Background. The purpose was to analyze the degree of restoring foot function using therapy with living cells after gunshot wounds to the extremities. Materials and methods. During the 10 years since the start of hostilities on the territory of Ukraine (from 2014 to the beginning of 2024), 39 patients with the consequences of compartment syndrome (presence of ischemic contracture) and nerve damage, which were also accompanied by gunshot fractures, were treated at the National Military Medical Clinical Center “Main Military Clinical Hospital”. Of these, 29 patients underwent therapy with living cells and 10 patients did not. Two groups were formed, with upper and lower limb injuries. Based on this, our team formed 2 study groups: the first one — the main (29 patients) and the second one — controls (10 patients). Results. Based on the data obtained through retrospective analysis, it can be concluded that the use of therapy with living cells has a positive outcome in the treatment of ischemic muscle injuries following gunshot limb wounds. Conclusions. The use of therapy with living cells has a positive effect on improving foot function after gunshot limb injuries with ischemic muscle damage.

Background. Knee osteoarthritis is a progressive incurable disease that in severe cases leads to total joint replacement, which requires significant economic costs and medical and social adaptation, has a number of postoperative complications and adverse outcomes. Therefore, special attention has recently been paid to the prevention and treatment of the early stages of the disease. The purpose of the study was to conduct a systematic analysis of scientific literature on the prospects and possibilities of using arthroscopy in the early diagnosis of monoarthrosis. Material and methods. A literature search was conducted in the PubMed and MEDLINE databases for 2010–2024 using the following medical subject headings and keywords: “deforming osteoarthritis of the knee joint”, “osteoarthritis of the knee joint”, “unilateral deforming osteoarthritis of the knee joint”, “unilateral osteoarthritis of the knee joint”, “gonarthrosis”, “monoarthrosis”, “arthroscopy”, “diagnosis”, “treatment”. If necessary, literature sources beyond the search period were used in some cases. A general search revealed 48 references on the use of arthroscopy as a diagnostic and therapeutic method in the early stages of monoarthrosis. The primary exclusion concerned the literature in which arthroscopy was used for the diagnosis and treatment of late-stage knee osteoarthritis (n = 38). The secondary exclusion included literature sources that contained only background information (summary, figures, references) (n = 12). As a result, only relevant full-text articles in professional journals remained (n = 15). Results. The lack of correlation between clinical symptoms and radiological signs of knee osteoarthritis causes low availability of orthopaedic care: more than 30 % of newly diagnosed patients have a severe stage of the disease, and in some cases the pathology is detected only in connection with the manifestation of complications; the diagnosis of osteoarthritis due to a large percentage of painless development of the disease (40 %) is often established at terminal stages. All of this suggests the need for further research into the various factors that influence the frequency, prevalence, economic and social burden of knee osteoarthritis. Arthroscopy is potentially the gold standard for validating non-invasive assessment methods such as magnetic resonance imaging, as it provides high magnification and direct view of articular cartilage with non-destructive interactive assessment of its structure and functional properties. Arthroscopy allows for a more detailed description of the depth and extent of lesions, as well as the detection of subtle changes such as cartilage softening, fibrillations, and tangential peeling. Clinical symptoms and structural changes in the knee joint elements visualised during arthroscopy in patients with monoarthrosis are covered in a few studies, some of which were published 10 years ago. The results of modern arthroscopic studies can be an important contribution to the development of diagnostic and differential diagnostic criteria for the early stages of monoarthrosis. Conclusions. Based on information and analytical studies of modern scientific literature, it has been found that knee osteoarthritis is accompanied by persistent pain, significant limitation of the lower limb function, and reduced ability to work, which often leads to joint replacement. Diagnosis of osteoarthritis in the early stages is difficult due to the absence of pathognomonic clinical, radiological and laboratory parameters, and in case of monoarthrosis with synovitis, it is complicated by differentiation with specific arthritis of the knee joint. Arthroscopy allows performing the necessary scope of diagnostic and therapeutic measures with verification of the pathological process and determination of gonarthrosis stage.

Background. In the structure of all traumatic spine injuries, the thoracolumbar junction is predominant, accounting for over 53 % of all vertebral fractures. One of the most clinically significant types of injuries in this area are burst fractures. The purpose was to study the stress-strain state of the thoracolumbar spine model with a burst fracture of the Th12 vertebra in various transpedicular fixation options under compression load. Materials and methods. The study developed and investigated a finite element model of the thoracolumbar spine with a burst fracture of the Th12 vertebra. The burst fracture was modeled by dividing the vertebral body of the Th12 into several planes, transforming it into separate fragments. The gaps between these fragments were filled with a material that simulated the interfragmentary regenerate. Variants of transpedicular stabilization using different types of screws, mono- or bicortical, and with or without cross-links, were examined. The model was analyzed under compression load. Results. The maximum level of stress among the bone structures directly involved in fixation was registered in the L2 vertebral body. It amounted to 19.9, 15.6, 19.4, and 15.1 MPa, respectively, for models with monocortical screws without cross-links, bicortical screws without cross-links, monocortical screws with cross-links, bicortical screws with cross-links. Simultaneously, the zone of screw entry into the arch of this vertebra shows values of 10.1, 15, 10.2, and 14.3 MPa for these models, respectively. Peak loads on the metal structure elements are observed on the rods, amounting to 212.5, 159.6, 203.7, 142.8 MPa, respectively, for the considered models. Conclusions. The results of the study showed that under the influence of compression load when modeling a burst fracture of the thoracolumbar junction, the use of long screws leads to a reduction in stress levels, both in the elements of the metal structure and in the bone elements of the model, while the use of cross-links has a negligible effect.

Background. Dislocations of the acromial end of the clavicle are quite common traumatic injuries of the locomotor apparatus and, according to various authors, account for 3 to 26.1 % of dislocations of other locations and about 10 % in the structure of acute injuries of the shoulder girdle, ranking third after dislocated shoulders and forearms. They occur mainly in young men of the most working age, which determines the social significance of this injury. Stabilization of the acromial end of the clavicle, as a rule, was ensured by fixation according to Weber and the use of a hook plate. The purpose of the study: to determine the shortcomings and strength characteristics of the fastening elements in the fixation of the acromial end of the clavicle according to Weber. Materials and methods. From 2015 to 2020, a retrospective analysis was performed of treatment outcomes in 57 patients who underwent surgery for dislocation of the acromial end of the clavicle and Weber fixation. Calculations of the strength of fixation of the acromial end of the clavicle with a cerclage wire and spikes in case of its dislocation were carried out in the biomechanics laboratory of the State Institution “Sytenko Institute of Spine and Joint Pathology of the National Academy of Medical Sciences of Ukraine”. Results. According to the results of clinical studies, a violation of the integrity of the wire and spikes was observed in 10.5 % of cases, destruction of the acromion process and acromial end of the clavicle — in 19.3 %, migration of the spikes — in 12.3 %. Results of the experimental study show that these shortcomings are clearly correlated with the mechanical properties of the wire and spikes. Conclusions. The factors for unsatisfactory results of surgical treatment for dislocations of the acromial end of the clavicle when using Weber’s method are the violation of the integrity of the wire and spikes, the destruction of the acromion process and the acromial end of the clavicle, the migration of the spikes, which are caused by the mechanical properties of these structures.

Despite the favorable prognosis of conservative treatment for clavicle fractures, unsatisfactory consequences reach 10–30 % cases. Surgical methods of treatment for dislocated clavicle fractures, such as osteosynthesis with a plate or an elastic titanium rod, are mostly used in practice. The disadvantage of the latter is the possible migration of the implant with perforation of the skin. The purpose was to study the effectiveness of an intramedullary rod, improved by us, for osteosynthesis of dislocated clavicle fractures type OTA 15A and OTA 15B according to the AO/ASIF classification. The essence of the improvement was the possibility of closed minimally invasive intramedullary osteosynthesis of the clavicle body, with a simplified technique of the surgical intervention itself, prevention of implant migration. The latter was achieved by the fact that one of the ends of the rod had a drill, which eliminated the need for predrilling the medullary cavity of the clavicle to insert the rod, and its opposite end had a thread onto which a nut is screwed to achieve compression between the clavicular fragments. Forty-two patients with closed dislocated clavicle fractures were under supervision in the clinic of traumatology and orthopedics of Kyiv City Clinical Hospital 6. They underwent intramedullary osteosynthesis for clavicle fractures with an improved compressing rod (closed in 28 cases, open in 14) under regional anesthesia. In dyna-mics of the postoperative period, a clinical and radiological examination was performed, the severity of the pain syndrome and the function of the upper limb were assessed according to the visual analog scale (VAS), Disability of Arm, Shoulder and Hand (DASH). As shown by the results of X-ray examinations, the average period of clavicle fracture union was 10.1 ± 1.4 weeks (range 8–12 weeks). During the observation of the patients, favorable dynamics on the VAS and DASH were noted; by the end of the study (12 months after the operation), the functional capabilities of the upper limb on the DASH corresponded to 1.54 ± 0.84 points, VAS score was 9.60 ± 2.11 points. The improved construction of the intramedullary rod for osteosynthesis of dislocated clavicle fractures of the OTA 15A and OTA 15B type can be recommended for use in practice, as it has demonstrated favorable clinical, radiological, and functional outcomes.

Background. Bone fractures are a public health concern. In recent years, there has been an upward trend in body weight of people of all age groups. Obesity has long been thought to help protect against fractures, but recent studies have shown that for every 5 cm increase in waist circumference, the risk of any fracture is 3 % higher. The purpose: according to the meta-analysis of modern medical literature, to determine the main directions of surgical treatment for long bone fractures, their advantages, and disadvantages, including in overweight patients, the features of diaphyseal fracture fixation in overweight patients. Materials and methods. A meta-analysis of special literature from scientific databases was conducted: Cochrane Library, Scopus, National Library of Medicine — National Institutes of Health, ReLAB-HS Rehabilitation Resources Repository. One hundred and thirty articles were analyzed, from them 31 were selected, which, in our opinion, reflect the purpose of the study. Results. All methods of surgical fixation of fractures have their advantages and disadvantages. The frequency of nonunions caused by intramedullary fixation of the femoral shaft can reach 10 %, and varus/valgus and rotational deformities and shortening can also be observed. But the use of locking screws prevents the occurrence of most complications. When fixing the fractures with plates, the main complications are related to superficial and deep infections, which were more often observed in overweight patients. The analysis demonstrated that in overweight and obese patients, the main complicating factor is not the method for fixing the fracture zone, but factors related to the health of the patient himself. So, despite the fact that the results of treatment of fractures in patients with normal weight and obesity did not have a statistically significant difference, an increase in cardiovascular complications, exacerbation of chronic respiratory diseases was observed. Moreover, it is the presence of concomitant diseases that often makes surgical intervention impossible. Conclusions. There is a large amount of research on surgical methods of fixing tibial diaphyseal fractures, but data on the choice of fixation method in overweight and obese patients as a separate approach were not found. There are data on complicating factors of excess weight in the treatment of fractures and surgical interventions. Systematic studies related specifically to the algorithm for choosing the method of fracture fixation and complications have also not been found.

Introduction Penetrating spinal cord injuries present unique clinical scenarios with high variability in presentation and management. These injuries are rare, accounting for 0.8% of annual penetrating spine injuries in the United States, with knives being the most common penetrating object. Retention of the knife blade further complicates management, with greater risk of infection and progressive neurologic injury. Given the rarity and variability of such injuries, preferred management for penetrating-knife spinal cord injuries (PKSCI), especially those with retained knife blades, remains contested. Furthermore, the management of PKSCI with concurrent lung injury is poorly described within the literature. Case Report Here we discuss a unique case of a neurologically intact adult male who suffered a large lower thoracic PKSCI with complete dural transection and lung involvement. The patient arrived with the blade in situ while maintaining full neurologic function. Emergent imaging revealed the blade trajectory passing through the T8 lamina exiting the spinal canal at the costovertebral junction with involvement of the lung parenchyma and associated pneumorrhachis and pneumothorax. The patient was brought to the operating room where the blade was removed under direct visualization, the dura was repaired, and pneumothorax was stabilized. Conclusion We describe in this case the choice of imaging, method of blade removal, cerebrospinal fluid leak management, dural repair, and concurrent lung injury management that afforded a favorable, ASIA class E outcome with complete preservation of neurologic function.

Background. To identify potential opportunities for carboxytherapy, it is necessary to assess the importance of various signaling mechanisms of sensitivity to СО2 and summarize the knowledge about the cellular and molecular mechanisms underlying the beneficial and safe effects of carboxytherapy. High level of СО2 activates the mechanisms that convert hypoxia into the mode of survival and physiological homeostasis. The balance between the pro-inflammatory and anti-inflammatory phases in inflammation also shifts towards homeostasis when tissue СО2 level increases, which is very important for wound and fracture healing. The physiological properties of СО2 provide oxygenation, enhancement of angiogenesis, mitochondrial biogenesis, blood flow in tissues, anti-inflammatory effect, and reduction of oxidative stress. These pro-perties of СО2 determine the potential use of carboxytherapy as a therapeutic approach in tissue hypoxia, to accelerate tissue repair and reduce inflammation. Methods. Тhe search for scientific information on the possibilities of СО2 in medicine was conducted in the PubMed and Google Scholar electronic databases. Results. Literature data on СО2 studies aimed at the mechanisms of pharmacological action of carboxytherapy were found, which have been investigated in animal models in vivo and in research with human participants. Conclusions. This review presents the scientific evidence supporting the clinical benefits of therapeutic exposure to СО2 (carboxytherapy).