No 4 (2009)

Comparative analysis of the results of cemented stems use of two different designs - calcarless polished tapered stem (CPT) and anatomical mat stem with calcar Lubinus Classic Plus was performed. From April 1997 to December 2004 106 CPT (Zimmer) stems implanted to 96 patients and 72 stems Lubinus Clаssic Plus (W.Link) to 64 patients. The mean follow-up period for CPT stems in 70 patients (81 hips) was from 5 to 12 years (8,0±2,2) and for Lubinus Clаssic Plus stems in 44 patients (48 hips) was 6-12 years 99,8±1,4). Multifactoral study proved the high clinical efficiency of both stems use. But the detailed study of the radiological and clinical characteristics allowed to reveal the structural features of devices, typical changes of cement mantle and variants of bone stock adaptive reaction.

122 series of graphic modeling, 3 series of mechanic modeling and 6 series of tibia and femur osteosynthesis rigidity testing by Ortho-SUV Frame in comparison with Volkov - Oganesyan device were performed. It was revealed that for Ortho-SUV assembly used for working out the motions in the knee joint with amplitude 120/0/0 and more application of ellipse supports is advisable. The proximal support must be placed at the distance 200-210 mm from the knee joint space, distal support must be placed at the distance 120 mm . The angulation of proximal support to the bone must be 90º, of distal - 60º. The rigidity of investigated assembly of Ortho-SUV Frame exceed the rigidity of tibia and femur fixation by Volkov - Oganesyan device in 1,5 times.

The analysis of surgical treatment of 122 patients with transarticular fractures of calcaneal bone is presentrd. Open reposition and fixation with a plate was performed in 78 patients, extrafocal osteosynthesis - in 44. Favourable outcomes were received in the group of patients who had undergone an open surgery.

50 children aged from 7 to 13 years with recurrent club foot and operated in the age from one to three years old in different regions of the country by methods of Ulzibat, McKay and Zatsepin were evaluated. After surgical treatment of the recurrent club foot by methods of Ulzibat and McKay, significant changes in soft tissues and osteoarticular structures made it necessary a reconstruction of the foot with the use of Ilizarov device for final correction of the deformity. The method by Zatsepin for surgical treatment of club foot in children was found to be the most favorable for preservation of soft tissues and anatomical position of foot bones. If the club foot re-occurred in children aged from 7 to 13 years, the operation of choice should be a ligamentous and muscular plasty with a full release of all joints in hindfoot, midfoot and forefoot and with the use of Ilizarov device for final correction of the deformity.

The optimization of vibroacoustic apparatus "Vitafon" on the processes of regeneration in fractures zone of the tubular bones in the early postoperative period, were confirmed in a experimental study on animals. Experimentally found the best way to influence Microvibration. This technique has been tested in the clinic, positive results.

Ultrasonography is a useful tool for imaging, which can be used for the assessment of joints and periarticular structures. In patients with pain and/or swelling of the foot and ankle, ultrasonography provides information about the presence of joint effusion, synovitis, tendinopathy and tendons tears. Ultrasonic diagnostics of various damages both pathological conditions of the foot and ankle should become daily and widely used method, allowing to optimize diagnostics and medical tactics.

The analysis of treatment of 76 patients at the age from 19 to 74 years after revision osteosynthesis was performed. In 68,5% of patients the necessity of revision surgery was determined by failures during previous operations. The results of revision surgeries were studies in 89,5% of the cases in 1-3 years. In 46 (67,7%) patients the anatomical axis and the length of injured segment were restored completely. The analysis of errors during the primary osteosynthesis allowed to divide it into three groups: organizational, diagnostic, treatment-and-tactic. The most of errors (69%) were made during internal osteosynthesis, 31% - during intramedullary osteosynthesis.

The results of operative treatment of acetabular fractures with application of various methods of osteosynthesis in 239 patients have been studied. Internal fixation in 217 patients and external fixation in 22 cases have been applied. The method of choice of osteosynthesis was determined by type of injury, time after trauma and concomitant pathology. The remote overcomes were estimated in 206 patients. The management of patients with acetabular fractures is based on the principles of treatment of intraarticular injuries with the differentiated approach to each technique.

Retrospective analysis of treatment results in 132 patients with calcaneal fractures was performed. The main reason of injuries was the fall from a height that l entailed serious consequences: fractures of other bone and visceral traumas. The principal method of treatment at solitary fractures was skeletal traction, external osteosynthesis was applied in 55 (58,5%) patients. The reasons of disability (10,6%) were analyzed.

The analysis of results of treatment of 24 patients with a pathology of hip joint by endoprosthesis of KazSRITO are presented. Intrasurgical monitoring of intraosteal pressure was measured. During implantation of a femoral component, the significant decrease of intramedullary pressure on the average is noted. At all patients of a wound have begun to live primarily, complications were not observed.

The case of echinococcosis of humeral diaphysis is presented. The author describes clinical presentation and roentgenological picture, surgical technique and the results of treatment.

The author describes the method of osteoplasty by cylindrical autografts in cases of delayed union and non-union of femur neck, which was used in 23 cases. This method allows to prevent posttraumatic aseptic necrosis of femur neck and hip joint arthrosis.

This article is devoted to actual problem of modern orthopedic - treatment of patients with extraarticular fractures of hip with osteoporosis. Short analysis of literature was performed, problem questions of this pathology treatment were found. One of scientific investigations with aim to improve the results of such trauma treatment was determined.