Combined Transosseous Osteosynthesis of Fracture of Humerus Diaphysis in Case of Reparative Process Disorder (Clinical Observation)

The treatment of the consequences of diaphyseal fractures of the humerus, despite the emergence of modern effective methods of internal osteosynthesis, has not lost its relevance. Transosseous osteosynthesis remains the method of choice in the treatment of pseudoarthrosis and delayed consolidating fractures of the humerus. The experience we have accumulated in the use of external fixation devices in the treatment of fractures, based on the use of the method of unified designation of transosseous osteosynthesis, made it possible to systematize and describe the surgical technique of combined transosseous osteosynthesis in the treatment of fractures of the humerus diaphysis with impaired reparative processes in combination with longitudinal corticotomy of the  pseudarthrosis zone, and evaluate its effectiveness. The article presents a case of successful surgical treatment of a patient with a pseudarthrosis of the humerus diaphysis by the method of combined transosseous osteosynthesis in combination with longitudinal corticotomy of the pseudarthrosis zone. A description of the technique of transosseous osteosynthesis is given. The presented clinical case shows that the use of combined transosseous osteosynthesis, taking into account the method of unified designation of transosseous osteosynthesis, makes it  possible not only to determine the optimal arrangement of the apparatus and the positions of the transosseous elements, but also to use this method to determine the optimal area for performing longitudinal corticotomy

THE THERAPEUTIC TACTICS OF INTRA-ARTICULAR FRACTURES OF THE ANKLE (LITERATURE REVIEW)

As a result of the analysis of literature it was revealed that in case of pronation-abduction ankle injury takes place injury of the articular surfaces. The hyaline cartilage significantly suffers. Typical localization of damage of the articular cartilage is the middle or front third of the inner edge of talus block. The damage can spread to articular surface of the outer block of the talus. In 50 % cases the articular cartilage is the front edge of the tibia is damaged. The combination of damages of the articular cartilage of the inner edge of the block of the talus and the outside the department anterior edge of the tibia is more often (from 43 % till 57 %). In 80 % cases the damage of the articular cartilage surface of the talus ankle as roughness, cracks, defects with exposure of subchondral bone was revealed. The results say that in case of damage bony and ligamentous structures of the ankle at the joint pronation-abduction mechanism the articular cartilage significantly suffers. The size and character of the damages of the articular cartilage differs. i4s a result we can say that initially severe damage of the articular cartilage at trauma will significantly worsen the immediate and long-term results and this fact should be taken into account while making plan of the treatment of patients with ankle injury

Using an Autograft from the Fibula Diaphysis in the Surgical Treatment of Patients with Fractures of the Proximal Humerus on the Background of Critical Osteoporosis

The frequency of unsatisfactory results of surgical treatment of patients with a fracture of the proximal humerus remains high and is up to 40 %. This is primarily due to the early instability of the metal structure against the background of osteoporosis and as a consequence of non-fusion of the fracture and the formation  of a false joint. The aim of the study was to evaluate the effectiveness and safety of a new surgical method for treating patients with a fracture of the proximal humerus against the background of critical osteoporosis. After the approval of the local ethics Committee, 2 groups of 10 patients were formed in the clinic: the patients of  main group were operated by the proposed method; the group of clinical comparison was operated by the standard method. In all clinical cases, fractures of the proximal humerus were consolidated on control radiographs. VAS assessment the pain syndrome in the early postoperative period showed that there were no  statistically significant differences in the shoulder joint area in the groups. Three months after surgery, when assessing the volume of movement in the shoulder joint (without the participation of the scapula), there was a statistically significant improvement in the main group: abduction – by 35° and external  rotation – by 25° (p<0.05). When assessing the range of motion of the operated shoulder joint using the ASES scale, a  statistically significant improvement was observed in the main group by 11.6 points after 3 months after  surgery. According to the assessment of the patient›s functional recovery according to the DASH scale, the indicators in the main group were statistically significantly better, which indicates a complete recovery of the shoulder joint function. Thus, the use of the proposed new method, in comparison with other known technologies for surgical treatment of fractures of the proximal humerus, allows achieving a more rigid and stable fixation of bone fragments in the aftermath of trauma and the presence of regional osteoporosis

Historical outline on the treatment of patients with chronic posttraumatic instability of shoulder joint (review of literature)

Systematic analysis of literature concerning treatment of patient with chronic posttraumatic instability of shoulder joint in historical aspect was realized. Main tendencies of development of surgical orthopedics including evolution of both palliative and. reconstructive surgical methods for shoulder joint were revealed. On the basis of more than 50 literature sources we managed to estimate progress of scientific researches from the point of view of evidence-based medicine. By the end of 1980s main directions in correction of described nosology which were determined by the level of device-dependent visualization were formed. Necessity of brand new change in mini-invasive surgery of deep and chronic injuries of shoulder joint structures according to the literary data caused, future creation of a new direction based on advanced extended data of pathogenesis of shoulder joint instability

Comparative Determination of the Mechanical Strength of a Transplant from a Tendon of a Semitendinosus Muscle for Plastic Surgery of the Anterior Cruciate Ligament Prepared in Various Ways (Experimental Study)

According to modern literature, a sufficient number of studies have been carried out to determine the mechanical strength of transplants from the tendon of the semitendinous and gracilis muscles, the autologous ligament of the patella, the broad fascia, peroneus longus tendon, each of which has unique characteristics, but at present, transplants prepared by original (new) methods are understudied.In the period from November 5 to December 17,2018 we conducted an experimental study to determine the mechanical strength of a transplant from a tendon of a semitendinosus muscle taken from cadaveric material. The transplants were prepared by original and well-known (Graft-Link technique) methods.The experimental study was approved by the Ethics committee of Irkutsk Scientific Center of Surgery and Traumatology. The material for the study was prepared on the basis of the Irkutsk Regional Bureau of Forensic Medical Examination.After sampling the cadaveric material being studied, the main stages of the experimental study were carried out at the materials resistance department of the Irkutsk State Technical University. Studies of the mechanical properties of the transplant were carried out on a Shimadzu testing machine registered in the State Register of Measuring Instruments and approved for use in the Russian Federation.As a result of the study, we obtained the following data. The mechanical strength of the graft obtained from the tendon of the semitendinosus muscle in an original way is on average 607.8 ± 101.2 N/mm. The mechanical strength of the graft obtained from the tendon of the semitendinosus muscle in a traditional manner (Graft-Link technique) is on average 351.8 ± 133.0 N/ mm

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

Our experience of surgical treatment of patients with old total injury of rotator cuff tendon

Injury of rotator cuff tendon is a common cause of pain and dysfunction of shoulder joint. The aim. of this study was to evaluate clinical efficiency of surgical treatment of patients with old total rupture of rotator cuff tendon. 63 patients were operated in clinic of Scientific Center of Reconstructive and. Restorative Surgery SB RAMS during 2007—2012. Average age of the patients was 47,6 ±2,1 years. Patients were randomized into two groups of clinical comparison. Patients of the first group had open reinsertion of rotator cuff tendons with transosseous sutures. Patients of the second group had the same procedure with use of an additional metal construction. The observation period differed from 3 months to 5 years (26 ± 5,1 months in average). As the result of the research positive results were in 83,1 % and 82,4 % of cases respectively at the assessment with use of UCLA scale. Reinsertion of full rupture of rotator cuff tendons in spite of risk of trauma of operative treatment is an operation. of choice that gives maximum prospects to the restoration of patients' capability. But analyzed technical defects of known methods caused the creation of a new method of surgical treatment of old injuries of rotator cuff tendon and. the device for its realization

Labour Potential of the Arctic Regions of the European Russia

The work considered the possibilities and directions of evolution of demographic development of the Arctic region, analyzed some characteristics of the labor potential of the population living in the Arctic regions of the European part of Russia.The purpose of the study is to substantiate the possibility of attracting the local population and the need to employment specialists from other regions of Russia for the development of the Arctic.To achieve the goal of the study, general scientifi methods were used — the collection and analysis of data from state statistics and sample surveys. The use of a systematic approach made it possible to comprehensively assess the situation on the territory under study and substantiate the possibilities for its development.Analysis of the quantitative characteristics of the labor potential of the studied regions showed a stable negative dynamics throughout the post-Soviet period. A number of reasons have been identifi  that contribute to the outfl   of population from the Arctic regions, the most important of which are the low standard of living compared to the Russian average, as well as the ineff     functioning of the mechanisms of northern guarantees and compensation. At the same time, the qualitative characteristics of labor potential, in particular, the level of education of the population can be increased due to the existing educational potential of neighboring regions.Conclusions about the need to attract people from the regions of the middle zone of Russia for the Arctic are made

Comparative analysis of the results of the anterior cruciate ligament reconstruction using an autograft preparation by known and new methods

Background. To date, the problem of choosing the optimal graft for anterior cruciate ligament (ACL) reconstruction and the methods for its formation is one of the main trends in the surgical treatment of patients with anterior knee joint instability.The aim. To compare the results of the anterior cruciate ligament reconstruction using the known method and the new proposed method for autograft formation.Materials and methods. The results of treatment of ACL injury in 44 patients were assessed. In the main group (19 patients), an original technique of ACL reconstruction from 1/2 of the width of m. peroneus longus tendon was used. In the control group (25 patients), ACL reconstruction was performed using a graft from the m. semitendinosus tendon prepared by the Lubowitz method.Results. The mean difference in the circumference of the distal third of the hip in the main group was 1.57 ± 1.162 cm and was statistically significantly better than in the control group, where the mean difference in the hip circumference was 4.74 ± 1.7207 cm.The range of motion of the knee joint in the main group 3 months after the surgery was 128.42 ± 9.287°, and in the control group mean flection was 109.6 ± 9.120°.The functional results in the main group were assessed by the Lisholm scale and were statistically significantly better than the results in the control group. The functional results by the AOFAS (American Orthopedic Foot & Ankle Society) scale in the main group were 100 points before the surgery and at all terms after the surgery: this indicates that the use of 1/2 of the width of m. peroneus longus tendon does not cause the its functional impairement.Conclusion. Anterior cruciate ligament plasty with use of 1/2 of the width of m. peroneus longus tendon prepared by the proposed method showed statistically significantly better results compared to the preparation of autograft from semitendinous muscle tendon using known method

THE RESULTS OF SURGICAL TREATMENT OF PATIENTS WITH CHRONIC POSTTRAUMATIC INSTABILITY OF THE SHOULDER JOINT AT SCAPULA BONE DEFECT

1n the clinic of Scientific Center of Reconstructive and Restorative Surgery SB RAMS of Irkutsk the open controlled randomized single-center study for evaluation of clinical efficiency of the surgical method was hold. The analysis of surgery was based on 34 patients with chronic posttraumatic anteromedial instability of the shoulder joint with the defect of the front edge of the blade articular process. The result of the research showed its efficiency in patients of young and working age. While evaluation of functional results by the scale of Rowe-Zarins in three months for 28,8 % and in six months for 16,4 % and by the scale of DASH for 18,5 % in three months after the surgery the better results were achieved (the level of evidence was 11 b) comparing to traditional method of surgery, that let to the patient of the main group much earlier get back to work and going in for sport