Purpose of the work was to study the effectiveness of intramedullary and extrafocal osteosynthesis in combination with additional fixation of bone fragments using tightening clamps with thermomechanical shape memory. Material and Methods. The results of osteosynthesis analyzed in 133 injured persons with comminuted shaft fractures of long tubular bones. Little-invasive intramedullary osteosynthesis with a locking rod performed in 19 (14.3 %) patients, and an additional fixation of bone fragments with tightening clamps – in 45 (33.8%) ones. Extramedullary plates used for osteosynthesis in 39 (29.3%) patients including those combined with tightening clamps in 10 cases. Extrafocal osteosynthesis used for proximal and distal shaft fractures in 30 (22.6%) patients and in 19 among them the osteosynthesis was combined with tightening clamps having thermomechanical shape memory. Results. Statistically significant differences revealed when making a comparative analysis of the results of performing closed intramedullary osteosynthesis using locking rods, extramedullary fixation using plates and those of performing intramedullary osteosynthesis and extramedullary fixation combined with tightening thermomechanical clamps in patients with comminuted humeral fractures (χ2=3.881; р=0.049). An additional stabilization of bone fragments with tightening clamps during intramedullary osteosynthesis allowed improving treatment results in patients with femoral fractures (χ2=4.756; р=0.029, a statistically significant result). The effectiveness of tibial extrafocal osteosynthesis increases when using external fixators combined with extramedullary shape-memory tightening clamps (χ2=6.058; р=0.014, a statistically significant result). Conclusion. The adaptation of bone fragments and their fixation in anatomically correct position using shape-memory clamps combined with intramedullary rods, extramedullary plates and external fixators in patients with comminuted shaft fractures of long tubular bones allows reducing rehabilitation periods, obtaining good functional results of treatment in 90.5 % of cases.

Relevance. Aseptic necrosis of the femoral head is a serious degenerative-and-dystrophic disease. 30-40% of the hip arthroses in adult patients appear to be a consequence of the diseases not completely treated in childhood such as congenital dislocation of the hip and Perthes disease. Purpose. To improve the outcomes of surgical treatment of the femoral head aseptic necrosis in children. Materials and Methods. We performed the study based on the data from 28 children and adolescents with the femoral head aseptic necrosis who were treated in the Department of Pediatric Orthopaedics of SRITO of the Ministry of Health of the Republic of Uzbekistan within the period from 2013 to 2014. All the patients underwent surgical tunneling and muscle-pedicle osteoplasty. Results. A year after the surgery X-rays revealed the significant increase in the head height, homogeneity of the head structure, fragmentation disappearance. Clinically limping was absent, the Trendelenburg symptom was negative at both sides. Conclusion. Microcirculation restoration in the hip zone achieved by tunnelization, as well as muscle-pedicle osteoplasty provide the possibility of early recovery of limb weight-bearing function.

Introduction. Under current development of science, technology and medicine surgical treatment of the hip destructive-and-dystrophic diseases by arthroplasty technology is considered to be the most effective method which provides social and everyday reintegration. However, in the opinion of a number of specialists, the incidence of arthroplasty-related complications increases. Purpose. To make a comparative analysis of the results of treating patients by the hip arthroplasty technology after reduction-and- reconstruction interventions on the proximal femur. Material and Methods. The main group included 42 patients who underwent the hip arthroplasty technology after reduction-and-reconstruction interventions on the proximal femur. The control group included 43 patients with idiopathic osteoarthrosis of the hip who underwent primary arthroplasty. Results. The arthroplasty performing in the main group patients was accompanied by the increase in the incidence of intraoperative and postoperative complications. Conclusion. After performing reduction-and-reconstruction interventions in persons the range of arthroplasty beneficial characteristics decreases significantly thereby requiring a special approach to diagnosing and treating such patients on the basis of evaluating connective tissue stage condition in view of reduction, reparation, and restitution of the proximal femur.

Introduction. Despite the excellent clinical success of total knee arthroplasty (TKA), controversy remains concerning whether or not to resurface the patella. This has led to a number of randomized controlled trials. Randomized controlled trials constitute the most reliable source of evidence for the evaluation of the efficacy of a potential intervention. But most of these studies include all degree of osteoarthritis of the patellofemoral joint. So we did this prospective study to compare clinical and radiological outcomes after TKA with or without patellar resurfacing in patients with grade IV osteoarthritis on patellofemoral joint. Materials and Methods. 123 cases with Kellgren-Lawrence grade IV osteoarthritis on patellofemoral joint were enrolled for this study. At the operating room, they were randomly assigned to undergo patella resurfacing (62 cases) or patella retention (61 cases). Among them, 114 cases that could be followed for more than 2 years were included in this study (resurfacing group; 59 cases, retention group; 55 cases). Preoperative and postoperative clinical outcomes were evaluated and compared regarding the Hospital for Special Surgery Patellar (HSSP) score (total 100 point; anterior knee pain, functional limitation, tenderness, crepitus, Q-strength). We also compared Hospital for Special Surgery (HSS) and WOMAC scores, and range of motion (ROM). Results. Average HSSP score was 85 in resurfacing group, 83 in retention group, which were showing no significant differences between groups (p=.75). Anterior knee pain subscale also showed no significant differences between groups (40 in resurfacing group, 36 in retention group, p= 0.52). HSS score improved to 94 points in resurfacing group and 95 points in retention group showing no significant difference (p=.92). While WOMAC score and range of motion was 32 point and 128°±10,5° in resurfacing group, respectively, they were 29 point and 126°±11,5° in retention group, without significant inter-group difference (p>.05). Conclusion. Identical good clinical outcomes were obtained after TKA with or without patellar resurfacing in patients with high grade osteoarthritis of the patellofemoral joint without significant differences. TKA without patellar resurfacing is a good choice in patients with high grade osteoarthritis of the patellofemoral joint.

Purpose. To analyze the effectiveness of conservative treatment of children with feet arthrogrypotic deformties in the Yaroslavl Region within the period of 2003-2013. Materials and Methods. The results of treatment in 29 children analyzed. There were equinovarus deformities (40 feet) in 26 children, equinoplanovalgus ones (six feet) – in three children. Within the period of 2003-2007 we treated the patients (15 children – 19 feet) using the Vilensky method, and further up to the present time (14 children – 27 feet) – using the techniques by I. Ponseti and M. Dobbs. Results. The analysis revealed high effectiveness of I. Ponseti and M. Dobbs techniques for feet arthrogrypotic deformities. The need for surgical correction of feet arthrogrypotic deformities in the early childhood 7.6-fold decreased. Conclusion. Despite the small number of observations in our work the demonstration of the results of treatment using I. Ponseti technique for arthrogrypotic clubfoot, as well as using M. Dobbs technique in correcting arthrogrypotic vertical talus should motivate orthopedists to master and introduce these techniques when treating children at the age below four years.

Purpose. To make a comparative evaluation of Dexmedetomidine and Midazolam sedative effect in children with cerebral palsy (CP) in the early postoperative period in Resuscitation and Intensive Care Unit (RICU) after performing multilevel acute interventions accompanied by reconstructive procedures of the hip. Materials and Methods. We made a comparative evaluation of the effectiveness of sedation with Dexmedetomidine and Midazolam in 14 children with CP in the early postoperative period after multilevel acute surgical orthopedic interventions who divided into three comparable groups. Ramsay Scale, Scale of Excitement Evaluation – Richmond sedation used in order to evaluate sedation level. Postoperative analgesia in all the groups performed by 0.2 % Ropivacaine infusion into the epidural space using a previously set epidural catheter. Results. As demonstrated, the children in the Group 1 (without sedation) were excited, anxious, they felt uncomfortable. In Groups 2 (sedation with Dexmedetomidine) and 3 (sedation with Midazolam) the level of sedation was significantly higher than in the control group, it attained light and moderate levels. Conclusion. Thus, Dexmedetomidine and Midazolam appeared to be effective preparations to sedate the children with CP staying in RICU in the early postoperative period, and no significant advantages in achieving surface sedation not revealed between them.

Design. A retrospective analysis of clinical observations. Purpose. To make a retrospective analysis of the results of resecting hemivertebrae by the dorsal approach through the root of the arch of the thoracic and lumbar localization. Materials and Methods. The data of 58 patients with the spine deformity through the leading malformation – formation disorder and asymmetric shapes of vertebral fusion at the age from 14 months to 27 years and 11 months who were treated within the period of 2012-2015. All the patients underwent interventions by the dorsal pedicular approach. All the surgical interventions were divided into three groups by fixation type depending on the extent and variant of the spine fixation: Group I – unilateral monosegmental fixation, Group II – bilateral monosegmental fixation, Group III – bilateral polysegmental fixation. The analysis criteria: deformity amount before and after the surgical treatment according to Cobb, correction percentage, the surgery duration, the volume of blood loss, the extent of instrumental fixation, bone block condition dynamically, the course of local deformity in the long-term periods (above two years), presence of complications. Results. In Group I deformity correction in the frontal and sagittal planes amounted to 67,4% и 90%, respectively. In Group II the correction in each of the planes was 72,8% и 88,4%. In Group III the correction values amounted to 71,2% и 83% in the frontal and sagittal planes. Complications were observed in 7 (12%) patients, being represented by progression of the deformity in the zone of stabilization, as well as by the deformity of adjacent segments that required re-adjustments of fixation systems and using correcting vertebrotomies. Conclusion. The radical extirpation of hemivertebrae by the dorsal pedicular approach allows achieving complete correction of the deformity, as well as reduces the time of surgery, the number of the implanted elements, intraoperative blood loss and the periods of rehabilitative treatment. The performance of pedicular extirpation combined with bilateral fixation is preferable.

Design of the Study. A retrospective analysis of a series of clinical cases. Purpose. To evaluate the functional state of internal organs for hereditary diseases of the connective tissue, as well as the reduction of perioperative risk in order to achieve maximum impact of vertebrologic correction. Object. 22 patients at the age from nine (9) months to 24 years with the connective tissue hereditary diseases who underwent surgeries for decompensated deformities of the spine analyzed within the period of 2011-2014. Methods. The analysis of functional state was made for the main selected syndromes: the syndrome of neurological disorders; asthenic syndrome; valve syndrome; thoracic outlet syndrome; arrhythmia syndrome; bronchopulmonary syndrome; visceral syndrome; the syndrome of vision organ pathology; hypermobility syndrome; vertebrogenic syndrome; cosmetic syndrome. We used clinical, functional, and statistical methods. The presence of developmental anomalies and functional disorders of the heart, respiratory organs, gastrointestinal tract, homeostasis and kidneys served as the subject of the analysis. Results. The main pathological states highlighted which characterize changes in various organs and systems for hereditary diseases of the connective tissue and determine both the risk of surgical correction and anesthesia providing, and the postoperative course. Both the plan of the patient multidisciplinary observation and the surgical tactics of systemic spine deformity correction substantiated. Discussion. To represent the direct connection of functional state with the risk of anesthesia providing and surgical treatment. Conclusion. The analysis of the individual profile of somatic pathology in each nosologic group allows objectifying the risk in view of somatic, neurological state and the extent of intervention.

Purpose. To study bone remodeling processes during limb lengthening at the stages of treatment and in the long-term period.
Materials and Methods. We examined 105 patients with limb shortening and deformities of different etiology at different stages of lengthening using computed tomography technique in order to study remodeling processes not only in the newly formed bone but in the adjacent parts of maternal bone as well.
Results. The obtained results demonstrated that during device limb distraction and fixation the cortical plate in all groups of patients was of heterogenic structure with presenting resorption zones of different size, shape and density shortly after the Ilizarov fixator demounting. The values of 300-350 HU were critical. The cortical plate local density in osteon layer was maximal. Bone organotypic reorganization after lengthening completed after 1-3 years depending on disease etiology and lengthening amount. As MSCT data demonstrated, bone remodeling in the zone of distraction regenerated bone occurred in several stages beginning with resorption of longitudinally oriented bone trabeculae, in the direction from maternal bone to the regenerated bone center. In the long-term period the medullary canal in this zone had an even surface on the part of endosteum.
Conclusion. The obtained results allowed to follow the dynamics of bone remodeling in the zone of lengthening for identifying the quality of newly formed bone, as well as to show the potentiality of intravital determining stages of remodeling which occurred similar to that of bone growth using current techniques of radiation diagnosis.

A significant number of the disease or accident consequences resulting in damaging the bone system require the obligatory recovery of its integrity. Various plastic materials are the most optimal bone-substituting substances for filling defects along with metalwork. To date, over the last 17 years demineralized bone allografts (DBA) proven themselves as success-ful effective osteoplastic material the technology of which manufacturing includes the processes of demineralization, ly-ophilization (freeze drying) and radiation sterilization with the absorbed dose of 20-25 kGy. DBA based on donor tissues – cranial vault bones, have been produced for more than 10 years. This material has found its use in performing revision arthroplasty of the hip complicated by acetabular destruction, in surgery of the spine and face bone defects. Lyophilized spongy allografts which can be demineralized or not, as blocks, proved to be promising and effective material. Bone chips are used as a carrier in addition to the blocks. As for scientific and practical prospects, the CITO tissue bank initiated stud-ies in order to produce a family of biocomposite osteoplastic materials comprising of recombinant bone morphogenetic proteins (rhBMP), antioxidants, antibiotics, etc.

Purpose. To study the possibility of stimulating bone tissue reparative regeneration by chen-chiu therapy technique for disordered posttraumatic regeneration of leg bones. Materials and Methods. 24 Chinchilla male rabbits of 3-kg weight at the age of 6 months used in the studies. We modeled pseudoarthrosis in all the animals by performing osteoclasia of both leg bones, and after that an external fixator was applied. Then we created the conditions which prevented normal process of reparative regeneration. The animals were divided into two groups (a control group and an experimental one). Chen-chiu therapy used in the animals of experimental group and influenced their biologically active points. Results. The obtained data of histology and radiography evidence of the fact that despite the conditions of disordered bone reparative regeneration in all the animals of experimental group subjected to chen-chiu therapy fracture consolidation observed in 100% of cases by the completion of experimental study, i.e. on Day 50, while in the animals of control group union didn’t occur in bone defect area and pseudoarthrosis formed in the zone of fracture. Conclusion. As it has been demonstrated by animal studies, the conditions of disordered reparative regeneration with delayed juxtaposition of fragmental ends on Day 14 lead to pseudoarthrosis formation, while the use of chen-chiu therapy techniques in the early postoperative period allows to prevent pseudoarthrosis formation with fracture healing and callus forming.

Introduction. Osteoporosis is a progressing systemic skeletal disease which is characterized by bone mineral density (BMD) decreasing and bone tissue microarchitectonics disordering. In highly developed countries primary osteoporosis affects up to 40% of women during menopause. Purpose. To identify the correlation between the degree of skeletal bone mineralization and osteoarthrosis in menopausal women. Materials and Methods. Ultrasonography and densitometry data studied in patients who were treated as inpatients or addressed as outpatients within the period of 2011-2014. Results. Two groups of women were taken for the analysis: Group 1 included women (n=168; 60%) with gonarthrosis; Group 2 – those (n=112; 40%) without gonarthrosis. Mean age of the patients – 56 years. Conclusion. On the basis of the studies performed we came to the conclusion that both ultrasound and densitometric investigations are an essential component of the complex diagnostic examination of women with osteoarthrosis. The knee osteoarthrosis was often combined with BMD decrease and with an inflammatory process in the joint (bursitis, synovitis, Baker cyst et al.).

Purpose. To determine the dynamics of tissue blood supply in the leg being lengthened using current techniques of blood supply evaluation including transcutaneous polarography. Materials and Methods. Oxygen condition in tissues and the leg blood flow rate were studied in order to determine the markers of ischemic disorders in tissues for surgical lengthening of limbs with growth retardation according to Ilizarov (n=80). The high level of oxygen tension and capillary blood flow in the leg and foot tissues was revealed in children before treatment. Results. Oxygen tension in the leg tissues during distraction decreased within 30%, and that of carbon dioxide – increased, the magistral type of blood flow in regenerated bone vessels was determined. 35 mm Hg was a critical level of arterial oxygen tension decrease, after that the rate of the regional blood flow in the regenerated bone and the leg tissues began to increase significantly. Conclusion. The dynamics of blood flow in the regenerated bone microvessels during distraction, fixation and in the immediate periods after limb lengthening can be controlled in patients using the method of ultrasound dopplerography.

Purpose. To develop the criteria of evaluating feet support responses by podography data in patients with the consequences of femur injuries treated using combined transosseous and locked intramedullary osteosynthesis. Materials and methods. The evaluation of feet support responses by podography technique was performed in 15 patients at the age of 19-64 (38.4±2.8) years with femur injury consequences using the technologies of consecutive and combined osteosynthesis. Results. At the follow-up of six and more months (eight subjects) all the patients walked without additional supports. The proper limb axis was maintained in all the cases with femur consolidation achieved. There were no clinical and X-ray signs of metalwork instability. The results of treatment were evaluated by Luboshitz-Mattis-Schwartzberg scale. The result of treatment was considered as good in six patients, and as satisfactory – in two patients. There were no unsatisfactory results. Conclusion. Podography values in patients with femur injury consequences have no specific diagnostic significance, and they manifest themselves in the locomotor stereotypes of feet support responses in varying degrees. The decompensation degree of the locomotor stereotype of feet support responses is an additional quantitative measure in the complex evaluation of treatment result at the stage of subsequent rehabilitation. The number of the compensatory elements registered by podograms underlie in the evaluation of locomotor stereotype severity. A result is considered to be excellent when Degree 0-I revealed, it is considered to be good for Degree II, satisfactory one – for Degree III, and unsatisfactory one – for Degree IV.

The work deals with the review of modern literature on the problems of classification, clinical aspects, diagnosis, and approaches to surgical treatment of the spine deformities in adult patients. The problem relevance determined not only by technical facilities in the spine surgery, but also by the expansion of indications for surgical interventions in such patients. The selection of optimal tactics for treatment appears to be the main challenge of the spine deformity surgery in adults.

We present a clinical observation of treating periprosthetic femoral fracture with non-cemented stem instability (Vancouver, В3). The implant stem closed retrograde lengthening performed with its position correction using a locking intramedullary rod. Subsequently, not only femoral fracture union observed, but the implant stem reintegration as well. A good clinical result achieved. The presented technology allows reducing trauma degree and blood loss, achieving patient’s early activation with limb weight-bearing recovery. Similar to revision arthroplasty result obtained when performing little-invasive intervention.

The article deals with a rare clinical observation of Patient V., 59 years old, presented with clinical dislocation of the shoulder implant (prosthesis). A consolidated fracture of scapular glenoid edge was revealed by computed tomography, as well as a consolidated fracture of the acromial edge of the left clavicle, glenoid component displacement and the implant stem instability. Despite the recommendations to refrain from revision surgeries the revision arthroplasty was performed using Biomet Comprehensive Reverse implant. The postoperative period was uneventful, an excellent result achieved three (3) months later.