Purpose. To analyze the efficiency of conservative and surgical methods of treating uncomplicated fractures of the hand tubular bones.
Material and Methods. 470 patients with uncomplicated fractures of the hand metacarpals and finger phalanges treated. Among them closed reduction and immobilization with a plaster splint performed in 41 (8.7%) patients; osteosynthesis with wires – in 71 (15.1%) ones; extrafocal osteosynthesis – in 19 (4.1%) cases; external fixation of bone fragments with a plate performed in 2 (0.4%) patients; and osteosynthesis using clamping shape-memory staples including that combined with closed intramedullary and extrafocal osteosynthesis performed in 33 (71.7%) patients.
Results. Osteosynthesis performed after conservative treatment of patients with fractures of the hand middle and proximal phalanges of II-V fingers and those of the hand I-V metacarpals in 31.8% cases due to the secondary displacement of fragments. Osteosynthesis with external fixators and combined osteosynthesis using clamping shape-memory staples is the most efficient method in patients with uncomplicated fractures of the hand phalanges and metacarpals (92.9%).
Conclusion. The use of extrafocal and combined osteosynthesis with clamping shape-memory staples reduces the probability of fibrosis-inducing processes, secondary displacement of bone fragments, as well as the periods of rehabilitative treatment.

Purpose. To study the efficiency of combined osteosynthesis technique in treatment of the consequences of long tubular bone injuries.
Materials and Methods. The combination of the techniques of interlocked intramedullary osteosynthesis and external one using the Ilizarov fixator used for treatment of eight patients with shaft defects of long tubular bones. Biomechanical, radiation-related, clinical and statistical methods of studying used. The clinical example of the technology use presented in a female patient with posttraumatic pseudoarthrosis of the left femur with 3-cm shortening.
Results. The patient had no complaints three (3) months after the surgery, as well as she walked without additional supports and with complete weight-bearing of the limb. Joint function was also complete. Computed tomography revealed the absence of bone resorption around the screw interlocking the middle fragment, consolidation of fragments in the zone of docking determined by X-rays, newly formed bone tissue – in the site of lengthening.
Conclusion. The proposed technique of combined osteosynthesis for long tubular bone shaft defects allows to reduce the periods of in-patient treatment, to exclude the device-based fixation of fragments without compromising fixation stability, and to create comfort conditions in patients’ everyday life.

The management of the humerus nonunion is one of the most challenging problems that the surgeon confronts in his practice. The procedures traditionally used are: IM nailing, interlocking, plating, transplantation of allograft. In our series, 46 cases with nonunion has been treated by G.A. Ilizarov technique. The age range was: 21-62 years with an average of 32 years. The initial treatment was done by DCP, Rush nails and plates with screw fixation. The duration of treatment ranged from 5-11 months (average 8 months). With the Ilizarov fixator application a good range of elbow and shoulder motion was achieved. The average follow-up period was 15 years with a range of 1-22 years. Union was achieved in all the 46 cases.

Introduction. To make a comparative analysis of treatment results including the formation details of distraction regenerated bone during the procedure of lengthening the leg proximal third in patients with posttraumatic discrepancy in the length of the legs under the same distraction conditions, and with comparable amounts of lengthening both injured and intact (“normal”) leg.
Materials and Methods. The results of treatment in 12 patients with posttraumatic discrepancy of limb length studied. The patients were divided into two groups depending on the segment being lengthened (injured or intact /”normal”/ leg). Group 1 consisted of seven (7) patients with shortening of the injured limb. Group 2 included five (5) subjects with injury consequence in whom shortening of the intact limb with respect to the injured one observed. The results of treatment and X-rays analyzed.
Results. The results of treatment considered as good and excellent in the both groups, there were no serious complications influenced the outcome of treatment. The analysis of X-rays demonstrated one and the same type of distraction osteogenesis radiological picture in the both subgroups, as well as it supported high efficiency of the transosseous osteosynthesis according to Ilizarov.
Conclusion. The procedure of lengthening the proximal leg third in order to equalize the lower limb length for posttraumatic length discrepancy using the method of guided transosseous distraction osteosynthesis according to Ilizarov applied to both the injured leg and the intact one proceeds favorably and allows avoiding the complications influencing the outcome of treatment.

Purpose. To determine the main directions and evaluate the efficiency of the technologies used in treatment of pseudoarthrosis of the leg bones.
Materials and Methods. The results of 57 patients treated in FSBI “RISC RTO” and in the Department of Surgical Orthopaedics A of the University Medical Center de DOUERA (Blida, Algeria) within the period of 2000-2013 (25 boys and 32 girls) analyzed. Mean age of the patients – 10.5 years. 17 (30%) patients operated for the first time, 38 (67%) patients underwent from two to eight surgeries before applying to our clinics. Two (3%) patients underwent more than eight interventions at the previous stages of treatment. The Ilizarov method was used by the authors in 37 cases (65%) (Group 1), the method of inductive Masquelet membrane – in 12 (21%) cases (Group 2), and extensive resection of bone part with further defect filling using an autograft performed in three clinical cases (5%) (Group 3). Clinical examples presented.
Results. The mean period of treatment in Group 1 was 246.4 days (monolocal compression-distraction), 219.7 days (bilocal compression-distraction), and 215 days (polylocal compression-distraction osteosynthesis). The fragments of leg bones lengthened by 9.3±3.8 cm on the average. Among the patients of Group 2 consolidation achieved in eight cases of 12, it was insufficient in two patients, and the result was not achieved in another two patients due to total lysis of the graft. The mean period of consolidation was six (6) months (range: 4-8 months). Additional bone transplantation required in six patients in order to increase the bone mass in the focus. In Group 3 consolidation achieved in two patients, and additional transplantation required for one of them for the graft thickening, after that consolidation achieved.
Conclusion. The main methodological principles of treating congenital pseudoarthroses of the leg should be based on using different variants of osteoplastic interventions and osteoinductive materials in pseudoarthrosis zone, as well as on additional reinforcement with various implants (wires, rods). The use of combined variants of external and internal osteosynthesis is promising.

Purpose. To study the clinical-and-radiological features of feet deformities in patients with acrocephalosyndactyly.
Materials and Methods. The results of medical rehabilitation of 40 children at the age from four (4) months to 18 years with acrocephalosyndactyly analysed. A clinical-and-radiological study of feet deformities in the specified patients performed, the pathology main types emphasized.
Results. A working classification of the existing feet pathology proposed on the basis of the data obtained.
Conclusion. The feet deformities identified in patients with acrocephalosyndactyly upset the feet function significantly and cause severe limitations of ambulation thereby inducing to perform surgical treatment in the earliest periods as possible and to correct all the deformity components acutely.

Purpose. To specify the causes leading to the development of tibial recurvation deformity in adolescents, as well as to analyze the results of surgical treatment.
Material and Methods. A retrospective analysis of the results of examination and treatment has been made in 13 patients at the age of 13-17 years with genu recurvatum of different etiology. Distraction osteosynthesis according to Ilizarov was used for surgical treatment. The mean value of posterior proximal tibial angle (aPPTA) before treatment was 105.9±5.9°.
Results. The main factors which caused the partial closure of growth plate were technical errors of skeletal traction performance, prolonged immobilization, unrecognized injury of the proximal tibial growth plate. The mean time of deformity correction was 27±4.5 days. Fixation index (FI) was 53.9 days/cm. aPPTA value after the final correction was 83.9±3.7°. aPPTA value was beyond the reference values in six (6) patients (46%), residual deformity observed.
Conclusions. The causes leading to the partial closure of the proximal tibial growth plate that thereby results in genu recurvatum development in adolescents are multifactorial. Distraction osteosynthesis is the method of choice for correction of such deformities associated with shortening.

Purpose. To determine the efficiency of the proposed by us technique of surgical treatment of the patellofemoral and tibiofemoral joints using the Ilizarov fixator.
Materials and Methods. The technique of simultaneous treatment of the patellofemoral and tibiofemoral joint osteoarthrosis using the Ilizarov fixator developed. This technique used in treatment of seven patients with Stage 3 patellofemoral and tibiofemoral joint arthrosis according to Kellgren classification. The patients’ age varied from 57 to 74 years. The technique of surgical intervention described.
Results. When the patients examined one year after the treatment they had no complaints. Moreover, they walked without additional supports. The knee flexion was up to 40-50°, extension – to 180° (active). In the process of the knee flexion and extension the patellas moved freely along the midline without causing pain.
Conclusion. The use of the proposed technique for treatment of patients with gonarthrosis allows simultaneous improvement of the conditions of functioning the knee both parts: tibiofemoral and patellofemoral. The advantage of this technique consists in the possibility of postoperative graduated elimination of the leg deformity components remaining after correction on the operation table before biomechanical axis normalization, and that of simultaneous traction of the separated tibial tuberosity fragment with attached to it patellar ligament by moving the fragment distal edge anteriorly. This surgery may be method of choice in treatment of patients with osteoarthrosis of the knee patellofemoral and tibiofemoral parts. The results are encouraging and allow to hope that the described technique will be used.

Purpose. To study the dynamics of BAP electric potentials in patients with gonarthrosis under the influence of conservative treatment in order to specify their diagnostic informative value.
Materials and Methods. Two human groups examined. Control Group I consisted of conditionally normal subjects (n=12), and Group II – of 12 patients with gonarthrosis and exacerbation signs. Measurements made in ten (10) corporal paired BAP using F. 216-1/3 digital voltmeter.
Results. The mean values of BAP electric potentials in patients with gonarthrosis after treatment 25.7% increased (p less 0.001) from 29.2±1.0 mV (millivolts) to 36.7±1.1 mV with respect to the values before treatment. At the same time 46.3% decrease of pain values according to visual analogue scale (VAS) observed after 12-14 days that was a significant evidence of the efficiency of the performed treatment and confirmed the possibility of objective evaluation of the results of electrophysiological treatment method.
Conclusion. The level of BAP electric potentials for gonarthrosis 25.0% decreases with respect to normal subjects (p less 0.001). The data confirm the value of studying skin electric potentials in order to characterize gonarthrosis condition.

Purpose. A comparative evaluation of the tribological characteristics of various friction pairs used for the hip arthroplasty.
Materials and Methods. 16 pairs of friction of the hip arthroplasty implants from different manufacturers (metal-polyethylene, metal-metal, oxinium-polyethylene, aluminum ceramics-polyethylene, zirconium ceramics-polyethylene, aluminum ceramics-metal) studied under dry friction and biological environment conditions.
Results. The strength of adhesive bonds, as well as the friction coefficient in the samples with a polyethylene liner was high for dry friction and reduced under biological environment conditions. As for the samples with a metal liner, the friction coefficient reached maximum values in biological environment and reduced for dry friction. In terms of tribological characteristics, “oxinium-polyethylene” and “aluminum ceramics-polyethylene” with 32-mm screw head diameter, appeared to be optimal kinematic units which demonstrated the minimum friction coefficient (0.009 ... 0.010), the least strength of adhesive bonds (0.2 MPa), and the lowest coefficient of strengthening these bonds (0.006 ... 0.008).
Conclusion. The knowledge of the range of operational sorts of the implant kinematic units allows to make a grounded choice of arthroplasty technology based on studying the adhesion interactions of friction pairs that may be one of the key factors of increasing the construct’s lifetime.

Purpose. To analyze the influence of age-related factor on functional ENMG-characteristics of the lower limb neuromotor system in patients with LV spondylolisthesis.
Materials and Methods. 36 patients at the age of 15-67 years with LV spondylolisthesis examined using ENMG methods (M-responses).
Results. ENMG-characteristics of LV root functional state demonstrated to correlate with age poorly, while the values of adjacent root state (LIV, SI) are largely age-dependent.
Conclusion. The results of the studies performed may be useful in developing the tactics, as well as in predicting the functional outcomes of surgical treatment of elderly and senile patients with lumbar spondylolisthesis.

Purpose. To reveal the pathogens of humeral osteomyelitis in patients with different mechanisms of the disease.
Materials and Methods. Sampling of patients with humeral osteomyelitis treated at “RISC RTO” within 1969-2013 performed. Patients (n = 212) divided into groups depending on the forms and mechanism of the disease development. Pathogens of the infection process analyzed in 63 patients. Bacteria identification and antibiotic sensitivity procedures performed by traditional methods using «WalkAway 40» bacteriologic analyzer. The frequency of pathogen occurrence expressed as percentage of the total number of strains of the bacteria isolated.
Results. Chronic humeral osteomyelitis has been established to develop most often (in 51 % of cases) after treatment of closed fractures. Microcenosis in examined patients varied depending on the type and mechanism of osteomyelitis development.
Conclusion. The use of antibacterial preparations in patients with chronic humeral osteomyelitis should be carried out in view of microcenosis determining the inflammatory process, and oriented towards S.aureus monoculture (patients with hematogenous osteomyelitis and osteomyelitis developed in the process of treating open fractures), or towards bacterial associations with P. aeruginosa, E. coli, P. mirabilis, S. marcescens, A. faecalis gram-negative bacteria (in patients with gun-shot osteomyelitis and osteomyelitis after treating closed fractures).

Purpose. Studying the knee changes in patients with hematogenous osteomyelitis consequences on the basis of modern methods of radiation diagnostics and the developed evaluation complex of parameters.
Materials and Methods. 41 patients with the consequences of hematogenous osteomyelitis of the knee bones at the age of 5-31 years examined by the method of multi-position radiography. Multispiral computed tomography performed in 23 patients.
Results. Radiological examination of the knee performed in all patients on admission demonstrated unilateral involvement in 37 patients, bilateral one – in six (6) patients. The change in the shape, height, configuration of femoral or tibial condyles resulted in the knee deformity which was predominantly varus (22) or valgus (19), but the deformity torsion component also took place in the patients, as well as moderately marked antecurvation deformities, however, the deformities in the sagittal plane prevailed. Computed tomography allowed to reveal the significant bone density reduction in the area of metaphysis and epiphysis in all the patients. Cortical density was also reduced in all the patients and amounted to 1014.21±117.03 HU in children at the age of 7-11 years, and 1065.92 HU – in children at the age of 14-18 years being considerably differed from the values of the normal limb. As for adult patients, their density of femoral or tibial meta-epiphyseal part didn’t exceed 108-120 HU with resorption zones of various amount. Specific changes revealed as “starry-shaped” foci of sclerosis.
Conclusion. The results allow to systematize the changes in the knee structures to better extent in order to plan further treatment.

Purpose. To reveal the pathologic changes and determine the response of m. semitendinosus and m. semimembranosus of experimental animals after ischial bone fracture under external fixation and conservative treatment.
Materials and Methods. The experiments performed in 35 adult mongrel dogs. An unilateral transverse fracture of ischial bone body and branch produced with further surgical and conservative treatment. Radiographic, anatomical, and histological methods of studying used.
Results. There was no bone fragment displacement in case of surgical treatment in Series I. As for Series II, when conservative treatment performed the displacement of ischial bone fragment revealed by X-rays by Day 35 of the experiments, and this displacement developed ventrally in the sagittal plane with forming the angle of 32.5±12.5°. Ischial bone restoration after fragmental fracture by surgical or conservative method accompanied by more marked injuring m. semimembranosus comparing with m. semitendinosus. When there was no stable fixation of bone fragments, or in case of their significant displacement m. semimembranosus didn’t recover in the previous volume by the end of the experiment, while m. semitendinosus tended to its recovery. Reposition and stable fixation of fragments with an external fixator accompanied by moderate destructive changes in the both muscles studied. When conservative treatment performed, histological signs of muscle atrophy were characteristic of the muscles yet at the early stages of the study, and besides the atrophy manifested itself as the increase of sarcolemmic nuclei in number, that of fatty degeneration of muscle fiber bundles, group atrophy of fibers, and also as the intensified fibrosis of endo- and perimysial spacing.
Conclusion. Displaced ischial bone fractures should be treated using internal or external fixation.

Purpose. To develop a model of bone defect with a sclerosal bone wall, suitable for studying various pathogeneses of the diseases related to bone sclerosing, as well as for studying their consequences.
Materials and Methods. 12 rabbits divided into two (2) groups were used in the experiment. The experimental group included the animals underwent modeling bone defect with a sclerosal wall (n=6). Bone defect without a sclerosis zone produced in the control group of animals (n=6). Radiological and morphological studies performed in the both groups by Day 45 and Day 90 after the surgeries made. Euthanasia in order to take organs for morphological investigation performed on Day 45, Day 90 after surgery, for three animals in each period, respectively.
Results. The percentage of fibrous tissue in the control group with unchanged bone defect was 3.33±0.8%, and in the model with a sclerosal defect wall the ratio of fibrous tissue was substantially higher – 26.7±5.2%, resulting in sharp retardation of regeneration rate comparing with the control group.
Conclusion. We have developed an experimental model of bone defect with a sclerosal wall confirmed radiologically and morphologically, which allows to study the processes of biodegradable bone-substituting material reorganization. The combined influence as a thermal burn and cement packing contributes to forming the zone of sclerosis and fibrosis around the bone cavity formed.

Purpose. The evaluation of morphological changes in the bone tissue of defect zone under disordered reparative regeneration.
Materials and Methods. The study performed on laboratory animals – Chinchilla rabbits. All the experimental animals underwent modeling the conditions of disordered reparative regeneration. Radiological and morphological changes in the zone of bone defect evaluated in the study dynamics. The technique of gamma scintigraphy used for evaluation of morphofunctional changes in the zone of bone defect.
Results. The delayed juxtaposition of fragments by Day 14 established to lead to marked morphological changes in the zone of defect by Day 20 of the study, with pseudoarthrosis formation by Day 50. During histological investigation the formed cavities revealed the walls of which were formed with hyaline cartilage, with observed enchondral ossification of callus underlying spongy bone, with collagen fiber foci and sites of spongy bone structure. The predominance of connective cartilaginous tissue and bone tissue ratio was 1:1. As it was established by bone scintigraphy technique, radiopharmaceutical accumulation in the zone of bone defect increased in phase 2 and 3 in the left limb thereby evidencing of the maintaining active reparation processes up to Day 50.
Conclusion. The disordered conditions of reparative regeneration as 14-day delayed juxtaposition of bone fragments lead to pseudoarthrosis formation by Day 50 of the study.

The analysis of national and foreign research literature devoted to different methods of treating multiple fractures of lower limb bones presented in the work.

A review of current literature presented related to the problems of developing biocompatible implants based on modern technologies including bioengineering and nanostructuring. The advantages and disadvantages of implants demonstrated, as well as the ways of improving their biological and mechanical properties.

The work deals with a rare clinical case of female patient A., 37 years old, after total cementless replacement of the right hip using an implant by “Ceraver”. The replacement performed for congenital dislocation of the hip, supra-acetabular neoarthrosis, with malposition of the screw fixing the implant pelvic component in the projection of sciatic notch, and sciatic nerve neuropathy as a complication.

The lecture on using intramedullary elastic osteosynthesis for diaphyseal fractures in children presented in the work. The general principles of intramedullary stable elastic osteosynthesis of diaphyseal fractures, as well as the treatment of femoral fractures by this technique considered in the first part.