Purpose. To evaluate the effectiveness of treating lower limb long bone shaft defects in the wounded and injured persons using the Ilizarov method as the main one. Materials and Methods. The authors demonstrate a retrospective analysis of the short- and long-term results of treatment of 48 wounded persons and 68 injured ones. We used the method of non-free bone grafting according to G.A. Ilizarov to fill the defects. Results. As the result analysis demonstrated, excellent and good results were obtained in 37 (77.1 %) wounded persons and in 39 (57.4 %) injured ones, satisfactory results – in 11 (22.9 %) wounded and 26 (38.2 %) injured persons, and unsatisfactory results – in three (3) injured persons (3.9 %). Conclusions. More favorable results of treatment in the wounded persons were due to fewer complications, as well as to using consecutive osteosynthesis in some cases.

Introduction. We have found it necessary to propose our own working scale in view of the fact that many authors mainly use I.A. Zurmaev technique to evaluate the results of metacarpal fracture treatment. Materials and Methods. We presented the evaluation of treatment results in 54 patients with fractures of the hand metacarpals in the immediate and long-term periods according to the clinically developed working scale. Results. The results were evaluated by a point score system: a result evaluated from eight to six points was considered as a good one, that from five to three points – satisfactory, and that of two points and below – as an unsatisfactory one. Conclusion. The proposed scale to evaluate the results of treating metacarpal fractures is simple and easy to use, it does not require additional instrumental examinations.

Recent traditional treatment of patella fractures are related with infection and failure of fixation. The complications that we see can be treated surgically which is cost effective and limits the function of the joint. But our locally made CEF device can effectively treat patella fractures with less complications. The transverse fracture of patella with displacement were treated by compressive external fixation, based on Ilizarov tensioned wire construct. All the patients were allowed to do movements in the joints and weight bearing postoperatively. Twenty five fractures were treated with CEF. 12 patients were treated percutaneously. Sound union was achieved in all the fractures. The CEF device was removed at 6 to 8 weeks. 12 patients regained excellent motion with a mean Insall knee score of 96 points, in an average follow up of 4 years. Minor complications like wire inflammation was observed in 5 patients which was treated by local care and antibiotics. CEF technique is a safe and effective method of treatment in patella fractures with advantages over traditional methods in case with a poor soft tissue envelope. CEF allows rapid recovery and no secondary surgery is needed.

We treated 28 clavicle fractures with a mean age of 45 years (15-55) years with mini Ilizarov fixation from January 1999 to January 2015 at Bari-Ilizarov Orthopaedic Centre and NITOR, Dhaka. Out of 28 patients 20 were male and 8 female. We are presenting here the use of mini Ilizarov apparatus for fracture clavicle. Among the complications 2 wire track infections were observed from which all responded positively to local care. The mini Ilizarov apparatus and technique represents a useful method for the successful healing of fracture clavicle.

Distraction osteogenesis according to Ilizarov is the most common method of bone lengthening and deformity correction including the hand and foot bones. This method forms the basis of the main techniques used for the hand bone lengthening. The author described the technical specifications of the minifixator developed for short tubular bones, demonstrated the diagrams of its application to finger phalanges and metacarpal bones, as well as he presented the illustrative clinical cases. The hand bone lengthening performed in 394 patients (566 segments of the hand) at the Center within the period of 1999 and 2012. The performed lengthening procedure improved the hand appearance and functions.

Purpose. To analyze the clinical-and-radiological data, causes and location of inflammation focus in patients with chronic osteomyelitis of long tubular bones. Material and methods. The authors studied the case records of 165 subjects at the age of 20-70 years. All the patients underwent polypositional radiography, multislice computed tomography (MSCT). The patients operated on in the Center’s departments of pyogenic osteology. Results. The studies demonstrated the pathology prevailing in the male subjects at the age of 40-60 years with leg injury consequences. The disease developed after the lower limb injuries which mainly occurred under living conditions, or it developed after the performed surgical treatment at the place of residence. The preoperative information by MSCT technique was comprehensive and identified the location of pyo-necrotic focus, destruction character, the extension and scope of bone tissue involvement thereby making it possible to choose the most optimal surgical intervention, as well as to obtain more effective results of restorative treatment with fewer complications and in shorter time periods. Conclusion. The taken studies made it possible to use the obtained data as criteria allowing to choose the most optimal surgical intervention, to control rehabilitation measures, to judge the effectiveness of the performed treatment.

Introduction. Leg lengthening in children is still indicated for shortenings of different etiology. The combined technique proposed – the procedure of lengthening using a robotic distractor that provided round-the-clock high-divisional lengthening combined with intramedullary reinforcement using elastic rods with bioactive coating, – in order to reduce the number of complications, the duration of external fixation. Purpose. To evaluate the details of surgical technique, the period of osteosynthesis, the developed complications and the immediate results of treatment. Material and methods. The procedure of leg lengthening performed in 17 children (5-16 years old) with congenital and acquired shortening of the segment. Lengthening performed using the robotic autodistractor assembled on the Ilizarov fixator basis. Intramedullary antegrade osteosynthesis performed using elastic rods with bioactive coating. Results. The mean amount of lengthening was 4.3 cm (for congenital shortenings) and 4.2 cm (for acquired ones). The index of osteosynthesis – 22.5±0.86 days/cm and 23.5±0.61 days/cm, respectively. The amplitude of motions of the adjacent joints recovered within 6-12 months after the fixator removal. The following complications developed: local inflammation of soft tissues in 7 patients, but it required wire change only in one case, and the peroneal nerve transitory paresis observed in one case. Conclusion. The main advantage of high-divisional lengthening with a robotic distractor consists in reducing the recovery period of the motions of the joints adjacent the segment being lengthened. Intramedullary reinforcement with elastic rods allows to reduce the duration of external fixation, as well as to avoid the complications related to delayed regeneration of bone tissue.

The authors proposed to perform distraction osteosynthesis of the femur using a robotic high-division distractor combined with using intramedullary elastic reinforcement with bioactive coating in order to improve the effectiveness of this procedure. Purpose of the work consisted in evaluating the characteristics of osteosynthesis period and immediate results of treatment when using this technique. Materials and methods. Femoral lengthening performed in 21 children (at the age of 6-16 years) with congenital and acquired shortening of this segment. Monolocal combined distraction osteosynthesis used in all the cases. Results. The mean amount of lengthening was 4.1 cm (for congenital shortenings) and 4.3 cm (for acquired ones). The index of osteosynthesis – 21.4±0.83 days/cm and 19.0±0.99 days/cm, respectively. The amplitude of motions of the knee recovered within 5-12 months after the fixator removal. The proposed combined technique allowed to reduce the duration of external fixation significantly. In most cases the knee motions recovered within the period below one year after lengthening at the high-division rate. Intramedullary elastic osteosynthesis prevented such complications as secondary displacement of fragments, delayed union, deformity and fractures at the level of lengthening after the fixator removal. In the authors’ series the combined technique of femoral lengthening demonstrated the advantages in terms of reducing the duration of external fixation and the fastest functional recovery after treatment. Conclusion. The combination of robotic high-division distraction and intramedullary elastic reinforcement allowed to avoid some complications or to reduce their incidence significantly.

Purpose. To evaluate the deformable characteristics of the regenerated bone for stepwise increasing and decreasing axial load. Materials and Methods. The authors developed the intravital assessment of bone fragmental fixation stiffness in the Ilizarov fixator at FSBI RISC “RTO”; the assessment is based on determining the changes in the distance between the wires coming out of bone for limb axial loading. The deformable characteristics of the regenerated bone for limb stepwise increasing and decreasing axial loading with 5 kg-increment each for 10 seconds were evaluated in patients with acquired (n=24) and congenital (n=21) shortening of the leg at the stage of fixation. The index of regenerated bone deformability (E) was used in order to characterize fixatorsegment system stiffness; the index was calculated as the value of mutual displacement of the wires inserted through proximal and distal bone fragments at the graduated load of 15 kg with respect to the height of the distraction regenerated bone (the value dimensional representation - μm/mm×15 kg). The deformability value (E) of the regenerated bone is determined by the rate of distraction and by the amount of bone lengthening. Results. A decrease in the relative deformability and residual deformation of the regenerated bone at the stage of fixation reflects an increase of the regenerated bone stiffness in fixator-segment system. The period within first 2-3 weeks of fixation is the “period of risk” of the regenerated bone deformity development in patients with the disease congenital etiology. As for patients with the disease acquired etiology, there is no such “period of risk” in them. The investigation of the regenerated bone deformable characteristics using walking as a functional test is a quantitative criterion of the adequacy of fixator-segment system load and stiffness. The test result is considered as positive if residual deformity decreases after walking. One can speak of the yield strength raising and recommend limb axial load increasing for patients. The test result is considered as negative if residual deformity increases after walking – it is recommended to decrease axial load of the limb or to increase fixator-segment system stiffness. Conclusion. Studying the regenerated bone deformable characteristics is an additional technique to evaluate distraction regenerated bones.

Optimizing the conditions for cranial bone fracture healing remains to be a relevant field of the current traumatology and orthopaedics. Purpose. To study the impact of compression on reparative osteogenesis when engrafting the resected flaps of calvarial bones. Materials and methods. Two groups of experiments performed in 20 adult mongrel dogs complying with all the requirements of the European Convention for the Protection of Vertebrate Animals used for Experimental and other Scientific Purposes. Dogs from Group 1 (n=10) underwent resection of the two sites of calvarial bones (the caudal flap preserved connections with surrounding soft tissues, the cranial flap – not preserved) of rectangular shape and 1.9×1.5 cm by size, they were laid into their former place and fixation performed with compression using thin wires with stoppers to the medial defect margin by transosseous osteosynthesis method. Compression produced by tightening fixing wires with the force of 40 kg. In Group 2 (n=10) bone flaps were laid into the defect without fixation. The investigations (clinical, radiological and histological) performed 7, 14, 21, 28 and 60 days after surgery. Results. Compression produced at the junction of the margins of free bone fragments and calvarial flat bone defect revealed to contribute to bone tissue formation in earlier periods of time. Conclusion. The results obtained in the present study formed the basis for using the technique of transosseous compression osteosynthesis in treatment of patients with cranial bone fractures in clinical departments of the Center.

Purpose. To improve the methods of treatment of open fractures by local stimulating impacting osteogenesis with Bacillus subtilis 804 metabolites containing the fibroblast growth factor. Materials and methods. In their work the authors used a model of open femoral fracture. They performed osteotomy of the middle femoral third via 1-cm approach with further intramedullary osteosynthesis using a wire in 112 rats. They infused 0.2 ml of Bacillus subtilis 804 metabolites into the fracture zone of 56 rats of the experimental group, 0.2 ml of 0.9% sodium chloride solution – into the fracture zone of 56 rats of the control group. Clinical observations and histological investigations performed. Results and conclusion. As it was found, Bacillus subtilis 804 metabolites possessed a stimulating effect on reparative osteogenesis and accelerated fracture consolidation in experimental animals.

Purpose. The authors performed the experiments performed in 12 dogs in order to determine the morphological and histomorphometrical changes in the superficial peroneal nerve in the process of leg lengthening using an autodistractor in the mode of 1 mm for 60 times during 12 hours daily. Methods. The sites of the superficial peroneal nerve studied 28 days after distraction of the leg, 30 days after its fixation with device, as well as one month after the device dismounting by means of transverse araldite semi-thin sections stained with Methylene blue and basic fuchsin. Results. Fibrosis and epineurium cellularity increase were marked at the end of distraction and fixation. The marked histologically documented neuropathy of the peroneal nerve (one experiment out of 12 – 8.3%) revealed in the experiment with obliterating the lumens the largest epineural arteries and the most endoneural capillaries, as well as with the necrobiotic changes in the part of them. In the remaining animals the endoneurium hypervascularization marked, along with the increase in the number of vascular bundles in the epineurium, the percentage proportion of destructively changed myelin fibers (MF) in the studied periods amounted to 4.0±0.84 %, 3.3±0.08 %, and 2.40±0.55 %, respectively (for intact control – 1.92±0.31 %). The changes in MF size characteristics were the most marked at the stage of distraction, those in MF distribution by the diameters – at the stage of fixation. 30 days after the device removal the qualitative and quantitative structural parameters of the peroneal nerve in 11 animals of 12 did not differ from those of the intact nerve. Conclusion. The risk of developing the peroneal nerve neuropathy for the studied procedure of canine leg lengthening is caused by the failure of the compensatory-and-adaptive potentials of the epineural vascular bed. The nerve fiber structural characteristics important for conductivity function in most animals change slightly and restored by the end of the experiment.

The authors presented a review of the literature on modern techniques of limb deformity correction in children with osteogenesis imperfecta. They described the details of surgical technique, the designs of the used telescopic intramedullary rods. They also demonstrated the place and the role of surgical methods of treatment in the multidisciplinary approach to rendering medical care for patients with osteogenesis imperfecta.

The authors presented a rare clinical case – male patient K., 21 years old, with an extensive scalped wound of the right foot, an open fracture of the first metatarsal bone in the middle third, traumatic avulsion at the middle third level of the proximal phalanx of the right foot toes IV and V, Degree I traumatic shock. A technique of foot skin plasty combined with fixation according to Ilizarov (using the Ilizarov fixator) was used in order to maintain weight-bearing.

The authors presented a clinical observation of treating a patient with chronic osteomyelitis of the talus and calcaneus. They performed the surgical treatment using transosseous osteosynthesis that included two stages: debridement of purulent focus; orthopedic reconstruction of the hindfoot bones. The treatment resulted in stable remission of osteomyelitic process and limb weight bearing recovery.

Based on the analysis of works of G.A. Ilizarov, Academician of RAS, his concept of stimulating effect of tension stress on genesis and growth of tissues on the locomotor system presented in the work. The identified regularities and mechanisms of neogenesis of bone, muscular, nervous tissues, as well as that of vessels and nerves demonstrated. It is G.A. Ilizarov’s works that proved the fact that tissue growth and regeneration under the influence of tension stress and under blood supply and load adequacy (the Ilizarov Effect) occurs similarly to the process of natural growth in ontogenesis.