The incidence of distal tibia-fibula fractures is as high as 100–200 cases to 200,000 of the population a year with ankle fractures being the most frequent. The methods of surgical management for these fractures are numerous but transosseous osteosynthesis by G.A. Ilizarov is the most adequate to human physiology. Its modifications (including the use of various kinds of transosseous elements) result in the decrease of the rate of complications typical for this method. This research investigates the stresses emerging in the bone fixed with transosseous fixators and the selection of the preferred positions for their insertions in the management of ankle fractures and their consequences. The study of the contact surface of rods and various kinds of nails with the bone revealed that the contact surface widened and therefore the stress in the osseous tissue decreases depending on the size of the threaded screw portion as well as the number of threads inserted into the bone. The points of insertion should correspond to the widest part of the bone (metaphyseal areas) as it provides a larger contact area of the screw thread with the bone fragment decreasing the probability of its failure and the formation of gaps between bone and crew (aseptic necrosis) that reduce the fixation stiffness within the system of external fixation apparatus.

Objective: to analyze some parameters of cellular and humoral immunity and peripheral blood cytokines in patients with grade III idiopathic gonarthrosis, as well as to identify most significant laboratory immunological tests indicating the activity of articular tissue degradation. Materials and methods. We assessed laboratory parameters reflecting the immune status in 20 patients with grade III idiopathic gonarthrosis (18 males and 2 females; mean age 64.1 years (range 58.6; 62.1 years). Results. We observed some immunological changes in peripheral blood of patients with grade III gonarthrosis, such as a decrease in the T cell count (T-helpers and T-suppressors), B cell count, and in the level of immunoglobulins G along with an increase in the count of natural killers, levels of serum immunoglobulin A, and proinflammatory (TNFa, IL-6) and antiinflammatory (IL-10, IL-4) cytokines. Conclusion. Degenerative dystrophic changes in the knee joint affect the immune status of patients with grade III gonarthrosis. It is necessary to evaluate parameters of cellular and humoral immunity of patients with advanced gonarthrosis before surgical interventions in order to minimize the risks of early and late postoperative complications.

The study investigates the treatment of septic ankle arthritis, a challenging issue of contemporary trauma care. Purulent infection of the ankle is persistent and repeated. The paper describes new technology that enables the resolution of infection in the ankle and formation of bone ankylosis in surgical management of osteoarthritis. The method was tried in 22 patients; none of them suffered any relapses of infection in over 5 years.

The assessment of clinical testing results of the new intramedullary rod which design features neutralize the disadvantages of conventional blocking devices.

Aim: to perform comparative analysis of surgical outcomes of patients with extraarticular fractures of proximal femur with the use of various types of external osteosynthesis. Material and Methods. 169 patients with extaarticular fractures of proximal femur who underwent surgical interventions with various kinds of external osteosynthesis were the subject of the study. Results. Extra-cortical osteosynthesis with DHS-construction provided the restoration of anatomic and functional characteristics by 90.3±0.6% of normal values in the short-term and by 95.2±0.4% in the long-term postoperative period. The implantation of intramedullary constructs resulted in high percentage of positive short-term (92.1±0.6%) and long-term (96.7±0.75%) treatment outcomes. Conclusion. The use of intramedullary osteosynthesis

ТЕХНОЛОГИЯ ЛЕЧЕНИЯ ГНОЙНЫХ АРТРИТОВ ГОЛЕНОСТОПНОГО СУСТАВАГражданов К.А. 1 , Барабаш А.П. 1 , Барабаш Ю.А. 1 , Кауц О

The aim of the study was the development and clinical approbation of the method of treatment of purulent arthritis with the formation of ankle ankylosis. Materials and MethodsTwenty-two patients underwent surgery after ankle trauma complicated by inflammation (18 male and 4 females ranging in age from 28 to 62).To open the ankle joint, an anterior approach was used.After opening the cavity of the joint, surgical treatment of the purulent-necrotic focus with necrotic sequestrectomy and resection of the tibia and talus bones were performed within the limits of healthy bone tissue, after which a compression/distraction device was applied.Distraction in the area of the resection of the tibia and talus bones artificially created a cavity in the ankle joint simultaneously.Through additional punctures in the projection of external and internal ankle bones, a perforated drain was placed in the created cavity.[Bonesaw-lines] of the tibia and talus bones were drawn together to the dimensions of the drain tube.In the postoperative period, sanitation of the purulent-necrotic focus was performed by means of continuous draining of the created cavity with antiseptic solutions.After the bacterial inoculation cultures were negative three times, the draining tube was removed, and gradually the tibia and talus bones were moved closer.The external fixation device was switched to the mode of consistent stabilisation with the possibility of putting weight on the damaged extremity.Fixation in the device continued until the X-ray picture of bone ankylosis in the ankle was obtained ResultsFor all patients we were able to achieve stable remission of the inflammation process and formation of a strong bone ankylosis in the ankle.The sanitation period of the purulent-necrotic focus was 14-16 days.After removal of the drain and compression in the external fixation device, the patients were allowed to move on crutches with moderate weight on the operated extremity.Duration of fixation in the device was 16-20 weeks.During 5 years of continuous follow-up, no relapses of inflammation in the ankle joint were observed. Conclusions.The suggested method makes it possible to solve the problem of ending inflammation in the ankle by means of forming bone ankylosis during surgical treatment of purulent osteoarthritis.

Aim: retrospective analysis of surgical treatment results of patients with the consequences of humerus fractures by locking intramedullary constructions. Material and Methods. 69 patients with ununited fractures and false joints of humerus diaphysis (39 females, 56.7±11.5 yrs (56.5%) and 30 males, 52.3±9.8 yrs (43.5%)) comprised observation group. In the course of surgical intervention they were treated by locking intramedullary rods to perform fragment anchorage, this including 12 patients (17%) with ununited humerus diaphysis fractures after conservative treatment, and 57 (83%) with false humerus joints. Clinical (limb functional restoration) and X-ray (integrity signs) methods were applied for the diagnostics and control of integrity restoration in bone structures; for the assessment of treatment outcomes we used standardized system of outcomes of locomotor fractures and their consequences (SOI-1). Results. Consolidation of the fracture up to 6 months postoperatively was observed in all patients with ununited humerus fractures, treatment outcomes by SOI were 85-94% of anatomic and physiological norm. The consolidation of humerus bone occurred in 50 patients with false joints with

The aim: to study the indices of stress-deforming state of biomechanical system «bone — hybrid anchor» in proximal humerus fractures. Material and Methods. The study of anchorage stiffness in juxta-articular fracture (type 11A3 by AO/ASIF) through applying three load types: axial (200 N), transverse (30 N) and torsional (5 N*m) was conducted followed by CAD modeling in SolidWorks and the analysis of stress-deforming state of the system «bone — anchor». Results. While studying the stability of «bone — anchor» system it was found that a new device for proximal humerus fracture ostheosynthesis under the applied loads do not decompose with maximal translocations of bone fragments and maximums of equivalent stress being present under torsional load and comprise 1.6 mm. and 152 Mpa respectively. Conclusion. The application of hybrid devices for juxta-articular fractures of humerus allows carrying out minimally traumatic anchorage with the following early functionality of the injured segment.

The aim: to identify the efficiency of the improved technology of treatment of tibia marginal defects with the use of granular composite osteoplastic materials during external fixation of fragments. Material and Methods. The observation group was made up of 12 patients with the consequences of lower extremity traumas who had undergone osteosyn-thesis of fractures by an external fixation device with defect alloplasty We used clinical and ray-tracing testing methods and also standardized system of assessment of outcomes of bone fractures and their consequences to control the processes of restoration of bone structure integrity. Results. According to the standardized system of assessment of outcomes in 12-18 months in the course of the rehabilitation measures degree of restoration of anatomic functional indices was 92±5%. Bone density made up 91,3±0,54 HU (p<0,05) before surgery according to the Hounsfield scale, increase in the given parameter was observed in a month and a half after surgery up to 153,1 ±0,97 HU and in 3 months up to 162,7±0,78 HU. Conclusion. Application of granular composite osteoplastic materials for plastic surgery of tibia marginal defects during external fixation of fragments allow us to carry out anatomic reconstruction of the bone reducing surgery injury rate based on the absence of necessity of taking autogenous tissues from the other zones.

A comparative analysis of indicators of cytokine profile in the experiment on laboratory animals (rabbits) at different times after transosseous osteosynthesis model of fracture of the tibia and the use of stimulus effects on reparative osteogenesis. As reparative osteogenesis promoters were used tunnelization bone fragments hydrodynamic effect on the fracture zone and a combination thereof. The fastest recovery indicators cytokine profile to baseline values ​​occurred in the group with stimulation of bone formation by tunneling all fragments fracture of the tibia. Attention is drawn to the fact that in this group of animals normalization of tumor necrosis factor occurred a week earlier than in the comparison group and other experimental groups, indicating that the most efficient method of stimulation of reparative osteogenesis.

In experiment on rabbits was studied the influence of stimulation of reparative osteogenesis by tunnelling fracture zone and hydrodynamic effects on the bone marrow. Studied x-ray and morphological results bone healing the wounds on the terms of 1, 2 and 3 weeks after the operation. The best results were noted in the group, where as a method of stimulation of regeneration of bone tissue was used tunnelization ends of fragments of a fracture of the tibia. The attempt to use for artificial stimulation hydrodynamic effects on the bone marrow showed the worst results due to the devastation of the red bone marrow and substitution last fatty tissue, as well as disorders of microcirculation and hypoxia.

In the work the analysis of methods of treatment of trochanterian fractures of the femur in 128 patients of elderly and old age who underwent the course of medical treatment in the clinic of acute trauma during the period from 1989 to 2010 is carried out. Results of treatment of patients by conservative (41) and surgical methods (external 26 and transosseous osteosynthesis 61) are evaluated. Absence of any prospect of the conservative treatment resulting in the progression of hypodynamic complications and consequently in 80 % of cases to formation of unacceptable results is proved. The indications for minimally invasive transosseous osteosynthesis, which is more preferable for elderly patients with the burdened somatic state are determined. For «safer» patients the application of immersed designs (DHS) caused the greater percentage (88,3%) of good results with optimal conditions of the life quality.