НАСЛІДКИ ЛІКУВАННЯ ХВОРИХ З ПЕРЕЛОМАМИ ДОВГИХ КІСТОК З ЗАСТОСУВАННЯМ МАЛОІНВАЗИВНИХ МЕТОДИК ІНТРАМЕДУЛЯРНОГО МЕТАЛОПОЛІМЕРНОГО БЛОКУЮЧОГО ОСТЕОСИНТЕЗА

Improving the effectiveness of treatment in patients with the consequences of diaphyseal fractures of the tibia (improperly fused, unfused fractures, pseudoarthrosis, bone defects) is one of the urgent problems of traumatology, which has not only medical but also important social significance. The aim of the study is to publish clinical experience in the use of closed and semi-open blocking intramedullary metal-polymer osteosynthesis (BIMPO) in the treatment of 125 patients with consequences of diaphyseal long bones fractures. An analysis of the use of closed and semi-open blocking intramedullary metal-polymer osteosynthesis (BIMPO) in 125 patients with fracture consequences (non-fused fractures, pseudoarthrosis), who were operated with the use of 3 and 8 BIMPOF. Long-term results were observed in 103 (88.89%) patients. The consolidation of the fracture in the optimal time was noted in 98 (94.64%) patients. Within 44-90 days from the operation, resistance and limb function were restored. No case of osteomyelitis was observed. This result is rated as good.The use of new generation of intramedullary metal-polymer clamps for the treatment of bone fractures and their consequences has provided a significant reduction in surgical trauma, which optimizes the process of anatomical and functional restoration of the limb.Improving the effectiveness of treatment in patients with the consequences of diaphyseal fractures of the tibia (improperly fused, unfused fractures, pseudoarthrosis, bone defects) is one of the urgent problems of traumatology, which has not only medical but also important social significance. The aim of the study is to publish clinical experience in the use of closed and semi-open blocking intramedullary metal-polymer osteosynthesis (BIMPO) in the treatment of 125 patients with consequences of diaphyseal long bones fractures. An analysis of the use of closed and semi-open blocking intramedullary metal-polymer osteosynthesis (BIMPO) in 125 patients with fracture consequences (non-fused fractures, pseudoarthrosis), who were operated with the use of 3 and 8 BIMPOF. Long-term results were observed in 103 (88.89%) patients. The consolidation of the fracture in the optimal time was noted in 98 (94.64%) patients. Within 44-90 days from the operation, resistance and limb function were restored. No case of osteomyelitis was observed. This result is rated as good.The use of new generation of intramedullary metal-polymer clamps for the treatment of bone fractures and their consequences has provided a significant reduction in surgical trauma, which optimizes the process of anatomical and functional restoration of the limb

РЕАБІЛІТАЦІЯ ПАЦІЄНТІВ ПІСЛЯ ЗАКРИТОГО ОСТЕОСИНТЕЗУ ДІАФІЗАРНИХ ПЕРЕЛОМІВ КІСТОК ГОМІЛКИ

Bone damage in fractures is never isolated and is always accompanied by soft tissue damage, microcirculation and neurotrophic processes. The severity of these disorders depends on a number of factors: the mechanism of injury, type and location of the fracture, the magnitude of the displacement of the fragments, the size of the hematoma in the fracture area.One analyzed the rehabilitation treatment after closed osteosynthesis of the tibia in 53 patients with fractures and their consequences (nonhealing fractures, pseudoarthrosis) that were operated with the use of blocking intramedullary metal polymeric fixation devices BIMPF – 3M and BIMPF – 8. No infectious complication was noted, one patient was characterized by a delayed consolidation of fragments in case of closed BIMPO. The average terms of fragments consolidation with a complete restoration of an operated extremity ranged from 10 to 12 weeks in case of dynamic version of BIMPO and 13 – 15 weeks with a static one.Bone damage in fractures is never isolated and is always accompanied by soft tissue damage, microcirculation and neurotrophic processes. The severity of these disorders depends on a number of factors: the mechanism of injury, type and location of the fracture, the magnitude of the displacement of the fragments, the size of the hematoma in the fracture area.One analyzed the rehabilitation treatment after closed osteosynthesis of the tibia in 53 patients with fractures and their consequences (nonhealing fractures, pseudoarthrosis) that were operated with the use of blocking intramedullary metal polymeric fixation devices BIMPF – 3M and BIMPF – 8. No infectious complication was noted, one patient was characterized by a delayed consolidation of fragments in case of closed BIMPO. The average terms of fragments consolidation with a complete restoration of an operated extremity ranged from 10 to 12 weeks in case of dynamic version of BIMPO and 13 – 15 weeks with a static one

PHYSIOLOGICAL AND REPARATIVE OSTEOGENESIS IN THE NORM AND UNDER CONDITIONS OF SELENIUM DEFICIENCY

The study presents the results of investigation of selenium deficiency condition on the bone tissue and healing post-traumatic bone defects under conditions of selenium deficiency.The experimental part of the study was performed on 63 randomized brand albino male rats of 3-month age. Peculiarities of the reparative osteogenesis were studied on the model of a traumatic injury simulated one-type in the proximal meta-diaphysis of the femoral bone irrespective of the experimental conditions in the frontal plane in the form of perforated defect. The defect was made by means of a drill 1mm in diameter.The results of the study are indicative of a negative effect of selenium deficiency produced on physiological and reparative osteogenesis manifested by inhibition of the process and associated with disorders in the formation of osseous regeneration, deterioration of the structural-functional state of the osseous tissue, development of degenerative-necrotic changes in the osseous tissue and epiphyseal cartilage.The study presents the results of investigation of selenium deficiency condition on the bone tissue and healing post-traumatic bone defects under conditions of selenium deficiency.The experimental part of the study was performed on 63 randomized brand albino male rats of 3-month age. Peculiarities of the reparative osteogenesis were studied on the model of a traumatic injury simulated one-type in the proximal meta-diaphysis of the femoral bone irrespective of the experimental conditions in the frontal plane in the form of perforated defect. The defect was made by means of a drill 1mm in diameter.The results of the study are indicative of a negative effect of selenium deficiency produced on physiological and reparative osteogenesis manifested by inhibition of the process and associated with disorders in the formation of osseous regeneration, deterioration of the structural-functional state of the osseous tissue, development of degenerative-necrotic changes in the osseous tissue and epiphyseal cartilage

SELENIUM IN BIOLOGICAL FLUIDS IN THE BODIES OF PATIENTS WITH ASSOCIATED TRAUMA

Modern literature widely covers the role of selenium and necessity of its intake in case of different diseases, but the studies concerning the dynamics of concentration of this element in patients with injuries of the muscular- skeletal system (MSS) and cranial-cerebral injuries (CCI) are isolated. At the same time, investigation of selenium metabolism in case of injuries of the MSS and CCI and development of the correction schemes are generally known to enable to improve the results of treatment considerably and decrease the consequences of injuries.Objective: to investigate the concentration of selenium in biological fluids in patients with associate trauma.Materials and methods: 42 patients, treated at the Traumatological Department for adults and Neurosurgical Department of the Emergency Rescue Hospital in Chernivtsi, were examined. All the patients were distributed into 3 groups: І group – patients with severe CCI and injuries of the MSS requiring vital activity support; ІІ group – with moderate CCI and injuries of the MSS; ІІІ (control group) – with injuries of MSS only.Results: The data obtained are indicative of decreased selenium concentration in all the biological media of the body (plasma, erythrocytes, urine) during the whole post-traumatic period, both in patients with severe CCI and injuries of the MSS and those with a moderate degree. Conclusions: 1. Pronounced disorders of selenium metabolism are evidenced to occur in patients with severe CCI and MSS injuries, which are manifested by its decreased concentration in all the examined biological media of the body during the whole acute period of injury. 2. The lack of considerable differences in selenium concentration in patients with severe CCI and MSS injuries and with moderate injuries is indicative of non- specificity of the disorders found, since they are a typical pathologic process peculiar for traumatic injury of any genesis and localization. 3. The state of selenium metabolism does not possess correlations with other clinical and biochemical laboratory indices. 4. Selenium deficiency requires administration of pharmacological correction, for example, with Selenase which is essential both in acute and post-traumatic periods.Modern literature widely covers the role of selenium and necessity of its intake in case of different diseases, but the studies concerning the dynamics of concentration of this element in patients with injuries of the muscular- skeletal system (MSS) and cranial-cerebral injuries (CCI) are isolated. At the same time, investigation of selenium metabolism in case of injuries of the MSS and CCI and development of the correction schemes are generally known to enable to improve the results of treatment considerably and decrease the consequences of injuries.Objective: to investigate the concentration of selenium in biological fluids in patients with associate trauma.Materials and methods: 42 patients, treated at the Traumatological Department for adults and Neurosurgical Department of the Emergency Rescue Hospital in Chernivtsi, were examined. All the patients were distributed into 3 groups: І group – patients with severe CCI and injuries of the MSS requiring vital activity support; ІІ group – with moderate CCI and injuries of the MSS; ІІІ (control group) – with injuries of MSS only.Results: The data obtained are indicative of decreased selenium concentration in all the biological media of the body (plasma, erythrocytes, urine) during the whole post-traumatic period, both in patients with severe CCI and injuries of the MSS and those with a moderate degree. Conclusions: 1. Pronounced disorders of selenium metabolism are evidenced to occur in patients with severe CCI and MSS injuries, which are manifested by its decreased concentration in all the examined biological media of the body during the whole acute period of injury. 2. The lack of considerable differences in selenium concentration in patients with severe CCI and MSS injuries and with moderate injuries is indicative of non- specificity of the disorders found, since they are a typical pathologic process peculiar for traumatic injury of any genesis and localization. 3. The state of selenium metabolism does not possess correlations with other clinical and biochemical laboratory indices. 4. Selenium deficiency requires administration of pharmacological correction, for example, with Selenase which is essential both in acute and post-traumatic periods

REPARATIVE OSTEOGENESIS IN NORMAL STATE AND UNDER CONDITIONS OF IODINE DEFICIENCY

The study presents the results of investigation of iodine deficiency condition on the bone tissue and healing post-traumatic bone defects under conditions of iodine deficiency.The experimental part of the study was performed on 63 randomized brand albino male rats of 3-month age. Peculiarities of the reparative osteogenesis were studied on the model of a traumatic injury simulated one-type in the proximal meta-diaphysis of the femoral bone irrespective of the experimental conditions in the frontal plane in the form of perforated defect. The defect was made by means of a drill 1mm in diameter.The results of the study are indicative of a negative effect of iodine deficiency produced on reparative osteogenesis manifested by inhibition of the process and associated with disorders in the formation of osseous regeneration, deterioration of the structural-functional state of the osseous tissue, development of degenerative-necrotic changes in the osseous tissue and epiphyseal cartilage.The study presents the results of investigation of iodine deficiency condition on the bone tissue and healing post-traumatic bone defects under conditions of iodine deficiency.The experimental part of the study was performed on 63 randomized brand albino male rats of 3-month age. Peculiarities of the reparative osteogenesis were studied on the model of a traumatic injury simulated one-type in the proximal meta-diaphysis of the femoral bone irrespective of the experimental conditions in the frontal plane in the form of perforated defect. The defect was made by means of a drill 1mm in diameter.The results of the study are indicative of a negative effect of iodine deficiency produced on reparative osteogenesis manifested by inhibition of the process and associated with disorders in the formation of osseous regeneration, deterioration of the structural-functional state of the osseous tissue, development of degenerative-necrotic changes in the osseous tissue and epiphyseal cartilage

40 YEARS EXPERIENCE OF INTERLOCKING INTRAMEDULLARY METALLIC-POLYMERIC OSTEOSYNTHESIS IN TREATMENT OF 1200 PATIENTS WITH SHAFT FRACTURES

The article comprises the main principles of interlocking intramedullary metallic-polymeric nailing (IIMPN) and the experience of its implementation in 1200 cases of shaft fractures during the period of 40 years. Three generations of metallic-polymeric nails and techniques for closed, semi-closed and open IIMPN were designed. The nails can successfully be interlocked with proximal and distal bone fragments without an intraoperative X-ray control. Therefore, the operation can be made in any hospital capable of surgical treatment of fractures. Unlike interlocking metallic nailing, the dynamic variant of IIMPN makes the additional operation of dynamization unnecessary. CMPN-3 and CMPN-2 nails have options of intraoperative axial and lateromedial compression between fragments, which is impossible in interlocking metallic nailing. The carving conjunction between screws and polymer, which flexibility is close to that of the bone, excludes critical concentration of tensions and considerable dynamic loadings, and therefore prevents fractures of the interlocking screws. Good follow-up results were obtained in 94.2% patients.The article comprises the main principles of interlocking intramedullary metallic-polymeric nailing (IIMPN) and the experience of its implementation in 1200 cases of shaft fractures during the period of 40 years. Three generations of metallic-polymeric nails and techniques for closed, semi-closed and open IIMPN were designed. The nails can successfully be interlocked with proximal and distal bone fragments without an intraoperative X-ray control. Therefore, the operation can be made in any hospital capable of surgical treatment of fractures. Unlike interlocking metallic nailing, the dynamic variant of IIMPN makes the additional operation of dynamization unnecessary. CMPN-3 and CMPN-2 nails have options of intraoperative axial and lateromedial compression between fragments, which is impossible in interlocking metallic nailing. The carving conjunction between screws and polymer, which flexibility is close to that of the bone, excludes critical concentration of tensions and considerable dynamic loadings, and therefore prevents fractures of the interlocking screws. Good follow-up results were obtained in 94.2% patients

RESULTS OF SURGICAL TREATMENT OF CALCANEAL FRACTURES IN PATIENTS WITH DIABETES MELLITUS

One of the complicated problems of traumatology in the treatment of patients with calcaneal fractures is prevention of diabetes mellitus consequences. The work presents the analysis of treatment results of 72 patients with calcaneal fractures treated by means of surgical method at the Traumatological Adult Department, of the Regional Clinical Hospital “Emergency Rescue Hospital” (ERH), Chernivtsi, for the period from 2011 to 2018. With the purpose to examine the efficacy of treatment of calcaneal fractures all the patients were distributed into three clinical groups, patients with diabetes mellitus were isolated, and remote results of treatment were compared. Therefore, analysis of surgical treatment remote results of intra-articular calcaneal fractures in patients suffering from diabetes mellitus demonstrated that application of closed reposition under electrical optical transducer (EOT) control and fixation by means of wires leads to 44,38% improvement of treatment results, shortened terms of inability-to-work and disability.One of the complicated problems of traumatology in the treatment of patients with calcaneal fractures is prevention of diabetes mellitus consequences. The work presents the analysis of treatment results of 72 patients with calcaneal fractures treated by means of surgical method at the Traumatological Adult Department, of the Regional Clinical Hospital “Emergency Rescue Hospital” (ERH), Chernivtsi, for the period from 2011 to 2018. With the purpose to examine the efficacy of treatment of calcaneal fractures all the patients were distributed into three clinical groups, patients with diabetes mellitus were isolated, and remote results of treatment were compared. Therefore, analysis of surgical treatment remote results of intra-articular calcaneal fractures in patients suffering from diabetes mellitus demonstrated that application of closed reposition under electrical optical transducer (EOT) control and fixation by means of wires leads to 44,38% improvement of treatment results, shortened terms of inability-to-work and disability

Reparative osteogenesis in normal conditions and micronutrient iodine deficiency

Department of Traumatology, Orthopaedics and Neurosurgery, Bukovinian State Medical University Chernivtsi, UkraineBackground: Today without attention of researchers a number of issues remain unsolved and require their study, including: the impact of iodine deficiency conditions on bone health, healing of bone defects and morphological characteristics of the process concerning iodine deficiency. Material and methods: The experiments were performed on 63 rendobrand albino male rats, 3-month old. The experiment was performed on the control, and the main groups of animals. The main group consisted of 42 rats, subdivided into two subgroups, with 21 experimental animals each. Iodine deficiency was modeled in the animals of the main group by using the diet with low iodine content (6 mg / 100 g) and using the drug daily during 21 days, once a day in the stomach in the form of aqueous starch suspension. Reparative osteogenesis was studied by means of histomorphological examination on the 7, 15 and 30th days after producing femoral defect with the diameter of 1 mm. Results: The data obtained are indicative of negative effects of iodine deficiency on reparative osteogenesis and saline, demonstrating the suppression of these processes, involving disorders of forming callus, deterioration of the structural-functional state of the bone development, degenerative and necrotic changes in bone and epiphyseal cartilage. Conclusions: In animals of the experimental group with simulated iodine deficiency regenerative bone formation was delayed and developed against the ground of pronounced disorders of blood supply. The reparative process was characterized by inhibition of formation and remodeling of the regeneration, leading to decrease in a relative area of lamellar bone tissue as compared to the controls

Морфологічний вплив дефіциту селену на остеогенез

The problem of selenium deficiency on thyroid hormones production and their influence upon the development of osteopenia and osteoporosis is discussed in the article. The authors examine peculiarities of reparative osteogenesis in case of post-traumatic defects of the femoral metadiaphysis under conditions of selenium deficiency on experimental animals. The evidence presented are indicative of a negative influence of selenium deficiency upon reparative and physiological osteogenesis which is exhibited by inhibition of these processes and is accompanied by disorders of osseous regeneration formation, deterioration of the structural-functional condition of the osseous tissue, development of degenerative-necrotic changes in the osseous tissue and epiphyseal cartilage. Selenium containing agents were found to have a positive effect on normalization of osteogenesis and osseous regeneration.В статье обсуждается проблема дефицита селена, влияние этого процесса на производство гормонов щитовидной железы, что в последствии может привести к развитию остеопении и остеопороза. Авторы рассматривают особенности репаративного остеогенеза при посттравматических дефектах метадифиза бедренной кости экспериментальных животных в условиях дефицита селена. Результаты исследования свидетельствуют о негативном влиянии дефицита селена на остеогенез, который сопровождается нарушениями регенерации, ухудшением структурно-функционального состояния костной ткани, развитием дегенеративно-некротических изменений в костной ткани и эпифизарном хряще.У статті обговорюється проблема дефіциту селену, вплив цього процесу на виробництво гормонів щитоподібної залози, що надалі може призвести до розвитку остеопенії і остеопорозу. Автори розглядають особливості репаративного остеогенезу при посттравматичних дефектах метадифізу стегнової кістки експериментальних тварин в умовах дефіциту селену. Результати дослідження свідчать про негативний вплив дефіциту селену на остеогенез, який супроводжується порушеннями регенераціі, погіршенням структурно-функціонального стану кісткової тканини, розвитком дегенеративно-некротичних змін у кістковій тканині і епіфізарному хрящі

Consequences in the Treatment of Long Bones Fractures with the Application of Minimally Invasive Methods of Intramedular Metallopolymer Blocking Osteosynthesis

Improving the effectiveness of treatment in patients with the consequences of diaphyseal fractures of the tibia (improperly fused, unfused fractures, pseudoarthrosis, bone defects) is one of the urgent problems of traumatology, which has not only medical but also important social significance. The aim of the study is to publish clinical experience in the use of closed and semi-open blocking intramedullary metal-polymer osteosynthesis (BIMPO) in the treatment of 125 patients with consequences of diaphyseal long bones fractures. An analysis of the use of closed and semi-open blocking intramedullary metal-polymer osteosynthesis (BIMPO) in 125 patients with fracture consequences (non-fused fractures, pseudoarthrosis), who were operated with the use of 3 and 8 BIMPOF. Long-term results were observed in 103 (88.89%) patients. The consolidation of the fracture in the optimal time was noted in 98 (94.64%) patients. Within 44-90 days from the operation, resistance and limb function were restored. No case of osteomyelitis was observed. This result is rated as good.The use of new generation of intramedullary metal-polymer clamps for the treatment of bone fractures and their consequences has provided a significant reduction in surgical trauma, which optimizes the process of anatomical and functional restoration of the limb