No 2 (2009)

The article presents new methods of hand and finger reconstruction by transfer of various hand segments, i.e. digits, digital and metacarpal stumps. Described methods are based on preparatory distraction of segments transferred, which is effected in order to elongate their pedicles. Pedicle distraction enables reconstruction of the thumb and, moreover, of any finger by transposing a digital or metacarpal stump with the proximal amputation level to a recipient with a more distal amputation level. The segment is transferred either on one or two pedicles depending on blood supply sufficiency. 100% of cases saw successful acceptance of transferred segments. Positive functional results were achieved in 92,5% of cases.

The article discusses the questions of chronic posttraumatic osteomyelitis combined with bone nonunion. The treatment results of such patients depend on the correctly chosen therapeutic management. When choosing the therapeutic approach surgeons are also guided by the revealed tendency of reparative osteogenesis in the nonunion zone. Diagnostic opportunities of osteoscintigraphy for such cases are not adequately explored. The monitoring results of bone tissue reparative regeneration in the nonunion zone of 42 patients are compared in this research, with using osteoscintigraphy. Scintigram data handling and interpreting are carried out by author's strategy. The results obtained show great diagnostic value of osteoscintigraphy. Carried out investigation demonstrate that using scintigraphy promotes making a sound tactical decision at an earlier stage.

We analyzed the results of treatment of 76 patients with rigid scoliotic deformity. All the patients taking into account the expressiveness of scoliosis arc, its degree of stiffness was used differing of tretment. In rigid scoliosis with residual deformation of the main arc of 60% or more of the baseline values shown in the first phase of implementation of ventral mobilize intervention. Ventral intervention allowed to increase the correction of scoliotic main arc in the final stage of surgical treatment.

41 patients, aged 14-60 years with posterior pelvic ring fractures were treated between 2006-2009. Fractures occurred after motor vehicle accident (33) , fall from height (7), gas explosion (1). 30 patients (73,1%) had sacral fractures, 10 (24,4%) - SI joint rupture, 1 (2,5%) had fracture of iliac bone. According to Denis classification 6 patients had transalar fractures (zone I), 20 patients - transforaminal fractures (zone II), and 4 - a central sacral fracture (zone III). 2 - complete sacroiliac joint dislocations. For stabilization sacroiliac screw fixation were used in 2 cases, sacral bars - in 2, posterior sacroiliac plate fixation had 9 patients, local osteosynthesis of a sacrum with a spinopelvic fixation - 24. The technique of ileolumbar fixation in a combination with local osteosynthesis of sacrum or with any other way of SI joint fixation is optimal for bringing down of half of pelvis at vertical displacement on zone SI joint or on sacral fracture.

The purpose of the work is to study the influence of therapeutic physical factors on synovial homeostasis at patients with posttraumatic osteoarthritis large joints. The rehabilitation of 194 patients with posttraumatic osteoarthritis of hip, knee and ankle joints which was accompanied by increased intra-articular friction as a result of disorders of synovial homeostasis was carried out. The most evident positive changes in synovial homeostasis were achieved by means of complex of therapeutic physical factors including mechanotherapy in the swimming-pool with nitric-siliceous radon containing mineral water, peloidotherapy, interferencetherapy and electromyostimulation of the para-articular muscles. The achieved medical effect is comparable with intraarticular introduction of elastoviscous synovial fluid implant «Synocrom».

The authors analyzed the results of treatment of 78 children with the extensive thermal injury in age from 4 months to 16 years. The frequency of invasive candidosis was 32%. Following peculiarities of surgical treatment exert statistically reliable influence on the development of this mycological complication: the burn more than 50% body surface, necrectomy on the 1-2 day after injury, escharotomy more than 15% body surface, disuse the xenografts, size of the donor wound more than 10% in the primary skin grafting, the number of skin graftings less than 3.

Aim of study - to estimate a reproducibility error (RE) of DERA measurements of periprosthetic bone around a non-cemented «Spotorno» stem on an in vitro model, and basing on these data to suggest an examination algorhythm allowing its minimization to clinically negligible values. The main factors influencing method RE are: patients' incorrect positioning and RE of the apparatus-programming unit. In cases of femoral bone rotation within the limits of +50 the greatest PBMD deviations amount to 5.1-8.8%. The maximal reproducibility error of the apparatus-programming DERA unit is found in Gruen area 7, amounting to 6.5%. With the help of computer modeling an algorhythm has been found, which allows to minimize the apparatus-programming unit RE to clinically negligible values.

The authors conducted a comparative analysis of dual energy X-ray absorptiometry, histomorphometry and radiogrammetry to assess the quality of bone and to identify possible correlations between them. Selected group of 40 patients with femoral neck fractures. Femoral head removed during the operation sent to histomorphometry, then do densitometry of proximal femur and the evaluation of the quality of bone radiogrammetry method to conventional X-ray proximal femur in the front-rear projection. The high degree of correlation method radiogrammetry with methods histomorphometry and dual energy X-ray absorptiometry, which allows you to use this method to evaluate the quality of bone in patients with neck fractures in the acute period of trauma.

The authors describe two cases of radical correction scoliosis complicated with syringomyelia. Stages of spinal operative treatment without using neurosurgical methods of central nervous system decompression are expounded.

A new internal fixator for osteosynthesis of periprithetic femoral fractures after hip replacement is described. This new plate is simple, reliable and AO-ASIF compatible metal implant designed for fractures around or below the stable endoprothetic stem i.e. for В1 and C types according the Vancouver classification by C.P. Duncan and B.A. Marsi. The periprothetic plate allows to fix these types of fracture more rigidly than other internal fixators and thus improve final functional results.

Разработан и внедрен в клинику оригинальный способ хирургической декомпрессии тениоперониального канала при посттравматических туннельных синдромах, вызванных неправильно сросшимися переломами пяточной кости. Характерной особенностью предложенного способа является поднадкостничая резекция латеральной стенки пяточной кости, которая позволяет увеличить объем канала и оптимизировать скольжение сухожилий малоберцовых мышц.

The authors present the literature review, devoted to a problem of reconstruction of osteomyelitic foot defects. In spite of the revealed tendencies, the necessity of some questions adjustment, connected with use of local plastic resources still remains.

Pathological fractures are leading complication of tumors and tumor-like diseases of bones. Principles of treatment of pathological fractures have the features. The comparative analysis of surgical methods for stabilization of pathological fractures is perfomed, optimum tactics of treatment depending on the localization, specific properties of the amazed bone and involving adjacent the soft tissue structures is certain. Operative treatment of pathological fractures on a background of malignant processes at lesion of the articulate end assumes replacement, and at lesion diaphysis of long bones - a segmentary resection with application of osteal cement or plastics and fixing metal designs. At pathological fractures on a background of good-quality tumors and tumor-like lesions it is necessary to adhere to active surgical tactics and to carry out a resection of a bone in a combination to an osteosynthesis in the first days after its occurrence.