

A clinical case of the knee arthrodesis with the Ilizarov fixator using computer navigation presented. The use of a special tool to perform arthrodesis surgery allows performing accurate and level filing of articular surfaces for maximum contact all over the surface thereby providing accelerated consolidation, more precise recovery of limb biomechanical axis.