NEW IN THE PATELLA FRACTURES TREATMENT

In the literature there is a gap of publications about patella fractures management which is due to the absence of serious attention to the injuries of this largest sesamoid bone. In addition, in the world literature there is a lack of monographs and toolkits for the treatment of patients with these injuries, furthermore, in textbooks and traumatology manuals there are only a few template recommendations to the tactics of treating patients with this trauma. Meanwhile, patella fractures represent approximately 0.5-1.5% of all fractures, delayed union, formation of a false joint, and the emergence of patellofemoral arthrosis after these fractures is not uncommon. In the scientific literature on traumatology there is no unified, all-recognized classification of these fractures, which hinders the development of a single algorithm for the treatment of patients with patellar fractures. There are no contradictory views to the treatment of patella fractures without displacement; however, in relation to the treatment of patients with complex patella fractures, there are divergent views between the fracture fragments preservation to partial or even total patellectomy. In connection with the foregoing, We considered the issue of treating patients with patella fractures topical. Based on a thorough analysis of treatment results of 113 patients we provided a working classification based on the number of patellar fracture fragments (two-fragmentary, three-fragmentary, four-fragmentary, multi-fragmentary, upper and lower pole fractures). Based on this classification, traditional, modified and new methods of treating patients with patellar fractures were used. This is described in more detail in the forthcoming article

Experimental study of the strength characteristics of fixation of the symphysis pubis with an original plate for the reconstruction of the anterior pelvic semi-ring

The destabilization of bone fixators has led to repeated surgical interventions that increased the risk of migrations of metal fixators, infectious and inflammatory complications as well. The modern trends in hip bone injury surgery are related to developing and using of metal fixators, which are effective in acute injury; however, sometimes the condition of the patient and the technical support of hospitals don’t allow performing surgery in the acute period, and these metal fixators are ineffective for chronic damage. Consequently, until now, the problem of finding the optimal design of structures for fixing chronic damage of anterior pelvic semi-ring which will be able to exclude its destabilization, is still of current interest.The purpose of the study: developing and experimental researching of durable features of original plate for reconstruction of the anterior pelvic semi-ring.Materials and methods: In order to ensure stable fixation of chronic pelvic injuries, the original metal plates have been worked out. They are made individually in accordance with the anatomical and functional structures of the anterior pelvic semi-ring of the patient with using additive technologies. The study of the reliability of the different variants of ostiosynthesis of the anterior pelvic semi-ring with using well-known pelvic plates and a new original design was carried out. Stability tests for different plate fixing methods and mechanical strength of metallophyxators were carried out on a universal test machine of LFM-50kN series.Results: one plate fixation in tensile test showed the lowest result – 0.341 kN, a low result of shear loads was received with the same object. The best result was shown by the polyaxial monolithic plate fixation in case of stretching – 0.51 kN at the shear loads – 0.591 kN. Necessary force applied to destabilizing of the metal structure while using a polyaxial monolithic plate was a half-higher than stretched, and a third higher than at shear loads, it demonstrates the benefits of using these metal fixators.Conclusion: It is experimentally confirmed that the polyaxial monolithic plate provides the highest stability of fixing anterior pelvic semi-ring indicator in contrast with fixing of one or two plates

Innovative technologies in pelvic fractures management

The article is based on our clinical experience and modern tendencies of development of minimally invasive surgery. It contains analysis of percutaneus osteosynthesis of pelvic fractures with various metal fixation devices. We analyzed 74 cases of pelvic fractures in which minimally invasive osteosynthesis was used. The patients underwent operative treatment with cannulated screws and new metal fixation devices - CITO screws. The innovative technology showed its high clinical efficiency, its advantages and weak points were analyzed. The majority of pelvic ring injuries are life-threatening and are often accompanied by fractures of other parts of the skeleton and injuries of internal organs. High quality operative treatment of pelvic fractures is often limited by severe general condition of patients and the necessity of simultaneous operative treatment of internal organs and injured parts of musculoskeletal system. Thus, on the one hand, it is necessary to provide high quality fixation of pelvic bone fragments, on the other hand, it is important to reduce surgical aggression during osteosynthesis. The most serious conditions are pelvic ring fractures associated with acetabular fractures, when there is need for intracapsular acetabular fracture stabilization for successful pelvic functional recovery. Acetabular fractures still remain one of the most crucial issues of modern traumathology. Disability, low life quality, hip arthroplasty are the main sequences of inadequate treatment of such fractures. Conservative treatment results in disability in 22-66.7% cases, that is 3 times more frequent compared to the level of disability after operative treatment (1, 2, 3). Only operative treatment makes it possible to achieve successful longtime functional recovery (4). Open reduction with internal fixation is associated with large surgical incision, massive intraoperative blood loss and high risk of infectious complications. The main recognized condition for bone fracture consolidation is intact blood supply of fragments, that is provided only by minimal surgical invasion (5, 6, 7, 8). Thus, development and implementation of implants and minimally invasive methods of bone fragments stabilization are main innovative tendencies of internal osteosynthesis development. The aim of our research was to develop minimally invasive osteosynthesis technologies and to invent a new metal fixation device

Сопроводительная терапия при хирургическом лечении патологических переломов длинных костей и застарелых переломов вертельной области

The article presents a study of palliative surgical treatment of patients with pathological fractures of the long bones and chronic trochanteric fractures. Those patients are not indicated for special oncological treatment. Therefore, the article does not provide staging of malignant neoplasms. The surgical treatment was aimed at improving the quality of life of palliative patients, and accompanying therapy in the form of the Altaicae extract adaptogen and the neutral anolyte led in our study to an increase in the effectiveness of surgical treatment of such a severe contingent of patients.INTRODUCTION According to domestic and foreign literature, the number of oncological diseases in young and old people is growing. There is a trend to neglecting the disease and late visits to doctors. Almost all types of cancer of various localization and other malignant tumors metastasize to the bones. An increase in the number of pathological (metastatic) fractures of the trochanteric region and the long bones was also noted. Surgical treatment of patients with such a severe type of fractures leads to an aggravation of the already existing immunodeficiency and, as a rule, creates the prerequisites for the occurrence of infectious complications in the postoperative period. The choice of a conservative method of treatment often does not justify itself as well, it leads to diagnostic and therapeutic errors, and in the future — to chronic pathological fractures.AIM To improve the effectiveness of surgical treatment and the quality of life of palliative patients with pathological (metastatic) fractures of the long bones and chronic trochanteric fractures using original authors’ accompanying therapy.MATERIAL AND METHODS 177 patients were examined and divided into two groups the main and the control groups. 72 patients were included in the main group, and 105 patients in the control group. There were 110 men and 67 women. The patient age ranged from 35 to 90 years. The main group received surgical treatment with the use of new accompanying therapy along with the basic one, and the control group received only surgical treatment and basic therapy.RESULTS In the main group patients with chronic pathological fractures of the trochanteric region, who underwent endoprosthetic replacement, osteosynthesis, a new method of surgical treatment of metastatic fractures of the long bones and the authors’ accompanying therapy, the effectiveness of surgical treatment increased significantly compared to the comparison group. As a result, most of the unwanted symptoms disappeared, time spent in hospital decreased, the psychoemotional status and immunity improved, the functional state of the body was optimized, and the quality of life improved.CONCLUSION The use of new accompanying therapy, the authors’ method of surgical treatment of patients with pathological (metastatic) fractures of the long bones, chronic fractures of the trochanteric region allows us to successfully and effectively operate on such severe patients and perform a fast track surgery program in the early postoperative period.В статье представлено исследование хирургического лечения паллиативных пациентов с патологическими переломами длинных костей и застарелых переломов вертельной области бедренной кости. Названным пациентам специальное онкологическое лечение не показано. Поэтому в статье не приводится стадирование злокачественных новообразований. Выполнение оперативного лечения было направлено на улучшение качества жизни паллиативных пациентов, а сопроводительная терапия в виде адаптогена экстракта Алтайского и антисептика анолита нейтрального привела в нашем исследовании к повышению эффективности хирургического лечения такого тяжелого контингента больных.ВВЕДЕНИЕ По данным отечественной и зарубежной литературы растет число онкологических заболеваний у лиц молодого и пожилого возраста. Наблюдается тенденция запущенности заболевания и позднего обращения к врачам. Практически все виды рака различной локализации и другие злокачественные опухоли дают метастазы в кости. Также отмечен рост числа патологических (метастатических) переломов вертельной области и длинных костей. Хирургическое лечение пациентов с таким тяжелым видом переломов приводит к усугублению уже имеющегося иммунодефицита и, как правило, создает предпосылки для возникновения инфекционных осложнений в послеоперационном периоде. Выбор консервативного метода лечения также зачастую не оправдывает себя, он приводит к диагностическим и лечебным ошибкам, а в дальнейшем — к застарелым патологическим переломам.ЦЕЛЬ Повысить эффективность хирургического лечения и качество жизни паллиативных пациентов с патологическими (метастатическими) переломами длинных костей и застарелыми переломами вертельной области с применением оригинальной авторской сопроводительной терапии.МАТЕРИАЛ И МЕТОДЫ Были обследованы 177 больных, которых разделили на две группы — основную и группу сравнения. В основную группу были включены 72 пациента, а в группу сравнения — 105. Мужчин было 110, женщин — 67. Возраст пациентов — от 35 до 90 лет. Основная группа получала хирургическое лечение с применением новой сопроводительной терапии наряду с базисной, а группа сравнения — только хирургическое лечение и базисную терапию.РЕЗУЛЬТАТЫ У пациентов основной группы с застарелыми патологическими переломами вертельной области с применением эндопротезирования, остеосинтеза, новой методики хирургического лечения метастатических переломов длинных костей и авторской сопроводительной терапии эффективность оперативного лечения значительно увеличилась по сравнению с группой сравнения. В результате ушло большинство нежелательных симптомов, уменьшилось время пребывания в стационаре, улучшился психоэмоциональный статус, иммунитет, оптимизировалось функциональное состояние организма и повысилось качество жизни.ЗАКЛЮЧЕНИЕ Использование новой сопроводительной терапии, авторской методики хирургического лечения пациентов с патологическими (метастатическими) переломами длинных костей, застарелыми переломами вертельной области позволяет успешно и эффективно оперировать подобных тяжелых больных и выполнить программу быстрого восстановления (fast track surgery) в раннем послеоперационном периоде

Organic chemistry. History and mutual relations of universities of Russia

© 2017, Pleiades Publishing, Ltd. The review describes the history of development of organic chemistry in higher schools of Russia over a period of 170 years, since the emergence of organic chemistry in our country till now

Current treatment options for patients with fractures of femoral neck

The article presents the tactics of treatment of elderly patients with fractures of the femoral neck. Depending on the nature of the fracture, the period from the date of injury presented by the selection of a method of surgical treatment of fractures of the proximal femur.with biomechanically favorable fractures of the femoral neck Pauwels type I-II with displacement of fragments of type Garden II-III up to 3 days after the injury we have produced a minimally invasive percutaneous osteosynthesis beam V-shaped spokes or AO cannulated screws.If after an injury took place over 3 days in patients older than 60 years at subcapital fractures type III of Pauwels, Garden IV of, patients produce primary hip arthroplasty. The article also describes the experience of doing pereoperatsionnogo elderly patients with femoral neck fractures in the preoperative and postoperative phases

Treatment of Pelvic Ring Injury with 3D Printed Patient-Specific Implant: Case Report

Rationale. The development of 3D printing technology allows the manufacture of individual implants to treat the patients with diseases and consequences of musculoskeletal system injuries. However, the use of additive technologies in the patients with multiple trauma in the acute period is limited. The purpose of study was to demonstrate the possibility of using individual implants for the definitive fixation of the anterior pelvic ring in a patient with multiple trauma.Patient concerns. A 22-year-old patient was admitted after an injury as a result of a fall from the 5th floor. The treatment was carried out in accordance with the ATLS protocol. Diagnosis: multiple trauma; closed chest, pelvis and limbs injuries; fracture of the left 2nd to 5th ribs; pelvic bones fracture AO/ OTA: 61-C1.3a; fracture of both bones of the left lower leg AO/OTA: 42-B3b; 2nd degree shock.Interventions. An emergency external fixation of the pelvis and lower leg bones was performed. An individual implant for pubic bone fixation was made using 3D printing. On the 8th day, the definitive fixation of the pelvic and left lower leg bones was performed. The patient is activated on the 1st day after the surgery.Outcomes. The early postoperative period was uneventful. The functional result on the Majeed scale in 6 months by remote filling out the questionnaire was 84 points. Lessons. The custom-made implants make it possible the successful fixation of the anterior pelvic ring. The use of 3D printing technologies for the osteosynthesis of pelvic fractures is promising, although requires further study