Vol 17, No 4 (2011)

ORIGINAL ARTICLES

MODERN STRUCTURE OF SEVERE BLUNT HAND TRAUMAS

Rodomanova L.A., Kutyanov D.I., Melikhov K.S., Nakonechny D.G., Ryabov V.A.

Abstract

The authors have studied the modern structure of severe blunt hand traumas in 123 patients. The size, type and localization of traumas were considerably determined by the reasons and circumstances of traumas. We have emphasized three main types of severe blunt hand traumas: traumas caused by immediate pressure of considerable traumatizing force (impaction); traumas caused by prolonged pressure of considerable traumatizing force (compression); explosive hand injuries. It has been proved that though the modern severe blunt hand traumas have mainly open character, the existence of various injuries of fascias does not provide complete decompression of compartments of hand and wrist. In the conditions of inadequate surgical treatment it may later lead to development of posttraumatic ischemic contractures of hand.
Traumatology and Orthopedics of Russia. 2011;17(4):5-10
pages 5-10 views

BIOMECHANICAL INDICES OF STANDING AND GAIT IN PATIENTS AFTER TOTAL KNEE REPLACEMENT USING COMPUTER NAVIGATION

Bezgodkov Y.A., Kornilov N.N., Petukhov A.I., Kulyaba T.A., Selin A.V., Muranchic Y.I., Croitoru I.I., Ignatenko V.L., Saraev A.V.

Abstract

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.
Traumatology and Orthopedics of Russia. 2011;17(4):11-17
pages 11-17 views

FEATURES OF SYNOVIAL ENVIRONMENT AND SUBHONDRAL AREA OF JOINTS IN PATIENS SUFFERING FROM GONARTROSIS

Matveeva E.L., Osipova E.V., Gasanova A.G., Chegurov O.K.

Abstract

The aim of the work was to investigate the changes in the values of synovial fluid electrolyte composition in patients with degenerative-and-dystrophic involvements of the joints, as well as to study the dynamics of the mean optical density of femoral and tibial epiphyseal bone structures. The samples of synovial fluid have been studied, as well as the x-rays of 37 patients with deforming arthrosis of the knee of idiopathic and posttraumatic etiology. The decrease of ionized calcium value and the increase of total calcium/inorganic phosphate ratio value have been found. The change in the mean optical density of epiphysis shadow has been demonstrated to be depended on the stage of the pathological process. The relationship of the values of bone structure mean optical density and the concentration of synovial fluid electrolytes evidences the involvement of subchondral zone mineral component in the development of joint pathology. These values can be used as an additional criterion in osteoarthrosis diagnosis, as well as for assessment of subchondral bone condition by biochemical synovial fluid test.
Traumatology and Orthopedics of Russia. 2011;17(4):18-22
pages 18-22 views

INFLUENCE OF VARIOUS METHODS OF TREATMENT PATIENTS WITH DIAPHYSIAL FRACTURE OF SHIN BONES ON A BLOOD RHEOLOGY

Pisarev V.V., Lvov S.E., Molchanov O.S., Grineva M.R., Pakhrova O.A.

Abstract

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.
Traumatology and Orthopedics of Russia. 2011;17(4):23-29
pages 23-29 views

USE OF TECHNOLOGIES OF PLASTIC AND RECONSTRUCTIVE MICROSURGERY IN TREATMENT OF PATIENTS WITH WRIST PATHOLOGY

Kutyanov D.I., Rodomanova L.A.

Abstract

We have analyzed the results of treatment of 44 patients with injuries and tumors of wrist. The main aims of microsurgical interventions in such patients were replacement of bone defects (40,9%), replacement of skin defects (25,0%), and also elimination of contractures of wrist joint and fingers (20,5%). At the same time high frequency of use of bony flaps was caused mostly not by the need in replacement of defects of bones, but by the need in stabilization of wrist joint aiming to create the conditions for normal function of fingers. It has been stated that the use of technologies of plastic and reconstructive microsurgery in patients with wrist pathology is not the main factor determing the good result of treatment. The good result of treatment is mainly determined by the condition of fingers, not only appropriate surgical treatment but also adequate rehabilitation helps them achieve their necessary function.
Traumatology and Orthopedics of Russia. 2011;17(4):30-36
pages 30-36 views

ANALYSIS OF COMPLICATIONS AFTER SUBTALAR ARTROEREISIS IN PATIENTS WITH PLANOVALGUS DEFORMITY

Tamoyev S.K., Zagorodniy N.V., Protsko V.G., Sultanov E.M., Khamokov Z.K., Butayev B.G.

Abstract

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.
Traumatology and Orthopedics of Russia. 2011;17(4):37-43
pages 37-43 views

THE CORRELATION DEPENDENCE OF THE CLINICAL AND MORPHOLOGICAL MANIFESTATIONS AND BIOMECHANICAL PARAMETERS IN PATIENTS WITH DEGENERATIVE SPONDYLOLISTHESIS L4 VERTEBRA

Krut’Ko A.V., Peleganchuk A.V., Kozlov D.M., Gladkov A.V., Ahmetyanov S.A.

Abstract

The study included 59 operated patients with spondylolisthesis L4 vertebra of I degree. All the patients were held clinical-anamnestic, neurological, radiological, radiopaque and biomechanical studies, MRI, CT, as well as puncture performed provocative tests. Revealed correlation of clinical manifestations of degenerative spondylolisthesis L4 and biomechanical parameters of the shape and orientation of the lumbar spine. The most pronounced clinical and morphological changes detected at the level of spondylolisthesis and adjacent segments in the group with hyperlordosis and excessive tilt angle of the chord forward, which is confirmed by MRI, CT, and carried out a disco-puncture provocative tests. A variety of pathological changes of the lumbar spine at L4 vertebra degenerative spondylolisthesis correlated with the biomechanical parameters violation of the shape and orientation of the spine in the sagittal plane.
Traumatology and Orthopedics of Russia. 2011;17(4):44-52
pages 44-52 views

EVALUATION OF LONG-TERM OUTCOMES IN PATIENTS WITH CHRONIC OSTEOMYELITIS OF LOWER LIMB BONES WITH BONE CAVITIES USING CONTROLLED TRANSOSSEOUS OSTEOSYNTHESIS

Lapynin A.I., Popova L.A.

Abstract

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.
Traumatology and Orthopedics of Russia. 2011;17(4):53-61
pages 53-61 views

THEORETICAL AND EXPERIMENTAL STUDIES

STRUCTURAL ADAPTABILITY AND THE REPARATIVE POSSIBILITIES OF ARTICULAR CARTILAGE DEPENDING ON THE ADJACENT EXTREMITY SEGMENT LENGTHENING CONDITIONS (AN EXPERIMENTAL-AND-MORPHOLOGICAL STUDY)

Stupina T.A., Schoudlo M.M.

Abstract

The changes of reactive and/or destructive-and-reparative character, the degree of which depends on distraction parameters, have been revealed in articular cartilage during leg lengthening by the methods of scanning electron microscopy and histomorphometry analysis. The analysis of quantitative data has demonstrated, that autodistraction by 3 mm per day for 180 times (increment и 17 μm) appears to be less traumatic for the articular cartilage than manual distraction by 1 mm per day for 4 times, and, at the time, the period of experiment decreases significantly. The articular cartilage recovery occurs in the most intense manner in case of autodistraction with the same increment, but with the daily rate of 1 mm.
Traumatology and Orthopedics of Russia. 2011;17(4):62-68
pages 62-68 views

EXPERIENCE EXCHANGE

SURGICAL TREATMENT OF SEVERE (2-3 DEGREE) DEFORMING ARTHROSIS OF FIRST METATARSOPHALANGEAL JOINT OF FOOT: TASKS, APPROACHES, TECHNIQUE

Mazalov A.V., Zagorodniy N.V., Protsko V.G., Sultanov E.M., Khamokov Z.K.

Abstract

Based on the experience of treating 67 patients (98 feet) with deforming arthrosis of first metatarsophalangeal joint is shown that the treatment of this disease the distal decompressing osteotomy in combination with maximally radical the separation of the unions and cheilectomy possesses the significant health-improvement potential, which makes it possible to be turned to arthrodesis or arthroplasty only in the limiting cases of that the heavy cases of hallux rigidus. L-osteotomy 1-st metatarsus gives more than possibilities for the correction with the heavy deformations and the degenerate changes, the basic criterion of sufficiency of which is the volume of the intra-operating straightening of 1-st fingers reached. Optimum is reaching the straightening 1-st toes to 65° even above. An indispensable stage of complex operation is maximally radical of cheilectomy. During the formation of arthrodesis 1-st metatarsophalangeal joint in the horizontal plane the axis of 1 finger should be oriented in parallel to axis second metatarsal bones. The sagittal angle of the formation of arthrodesis depends on the manifestation of valgus of rear division. Active postoperative conducting essentially improves the distant results of the surgical treatment of deforming arthrosis of first metatarsophalangeal joint.
Traumatology and Orthopedics of Russia. 2011;17(4):69-76
pages 69-76 views

INVESTIGATION OF THE NEURO-MUSCULAR SYSTEM IN PATIENTS WITH UNCOMPLICATED FRACTURES OF THE SPINE

Tomilov A.B., Zubareva T.V., Kuznetsova N.L.

Abstract

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.
Traumatology and Orthopedics of Russia. 2011;17(4):77-82
pages 77-82 views

CONSERVATIVE TREATMENT OF PATIENTS WITH OBSTETRIC PALSY OF UPPER LIMB

Naumochkina N.A., Ovsyankin N.A.

Abstract

The clinical materials of the Institute based on the treatment of more than 150 patients in the age of newborn till 7 with brachial plexus injuries is presented. Only conservative method of treatment was carried out.
Traumatology and Orthopedics of Russia. 2011;17(4):83-88
pages 83-88 views

SURGICAL METHODS FOR TREATMENT OF DIAPHYSIAL FRACTURES OF FOREARM IN CHILDREN

Khodjayev R.R., Shermatov G.A.

Abstract

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.
Traumatology and Orthopedics of Russia. 2011;17(4):89-91
pages 89-91 views

THE EFFECTIVENESS OF COMBINED THERAPY OF POSTMENOPAUSAL OSTEOPOROSIS WITH DUAL ACTION DRUGS

Minasov T.B., Minasov B.S.

Abstract

Osteoporosis is one of the most dangerous diseases occurred in elderly persons. Results of application of strontium ranelate in combination with calcium for treatment a women with a postmenopausal osteoporosis are resulted. The influence of this complex therapy on dynamics of mineral density indexes of a bone tissue and the level of bone metabolism were studied. Strontium ranelate both at monotherapy, and in combination with calcium promotes the augmentation of mineral density of bone tissue in an axial skeleton. The taking Strontium ranelate doesn’t cause serious side effect.
Traumatology and Orthopedics of Russia. 2011;17(4):92-94
pages 92-94 views

CASE REPORTS

THE COMPLEX TREATMENT OF THE PATIENT WITH MULTIPLE SPINE AND SPINAL CORD MALFORMATIONS

Vissarionov S.V., Golubev K.E., Belyanchikov S.M.

Abstract

Clinical case of the patient with the congenital deformation of thoracic and lumbar parts of the spine due to multiple congenital anomalies of vertebrae (disturbance of formation, fusion and segmentation), a terminale filum lipoma at the level of L5, tethered cord, rightside lower leg monoparesis. Multistage surgical treatment was performed: removing of intracanal deformity, correction and stabilization of the deformity at the thoracic and lumbar part of the spine. Patient was followed up during 2,5 years after the last step of the surgical operation. No evidence of recurrence or neurological deterioration were observed.
Traumatology and Orthopedics of Russia. 2011;17(4):95-99
pages 95-99 views

INTESTINE INJURY BY BONE FRAGMENT IN PATIENT WITH UNSTABLE PELVIC FRACTURES AT POLYTRAUMA

Batpenov N.D., Baymagambetov S.A., Mahambetchin M.M.

Abstract

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.
Traumatology and Orthopedics of Russia. 2011;17(4):100-104
pages 100-104 views

RESULTS OF TOTAL SHOULDER REPLACEMENT BY THE REVERSING CONSTRUCTION DELTA Xtend™

Dlyasin N.G.

Abstract

A good result of a reversible shoulder replacement by DELTA Xtend ™ construction in a patient with posttraumatic osteochondrosis of the proximal part of the humeral bone is demonstrated. The advantage of the reversing system over the ordinary total replacement and hemiarthroplasty in patients with old damages of the proximal part of the humeral bone is detected.
Traumatology and Orthopedics of Russia. 2011;17(4):105-107
pages 105-107 views

MODERN TECHNOLOGIES IN TRAUMATOLOGY AND ORTHOPEDICS

LIGAMENTS RECONSTRUCTION WITH A PERONEUS LONGUS TENDON AUTOGRAFT IN INSTABLE KNEE

Kozhevnikov E.V., Bazhenov P.A.

Abstract

Purpose: to improve the outcomes of instability treatment by ligaments reconstruction with a peroneus longus tendon autograft. All the patients (n = 88) before the procedures had chronic knee ligament injures. All the patients were treated with a peroneus longus tendon autograft reconstruction. The method of simultaneous reconstruction of anterior cruciate and lateral ligaments with a peroneus longus tendon autograft was described. The method of reconstruction of antero-lateral stability of knee joint we mean is simple and effective, because the tendon autograft is long and strong, and peroneus longus tendon is located out of knee joint proection. In such case the procedure doesn’t weaken knee joint ligaments and capsule.
Traumatology and Orthopedics of Russia. 2011;17(4):108-113
pages 108-113 views

THE METHOD OF SURGICAL TREATMENT OF HUMERAL EPICONDYLITIS

Korolev S.B., Kachesov A.V., Nosov O.B., Klenin A.A., Abramenkov A.N.

Abstract

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.
Traumatology and Orthopedics of Russia. 2011;17(4):114-117
pages 114-117 views

TRAUMA AND ORTHOPEDIC CARE

VERTEBRAL DEFORMITY IN CHILDREN AND DISPENSARY CARE ORGANIZATION

Batrshin I.T.

Abstract

In order to analyze the prevalence of spine deformation pathology and the state of vertebral children care screening of 18 500 schoolchildren was conducted by computer optical topography. In 79.5% of them the posture disturbances and in 14.5% - spinal deformity were detected. The multivariate analysis of vertebral deformity was performed. It is established that vertebral deformity till 10° on Coob has usually monoplane form, and more than 10° - only multiplane form. Dispensary health groups were formed, screening program for children with subsequent monitoring was proposed.
Traumatology and Orthopedics of Russia. 2011;17(4):118-122
pages 118-122 views

REVIEWS

SURGICAL TREATMENT OF HALLUX VALGUS AND ITS POSSIBLE COMPLICATIONS (REVIEW)

Sorokin E.P., Kardanov A.A., Lasunskiy S.A., Bezgodkov Y.A., Gudz A.I.

Abstract

Hallux valgus surgery remains the most important direction of modern orthopedics. In this article authors analyzed the history of Hallux valgus surgical treatment development observing the details of different types of methods directing on various pathogenic parts of pathology as well as complications occurring with different types of methods. Main tendencies of development and improvements of hallux valgus surgery are described.
Traumatology and Orthopedics of Russia. 2011;17(4):123-130
pages 123-130 views

THE USE OF ARTHROSCOPY FOR INTERNAL KNEE INJURIES IN CHILDREN AND ADOLESCENTS (REVIEW)

Avramenko V.V., Kuznetsov I.A.

Abstract

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
Traumatology and Orthopedics of Russia. 2011;17(4):131-139
pages 131-139 views

ARTHROPLASTY AT VALGUS DEFORMITY OF THE KNEE (REVIEW)

Ignatenko V.L., Kornilov N.N., Kulyaba T.A., Selin A.V., Petukhov A.I., Croitoru I.I., Saraev A.V.

Abstract

The authors overviewed particular features of TKA in patients with valgus deformity. The questions of epidemiology, distinctive bone and soft tissues abnormalities, optimal surgical approaches and deformity correction methods, as well as treatment results and complications were discussed. Authors came to the conclusion of lacking commonly accepted and reliable algorithm that would help the surgeons to deal with valgus knee in TKA.
Traumatology and Orthopedics of Russia. 2011;17(4):140-146
pages 140-146 views

METHODS OF TREATMENT OF CHILDREN WITH ELBOW INJURIES (REVIEW)

Proshchenko Y.N., N.a. Ovsyankin .N., .

Abstract

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.
Traumatology and Orthopedics of Russia. 2011;17(4):147-151
pages 147-151 views

HISTORY OF MEDICINE

WILHELM CONRAD RONTGEN (1845-1923)

Bashurov Z.K.

Abstract

Article is devoted to biography of famous German physicist WK Rontgen and the history of his discovery of new form of radiation - the so-called X-rays.
Traumatology and Orthopedics of Russia. 2011;17(4):152-155
pages 152-155 views

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