Vol 6, No 3 (1999)

Original study articles

Compartment syndrome in patients with surgical pathology

Nazarenko G.I., Kanyuchevsky A.B., Minasyan A.M., Arablinsky A.V., Kuchin G.A.


Compartment syndrome (CS) combines different clinical conditions of organs and tissues blood supply disturbance with the closed space. Evolution of CS results from progressively increasing intraspace pressure which may cause the hemodynamic disorders in organs and tissues isolated within the space. Two main mechanisms of increased pressure are distinguished: decrease of space volume with unchanged volume of contents (e.g. as a result of localized external pressure) or increase of contents volume in the space. In clinical practice two types of CS are found most frequently: muscular-fascial and abdominal. Muscular-fascial CS evolves in the muscular-fascial space under increased pressure that evokes compression of vascular-nervous structures. Increase of intra-abdominal pressure is a mechanism of the CS evolution. Delay in diagnosis as well as the delay in operative intervention may result in severe complications, especially in elderly patients with a great number of concomitant diseases. In the same time severe complications of CS can be prevented by timely diagnosis and decompression of fascial spaces using minimum invasive surgical interventions, i.e. fasciotomies.

N.N. Priorov Journal of Traumatology and Orthopedics. 1999;6(3):3-11
pages 3-11 views

Surgical tactics in concomitant injury of the skull and lower extremities

Suvalyan A.G., Golikov P.P., Davydov B.V., Rahimi K.I.


The treatment results of 31 patients with severe craniocerebral injury in combination with the extremity fractures (mainly femur and shin) are analysed. In 13 patients the osteosynthesis of long bones was performed within 3 days after injury and in 8 patients the fractures of the extremities were treated conservatively. Early 1-3 days osteosynthesis is shown to be performed on a more favorable metabolic level and contributes to the normalization of the disturbed correlation of the lipid peroxide oxidation and antioxidation system. Early stable osteosynthesis of the extremity fractures enables to improve the efficacy of the craniocerebral injury treatment and to prevent hypostatic complications, to shorten the terms of hospitalization (by 36% in comparison with later osteosynthesis) as well as the rehabilitation period. When no contraindications exit the osteosynthesis in this group of patients should be performed within 1 to 3 days after injury.

N.N. Priorov Journal of Traumatology and Orthopedics. 1999;6(3):11-16
pages 11-16 views

Early surgical treatment of acute patellar dislocation

Lazishvili G.D., Kuzmenko V.V., Girshin S.G., Lishansky A.D., Gorbunova E.V.


Analysis of surgery for acute primary lateral dislocation of the patella is presented. There were 20 patients with acute trauma. Mechanism of injury and principles of examination are given. Authors are the active supporters of early surgery, preferring arthroscopic treatment with primary suture of med. retinaculum (Yamamoto technique) with lateral release. Special attention is given to the treatment of patellar dislocation complicated by osteochondral fractures. In 17 patients long-term results have been assessed with a 3 months — 5 years follow-up. Fifteen of the patients have excellent and good results.

N.N. Priorov Journal of Traumatology and Orthopedics. 1999;6(3):16-21
pages 16-21 views

New treatment of old ankle joint injuries

Mironov S.P., Cherkes-Zade D.D.


The authors showed and scientifically stipulated the possibility to improve the treatment results in patients with old ankle joint injuries by means of arthroscopic debridement of the articular surfaces in combination with inactivation of the extraarticular pain sauces.

N.N. Priorov Journal of Traumatology and Orthopedics. 1999;6(3):21-26
pages 21-26 views

Colles’ fracture: two years follow-up. (results of conservative treatment)

Golubev I.O., Shershneva O.G., Klimin D.N.


In 82 patients with fracture of distal methaepiphyseal bones of forearm treated conservatively X-ray, clinical and functional outcomes were assessed at mean 2.2 years follow-up after trauma. Anatomical relation ship in radiocarpal joint was shown to provide only partial restoration using hand reposition. In time achieved correction was lost. The highest influence on the clench strength was exerted by varies degrees of carpal instability that was noted in 26% of patients as well as distal radioulnari’s instability (43% of patients). The affect of slope augle of radius articular surface and degree of its shortening was unauthentic. The authors consider that Colles’ fracture to be taken as a complex injury of the wrist joint and thus the further development of treat ment technique is reqnired.

N.N. Priorov Journal of Traumatology and Orthopedics. 1999;6(3):26-31
pages 26-31 views

New aspects of the use of «signal» flaps of the transplanted tissue complexes and skin- fascial flaps on microanastomoses in plasty reconstruction of fingers

Aleksandrov N.M., Petrov S.V.


The possibility to use skin-fascial flaps grafted on the microanastomoses either in isolation or as a part of bone-dermal graft for the substitution of soft tissue defects in various regions of the reconstructed fingers and in the first interdigital space is studied. It is determined that the formation of the face surface by «signal» flap prevents the prolapse of its bone stroma and the development of trophic disorders in the soft tissues. The expediency of the transplanted flaps reinnervation is showed. A new approach to the formation of the first interdigital space in the adduction contractures of the first metacarpal bone in the carpo-metacarpal joint.

N.N. Priorov Journal of Traumatology and Orthopedics. 1999;6(3):31-34
pages 31-34 views

Peculiarities of metal-osteosynthesis in un united fractures and pseudoarthroses of lower extremities complicated by purulent infection

Roskidailo A.S., Urazgildeev Z.I.


The experience treatment in 123 patients with un united diaphyseal fractures and pseudoarthroses of the crus (93 patients) and femur (30 patients) complicated by purulent infection is presented. Term after trauma ranged from 2 months to 12 years. Readmission treatment failed. Contractures, marked trophic disturbances, muscular at rophy were detected in almost all patients. Closed trans- osseous osteosynthesis using external fixation device was performed in 12 patients. One hundred eleven patients underwent one-stage operation including radical fistulosequester-necrectomy, when indicated or vast segmental sequestrnecrectomy and transosseous osteosynthesis by external fixation device with pins, rods or their combina tion. The pattern of osteosynthesis depended on the volume of bone defect formed after sequestrnectomy: monolacal osteosynthesis was used when the defect was up to 4 cm, bilocal osteosynthesis in 5-8 cm defect and polyfocal osteosynthesis when defect was over 8 cm. In one-stage treatment 96% of patients had positive out comes: elimination of osteomyelitis, bone healing and restoration of the extremity length. Treatment duration was 1.5-2 times shorter in comparison with routine treatment methods.

N.N. Priorov Journal of Traumatology and Orthopedics. 1999;6(3):34-41
pages 34-41 views

Surgical treatment of juvenile progressive scoliosis (preliminary report)

Mikhailovsky M.V.


Ten children with juvenile malignant progressive scoliosis were operated on at the Novosibirsk Institute of Traumatology and Orthopedics and Adolescent Vertebrology. The applied methods includes epiphyseospondylodesis along the convex side of the curvature, step- by-step distractions using the endocorrector assembled of the elements of Cotrel-Dubuosset instrumentation arranged for pediatric application and final posterior spondylodesis when patient reaches the pubertal age. The main principle of the method is the simultaneous suppression of the vertebral bodies growth on the convex side of the curvature with the activization of growth on the concave side. Initial mean deformity was 81°, after epiphyseospondylodesis and the first step of distraction — 41.7°, after the third step — 44.8° (average follow up period — 14.1 months). The results obtained during the first two years show the expediency of the further work in this direction.

N.N. Priorov Journal of Traumatology and Orthopedics. 1999;6(3):41-45
pages 41-45 views

Anaesthiologic provision of operations in scoliotic patients with simultaneous intervention on the ventral and dorsal spine

Kralin A.B., Vetrile S.T., Arzhakov N.I., Kuleshov A.A.


The experience in the anaesthiologic provision of 8 operations for the extremely severe rigid scoliosis is presented. Surgical intervention consisted of multilevel (6-7 levels) discectomy via transthoratic approach with subsequent implantation of Cotrel-Dubousset system. Such operations are rather traumatic and are characterized by a considerable blood loss, long time of general anaesthesia. The operations are to be performed under a careful monitoring of the cardio-vascular system, volume of circulating blood and qualitative blood content. The work of anaesthiologist consisted of preoperative correction of the initial hypovolemia without the dextranes, multicomponent anaesthesia with main analgetic, controlled hypotension, prevention of intraoperative blood loss and reinfusion, maintenance of temperature balance. It is shown that in complex approach to the management of such patients the long and adequate anaesthesia with rather short (3-4 days) subsequent admission of patients to the ICU is possible.

N.N. Priorov Journal of Traumatology and Orthopedics. 1999;6(3):45-49
pages 45-49 views

Collapan for spine stabilization after vast resection of vertebral bodies

Protsenko A.I., Germanov V.G., Berezhnoy S.Y., Sotikov K.V., Gorina L.B.


Effect of Collapan on the formation of osseous block after vast vertebral bodies resection is presented. Collapan containing highly purified collagen and hydroxyapatite and possessing osteogenic properties is a biocomposite material. Collapan was applied in 22 patients who underwent vast vertebral bodies resection (with aim of spinal cord and roots decompression in 18 patients and tumor removal in 4 patients). In all cases average term 10 weeks postoperatively of the osseous block formation was. Time for bone formation depends on the number of stabilized segments and the level of operated vertebral. Osseous block formed in early load on the spine without postoperative orthopaedic complications.

N.N. Priorov Journal of Traumatology and Orthopedics. 1999;6(3):49-52
pages 49-52 views

Chronic hemorrhagic villous synovitis of the spine

Makhson A.N., Kuzmin I.V., Maksimchuk Y.V.


Case of chronic hemorrhagic villous synovitis (CHVS) of the spine in 20-years old male is presented. Tumorlike formation was located in lumbar region. The initial diagnosis was the benign tumor which was removed. Two years postoperatively the recurrence with light neurologic deficit was detected. MRT revealed multi- nodulous formation with homogenous structure and 11.8 x 8.7 cm in size. The formation spread rightly, posteriorly and infiltrated into soft tissues and iliac bone. Biopsy results suspected malignant «histiocytoma» and symptomatic treatment was recommended. In specialized hospital repeated biopsy was and CHVS was diagnosed. Pathologic focus was removed and destroyed L3 spinous process and lateral sacrum were resected. Postoperatively radiotherapy (60 Gy) was given. Seven months after surgery no recurrence was detected. Diagnostic problems are discussed. In CHVS authors recommend to use the combined treatment.

N.N. Priorov Journal of Traumatology and Orthopedics. 1999;6(3):52-57
pages 52-57 views

From Practical Experience

Diagnosis and treatment of fractures of the nail phalanges of the fingers in children

Shastin N.P., Nemsadze V.P., Kulikova N.V.


Children with damage to the nail phalanges of the fingers, according to our data, make up about 1.2% of the total number of those who first applied for an injury. Fractures of the distal phalanx of the fingers, especially with inadequate treatment, sometimes lead to post-traumatic deformities, contractures in the interphalangeal joint, and the formation of rough scars in the area of the fingertip. This is not only unfavorable in cosmetic terms, but is also fraught with a significant decrease in the function of the hand, primarily touch and fine grip.

N.N. Priorov Journal of Traumatology and Orthopedics. 1999;6(3):58-61
pages 58-61 views

Inguinal flap planning

Zolotov A.S.


For the treatment of severe open injuries of the hand with extensive soft tissue defects, skin grafting with a pedunculated inguinal flap is widely used. The inguinal flap was one of the first axial flaps described in the literature [5]. It was first used as a pedicled flap, then as a free flap using microvascular anastomoses. In the future, it was replaced by other, more modern and effective flaps. However, in recent years, in the treatment of hand injuries, the pedunculated inguinal flap has experienced a rebirth [4]. And this is due to its undoubted advantages over other methods of skin plastic surgery. The inguinal flap can be taken quite large, and the donor site suffers slightly. If microsurgical reconstruction is to be performed in the future, then it is better to perform it on the hand, where microvascular anastomoses have not been done before.

N.N. Priorov Journal of Traumatology and Orthopedics. 1999;6(3):61-62
pages 61-62 views


Infectious complications in polytrauma

Sokolov V.A.


Diagnosis and treatment of polytrauma is one of the leading problems of modern medicine. In the structure of the causes of death of the population, injuries occupy the third place, and among the population under the age of 40 - the first place. Despite the fact that victims with polytrauma make up only 8-10% of all victims subject to inpatient treatment, they account for up to 70% of deaths from injuries.

N.N. Priorov Journal of Traumatology and Orthopedics. 1999;6(3):63-73
pages 63-73 views

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