Vol 7, No 2 (2000)

The conference, held on April 20-21, 2000 at the Central Institute of Traumatology and Orthopedics named after. N.N. Priorov, in essence, was the first Russian conference of young scientists working in the field of traumatology and orthopedics in the last 25 years. The right to participate in it had professionals under the age of 35 years. The organizers of the forum were the Ministry of Health of the Russian Federation, TsITO them. N.N. Priorov, RNIITO them. R.R. Harmful.

Mechanisms and different types of quadriceps injuries are considered. The diagnostic peculiarities are described in detail. The experience in early surgical treatment of 52 patients with 53 quadiceps injuries is present. The advanced operative technique with application of blocking wire loop is given. The advantages of this technique are shown. Recommendations on early postoperative management and rehabilitation program are suggested. In 32 examined patients long-term results were good for 84.4%) of patients and satisfactory for 15.6%).

Treatment results of 287 patients with diaphyseal fractures of basidigital bones and phalanges using stable intramedullar osteosynthesis is analyzed. There were 77 patients (26.8%) with open fractures, 110 patients (38.3%) with closed fractures, 53 patients (18.5%)) with composite fractures and 47 patients (16.4%)) with ununited and irreducible fractures. Conduction anesthesia of the median and ulnar nerves in lower third of forearm or brachial plexus in axilla was the optimum method. The technique of stable intramedullar osteosynthesis with pins was described. For the restoration of adequate wrist function in ununited and irreducible fractures as well as in composite fractures distraction was used as the first stage of treatment. After distraction of fragments with hypercorrection by 5-8 mm the intramedullar osteosynthesis was performed. Good results were achieved in 93.9% of cases.

Non-operability is defined as patient's condition in which total disturbances or peculiarities of local pathologic process exclude the possibility of surgical intervention. Authors give attention to some subjective factors which the stipulate the refuse from indicated operation. They include the level of clinical mentality and skills of a surgeon who considers the patient as non-operable one, surgeon’s «radicalism» and his ability to run a risk taking into account the rule: danger of surgical intervention must not exceed the danger for patient’s life, as well as the peculiarities of the type and spirit of the hospital where the patient was considered to be the non-operable one. Six cases were given as example. All patients had been considered as non-operable patients before their admission to Clinical Hospital # 62. According to pathologic process radical surgical intervention was compulsory in all cases. The patients were successfully operated on.

There were 68 patients with low back pain which developed 2-6 years after myofascial injury of the lumbar spine. All patients were examined neuro-orthopaedically and with EMG, rheography, manual muscular testing and ultrasonography. Course of treatment using pathogenetic method of therapeutic exercises which were differentiated depending on the type of atypical pain pattern and the stage of its development was applied. Treatment resulted in the increase of contraction force and bioelectric activity amplitude of muscle-antagonist, restoration of the pattern of muscles activation (according to EMG data), elimination of static and dynamic overload of the contracted and hyperexcitable muscular groups (according to manual muscular testing data), restoration of the optimum dynamic stereotype. In 92.0% of patients recovery with the elimination of subjective neurologic symptoms and restoration of spine function was achieved.

Immunologic examination of 62 children with composite and concomitant injuries of locomotor system is present. In 9 patients (14.5%)) development of purulent inflammatory complications has been determined. Indices of immunologic status allowing to predict the development of purulent inflammatory complications in early period (> 7-10 days) of traumatic disease are defined. Indices including the level of functional activity of the compliment, NBT-test, IgM level, number of T and В lymphocytes are the most reliable. Prognostic value of the immunologic indices undergoes changes during the posttraumatic period.

Conceptual approach to pathological gait analysis requires special equipment and is insufficiently elaborated. Suggested approach divides the pathological gait symptoms into nonspecific (walking slowing-down) and pathognomic ones. The levels of motion pathology compensation are distinguished: ipsilateral level - compensatory mechanisms affect the structures of the injured limb only, bilateral interaction level - compensatory processes affect healthy and injured limbs. Several main rules are formulated. Redistribution of functions - healthy limb performs mainly the weight bearing function, while injured limb performs mainly the transfer function; functional imitation - healthy limb imitates the function of the injured one to decrease the functional asymmetry; provision with optimum - to change the healthy limb function so that to approach the walking close to norm. Balance of lower extremities motion takes place at the level of pelvic and lumbar spine but the trunk remains relatively stable. Terminal balance at walking is performed at the level of trunk and upper extremities motion. If the balance is impossible the crutches and sticks are used - level of additional support. Impossibility to walk results in the use of other types of locomotion or other additional mechanical devices - level of locomotion different from walking.

In 17 patients with diaphyseal shin fractures treated by transosseous osteosynthesis the weight bearing ability was studied at standing and walking. Immediately after transosseous osteosynthesis in all patients the weight bearing was shown to be present both at standing and at walking with crutches. Then the weight bearing load on the operated limb at standing was increased to a greater degree compared to the duration of weight bearing on the operated limb at walking. By the end of fixation period the load of weight bearing on the operated limb at standing was almost normal, but the time of weight bearing on the operated limb remained 1.6 times below the norm. The stages of weight bearing ability were distinguished as following: I-st stage - adaptation (immediately after operation up to 1.5 months), ІІ-nd stage -stabilization (from 1.5 months to the end of fixation period). The period from 1.5 months ±0.2 months after operation was conditionally defined as the beginning of weight bearing ability.

Osteogenic sarcoma is a malignant tumor in the second decade of life [10, 25]. The incidence of it is quite high - 1.6-2.8 per 1 million children under the age of 15 per year [26]. Advances in modern chemotherapy have made it possible to increase the survival rate of patients from 0-5% in the past decades to 60-70% today [6, 9, 26, 42]. This raised the question of replacing the previously used crippling surgical techniques - amputations and exarticulations with limb-sparing operations and the development of rational approaches to choosing an organ-preserving technique in each specific case [25, 26].

On May 25, 2000, Dursun Ismailovich Cherkes-Zade, head of the adult traumatology clinic of CITO, MD, Professor, Honored Scientist of the Russian Federation, Academician of the Academy of Medical and Technical Sciences, Honored Innovator of the Russian Federation, turned 70 years old. Of these, 45 years were devoted entirely to medical and scientific activities, which brought him wide fame not only in our country, but also abroad.