Vol 5, No 2 (1998)

Long-term experience in treatment of patient with concomitant chest injuries is presented. The authors distinguish two main types of severe concomitant injuries of the chest - monoconcomitant (49.7%) and polyconcomitant (50.3%). In such injuries the difficulty of the clinical picture is caused by the syndrome of mutual aggravation and depression of immune system. Thus, in 62% of cases clinical manifestations are inadequate to the pattern and severity of the separate organs injury. Under modern clinical conditions the difficulty of diagnosis are overcome by means of objective instrumental methods of examination. Surgical tactics consists of a single general complex of measures on elimination of critical states as well as specific tactical activities depending on the peculiarities of the injury. Maximum possible accuracy of the choice of surgical tactics depends on the dominant injury detection.

The treatment results of 256 patients with ununited fractures and pseudoarthroses of navicular bone are presented. In 107 patients (41,8%) diagnostic «mistakes were made at early stages and in 84 patients (32,8%) treatment mistakes were detected. In 65 patients (41.4%) navicular bone fractures were not diagnosed at timely radiologic examination. Two hundred four patients (79.6%) were treated with distraction device elaborated at the clinic. In ununited fractures the rate of distraction was 1 mm/day up to 6-8 mm distraction wrist joint and then fixation in device during 4 weeks was used. After the removal of the device plaster cast was applied. In pseudoarthroses the distraction rate was 1 mm/day up to 1 cm distraction of the joint with subsequent fixation for 6-8 weeks. In navicular bone fractures with displacement fragments the reduction of fragments took place in most of the cases. When reduction was not achieved the open reduction of fragments was performed after joint distraction. Good and satisfactory results were achieved in 90.2% of cases.

Out of 976 patients with humerus fractures and follow-up period during 13 years 12 patients had refractures. In 1 patient refracture was in the surgical neck region and in 11 patients in the diaphysis zone. Statistic analysis of complication rate depending on the injury pattern and severity as well as the treatment method gave the possibility to detect the risk factors. They included combined and multiple injuries, open fractures and surgical treatment. Term «refracture» as well as possible causes and preventive measures of that complication were discussed.

New effective method of active immunoprophylaxis of Bacillus Pynocyaneous in victims with open long bones fractures was elaborated. Anatoxin of Bacillus Pynocyaneous (15-30 mkg of protein/day) was injected into medullar canal of injured limb for 3-5 days after trauma. Injection of anatoxin was performed through microirrigator that was placed at the time of first osteosynthesis operation. Application of that procedure activated all components of immunity at early stages (by 7 day after injury) resulting in subsequent increase of immune response. Advantages of the given method in comparison with standard scheme of active immunoprophylaxis were confirmed by immunologic study data as well as by favorable clinical outcome of wound process.

Results of laser doppler fluorometry and computer thermometry of skin at endoexpander use were analyzed in 30 children with injury sequelae, i.e. cicatrical deformities of soft tissues. It was shown that during expansion the skin vascularization increased and capillary component of hemodynamics activated. The utmost increase of microcirculation was noted during the first 2-3 weeks, especially in the projection of the endoexpander dome. The safe threshold of liquid volume injected into standard expander with capacity of 600 ml was 16.5±3.4 ml (single dose). In endoexpander the most acceptable control method for skin blood circulation was laser doppler fluorometry. In children skin expander did not aggravate microcirculation of cicatrical tissue and the bed of skin flap to be used that was favorable for flap survival.

Authors elaborated and introduced into clinical practice the method of controlled hip joint arthrodesis using the rod device for fixation. The proposed method not only allowed to activate patients earlier but also relieved their self-service and enabled the surgeon to influence the bone tissue reparative regeneration at all stages of postoperative management. 63 patients with different hip joint pathology were operated on. In 57 cases ankylosis was achieved in 5-12 months after operation.

In 17 athlets and ballet dancers with Achilles tendon ruptures oxyprolinuria and urine content of hexuronic acid were studied. Considerable increase of collagen and glycosaminoglycans decay products was detected. The results of differential spectrophotometry showed that urine glycosaminoglycanes presented by proteoglycans. It was assumed that Achilles tendon ruptures could be caused by excessive mechanical load and/or lack of the connective tissue metabolism. The authors consider that further study of oxyprolinuria as well as enzyme-substrate systems of glycosaminoglycans are perspective for the detection of «trauma risk group».

Combined injuries are simultaneous injuries to the brain and spinal cord, facial skeleton, internal organs of the chest and abdomen, pelvis, spine, bony skeleton of the chest, bones and soft tissues of the extremities in various combinations. Most foreign researchers additionally include in this concept a certain lower level of injury severity index (for example, according to the ISS scale not lower than 20).

Fat embolism (FA) - multiple occlusion of blood vessels by fat droplets - is one of the severe complications of early traumatic illness. According to different authors, it accompanies 60-85% of skeletal injuries with traumatic shock and is the leading cause of death in 1-15% of cases. It is also noteworthy that after so many intramedullary osteosynthesis operations, 0.5% of deaths are caused by this syndrome. During the Great Patriotic War, PE was reported in 10% of all wounded and in 7-10% of the wounded with gunshot fractures of bones. Unfortunately, PE is rarely diagnosed while alive, in only 1-2.2% of cases. The condition is often misdiagnosed as traumatic brain injury, pneumonia, respiratory distress syndrome ('shock lung').

Zoya Sergeevna Mironova began her working life in pre-war 1940, when, after graduating from the First Moscow Medical Institute, she came to work as a resident in the surgical department at the Medsantrud Hospital. "Medsantrud". In 1941 the hospital was reorganised into an evacuation hospital, where Zoya served throughout the war.

Professor Viktor Nikolayevich Burdygin, MD, PhD, Head of the Adult Bone Pathology Clinic at the Priorov Bone Pathology Centre, celebrates his 60th birthday.