Based on the analysis of works of G.A. Ilizarov, Academician of RAS, and his scientific School the variants of clinical using the method of controlled transosseous osteosynthesis presented for different pathologies of the locomotor system: fractures, defects, pseudoarthroses, congenital anomalies, systemic skeletal diseases, osteomyelitis, the hand and foot pathology, congenital and acquired limb shortenings, as well as joint diseases.

Purpose. To analyze the results of surgical treatment of distal tibial intra-articular fractures using b-tricalcium phosphate synthetic material (b-tricalcium phosphate, bTCP) and Osteomatrix xenoplastic material. Materials and Methods. The authors made a retrospective analysis of the results of surgical treatment of 51 patients with intra-articular impression fractures of the distal tibia (DT) over the period of 2009-2013. The inclusion criteria were the following: the use of open reposition and internal fixation technique, the augmentation of bone impression defects with bTCP or Osteomatrix xenoplastic material, the period of postoperative follow-up to 36 months inclusively. Two groups presented for evaluation of comparative efficiency of impression DT defect augmentation: Group А (n=32), the procedure of augmentation performed using b-tricalcium phosphate synthetic material (bTCP); Group B (n=19) – that using Osteomatrix xenoplastic material. X-ray, clinical and statistical methods used in the study. Statistical methods included the evaluation of the significance of differences by parametric and non-parametric criteria, the evaluation of the relationship of signs by the value of the Pearson coefficient of linear correlation. The difference in the distal epiphysis-diaphysis angle (ΔdEDA) determined in order to evaluate reposition maintenance; the Mazur point scale (2006) – to evaluate functional status. Results. 36 months after surgery ΔdEDA value within 1°-5° encountered in 90.7% among Group A patients and in 89.4% among those of Group B (p=0.127). Unsatisfactory roentgenometric results equally observed in both groups (p=0.0412). In Group A the percentage of excellent and good results by the Mazur scale (2006) was 53.0 %; that of satisfactory ones – 37.5 %, unsatisfactory – 9.5 %. As for Group B, the percentage of excellent and good results was 57.9%; satisfactory results encountered in 36.8%, unsatisfactory – in 5.3%. The direct correlation of average degree revealed between roentgenometric and functional parameters (r=0.670±0.143 for Group A, r=0.549±0.103 – for Group B). The total number of complications for both groups was 8 (15.7%) cases. Conclusion. No significant roentgenometric and functional differences observed in the follow-up period of 3, 6, 12, 24 and 36 months when bTCP and Osteomatrix used. The use of bTCP and Osteomatrix for bone defect filling is a little-invasive and effective technique of augmentation, and it can be recommended for surgical treatment of patients with intra-articular impression fractures of the distal tibia.

Introduction. The use of two-stage tactic with improving the techniques of little-invasive osteosynthesis is the recent trend in treatment of intra-articular fractures of the distal leg bone parts (DLBP). Purpose. To optimize the two-stage tactic of surgical treatment of patients with intra-articular fractures of distal leg bone parts. Materials and Methods. The analysis of 84 cases of surgical treatment in patients with DLBP formed the basis of the study. AO/ASIF Classification used to systematize bone trauma, soft tissue injuries classified according to H.G Tscherne, L. Gotzen (1984) and R.B. Gustilo-J.T. Andersen (1976). A two-stage tactic of treatment used in all the injured persons. Clinical, x-ray, laboratory and statistical methods used in the study. Results. Treatment results in the long-term period (from six months to three years) studied in 65 cases. Excellent results obtained in 40 patients (61.5 %), good ones – in 16 (24.6 %), satisfactory – in 6 (7.1 %), unsatisfactory – in 3 (4.6 %) patients. Conclusion. The two-stage tactic of treating DLBP intra-articular fractures including the developed algorithms of choosing the techniques of primary stabilization and definitive osteosynthesis allowed obtaining excellent and good results in 86.1% of cases.

The problem of surgical treatment of hallux deformity has not lost its relevance to date. Purpose. To study the results of using little-invasive SERI-osteotomy surgery for hallux valgus deviation treatment. Materials and Methods. 34 patients at the age of 30-55 years (29 females and 5 males; 58 feet) underwent surgery in Traumatology Department of RCH No 1 within the period from December, 2011 to March, 2014 for hallux valgus. All the patients underwent SERIosteotomy of the first metatarsal bone. Among them, there were 27 patients (42 feet) with HVA below 40 degrees and IMA below 20 degrees, and 4 patients (8 feet) – with HVA above 40 degrees and IMA – above 20 degrees. Oblique osteotomy with the first metatarsal bone lengthening was performed in four patients (6 feet), and transverse osteotomy without lengthening – in one patient (two feet). Results. Two months later clinical signs of bone fragment union were observed in 24 patients. The union was considered satisfactory by the results of X-ray examinations in 13 patients, it was considered poor – in 15 ones. There were no signs of union in three patients. Three patients were lost for follow-up. Correction was considered satisfactory in all the patients. All the patients were satisfied with the results of surgery. Long-term results of treatment were scored by AOFAS scale. At the fourth month of observation treatment results were considered as excellent in 22 patients (95-97 points), as good – in 23 patients (80-92 points), as satisfactory – in 10 patients (72 points). Conclusion. SERI-osteotomy for hallux valgus correction can be proposed as one of the little-invasive and efficient techniques of surgical treatment, and its further more careful study is required.

Purpose. To compare the efficacy of autologous blood injection versus corticosteroid injection for Tennis elbow. Materials and methods. 25 man and 35 women (mean age, 35.2 years) presenting with Tennis elbow were randomized to receive either autologous blood injection (2 ml autologous venous blood mixed with 1 ml of 2 % xylocaine) given by a single surgeon. Patients were assessed before (days 0) and after (days 15, 30, 60) treatment for elbow pain, function and grip strength. Patients were followed up at 1 year to assess elbow pain. Results. Infection, tendon rupture and neurovascular damage were not found. 5 patients reported pain for upto 3 days after autologous blood injection. In both groups grip strength improved dramatically after treatment, but the mode of improvement differed. Compared with autologous blood injection corticosteroid injection improved at a faster rate over the first 15 days and then started to decline slightly until day 60. After autologous blood injection pain, function and grip strength improved steadily and were eventually better. Conclusion. Autologous blood injection was more effective over the long term follow up period than corticosteroid injection in improving pain, function and grip strength. That’s way we recommend this as a first line injection treatment because it is very simple, cheap and more effective.

Introduction. Deformities are the most common malformations of the feet and they reach 35.8 %. Purpose. To demonstrate the possibility of arthrodesing surgeries for different feet deformities in children above 10 years of age. Materials and Methods. The analysis of the results of treating severe feet deformities in the Regional Clinical Hospital of Yaroslavl since 1999 using internal and external structures (38 children, 47 feet) served as the study material. Mostly clubfoot (19 feet – 40.4%) was the cause of performing such difficult surgeries in adolescents. These children underwent on the average 2, 3 unsuccessful surgeries in their history. Children with central nervous system (CNS) pathology (cerebral palsy, fixed spinal cord, consequences of craniocerebral injury) underwent 17 arthrodesing surgeries of feet. The interventions in 7 feet performed for the consequences of Charcot-Marie progressing muscular atrophy and those in two feet – for conservatively incurable tarsal coalitions. The use of screws after performing arthrodesing surgeries allows loading the operated limb significantly faster comparing with wire- and device-related fixation. Results. The introduction of new little-invasive techniques for treatment (that of I. Ponseti for clubfoot and that of M. Dobbs for vertical talus) in the routine practice of pediatric orthopedists resulted in a sharp reduction in the number of releases that should decrease the need for large arthrodesing surgeries in future. But at the moment arthrodesis procedures in adolescents revealed as a reliable option for surgical correction of feet deformities in severe and advanced cases, as well as they allowed correcting feet deformities in the mentioned age-related group in 97.9 % of cases. Conclusion. Arthrodesing surgeries for severe deformities are the method of choice in treatment of recurrent and conservatively incurable feet deformities.

Introduction. The proportion of clubfoot in the structure of the lower limb malformations is about 40% of deformities. There is a lot of treatment options, as well as a lot of variants of result evaluation, that doesn’t allow reliable comparing the effectiveness of various approaches to clubfoot treatment. Purpose. To analyze the long-term results of clubfoot treatment by the classical approach (plastering according to V.Y. Vilensky and surgical treatment according to T.S. Zatsepin), after arthrodeses formation and using the Ponseti method using Midfoot Scale АО, Hindfoot Scale AO and Laaveg-Ponseti International Scales. Materials and Methods. The authors treated 741 children with congenital clubfoot within the period of 1993-2010 in their clinic. They analyzed 329 questionnaires using the above-mentioned scales. Mean follow-up was 8.6 years. Results. The questionnaire analysis allowed evaluating the results of treatment by the Ponseti method as “good” using the all three scales unlike other methods and approaches to treatment which overwhelmingly provided satisfactory and unsatisfactory results. Conclusion. АО and Laaveg-Ponseti International Scales evidence of advantages of the Ponseti method both in the period of immediate and long-term follow-up, so it should be used as the base for treatment of congenital clubfoot.

Background. An important role in solving the problem of treating children with posttraumatic deformities of the elbow belongs to radiation diagnostics, in particular, MSCT which allows to reveal all the changes in the elbow for its injuries in order to determine the tactics and technique of treatment. Purpose. To use the possibilities of modern methods of radiation diagnostics in revealing the elbow changes in children with posttraumatic deformities, as well as to study the results of treatment. Results. The examination of children with the consequences of distal humeral fractures using the techniques of radiography and multislice computed tomography (MSCT) allowed to obtain the objective data about pathological change character to substantiate a treatment technique. Excellent and good results of treatment achieved in the long-term period. Conclusion. Modern techniques of radiation diagnostics allowed obtaining an objective image of restoring the roentgen-morphological and anatomical parameters characterizing the elbow after fracture consequence treatment.

Disability among women and girls has been stigma in Indian rural society. Political will, health system, and indigenous physician approach towards patient can make lot of difference to this social problem. Contributions on behalf scientist to correct disability and deformity should not be ignored.

Purpose. To study the characteristics of somatic status and concomitant diseases in children with cerebral palsy (CP) admitted for surgical orthopedic treatment. Material and Methods. The continuous sampling of children (100 subjects) with CP spastic forms admitted for surgical orthopedic treatment studied from the viewpoint of somatic pathology occurrence. A pediatrician consulted all the children before admission and also in the early postoperative period. Standard anthropometric parameters, the data of medical history, physical examination, ECG, as well as laboratory method values, the data of additional examination techniques and particular specialist consulting considered to evaluate the children’s somatic status and concomitant pathology. Results. In the performed study concomitant pathology revealed in every patient. The distribution of the cases of somatic diseases indicates more frequent incidence of the pathology of the cardiovascular system and the urogenital one, as well as anemia in patients with reduced body mass index (less than the tenth percentile) and those with marked motor disorders (GMFCS IV and V) that defines a higher risk of exacerbation and/or decompensation of concomitant somatic disease and perioperative risk. The pathology incidence and severity increases significantly in patients above 10 years. Conclusions. We suggest that all the patients above 10 years and those with GMFCS IV and V are in need of correcting therapy in order to reduce the perioperative risk. The age below 10 years in children with severe CP forms is optimal both in terms of the results of correcting severe orthopedic pathology and in terms of reducing risks associated with concomitant diseases. In our series somatic diseases not prevented the implementation of the planned extensive program of surgical orthopedic treatment, but provided adequate pediatric support at all the stages of in-patient treatment.

Purpose. To perfect the tactic of surgical treatment and postoperative management of patients with the rearfoot neurotrophic ulcers based on using functional flaps. Materials and Methods. The work deals with the long-term results of surgical treatment in 46 patients with the rearfoot neurotrophic ulcers using vascularized free and non-free flaps. The authors studied quality of life in the treated patients before and after surgeries. They introduced the concept of “five-year survival of flaps”. Results. A significant improvement in quality of life after surgical treatment observed in all the patients. Within the periods below five years flap ulcerations formed in seven patients and corns in the scar site – in three ones. Conclusion. The authors consider the procedure of plasty using vascularized skin flaps with axial type of blood supply both in the free and non-free form as the most optimal one to fill soft-tissue defects developed after the rearfoot neurotrophic ulcer dissection. Competent and proper management of such patients is important. The proposed complex approach reliably improves quality of life in patients with the rearfoot neurotrophic ulcer.

Purpose. To improve the results of treatment in patients with chronic injuries of the long extensor tendon of the hand first finger. Materials and Methods. The authors proposed an original technique for tendoplasty of the long extensor of the hand first finger by transposition of the tendon of the intact long muscle abducting the thumb. They analyzed the long-term functional results of treatment by the proposed technique in 32 patients within the periods from one to ten years. Results. The following results were obtained: excellent – 81.3 % (n=26), good – 18.7 % (n=6). There were no satisfactory and unsatisfactory surgical outcomes. Conclusion. The proposed plasty technique allows to improve surgical functional results significantly when recovering the tendons of the hand first finger extensors in different posttraumatic periods.

Purpose. To study the characteristics of forming a distraction regenerated bone and histogenesis of the anterior tibial muscle through electromagnetic terahertz waves in tibial defect filling under transosseous osteosynthesis. Materials and Methods. The authors performed transosseous osteosynthesis with the Ilizarov fixator experimentally in 16 adult mongrel dogs, in the lower third of leg they modeled 3.0-cm bone defect which was 16.3±0.3 % of the segment length. The authors broke the fragment integrity at the border of proximal meta-diaphysis by osteotomy, after seven (7) days they started the formed fragment transferring in the interfragmental diastasis using the rate of 1.0 mm per day for 4 times during 30 days. The local impact of electromagnetic waves at the regenerated bone level proceeded in experimental group I (n=10) from Day 25 of distraction. There was no impact in control group II (n=6). Results. The stimulating effect of electromagnetic terahertz waves on the formation of mechanically proper regenerated bone observed when tibial postresection defect filling. The best vascularization of the anterior tibial muscle, sclerotization of lesser degree in combination with angio- and myohistogenesis signs suggested improving the main muscle function – contraction – in the long-term periods of the experiment. Conclusion. According to the study, it is advisable to recommend prescribing physioprocedures with terahertz radiation for orthopedic-and-traumatologic patients in order to reduce the periods of treatment, rehabilitation and limb function improvement.

The authors analyzed the information value of the laboratory tests used for diagnosis and that of evaluating the risk of complications after arthroplasty of large joints (ALJ): aseptic loosening, periprosthetic infrection, heterotopic ossification. They revealed that by now the use of the following laboratory signs for early diagnosis and evaluation of aseptic loosening risk in subjects after ALJ is quite convincing: the increase in the level of N-terminal telopeptide of Type I collagen (NTx) in urine, the increase in the activity of tartrate-resistant acid phosphatase in blood serum, the increase in the concentration of Type I collagen (CTX-I) C-terminal telopeptide in blood serum, as well as the increase in urine desoxypyridinoline (DPYR) and blood osteoprotegerin (OPG). The following clinically significant signs are evidential for laboratory diagnosing periprosthetic infection in patients after ALJ: the increase in the level of C-reactive protein, procalcitonin and interleukin-6 in blood serum, as well as erythrocyte sedimentation rate (ESR) increasing. The authors demonstrated the possibility of using the techniques of laboratory diagnosis for prediction and evaluation of the degree of developing heterotopic ossification in patients after ALJ.

The proportion of the procedures of the knee surgical revision arthroplasty performed due to infection is ab ove 58% of all revision interventions. In their presented review of the literature the authors analyzed the data of numerous references covering the problems of current diagnosis, as well as the approaches to treatment of periprosthetic infection. Most authors report of the efficiency of two-staged treatment, wherein a type of the spacer implanted at the first stage does not influence the effectiveness of the debridement of infection inflammation focus. However, the use of articulating debriding structures at the first stage has some advantages over non-articulating ones, and among them the better range of motions in the operated knee is one of the most important.

The authors presented a case of major injury of the leg soft tissues with a subtotal skin defect, left-sided comminuted fractures of the femur and leg in patient M., 13 years old, who got in a serious traffic accident. The major craniocerebral trauma and the remoteness from the regional centre delayed the start of qualified surgical treatment by 22 days. The first stage included a simultaneous surgery consisting in performing bridge osteosynthesis of the left femur using an internal plate of limited contact and osteosynthesis of the leg using the Ilizarov fixator with secondary debridement. The main defect of the shaft after the debridement was 25 cm. The following reconstructive intervention using bilocal osteosynthesis in order to fill the bone defect performed in the patient after necrectomy, subsequent free grafting with split-thickness skin flaps 5.5 months after the first main stage. Using this procedure the authors managed to fill the tibial defect partially, and four months later they performed the stage of free tibialization of the remaining bone defect over 10 cm using a fibular fragment obtained from the same leg. Subsequently, 19 months after the first stage of reconstruction they performed bone autografting of the femoral defect with maintaining fixation using the same plate. 2.5 years after the trauma the fixator was demounted from the leg. Consolidation in the femur and the leg was achieved, all the motions in the hip, the knee and the ankle maintained, the shortening of the lower limb remained on the involved side amounting to two cm. A good result was obtained after the performed surgical treatment with its inevitability of using the Ilizarov fixator for the leg. The serious comminuted femoral fracture and a great subtotal defect of the leg bone tissue and skin resulted in bone consolidation with soft staged using different techniques of long tubular bone reconstruction.

The authors presented a clinical case of correcting the feet planovalgus deformity by lateral column lengthening in an 11-year-old child with cerebral palsy (CP) within performing the acute multilevel orthopedic intervention. The performed treatment resulted in complete correction of the feet deformity, elimination of the joint contractures, weight-bearing recovery for both lower limbs. The analysis of the gait kinematic parameters demonstrated their improvement.

The authors presented a clinical case of treatment of a female patient with right calcaneus chronic osteomyelitis of blastomycotic etiology. The patient underwent complex restorative treatment which resulted in achieving stable remission of osteomyelitic process, as well as in limb weight-bearing recovery.