Purpose. To develop a visual-and-analogue test in order to evaluate the functional state of a patient with the spine deformity in childhood and adolescence. Material and methods. We tested thirty five patients with diagnosed idiopathic scoliosis of the spine at the mean age of 16.1±3.4 years. There were six males and twenty nine females among the patients. We used paired and non-paired Wilcoxon test and Student t-test for statistical processing of the data. Results. As determined, the use of this test allows evaluating the functional state in children at the age of nine years with idiopathic scoliosis, as well as in adolescents with the same condition. Conclusion. The quantitative self-rating of the functional state in children and adolescents in the early and long-term postoperative period by the three components: pain, activity and self-image makes it possible to objectify the dynamics of sings and to identify the degree of changes at the patient’s psychophysiological level.

Introduction. The problem of the quality of rendering medical care to elderly and senile patients (according to WHO, the elderly age is 60-74 years; the senile one – 75-90 years, and the age above 90 years is the age of centenarians) currently remains relevant. The draft protocol of preoperative examination and management of patients with proximal femoral fractures is not officially approved by authorized executive authority of Moscow. Purpose. To analyze the regulatory documents governing the grounds of performing "urgent surgeries” in elderly and senile injured persons; to make a medical-expert analysis of medical documentation management in view of the quality of medical service realization. Materials and methods. Analyzing medical records of the patients from these groups who were admitted to the Department of Traumatology of the Moscow Pirogov Municipal Clinical Hospital (MCH) No1 during the last three years (2012-2014). Totally, the medical-expert analysis was made for 82 medical records of in-patients with the mentioned pathology. Results. The medical-expert analysis has demonstrated that at present there are no regulatory documents governing the grounds of performing "urgent surgeries” in patients of this category. There are no objective recommendations for preoperative preparation as well. The medical-expert analysis of medical documentation revealed some flaws in both the documentation managing and treatment of injured persons from this category. Conclusion. An objective analysis of a significant amount of clinical material indicates the rationality of using an active surgical tactics in treatment of such patients. However, in order to justify legally the need of performing surgery to “urgent indications” it is required to develop the detailed recommendations which determine the complex of preoperative preparation, as well as to approve indications and contraindications for performing surgical intervention in elderly and senile persons with proximal femoral fractures.

Introduction. Concomitant injuries with spine-and-spinal cord trauma as their component have long become not only a medical problem but also a social one. In case of multiple and concomitant injuries the diagnosis of the spine traumas in the injured persons should not have the character of confirmation, but that of possible injury exclusion. Purpose. To evaluate the severity, prognosis and outcomes, as well as to analyze the details of providing medical care for spine-and-spinal cord trauma in miners at the prehospital stage. Materials and methods. The outcomes of treatment were analyzed in 146 injured miners with spine-spinal cord trauma. Mean age of the injured persons was 37.7±0.8 years. 12 (8.2 %) injured persons had isolated injuries, 21 (14.4 %) – multiple injuries, and 113 (77.4 %) – concomitant ones. Spine-and-spinal cord trauma was dominant in 67 cases (45.9 %). The physicians of resuscitation-antishock groups of the State Paramilitary Mountain-Rescue Service rendered medical care at the prehospital stage. Results. There were no fatal outcomes at the prehospital stage. The death of injured persons was observed in eight (8) cases (5.5 %) in a medical institution. Severe concomitant injuries of the chest, abdomen, pelvis were observed in six (6) patients; the spine trauma with spinal cord injury prevailed in two cases. Conclusion. It is advisable to use an integrated predictor in order to identify the severity and prognosis of trauma outcomes at the prehospital stage, and numerical scoring of trauma shock genicity should be used to highlight the dominant injury.

Purpose. To study the efficiency of using the military-field rod kit for osteosynthesis of gunshot limb bone fractures. Materials and Methods. We studied the results of treating 117 wounded persons with isolated gunshot fractures of limb bones. Damage control approach, as well as consecutive osteosynthesis of fragments was used in the tactics of the wounded managing. The results of using the device of the military-field rod kit (MFRK) were compared in 54 wounded persons, as well as those of using another rod device in 63 wounded persons at the first stage of multistage surgical treatment. Results. The results demonstrated MFRK device potential to provide external fixation of long bone fragments faster and more efficiently. Conclusion. The use of MFRK at the first stage allows early switching to internal osteosynthesis, as well as obtaining good functional and anatomical outcomes.

Relevance. A clinical-and-tactical approach to treatment of patients with polytrauma still remains an unsolved problem. Specific challenges appear at the resuscitation stage. Purpose. To select clinical-and-tactical groups, as well as to make a retrospective analysis of lethality in every of them, as well as to determine the effect of the selected treatment tactics on this parameter. Materials and Methods. Screening based on more simple evaluation criteria, emphasizing the clinical-and-tactical groups of the patients admitted to the department of resuscitation and intensive care (DRIC). We used the data of clinical examination and diagnostic tests. The treatment tactics depended on trauma severity, and it was different in the emphasized groups. Results. We distributed the patients into groups on the basis of the cumulative estimation of injury character, delivery periods of time, somatic, neurological status. This allowed determining the approach to the selection of intervention character and scope at the resuscitation stage. Conclusion. The proposed division into five (5) clinical-and-tactical groups enabled to determine that no osteosynthesis types were acceptable for Group 1 patients (extremely severe). As for patients with less severe injuries and those in less serious condition (Group 2), it was admissible to perform osteosynthesis in them in the early periods. It is just in this group Damage control tactics is a perfect one regarding skeletal trauma. Osteosynthesis performing in Group 3 patients did not generally cause the critically significant level of second hit phenomenon. Fatal outcome occurred in only one person among those fourteen ones undergone surgeries of the locomotorium segments that amounted to 7.14 %. The lethality level in Group 4 patients is not associated with injury localization and character, but with the complications of the third period of traumatic disease (TD). And, at last, the lethality level in Group 5 patients expectedly turned to be 8 % that was due to more compensated condition of injured persons after preoperative preparation for the planned surgery.

Purpose of the present study consisted in making a comparative analysis of the long-term cosmetic and functional results after pectus excavatum (PE) correction using different techniques. Materials and methods. The study was performed on the basis of analyzing the long-term results in 40 children with PE after performing correction using various techniques in different clinics. The main group included 20 children who underwent correction according to D. Nuss technique in the clinic of Scientific Research Institute of Traumatology and Orthopaedics (SRITO) of the Republic of Uzbekistan. To compare the results we selected the reference group of 20 children who underwent PE correction using G.A. Bairov and Ravich-Gross techniques in the clinic of the Andizhan Regional Children Multidisciplinary Hospital. Results. The analysis was made comparatively in view of the subjective, objective, and the presented instrumental studies. In children of the main group a good cosmetic result was observed in 18 (90 %) cases with positive emotional spirit of the patients themselves and their parents that was significantly different (р less 0.01) from the data of the reference group where a good result was observed in 15 (75%) cases. Satisfactory results were noted in two (10%) cases in children from the main group only because of cheloid scars, and such a result in the reference group took place in three (15%) cases (р>0.05) where the zones with retraction parts were observed on the chest anterior surface in addition to cheloid scars. Unsatisfactory results as a funnel recurrence in children from the main group were observed in no cases. Such an outcome was registered in two (10%) cases in children from the reference group, as well as preservation of sternum pathological rotation, significant gross cheloid scars with uneven parts of the chest surface. The functional parameters by spirogram were significantly within the norm in children from the main group, and the disorder of external respiration function (ERF) by restriction type was preserved in the reference group (р less 0.001). Conclusion. Thus, the data of the comparative analysis of the long-term comparative results demonstrated the superior cosmetic and functional results when using D.Nuss technique and its modifications comparing with the external traction techniques. The internal plate used by us allowed increasing the chest volume almost instantly, eliminating all the components of the funnel-shaped defect, and creating a normal anatomical shape with the appropriate effects positive for patients’ organism.

Purpose. To familiarize specialists in the field of traumatology, orthopaedics, social services with the successful results of rehabilitating patients who underwent intrascapular-and-thoracic resection (ICThR), as well as to prove the expediency of practical application of the orthopedic devices (exoskeletons) developed by the authors in order to recover the upper limb function. Materials and Methods. The long-term results of rehabilitative treatment and orthotics presented. The designs of exoskeleton orthopedic device for upper extremity after intrascapular-and-thoracic resection described, and its novelty confirmed by patents for utility model. The results of orthopedic providing studied by clinical, physiological and biomechanical methods. The long-term results in such patients followed for 15 years and more. Results. Both the cosmetic defect correction and the increase of limb functional activity provide social rehabilitation and integration of disabled persons into society. Conclusion. The clinical observations and long-term results of orthosing patients after ICThR confirm the efficiency and rationality of the exoskeleton new construct due to which the cosmetic defect can be corrected thereby providing normal functioning of the operated limb and the scope of patients’ activity extension.

Purpose. To study humeroscapular periarthrosis (HSPA) pathogenetic dependence on degenerative diseases of the cervical spine. Materials and methods.We performed a prospective study and identified the long-term results of disc-puncturing treatment in 140 patients with humeroscapular periarthrosis. Results. As proven, the puncturing treatment-and-diagnostic manipulation is the most objective confirmation of the humeroscapular pain syndrome relationship with pathological impulsation from the involved intervertebral disc. The syndrome familiar to the patient can be reproduced with experimental accuracy by solution infusion into the disc, and it right can be eliminated by alcohol-novocaine denervation. The humeroscapular pain syndrome is most often associated with pathological impulsation from С4-C5 spinal motion segment (SMS). An excellent result of the patient disc-puncturing treatment (on the average, 34.9 points according to UKLA scale) was obtained mostly at the initial stages of HSPA. Good and excellent long-term results of discpuncturing treatment were obtained in 31 of 58 patients (53.3%) with Stages 3 and 2 of the disease (totally) thereby evidencing of the practicability of vegetative denervation of the involved shoulder by elimination of pathological impulsation from the clinically relevant intervertebral discs being in the associate vegetotome (sclerotome) with the shoulder. Conclusion. The simplicity and security of the disc-puncturing treatment-and-diagnostic manipulation combined with efficiency at half of the patients, even those with gross morphological changes in the shoulder, allow recommending its using for HSPA.

Purpose. To study the effect of low-frequency ultrasound on the thermodynamic and diffusion processes in long tubular bones in order to have the possibility of using contact ultrasound impact on bone and its combining with transosseous osteosynthesis. Materials and methods. The study was conducted as a poster experiment using cadaver segments of animals’ long tubular bone. We used pins made on the basis of an external fixator half-pin, inserted in the bone as waveguides (a standard half-pin, an entire pin-waveguide, a hollow half-pin with inserted waveguide). The features of waveguidebone thermodynamic interaction were determined, as well as diffusion processes in bone induced by ultrasound. All the material was divided into six (6) equal groups and a control group depending on waveguide type and fixation technique. Results. The temperature at bone-waveguide interface was 45-55°, diffusion processes: 9.92 mm (monocortical fixation), 23°, 1.1 mm (bicortical fixation), respectively, – in the groups with a standard half-pin (1 and 2); 79-99°, 39.8 mm (monocortical fixation), 65-99°, 35.7 mm (bicortical fixation) – in the group with an entire pin-waveguide (3 and 4); 35-45°, 28 mm (monocortical fixation), 23-34°, 10 mm (bicortical fixation) – in the group with a hollow half-pin (5 and 6). Conclusion. The use of a half-pin and its modifications as waveguides for contact ultrasound impact induces thermodynamic and diffusion processes in the bone.

Purpose. To achieve the optimal clarity of visualization and obtaining quantitative data of the density and structure of the newly formed bone. Materials and methods. Digital processing of the leg X-rays at different stages of lengthening was made in 19 patients with achondroplasia and subjectively low height using a personal computer. The use of color contrasting served as an additional information attribute allowing to objectify the process of image interpretation owing to the fact that the human eye can distinguish more colors than the tones of any one and the same color displayed on the X-ray. Results. The zoned structure of the regenerated bone was clearly visualized on the X-rays during distraction and fixation, the height of the bone parts could be determined, as well as the height of radiolucency zone (a connective-tissue interlayer), and their qualitative parameters could be evaluated. It is practically impossible to identify the differences in the status of the distal and proximal regenerated bones, as well as their parts especially in the front X-ray view at the end of fixation period and after the fixator removal when the borders between its zones disappeared. After the X-ray processing using «Hi-scene» software the differences in the optical density of the proximal, central, and distal parts of the regenerated bone were revealed. Conclusion. The use of this technique allowed identifying the differences in the structure of different regenerated bone parts and those after the fixator dismounting when it was not always possible to visualize such differences by X-rays.

The hip pathology in patients with arthrogryposis is observed in up to 90 % of cases, and it is represented by the hip contractures and dislocations. There is no generally accepted tactics of treatment of the said deformities for arthrogryposis in the world practice so far. The data of the native and foreign literature relating to the etiopathogenesis, clinical picture and classifications of the hip pathology, as well as the results of its conservative and surgical treatment analyzed in the work.

The literature data of etiologic pathogenesis and diagnosis of the hip instability in patients with infantile cerebral palsy analyzed in the present review. The mechanism of the hip formation in children with tonus disorders widely covered. The most common techniques of surgical treatment considered as well. The authors conclude that there is so far no standard pattern of approach to selecting a variant of surgical intervention for the hip instability in children with infantile cerebral palsy. The development of such a system to date is promising in managing these patients.

We propose a technique of combined osteosynthesis for humeral fractures on the basis of a monolateral device with simultaneous using intramedullary implants with bioactive coating. A case report of using the technique in a patient at the age of 26 years with diagnosed concomitant injury is presented (hepatorrhexis, closed comminuted fracture of the right humerus, closed fracture of the left ulna). As demonstrated, the combined osteosynthesis using the monolateral external fixator coupled with intramedullary reinforcement using wires with bioactive coating has a simple technology, reduces the time of surgery and facilitates patient care postoperatively.