Vol 17, No 4 (2011)

Several biomechanical parameters of standing and walking in 50 patients with osteoarthrosis after total knee arthroplasty were evaluated. The patients were randomly divided in two equal groups: in the first group the surgery was performed with computer navigation system and in the second - with traditional instruments. After TKA with computer navigation centers of common body pressure and legs pressure during standing phase improved significantly better than in traditional group. Walking parameters like step length, ground contact time and rhythm coefficient improved in both groups of patients but without significant difference. Thereby more precise orientation of implant that achieved during computer assisted TKA leads to better functional performance at 6 and 12 month after surgery.

The changes of blood rheology were studied in 93 patients with close diaphysial fracture of shin bones, one group also having osteosynthesis by means of plates performed on the 1st day, and other group undergoing a skeletal stretching. 18 healthy patients composed the control group. We found out that in the early stages of treatment the changes of rheological properties are uniform in character independent of the way of treatment (emergent osteosynthesis or skeletal stretching). After the osteosynthesis performed on the day of trauma restoration of rheological properties occurs more quickly than after conservative methods of treatment.

The results of observation of 9 patients after subtalar arthroereisis with developed different complications from 2008 to 2011 were presented. In 7 patients subtalar arthroereisis was held in conjunction with surgical correction of forefoot, in 2 patients was carried out in isolation. All complications were divided into 4 groups: talar sinus syndrome, the migration of subtalar implant, overcorrection of deformation, the subtalar implant destruction. Development of talar sinus syndrome after subtalar arthroereisis was associated with the using of too large implant. The implant migration was associated with failure to topographical requirements for its installation, as well as the inadequate size of it. Overcorrection of deformation was observed in cases where the subtalar implant was introduced deeper than the required. In cases of migration of implant «Vilex» its reimplantation was performed, while in other cases the implant was removed to eliminate the pain. In order to prevent complications after subtalar arthroereisis the topography of the subtalar implant in the sinus area and adhearance to the technology should take into account.

The long-term results of treatment of 48 patients with chronic osteomyelitis and osteomyelitic cavities are presented in the work. A polycriterial analysis has been made by 16 pathological signs typical of the patients of this category Quality of life assessment has been made using the scale of social limitations WHO (WHO Handicap scale, 1980). The patients’ status has been determined before treatment and in the long-term period. The results obtained evidence high effectiveness of the controlled transosseous osteosynthesis technique in medical-and-social rehabilitation of patients with the pathology mentioned: and, besides, good long-term result is obtained in 37 patients (77,1%), satisfactory - in 11 ones (22,9%). Quality of life according to WHO social spheres were increased in treated patients for 20-25%, 34 subjects resumed their work and study versus 5 subjects before treatment.

The results of electroneuromyography of the neuromuscular system of the lower extremities in patients with uncomplicated fractures of the lower thoracic spine showed that during the rehabilitation period after surgery (1 year) the function of foot flexors remain fully intact. In 12-22% of cases in the early stages there are signs of motor deficit of foot extensor muscles, which disappears for half a year after surgery and again detected in 17% at 1 year after injury. In the early postoperative period electroneuromyography of peripheral nerves of the lower extremities revealed a mild subclinical neuropathy of n. tibialis in 24% of cases, n. peroneus - in 38%. A year after the operation a complete normalization of the tibial nerves functions occurred as the signs of «hidden» neuropathy of peroneal nerves were found in every third patient. In 2 weeks after the surgery at the level of the lumbosacral plexus the signs of hyperexcitability of motoneurons pool were reported in 50% of patients, which grew to half a year after surgery In a year at plexus level signs of deficiency of efferent fibers excitability, more expressed on L4-L5 level have been revealed. In the study of reflex activity of the lower extremities in 70-80% of patients with uncomplicated spine fractures bilateral suprasegmental violations by type of increased excitability of afferent fibers at the level L5-S1 were registered.

Treatment of diaphyseal fractures of the forearm: among children is an urgent and complex issue. Results of treatment of closed fractures of the forearm in 43 children who have used surgical treatment using the existing (open reduction, intramedullary fixation combined with external fixation by Ilizarov ring of the two towers) methods. The main principles of treatment of forearm fractures in children the correct mapping of one fragments, their reliable fixation, early adequate functional load.

Injuries of sigmoid colon and ileum by bone fragment of in pelvic fractures are extremely rare. Early diagnostics of intestine damage at polytrauma has specific features. The authors presented clinical cases intestine perforation by bone fragments. The signs of abdominal injuries in polytrauma and recommendations on their timely diagnostics are diagnostics.

Method of treatment of epicondylitis of humeral bone is descripted. This metod is proposited to use if conservative therapy was not effective. Experience of use this method show excellent results.

In the present review the authors discussed the indications and contraindications for arthroscopy at knee trauma in children, optimal terms of its implementation, the features of knee injuries in childhood and the role of arthroscopy in its diagnostics and treatment. Particular attention is paid to assessing long-term results of arthroscopic treatment for this condition

In spite of the many existing methods of treatment of elbow fractures, proportion of complications and poor outcomes is still quite a high (18-85%), and the risk of non-united fractures and false joints ranged from 13 to 27%. Difficulties in of the treatment of elbow fractures in children caused by a number of features: a complex anatomic and topographic location, small size of the distal fracture fragment, the frequency of damage to the articular capsule, blood vessels and nerves. This review describes the modern methods of treatment of children with this pathology.