Relevance. The article deals with the problem of femoral neck fractures. The average number of fractures per 100,000 people in Russia is 60. The first year mortality when using conservative treatment is 60-80%. Complications of metalosteosynthesis amount for 41.8% of cases. Among them, there is no consolidation in 23.6%, aseptic necrosis of femoral head develops in 18.3%. Purpose. To perfect the tactics of surgical treatment of femoral neck fractures based on using new technical devices, maintaining spongy bone tissue and recovering intraosseous circulation in the neck and head of femur. Materials and Methods. Surgical treatment performed in 39 patients with femoral neck fractures. Mean age of patients by the time of surgery was 68.7 years. Surgeries performed urgently. Reposition of bone fragments performed on an orthopedic table of original design. And a fixator of original design used for metalosteosynthesis. Rehabilitation program of six stages prescribed in the early postoperative period. Results. The results of treatment evaluated 12 months after surgery using clinical and X-ray techniques. Function assessment performed according to W.H. Harris score system. Excellent results obtained in 23 patients, good ones – in 11, satisfactory – in three patients, and unsatisfactory – in two ones. Long-term results with follow-up period from one (1) to five (5) years studied in 29 patients. Good function without degenerative-and-dystrophic changes in the hip achieved in 74. 3%. Conclusions. Immediate internal-and-transosseous osteosynthesis required for patients with femoral neck fractures. Reposition of bone fragments should be performed on an orthopedic table equipped with a system of skeletal traction. Rehabilitation measures should be started on the second postoperative day.

The management of segmental defects within the diaphysis of long bones is one of the most challenging problems that the surgeon confronts in his practice. The procedures traditionally used to bridge bone gaps include autogenous bone grafting [1], posterolateral bone grafting [2], transplantation of allograft bone [3] and fibular protibia procedures [4]. All the above traditional methods of management of bone defects sometimes require multiple surgical interventions. The treatment period is long and weight bearing may not be possible while the functional results are often less than satisfactory. Recent studies showed that the G.A. Ilizarov Technique is a more popular than vascularised bone grafts especially for big bone defects [5, 14].

Purpose. To detect reliable preoperative markers of the shoulder hemi-implant instability by the results of electromyographic study in patients with proximal humerus (PH) injuries. Materials and Methods. We performed surgical treatment of 50 patients, among them: 23 patients with chronic factures, 20 patients with PH fracture-dislocations, 7 patients with avascular necrosis of the head who underwent hemiarthroplasty. Methods of studying: clinical, radiological, multispiral CT with evaluation of the state of the shoulder bone structures, rotator cuff and ligaments, in some cases we performed MRI of the shoulder. All the patients underwent electromyography (EMG) of the shoulder girdle muscles of both upper limbs with determination of their functional state preoperatively. Periods of observation were from six months to 7.5 years after surgery. The patients were divided into two groups: those with a stable implant (Group 1) and those with an unstable implant (Group 2). Results. Before surgery the muscle functions in patients of Group 1 and Group 2 revealed to be different. In patients of Group 2 EMG parameters before surgery were reduced on both sides with respect to Group 1 patients. The asymmetry between the sides was more marked in the group with unstable implants. We have obtained the reliable preoperative criteria of hemi-implant instability in the long-term periods by electromyography results. The mean frequency (MF) of the biceps bioelectric activity (BA) can serve as a quantitative criterion of implant instability. The less MF of m. biceps BA (below 174 Hz) and the smaller MF difference between the sides (less 30 Hz), the more likely the shoulder implant instability. While studying m. triceps the amplitude parameters should be considered as a criterion of the likely implant instability. Conclusion. The obtained data demonstrated the state of the shoulder girdle muscles of the involved limb to influence the shoulder hemiarthroplasty results principally. When we compared the results of electroneuromyography (ENMG) of patients with PH injuries using a blind method, the error of the proposed method was 10.5%.

Purpose. To optimize the results of treating the elbow severe injuries and their consequences, as well as the elbow diseases in young patients, to evaluate the immediate and mid-term results of the elbow arthroplasty in young patients. Materials and Methods. We have analyzed the results of 52 surgeries of primary total arthroplasty of the elbow in patients at the age below 40 years. We used the implants by Endoservice (Russia) and those Coonrad-Morrey by Zimmer (USA). The main indications for the elbow arthroplasty in young age developed. The technique of surgery and postoperative rehabilitation described. We evaluated the results according to ASES system (Richards R.R. et al., 1994). Results. The results of treatment analyzed within 1-10 years after surgery. Good and excellent results obtained in 78.8% of all treated patients; satisfactory ones registered in 15.4% of all treated patients. Unsatisfactory results of arthroplasty occurred in 5.8% of the total number of operated patients. Conclusion. The elbow arthroplasty in young patients is a high-tech surgical intervention which is a traditionally used alternative, and in some cases it is the method of choice for treatment of some severe injuries and diseases of the elbow. It should be performed in the extreme and severe cases when the limit of other familiar techniques reached.

Purpose. To substantiate the strength properties and wear resistance of the hip implant made of carbon material. Materials and Methods. We have developed a construct of the hip carbon implant; picked and used the durable biocompatible carbon material during the implant making; studied and presented the properties of the materials being used. The implant consists of a stem, a cup and a head. We mounted all the details as a unified medical product in a free condition during surgery. The implant stem is made of carbon plastic and firmly fixed in femur by cementless fitting. The implant head is made of firm fine-grained graphite of MPG-7 trademark, and it is attached to the stem by cone fitting. The implant cup is made of MPG-7 graphite and fit into the acetabulum with cement. We used slide fitting to attach the cup to the head. Results. The friction coefficient for graphite-graphite shown to be 0.1, erosive wear within 20 hours of uninterrupted abrasion with 100-kg load (weight of a person) to be 0.453×10-9 m/m, thereby allowing to suggest the product wear resistance for one hundred years. Conclusion. The material proposed for implantation is highly biocompatible, non-toxic, it doesn’t change under the influence of biological environments, is not subjected to corrosion when contacting with living tissue, as well as it is characterized by the lack of fatigue stresses, the low friction coefficient and wear amount, the potential to stimulate the growth of biological tissue. None of the currently used implanted materials possesses such a set of properties.

Purpose. To study the details of medical-and-social rehabilitation of patients and disabled persons after the hip total arthroplasty (HTA), as well as to reveal the possible ways of reducing the primary disability and restoring the optimal working ability in the patients and disabled persons with this pathology. Materials and Methods. We analyzed the materials of 499 patients after the hip arthroplasty, studied the data of the labor character, the degree of physical stress, professional moving, education in the persons, recognized as disabled, and also the problems of social-and-labor rehabilitation of patients. In addition, we developed the predictors of clinical-and-functional outcomes after HTA. Results. As a result of examination, 384 patients were recognized as disabled, among them the disability was determined during the initial examination in 52 patients, and during reexamination – in 332 patients. The vast majority of patients worked in conditions with harmful factors and physical exertions before disability determination (83.3%), and more than a half of them were engaged in hard kinds of work. As it has been demonstrated, the functional potential formed six months after surgery in case of adequate rehabilitation in majority of the examined patients with unilateral involvement of the hip in the absence of the operated joint complications will be able to meet the requirements of the technological process of a wide range of professions if the contraindicated factors of labor are excluded. Conclusions. The main factors of evaluating the working ability of patients with the implanted joint include etiology, the character of disease process, the stage of pathological process, the degree of statodynamical function disorder, clinical and employment prediction, patient’s social adaptation. The problems of working ability examination should be solved differentially taking the mentioned factors into account.

Introduction. The pathological symptom-complex of the knee arthrosis deformans in addition to the changes in femoral and tibial articular ends includes the cartilage injury, the dystrophic changes in menisci, ligaments, capsule. Purpose. To study the changes in the knee capsuloligamentous system in patients with arthrosis deformans using MRI technique. Material and Methods. 87 patients with arthrosis deformans examined by the technique of magnetic resonance tomography before treatment (Siemens Magnetom Symphony Maestro Class magnetic resonance tomograph with 1.5-T induction). Results. The data strongly evidence of the fact that in patients with arthrosis of the knee as far as the process worsens the changes in the capsuloligamentous system also increase in it along with the cartilage and bone changes. Conclusion. The results have demonstrated that MRI is one of the highly informative methods of evaluating the pathological changes in menisci, ligaments accompanying bone changes for osteoarthrosis deformans.

Design: a retrospective analysis. Purpose. To analyze the experience of using posterior screw fixation for subaxial injuries of cervical spine. Materials and Methods. The study based on the data of diagnosis and treatment of 32 patients with subaxial injuries treated in the Department of Neurosurgery of the Ilizarov Center within the period of 2010-2014 who underwent posterior screw fixation over the lateral mass, as well as interlaminar (translaminar) fixation – with implantation of 178 screws. Magerl and Roy-Camille technique combination used. Different options of stabilization applied: posterior bilateral, posterior unilateral, combined (anterior and posterior). Results. Follow-up of the patients was from six (6) months to three (3) years. There were no intraoperative complications due to the screw insertion (vertebral artery and nerve root damages). Intraoperative blood loss amounted from 100 ml to 600 ml (mean: 175±10 ml). The pain syndrome in the zone of surgical intervention eliminated completely within up to four (4) weeks after performing fixation in all patients. The degree of movement limitation corresponded to the level and number of fixed vertebral motion segments (VMS). The completeness of social adaptation depended on the presence and extent of the damage of the spinal cord and nerve roots and, accordingly, on the manifestation of neurological disorders. Conclusion. Posterior screw fixation in the subaxial area is an efficient way of stabilization for multicolumn damages. The technique of fixation over the lateral mass is the most common and safe one.

Purpose. Comparative studying the local state of bone tissue in the regeneration zone for fixation of tibial fragments using wires of 12X18H9T steel with nanotech coating experimentally. Materials and Methods. Biological properties of nanocoating based on superhard compounds of titanium and hafnium nitrides studied experimentally in 40 mongrel rabbits. Results. The positive effect on the formation of regenerated bone observed in the animals with the coating studied. The processes of bone tissue reorganization occurred earlier unlike the comparison group determined by higher cortical density. Conclusion. The use of implants with the coating of titanium and hafnium nitrides having high strength, thermal and chemical stability accompanied by forming the cortical plate with higher density values in osteoclasis zone.

Purpose. To study the possibility of using gamma-scintigraphy for evaluation of bone tissue vascularization and formation in the zone of regenerated bone in order to determine the proper rate of distraction, the periods of bone fragment fixation, and to analyze the efficiency of acupuncture point (APP) stimulation effect on the process of regeneration. Materials and Methods. The features of vascularization, formation and remodeling the distraction regenerated bone substance of forearm bones in the rabbits when inserting transosseous elements through APP studied experimentally using gamma-scintigraphy. One of the forearms underwent 1-mm lengthening by the Ilizarov method. Results. The prolonged APP irritation with the inserted transosseous elements has been demonstrated to result in acceleration of vascularization of the regenerated bone, as well as in intensification of formation of the bone substance, both of which by their characteristics are most similar to the parameters of intact animals’ structures. Conclusion. The results of the study using gamma-scintigraphy of distraction regenerated bone of forearm bones are an objective measure of its vascularization evaluation with the help of which combined with the known techniques (radiography and multispiral computed tomography /MSCT/) the degree of regenerated bone maturity and the process of osteogenesis can be evaluated.

Introduction. Reconstructive arthroplasty of the hip in patients with coxarthrosis accompanied by femoral deformity is a difficult and relevant problem. The issues related to the definition and classification of femoral deformity, the reconstruction optimal amount and the type of femoral component fixation are still open. Purpose. To analyze the available data about the hip arthroplasty in patients with femoral deformity in terms of the reconstruction optimal amount and the type of femoral component fixation. Materials and Methods. The literature search made in various information systems (PubMed, MedLine, Scopus, Library.ru, State Public Scientific and Technical Library /GNTB/, Central Scientific and Technical Library /TsNTB/, and others) using the terms: “femoral deformity”; “total hip arthroplasty after previous osteotomy”; “the hip arthroplasty in patients with coxarthrosis accompanied by femoral deformity”; “femoral osteotomy”. Conclusions. There is no generally accepted definition of the concept of the femoral deformity and its classification in literature at present.

A rare clinical observation is presented in the work – a patient with ischemic distraction regenerated bone achieved in the process of filling an extensive tibial shaft defect using the technique of transosseous bilocal compression-distraction osteosynthesis.

A first report of simultaneous femoral lengthening with concomitant non-union compression over a previously implanted intramedullary nail is described. A 38 year old male sustained a femoral segmental fracture and developed a persisting atrophic femoral non-union with significant femoral shortening. Combined simultaneous lengthening to correct limb discrepancy with compression of the established non-union with an intramedullary nail in situ was performed using circular external fixation. Successful bifocal non-union compression and femoral lengthening over a nail to address sequelae of a fracture is here described for the first time.

The work deals with the presentation of a clinical case of treating a male patient at the age of 15 years with progressive kyphotic deformity accompanied by pain in the spine, limited movements, dyspnea and tachycardia. The patient underwent conservative treatment in different clinics more than once. On admission, marked fixed kyphoscoliosis revealed by radiography and CT data with 135° angle of scoliosis and 155° - that of kyphosis. The patient underwent correction and posterior fixation of the spine at Th2-L4 level (REED system, France). A double rod used on the right, for the system enhancement, in order to prevent rod breaking. No osteotomies performed during surgery. Osteoplasty used after the construct implantation, as well as posterior fixation and resection of six ribs. After surgery scoliotic deformity amounted to 38º, kyphotic one – to 73º.

The variants of ring-finger avulsion injury with a ring presented. The existing classifications demonstrated. The methods of treatment, indications for them, surgical technique and efficiency analyzed. The technique of surgeries of the osteotendinous apparatus described, as well as the variants of circulation recovery and the avulsed finger innervation.