Vol 18, No 2 (2012)

Objective: 9 patients with sequela of serious injuries and burns of the shoulder joint region operated in Vreden’s Scientific Research Institute of traumatology and orthopaedics (Saint-Petersburg, Russia) within the period from 2000 to 2011. Methods: 12 microsurgical operations having used 12 flaps were performed. In 10 cases it was pedicled flap transfer, in 2 cases - free tissue transfer. Patients with defects of bones have been additionally fulfilled 4 operations of shoulder arthrodesis and 2 operations of interlocking intramedullary nailing of proximal humerus. The results of treatment were estimated according to modified UCLA end-results score. Results: for reconstruction of isolated scar deformations and defects of skin in the shoulder joint region in 6 cases we used pedicled latissimus dorsi musculocutaneous flaps, in 1 case - pedicled trapezius musculocutaneous flap, and in 1 case - free radial forearm flap. In cases of shoulder arthrodesis we used pedicled latissimus dorsi osseous musculocutaneous flap with a segment of the 8th rib and free vascularized graft of iliac bone in patients with defects of bones. In two patients with circular defects of proximal humerus we fulfilled osteoplasty of the area of contact of fragments with pedicled grafts from the lower corner of scapula. 4 patients with scar contractures of shoulder-joint had excellent results, others had good results. Conclusion: tactics of using microsurgical technologies and choice of flaps in patients with pathology of shoulder-joint region should be specified for every concrete occasion. Microsurgical operations form an important part of the system of surgical treatment and are usually fulfilled simultaneously with other orthopedic operations.

From 1998 to 2010 32 patients (14 men, 18 women), aged 15-65 years, underwent surgical treatment for old Achilles tendon rupture. In all cases correct diagnosis was made not earlier than 1 month after injury. The importance of clinical Thompson test and sonographic examination for diagnosis of Achilles tendon rupture is underlined. For the restoration of Achilles tendon V-Y plasty was used. Surgery was performed in a period of 1 to 13 months in patients with subcutaneous Achilles tendon ruptures. Follow-up results of patients in the postoperative period ranged from 6 months to 10 years (mean follow-up 1 year 7 months). Date of observation in the postoperative period ranged from 6 months to 19 years. Marginal necrosis wound occurred in 3 (10%) patients, re-rupture of the Achilles tendon to tendon suture zone - in one patient, even in one patient on day 14 became infected. Violations of the foot innervation were no detected.

The study includes retrospective analysis of data of 520 old and senior age patients after hip replacement. 20 prognostically significant criteria of development of postoperative period purulence were identified. Registration of these criteria in prospective study (123 clinical observations) has helped to definitely reduce a frequency of purulent complications of operative wound in comparison with frequency in the group of retrospective studies (from 7,1% to 4,1% for the second group). Efficiency of the offered program has made 80%.

We analyzed the results of 63 pollicizations to 51 children with congenital and posttraumatic pathology of the hand with the age from 6 months till 18 years old. To examine the hand function before and after pollicization we used International Classification of Functioning, Disability and Health. Authors determined criteria and analyzed the ability to live restrictions before and after pollicization. The carried out analysis has shown that before operative treatment in most cases (94%) patients had heavy and absolute difficulties of infringement of function of force of the hand isolated muscles and muscular groups, infringement of change of structure and difficulty of hand use. At an estimation of the remote pollicization results positive outcomes have been reached at 49 (96%) patients from 51. Formation of bilateral pinch possibility at patients kept only easy and moderate difficulties of infringement of function of the hand.

The paper contains a critical analysis of the mechanostat theory. It is shown that for continuous modeling and osteoklastic-and-osteoblastic remodeling is not providing the necessary safety margin of skeletal structures and reduce risk of fractures. It is established that at each level of the hierarchical organization of a skeleton there are also other mechanisms of its reorganization. The functioning of this system is controlled by mechanisms of osteocytes and purposefully provides two effects: the first -preservation of bone structures deformability according to demanded productivity of convective fluid movement mechanism of a lacunary-tubular system, second - the optimization of the cross-section of the cavities of a lacunary-tubular system, respectively, the required level of throughput for the flow of fluid. As a result, the parameters of mechanical-metabolic environment surrounding the osteocytes are stored in the homeostatic limits, which increases cell viability, and hence bone and skeleton as a whole. However, this is often at the expense of the strength properties of bone structures.

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