Internal Osteosynthesis Research Articles

External Fixators as a Tool for Damage Control Orthopedics in Severely Injured or Polytrauma Patients.

The purpose of this study is to explore the use of damage control techniques in the emergency surgical management of polytrauma patients - those with traumatic injuries affecting at least two anatomical regions - at a District General Hospital in Greece. We conducted a retrospective review of medical records from patients who visited the orthopedic emergency department between 2021 and 2024. From approximately 10,000 injured patients treated annually in our emergency department, we selected a sample of 29 polytrauma patients who required surgical intervention. We utilized the Injury Severity Score (ISS) to evaluate these patients. For 16 patients, the initial surgical intervention was also the definitive treatment, utilizing intramedullary nailing or internal osteosynthesis techniques. In the remaining 13 patients, damage control techniques, including external osteosynthesis (ExFix), were employed. The ISS was the primary criterion for deciding between definitive management and damage control procedures. Data on the 13 patients managed with damage control techniques were further analyzed and are presented in this study. External osteosynthesis was used to stabilize fractures and control bleeding, particularly in patients with multiple orthopedic injuries such as femoral or diaphyseal tibial fractures. This approach facilitated resuscitation and recovery. Our findings suggest that stabilizing long bone fractures with external fixation in patients with an ISS greater than 9 is both safe and likely contributes to overall recovery. This study demonstrates that a damage control approach for polytrauma patients with significant orthopedic trauma is effective for fracture stabilization and bleeding control. Additionally, in three cases, this approach also served as the definitive treatment.

Postoperative outcome of 30patients with navicular bone fractures-In connection with AOFAS-Score, SF-12 and fracture classifications

Fractures of the navicular bone are rare and the number of those treated surgically is even smaller. Moreover, scientific analyses on this topic are only sporadically present in the literature, therefore this retrospective and monocentric study was initiated. Atotal of 30patients with 30fractures were included. With the exception of one primary fusion, all patients underwent open reduction with internal osteosynthesis. Clinical and radiological follow-up was performed at least 2years postoperatively using AOFAS-Score, SF-12 and a radiological examination. The primary objectives were the clinical and radiologic outcomes as mid-term to long-term outcomes. The secondary objective was to compare these results with two existing computed tomography (CT) fracture classifications in terms of their association with the outcome. The median follow-up was 7.8years (range 2-16.2 years) postoperatively. One patient suffered an infection, four patients required secondary arthrodesis and eight patients had to change their occupation. The mean AOFAS-Score was 80.8/100 and the mean physical and mental SF-12 component summary scores were 47.1 and 55.7 points, respectively. Male sex and arthrodesis were associated with worse outcomes in both scores but not patient age or ipsilateral concomitant injuries. Both CT fracture classifications showed low predictive value. The severity of the injury in the preoperative CT showed no connection with the clinical outcome in the AOFAS-Score and SF-12 scores. Posttraumatic osteoarthritis and secondary arthrodesis are associated with apoor outcome. In the course of the observational period the reduction results improved, which was accompanied by abetter clinical outcome.

Special aspects of total hip arthroplasty in patients with proximal femur pseudarthrosis

IntroductionThe rate of proximal femur fractures (PFF) in the structure of musculoskeletal system injuries among all fractures of long bones ranges from 3.9 to 18%. According to Russian Ministry of Health 2020 data, the incidence of femoral fractures in Russia was up to 61 cases per 100,000 population (90,000 per year); and femoral neck fractures incidence was 4 times higher among people over 75 years of age. The choice of surgical technique and the fixator used depend on many factors, such as fracture location and its nature, the age of the patient, comorbidities, and the quality of bone tissue. Internal osteosynthesis, is the current treatment method of choice for extra-articular proximal femur fracture, but every treatment method has its limitations. a significant number of complications caused by technical errors, vicious union or nonunion with the subsequent development of false joints, the development of femoral head aseptic necrosis, which leads to coxarthrosis and persistent pain syndrome. To solve the above-described problems, it is necessary to use a conversion surgery - total hip replacement. Objectiveslong-term analysis of the results of total hip replacement in patients with proximal femur pseudarthrosis. MethodsThe study was based on clinical and laboratory data analysis and on the results of total hip arthroplasty (THA) in 45 patients aged 56–84 years (mean age 68.3), including 32 (71.1%) women and 13 (26.1%) men. 12 patients initially received conservative treatment, and 33 patients received initial surgical treatment using various metal osteosynthesis procedures. The time from osteosynthesis or from the moment of injury to admission to the hospital for hip arthroplasty ranged from 12 to 30 months. All patients, before conversion arthroplasty and after discharge, were repeatedly invited to the clinical diagnostic department for a clinical examination and for assessment using rating scales. 3, 6 and 12 months after the surgery, pain syndrome and patient quality of life were assessed using the following questionnaire scales: Harris Hip Score, MOS SF-36, VAS. The maximum follow-up period ranged from 12 to 60 months. ResultsBased on the results obtained, patients of all 4 groups after conversion arthroplasty noted a significant quality of life improvement, a decrease in pain severity and functional results improvement. This was probably due to the presence of a severe limitation of range of movements in the joint, intense pain, absence of support ability of the extremity, as well as low operative efficacy expectations.In 1 (2%) patient, acute PJI was diagnosed in the early postoperative period, followed by sepsis and death.In 4 patients (9%) the result was considered unsatisfactory. At 1 year of follow-up after surgery, they complained of pain and claudication in the operated joint.3 (6%) patients underwent reduction of dislocation. ConclusionsStrict adherence to the recommended treatment algorithm for patients with proximal femur pseudarthrosis made it possible to achieve good treatment results in 90% of surgically treated patients. An important step in the treatment of this patients is a careful preoperative planning with thorough assessment of bone tissue quality and muscles condition in the proximal femur area, allowing to choose the optimal endoprosthesis components.

Surgical Treatment of Fractures of the Trochanteric Zone of the Femur in Older Patients

Summary. Treatment of fractures of the trochanteric zone of the femur in the elderly still remains one of the problems that need further study.
 Objective: to analyze clinical application of internal osteosynthesis for fractures of the trochanteric zone in older and senile patients.
 Materials and Methods. The results of treatment of 102 older patients with fractures of the trochanteric region of the femur were analyzed. All patients were treated surgically using a proximal femoral nail antirotation (PFNA); the indicators at the inpatient stage of treatment and long-term consequences up to 3 years after treatment were analyzed using improved standards for evaluating the quality of treatment of injuries and diseases of the organs of movement and resistance with modification.
 Results and Discussion. Analyzing the treatment of 102 patients with fractures of the trochanteric region type A1, A2, A3 according to the AO classification, it was found that surgical treatment with the use of PFNA proves its effectiveness due to minimally invasive access, minimal intraoperative blood loss, a short time of surgical intervention, and the possibility of early activation of patients and provides low rates of postoperative complications and mortality.
 Conclusions. 1. The conducted clinical study allows us to confirm the effectiveness of the PFNA system in the surgical treatment of older patients with fractures in the trochanteric zone in a trauma hospital. 2. In older patients with fractures of the trochanteric zone of the femur, PFNA osteosynthesis allows restoring the function of the hip joint in 54.6% (55% СІ 85.4-55.8) of cases. 3. PFNA can be recommended as a priority in the treatment of older patients with fractures of the trochanteric region of the femur in a trauma hospital.

Navigated or conventional acetabular surgery : Comparison of positional accuracy exemplified by the infra-acetabular screw

The principle of joint-preserving treatment of acetabular fractures is the anatomic reduction of joint-bearing elements and internal osteosynthesis. For stabilization of the anterior and posterior columns against each other, the infra-acetabular screw (IAS) is regularly used in the clinical routine. The aim of this study was to compare the position of the IAS in the infra-acetabular corridor after navigated placement and after freehand placement. The position of the screw was evaluated in 42 patients using multiplanar reconstructions. The screw was placed freehand in 30 patients and using image-guided navigation in 12 patients. In addition to measurement of the position of the screw, demographic data, operating time, radiation exposure and blood loss were recorded. The vast majority of the patients were male (86%), the median age was 67 years and the median body mass index (BMI) was 25 kg/m2. The median operating time was 166 min and the median blood loss was 900 ml. The adjusted values in the whole sample considering the position of the screw were: distance of screw to cartilage mean value (m) = 3.8 mm, distance of screw to corridor center m = 3.5 mm and angle of screw to corridor m = 1.4°. There were no differences between the groups in the demographic parameters and the accuracy of positioning of the screw (p-value > 0.05). There was a longer irradiation time and a higher radiation dose in the navigated group compared to the group without navigation (p-value < 0.001). With appropriate experience both procedures are comparable taking into account the accuracy. Taking into consideration other perioperative parameters, such as radiation exposure and planned operating time, patient-related factors should be taken into consideration.

Treatment of the patient with bilateral tibial plateau fractures with posterior column involvement (clinical case)

Treating patients with bilateral tibial plateau fractures remains a difficult task, demanding in the majority of cases staged surgical tactics, thorough preop planning, and combination of approaches and implants. At the same time, various options of osteosynthesis are possible. The aim of the study: to demonstrate the preop planning technology and the possibilities of the use of proposed surgical approaches’ modifications and maneuvers to fix posterior tibial plateau. A clinical case is presented of a patient with bilateral tibial high impact fractures with posterior involvement. At admission, external fixing of fractures was performed. Later, after soft tissues’ normalization and preop planning based on computer tomography, consecutive internal osteosynthesis was done. Variations of surgical approaches and maneuvers for fixing the fragments and implants were used, that allowed for stable fixation of fragments after the articular surface fragments’ anatomical reposition. Good anatomical and functional mid-term result was achieved, without any worsening of the fragments’ position in dynamics or implants’ migration.The clinical case demonstrated that the combination of modified anterolateral and posteromedial approaches together with the use of anatomical implants granting subchondral support for articular surface fragments allows to stably fix even complex tibial plateau fractures. Restoration of axial correlations in the limb, preservation of the joint stability on the whole allows to wager on good functional results, even in case of extensive articular surface lesions.

Хирургическое лечение обширных дефектов мягких тканей конечностей и таза

In modern armed conflicts the incidence of multiple and combined limb wounds with extensive wound defects of the limbs and pelvis remains high and tends to increase [1]. Such wounds are accompanied by prolonged treatment period, high frequency of wound infection development (up to 35–80%), impossibility of early internal osteosynthesis and early rehabilitation, and rather high incidence of disability [2–4]. The closure of extensive defects in combination with the wound management algorithm in the early posttraumatic period reduces blood and plasma loss, the development of endotoxicosis and wound infection, significantly improves the results and outcomes of treatment, increasing the efficiency of wound healing and reducing the duration of patient treatment.

TREATMENT OF COMBAT SURGICAL TRAUMA OF THE LIMBS IN THE CONDITIONS OF MODERN WAR

Among the total number of wounded who entered the Military Medical Clinical Center of the Western Region from February to September 2022, combat injury to the limbs was in 63.3%. Bullet wounds caused combat injury to the limbs in 10.4%, shrapnel and mine-explosive – in 68.1%, explosive injury – in 21.5%. At the second role of medical care, emergency surgical interventions were performed on the wounded, immobilization of bone fractures with an external fixation and anti-shock therapy. At the third and fourth roles – the treatment of the wounded consisted in the use of a multidisciplinary approach with the involvement of doctors of various specialties, first of all, general surgeons, traumatologists, vascular, plastic surgeons and anesthesiologists. The most frequent surgical intervention was repeatened and secondary debridment of gunshot wounds, which was required by 93% of the wounded. The main pathogens that vegetated in wounds were Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter aerogenes, Proteus vulgaris, Enterococcus faecalis with high levels of microbial contamination – 104-108/g in tissues., Various types of plastics were used to close soft tissue defects, according to the rule of the reconstruction ladder. After healing a soft tissue wound to determine the timing of replacing the method of fixing fractures with internal osteosynthesis, were analyzed clinical and laboratory parameters and assessed the risks of complications. The main causes of amputations of the limbs were common defects in soft tissue and bones, which were not subject to reconstruction with no prognosis for bone fusion and progression of the infectious-necrotic process.

The Use of the Ilizarov Fixator for the Treatment of Open and Closed Tibial Shaft and Distal Tibial Fractures in Patients with Complex Cases.

Open and closed fractures of the tibial shaft or distal tibia can be challenging for surgeons to treat if the fractures are accompanied by aggravating conditions, such as various accompanying diseases, pronounced soft tissue injuries, osteomyelitis, and/or noncompliance. The aim of this retrospective study was to present our approach and results with the Ilizarov fixator as a treatment option for such individually complex cases. Between 2005 and 2018, 20 patients were treated with the Ilizarov fixator for fractures of the tibial shaft/distal tibia. The indication for this was a 2nd- to 3rd-degree open fracture in 10 patients, a 1st-degree open fracture in one patient, and closed fractures in 9 patients. Aggravating conditions included soft tissue injuries, osteomyelitis, leg deformities, multiple traumas, smoking, alcohol/drug abuse, and obesity (BMI > 60). In addition to demographic data, the time of fixator treatment, complications, and the endpoint of consolidation were evaluated retrospectively. The mean time of fixator treatment was 29 (range 15-65) weeks. Complete fracture consolidation was achieved in 13 patients (65%) with the Ilizarov fixator. The mean follow-up period after fixator removal was 36 (range 2-186) months in 14 patients. Five patients with complete consolidation were lost to further follow-up. One patient was amputated. In six patients without union, internal osteosynthesis was carried out. The use of the Ilizarov fixator is a treatment option for individual high-risk patients with complicating courses but should be seen as a salvage procedure due to the high complication rate and long treatment process.

Open release of stiff wrist: a medium to long term case series and literature review.

The authors reported a personal case series of open release of stiff wrists performed after previous internal osteosynthesis of distal radius fractures. From a series of 16 patients operated by a single surgeon, 12 were evaluated at a mean 7.1 years follow-up (range 2.25 to 19 years), while 4 were lost at follow-up. The ROM in flexion-extension achieved at the final control was measured with a goniometer and compared to that recorded before surgery. The PRWHE questionnaire was administred at the last follow-up. The mean flexion improved from 25.5° to 42.3° and the extension from 15.75° to 43°. The mean PRWHE value was 32.9. Although arthroscopic release is increasingly used in clinical practice for its minimal invasinevess and warranty of fast recovery, open arthrolysis in post-traumatic stiff wrists appears to be an effective procedure, adaptable to all types of stiffness, that lets get good long lasting functional results.

Surgical treatment of patients with polyfocal fractures of the proximal humerus on the background of osteoporosis

The article presents clinical observations of surgical treatment of 2 patients aged over 60 years having polyfocal fractures of the proximal humerus on the background of osteoporosis. The patients were operated in the clinic on the basis of the KGAUZ "VKB No. 2". In both cases, the injury was got on streets. Patients fell on a slippery sidewalk. In the first week after the injury, internal osteosynthesis was performed according to the original technique: open reposition and interfragmental compression with a wire loop in combination with fixation of the fracture with a lockable plate for the proximal shoulder. As a result, anatomical restoration of the humeral head and the interrelation of the shoulder joint was achieved. Compression stable osteosynthesis according to the method developed by us allowed patients to begin active rehabilitation in the early postoperative period without risk of secondary displacement. We noted a clear advantage of the developed method of osteosynthesis in comparison with the use of a standard PHILOS-type interlocked plate.

Rare Case of a Doubly Complicated Clavicle Fracture in a Cyclist

Fractures of the clavicle represent 2.6 to 5% of all fractures. Respiratory and vascular-nerve complications of isolated clavicle fractures are rare. We report the case of a 29-year-old cyclist who presented a fracture of the right clavicle following a sport accident, complicated by both pneumothorax and deep vein thrombosis of axillary vein. Patient underwent thoracic drainage and curative anticoagulation followed by internal osteosynthesis of the clavicle as soon as he was stabilized on respiratory level. At the last check-up, the clavicle healed and no recurrence of pneumothorax nor deep vein thrombosis was noted.

Застосування зовнішнього черезкісткового остеосинтезу в практиці спеціалізованого травматологічного відділення міської лікарні (на прикладі міської лікарні № 3 м. Краматорська)

Актуальність. При лікуванні переломів у деяких випадках з’являється можливість вибору способу остеосинтезу, що відображено в «Клінічних рекомендаціях з лікування переломів», затверджених Пленумом асоціації ортопедів-травматологів України 15.05.2013 р. З урахуванням цього важливо знати, яке місце займає кожен із варіантів остеосинтезу, зокрема зовнішній черезкістковий остеосинтез (ЧКО), у практиці травматологічних відділень. Мета дослідження: встановити частоту застосування ЧКО та його співвідношення з внутрішнім остеосинтезом у практиці травматологічного відділення міської лікарні. Матеріали й методи. Проведено ретроспективне дослідження за матеріалами травматологічного відділення КМУ «Міська лікарня № 3» м. Краматорська (лютий 2015 р. — січень 2017 р.). Здійснено тотальну вибірку операцій ЧКО (72 спостереження), досліджено співвідношення зовнішнього та внутрішнього остеосинтезу. Результати. Як основний варіант остеосинтезу при лікуванні переломів ЧКО застосовано в 53 випадках (73,6 %). При наслідках травм його використано в 11 (15,3 %) спостереженнях, як спосіб тимчасової фіксації — у 8 (11,1 %). ЧКО становив 31,9 % серед втручань на аналогічних сегментах (72 із 226, співвідношення — 1 : 2,14). Він виявився домінуючим при діафізарних переломах кісток гомілки (26 із 47, 1,24 : 1), переважав при переломах дистального епіметафізу променевої кістки (2 : 1) та п’яткової кістки (2,5 : 1). Співвідношення ЧКО та внутрішнього остеосинтезу при пошкодженнях надп’ятково-гомілкового суглоба становило 1 : 2,93 (14 проти 41). При лікуванні наслідків травм найбільш часто ЧКО застосовували при наслідках переломів діафіза стегнової кістки (6 спостережень — 8,3 %). Висновки. Зовнішній черезкістковий остеосинтез становив 31,9 % серед усіх операцій остеосинтезу. Як основний вид остеосинтезу ЧКО застосовано у 88,9 % випадків, в 11,1 % — як спосіб тимчасової фіксації. Найбільш часто ЧКО використовували при діафізарних переломах кісток гомілки, ділянки надп’ятково-гомілкового суглоба, дистального епіметафізу променевої кістки.

Chronic Lymphoedema and Bone Infarction: Rare Complications of Multiple Segmental Fractures of the Lower Limb in a Young Adult

Multiple segmental fractures of the lower limbs, common in developing countries, are the prerogative of Road Traffic Accidents (RTA) involving two-wheeled vehicles. Their management is difficult, associated with complications, and is most often based on a two-stage strategy: Damage Control Orthopaedics, followed by delayed internal osteosynthesis. The aim is to allow early functional rehabilitation and rapid recovery of patients. We report the case of a 39-year-old man, bike rider, after his RTA, presented with segmental homolateral fractures of the femur and two bones of the left leg. Short-term evolution was marked by the appearance of significant lymphedema and bone infarctions of the lower left limb necessitating a transfemoral amputation. Through this observation, the authors highlight the problems related to the complexity of the management of multiple segmental fractures of the lower limb by emphasizing two post-traumatic complications rarely described but to be feared: chronic lymphedema and bone infarction.

Хирургические доступы для оперативного лечения повреждений вертлужной впадины

Objective. Comparative evaluation of the results of surgical treatment of acetabulum injuries during theuse of various surgical approaches, taking in to account the features of fractures.Маterial and methods. In 2015–2020 years, in the department of trauma consequences of the SI ofRepublican Specialized Scientific and Practical Medical Center of Traumatology and Orthopedics, 80patients were operated with fractures in the acetabulum. There were 64 men (80%), 16 women (20%).Traffic accidents were the cause of injuries in 69 (86%) of patients, catatrauma in 11 (14%).Results. Long-term results in the period from 6 months to 5 years after internal osteosynthesis withthe use of surgical approaches Kocher-Langenbeck and extended ilio-femoral were studied in 50 (81%)patients. Excellent results according to the Harris scale were obtained in 36 (72%) patients, good – in 9(18%) and satisfactory – in 5 (10%) ones. In all cases, complete fracture consolidation was achieved.Conclusion. The main goal of treating victims should be not only to preserve life, but also to performoperations to stabilize bone fragments as soon as possible by choosing the right surgical access.

Новые возможности накостного остеосинтеза при оскольчатых переломах проксимального отдела плечевой кости у пациентов с остеопорозом

The purpose — to conduct a comparative analysis of the results of surgical treatment of patients with bifocal and polyfocal fractures of the proximal humerus on the background of osteoporosis. Material and methods. In 2017–2020, 96 patients with fractures of the proximal humerus aged 55 to 88 years (average age 64 ± 2.3 years) were operated on in Vladivostok Clinical Hospital No. 2. The main group included 77 patients, the control group included 19 patients who underwent internal osteosynthesis according to the authors’ technique: interfragmental compression combined with fixation with a lockable plate. Results. The best results of the reposition were achieved in cases of earlier surgical intervention in both groups of patients. Complications (33.3%) were noted in the main group, including aseptic necrosis of the shoulder head and non-fusion of fractures. There were no similar complications in the control group. A significant difference in functional results in the studied groups of patients is explained by a number of reasons. Compression stable osteosynthesis allowed most patients to begin early active rehabilitation. Conclusion. Predictors of complications in the surgical treatment of patients with fractures of the proximal shoulder are the bone density, the choice of a fixator and the method of osteosynthesis.When evaluating the results of treatment in the main group of patients, a clear advantage of the developed method of osteosynthesis is shown in comparison with the standard use of a PHILOS-type lockable plate.

INTERFERENCE OF EXTERNAL DAMAGE CONTROL FIXATION IN DEFINITIVE OSTEOSYNTHESIS.

ABSTRACTIntroduction: Indications for provisional external fixation prior to the definitive treatment of fractures are associated with the control of local and systemic damage and the impossibility of definitive osteosynthesis in the emergency.Objective: To identify complications associated with external fixation prior to definitive internal osteosynthesis.Methods: This is a comparative, prospective study (Level II). Inclusion criteria: patients treated as emergencies (November 2019 and March 2020) who underwent provisional external correction followed by definitive osteosynthesis. We look for signs of inadequacies in external correction and correlation with infections (erythema, hyperemia, fistulae in the path of the pins or surgical scars), systemic symptoms of infection, and radiographic parameters for treatment up to eight weeks after surgery.Results: The average time for conversion to definitive osteosynthesis was 15.9 days and 47 lower limbs and three upper limbs were fixed. Of the participants who had deep infections, three (6%) showed signs during initial treatment (external fixator) and nine (18%), after definitive internal osteosynthesis. We found no correlation between provisional external correction and complications in the definitive treatment with osteosynthesis.Conclusion: The use of temporary external fixation before definitive internal osteosynthesis in fractures of the appendicular skeleton failed to increase complication rates even if the path of the implants in both procedures overlapped. Level of Evidence II, Comparative Prospective Study.

Первичная артропластика как метод выбора при лечении чрезвертельных переломов у лиц пожилого и старческого возраста

Актуальность. Первичное эндопротезирование применяется как альтернатива внутреннему остеосинтезу при остеопоротических чрезвертельных переломах у пациентов пожилого и старческого возраста. Существуют контраверсийные взгляды хирургов на выбор показаний, хирургического доступа, технику реконструкции вертельной области, технику имплантации бедренного компонента эндопротеза и травматичность операции. Цель работы — обосновать собственный подход к первичной артропластике при чрезвертельных и межвертельных переломах у пациентов пожилого и старческого возраста с позиции оценки ближайших и среднего срока клинико-функциональных результатов. Материалы и методы. В период с 2015 по 2019 год первичная цементная артропластика выполнена у 44 пациентов. Возраст пациентов — от 72 до 89 лет (средний возраст — 77,34 ± 2,10 года). В соответствии с классификацией АО у 13 переломы относились к типу 31-А1, у 25 — 31-А2, у 6 — 31-А3. Перед имплантацией бедренного компонента выполняли реконструкцию вертельной области с восстановлением калькара по собственной методике. Результаты. Мы не наблюдали осложнений, связанных с реконструкцией вертельной области и имплантацией эндопротезов. Продолжительность хирургических вмешательств варьировала от 50 минут до 1 часа 20 минут. Средняя интраоперационная кровопотеря составила 280 ± 60 мл. Продолжительность лечения в отделении — от 6 до 11 дней (в среднем 8,3 ± 2,6 дня). Клинико-рентгенологические результаты изучены у 32 (72,72 %) пациентов в сроки от 4 до 14 месяцев. У всех восстановлена функция ходьбы с опорой на поврежденную ногу. При контрольной рентгенографии отмечены репаративные процессы в области реконструкции, удовлетворительная плотность кости вокруг цементной мантии и ножки эндопротеза. Согласно опросу, восстановленная функциональная активность соответствовала уровню до травмы. Выводы. Общая оценка анатомических и функциональных результатов подтверждает целесообразность применения первичной артропластики как альтернативного метода лечения остеопоротических вертельных переломов.

Features of medical care in patientswith elbow joint gunshot wounds

Gunshot wounds of the elbow joint are the third most common after knee and shoulder injuries. Features of the anatomical and functional structure of the elbow joint, the close location of the vascular and nervous formations, favorable conditions for the development of infection determine the severity of gunshot wounds and cause the complexity of its treatment. Objective. To evaluate the frequency and nature of the elbow joint gunshot wounds in the structure of the general combat injuries, as well as to determine the volume of medical care and direction of treatment of such injuries in the conditions of the regional hospital as a stage of care. Methods. A retrospective study included 1 809 patients (96.0 % of men, mean age (33.7 ± 0.2) years). Firearms limb injuries were detected in 1 013 (56.0 %) of all victims, of which the elbow joint — 25 (2.47 %). Mines and explosives injuries were in 22 (88 %) of the patients, bullet — in 3 (12 %). Results. Tactics of treatment of elbow joint gunshot wounds depended on the severity of the condition of the victims and the nature of concomitant traumatic injuries. In the structure of combat injury of the elbow joint the majority was combined (52 %) and multiple (40 %) injuries and was accompanied by gunshot fractures in 60 %. In patients who were in severe state, applied the tactics of Damage control in two stages. At the first stage the fractures were fixed with plaster splints or external fixation devices (EF), the wounds were not subjected to full surgical debridment (SD), but only washed with antiseptics and the visible foreign bodies were removed. In patients with soft tissue injuries wounds the primary SD was performed according to general principles, injured nerves were not restored. In the second stage, after patient is stabilized, the repeated SD of the wound was performed. After their uncomplicated healing the EF was removed and the method of fixation was changed to internal osteosyntesis. Conclusions. It is recommended to perform stabilization of intra-articular gunshot fractures of the elbow joint with EF and after uncomplicated wound healing go to the internal osteosynthesis. Key words. Elbow joint, gunshot wounds, treatment.

Bone transport over the nail vs Ilizarov method in the treatment of posttraumatic defects of the femur and tibia

Relevance. From the point of view of using the advantages of both external fixation and internal osteosynthesis, the method “Bone transport over the nail” (BTON) deserves attention.Intention: To compare the effectiveness of the BTON and Ilizarov method in the treatment of patients with post-traumatic defects of the long bones of the lower extremities.Methodology. We analyzed 24 BTON cases and 47 cases of defects replacement via the Ilizarov method. The analysis included patients with segmental defects of the tibia, femur and knee joint bone defects complicated by chronic osteomyelitis.Results and Discussion. The external fixation period in BTON group was 3 times less than in the comparison group, as was the external fixation index. In case of monolocal defect replacement, the external fixation period and external fixation index in the BTON group was 4 times less than in the Ilizarov defect replacement group. With bifocal replacement of the defect, the external fixation period was 2.5 times less, and the external fixation index was 2 times less. BTON interventions were associated with complications in 31 cases (129.2 %) vs 82 cases for the Ilizarov method (174.5 %). The most pronounced decrease (3 times) was noted for cases of transosseous elements inflammation.Conclusion. The “Bone transport over the nail” technique reduces the external fixation period by an average of 3 times. This facilitates management of the outpatient phase and reduces the number of complications, especially the pin-tract infection. Cable technique combined with an orthopedic hexapod allows bifocal replacement of extended defects of the distal femur and knee joint applying the apparatus only to the lower leg. Risks of jamming the transported bone fragments by the intramedullary nail are thus excluded. To avoid breaking the traction cable, only designated devices should be used.