Vol 3, No 3 (1996)

The authors elaborated new tacktics for simultaneous combined reconstructive operations in patients with severe limb injury sequelae. Experience included 268 patients, aged 13-56, who underwent microsurgical operations for restoration of injuried fragment of the limb. The total number of interventions was 589; altogether 474 tendons (169 patients), 277 nerves (194 patients), 76 arteries (114 patients) were restored. For the correction of secondary neurogenic deformity of fingers and wrist (170 patients) 200 operations were performed. In 50 patients plasty with free vascularized skin-bone grafts was carried out. In 22 patients free skin (18 cases), skin-fascial (2 patients) or skin-tendenous (2 patients) plasty was carried out. In 13 patients total elbow joint replacement using Sivash implant, in 3 patients total replacement of metacarpophalangeal and in 1 patient - matatarsophalangeal joints was performed. In 4 patients transposition of broadest muscle of the back was performed due to sequelae of severe damage of shoulder area or elbow joint. Good and satisfactory results were obtaained in 87.6% of cases.

The experience of halo-apparatus application is presented in 36 patients, aged 1,5 - 60 years, with injuries and pathology of the cervical spine. There were 12 patients with fractures of the odontoid process, 6 patients with C2 arch fractures, 2 patients with transligamentous dislocation, 1 patient with epiphysiolysis, 5 patients with rotatory subluxation, 2 patients with Jefferson fracture, 2 patients with eosinophilic granuloma, 4 patients with subluxation in the lower cervical spine and 2 patients with discitis. In all cases halo-apparatus showed its high efficacy as a stabilizing and correcting device. Obtained results allow the authors to recommend more wider application of halo-apparatus in clinical practice.

The thesises detected do not allow to keep the pathogenesis of PD within the framework of the theory of primary vessels occlusion. In children with PD marked anomalies including the retardation of bone growth, increased rate of signs of general dysplasia of the connective tissue (detected also in near ralations - parents and siblings), changes of «nondamaged» contralateral head of the femur and spine, disturbance of glycosaminoglycane metabolism, asymmetric retardation of growth of different segments of the limbs. The authors believe that PD is the damage of femur associated with its overloading or another provocing factors that occur on the background of genetically substantiated defect with the damage of bone development. Further infarcts of the head of the femur develop repeatedly and independantly and thus the cupping of PD could be delayed. By the authors opinion PD could not be considerad as femur pathology in a normal child any more but rather as a local manifestation of the general skeleton dysplasia.

Twenty seven patients (9 men and 18 women, aged 16-87 years) with the fractures of the condyle of the tibia complicated by subluxation or dislocation of the crus were observed. The authors believe that the most effective treatment method for such injuries is the reposition with apparatuses on the orthopaedic table and simultaneous fixation of the fragments by specialscrew that allows to eliminate subluxation or dislocation of the crus and to perform compression osteosynthesis with firm fixation of the fragments. In severe displacement of the condyle with its angular rotation, disturbance of spongy bone and crus dislocation, open reposition of the fragments and elimination of crus dislocation with the plasty of spongy bone defect using the autografts from the upper flaring portion of te ilium or biocompatible porous ceramics with the fixation of fragments by a screw is indicated. Permanent skeletal traction is much less effective than the surgical methods of treatment.

Pathomorphologic examinations of the biopsy and operative specimens were performed in 39 patients with osteitis deformans who underwent surgery at the department of Bone Pathology in Adults (CITO) during the period fron 1958 to 1995. On the basis of the personal and literature data the authors underlined three stages of the osteitis deformans development that differed by the pathologic peculiarities and activity of the pathologic process: 1st stage - stage of osteolysis characterizing by marked bone resorption; 2nd stage - stage of remodelling characterizing by the combination of disturbance process and formation of new bone; 3rd stage - stage of the attenuation of pathologic process during which the resorption and new bone formation stopped. Application of drugs that inhibit bone tissue resorption is the most expedient in the 2nd and especially in the 1st stage of the disease.

In Russian Federation traumatism due tto traffic accidents as well as its influence upon demographic indices are considered. The work is based on the SAI information about traffic accidents and data on 4486 victims with fatal traffic accidents in Moscow and Moscow region from 1991 to 1993. The study shows that traffic mortality in Russia is significantly higher than in USA and this index constantly increases. Injury features and mortality in different age-groups of road users (drivers, passangers, pedestrians, motorcyclists) are presented. Recommendations concerning improvement of primary medical care organization are determined.

March 28, 1996 was the 125th anniversary of the birth of Alexander Eduardovich Rauer, a man who operated on the face, restoring an image disfigured by war. A bloody mask instead of a face, a gaping wound instead of a nose, splinters of bones and teeth sticking out instead of jaws, mooing instead of speech - all this was horrifying and repulsive. All this is the face of war. We know from the history of past world wars how terrible the fate of those who were wounded in the face was. The orderlies sometimes left such wounded on the battlefield, considering them doomed to death. Bitter was the fate of those who were brought to hospitals: they could not drink, feed and nurse them. They died not from wounds, but from exhaustion. The survivors were doomed to wear a white mask on their face, hiding the face with the stigma of war under it. There were few surgeons who tried to perform reconstructive surgeries. Plastic surgery as an independent branch of medicine at the beginning of the century were making their first steps Wounded in the face were afraid to leave the walls of hospitals, afraid to appear in human society. The stigma of war deprived them of the joy of being, communication and family.