СРАВНИТЕЛЬНЫЙ АНАЛИЗ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ НЕСТАБИЛЬНЫХ ПЕРЕЛОМОВ КЛЮЧИЦЫ

Introduction. Study of different treatments effectiveness of these injuries allows to distinguish the rational side of medical factors, which directly reflect the key pathogenetic mechanisms. A substantial portion of the currently used methods of clavicle fractures surgical treatment allow one to achieve rapid recovery of structural and functional patterns of the patient in most cases.The purpose of the study is to improve the results of surgical treatment of patients with fractures of the clavicle in the middle third. Material and methods. The study included 104 patients with fractures of the clavicle in the middle third.In the main group (48 patients) the clavicle lockable rod of the original design was used for osteosynthesis, in the comparison group (56 patients) plate osteosynthesis was performed.Results and discussion. The proposed technology of operative treatment of clavicle fractures in the middle third using the original hip compression-locking rod must improve the results of treatment in this group of patients. The developed algorithm of diagnostics, treatment and rehabilitation of patients with clavicle fractures allows to improve the results of treatment, provides domestic and social reintegratie patients. Conclusion. Analysis of the clinical studies results have revealed a reliable advantage of the results on a scale DASH and a lower frequency of complications in the main group (p<0.05).Введение. Изучение эффективности различных способов лечения данных повреждений позволяет выделить рациональные стороны лечебных факторов, что прямо отражает ключевые патогенетические механизмы. При этом значительная часть используемых в настоящее время методик оперативного лечения переломов ключицы позволяют достичь быстрого восстановления структурно-функциональных стереотипов пациента в большинстве случаев. Цель исследования: улучшение результатов хирургического лечения пациентов с переломами ключицы в средней трети.Материал и методы. В исследование вошли 104 пациента с переломами ключицы в средней трети. В основной группе (48 пациентов) для остеосинтеза ключицы использовался блокируемый стержень оригинальной конструкции, в группе сравнения (56 пациентов) проводился накостный остеосинтез. Оценка результатов проводилась по шкале DASH через 3, 6 и 12 месяцев после остеосинтеза. Результаты и их обсуждение. Предложенная технология оперативного лечения переломов ключицы в средней трети с использованием оригинального компрессирующего блокируемого стержня повысила результативность лечения данной группы пациентов. Разработанный алгоритм диагностики, лечения и реабилитации пострадавших с переломами ключицы позволяет улучшить результаты лечения, обеспечивает бытовую и социальную реинтеграцию пациентов.Заключение. Анализ результатов клинического исследования выявил достоверное преимущество результатов по шкале DASH и меньшую частоту осложнений в основной группе (p<0,05)

COMPARATIVE ANALYSIS OF SURGICAL TREATMENT OF UNSTABLE FRACTURES OF THE CLAVICLE

Introduction. Study of different treatments effectiveness of these injuries allows to distinguish the rational side of medical factors, which directly reflect the key pathogenetic mechanisms. A substantial portion of the currently used methods of clavicle fractures surgical treatment allow one to achieve rapid recovery of structural and functional patterns of the patient in most cases.The purpose of the study is to improve the results of surgical treatment of patients with fractures of the clavicle in the middle third. Material and methods. The study included 104 patients with fractures of the clavicle in the middle third.In the main group (48 patients) the clavicle lockable rod of the original design was used for osteosynthesis, in the comparison group (56 patients) plate osteosynthesis was performed.Results and discussion. The proposed technology of operative treatment of clavicle fractures in the middle third using the original hip compression-locking rod must improve the results of treatment in this group of patients. The developed algorithm of diagnostics, treatment and rehabilitation of patients with clavicle fractures allows to improve the results of treatment, provides domestic and social reintegratie patients. Conclusion. Analysis of the clinical studies results have revealed a reliable advantage of the results on a scale DASH and a lower frequency of complications in the main group (p<0.05)

Bilateral reconstruction of palmar soft tissues defects of the hands after thermal injury

Introduction Thermal injury to the palmar surface of the hand is usually complicated by flexion desmogenic contracture of the finger joints. This condition is more complicated with significant wound areas and depths of soft tissue destruction. Conventional surgical methods and soft tissue reconstructions may fail to provide full restoration of the hand function. The objective was to present the optimal treatment strategy for patients with scar flexion contractures of the fingers after thermal injury to the palmar surface of both hands using a pediatric case report. Material and methods A child aged 2 years and 4 months underwent surgical treatment to include excision of scars, skin grafting of both hands with a vascularized fasciocutaneous flap raised with the radial artery. Result The patient could regain all types of hand grip on both sides 12 years after surgical treatment. Both hands were aesthetically acceptable. Discussion Treatment of patients with thermal injury and substantial soft tissue damage is a complex disease process. Conservative treatment and surgical procedures using non-vascularized skin flaps are normally used for the condition. These approaches are associated with cicatricial and arthrogenic flexion contracture of the finger joints. The radical treatment includes thorough wound debridement and early flap coverage and wound closure using a flap with an axial-pattern blood supply, free flaps and reverse-flow flaps. The surgical approach helps to avoid flexion contracture of the fingers initiating early restoration of professional, social stereotypes and stereotypes in everyday life. Conclusion The clinical observation has shown the possibility of one-stage organ-preserving surgical treatment using flaps with an axial blood supply