Introduction. Fractures of the distal radius occupy a leading place in the general structure of limb injuries. In most cases, they are comminuted in nature and require open reduction and fixation. With traditional surgical approaches to the distal radius, there is a risk of injury to the tendons of the muscles of the anterior group of the forearm and the median nerve; in addition, the skin incision lines pass through the projection of the gap of the wrist joint, which leads to the formation of painful scars and difficulty moving in the early postoperative period.The purpose of the work is to evaluate the results of using a new surgical approach to the distal radius for the treatment of comminuted intra-articular fractures.Materials and methods. A retrospective analysis of the results of surgical treatment of 124 patients aged 19 to 78 years with a fracture of the distal radius for the period from 2015 to 2019 was carried out. A patient with a fracture of the distal epimetaphysis of the radius, Fernandez type III, underwent surgery through the proposed approach.Results. Aſter transosseous osteosynthesis with a distraction external fixation device, on the sixth day, open reduction, bone graſting and plate osteosynthesis were performed through the proposed approach. Restoration of congruence of the articular surfaces of the wrist joint has been achieved. In the early postoperative period, movement in the joint is free, discomfort during the rehabilitation program is minimal. Aſter 12 months, movements in the joint are fully realized.Discussion. The new access makes it possible to improve the conditions for operations on the distal part of the radius with its fractures, creates a sufficiently spacious and safe access to the radius, which allows you to preserve the muscular part of the square pronator and does not violate the anatomy of the synovial sheaths of the tendons of the muscles of the anterior forearm group, which is prevention of the development of deficiency of rotational movements of the forearm and contractures of the hand and fingers in early and late postoperative periods.Conclusion. The developed new surgical approach to the distal radius provides optimalvisualization of the fracture andis low-traumatic, which has a positive effect on restoring full range of motionin the wrist jointin the early stages aſter surgery.

The structure, the deformation, and the fracture mechanisms of the trabecular bone tissue during a depressed fracture are studied. The compression of the bone trabeculae is shown to be accompanied by the separation of the organic matrix and the appearance of a large number of microcracks, which subsequently leads to the destruction of the trabeculae and the compaction of the bone tissue without breaking a specimen into fragments.

Background. The ceramic based on lanthanum zirconate is characterized by optimal mechanical characteristics, low corrosion potential and the absence of cytotoxicity. Thus, the possibility of its use as bone substituting material is currently studied.The purpose of the studywas to determine the mechanical, morphological and x-ray spectral characteristics of bone tissue after implantation of ceramic material based on lanthanum zirconate.Materials and methods. The experiment was conducted on 27 female guinea pigs of a single line, divided into 3 groups of 9 animals each. In the main group (LZ), lanthanum zirconate rods were implanted. In the comparison group (b-TCP), fixation was performed with b-tricalcium phosphate rods. In the native control group (NC) no surgical procedures were performed. A fracture was created in distal metadiaphysis area of femur using open osteoclasia. Animals were hatched 4, 10, and 25 weeks after the start of the experiment. Bone tissue features were studied in the perifocal region. The following methods were used: uniaxial compression, scanning electron microscopy (SEM), energy dispersive x-ray microanalysis (EDxMA). The statistical analysis was performed using the Mann-Whitney test.Results. The architectonics of the newly formed bone in the LZ group appeared as a developed lacunar tubular network. The structural components of the extracellular matrix were oriented along the bone functional load vectors. The Ca/P ratio in the periimplant region of the bone in the LZ group was significantly higher than in the b-TCP and NC groups. This may indicate a high strength of the newly formed bone. Mechanical testing showed that the strength and performance of the system of “lanthanum zirconate – bone” under uniaxial compression exceeded the similar indicators in the b-TCP group.Conclusion. The synthesized new material based on lanthanum zirconate seems promising for use in traumatology and orthopedics. Although, additional studies are needed to optimize these implants integration into bone tissue.

The effects of bone graft materials on the inflammatory response and biochemical markers of bone remodeling were studied on a rabbit model of fracture augmentation with the following grafts: β-tricalcium phosphate, demineralized bone matrix, nanostructured carbon implant, and porous titanium implant made by additive 3D printing. The markers of bone remodeling and the blood system response in the postoperative period were studied. It was found that porous titanium implant and β-tricalcium phosphate induced osteogenesis and minimized osteoclastic resorption. Augmentation with nanostructured carbon implant and demineralized bone matrix stimulated the processes of osteoclastic resorption.

The article analyzes the data of microscopic studies of human trabecular bone tissue. Differences in the deformation behavior are due to the morphology of the organic and mineral components of the extracellular matrix at all structural levels of the hierarchical organization of bone tissue. The purpose of the work was to determine the most informative microscopic method for certifying the deformed microstructure of trabecular bone tissue in terms of the mechanism of its formation at the microlevel. Proceeding from the localization of the appearance of impression fractures, the bone tissue of the lateral condyle of the tibial bone was taken for examination. All samples were divided into two groups: basic (N = 20, 50.0%), in which each sample was subjected to uniaxial compression; the control group (N = 20, 50.0%) was intact to the methods of studying the deformation behavior. For the certification of osteoarchitecture, modern visualization methods are applied: raster electron microscopy and atomic force microscopy. A detailed description is given of the deformation behavior of trabecular bone under uniaxial compression as the morphological substrate of impression defects. Photos of morphological changes during uniaxial compression are presented at the macroscopic, intermediate, and microscopic levels of organization of the extracellular matrix of bone tissue. It is established that trabecular bone tissue is a plastic material at all levels of the organization of the extracellular matrix. The morphological substrate of microfracture was determined at each structural level: macroscopic (100–200 μm) level – transverse, longitudinal, and fragmented trabeculae fractures; mesoscopic (10–50 μm) – interlamellar cracks observed in trabeculae; microscopic (5–10 μm) – the lamella is disorganized by collagen fibrils, the interfibrillar gaps are reduced, the hydroxyapatite crystals are disrupted and their bonds with collagen are destroyed. Each type of research complements data from other types of microscopy, none of them can completely replace the others.

: The trabecular bone tissue is a natural composite material with the developed hierarchical structure. The detailed study of its mechanical properties is important both for understanding the mechanism of injury production and for developing the optimal designs for osteosynthesis, prosthetics, and replacement of bone defects. The study of mechanical behavior of the trabecular bone under the cyclic loading is fundamental for the formation of current approaches to the prevention, as well as to the conservative and surgical treatment of fractures, as the bone tissue has different strength in different parts of the skeleton. The authors studied the uniaxial compression deformation behavior using five cylindrical specimens made from fragments of the trabecular bone tissue of lateral condyle of the tibia. The ratios of elastic and nonreversible deformations in the trabecular bone tissue of the subchondral area of the tibia under the uniaxial compression were investigated depending on the magnitude of the applied load and the total deformation. The authors carried out phased loading with the step of 0.5 % to 10 % of deformation and then with the step of 1 % to 15 % of deformation. The study showed that the trabecular bone is deformable both elastically and plastically. The elastic properties of bone tissue slightly decrease only with the appearance of macroscopic cracks in the sample. Thanks to the high porosity (30–90 %) and organic components, the trabecular bone is significantly deformable. The deformation of less than ~3 % is elastic and, therefore, does not lead to nonreversible changes in the trabecular bone tissue. With deformations exceeding 3 %, the nonreversible changes in the microstructure causing a depressed fracture of the limb bones take place in the bone tissue.

Purpose Improve results of surgical management of intra-articular impression distal radius fractures (DRF). Material and methods Retrospective study of 69 patients with intra-articular impression DRF surgically treated between 2011 and 2015 was performed. Inclusion criteria were impression intra-articular epimetaphyseal or metadiaphyseal defects seen on CT scan, open reduction and plating, and follow-up period of at least 36 months. Two groups of patients were identified to compare the effectiveness of new surgical technologies and bone grafting of impression defect applied in index group (n = 35) and conventional surgical technology with no graft in the control group (n = 34). Radiological, clinical and statistical methods of study were used. Parametric and non-parametric statistical tests were employed to evaluate significant differences. The difference between radial inclination (RI) and palmar tilt (PT) was measured to assess reduction persisted. DASH questionnaire (1996) was an outcome measure used for functional assessment. Results Intra-articular impression DRF were mostly seen in older adults and females with mean age of 48.9 ± 16.3 years. There were 14 (20.3 %) male and 55 (79.7 %) female patients. D.L. Fernandez type II fracture was most common (43.5 %). RI radiometric parameters measured 13.34 ± 0.43 ° in index group and 9.33° ± 0.51°(p = 0.003) in the control group at 3-month follow-up. RI was noted to decrease in the control group and showed maximum values of 3.71° ± 0.31°, p < 0.05 at 3-month follow-up. Excellent and good results were observed in index group at 36-month follow-up measuring DASH score of 94.2 % vs. 61.8 %, p < 0.05. Conclusion Surgical repair of intra-articular impression DRF combined with new approach and modern bone grafting materials facilitated restoration of optimal radiometric parameters of the distal radius with bone graft preventing secondary impression and providing reliable bone fixation with the possibility of early rehabilitation.

Purpose – to improve the tactics for surgical management of bicondylar tibia fractures to gain better outcomes. Materials and methods. The authors analyzed outcomes of surgical management of 69 patients within 36 months after the procedures. Two comparison groups were created to assess the effectiveness of the proposed techniques: the main group of 27 patients (39.1%) and control group of 42 patients (60.9%). In the main group the advanced and new techniques were applied (two-staged protocol of surgical correction, internal fixation with joint distraction, a combination of new L-shaped external and L-shaped internal approaches, bone grafting with b-TCP, carbon nanostructure implant and «Osteomatriks» xenograft). In the control group the conventional internal fixation was used. The difference in tibiofemoral (ΔFTA) and plateau-diaphyseal (ΔPDA) angles at various follow up stages were checked to evaluate reduction stability. P.S. Rasmussen score was used to assess the functional status and life quality of patients. Statistical methods of evaluation included parametric and non-parametric test to check confidence value of variances.Results. In 36 months postoperatively ∆FTA 5° in the main group was observed 1.97 times less than in control group (23.1% and 45.5% respectively); ∆PDA 5° in the main group was observed 1.66 times less than in control group (30.8% and 51.5% respectively). Total number of excellent and good results the main group 36 months postoperatively according to P.S. Rasmussen score was reported as 1.81 times higher than in the control group (50% and 27.6% respectively). Conclusion. The paper proves the efficiency of the proposed surgical procedure for bicondylar tibia fractures management.

Purpose – to improve the tactics for surgical management of bicondylar tibia fractures to gain better outcomes. Materials and methods . The authors analyzed outcomes of surgical management of 69 patients within 36 months after the procedures. Two comparison groups were created to assess the effectiveness of the proposed techniques: the main group of 27 patients (39.1%) and control group of 42 patients (60.9%). In the main group the advanced and new techniques were applied (two-staged protocol of surgical correction, internal fixation with joint distraction, a combination of new L-shaped external and L-shaped internal approaches, bone grafting with b-TCP, carbon nanostructure implant and «Osteomatriks» xenograft). In the control group the conventional internal fixation was used. The difference in tibiofemoral (ΔFTA) and plateau-diaphyseal (ΔPDA) angles at various follow up stages were checked to evaluate reduction stability. P.S. Rasmussen score was used to assess the functional status and life quality of patients. Statistical methods of evaluation included parametric and non-parametric test to check confidence value of variances. Results. In 36 months postoperatively ∆FTA >5° in the main group was observed 1.97 times less than in control group (23.1% and 45.5% respectively); ∆PDA >5° in the main group was observed 1.66 times less than in control group (30.8% and 51.5% respectively). Total number of excellent and good results the main group 36 months postoperatively according to P.S. Rasmussen score was reported as 1.81 times higher than in the control group (50% and 27.6% respectively). Conclusion . The paper proves the efficiency of the proposed surgical procedure for bicondylar tibia fractures management.

AIM:To improve surgical treatment of bicondylar tibial fractures.MATERIAL AND METHODS:Outcomes of 69 victims were analyzed. Two groups were compared to assess an efficacy of surgical techiques (two-stage surgery, osteosynthesis under joint distraction, combination of new L-shaped external and L-shaped internal approaches, osteoplasty with b-tricalcium phosphate, carbon nanostructured implant and xenoplastic material "Osteomatrix").CONCLUSION:Efficacy of treatment was higher in the main group compared with control group (50 and 27.6% respectively).

ГБОУ ВПО «Уральская Государственная медицинская академия Минздрава РФ», г. Екатеринбург (ректор – проф., д.м.н. С. М. Кутепов)Статья содержит литературный обзор отечественных зарубежных и научных публикаций за последние 5-10 лет, посвященных диагностике и лечению внутрисуставных переломов проксимального эпиметафиза большеберцовой кости. В работе представлены широко используемые классификации данных повреждений, показания к хирургическому лечению, освещены особенности применения внутреннего остеосинтеза, характеристики и обоснование выбора современных металлыофиксаторов. Использование современных методов диагностики внутрисуставных переломов проксимального отдела большеберцовой кости (КТ и МРТ), своевременно выполненное хирургическое лечение с восстановлением целостности суставной поверхности, восполнением субхондрального костного дефекта аутокостью и первично стабильный остеосинтез опорными металлофиксаторами позволяют, по данным литературы, достичь положительных результатов. Ключевые слова: большеберцовая кость, плато, проксимальный отдел, внутрисуставной перелом, остеосинтез, аппарат внешней фиксации, артроскопия, пластина АО, пластина LCP, система LISS, аутотрансплантат, аллотрансплантат, гетеротрансплантат, композитный кальций-фосфатный трансплантат.This article presents the literature review of native, foreign and scientific publications for the last 5-10 years dealing with diagnostics and treatment of intraarticular fractures of proximal tibial epimetaphysis. The authors describe the widely used classifications of these injuries, the indications for surgical treatment, as well as they highlight the details of using internal osteosynthesis, characteristics and substantiation of selecting modern metal fixators. The use of current methods for diagnosing the intraarticular fractures of proximal tibia (CT and MRI), timely performed surgical treatment with restoring the integrity of articular surface, subchondral bone defect filling with bone autograft, and primary stable osteosynthesis using support metal fixators allow to achieve positive results, by the data of literature. Keywords: tibia, plateau, proximal part, intraarticular fracture, osteosynthesis, an external fixator, arthroscopy, AO plate, LCP plate, LISS system, autograft, allograft, heterograft, composite calcium-phosphate graft.

Резюме. Проведен анализ оперативного лечения 23 больных с внутрисуставными переломами дистального отдела бедренной кости (тип B и С по классификации AO/ASIF) с применением метода открытой репозиции и накостного остеосинтеза пластинами. Авторами статьи предложен комбинированный метод хирургического лечения, заключающийся в проведении открытой репозиции и накостного остеосинтеза в условиях модуля шарнирно-дистракционного аппарата внешней фиксации. В статье приведены группы сравнения для оценки эффективности предлагаемого метода. В группе больных, пролеченных комбинированным методом, к отдаленному периоду получено 63% отличных и хороших результатов, что превосходило в 2,08 раз аналогичный показатель у контрольной группы.

Treatment results for 109 patients (mean age 56 ± 1.7 years) with monocondylar impression tibial plateau fractures (ITPF) are presented. Patients from the control group (n=63) were operated on during the period from 2008 to 1010, patients from the main group (n=46) - from 2011 to 2013. Patients from the main group were treated with regard for injury localization relative to plateau center according to proposed operational classification of impression fractures (by CT data) and algorithm to choose the osteosynthesis technique depending on the anatomic and morphologic peculiarities of the intra-articular injury. In patients from the main group the evaluation by Rasmussen scale 36 months after intervention showed excellent results in 15 (38.4%), good - in 22 (56.4%), satisfactory - in 5 (12.8%) of patients, no poor results were recorded, and in patients from the control group - in 6 (11.5%), 8 (15.3%), 36 (69.3%) and 3 (5,8%) patients, respectively. Three (7.6%) complications (secondary displacement of fragments (2), knee contracture (1)) were observed in the main group, and 11 (20.9%) in the control group (20.9%) - local infectious inflammatory process (4), secondary displacement of plateau fragments (6), condylar sag (1). Perfected tactics of treatment of patients with ITPF enabled to achieve 3.48 times more excellent and good results (p<0.05).

Введение.Тенденцией последнего времени в лечении внутрисуставных переломов дистального отдела костей (ДОКГ) является использование двухэтапной тактики с совершенствованием методик малоинвазивного остеосинтеза.Цель.Оптимизировать двухэтапную тактику хирургического лечения пациентов с внутрисуставными переломами дистального отдела костей голени.Материалы и методы.Основу исследования составил анализ 84 случаев хирургического лечения пациентов с внутрисуставными переломами ДОКГ.Для систематизации костной травмы использовали классификацию АО/АSIF, повреждение мягких