Objective. To analyze changes in the nosological structure of patients, treatment technologies, to outline the peculiarities of surgical interventions in the trauma profile of a civilian clinical hospital during the war period and to emphasize the need for relevant knowledge and skills of specialists in the treatment of combat trauma and its consequences.Methods. A comparative analysis of the clinical and nosological structure of 2,475 patients were treated during the year before the war and 3,838 patients during the full-scale war year. Among them, 83.1 % were civilians, 7.7 % were temporarily resettled, and 9.2 % were military personnel. The study utilized bibliosemantic, medical-statistical, and clinical methods. Results. During the active phase of the war, the Orthopedics Department of the civilian clinical hospital provided specialized medical assistance to both civilian populations and military personnel injured during hostilities. The relative number of hospitalized men increased by 4.83 %, and although the absolute number of those urgently hospitalized decreased. Despite the overall increase in the number of operations per patient, surgical activity in the Orthopedics Department decreased from 86 to 80 %. The intensification of inpatient treatment organization, patient preparation for subsequent stages of surgical interventions in the Rehabilitation Department, and outpatient medicine work collectively reduced the average bed-day in the Orthopedics Department by 12.3 %. Conclusions. Thus, during the war, the structure of patients in the Orthopedics Department of the civilian medical clinical institution changed, with an increase in the relative number of male patients and those with multiple and combined injuries. A notable feature of the treatment process organization during hostilities is the phasing of the treatment of the wounded not only at the levels of medical evacuation but also within the clinical hospital. The intensification of the organizational component and the outpatient link of the treatment process allowed for a reduction in bed-days and the provision of inpatient treatment to a larger number of patients.

One of the most common complications of long-term talocrural joint (TCJ) injury is the development of chronic instability. Among the risk factors for its occurrence - congenital or acquired shortening (hypoplasia) of the lateral malleolus of varying degrees. Objective. Determine the effect of lateral malleolus hypoplasia on the distribution of stresses in the bone and ligament elements of the foot. Methods. Mathematical modeling of the distal end of thelower extremity was performed. There are two variants of the position of the heel bone — varus and valgus with an angle of deviation from the vertical axis in both cases 15°. A vertical distributed load of 700 N was applied to the tibial plateau. On the supporting surface of the feet model's were rigidly fixed. Measurements of mechanical stresses were performed at control points. According to the criteria for estimating the stress-strain relations (SSR), the Misesstress was used. Results. It was determined that lateral malleolus hypoplasia increases the values of stresses on the lateral side of the distal tibial bone from 6.3 MPa to 6.4 MPa, from the medial — on the heel bone from 5.8 MPa to 6.0 MPa, talus from 2.1 MPa to 2.3 MPa. SSR on TCJ are also varies. In the case of a neutral position of the heel bone, lateral malleolus hypoplasia causes a decrease in the values of the ligaments on the lateral side of the TCJ,which can be explained by their elongation and, consequently, the projection increase in length In the case of varus or valgus position of the heel bone under conditions of lateral ankle hypoplasia, it was found that the varus position of the heel bone overstrains the ligaments on the lateral side, valgus - from the medial. Conclusions. Decreased stress in the ligaments of the TCJ in cases of valgus or varus position of the heel bone is one of the factors reducing the functional stability of the joint and may be the cause of its chronic instability.

The treatment of mobile flat-foot deformity in children with cerebral palsy remains unresolved due to a variety of structural, functional and biomechanical changes in the foot, as well as the complex pathogenesis of formation. Objective: to present a differentiated approach and analysis of the results of surgical treatment of mobile flat-foot deformity in children with cerebral palsy. Methods: the results of surgical treatment of mobile flatfoot deformity were analyzed in 39 patients with cerebral palsy, who were divided into three groups. The choice of intervention method depended on the child's age, level of motor functions and clinical characteristics of the deformity. Sape and function disorders of the foot were evaluated according to AOFAS hindfoot scale. The author’s working clinical and radiological classification of this deformity was also applied. Results: surgical treatment of mobile flat-foot deformity in patients with cerebral palsy aged 7–11 years using soft tissue surgery is accompanied by a significant percentage of reccurence deformations (66.7 %). Additional application of the technique of subtalar arthroereisis can improve clinical and radiological results, but 80 % is accompanied by the development of chronic pain syndrome. In patients with cerebral palsy, older than 12 years, the effectiveness of surgical treatment of moderate and severe mobile flat-foot deformity using corrective lateral elongating osteotomy of the calcaneus bone and corrective osteotomy of the medial sphenoid bone has been clinically confirmed. Conclusions: the developed algorithm for differentiated choice of surgical treatment for mobile flat-foot deformity in children with cerebral palsy, depending on age, level of motor functions and clinical characteristics of the deformity, allowed us to choose between minimally invasive methods (subtalar arthroereisis, soft tissue surgery) and surgical interventions on the bones and joints of the foot (corrective calcaneus osteotomy, arthrodesis of the joints of the posterior and middle parts of the foot).

Objective: to study the stress-strain state of the hip joint elements in cases of different localization of the destruction of the femoral head due to aseptic necrosis in children with lesions 50 and 75 % of its volume. Methods: on mathematical models of the hip joint, the stress-strain state was investigated in the case of femoral head defects of 50 and 75 % of its volume of various localization. The model consisted of components with the properties of cancellous and compact bone tissue, as well as with growth zones with the mechanical characteristics of cartilage. The models were loaded with a vertical distributed force of 270 N. Reproduced the action m. gluteus medius of 450 N and m. gluteus minimus force of 200 N. Results: when we increased the area of the femoral head defect up to 50 % at weight bearing on a limb the values of maximum stresses increased in all studied areas of the model compared to the normal state and the case of 25 % defect. At increased defect upto 75 % in the critical zone, the stress-strain state reached the number of 31.9 MPa, stress increased on its lateral edge in the cortical layer up to 25.6 MPa, and in the cancellous boneup to 9.1 MPa. Stress decreased on the medial edge of the defect to 5.0 MPa in the cortical layer and up to 0.8 MPa — in the cancellous bone. Near the middle part of the defect stress increased in the cortical layer to 4.8 MPa, and in the cancellous bone decreased to 0.8 MPa. Conclusions: in the models with a lesions size of 50 and 75 %, the most unfavorable is the location of the defect on the border of the upper edge of the acetabulum and the upper part of the femoral head, in the zone of its greatest load. If the volume of the femoral head goes up to 50 %, with the weight bearing on the limb the values of maximum stresses increase practically on all studied areas of the hip joint model. The size of the lesion of the femoral head up to 75 % leads to an increasing of magnitude of the stresses in the loaded areas and to a decreasing in other investigated areas.

On October 4-5, 2017, events took place in Kharkiv on the occasion of the 110th anniversary of the State Institution "Institute of Spine and Joint Pathology named after Professor MI Sitenko National Academy of Medical Sciences of Ukraine "

In the last decade, there has been an increase in the number of patients of different ages with the pathology of the foot. Thus, the flatfoot, according to different authors, is from 35 to 50 % of the entire pathology of the feet in children and up to 75 % in adults. One of the modern methods of surgical treatment of flatfoot is subtalar arthroesis. However, the researchers did not agree on its effectiveness. Objective : to study the stress-strain state of the bone elements of the foot in the normal and with flatfoot deformity. Methods : to solve this problem, a fi­nite-element foot model was constructed, consisting of heel, talus, n avicular a nd s phenoid b ones, a s w ell a s t ibial a nd peroneal fragments. The joint surfaces were modeled by ele­ments with mechanical properties of the cartilaginous tissue. Results : it is established that for the foot model, the stress inten­sity in all bone elements is uniformly distributed and has values in the range from 0.1 to 1.7 MPa. The zone of increased stress level is located on the supporting surface of the heel bone, where their maximum value reaches 4.9 MPa. As a result of the study of the model, a stress level was revealed in all bone elements of the foot, especially on the supporting surface of the calcaneus (from 4.9 MPa in the norm to 7.2 MPa) and on the surfaces of the joint, on the scaphoid bone (from 0.6 MPa in the norm to 6.9 MPa with the FFD). The highest concentration of stress­es is determined on the posterolateral part of the joint surface of the talus bone — from 1.0 MPa in the norm to 13.5 MPa. Conclusion : the increase and redistribution of stresses in the os­teochondrium elements of the foot in case flatfoot deformity can be a trigger mechanism for the development of an unstable ankle joint and arthrosis phenomena in the joints of the foot.

One of the modern types of flatfoot surgical treatment is subtalar arthroereisis with implant placement in sinus tarsi. There are a lot of kinds of such implants.Objective: to study stress-strain state of the foot bone elements in normal and in cases of its flatfoot deformity before and after implant placement.Methods: we made finite element model which consist of tibia, fibula, talus, calcaneus, navicular and cuneiform bones. Joint surfaces were modeled with mechanical properties of cartilage tissue. We compared two types of models-conical and cylinder, also made assessment of mechanical properties (titanium, sapphire, carbon) on stress-strain state.Results: using of implants with conical and cylinder shape led to increasing of stress values in the place of contact with the bone, especially on the subtalar surface 8,0 и 7,1 МPа. Difference in stress values on the all areas of the foot model with both implants is not significant, but at cylinder shape implantation we observed quantitatively better indexes improvement. Implant material does not influence on the strain distribution in the foot bones.Conclusions: using of implants for subtalar arthroereisis can influence positively on strain distribution of the foot at its surgical correction. Subtalar arthroereisis is one of the kinds for flatfoot deformity treatment and ankle joint stabilization.

Aseptic femoral head necrosis in children has a polyethiological structure and leads to the formation of various deformities or the entire proximal femur. Consequences of this may be the early development of hip joint arthritis.Objective: to study the stress-strain state of the hip joint components in cases of femoral head defects of 25 % of its size with different localization due to aseptic femoral head necrosis in children.Methods: a simplified finite element model of the child's hip joint was constructed and mathematical studies of the stress-strain state were performed in the normal joint and modeling of the femoral head defect with a 25 % of its volume. The defect was located in the lower and middle parts of the femoral head, in the zone of its loading and at the boundary of the upper edge of the acetabulum. The study of the stress-strain state model was made under the influence of a vertical load of 270 N, and also simulated the effect of the gluteus medius (450 N) and gluteus minimus (200 N) muscles.Results: Normally the main loading transfers through the cortical layer of the femur, the tensions in the cancellous bone are insignificant. The most stressed zone is the femoral neck, especially in the upper part, in the area of its transition to the head under the growth zone. In the case of a defect in the medial and upper parts of the femoral head, slight changes of the stress-strain state were found, and at the border of the upper edge of the acetabulum and in the growth zone — were pronounced. The maximum stress level reached 22.0 MPa, which is 2.5 times higher than the norm.Conclusions: as for to stress distribution in hip joint models, the most unfavorable position is the location of the defect in size 25 % of the femoral head volume at the border of the upper edge of the acetabulum and in the upper part of the femoral head, in the zone of its main load. It is with this option that the highest level of stress is observed on all the sites of the femur.

The flat-valgus foot deformity is one of the most common pathologies of the bone-joints system. flat-valgus foot deformity leads to the development of hallux valgus, excessive torsion of the crus, valgus deformation at the ankle and knee joints.Objective: to analyze the stress-strain state of the foot elements in the case of the results of experimental lumbar posterior-lateral fusion with platelet rich fibrin and after its correction with screws for subtalar arthroris.Methods: a biomechanical (mathematical) study was made with the finite element method on the foot model in normal and with The results of experimental lumbar posterior-lateral fusion with platelet rich fibrin. We performed subtalar arthroris with corrective screws, implanted into the calcaneus or talus bones.Results: in case of the results of experimental lumbar posterior-lateral fusion with platelet rich fibrin increases the level of stress in all the elements of its bone model, especially on the supporting surfaces of the calcaneus and the surfaces of subtalar joint. At screws fixation there are two areas of high stresses (in the contact of the bone elements of the model with screws) with absolute values exceeding the parameters of the model with the results of experimental lumbar posterior-lateral fusion with platelet rich fibrin. Strain distribution was almost equal in cases of screw implantation in the calcaneus or talus bones. The highest stresses in the talus (12.5 MPa) were lower in the model with screws implanted into the calcaneus (11.1 МПа), so this option can be considered to be better.Conclusions: usage of screw for subtalar arthrorisis allows to reduce stresses compared to the model with implants for arthroeresis, with the exception of contact points of bone with screws.

The paper presents an analysis of the scientific literature on the treatment of plano-valgus deformity of the foot (PVDF) in adults and children using subtalar arthroeresis. The indications and contraindications for this intervention discussed and possible complications are shown.It is shown that, on the one hand, most authors emphasize quite high efficiency of the said intervention (from 60 to 95.4 % of excellent and good results) in the presence of the other undoubted benefits — less traumatic and minimally invasive, relative cheapness, early verticalization and timely reha­bilitation that meets modern requirements in orthopedics.On the other hand, the method could provoke different complications that do not exclude the repeated interventions and the development of irreversible states in the posterior part of foot.An algorithm choosing the optimal treatment PVDF in children, including the conditions of cerebral palsy, depending on the grade of foot deformity and characteristics of movement disorders, has not worked out yet. There are no generally accepted clinical-radiographic criteria for the choosingof type and size of implant. Determining the indications and contraindications for subtalar arthroeresis requires clarification in children of different age groups.The issue of early postoperative treatment and further rehabilitation patients (both children and adults) were not practically highlighted. Combination of subtalar arthroeresis with other interventions in different parts of the foot and various anatomical structures (soft tissue and bone) depending on the patient's age and degree of foot deformity remains to be a questionable issue. The authors emphasize that today no papers are found in the scientific literaturethat meet the high level of evidence and efficacy of use of sutalar arthroeresis in the conditions of PVDF in children and adults.

У статті представлено матеріали Всеукраїнської науково-практичної конференції «Сучасні дослідження в ортопедії та травматології», проведеної у Харкові 30-31 жовтня 2014 року.

The article presents the materials of the international medical forum, which was held in Kiev on April 15–17, 2015.

On the basis of radiometric studies to identify possible options for the deviations in the structure of the greater trochanter (gt) in the pathology of the hip joint (hj) of various origins, to develop a working classification of its deformations (abnormal location) for further substantiation of methods of surgical treatment. methods: we performed a retrospective analysis of clinical examination and radiological diagnostics (x-ray, ct and mri) to compare the development of a trochanteric component of hj in 153 children with varying of its pathology (congenital dislocation and subluxation of the hip, deformation of the proximal femur due to injuries and inflammatory disorders, sepsis, suppurative arthritis, etc.) coxavara, aseptic necrosis of the femoral head, and hj patholog y on a background of neurological diseases (cerebral palsy, spinal hernia). results: there were identified and classified options of violation in gt structure as well as its spatial deviation from the norm with respect to the center of rotation of the femoral head in children with hj disorders of various origins. the most pronounced changes in the trochanteric component of hj were established in the case of inflammatory diseases carried in the period from birth to 6 years. changes of gt in cases of hj pathology of other genesis depend on the age at which it is developed, the area and the extent of damage in growth zones of the trochanter and the femoral head, peculiarities of pathology, treatment, the rate of growth of the child. firstly developed working classification of gt deformations in children for integrated assessment of hj, in particular its trochanteric component will create in the future a diagnostic and treatment algorithm of welltimed diagnostics, prediction and early surgical treatment, will lead to better anatomical and functional outcomes in patients with this pathology.

Objective: To assess the results of correction of the shape and position of the greater trochanter of the femur (GTF) after surgical treatment of hip joint (HJ) pathology in children. Methods: A retrospective analysis of the results of surgical treatment of the GTF deformities in 70 children (46 boys and 24 girls) between 2 and 18 years old. The children were divided into several groups: 18 patients with deformities the GTF (pathological hip dislocation (PHD) and the consequences of osteomyelitis), 8 with avascular necrosis of the femoral head (ANFH), 33 with congenital hip dislocation and 11 with coxa vara. The results of the treatment were assessed in terms from 3 to 16 years with the help of clinical, biomechanical and radiological methods. Results: In 88.7 % of cases there was achieved an improvement in clinical, radiological, biomechanical marks characterizing the HJ state comparing to preoperative ones. So, the symptom of Trendelenburg disappeared or decreased, strength of the abductor muscles increased in average on 11–20 % in the cases of coxa vara and on 30-45% in cases of ANFH. Indicators statopodographic study had a clear tendency towards normalization. Radiographic characteristics of trochanteric component of the HJ were within normal limits for each patient. Based on the working classification of the deformations of the GTF developed a differentiated approach to surgical procedures on it was offered in view of multiplanar character, extent and rate of progression of deformation, as well as with etiological factor and age of the patients. The most favorable outcomes after 3 years or more after the operation were obtained in cases of ANFH and coxa vara, and the least favorable - in the group of children with consequences of inflammatory diseases. Conclusion: The diagnosis and correction of the shape and position of the GTF in children with pathology of the HJ deserves special attention, and the surgical treatment of these abnormalities allows you to get better anatomical and functional results.

Objective: to determine the status and structure of children's disability due to vertebral pathology. Methods: With help of mathematical methods for the statistical processing of socio-sanitary data a comparative analysis of abundance of injuries and spinal pathology among children, and indicators of child disability in 2012 was conducted in eight regions of Ukraine — Donetsk, Kharkiv, Zakarpatian, Chernivtsi, Kirovohrad, Kherson, Poltava and Sevastopol. Results: Level of disability due to spinal pathology among children has no direct relationship to the prevalence of this pathology which may be due to severity of spinal diseases, lack of common methodical approaches to the definition of disability signs of a sick child, and the quality of the provision of orthopedic and trauma care for children in the region. In structure of children's disability due to injuries and diseases of the musculoskeletal system pathology of the spine is (19,46 ± 1,76) % in average. Herewith the amount of children recognized as disabled persons due to this disorder increases. Peculiarities of the structure of children's disability on nosologies depending on age were revealed. In children surveyed (77,83 ± 0,06) % accounted for dorsopathies, (19,90 ± 0,06) % — for congenital deformities and malformations of the spine, and (2,27 ± 0,002) % — the consequences of vertebral fractures. In disabled children with dorsopathy the majority (70,53 ± 0,06) % were patients with scoliosis. Conclusion: Scoliosis, congenital deformities and malformations of the spine the most often lead to significant limitation of life and disability in children of all ages. However, among patients from 12 to 18 years, in contrast to other age groups juvenile osteochondrosis, intervertebral disc lesions and spondylopathies in cases of systemic diseases can also be cause of disability.

Abnormalities of development of hip joints (HJ) in children with cerebral palsy (CP) lead to hip decentration, subluxation and dislocation. Spastic hip subluxation and dislocation is a significant problem in patients with CP and leads to significant disturbances of self-service and movement functions.Purpose: to identify patterns of development of HJ in children with CP basing upon retrospective clinical and radiographic analysis.Methods: this work is based on an analysis of 148 medical records of children with CP with hip subluxation and dislocation treated at the hospital. There were 86 boys and 62 girls among them. All patients were divided into 3 age groups (from 1 to 6 years, from 6 12 years, and from 12 to 18 years) as well as according to mode of CP: hemiparetic mode was in 24.3% of cases (36 patients), double hemiparesis (tetraparesis) - in 13.5% (20 patients), spastic diplegia - in 37.2% (55 patients), hyperkinetic mode - in 10.8% (16 patients), atonic-astatic mode - in 6.1% (9 patients), and mixed one - in 8.1% (12 patients). Concerning the level of motor activity according to the GMFCS classification all patients were divided as follows: in 61 patients (41.2%) there were marked movement disorders of the 2nd level, in 50 (33,8%) patients – the 3rd level, and in 37 (25,0%) – the 4th level.Results: dynamics of main indexes of HJ development were analyzed and direct dependence of the degree of pathological changes in HJ in children with CP on the severity of neurological and orthopedic deficit was revealed. Clinically, the most informative sign is magnitude and dynamics of limitations of hip abduction and extension (severity of hip flexion-adduction contracture) which correlates with value of migration index (MI). We strongly insist on exacerbation of orthopedic cautions in the "non walking" children (GMFCS III, IV, V) concerning development and progression of HJ pathology. The beginning of spastic hip subluxation and dislocation has usually no clinical manifestations. Examining the children with CP one must follow the principle: to define HJ abnormal until otherwise will not be proven. We recommend to make panoramic X-ray films of the pelvis in all children with CP at the age of 1 year for screening assessment of pathological changes in HJ and for further dynamic surveillance. The main attention should be paid to the analysis of the values of the MI, Wìberg's angle (WA) and acetabular index (AI).Conclusions: clinical examination and analysis of the pelvis panoramic radiographs in children with CP allow to distinguish clinical groups and to define individual approaches to the choice of medical (including surgical) tactics and to keeping children of this category. MI clearly correlates with the femoral neck-shaft angle, AI and WA, and the dynamics of these indexes allows to use them as prognostic indicators of HJ development. Discovered anatomical and functional differences between the signs of congenital and spastic hip dislocation in children with CP have to be used in daily practice of children's orthopedics-traumatologists and must be taken into account while planning medical therapies (conservative and/or surgical) for eliminating HJ pathology.

Objective: To present outcomes of applying of a method of tempo­rary blocking of long bones’ sprout area for treatment of frontal angular knee joint deformities (FAKJD) in children. Methods: From 2010 to 2014 at the clinic of the Institute we treated 14 patients (9 boys, 5 girls) with FAKJD (mean age 11 years 2 months). In 8 patients (57.1 %) we revealed varus, and in 6 (42.85 %) valgus deformity. Among children with varus FAKJD in 7 of them we diagnosed Erlacher-Blount disease, and in 1 we found postosteomyelitic deformation. In patients with valgus FAKJD in 5 cases we revealed dysplastic deformities, and in 1 — postosteomyelitic deformation. We performed clinical examination with measurement of tibial-femoral angle (TFA) and X-ray protocol proposed by D. Paley. The average value of clinical TFA in patients with varus FAKJD was 15° (10° to 24°), and with valgus — 13,25° (11° to 18°). In all patients we performed temporary blocking of long bones’ sprout area using the plate with two screws. Control examinations were performed every 3 months. We defined clinical TFA, radiological assessment of deformation conducted according to D. Paley. After reaching full correction of deformity we removed plates. Results: Full correction of FAKJD in 13 patients there was in a period of 7 to 16 months. In one child with varus FAKJD (age 10 years) correction for 14 months could not be reached because of the lack of growth of the patient. The average speed of correction of deformation was 0,9° per month. Complications during treatment were not recorded. Conclusions: Minimally invasive method presented is effective in treating FAKJD in children with Erlacher-Blount disease, and with deformities of dysplastic and postosteomyelitic etiology.

The article deals with the problem of early diagnosis of traumatic epiphysiolysis in the distal radius “without displacement of epiphysis” (type I by the Solter-Harris classification, 1963). Clinical, radiological and sonographic examinations were conducted in 58 cases with an injury of the distal forearm. A method of early diagnosis of distal epiphysiolysis of the radial bone and a technique of ultrasonographic examination were developed; sonographic semiotics of traumatic epiphysiolysises of the distal radial bone “without displacement of epiphysis” is described. An algorithm for diagnosing injuries in the distal part of the radial bone was developed.