Introduction Endovascular management of penetrating intra-abdominal vascular trauma is an evolving modality that may support hemodynamic stability, reduce operative time, and avoid open conduit-based reconstruction in contaminated fields. We present the case of a 24-year-old male with a gunshot wound to the left lower abdomen who was found to have multiple traumatic arteriovenous fistulas (AVFs) involving the right common iliac artery (CIA), inferior mesenteric artery (IMA), and inferior vena cava (IVC). Case Report The patient was hemodynamically stable on presentation and underwent exploratory laparotomy, which revealed enteric injuries with gross contamination and a stable retroperitoneal hematoma. Following bowel resection and damage control, a staged endovascular approach was pursued in a hybrid operating room. Covered stent placement in the right CIA and coil embolization of the IMA successfully excluded the identified AVFs. A contained IVC injury was managed non-operatively. Postoperative imaging demonstrated initial resolution; however, on postoperative day (POD) five, the patient developed a persistent AVF via collateral flow from the superior mesenteric artery through the middle colic artery to the distal IMA. This was successfully treated with repeat endovascular coil embolization. The patient required minimal transfusion, had no infectious complications, and was discharged on POD 16. At 1-year follow-up, imaging demonstrated durable exclusion of AVFs and stable remodeling of the IVC injury. Conclusion This case highlights the feasibility and advantages of a staged hybrid approach in penetrating abdominal vascular trauma, particularly in contaminated operative fields. Endovascular techniques may reduce infectious risk, minimize blood loss, and allow for precise identification and treatment of complex vascular injuries, including those not apparent during open exploration. Early triage to hybrid operating environments and a high index of suspicion for delayed or collateralized AVFs are critical to optimizing outcomes.
Introduction Although machete-related injuries are common in South Africa, there is no comprehensive review of the spectrum and outcome of these patients and their injuries. This study aims to address this deficit by reviewing our institutional experience in managing such injuries over the past 12 years. Materials and Methods A retrospective study was conducted on all patients with machete-related injuries from January 2013 to December 2024 at a major trauma centre in South Africa. Results A total of 538 cases were included (91% male, mean age 33 years). The median Injury Severity Score (ISS) was 9 (IQR 5–12). The head, face and upper limb were the most commonly injured regions, with 58% of all patients sustaining injuries to multiple body regions, 19% requiring operative interventions, 10% (51/538) sustaining at least one complication and 4% (21/538) requiring intensive care unit admission. The mean length of hospital stay was three days. The overall mortality rate was 2% (11/538). The mean number of cases per year was 45. Conclusions Assault with a machete is not infrequent and results in multiple injuries, which are not confined to single body regions. The most frequent body regions injured include the exposed areas of the head, face and upper limbs. Care needs to be coordinated between a variety of subspecialties and must include allied medical professionals to ensure optimal recovery.
Introduction Approximately 1% to 3% of blunt trauma patients experience blunt cerebrovascular injury (BCVI), which may lead to thromboembolic stroke if not addressed. While clinical screening criteria for BCVI exist (e.g. Denver, Memphis), some injuries are not promptly recognized. To better detect BCVIs, some institutions have begun performing head and neck computed tomography angiography (CTA) on all patients following serious blunt traumatic injury. The expanded use has led to a corresponding increase in incidental findings (IFs), some of which merit further scrutiny. The authors’ institution adopted a policy of universal head and neck CTA screening for all serious blunt trauma patients in February 2023. This study explores frequencies of BCVIs and IFs and assesses whether patients with IFs undergo further evaluation and/or treatment. Methods A retrospective review was performed of Epic medical records of patients treated at the authors’ institution for a blunt traumatic injury who underwent head and neck CTA between 3 January 2023 and 29 February 2024. Results A total of 45 BCVIs were detected among 33 of the 535 patients (6.2%). The majority (81.8% [27/33]) of patients were treated with ambulatory antithrombotic therapy. Two patients experienced strokes during hospitalization. Of patients with BCVIs, 1 met only Memphis criteria (3.0%), 15 met only expanded Denver criteria (45.5%), 12 met both Memphis and Expanded Denver criteria (36.4%); 5 met neither set (15.2%). A total of 122 patients (22.8%) had IFs on head and neck CTA. Twenty-eight (21.9%) had follow-up recommended, and seven (5.5%) pursued follow-up. Of those treated for IFs, four (3.1%) received medication, and one (0.8%) underwent a surgical procedure. Conclusions Application of universal head and neck CTA screening aided in the timely detection of BCVIs among serious blunt trauma patients. IFs were not uncommon with this imaging method; some were considered medically relevant and subsequently monitored and/or treated accordingly.
INTRODUCTION:The complexity of orbital fracture management necessitates systematic investigation of the financial burden of these fractures and the cost-effectiveness of management. Here, we analyze the cost and inpatient burden of patients presenting with orbital fractures at an academic medical center. METHODS:A retrospective chart review of 1,449 patients presenting with orbital fractures between 2008 to 2022 was performed. Patient characteristics, treatment approach, length of stay (LOS), and hospital costs were collected. Linear regression and pairwise comparison tests were performed to identify factors associated with increased cost burden and LOS. RESULTS:Of the 2,093 total orbital fractures, the most common locations were floor (50%) and medial wall (24%). Average cost of management did not significantly change over time (p=0.072) while average LOS decreased (6.3 to 4 days, p=0.050). Compared to injuries from falls, traffic injuries were associated with higher cost $36,703 vs. $12,513, p<0.001). The presence of ≥4 facial fractures was associated with higher cost ($29,746 vs $6,415, p<0.001), while surgical management was associated with longer LOS (8.3 vs. 3.5 days, p<0.001). CONCLUSIONS:The cost or inpatient burden of treating patients with orbital fractures is greater in patients with traffic injuries, ≥4 facial fractures, and operative management.
Background. Modern combat trauma of the extremities is characterized by a significant amount of damage to both bones and soft tissues. Bone defects are one of the most severe and common complications of modern combat trauma of the extremities. Such injuries are accompanied by significant soft tissue defects. The purpose was to evaluate the necessity and feasibility of soft tissue plastic surgery in victims with long bone defects due to modern combat trauma. Materials and methods. This retrospective cohort research is based on the study and analysis of 141 cases of limb injuries due to modern combat trauma with the presence of long bone defects. The inclusion criterion was the presence of combat damage to the limbs with defects of long bones and soft tissues. Results. The study found that the vast majority of victims (68.09 %) with long bone defects caused by combat trauma require surgical interventions for soft tissue plastic surgery. It was revealed that the soft tissue plastic surgery was mostly required in victims with long bone defects measuring 5–9.99 cm (42.71 % of victims by the specific weight in this group), and the least soft tissue plastic surgery was required by patients with long bone defects of up to 5 cm (5.21 %). A trend towards increasing need for soft tissue plastic surgery with increasing bone defect size has been established. Starting from a bone defect size of more than 5 cm, the risk of the need for soft tissue plastic surgery is catastrophic in terms of qualitative characteristics, and up to 5.0 cm, it is significant. It was also found that the greatest need for surgical interventions for the purpose of soft tissue plastic surgery was in victims with defects in the tibia (83.87 %) and forearm (75.00 %) bones, and the least need was in victims with defects in the femur bone caused by combat trauma (12.00 %). It has been proven that the size and location of the bone defect are risk factors in terms of the need for surgical interventions for soft tissue plastic surgery. Conclusions. 1. The size and location of the bone defect are risk factors for the need for soft tissue plastic surgery in victims with long bone defects as a result of modern hostilities. 2. The clinical outcome risk of the need for soft tissue plastic surgery in victims with long bone defects resulting from modern warfare is significant for sizes up to 5 cm and catastrophic for sizes over 5 cm, which determines the relative or absolute indications for soft tissue plastic surgery, respectively. 3. The clinical outcome risk of the need for soft tissue reconstruction is catastrophic for defects of the shoulder, forearm, and lower leg and is insignificant for defects of the hip. This also determines the absolute or relative indications for soft tissue reconstruction.
Background. Gunshot femoral fractures represent one of the most challenging conditions in military and civilian traumatology due to high-energy mechanism, extensive bone and soft-tissue destruction, significant wound-tract contamination and impaired tissue vascularization. These injuries account for 15–22 % of combat-related limb trauma with a rising proportion of high-energy injury with comminuted fractures and critical defects. The complexity of treatment is determined by the need to balance the radicality of the initial surgical treatment and the preservation of viable tissues for subsequent reconstruction. The purpose was to systematically review contemporary surgical strategies for the management of gunshot femoral fractures and to summarize available evidence on the role of systemic inflammatory response markers, namely procalcitonin (PCT), interleukin-6 (IL-6) and C-reactive protein (CRP), in guiding surgical decision-making and risk stratification. Materials and methods. A systematic review was performed following the PRISMA 2020 statement. We searched PubMed, Scopus, Web of Science and Cochrane Library for publications from 2018 to 2025 using Boolean combinations of “gunshot fractures”, “femoral fractures”, “damage control orthopedics”, “external fixation”, “intramedullary nailing”, “interleukin-6”, “C-reactive protein”, and “procalcitonin”. Eligible publications included original cohort and retrospective studies, systematic reviews, meta-analyses and clinical guidelines addressing surgical treatment for gunshot or open femoral fracture or biomarker dynamics in severe trauma. Methodological quality was evaluated using the ROBINS-I and MINORS tools. A qualitative narrative synthesis was performed without meta-analysis. Results. Twenty-four publications were included in the final analysis. We systematized the indications and limitations of the main methods for primary stabilization such as external fixation, intramedullary nailing and plate osteosynthesis. External fixation remains the method of choice in cases of multiple trauma, unstable hemodynamics, massive soft tissue injury, and the need for vascular reconstruction. The damage control concept in orthopedics presumes initial minimally invasive stabilization followed by conversion to definitive osteosynthesis once the systemic inflammatory response subsides. The reported dynamics of PCT, IL-6 and CRP are based on a summary of the included primary sources and reflect approximate clinical ranges proposed by the authors of individual studies as auxiliary markers for decision-making rather than formally validated diagnostic thresholds at the meta-analysis level. Conclusions. The findings support the feasibility of an individualized approach to surgical treatment for gunshot femoral fracture based on fracture pattern, soft tissue condition and the dynamics of systemic inflammation markers. Integration of contemporary surgical strategies with PCT, IL-6 and CRP monitoring may serve as an adjunctive tool for clinical judgement regarding the timing of conversion and infection risk; however, final formal validation of the proposed ranges requires prospective comparative studies with quantitative synthesis.
Background. The choice of treatment strategy for type A injuries of the thoracolumbar junction (T11-L2) remains controversial. The AO Spine classification describes injury morphology and serves as an international language for communication; however, it is insufficient for individualized selection of a specific intervention, especially in complex reconstructive scenarios. This supports the identification of intratype quantitative morphotypes and the development of an individualized treatment algorithm. The purpose was to perform morphofunctional stratification of type A thoracolumbar junction injuries by identifying CT morphometric morphotypes that reflect the relationship between local fracture morphology and the deformation response of the spinal segment, as well as to develop an algorithm in which the morphotype formalizes the baseline tactical scenario, while quantitative threshold values modify it. Materials and methods. Morphotypes were identified using CT morphometric parameters (CA, GA, A/P ratio, AVH ratio, AED, PED, and HU) with k-means clustering and Gaussian mixture model; HU was used as a modifier of bone quality. Clustering was assessed using silhouette, BIC, and clinical interpretability. Differences were evaluated using the Kruskal-Wallis/Mann-Whitney tests and test; discriminatory ability was assessed by ROC analysis, and the association with outcome was evaluated using odds ratios. The algorithm was constructed according to the principle “AO Spine type morphotype baseline treatment strategy quantitative modifiers”. Results. Within A1-A2 injuries, three morphotypes were identified: compensated, subcompensated, and decompensated, reflecting a gradient of anterior support loss. Within A3-A4 injuries, two morphotypes were identified: kyphotic-deformational and compression-retropulsion. The morphotype was closely associated with the implemented treatment strategy: in A1-A2 injuries, there was a transition from observation to cementoplasty and short-segment transpedicular fixation (TPF); in A3-A4 injuries, the choice was between long-segment TPF and decompression with fixation. Threshold values, including CA > 14°/GA > 25° for construct length, level-dependent canal stenosis thresholds of 35/45/55 % for open versus indirect decompression, and HU < 150 as an argument for augmentation, refined the baseline decision. The kyphotic-deformational A3-A4 morphotype was treated with long-segment TPF in all 40 cases, whereas treatment of the compression-retropulsion morphotype was variable. Conclusions. The morphotype may be used as a quantitative clinical and tactical refinement of the AO Spine subtype: AO Spine defines the morphological axis, the morphotype provides the level for baseline decision-making, while ASIA grade, posterior ligamentous complex, and bone quality remain mandatory modifiers. The proposed algorithm is a derivation model and requires prospective validation.
Background. Blunt abdominal trauma in polytrauma patients remains diagnostically challenging due to hemodynamic instability, depressed consciousness and combined injuries. An additional risk is associated with delayed recognition of bowel, mesenteric or retroperitoneal injuries. The purpose was to compare the diagnostic performance of clinical examination, initial Focused Assessment with Sonography for Trauma (FAST), serial FAST, contrast-enhanced multidetector computed tomography (CT) and an integrated algorithm for detecting clinically significant blunt abdominal injury in adult polytrauma patients. Materials and methods. A retrospective diagnostic study included 184 adults aged 18–79 years with blunt trauma and Injury Severity Score ≥ 16. The reference standard was operative verification or a concordant clinical-radiological diagnosis after 72-hour observation, repeat CT, angiographic intervention or surgery. Sensitivity, specificity, predictive values, accuracy and 95% confidence intervals (CI) were calculated. Predictors of delayed diagnosis were assessed using multivariable logistic regression. Results. Clinically significant intra-abdominal injury was identified in 72 of 184 patients (39.1 %). Therapeutically significant injury was found in 38 patients (20.7 %). Initial FAST showed 69.4 % sensitivity and 91.1 % specificity. Serial FAST demonstrated 80.6 % sensitivity and 89.3 % specificity. Contrast-enhanced CT showed 94.4 % sensitivity and 95.5 % specificity. The combined algorithm had 97.2 % sensitivity and 92.9 % specificity. Early contrast-enhanced CT/whole-body CT reduced the median time to definitive diagnosis from 88 to 49 min (p < 0.001). Missed or delayed diagnosed injuries decreased from 10.5 to 2.0 % (p = 0.018). Negative initial FAST with lactate > 2.5 mmol/L independently predicted diagnostic delay (odds ratio = 3.90; 95% CI 1.44–10.56; p = 0.008). Conclusions. FAST is useful for early triage but is insufficient as a stand-alone exclusion test in blunt abdominal trauma. Early contrast-enhanced CT provides the highest diagnostic yield in stable or stabilized patients. An integrated algorithm had additional value, it combines clinical, laboratory and ultrasound signs. Future studies should prospectively validate the proposed algorithm in multicenter trauma cohorts. A group of patients with negative FAST and laboratory markers of hypoperfusion requires a separate study.
Background. The calcaneus is a key structural component of the foot that plays a crucial role in weight bearing and load transmission. Its trabecular bone forms a complex three-dimensional architecture that ensures efficient distribution of mechanical stresses. Of particular interest is the neutral zone (Ward’s triangle), an area of reduced trabecular density whose functional significance remains incompletely understood. Modern three-dimensional imaging techniques provide new opportunities for detailed analysis of the structural organization and morphometric characteristics of the trabecular bone of the calcaneus. Therefore, the aim is to investigate structural organization and morphometric features of the trabecular architecture of the calcaneus. Materials and methods. The study used anatomical specimens of calcanei from adult humans (n = 5) obtained from the Department of Human Anatomy of Poltava State Medical University. The bones showed no signs of pathological changes or traumatic damage. Results. Two principal trabecular systems — compressive and tensile — were identified in the trabecular bone of the calcaneus, forming a biomechanically efficient framework for optimal load distribution. Between these systems, a central neutral zone (Ward’s triangle) was observed as an area of reduced trabecular density with moderate variability in its geometric parameters. At the same time, the main morphometric characteristics of the most prominent trabeculae remained relatively stable among the examined specimens. Three-dimensional reconstruction performed using the Artec 3D Artec Micro scanner confirmed the adaptive orientation of trabeculae in accordance with functional loading patterns: dense, short trabeculae predominated in the calcaneal tuberosity, a more sparse trabecular arrangement was observed in the central region, and the anterior part exhibited a plate-like linear architecture. Conclusions. The trabecular architectonics of the calcaneus is represented by a complex system of compression and tensile trabeculae, oriented according to the directions of mechanical forces. The neutral zone (Ward’s zone) is a three-dimensional morphological structure that plays a key role in load redistribution.
The study involved 52 patients who were divided into two groups according to the vegetative passport, comorbidity, and form of somatogeny: group 1 (n = 38) — vagotonics with seropositive rheumatoid arthritis (RA) and calcium-deficient comorbidity, combined with acetylcholine anxiety-depressive somatogeny; group 2 (n = 24) — sympathotonics with seronegative RA, and calcium-excessive comorbidity and panic-phobic reactions. The patients were divided into groups of vagotonics and sympathotonics according to the findings of the heart rate spectral analysis as well as using automated tests for determining the vegetative passport and form of somatogeny. The seropositive variant of arthritis was determined by rheumatoid factor and antibodies to cyclic citrulline peptide. The form of comorbidity (calcium-deficient or calcium-excessive) was determined by the level of intracellular calcium in the hair. In the pathogenesis of somatogeny, an important role is played by the vegetative passport, violations of homeokinesis parameters, and comorbidity. Vagotonic calcium- and serotonin-deficient, homeokinesis comorbidity form the pathogenesis of seropositive RA, combined with acetylcholine serotonin-deficient anxious-depressive somatogeny. Sympathotonic magnesium- and potassium-deficient and serotonin-excessive, homeokinesis, calcium-excessive comorbidity underlie seronegative RA, combined with panic-phobic reactions. The drawn clinical and pathogenetic parallel of somatogenies in articular syndrome allowed distinguishing dysneurotic, dyshormonal, dysimmune, dysmetabolic, dyscirculatory, dyselemental somatogenies; establishing their informative criteria; developing a homeokinetic classification of somatogenies and proposing an individual program/plan of evidence-based treatment and rehabilitation of patients. In acetylcholine anxiety-depressive somatogenies, antidepressants, replacement Ca, I psychostimulating diet, homeokinetic breathing, light therapy are indicated for vagotonics. Adrenergic panic-phobic reactions in sympathotonics with RA are eliminated by sedatives, Mg drugs, replacement K, Na, Mg, Mo sedative diet, homeokinetic breathing, and magnetotherapy.
Background. In the context of intensive hostilities, early diagnosis of ophthalmic injuries, well-defined patient routing, and a multidisciplinary approach to treatment are of critical importance. Most injuries are caused by blast, shrapnel, and fragment mechanisms, resulting in high-energy penetrating wounds, extensive destruction of ocular anatomical structures, and combined craniofacial trauma. The purpose of this study was to perform a retrospective comparative analysis of international and national scientific evidence and to analyze the structure of ophthalmic injuries and the specific features of surgical management among military personnel in different regions of Ukraine. The study sought to identify regional variations in the patterns and severity of ocular trauma, the extent and tactical approaches of surgical interventions, and to evaluate the influence of injury mechanisms, timeliness of specialized ophthalmic care, and organizational aspects of patient routing on clinical outcomes. Materials and methods. The study employed content analysis of national and international scientific sources, as well as systematic literature review, analytical, and statistical research methods. The analysis was based on data from 78 military personnel who received treatment in two regions of Ukraine. Results. Prevalence and nature of ocular injuries: in both cohorts, the most frequently recorded injuries were penetrating globe injuries with intraocular foreign bodies (17.1 % in Haisyn and 33.3 % in Cherkasy) and traumatic cataracts (11.4 % and 11.1 %, respectively), indicating the significant role of mechanical, including penetrating, trauma in the development of severe ophthalmic complications. The incidence of burns and open wounds was lower: in Haisyn, both accounted for 8.6 %, whereas in Cherkasy, open wounds were detected in 29.6 % of patients and burns were absent. Ocular contusions were less common, occurring in 2.9 % of cases in Haisyn and 22.2 % in Cherkasy. Regional differences: in the second cohort (Cherkasy), the proportion of ocular injuries with intraocular foreign bodies (33.3 vs. 17.1 % in Haisyn) and open wounds (29.6 vs. 8.6 %) was significantly higher, indicating a more severe injury profile and a greater prevalence of penetrating trauma. The frequency of ocular contusions (22.2 %) and the decreased incidence of purulent endophthalmitis (7.4 vs. 14.3 % in Haisyn) reflect different trauma mechanisms and variations in the course of complications. Prevalence of surgical interventions: in the first sample (Haisyn), the most frequently performed procedures were “other surgical interventions” — 40.0 %, foreign body removal — 20.0 %, evisceration and surgical wound management — 14.3 % each, lens extraction with implantation — 11.4 %. In the second sample (Cherkasy), surgical wound management predominated — 46.9 %, intraocular foreign body removal was performed in 21.9 % of cases, lens extraction — in 9.4 %, evisceration — in 6.25 %, and other interventions — in 15.5 %. Conclusions. Timely integration of early surgical intervention, coordination of a multidisciplinary team, and implementation of modern rehabilitation approaches significantly improve anatomical and functional outcomes, reduce the risk of vision and eye loss, and promote more effective social and professional reintegration of affected military personnel.
Background. Fractures remain a leading cause of morbidity worldwide, with hip fractures carrying high mortality and socioeconomic impact. Osteoporosis — driven by reduced bone mineral density — represents a primary risk factor for fractures. Emerging evidence highlights the role of secondary causes of impaired bone remodeling, including endocrine disorders, renal dysfunction, and disturbances in mineral metabolism. Aligned metabolic pathways involving calcium, phosphate, parathyroid hormone (PTH), vitamin D, and fibroblast growth factor-23 (FGF23) link osteoporosis with nephrolithiasis. The purpose was to emphasize the importance of an integrated clinical approach for early detection and prevention of both osteoporosis and kidney stone disease, focusing on primary laboratory monitoring of ionized calcium, phosphorus, PTH, vitamin D and — where feasible — FGF23; to provide recommendations for safe supplementation and targeted specialist referral. Materials and methods. Narrative synthesis of recent evidence (2022–2026) regarding shared risk factors for osteoporosis and nephrolithiasis, including hypercalciuria, hypercalcemia, secondary and primary hyperparathyroidism, and the role of FGF23 in mineral metabolism regulation. Results. Insufficient dietary calcium stimulates secondary hyperparathyroidism, contributing to bone loss and hypercalciuria. Hypercalciuria is associated with reduced bone mineral density in stone formers and higher fracture incidence. Vitamin D is essential for calcium homeostasis, but excessive supplementation may increase urinary calcium excretion in predisposed individuals. Interactions between PTH and FGF23 are central to mineral balance, especially in chronic kidney disease, promoting maladaptive endocrine responses that worsen both skeletal and renal pathology. Conclusions. Osteoporosis and nephrolithiasis should be viewed as manifestations of systemic mineral metabolism dysregulation. A unified clinical framework centered on comprehensive laboratory evaluation, cautious calcium and vitamin D supplementation (preferably calcium citrate in patients at risk of developing kidney stones), and timely referral for hyperparathyroidism can improve prevention of both fractures and nephrolithiasis. Personalized strategies targeting endocrine mediators are essential to reduce the burden of these interconnected conditions.
Актуальність. Після тотального ендопротезування кульшового суглоба зменшення болю не завжди супроводжується відновленням симетричності сили м’язів стегна. Доопераційна асиметрія при кокс-артрозі та асептичному некрозі головки стегнової кістки може зберігатися або посилюватися у ранньому післяопераційному періоді. Мета: оцінити динаміку коефіцієнта асиметрії сили м’язів стегна після ендопротезування залежно від хірургічного доступу та етапу реабілітації. Матеріали та методи. Проведено проспективне нерандомізоване порівняльне дослідження відповідно до TREND. Проаналізовано дані 41 пацієнта: 18 після прямого переднього доступу (DAA) та 23 після латерального доступу Hardinge (HA). Оцінку проводили до операції, через 1 та 3 місяці. Визначали коефіцієнт асиметрії (Kas, %) сили м’язів стегна. Використовували Welch t-test, парний t-test та mixed-design repeated-measures ANOVA з оцінкою g. Результати. До операції міжгрупових відмінностей Kas не виявлено. Через 1 місяць асиметрія збільшувалася в обох групах. Для відвідних м’язів Kas становив –54,55 ± 2,92 % для DAA та –58,78 ± 3,13 % для HA (p < 0,001). Через 3 місяці асиметрія зменшилася до –19,55 ± 6,66 % в групі DAA та –36,99 ± 3,10 % — HA (p < 0,001). У період 1–3 місяці поліпшення Kas було значущим для всіх м’язових груп (p < 0,001). Найбільша динаміка при DAA відзначена для відвідних м’язів —39 процентних пунктів. ANOVA показав значущий ефект часу для всіх груп м’язів (g = 0,526–0,939) та взаємодію група час для відведення (F = 13,03; p < 0,001; g = 0,191). Висновки. Через 1 місяць після ендопротезування симетрія сили м’язів не відновлюється. Індивідуалізована реабілітація після функціонального контролю сприяє зменшенню асиметрії, однак через 3 місяці повна симетрія ще не досягається.
Background. Among patients with multiple injuries, approximately 50 % have chest trauma, which significantly affects treatment outcomes and survival rates. In patients with multiple injuries who have suffered blunt chest trauma, the most common injuries are rib fractures (86 %), clavicle/clavicle fractures (19 %), or a combination of these (19 %). Clavicle and rib fractures are considered markers of chest injury severity, and their combination significantly increases mortality. According to some authors, in patients with blunt chest trauma and concomitant clavicle fractures, no differences were found between surgical and conservative treatment of clavicle fractures, while others point to a significant impact of clavicle stabilization on the final outcomes. The purpose was to improve treatment outcomes in patients with combined clavicle and rib fractures by substantiating and implementing modern technologies and differentiated care. Materials and methods. The clinical study is based on the examination and treatment of 101 patients with combined clavicle and rib fractures. Their average age was 48.7 ± 16.4 years. Patients were divided into two groups: the main (n = 48) and comparison ones (n = 53). Results. In the total cohort, males prevailed (n = 85, 84.2 % versus 16 females (15.8 %)). The average number of damaged ribs was 4.2 ± 1.5 per patient. In patients aged 61 and older, this indicator is significantly higher (5.5 ± 1.4), which can be explained by age-related loss of elasticity of these structures. In terms of specific weight, fractures of the middle third of the clavicle predominate — about 74.0 %; fractures of the acromial end accounted for 20.6 %, of the sternal end — 5.4 %. Post-traumatic pneumonia was found in 31.3 % of cases in the main group, in the comparison group — in 39.6 %. Patients in the main group had statistically proven (p ≤ 0.05) better indicators for artificial lung ventilation and length of stay in the intensive care unit. Mortality in the main group was 4.2 %, in the comparison one — 7.5 %. These patients had two dominant competing injuries: chest trauma and traumatic brain injury, which caused severe or extremely severe general condition. Conclusions. Combined clavicle and rib fractures are more common in men (84.2 %) in the 31–50 age group (50.5 %). The average number of damaged ribs is 4.2 ± 1.5 per patient. In patients aged 61 and older, this indicator is significantly higher (5.5 ± 1.4). In terms of location, fractures of the middle third of the clavicle prevail — about 74.0 %. Among concomitant injuries, traumatic brain injuries predominate — 23.8 % (of which 41.7 % are open), which are competing dominant injuries, significantly worsen the general condition of the patient, affect treatment tactics and mortality rates. Surgical stabilization of the clavicle and ribs and active pulmonary hygiene improve the rate of post-traumatic pneumonia (31.3 vs. 39.6 % of cases), the need for artificial lung ventilation (10.6 ± 8.4 vs. 16.7 ± 7.9), reduce the length of stay in the intensive care unit (14.6 ± 10.6 vs. 23.6 ± 10.2) and mortality rates (4.2–7.5 %), and restores shoulder joint function (according to American Shoulder and Elbow Surgeons score: 98.8 ± 2.8 points vs. 83.0 ± 11.7 points; Shoulder Pain and Disability Index was 2.0 ± 3.2 points vs. 20.7 ± 22.3 points).
Background. The elbow joint dysfunction ranks first in terms of the number of post-traumatic complications and in 29.9 % of cases leads to permanent disability of patients. The aim of our study was to assess the impact of an integrated orthopedic rehabilitation program on the restoration of elbow joint function in patients after surgical treatment of ulnar process fractures. Materials and methods. To fulfill the tasks and objectives of our study, we conducted an analysis of the functional results of treatment of 111 patients with ulnar process fractures who were inpatients in the Department of Reconstructive Traumatology and Orthopedics of the State Institution “Ukrainian State Research Institute of Medical and Social Disability Problems of the Ministry of Health of Ukraine” in 2021–2025 and were divided into two groups. Results. The original integrated rehabilitation program developed in our clinic included several stages. To determine treatment outcomes after the implementation of rehabilitation programs, we comprehensively examined the function of the elbow joint. In the first group, the average visual analogue scale score was 2.5 ± 0.7, while in the second group, it was 3.8 ± 0.9. Among the patients of the first group, the average flexion indicators were 113.4 ± 10.8, extension — 4.9 ± 0.8, pronation — 65.5 ± 6.8 and supination — 58.4 ± 5.9. In the second group, the indicators were slightly different and on average were: flexion — 83.9 ± 8.4, extension — 1.7 ± 0.3, pronation — 40.1 ± 6.1 and supination — 46.4 ± 5.2. As indicated by the data of our study, an integrated orthopedic rehabilitation program significantly improves treatment outcomes after surgical intervention on the ulnar process. This approach allows for better functional recovery of the elbow joint after surgery. Conclusions. In patients with ulnar fractures, an integrated orthopedic rehabilitation program leads to better outcomes in terms of elbow function, range of motion, pain relief, and activities of daily living compared to conventional rehabilitation.
Data from modern literature sources indicate insufficient assessment, diagnosis and treatment of osteoporosis in men, which has negative medical and social consequences for society. The aim of this project was to create the first Ukrainian recommendations for the diagnosis, prevention and treatment of osteoporosis in men in order to improve the awareness of the medical community and increase the efficiency of medical care. To achieve this goal, a multidisciplinary expert group was created, which, based on a comprehensive analysis of modern literature sources and their assessment using the GRADE tool, formulated and successfully voted on 19 statements regarding risk factors, screening, diagnosis, non-pharmacological and pharmacological treatment of osteoporosis in men. The authors proposed an algorithm for the management of osteoporosis in men depending on age and the risk of osteoporotic fractures. The statements of these recommendations are supported by the Ukrainian Association of Osteoporosis and are recommended for use at different levels of providing medical care by health professionals of various specialties.
