Purpose. To increase the efficiency of treating fractures of the bones forming the anterior pelvic ring in the injured persons with polytrauma. Materials and Methods. Clinical-and-radiological analysis of treatment results made in 154 injured persons with polytrauma, type A fractures of pelvic bones. Conservative treatment performed in the first group (n=28), and surgical treatment using the developed little-invasive devices and pelvis osteosynthesis techniques performed in the second group (n=126). Multiple injuries of the anterior pelvic ring (of Type А2.3) prevailed in patients of this group – 101 (65.58%) cases. Results. 12 patients of the first group completed their treatment with good consolidation of fragments in proper position, callus transformation with gross deformity in the sites of fragmental union observed in 16 patients after vertical weight-bearing started. Open reposition and internal fixation using Matta Pelvic System instruments performed in four (4) cases, and delayed closed reposition with an external fixator – in 12 cases. Patients of the second group underwent early stabilization of the pelvic ring thereby providing safe examination and care of patients while combining the time-period of treating the injuries of internal organs and pelvis. Fixation of pelvic ring fractures with an external fixator was possible at all the stages of traumatic disease, and it provided positive results in all the cases. The time-periods of pelvic ring fixation with an external fixator were 58.83±1.31 days (p less 0.05). The results of treatment evaluated by S.A. Majeed score system. Good results obtained in 67.53% of cases and satisfactory ones – in 29.87% ofcases. Conclusion. Early osteosynthesis of type A pelvic fractures with an external fixator in case of polytrauma is animportant antishock measure creating optimal conditions to recover the pelvic ring integrity and contributing to treatment result improvement.

Purpose. To evaluate the efficiency of treating tibial plateau fractures using external fixators. Materials and Methods. The retrospective analysis of the short- and long-term results of treatment of 12 patients with fractures of the proximal tibia – plateau presented in the work. Surgical treatment consisted in open or closed reposition of the fractures using osteosynthesis with external fixators (EF). Evaluation of the results of treatment, both clinical and radiological, performed by the Rasmussen method. Results. The analysis of treatment results demonstrated the clinical and radiological outcomes to be considered as good and excellent in 11 of 12 patients treated. Poor result observed only in one patient who required an additional surgery. Conclusion. Based on these data, it can be said that the use of EF for treatment of tibial plateau fractures of type 5-6 according to Schatzker classification is the method of choice.

Purpose. Quantitative evaluation of the roentgen-and-morphological characteristics of long bone shaft fracture healing experimentally. Material and Methods. Open tibial fracture modeled in dogs experimentally, osteosynthesis using the Ilizarov fixator performed with hydroxyapatite-coated wire intramedullary insertion. A quantitative analysis of fracture consolidation dynamics made using computed tomography methods, and digitized images of X-rays made in two standard views investigated using “DiaMorph” hardware-and-software complex. Results. Fracture consolidation clinically and by X-rays occurred after 3-4 weeks. The density of regenerated bone in the intermediate zone three weeks after osteosynthesis amounted to 37% of the density of contralateral limb cortex, and besides the share of highly mineralized structures in the medullary space increased significantly (р=0.003) more than 5-fold, and that in the zone of cortical plate – 3-fold. Conclusion. The results of the study evidence of a positive effect of intramedullary wires with hydroxyapatite coating on the course and intensity of reparative osteogenesis during the fracture healing and the onset of consolidation within a month. The data allow to recommend this comparatively little-invasive technique of osteoreparation condition optimization for using in complex with other methods of conservative and surgical treatment of bone fractures.

Introduction. Skeletal trauma plays the role of one of the trigger mechanisms that lead to changes in the concentrations of plasma protein components in the posttraumatic period. Purpose. To evaluate the changes in the fraction composition of blood serum proteins in the posttraumatic period in patients with skeletal trauma of different types during treatment according to Ilizarov. Materials and Methods. The fraction composition of blood serum proteins studied in 65 patients with lower limb bone fractures of different types. Results. Hypoproteinemia and hypoalbuminemia combined with the increase in acute-phase protein fraction proportion developed in patients in the early period. Conclusion. The disorders of protein metabolism values did not depend on the character of traumatic injury, but their recovery rate had a clear dependence on the type of trauma.

Purpose. To evaluate the planning of long bone deformity on the basis of the model of 3D printing. Materials and Methods. A dog with posttraumatic deformity of forearm bones served as the object of the study. Computed tomography of the deformed and contralateral ("healthy") segments performed with creating the mirror copy of the intact forearm, thereby making the image of ideal correction. The three-dimensional models printed to a 3D. Thereafter the planning and modeling the deformity correction performed. The deformity correction implemented using Ortho-SUV, and the results compared with the planned ones. Results. The protocol of correction modeling divided into two stages according to the principles of correcting deformities of both forearm bones. The first stage included performing transosseous osteosynthesis with Ortho-SUV Frame, radius osteotomy at the apex of the deformity with its further isolated correction in order to restore the relations in the distal radioulnar articulation. At the second stage additional transosseous elements inserted into radius, its osteotomy performed with subsequent 25-mm lengthening of both forearm bones. Rendering this method to a dog led to optimal deformity correction which conformed to the planned one. Conclusion. The rendering deformity correction in the 3D model according to "healthy" segment image and the correction implementation using the orthopedic hexapod based on computer navigation provided a good result being the basis for wider introduction of the method.

Purpose. To analyze the change in blood serum biochemical parameters in patients who underwent leg proximal third lengthening in order to increase their height, depending on the amount of lengthening. Materials and Methods. Blood serum studied biochemically in 45 patients who underwent leg proximal third lengthening in order to increase their height. The concentration of total protein, albumin, lactate was determined in blood serum, as well as creatine kinase (CK) activity. All the patients treated divided into three subgroups depending on the amount of lengthening. On the average the amount of lengthening was 10.9±2.83% of the initial length of segment in the first subgroup, in the second one – 17.5±1.49%, and in the third – 23.2±2.48%. Results. The level of total protein established to increase slightly at the stage of distraction in all the subgroups. Creatine phosphokinase (CPK) activity increased significantly at the stage of distraction in all the patients examined, with the highest values in the third subgroup patients. Lactate level in blood serum significantly increased statistically as well in the third subgroup patients in the same period. Conclusion. The process of leg bone lengthening by more than 20 % of initial length leads to more significant change in organism’s systemic and local reactions comparing with lower amounts of lengthening.

Introduction. Joint replacement is currently a routine surgery and a radical method of osteoarthrosis treatment. However, the high cost of implants, the development of serious complications, and the presence of contraindications to surgical treatment make to continue searching efficient conservative techniques of osteoarthrosis treatment. Materials and Methods. The clinical experience of treating 35 patients, males and females, at the age of 31-75 years with posttraumatic gonarthrosis of Stage 3-4 according to Kellgren classification with the existing contraindications to joint replacement or those resisting surgical treatment for any reason. The treatment consisted in consecutive courses of intraarticular injections of Cel-T and Adgelon chondroprotectors. Results. By three (3) months after the end of treatment the pain syndrome released significantly, the number of overcome staircases without the need of rest increased, as well as the range of motion in the joint, both the crepitation in the involved joint and the need for analgetics decreased. Conclusion. In our opinion, the achievement of a positive result is associated with the pharmacological effect of potentiating the action of two different chondroprotectors, and gives the possibility to continue working in the desired direction.

Purpose. To evaluate the practical significance of the ultrasound Dopplerography of the hips in children with congenital hip dislocation and Legg-Calve-Perthes disease. Materials and methods. The results of the hip ultrasound Dopplerography are presented in 58 children with congenital hip dislocation (n=30) and Legg-Calve-Perthes disease (n=28) 1-6 months after surgery. The results of the study were taken into consideration for prescribing medicinal therapy; and the authors’ technique of hydrodynamic cuff therapy used as well. Results. The examination in the long-term periods after the treatment performed evidenced of improving the femoral head blood supply. Conclusion. The complex and individual approach to the hip pathology diagnosing in children using ultrasound Dopplerography of blood flow during orthopedic treatment can be used as a method for preventing dysplastic coxarthrosis.

Purpose. To determine the role of the integrated use of the techniques of standard roentgenography and computed tomography in assessing the severity of joint destruction in patients with hemophilia. Material and Methods. The work is based on analyzing the results of examination and treatment of 87 patients with hemophilic arthropathies of large joints. They were treated in JSC “RNTsNPM” specialized department of restorative orthotic surgery and polytrauma, their mean age was 42.5±10.3 years, they had the diagnosis of hemophilia A revealed by laboratory tests, and they were considered disabled persons with disability group II-III since childhood. There were 104 knees and 9 hips among 113 joints examined by the techniques of roentgenography and computed tomography. Results. Roentgenographic data revealed no pathology in 26% joints among 104 knees examined (when patients complained of pain in the joints), Stage I determined in 5.8%, Stage II – in 6.7%, Stage III – in 37.5%, and Stage IV – in 24%, as for the hip examination, Stage III-IV determined (according to E.Z. Novikova classification /1967/). In recent years X-ray computed tomography has been widely used in order to determine bone changes at different stages of hemophilic osteoarthroses more accurately. The authors propose a technique of semiquantitative evaluation of hemophilic arthrosis progression for standard roentgenography supplemented by CT data. For CT of 104 knees: among 26% of the joints without X-ray signs of arthrosis by X-rays, Stage I and II arthrosis revealed by CT, as well as CT signs of osteoporosis as local areas of bone tissue rarefaction revealed in all the joints, while regional osteoporosis by X-rays observed in 50.6%. Unlike roentgenography CT is of high sensitivity in diagnosing the signs of hemophilic arthropathies (91.8% and 72.7%, respectively), while roentgenography specificity is superior to CT specificity (86.4% and 71.3%). These two techniques complement each other that confirmed by the analysis of diagnostic test operation characteristics. When combining X-ray+CT techniques sensitivity increases to 96.7%, at the same time diagnostic sensitivity/specificity ratio is optimal (3:2). Conclusion. The proposed technique of semiquantitative evaluation of hemophilic arthrosis progression using standard roentgenography supplemented by CT data with detailing the roentgen-tomographic semiotics of different stages of hemophilic arthropathies which has the diagnostic sensitivity of 96.7% can serve as practical recommendations for physicians – roentgenologists, hematologists, traumatologists-orthopedists. Timely determination of the stage of changes in joints for hemophilia contributes to prescribing the adequate therapy which can significantly influence the disease evolution prognosis, as well as it allows to reveal indications for joint arthroplasty.

Study Design. 3 patients with CII-CIII tropism anomaly and unilateral subluxation were investigated and treated. Objectives. To demonstrate clinical and CT findings in children with the new anomaly in CII-CIII junction. Summary of Background data. A thorough in vivo research of CII-CIII junction became possible only after introduction of modern CT scanning technologies. We have not managed to find other clinical observations of this segment pathology in children in contemporary medical literature. Methods. We determined not typical cases of acute wryneck from the group of 262 children hospitalized in our clinic. X-ray and CT scans were used for evaluation of the problem. Results. From the group of patients with acute stiff-neck we selected three with the following symptoms: neck blocked and movement not possible; head advanced forward. On the lateral X-ray scans there were a cervical lordosis straightening and the pars interarticulares of the CII were overridden by the processus articularis superior of the CIII. The CT-scan of the cervical spine showed a unilateral subluxation of the CII segment in the forward direction. The articulation planes of the CII-CIII facets had different orientation on the left and right sides. Conclusion. We propose the hypothesis that non-symmetrical orientation of the articulation facet planes in the CII-CIII segment can cause a stiff-neck syndrome in children. In the described cases, the sole detected source of the pain syndrome and blocked neck was the tropism anomaly in the CII-CIII segment accompanied by a subluxation of the joint. Conclusions. Differential diagnosis is relevant both during the selection of surgical treatment tactics and in terms of patient’s legal status.

Purpose. A comparative morphological study of bone tissue responsiveness to transosseous insertion of the implants made of copper (Cu), 12X18H9T medical steel, 12X18H9T steel with variant coatings of titanium and hafnium nitrides (TiN + HfN), as well as with those of titanium and zirconium nitrides (TiN + ZrN) into the tibial shafts of experimental rats. Materials and Methods. Four (4) groups of rats were formed including two (2) groups of comparison (12Х18Н9Т and Cu) and two (2) experimental groups (TiN+HfN and TiN+ZrN) with the above implants. Histological investigation of the tibial parts directly contacted with the implants performed at the end of each period of experimental observation. Results. The obtained results demonstrated the restoration of the bone injured with the implant, and bone marrow in groups with the implants of 12X18H9T steel to occur without granulation and cartilaginous tissues, while that with the implants of steel coated with titanium and hafnium nitrides (TiN + HfN) to occur free of complications and in earlier periods. At the same time, cases of necrosis, bone tissue destruction and lysis registered in the groups of using the implants of copper (Cu), the implants of steel with the coating of combined titanium and zirconium nitrides (TiN + ZrN), and the recovery process was secondary via the cartilaginous tissue. Conclusion. The applied coatings of combined TiN+HfN give the implants chemical and biological inertness, and they can be recommended for clinical use.

Introduction. The improvement of surgical activity in the outpatient setting is relevant. Purpose. To develop the recommendations for improving this work based on studying the character and amounts of surgical interventions performed in the outpatient setting. Materials and Methods. Statistical reporting for 5 years, the operation registration books of the outpatient surgery center and the trauma center (21479 surgeries), techniques of parametric statistics. Results. The structure of surgical interventions for different forms of organizing the outpatient care revealed, as well as the supplying medical care of this type for the population, and the resource base of the outpatient surgery analyzed. Conclusions. It is advisable to review the procedures for rendering the outpatient surgical care, to bring the resource base into conformity with modern requirements and possibilities, and to introduce a differentiated training of physicians in outpatient traumatology and orthopaedics.

The elbow injuries are most common in adolescence, they account for about 50% of all fractures, and in childhood they rank first in frequency, variety, quantity and severity. Transcondylar and supracondylar fractures are among the most common injuries of the distal humeral end making 47.5-80% of all intraarticular fractures of the elbow area in children. The relevance of the present problem is due to a high proportion of complications and unsatisfactory outcomes (18-85%) despite a lot of available techniques for the elbow area fracture treatment, and the risk of nonunion and pseudoarthrosis formation amounts to 13-27%. The elbow injuries are the first by the number of posttraumatic complications. The complications are caused by various tactical, diagnostic, medical errors. The analysis of errors and complications covered in the work, as well as the main tendencies in the process of treatment of the elbow posttraumatic deformities in children.

The review of literature devoted to the problems of diagnostics, treatment, and classification of the shoulder instability in children presented in the work.

The literature review on the possible use of physical factors in treatment of complicated bone fractures presented in the work. The causes of bone tissue regeneration disorder described. The possibility of using such physical factors as electromagnetic and laser radiation, electric and acoustic impact evaluated. Particular attention is paid to using low-frequency ultrasound. The use of low-frequency ultrasound impact to optimize bone tissue regeneration demonstrated to be promising, but it is not widely used in clinical practice. The problem of ultrasound optimal parameters and application points should be studied further.