Purpose: To analyze the complications of extramedullary osteosynthesis using bio-inert and bioactive constructs, and to develop their number reduction.
Materials and Methods. The study included the cases of joint contractures, delayed unions and pseudoarthrosis formation, unions of fractures with gross deformities, plate break and shift, suppurations while treating 1265 patients of both genders, at the middle age of 37.1±6.5 years, with closed fractures of femur (n=440), tibia (n=532), and humerus (293). Type C fractures accounted for 44.7%, those of type B – 29.2%, those of type A – 26.1%. Surgery in 672 patients performed using bio-inert plates (BIP), that in 593 patients – using bioactive ones (BAP) with calcium-phosphate (CP) coating.
Results. When extramedullary osteosynthesis used suppuration complications developed in 1.2% of the patients treated, unions with significant displacement observed in 2.1% of them. Persistent contractures of joints observed most often. They accounted for 8.6% of the cases in patients with BAP, and 15.8% in those with BIP.
Conclusion. The use of bioactive implants allowed reducing the level of unsatisfactory results twice. The use of plates with CP coating is advisable for type C fractures, as well as in patients through osteoporosis.

Introduction. The search of informative criteria for monitoring the treatment of patients with low bone mineral density is relevant.
Purpose. To reveal and substantiate the correlation of the blood phosphatase index with mineral metabolism indicators.
Materials and Methods. 49 patients with bone non-unions examined dynamically. The activity of phosphoric monoesterase bone isoenzymes with phosphatase index calculation was determined in blood serum and daily urine, as well as the concentration of total and ionized calcium, magnesium, inorganic phosphate, parathyroid hormone, calcitonin; the excretion of calcium, phosphate was determined in daily urine based on creatinine.
Results. The significant correlations of the blood phosphatase index with mineral metabolism indicators revealed which determined by the volume of injury, its duration, the level of bone tissue mineral density.
Conclusion. The monitoring of these laboratory values is efficient for diagnostics and treatment of patients under immobilization conditions.

Purpose. To study femoral muscle state and walking biomechanics before and after treatment in order to predict rehabilitation of patients with patellar dislocation of different severity.
Material and Methods. Physiological examination (dynamometry of femoral muscles, and determination of feet support response) performed in 29 patients at the age of 12-46 years with unilateral patellar dysplastic dislocation and in 12 patients (age: 10-42 years) – with bilateral one before and after surgical treatment.
Results. As it has been shown, “maximally accelerated walking pace” functional test revealing ompensatory supporting responses of foot is of diagnostic significance in patients with unilateral involvement. As for patients with bilateral dysplastic process, the manifestation and the number of compensatory response types in locomotor stereotype indirectly reflect the severity of the involvement. Statistically significant asymmetry of leg extensor strength revealed both before treatment and during follow-up examinations after treatment. Muscle strength of the involved limb was on the average 61% decreased before treatment, and 29% decreased – after treatment. The parameters of limb functional state equalized approaching the level of values in normal subjects two years after surgical treatment.
Conclusion. Studying muscle functional state and walking biomechanics allows more efficient approach to rehabilitation process of patients with patellar dysplastic dislocation.

Introduction. High prevalence of the hip instability in children, as well as inconclusive results of treatment are so far of great interest in this problem for specialists. Bilateral involvement of joints is determined statistically in about 20% of cases, and staged surgical treatment is traditionally used in this group of patients.
Purpose. To develop the method of differentiated simultaneous surgical treatment of the hip bilateral instability in children.
Materials and Methods. The analysis of case records and out-patient medical cards of 65 children operated in our clinic for the hip bilateral instability carried out.
Results. The number of surgical treatment stages reduced in the last five years in our clinic due to performing simultaneous surgeries of the both hips. Different types of interventions in the hip performed including open femoral reposition, acetabuloplasty, periacetabular osteotomies of pelvic bones, correcting femoral osteotomies from two sides simultaneously.
Conclusions. Both the time periods of in-patient treatment and the time prior to the child’s verticalization postoperatively reduced significantly for simultaneous approach. When this method used the number of complications does not exceed the complication statistics for the staged management of patients.

Purpose. To compare the efficiency of using traditional exercise therapy for coxarthrosis, and the original complex of exercises based on manual therapy soft-tissue techniques.
Materials and Methods. A comparative analysis made regarding the efficiency of using traditional exercise therapy for coxarthrosis and after the hip replacement, as well as the original exercise complex based on the soft-tissue techniques of manual therapy. The complex proposed by the authors includes exercises with gravitational loading, postisometric relaxation, relaxing exercises of accelerated rhythm and small amplitude, and it is directed to improving the hip functional state (the decrease of the pain syndrome severity, the increase of range of motion, the increase of tolerance to loads).
Results. The results of using the proposed exercise complex in the system of restorative treatment demonstrated its great efficiency comparing to traditional exercise therapy.
Conclusion. The proposed exercise complex allows to relieve the suffering of patients with joint pathologies and to improve their quality of life.

Introduction. The works related to using Nitinol possessing thermomechanical memory, superelasticity, and self-regulating compression, appeared at the end of XX century, the implants biochemically and biomechanically compatible with body tissues developed for anterior and posterior fixation of the spine.
Purpose. To study the results of using Nitinol fixators in the surgery of degenerative-and-dystrophic diseases (DDD) of the spine in its cervical and lumbar parts.
Methods. 71 cases of such surgeries analyzed in order to study the experience of using Nitinol fixators in surgeries for DDD of the spine. DDD of the spine combined with osteoporosis in 33.8% of patients. In 83.1% instability occurred which resulted in developing different ultrasound syndromes of vertebral artery pathology in patients with DDD of cervical spine revealed by color duplex scanning (CDS).
Results. Intrabody fixators (in 28 patients), looped ties of Nitinol (40), and their combinations (3) used. When the indications determined for Nitinol implants use in interventions, not only general clinical indications considered but four technical ones as well: performing surgery with resection of one or more vertebral arches, or resection of articular processes, for spinal canal stenosis in the absence of radicular canal stenosis, in the presence of instability in one or more vertebral-motor segments (VMS) revealed before surgery, or in case of instability development possibility postoperatively, the deformity of vertebral bodies when DDD of the spine combined with its osteoporosis. The analysis of catamnestic data demonstrated a good result of using Nitinol implants.
Conclusion. The dynamic fixation using Nitinol implants is one of the possible options of performing surgery for DDD of the spine which allows to provide neurovascular structure decompression accompanied by resection of one and more vertebral arches or resection of articular processes with maintaining minimum mobility of VMS, without its instability, in one or more VMS, when revealed before surgery, as well as in case of moderate deformity of vertebral bodies for the spine osteoporosis with compression of spinal canal neurovascular structures. The procedure of neck vessel CDS gives the possibility to assess hemodynamics in vertebral arteries, and the adequacy of surgical intervention in the cervical spine.

Purpose. To study the efficiency of combined osteosynthesis use for treatment of lower limb deformities in children with vitamin D-resistant rickets.
Materials and Methods. The authors evaluated the recurrence incidence for long bone deformities of the lower limbs, and revealed the morphological features of the bones based on analyzing 369 case reports reflecting the results of surgical treatment of multiplanar deformities in patients with vitamin D-resistant (hypophosphatemic) rickets.
Results. Osteosynthesis with the Ilizarov fixator after correcting osteotomy is the most reliable option of fixation for such patients, though the periods of fixation still been significant (up to 160 days), and deformity recurrences in the growing child observed in 69.5 % of cases. The combined osteosynthesis using the Ilizarov fixator with intramedullary reinforcement by wires with bioactive coating reduces the risk of re-deformities up to 20 %, and the fixation periods using the external fixator 2-3-fold decrease. Re-deformities develop at the level of new parts of bone metaphysis formed during growth.
Conclusion. The success of deformity treatment in patients with diabetes phosphaticus largely depends not only on the accuracy of limb axis biomechanical correction and the technique of bone fragmental fixation, but also on the real possibility of controlling the rate of reparative process and influencing the regenerated bone quality through the bioactive coating of bone implant. Surgical treatment should be accompanied by intense conservative treatment influencing the disease pathogenesis (the increased doses of vitamin D and its metabolites, the preparations with vitamin D-activity, calcium and phosphorus preparations, Somatotropin and Calcitonin if necessary).

Purpose. To study the mid-term results of lower limb lengthening in patients with pathologically short stature in equal view of lengthening amount, functional result, duration, encountered complications, and ways of their treatment.
Material and Methods. The results of the stages of lower limb lengthening considered in patients with systemic skeletal diseases accompanied by low height, in terms of Lascombes classification.
Results. The favorable and unfavorable factors highlighted in order to perform the planned treatment; these factors are required to be taken into consideration for staged surgical treatment of patients with pathologically short stature.
Conclusion. The classification of the results of lower limb lengthening according to Lascombes with some modifications for functional result analysis can be applied to the assessment when performed surgical increasing the height of patients with systemic skeletal diseases accompanied by pathologically low height.

Purpose. To study the reparative processes during correction of metacarpal bone and finger phalanx deformities using transosseous osteosynthesis.
Material and Methods. Polypositional roentgenography which performed after patient’s admission to the clinic, during deformity correction, and after treatment (device fixation) completion, was used for studying reparative osteogenesis features in the process of correcting deformities of the hand different segments in 56 patients.
Results. The roentgenological signs of reparative osteogenesis during deformity correction have been demonstrated to manifest themselves as periosteal reaction, interfragmental reparative processes the severity of which depends on diastasis size, reposition completeness, soft tissue state.
Conclusion. Treatment of malunited or maluniting fractures of metacarpal bones and finger phalanges using the Ilizarov mini-fixator allows to obtain good results, to restore segmental axis and proper anatomical relations between the hand segments.

Purpose. Comparative characterization of the species composition of microorganisms in patients with chronic posttraumatic and hematogenous osteomyelitis.
Material and Methods. The results of microbiological investigation of the wound discharge analyzed in 56 patients with chronic posttraumatic osteomyelitis, and in 13 patients with chronic hematogenous osteomyelitis.
Results. The microcenosis structure in patients with chronic posttraumatic osteomyelitis characterized by the increase in bacterial species variety comparing with hematogenous osteomyelitis, and it differed by a great number of isolated gram-negative bacteria having high persistent potential, thereby leading to long duration of purulent infection. Nevertheless, S. aureus is the main pathogen of purulent process in the groups studied, being isolated in association with gram-negative microflora in 72.7% for chronic posttraumatic osteomyelitis, and in 100.0% – for hematogenous osteomyelitis, and, what is more, isolated with P. aeruginosa in 45.5% and 75.0% of cases, respectively. In the investigations of cases with chronic posttraumatic and hematogenous osteomyelitis the revealed microorganisms can form biofilms in the inflammation focus which protect bacteria from exposure to the immune response and antibacterials.
Conclusion. Timely microbiological diagnostics, efficient antibacterial therapy, prevention of forming biofilms, that is early suppression of their formation using various antimicrobial agents and modern methodical approaches – all this plays an important role in successful treatment of chronic osteomyelitis together with traditional surgical methods.

Introduction. In infancy brachial plexus blocks are usually performed under deep sedation or inhalation anesthesia. The use of a nerve stimulator for nerve plexus verification does not protect against the complications related to the technique. The use of ultrasound has some advantages: the time spent for the block performance is shorter, the percentage of successful anesthesia – higher, and the volume of local anesthetic – less. Many authors consider the combined use of ultrasound and a neurostimulator to be the most optimal variant.
Purpose. Comparative evaluation of peripheral block efficiency depending on the technique of brachial plexus verification for surgical corrections of the hand congenital deformities in infants.
Methods. Thirty infants and young children studied. Brachial plexus blocks performed using supraclavicular approach with ropivacaine at the dose of 2 mg/kg. The plexus verification performed using ultrasound navigation and neurostimulation in the first group (15 children); and using neurostimulation alone – in the second group (15 childtren).
Results. Wholly efficiency of the blocks observed in the patients from the main group, that was 93,3% in the patients from control group. The reliable decrease of the heart rate (HR) and respiration rate (RR) up to the age-related norm documented at all the stages of surgical intervention in the both groups. The stability of the values of central hemodynamics, respiration, oxygen delivery index observed, and the balance of acid-base state and lactate level maintained through these values. The normal balance of sympathetic and parasympathetic activity of the vegetative nervous system (VNS) in the main and control groups evidences of anesthesia adequate level.
Conclusion. The use of ultrasound for brachial plexus block allows direct nerve and tissue visualization, as well as anesthetic spread controlling, thereby making it possible to minimize the number of potential complications and to increase the block efficiency significantly. Brachial plexus block provides adequate protection of the child from surgical injury.

Introduction. Injuries of the cervical spine are the most common and severe variants of injury. So far, there is no unified and generally accepted system of assessment, and that negatively affects the subsequent tactics of treatment.
Purpose. To analyze the existing classifications of subaxial injuries in terms of reliability, clinical significance, and the possibility of treatment tactics determination.
Materials and Methods. The existing classifications analyzed on the basis of the data of the literature.
Results. The classifications with scoring system (CSISS, SLIC) are the most reliable ones for subaxial injury assessment. CSISS classification is preferred to assess the subaxial injuries without neurological disorders. SLIC classification is optimal for assessing the injuries accompanied by neurological disorders.

The review deals with the analysis of the publications related to the evaluation of mucopolysaccharidosis clinical manifestations. The pathological conditions and syndromes characterizing the changes in different organs and systems for glycosaminoglycan degradation disorder described, as well as mucopolysaccharidosis types, the plan of the patients’ examination, the diagnostics and the details of treatment.

Purpose. To describe the dynamics of paying scientific medical community’ attention to the problem of osteomalacia on the basis of the quantitative analysis of bibliographic search in MEDLINE database, as well as on selective studying the publication content.
Material and Мethods. The annual quantitative dynamics of the publications for the period of 1960-2012 analyzed using the method of statistical mathematical modeling. For this purpose dynamic series were formed containing the data about the number of annual publications which approximated by forth-order polynomial spline obtaining a trend model with approximation parameters p=0.1 (P less 0.05).
Results. The number of the publications on osteomalacia problem has been established to decrease since 1984 simultaneously with exponential increase in the number of the publications related to osteoporosis diagnosis by double-energy X-ray absorptiometry (DEXA). Since 1970 steady increase demonstrated in the proportion of the annual publications related to description of cases or observation series of patients with osteomalacia where diagnostic biopsy of bone structures performed in order to determine the tactics or efficiency of treatment in patients with chronic renal disease and others.
Conclusion. It has been suggested that a part of patients with osteomalacia are treated in the guise of osteoporosis diagnosis. Therefore in case of significant bone mass reduction before prescribing anti-osteoporotic therapy biopsy should be performed in order to differentiate between osteoporosis and osteomalacia.

The work deals with the modern trend in neurorehabilitation – robotic mechanotherapy applied to pediatric patients, based on the review of the literature. Robotic mechanotherapy demonstrated to be efficient and safe when used in patients of this age-related group. The technique safety demonstrated in some works. Neuroplasticity activation seems to be the main mechanism of the technique efficiency. The advantages and disadvantages of the most promising devices for robotic mechanotherapy use considered. The lack of control and objective evaluation of the change in the motor system functioning with clinical assessment prevalence is the disadvantage of the works related to evaluating the efficiency of using robotic mechanotherapy in children.

A rare case of humeral shaft echinococcosis presented. Clinical, radiological, and morphological picture of the disease described. An original technology proposed for filling the formed postresection defect with free fibula-deived autograft under transosseous osteosynthesis.

The Gorlin-Goltz syndrome is a genetically determined polyorganic syndrome of autosomal dominant type. The mutant gene is localized in chromosome 9, and the disease is associated with H 1A-A10, B14 antigens. Multiple basal cell tumors often develop in late childhood in case of the Gorlin-Goltz syndrome, but they can be congenital as well. Basaliomas can reach several hundred in number. The area of face, neck, trunk, and limbs is mainly affected. The pigment spots arranged longitudinally on the upper and lower limbs and having light-crimson color are stigmal signs of the syndrome. Bone abnormalities presented in 75-90% of patients: jaw cysts, kyphoscoliosis, bifid ribs, synostoses, prognathism, true hypertelorism, subcortical cystic changes in tubular and flat bones, extra fingers and toes developed sometimes. Cleft feet of different severity appear to be the leading sign. Treatment of patients with the Gorlin-Goltz syndrome is symptomatic. Recently, preparations of interferon group used as therapy. As a result of adjuvant immunotherapy, tumors can either regress completely, or inoperable tumors can become accessible for removal. The authors present two children with malformations of the upper and lower limbs treated in the Turner Institute. Surgical treatment performed for abnormalities of the hands and feet. Good functional results achieved in both cases. Postoperative wound healing, as well as skin and bone engraftment occurred in standard time. Surgical correction of limb deformities is an efficient way of treating orthopedic disorders for the Gorlin-Goltz syndrome.

The work deals with a clinical case of treating a patient with congenital pseudoarthrosis of leg bones by transosseous osteosynthesis method according to G.A. Ilizarov using intramedullary reinforcement with osteoinducting-coating wires.