Organizing high-technology medicine in traumatology and orthopedics

The article reviews in details regulating documents of Ministry of Public Health of Russian Federation, Russian Academy of Medical Sciences, resolutions of the Government of Russian Federation concerning providing high-technology medicine in traumatology and. orthopedics and. prospects of development of organizational problems on the realizing of high-technology medicine. High-technology medicine is the complex of treatment and. diagnostics medical services, that are realized in hospital conditions with use of complex and. (or) unique resource-demanding medical technologies. Hightechnology medicine is provided under the standards of medical aid approved by the orders of Ministry of Public Health of Russian Federation for federal special-purpose medical institutions providing high-technology medicine and is financed by federal budget. Selection of patients and their referral to the Commission of the subject of Russian Federation is realized by Medical commissions of medical organizations where patients are treated and observed after recommendations of doctor in charge on the basis of the excerpt from medical documentation of the patients. In 2013—2014 development of the further problems on the providing of high-technology medicine is planned: optimization of kinds of high-technology medicine, development of innovative technologies, training of the personnel, licensing of medical organization taking into account providing kinds of high-technology medicine, development of information-analytical system of high-technology medicine, united choice of medical organization. for providing high-technology medicine by the doctor and. the patient. In 2015—2020 the transfer of high-technology kinds of medicine in the system of compulsory medical insurance is planned. 55 billions rubles a year are needed for the development of resource-demanding technologies including transplantation, complex kinds of prosthetics, robotized and innovative technologies. Organization, in federal state institutions special bed funds providing permanent innovative development of medical aid. is prognosed

Remote results of treatment of patients with Monteggia injuries by transosseous osteosynthesis

The research is based on the analysis of treatment of 30 patients (during 2002-2010 years) with. Monteggia injuries by transosseous osteosynthesis. The aim. of the work was to show opportunities of transosseous osteosynthesis as mini-invasive method that allows to restore anatomical structures of injured segment by closed method. Separate fixation of radial and ulnar bones used in the work allowed to remove fixator from the radial bone without losing rigidity of fixation of ulnar bone and. to provide the opportunity of earlier development of rotation. At the estimation of effectiveness of treatment we considered functional activity of injured upper extremity in addition to the result of clinical and. radiologic examination of the patient. The accent was made on the typical mistakes at the treatment of these patients. Study of outcomes of treatment showed that 13 patients (86,6 %) had. usual degree of social integration in 6 months, 2 patients (13,4 %) had. slight limitations of social life. In a year all patients were considered socially integrated

Our First experience of Using Biodegradable Implants in Latarjet – Bristow Surgical Procedure at Chronic Posttraumatic Anterior Shoulder Insta

Background. Multi-layer spiral computed tomography shows that the main cause of shoulder instability is glenoid cavity bone defect. The aim of our research was to assess the effectiveness and safety of biodegradable implants in the treatment of patients with chronic posttraumatic anterior shoulder instability under conditions of bone defect of glenoid cavity margin by the restoration of anatomic shape and structure of scapula articular surface.Materials and methods. We performed a pilot study based on the results of surgical treatment of 7 patients using 4.5 mm biodegradable compressing screws. In preoperative period, all patients had standard two-dimensional X-rays and MSCT with 3D-reconstruction. In postoperative period, all patients had check-up X-ray right after the surgery and MRI in 3 months after the surgery.Results. The results of the treatment were assessed by common clinical criteria, functional criteria, X-ray evidence and intraand postoperative complications. We registered strong functioning of an arm and an increase in the range of motions. Data from Rowe/Zarins and DASH questionnaires showed that the patients totally recovered. X-ray evidence showed consolidation of non-free autograft to the zone of scapula bone defect without osteolysis or widening of a drilled hole. We did not observe either a failure of union, or any formation of false joint, or any screw fractures in bone tissue. Beyond that, we did not observe any complication in postoperative period and early postoperative complications in particular.Conclusion. Pilot study with use of modern biodegradable implants in osteoplastic stabilization of shoulder joint at recurring instability showed their effectiveness and safety in patients of young and active working age. However, considering small number of patients in pilot study we cannot extrapolate our results to all similar and analogue cases of using biodegradable implants. In this regard, it is necessary to perform major multicenter clinical randomized study for further long-term observation and detection of possible unwanted side effects

Clinical use of Ortho-SUV transosseous hexapod in treatment of lower limb false joints

We studied the use of Ortho-SUV hexapod in the treatment of 15 patients with lower limb false joints. All patients were at active working age - from 22 to 50 years. 1n 12 patients, the period from the moment of trauma was 1 to 3 years, in 3 patients - 3 to 6 years. 5 patients had femoral false joints, 10 patients - shin false joints. 1n 98 % of cases, the formation of false joints was caused by inadequate treatment of initial trauma. 1n 100 % of cases, false joint localized at diaphyseal level and was accompanied with shortening of injured segment for 2.5 ± 1.0 cm in 13 patients, and for 0.5 and 0.8 cm in 2 cases. We also registered recurvatum and valgus deformity in 5 patients, recurvatum and varus deformity in 8 patients, and antecurvatum and varus deformity in 2 patients. Combined contracture in knee and ankle joint was found in 90 % of patients. Using combined transosseous osteosynthesis along with Ortho-SUV hexapod allowed us to correct hip deformity for 35 ± 10 days and ankle deformity - for 20 ± 5 days on the average. When shortening of femoral bone for more than 5.0 cm, the deformity was corrected in two stages. At the first stage, we reconstructed the length of a segment using methods of transosseous osteosynthesis at discrete-continuum distraction. At the second stage, we corrected deformity using Ortho-SUV hexapod within specified time limits. Duration of femoral and shin false joint consolidation was 194 ± 16 days. We registered inflammatory complications in the areas of transosseous elements contacting soft tissues in 3 (0.2 %) patients. These complications didn't have an effect on the treatment results

EXPERIENCE IN THE TREATMENT OF THE FALSE JOINT OF THE DIAPHYSIS OF THE RADIAL BONE COMBINED WITH A MAJOR DEFECT IN THE ULNAR DIAPHYSIS (CASE FROM PRACTICE)

This article presents the experience of surgical treatment of rare pathology of the upper limb – pseudoarthrosis of the middle third of the diaphysis of the radius, defect pseudoarthrosis of the upper and middle third of the ulnar diaphysis. The definition and compilation of an accurate model and treatment tactics are critical to restoring the anatomy and function of the injured upper limb. The rarity of this case was the size of the ulna defect, which was up to 4.0 cm, the scarring and cicatricial changes in the soft tissues and muscles of the right forearm, due to the severity of the injury and the multitude of surgical interventions on the right forearm. The chosen treatment tactics consisted of several successive stages: resection of the zone of false joint of the right radial bone, combined transosseous osteosynthesis of the right radius bone, resection of the false elbow joint of the right ulna with replacement of the defect with autograft from the lower third of the fibula, combined strained osteosynthesis and transosseous osteosynthesis by external fixation apparatus with rod configuration of the right ulna. The results of surgical treatment of false joints depend on the determination of the correct indications for a certain type of surgical intervention and the competent implementation of the planned treatment plan. The chosen treatment tactics allowed us to successfully restore the anatomy and function of the damaged segment, thus rehabilitating the patient

Old laceration of deltoid muscle (case report)

Traumatic isolated injury of deltoid muscle is a rare nosological orthopedic injury that occurs in 1,3 % of all shoulder joint injuries. In normal state function of shoulder joint is provided by deltoid muscle up to 50 % of capacity in scapular area. Degree of abolition of function of shoulder joint depends on the degree of deltoid muscle injury. Differential diagnosis is necessary to conduct with other traumatic injuries accompanied with such upper limb dysfunctions as chronic posterior humerus head dislocation, injury of rotatory cuff tendon, chronic complete or partial disorder of deltoid muscle integrity. The article contains clinical case of diagnostics and surgical treatment of the patient with isolated old deltoid muscle injury of more than 2 years accompanied with combined contracture of shoulder joint. Check-up examination in 6 months after the operation showed full restoration of a function of upper limb and no complaints. Results of control MRT examination of shoulder joint in 11 months after the operation showed full adhesion of tendomuscular autograft with acromial process of scapula

Using Combined Osteosynthesis in Trauma Practice in the Treatment of Diaphyseal Forearm Injuries

The article presents the experience of surgical treatment of a rare pathology of the upper limb – the pseudarthrosis of the middle third of the radial shaft with a bone defect in combination with the pseudarthrosis of the middle and lower third of the shaft of the ulna of the forearm. Determination of reasonable and well-considered treatment tactics is of great importance in the treatment of patients aimed at restoring the anatomy and function of the injured upper limb. A feature of this case is the formation of several false joints at different levels of the forearm bones, the presence of a bone defect of 2.5 cm, which required its replacement with an autograft, and a previously performed surgical intervention using transosseous osteosynthesis. The applied tactics of surgical treatment consisted of several stages: bone osteosynthesis of the ulna with opening of the medullary canals of the ulna; replacement of a bone defect in the area of the pseudarthrosis of the radius with an autograft from the iliac crest using combined stress osteosynthesis in combination with transosseous osteosynthesis. The results of surgical treatment of false joints and bone defects depend on the correct treatment tactics, according to the indications, and the correct implementation of the selected treatment tactics. The surgical tactics of treatment used in this clinical situation made it possible to create conditions for the fusion of fragments of the radius and ulna  bones, as well as to replace the defect of the radius, as a result of which the anatomy and function of the damaged segment were successfully restored

DYNAMICS OF PERIPHERAL BLOOD CIRCULATION IN TREATMENT OF RADIAL BONE FRACTURES WITH THE METHOD OF PEROSSEOUS OSTEOSYNTHESIS

To study the parameters of peripheral blood circulation of upper extremity in patients with fractures of radial bone at perosseous osteosynthesis we studied the group of patients with fractures externally fixed by apparatus with pin arrangement and the group of patients treated by apparatus of rod arrangement. Rheovasographic examination of upper extremities was performed before the surgery, the day after it, on the 7th, 14th and 21st day after the surgery. In all patients during preoperational period we revealed disturbances of blood circulation in distal parts of upper extremities of angiospastic type giving evidence of sympathicotonia. Having analized the results of clinical and rheovasographic researches in established terms of observation we were able to mark gradual improvement of arterial and venous blood flow in forearm in examined groups. In the group with rod fixation positive dynamics occurred 5-7 days earlier than in the group with pin fixation. Original method was applied, consisting in rod fixation of apparatus of external fixation. Evaluation of clinical parameters marks good results in 97 % of cases. In early postoperative period improvement of rheovasographic parameters has been marked, which says about increased blood perfusion in tissues and about normalized vessel tone

ADVANTAGES OF ROD EXTERNAL FIXATION AT DIAPHYSEAL FRACTURES OF FOREARM BONES ACCORDING TO THE DATA OF RHEOVASOGRAPHY

The authors present the result of the research of peripheral blood flow of upper extremity in patients with diaphyseal fractures of forearm bones at transosseous osteosynthesis by external fixation devices of different set. Significant difference between rheographic indices and the set of external fixation device: greater effectiveness of transosseous osteosynthesis by rod external fixation devices with saving of moves in joints interfacing with injured segments was determined

New Method of Surgical Treatment of Patients with a Fracture of the Proximal Humerus on the Background of Critical Osteoporosis

Fractures associated with osteoporosis, due to the high prevalence and high percentage of related complications, are a serious problem for modern traumatology and orthopedics. Among all injuries of the upper extremities, fractures in the proximal humerus occur in 32-65 % of cases. Fractures of the proximal humerus account for 4-5 % of all fractures and 50 % of fractures of the humerus. The aim of the research was to develop a new method for the surgical treatment of fractures of the proximal humerus against the background of osteoporosis and to evaluate the clinical effectiveness of the new method. A pilot study was conducted to evaluate the clinical efficacy and safety of surgical treatment of patients with a fracture of the proximal humerus. The results showed that the new "Method for the surgical treatment of patients with a fracture of the proximal humerus" is clinically effective and safe. Additional intramedullary bone stabilization of the proximal humerus with a fibular autograft allows for more rigid and stable fixation of fragments, especially in the presence of critical osteoporosis. The early restoration of passive and active movements in the shoulder joint made it possible to fully restore the function of the limb in a severe fracture of the proximal section