Introduction. Pseudoarthroses and defects of limb bones occur in 0.5-27% as a complication of fracture treatment. Recently, much attention is paid to the treatment techniques using non-free vascularized bone grafts, however, there are very few publications relating to the techniques of graft formation and transplantation.
Purpose. To study the results of surgical treatment of patients with bone pseudoarthroses and defects using non-free vascularized bone grafts.
Materials and Methods. An experimental study of 73 cadavers performed in order to investigate the donor zones. The analysis of treatment of 135 patients using such grafts made in the work. The results of treatment estimated according to DASH Questionnaire (Disabilities of the Arm, Shoulder, and Hand Questionnaire).
Results. Unions achieved in 130 operated patients. There were the following causes of failure: early stoppage of immobilization, repeated trauma, and osteomyelitis of the transplanted bone graft.
Conclusion. The analysis of the experimental studies made it possible to identify the donor zones for forming the non-free vascularized bone grafts and their transplanting into the area of bone pseudoarthrosis or defect. The use of the developed techniques of transplanting the non-free vascularized bone grafts resulted in filling bone defects and consolidating pseudoarthroses in 130 (96.3%) of 135 operated patients.

Purpose. To analyze the used variants and evaluate the results of restoring the hand bilateral grip in patients with congenital and acquired pathology of the first ray combined with congenital and acquired pathology of the upper limb using the International Classification of Functioning (ICF) before and after surgical treatment.
Material and Methods. 94 pollicization surgeries performed in 81 patients at the age from 6 months to 38 years within the period of 2000-2013. Pollicization in its classical form performed in 32 cases for 29 patients. In all other observations the modifications of pollicization surgery used the features of which were caused by a variant of the main pathology or accompanying one. ICF used for function evaluation before and after treatment.
Results. Four main groups of pollicization non-standard variants allocated. A positive result achieved in 98.5% – the improvement of the hand function, structure, use. The best postoperative results obtained in patients with a triphalangeal thumb (TPT).
Conclusion. 93.7% of patients had severe and absolute disorders of the hand function and structure before pollicization performance. After pollicization surgery performance the bilateral grip was formed in all the cases except one (1.5%) being characterized by moderate and light difficulties in the hand use. The best postoperative results achieved in patients with TPT. Light difficulties observed in patients with thumb aplasia and hypoplasia. Moderate disorders remained in case of thumb aplasia and hypoplasia combining with the pathology at forearm level (radial club hand).

Introduction. At present, cerebral palsy (CP) is the main pathology in children which accompanied by motor disorders. The complexity of rendering care to such patients is due to the multilateral character of the disease manifestation, as well as due to the necessity of various specialist participation in the treatment.
Purpose. To determine the clinical-and-statistical characteristic in children with cerebral palsy appealed to RISC RTO consultative-anddiagnostic department.
Materials and Methods. The work based on analyzing the outpatient cards of 147 children with CP at the age from 12 months to 17 years. The children divided into five (5) age-related groups: below two years – five (3.4%) children, those aged from two to four years – 21 (14.3%), from four to six years – 26 (17.7%), from six to eleven years – 65 (44.4%), and from 12 to 18 years – 30 (20.4%) children. The highest appealability observed among children at the age from six to 11 years. Mean age was 8.1±4.0 years. The disease history and orthopedic status of the patients studied.
Results. The diagnosis of spastic diplegia put in 50.3% of children from this group. There were 48 patients among children with motor disorders and Degree I for locomotion severity. Regular and full in duration and indications conservative complex orthopedic treatment performed only in 34 (23.1%) children among those appealed previously. The indications for surgical orthopedic treatment within the nearest year after consultation established in 88 (59.9%) children.
Conclusion. The results of the study carried out evidence of an insufficient level of the conservative orthopedic and rehabilitative measures being performed, thereby pointing to the need of developing and implementing a program to improve the quality of timely specialized care for children with CP in order to enhance and optimize functional results of treatment in children.

Purpose. To evaluate the efficiency of the proposed rehabilitation system for children with defects of the hand.
Materials and Methods. The program of social-and-pedagogical rehabilitation and habilitation of preschoolers with congenital and acquired defects of the hand developed and implemented in order to perfect functional potential and to form social and everyday skills after surgical treatment and prosthetics using a system of didactic games. Habilitation under this program performed in 70 preschool children at the age of 3-7 years. Most children had congenital pathology of the hand – 61 (87%) which was caused by disordering the linear and volumetric parameters of the upper limb (adactylia, hypoplasia, aplasia, split hand and partial gigantism) and nine (9) children (13.0%) had acquired defects and deformities including amputation. 55 children (79.0%) undergone the stage of surgical correction; 15 ones (21.0%) – the stage of prosthetics. Most children taking part in the experiment had unilateral defects of the hand – 39 (56.0%). The program aimed at solving specific methodological problems: the formation and perfection of all the possible types of grasp in the presence of existing defect of the hand, including the cases after surgery and prosthetics; the development of tactile sensations in the fingers; the development of fine motility; the increase of the range of motions in the joints of the defective hand; the development of attention and concentration; the formation of social and everyday skills according to the age; the development of the ability to achieve the set tasks.
Results. As it was demonstrated by the analysis of the level of social-and-everyday skills in children with defects of the hand who underwent in-patient treatment, depending on the age before medical rehabilitation and habilitation, the finding of high level of social and everyday skills (31.0%) observed in preschool children of the age group from three years comparing with children of other age groups. The rates for four- and five-aged children were slightly lower – 25.0% and 25.9%, respectively. The lowest values of the studied parameter registered in children at the age of six years – 20.6%.
Conclusion. The statistically significant parameters of functional potential level in terms of grasp and social-everyday skills in children with defects of the hand obtained during the study showed that the use of the system of didactic games increased the efficiency of treatment significantly regardless of the defect type. These data demonstrate the advisability of habilitation measures immediately after surgery or prosthetics because they significantly increase the overall efficiency of medical rehabilitation already at the early stages.

Purpose. To determine the activity and depth of the pathological process in the bone and cartilage tissues of children and adolescents with the hip dysplasia, as well as to reveal the informative value of the biochemical tests used for diagnosing and controlling the efficiency of this pathology treatment.
Material and Methods. The laboratory investigation of blood serum and daily urine performed in 36 patients with different manifestation degree of anatomic disorders for the hip dysplasia. The patients were divided into two groups. The first group consisted of children with the involvement of mainly femoral component of the joint, the second one consisted of the children with both joint component involvement. The values of electrolytes and the markers of bone tissue organic matrix degradation determined in blood serum and urine. Moreover, five samples of synovial fluid investigated.
Results. The investigation of blood serum and daily urine in the patients of the first group allowed to conclude the involvement of bone tissue organic matrix. No significant changes in the values of bone tissue mineral composition revealed in these patients. In addition to the increase in the concentration of degradation markers of the organic markers, significant deviations in the degree of its sulfation observed, as well as the tendency toward the change in some electrolyte ratio and the increase in calcium and phosphate excretion from the body. The investigation of the concentrations of bone tissue organic matrix degradation markers in blood serum of the children in the second group demonstrated significant increase in the degree of glycosaminoglycane (GAG) sulfation, as indicated by more than five-fold increase in sulphates/hexuronic acids (HUA) ratio.
Conclusion. The use of integral biochemical parameters provides an objective assessment of skeletal homeostasis in diagnosis, and allows controlling the efficiency of this pathology treatment.

Purpose. To reveal the effect of anemia on myocardial infarction incidence in the early postoperative period in patients with femoral neck fractures who underwent total hip replacement.
Materials and Methods. The correlation of myocardial infarction development with low hemoglobin level on Day 2 after surgery determined retrospectively in 303 patients at the age of 65-92 years with femoral neck fractures who admitted to traumatological departments of Yekaterinburg within the first 24 hours from injury not later.
Results. 100 g/l and more hemoglobin level in the early postoperative period established to be connected with the decrease of myocardial infarction incidence in patients with femoral neck fractures who underwent total hip replacement.
Conclusion. Postoperative anemia of moderate and severe degree is a predictor of myocardial infarction development in patients with femoral neck fractures who underwent total hip replacement.

Introduction. The urgency of this problem is caused by the complexity of visualizing the injuries of the posterior support complex of cervical spine (CS). A delay in diagnosis can lead to chronic pain syndrome, CS instability, manifestation of degenerative-and-dystrophic changes, and neurological deficit which aggravate the trauma clinical course and prevent patient’s proper rehabilitation.
Purpose. To analyze the long-term results of treating patients with CS posterior support complex injury in case of trauma whiplash mechanism.
Materials and Methods. The long-term results of treatment evaluated in 25 patients with CS posterior support complex injury who had trauma whiplash mechanism after road traffic accident without direct impact of the neck with analyzing clinical and X-ray data.
Results. All 25 patients started to work at 6 weeks after trauma, and they had no CS-related complains and symptoms. The range of motion in all the patients was 16-18 points that considered as a good result. Degenerated changes at the level of С5-С6, С6-С7 discs observed in 4 (16 %) cases. Consolidation of spinous process fractures occurred in all the cases. Ossification of supraspinous and interspinous ligaments at the level of the spinous process consolidated fractures observed in 17 (68 %) cases, as well as mild-degree disorder of functional adaptation according to Neck Disability Index found.
Coclusion. The involvement of the posterior support complex occurs in case of whiplash trauma during road traffic accidents. Radiography should be performed in three views, and it is possible to use CT scans in some cases as a standard diagnostic algorithm in order to rule out CS involvements in patients with whiplash trauma. Conservative treatment of patients with such injuries allows to obtain favorable results.

Purpose. To reveal correlations between the manifestations of atrophic, substitutive, and reorganization processes in muscles, as well as between muscle structural changes and some clinical data on the basis of studying the qualitative-and-semi-quantitative pathological changes and their manifestation degree in skeletal muscle bioptates of patients with the consequences of limb nerve injury.
Materials and Methods. 74 incision bioptates and the data of clinical examinations of 62 patients with the consequences of injuries of upper and lower limb nerves of different duration served as the material for the work. The following clinical data were taken into consideration: patients’ age at the time of injury; total duration of injury, the integral index of muscle functional state, as well as the morphological data were considered: a degree of muscle atrophy, a degree of type-grouping manifestation, and a degree of muscle fiber (MF) replacement by fibrofatty tissue. Correlations between clinical and morphological data investigated with calculating the coefficient of association, determining its parameter, the sign and degree of reliability.
Results. The degree of developing muscle pathological changes for the consequences of limb nerve injury can vary widely thereby reflecting both the heterogeneity of the initial parameters of nerve injury, and different rates of developing atrophic, dystrophic, substitutive, regenerative, and reorganization processes, but the degree of these changes, in most cases, reaches moderate or significant manifestation in the long-term periods. A complex set of these changes in muscle causes a certain degree of its structural-andfunctional insufficiency.
Conclusion. The results of correlation analysis of the relationships between the clinical data and morphological parameters of innervation disorder manifestations in muscle bioptates evidence of the fact that the relationship parameters for “morphology – morphology” and “clinical picture – morphology” analogous pairs for the upper and lower limbs somewhat differ. The morphological parameters of the upper limb muscle status show a stronger relationship between each other comparing with the analogous parameters of the lower limb muscles, however, the relationship between "MF hypo-grouping МВ" and "MF replacement by fibrofatty tissue" parameters in the upper limb muscles is very weak.

Purpose. To study the efficiency of the techniques of surgical treatment of patients with defects of integumentary tissues.
Materials and Methods. The analysis of the long-term results of surgical treatment made in 204 injured persons with defects of integumentary tissues who underwent 219 surgical interventions for the last 25 years. Transplantation of split-thickness dermatome grafts used for treatment of skin integument superficial defects. The plasty procedure with local tissues used to treat deep fasciocutaneous defects. The cross plasty procedure used in treatment of injured persons with the defects of the hand finger dorsal and palmar surfaces. The laterodorsal flap of the second finger, an interdigital flap or Littler flap used for treatment of the first finger defects. Complex axial flaps used in order to restore forearm active extension, as well as to close the defects of the hand ulnar and dorsal surfaces. The technique developed for filling the defects of the anterior surface of the leg lower third using a musculofascial graft of the leg.
Results. The transplanted flaps engrafted in 90 % of the operated patients. Skin detachment and necrosis of the transplanted flap were the causes of poor results. Such patients underwent necrectomy and transplantation of split-thickness dermatome grafts. The engraftment achieved in all of them.
Conclusion. The used techniques of reconstructive-and-plastic surgeries proved efficient for treatment of injured persons with integumentary tissue defects.

Purpose. To demonstrate the value of anthropometric characteristics in the structure of the skull and the hand bones for different systemic skeletal dysplasias, and their role in the process of differential diagnosis.
Materials and Methods. The photos of 25 patients with achondroplasia studied, as well as those of 15 patients with hypoachondroplasia and 10 patients with epiphyseal dysplasia, and also the photos of 25 normal subjects who formed control group. All the persons studied were Caucasians and females. Patients of different nosological groups underwent anthropometric measurements of the head, the hands, and the data of the presence and the possible combination variants of the disease anthropometric characteristics were obtained in them.
Results. The patients with hypoachondroplasia demonstrated to have no anthropometric characteristics of structure disorders of the skull and the hands, as for those with achondroplasia – structure disorders of both the skull and the hands observed in them, and the disorders of the hand bones only observed in patients with epiphyseal dysplasia.
Conclusions. Differential diagnosis is relevant both during the selection of surgical treatment tactics and in terms of patient’s legal status.

Purpose. To study the dynamics of remodeling the tibiae in patients with achondroplasia (AChP) after their lengthening.
Material and Methods. Remodeling of tibiae after their lengthening studied using the method of polypositional roentgenography, that of computed tomography (CT) and multisectional computed tomography (MSCT) in 47 patients with achondroplasia at the age of 14-20 years.
Results. As our data demonstrated, remodeling of distraction regenerated bone is similar to the process of bone natural growth. When newly-formed bone load increased with appropriate biomechanical and biochemical changes the trabecular adaptation of bone tissue occurred, the inter-trabecular space filled with bone thereby forming a cortical plate with simultaneous resorption of trabeculae in the area of future medullary canal.
Conclusion. Bone remodeling in the zone of distraction regenerated bone takes place by several stages, and consists in forming longitudinally oriented bone trabeculae with further trabecular resorption in the medullary canal up to complete organotypic reorganization which ends in 1-1.5 year. The algorithm of bone quality studying should include advanced techniques of MSCT data processing. The process of studying the cortical plate quality should be accompanied by measuring its total and local density.

Purpose. To substantiate the ergonometric approach to medical-and-social rehabilitation of patients with achondroplasia under operative reconstruction of the locomotor system (LMS).
Materials and Methods. The work is based on the material obtained by anthropometric measuring 125 patients with achondroplasia at the age of 6-30 years. During the anthropometric study the measurements of longitudinal height sizes made in the standing and sitting position, as well as those of separate segments of the upper and lower limbs using generally accepted techniques and anatomic landmarks in orthopedic practice.
Results. Patients with achondroplasia demonstrated their height in the sitting position to be practically not different from the age-related standard of 5th percentile females. Based on the skeletal structure features, the zones of optimal, easy and total reach-range are ergonomically reduced significantly in patients with achondroplasia (reduction of the longitudinal sizes of long tubular bones). Taking into account that the limb length deficit reaches 30% of the age-related norm, it becomes evident that the reach-range zone is reduced in proportion to this measure.
Conclusions. The anthropometric parameters of patients with achondroplasia must be maximally approximated to those analogous with the statistically averages of 5th percentile females.

Purpose. To study osteointegration characteristics of titanium nickelide mesh constructs and reparative osteogenesis under their implantation into bone defects.
Material and Methods. Tibial bone defect modeled experimentally in rats and dogs, and an implant of titanium nickelide mesh constructs inserted. The methods of radiography, scanning electron microscopy, and X-ray electron probe analysis used.
Results. The implant of titanium nickelide established to be biocompatible and have osteoconductive properties, the zone of osteogenesis and angiogenesis formed around it, and bone sheath is formed as well. Osteointegration of the implant structures occurs early, as well as regenerated bone organotypic remodeling, and the defect is filled with lamellar bone tissue by the type of bone wound primary healing.
Conclusion. The implant of titanium nickelide mesh constructs is one of the most optimal osteoplastic materials, and its use is encouraging and substantiated theoretically.

Purpose. To determine the effect of the scale factor (the increase of fibrils in diameter) on the strength properties of bone structures in organism’s aging based on the results of the authors’ own studies, as well as on those of other authors.
Results. The increase of fibrils in diameter in organism’s aging demonstrated to be an additional factor of bone structure mechanical weakening. The relationship between mineral matrix structures is the morphological basis of “weak link”. The local disagreement of the direction of acting forces and the longitudinal axes of mineral structures is a biomechanical condition of breaking these relations. This disagreement is caused by the fact that the morphological basis of bone tissue at each skeletal locus is relatively unchanged, and the direction of acting forces when performing locomotor functions is changing at all times, as well as their value. As a result, the locus of the greatest disagreement of the longitudinal axes of mineral structures and that of the direction of acting forces is steadily «migrate» in a particular part of bone tissue. It has been demonstrated in the development of the theory of «weak link» that under animate nature conditions the process of exchanging and continuous updating bone structures in aging leads to an increase in the absolute number of «weak links».
Conclusion. Under animate nature conditions the regulatoryand- metabolic shifts in the process of exchanging and continuous updating bone structures cause an increase in the absolute number of «weak links». It is this increase being one of the reasons of exponential reducing the strength properties of bone structures, for example, during the aging.

The review of foreign literature and that of our country highlighting clubfoot treatment in children presented in the work. Current conservative and surgical techniques covered, as well as the main problems of clubfoot treatment represented.

As it has been demonstrated, just “impression fracture” term rather than “compression fracture” one should be used for limb bone fractures from the Russian language logics point of view.

The work deals with a clinical example of treating a female patient with periprosthetic infection in the knee area. The following surgical intervention performed: removal of the left knee implant, necrectomy of the knee bones by resection type (7 cm), draining. Osteosynthesis of the femur and the leg using the Ilizarov device carried out. The characteristic feature of the performed surgery consisted in making resection within normal bone, as well as forming the femur and leg bones of “fossa-sphere” type (a hollow formed in the femoral condyles, and the tibial end fitted to the congruence with the hemisphere). A second course of antibiotic therapy used postoperatively. Wound healing occurred by first intention, fistulas closed. The following delayed surgery performed 1.5 months after the purulent process was stopped in the knee: osteotomy of the left tibia in its lower third in order to fill the defect. The technique of bilocal compression-distraction osteosynthesis in the left femur and leg implemented for 127 days. Fixation with the Ilizarov device lasted for 174 days. A positive result achieved.

A lecture on intramedullary elastic osteosynthesis for shaft fractures in children presented. The second part deals with using intramedullary stable elastic osteosynthesis for shaft fractures of the forearm, humeral and leg bones.