Vol 5, No 3 (1998)

The report deals with the treatment of gunshot femur fractures. Brief historical review of curative methods for that type of military pathology is presented. Authors give their experience in management of 150 patients with gunshot femur fractures: statistic data, analysis of mistakes at the early stages of rendering surgical care, methods of the debridement of bone- muscular femur wound, recommendations on the complex treatment and rehabilitation of the victims.

Morphogenesis and pathogenesis of traumatic infarction of long bone was studied in experiment (45 rats and 8 dogs). Tibial osteotomy with section of great branches of the main nutritive arteria were performed. Morphogenic indices of pathologic changes were studied in terms from 3 hours to 60 days and physiologic indices of intraosseous hemodynamics were studied in terms from 10 min to 8 hours During the first hours after osteotomy extensive loci of blood supply occulusion of bone marrow and diaphysial cortex were detected in free fragment ends. Then those loci were transformed into diaphysial infarction. Occulusion loci increased up to the end of the first day after osteotomy, then they started to decrease. Infarctions in distal fragment were reliably more extensive than the infarctions in proximal fragment. Physiologic indices testified severe blood supply aggravation in free distal fragment end.

In 20 children with genetic caused vit.D metabolism disturbance and 13 conditionally healthy children (control group) 29 chemical elements (main elements — Ca, Cl, K, Mg, P and microelements — Al, Ag, Co, Cr, Cs, Fe, Hg, Rb, Sb, Sc, Se, Sr, Tc, Zn) were evaluated in bioptates of the upper flaring portion of the ilium using neutro-activative analysis. In test group the study was performed twice: before treatment and 1 year after the treatment course. Madication consisted of high doses of vit.D and its active metabolites, drugs containing Ca, P as well as vit.A, vit.E and group of vit.B. Bone tissue of patients had marked deficit of main elements, especially Mg, and the content of most of microelements including Zn, Sr, Mn was higher than in control group. In 1 year after the beginning of treatment the mineral bone content in the test group increased almost to norm. However the remaining Mg deficit and high content of some microelements allow to assume certain inferiority of bone tissue and indicate the necessity of further treatment.

Clinical and radiologic study of the results of revision total hip arthroplasty with Zweymuller prosthe- ses was performed in 67 patients (mean follow up period 52 months). The causes for revision arthroplasty were the following: acetabular loosening (19 patients), femur loosening (1 patient), loosening of both components (47 patients). Surgical technique and choice of the implant depended on the severity of bone destruction (by Engelbrecht and Heinert). Clinical results were evaluated by Merle d’Aubigne score, mean value was 15.3. In 60 out of 67 cases bone formation around the implant components was detected radiologically. In two cases relative recovery was achieved. In 4 patients the signs of initial loosening of the acetabular cup were defined and those patients had marked acetabular bone destruction prior to revision operation. In 1 out of 48 cases bone integration and stem stabilization could not be achieved. The results obtained testified the advantage of cementless implant in revision arthroplasty over the classic cemented technique.

In 28 patients (27 hip and 1 knee replacement) Clexane was used in dose 40 mg/day to prevent the development of complications. Clexane («Rhone-Poulenc Rorer», France) is a low molecular weight heparin. The volume of intra- and postoperative blood loss, hemoglobin level, platelets count, coagulogram were analysed in all patients. Efficacy of clexane was evaluated by the absence of clinical signs of deep veins thrombosis and pulmonary embolism, the safety was evaluated by the absence of clinical signs of bleeding. Clexane was determined to give effect on the system of blood coagulation and platelets count (tendency to thrombocytopenia). In no one case clinical signs of deep veins thrombosis and pulmonary embolism as well as the signs of hemorrhagic events were detected.

The report is based on the analysis of the materials of the High-level experts' Report for European policy of traffic safety as well as the materials of the Interparty Parliamentary commission for research of the problem of traffic accidents in Greece. The analysis was made with regard for the established by the Commission the main indices (criteria) of the state of road safety: number of deaths per 1 mln population, number of deaths per 1 mln vehicles, distribution of fatal victims by categories (groups) , severity of the injuries, place of road traffic accident. It is shown that insufficient road safety is a great threat to the public health and in order to decrease this threat the effective measures are to be taken urgently. Commission suggests to set as an object the 20-30% decrease of the number of fatal and severely injured victims in the countries of European Community till 2000.

Osteosynthesis with a constricting loop is widely used in orthopaedic traumatology due to its ease of use. However, there have been reports of complications with this technique: cases of Kirschner spokes dislocation, bone penetration by the wire, and loop fracture have been reported. Rockwood et al. retrospectively evaluated 49 cases over the past 47 years of complications with this technique on the shoulder.

The problem of burns treatment is attracting increasing attention from a wide range of professionals and social welfare agencies. This is due not only to the increasing severity of burn injuries, but also to the difficulty of treating those affected, which often results in an unfavourable outcome or disability.

Disturbances of the distal radioulnar joint (DDRJ) have recently received more attention in the literature, and they have been diagnosed more frequently and treated better. As early as 1814. A. Colles wrote: "If the surgeon takes the trouble to carefully examine the injured hand, he will find that the end of the ulna is easily displaced forward and backward". However, the diagnosis of DDRJ injuries continues to be difficult and is often delayed due to manifest collateral injuries to the radius and wrist, and the fact that radiological changes, even in cases of significant DDRJ injuries, are often minimal.

25 July marks the 75th anniversary of the birth and 55th anniversary of the surgical work of Sergei Timofeyevich Zatsepin, one of the leading specialists in bone pathology.

Sergei Pavlovich Mironov turned 50 on 6 August. All his clinical and scientific activity is connected with Priorov Central Research Institute of Traumatology and Orthopaedics, where he came in 1973, immediately after graduating from Sechenov First Moscow Medical Institute. He worked as a resident, junior and then senior researcher in the Pediatric Trauma Clinic, headed by his teacher Prof. Ter-Egiazarov.

In August 1997, the 3rd International Congress on Skeletal Dysplasia was held in Los Angeles, USA. Scientists from Argentina, Belgium, Great Britain, Venezuela, Finland, France, Germany, Egypt, Italy, Israel, Japan, Korea, Macedonia, Mexico, the Netherlands, New Zealand, Norway, Portugal, Spain, Sweden, Switzerland, Taiwan, the USA, took part in its work. Recall that the 1st Congress on Skeletal Dysplasias, organized by Prof. A. Poznanski, was held in Chicago in 1993, and the 2nd Congress, organized by Prof. P. Maroteaux, in Versailles in 1995.