Vol 19, No 2 (2013)

The aim of the investigation was development of science-based recommendations for increasing efficiency of operative treatment of adult patients with shin fractures in multiprofile city hospital. Investigation was made in Saint-Petersburg Alexandrovskiy City Hospital. Clinical material was presented by official hospital reports, individual medical documentation and results of direct survey of patients treated in this hospital in period 1999-2010 years. All patients had follow up treatment in outpatient department of this hospital. Information was completed following federal and local laws. Recommendations for standardization of modern specialized medical care of patients with shin fractures, based on methods of internal fixation, were performed. We took into consideration possibilities of conventional and minimally invasive fixation of closed and open fractures including politrauma injuries. Models of patients with shin fractures depending on method of internal fixation and list of basic diagnostic procedures and treatment were formed. Operations classifier of internal shin fractures fixation was developed. This classifier includes calculation of hospital costs in process of specialized medical care considering actual correction coefficients. Calculation of each surgical procedure component was performed. List and composition of instrument sets and expense materials for such operations were formed. Analisis of organizational, medico-technological, economica aspect and expert evaluation of clinical results of different methods of long bones fractures fixation have provided conceptual approach to treatment standardization. On this base we have developed medico-economical standards of long bones fractures treatment in city multiprofile hospital.

Purpose: to identify risk factors of dislocation after total hip arthroplasties and to suggest a model to determine the probability of occurrence of this complication in every patient. Material and methods: since 2000 till 2010 2569 primary and 319 total hip revisions were performed in 2409 patients. The age of patients varied from 15 to 92, average - 58,5. Women were 1582 (65,68%). All procedures were made through the posterior approach (Kocher-Langenbeck). Results: there were 136 dislocations. The authors analyzed three groups of risk factors: 1) related with patient; 2) depending on surgeon; 3) associated with implant design. Most important risk factors were found by the method of logistic regression: age, gender, diagnose, surgeon, cup-to-head ratio. The authors suggested the predictive model of probable dislocation.

Objective: to determine the capabilities and perspectives of flap surgery in treatment of patients with traumas and diseases of ankle joint region. Material and methods. The results of surgical treatment of 88 such patients. All the patients were treated in the Vreden Russian Research Institute of Traumatology and Orthopedics within the period from 2000 to 2011. All the patients had pedicled flap transfer (46 cases) or free tissue transfer (45 cases). 11 patients had additional need in other open orthopedic operations of ankle joint. Besides this, scientific works dealing with the studied problem have been analyzed. Results and conclusions. It has been stated that flap surgery is predominantly used as the only and exhaustive method of treatment of such patients (87,5%). In these situations pedicled flap transfer and free tissue transfer tend to be used in comparatively equal quantities. Flap surgery is now seldom used as a component of complex surgical treatment. It is used only in some cases of bone reconstruction of distal tibia by Ilizarov bone transport, in some cases of tumors of ankle joint as well as in some cases of local infectious complications after internal fixation and total ankle arthroplasty. Patients with the pathology of this kind have a high need in free tissue transfer (from 66,7% to 83,3%). Progressing technology of total ankle arthroplasty will contribute to the frequency of use of flap surgery for patients with pathology of ankle joint.

The purpose - to devise the algorithm of patient examination with spastic hand to determine what the variant of surgical treatment is indicated. The variant of surgical treatment and it's results are depend on the cause of upper extremity deformation. Materials and methods. This study is based on a survey of children with cerebral palsy with lesions of the upper extremity. The main criterion for the selection of patients was the presence of the combined lesion of the upper extremity, where the cause of dysfunction hands are not only fixed contractures, but primary tonic. Was to survey 47 patients with spastic forms of cerebral palsy with the defeat of the upper limb, but the study group included only 26 of them in the ages of 7 to 18 years (average 12,1), as having the clinical picture both types of contractures. We have developed and applied a system of examinations, modeling expected outcome of selective neurotomy motor nerves of the upper limb, which allows to estimate the possible result of such treatment, and clearly differentiate tonic and fixed contracture. Results and conclusions. Based on the results of study we supposed that, using diagnostic blockade motor nerve at the period of planning surgical treatment help us to create temporary reversible model of selective neurotomy motor nerve branches and identify the type of contracture, degree of manifestation and functional perspective.

For the first time on the basis of computer modeling using the finite element method the mechanical role of mineral compounds, binding all of the bone minerals in the whole monolith was evaluated. By multivariate computational experiments the authors established the qualitative features and obtained the quantitative assessment of the influence of the bridges on the stiffness and stress-strain state of the representative volume element (RVE). The effective elastic moduli of the nanocomposite bone RVE were estimated by the of finite element homogenization method taking into account the availability of bridges. The presence of the bridge enhances bone stiffness regardless of the direction of acting loads. Consequently, bridge plays an important biological role in increasing the strength properties of the skeleton at nonstandard directions of the load. Data presented in this paper show an extremely complex mechanical phenomena developing in the mineral matrix, which can be adequately assessed only by using a computer modeling based on the morphologically correct structural relationships of its components.

An anonymous sociological survey of 408 patients hospitalized due to injuries in R.R.Vreden RNIITO and traumatological departments of St. Petersburg city hospitals was carried out. The social structure of injury victims under hospital care has no fundamentally differences comparing to the social structure of the city population. The most patients were males, aged 20-30 and 40-50 years, St. Petersburg residents, with higher and secondary education. Most of the patients were married, had an average or low income, living in decent housing. Many of the injured have abused alcohol, smoked regularly, some use drugs. Most often injuries leading to hospitalization occur as a result of falls, and criminal attacks and road accidents. According to opinion of the majority of patients, sanitary condition of their departments is good, but the quality and range of food does not satisfy most of the respondents. Many patients are faced with the need to pay for the recommended care. Patients highly appreciate the human and professional qualities of the medical staff. The social efficiency of treatment coefficient was 0.95.

Ankle arthroplasty is known to become more successful procedure versus ankle fusion in patients with ankle osteoarthritis. This article represents a clinical case of performing three-staged bilateral ankle arthroplasty by means of HINTEGRA and Mobility implants in a patient with severe defect of the talus. The patient was followed up for 2 years for right ankle and 4 years - for left ankle. The correct treatment strategy gave the patient a new lease of life. He resumed sports activities, being pain-free in both the ankle joints.

Alkaptonuria is rare disease with deficiency of homogentisate-1,2-dioxygenase enzyme, resulting in excess deposition of homogentisic acid in connective tissue. This deposition leads to ochronosis - brownish-black pigmentation of connective tissue. The result of pigmentation is weakness of connective tissue and, finally, chronic inflammation and osteoarthtritis. Currently specific treatment is absent, only sympothomatic. But total knee arthroplasty has good outcomes in patients of severe ochronotic arthritis similar to osteoarthritic patients without ochronosis. We present a case report of a patient with knee ochronotic arthritis treated with total knee arthroplasty.

In the articles recent publications on postoperative delirium, the development of which is relevant and socially significant issue of Orthopedics and Traumatology. The review include modern concepts in pathogenesis, risk factors, diagnosis, treatment, and prevention of this complication. It is concluded that the main direction of prevention of postoperative delirium is a modification of the risk factors for its development.

The possibility of the spinal stabilization in patients with a history of somatic diseases and contraindications to general anesthesia is discussed. As an example, the authors have given the histories of two patients with vertebral pathological fractures against a background of the osteoporosis and metastatic gastric cancer who underwent transpedicular fixation of the spine under local anesthesia. In both cases good results of treatment were received.

The aim of the study is to assess the possibilities of functional magnetic resonance imaging (MRI) of the knee and the comparison of its results with other known methods of quantitative diagnosis of anterior instability. Material and methods. The study included 22 patients aged 16 to 84 years. The first group comprised 16 patients with complaints of instability of the knee joint, the second - six patients with no signs of instability (relatively healthy). In addition to conventional clinical examination (Lachman test and the "front of the drawer"), all participants in the study conducted functional MRI according to our methodology on the unit «HELPIC RENEX» 0,25 T open. In order to assess its informativeness all patients underwent functional X-ray of the knee on the unit Italrey «PIXEL HF» (Italy). Arthroscopy with intraoperative Lachman to testing performed in 11 patients of the first and second group of five patients on the equipment «Rudolf», Germany. Results. These data suggest that functional MRI is a valuable method to identify the anterior instability of the knee, which can be used as a supplement to commonly used functional imaging, and independently, since comparable results. The main advantages of functional MRI is the lack of radiation exposure and non-invasive visualization of the anterior cruciate ligament in tests on the instability of the knee.

The comparative analysis of the results of the surgical treatment of 130 patients with closed comminuted unilateral diaphyseal femoral fractures, including assessment of anatomic functional outcomes of treatment according to the technique of the standardized investigations in traumatology and orthopedy and determination of quality of life according to SF-36 method is carried out. Osteosynthesis with the help of external fixation devices was performed in 36 patients, intramedullary interlocking osteosynthesis - in 57 patients, compression plating - in 37 patients. Level of anatomic functional rehabilitation of the patients in the early postoperative period made up 69-79 %, 6 months later increased up to 74-92%, and after the expiration of 12 months the level of rehabilitation reached 85-99%. During the treatment quality of life concerning physical component was within the limits from 36,8 up to 55,5 %, and concerning mental component - 54,3-60,8 %. After the expiration of a year increase in the parameters of physical and mental components up to 55,7 - 59,8 % and 57,2-65,8 % is detected respectively. In the group where the transosseous osteosynthesis technique was applied we got 93,7-95 % of positive outcomes, with the average disability period of 212,3±18,1 days. In 47,2 % of cases the following complications are observed: knee contracture - 7; inflammation of the soft tissues located near the transosseous fixators - 5 (13,9%); shortening of the limb less than 5% of its length - 3; false joint formation - 1; fracture union with formation of varus deformity in the femoral bone - 1. When using intramedullary interlocking osteosynthesis we had positive results in 96,5 % of cases, with the average period of disability 176±17,8 days. In 10,5 % cases the following complications are observed: suture sinus - 1(1,75 %); femoral osteomyelitis - 1; break of the design - 1; false joint formation - 1; knee contracture - 1; shortening of the limb less than 5% of its length - 1. The best outcomes of the surgical treatment (up to 100 %) were observed in cases when compression plating with LCP with fixation of no less than 57 % of the length of each fragment was performed. Complications in the form of a knee joint contracture were observed in 13,5% of patients.

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