Vol 4, No 2 (1997)

Original studies

Prevention of taumatic dsease complications at prehospital stage (experience of resuscitation-traumatologic team of first aid)

Ryabtsev S.L., Samkov A.S., Ryabtsev K.L., Malginov S.V., Tskhakaya D.C.


Protracted systemic disorders of homeostasis of traumatic disease may cause such severe and often lifeincompatible complications as acute respiratory and acute renal failure, sepsis, fat embolism. The effective way of their prevention is as early as possible rendering of qualified medical care to the injured. Under the Moscow First Aid Station there is a resuscitation-traumatologic CITO team. During 2,5 years the team rendered medical care to 1480 patients with severe multiorgan and concomitant injuries, 6,7% of patients had a severe degree of traumatic shock. Authors suggested the algorithms for diagnosis and prehospital management of severely injured. Use of those algorithms allowed to lower the rate of fat embolism and acute respiratory failure, to shorten the terms of assisted ventilation, duration of resuscitation and hospitalization. Twenty two patients (0,87%) with life incompatible injuries were lost.

N.N. Priorov Journal of Traumatology and Orthopedics. 1997;4(2):4-7
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Outcome prognosis in combined trauma of loco-motor system and brain injury at early hospital period

Sokolov V.A., Bialik E.I., Sharipov I.A., Shchetkin V.A., Semenov M.N., Markov S.A., Ioffe Y.S.


Retrospective study of complications and lethality in 284 victims with combined brain and loco-motor system injury allowed to determine the most important complications that were the cause of lethal outcomes in a great number of cases. Those complications were edema and cerebrum dislocation, acute bleed, early and delayed pneumonia. Purulence of soft tissue wounds and open fractures significance influenced the duration and outcome of treatment. Criteria and schemes of outcome prognosis as well as development of soft tissue wounds and open fractures purulence were worked out.

N.N. Priorov Journal of Traumatology and Orthopedics. 1997;4(2):7-12
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Treatment of femoral neck fractures at the turn of the century

Lirtsman V.M., Zorya V.I., Gnetetsky S.F.


On the basis of world literature data review and personal observations the authors conclude that primary osteosynthesis should be performed on the day of patient’s admission in case no special contraindications are present. The application of massive monolithic fixators is not expedient because of their depress the reparative regeneration in fracture zone and damage blood supply of the femoral head. Two fixators are sufficient for stable osteosynthesis: distal fixator is placed with support at Adams arch and/or Markel «spur» and prevents varus deformity of the femoral head and neck; proximal fixator is inserted into cortex of the femoral neck and prevents the backwards displacement. Stabilisation of femoral neck fragments with screws should be performed by their maximum insertion into cortical bone. Unipolar prosthesis of the femoral head or total hip replacement are indicated mainly in failed osteosynthesis.

N.N. Priorov Journal of Traumatology and Orthopedics. 1997;4(2):12-19
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Osteosynthesis and total hip replacement in femoral neck fractures

Ankin N.L.


Three hundred thirty nine patients with femoral neck fractures were operated on during the period from 1990 to 1994. Most of operations were performed within 48-72 hours after trauma. 235 patients with an average age of 70 years were treated by osteosynthesis using plates, srews, rods, DHS. 104 patients with average age of 76 years underwent total hip replacement procedures using Moore, Baitmann, Muller, Spotorno («Etalon», Kiev) implants. 17 patients (5%) died. Out of them 10 patients died after total hip replacement, 4 patients - after closed osteosynthesis and 3 patients - after open osteosynthesis. In 96 patients with osteosynthesis results were evaluated after 1-2 years. Good results were in 78% of them, satisfactory - in 15,7% and bad - in 6,3%. Author supports as early as possible operative treatment of patients with femoral neck fracture and prefers an open osteosynthesis with spongy screws. Advantages of closed osteosynthesis with DHS is noted too.

N.N. Priorov Journal of Traumatology and Orthopedics. 1997;4(2):19-22
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Operative treatment of combined fractures of pelvic bones and lower extremities

Cherkes-Zade D.I., Chelyapov V.N., Lazarev A.F.


The experience of surgical correction for combined injuries of pelvic bones and lower limbs was presented. There were 44 patients: 24 patients with acute trauma including 10 patients with injuries of the inner organs; and 20 patients with posttraumatic deformities and other sequela. Fractures of lower limbs (mainly femur and crus) were combined in 79.5% of cases with polyfocal injuries of pelvic ring and in 20.5% of cases with monofocal ones. Others’ technique of transosseous osteosynthesis for femur and crus fractures as well as closed reposition and pelvic ring stabilization was of relative simplicity and minimal trauma and allowed to perform lower limb fracrure osteosynthesis independently of the number of injured segments and fracrture number as well as to perform the operation by several teams simultaneously. Authors considered the following tactic as rational: 1) closed simultaneous reposition of pelvic ring and lower limb fractures may be performed on the day of patient’s admission; 2) delayed open surgical correction with combination of transosseous osteosynthesis may be performed simultaneously in the pelvic ring and lower limbs; 3) open surgical correction of pelvic ring and lower limbs may be performed separately and step-by-step.

N.N. Priorov Journal of Traumatology and Orthopedics. 1997;4(2):23-27
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Osteosynthesis with arthroscopic control in fractures of tibial condyles

Lazishvili G.D., Kuzmenko V.V., Girshin S.G., Dubrov V.E., Grishin S.M., Novikov O.E.


Modern opportunities of the arthroscopic surgery in intra-articular knee injuries (including fractures) are described; the advantages of arthroscopic method are shown. Authors give the precise description of reposition and osteosynthesis technique in various types of tibial plato fractures. Principles of postoperative and rehabilitation management are given. Authors consider the restoration of knee ligament tears in intra-articular fractures. Meniscus repair and collaterall ligaments reconstruction should be done in acute period of injury. Arthroscopic autoplasty of anterior cruciate ligament should be performed not earlier than 4 months after injury and prior ostheosynthesis. The results of the treatment of 27 patients allow to recommend the osteosynthesis of the tibial condyle with arthroscopic control for the wide clinical practice.

N.N. Priorov Journal of Traumatology and Orthopedics. 1997;4(2):27-30
pages 27-30 views

Extrafocal osteosynthesis in open crus fractures

Krasnov S.A., Dubrov V.E., Kolesnikov B.N.


The purpose of this study was to compare the treatment of open crus fractures with pin (116 patients) versus rod (107 patients) extrafocal fixation devices. In all cases primary osteosynthesis was performed within the first hours after trauma. Authors consider that choice of extrafocal fixation technique depends on the pattern of open fracture. Rod fixation is preferred in simple or wedge fractures. Pin fixation provides better outcome in all types of comminuted shaft fractures. Rod fixators are of more simple design than pin ones and it takes less time to handle with them. Uncomplicated postoperative period was noted in 179 patients (80.3%) out of 223. Purulent complications were in 16.5% of cases (5.8% of cases in rod fixation, 10.7% of cases in pin fixation). The rate of other complications was 3.2%.

N.N. Priorov Journal of Traumatology and Orthopedics. 1997;4(2):30-33
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Treatment of dislocations and dislocationfractures of carpal bones

Magdiev D.A., Korshunov V.F.


One hundred eighty seven patients with dislocation and dislocation-fracture of carpal bones were treated. There were 81 patients with acute injuries and 106 patients with old ones. In 33.6% of cases injuries of carpal bones were combined with fractures of other bones forming wrist joint. In 20.3% of cases neurologic deficit was detected. Clinical manifestations, diagnosis and peculiarities of treatment were presented. Authors considered the conduction anesthesia to be the best analgetic method. In acute trauma close manual reduction was indicated. Indications for operative treatment were non-reduced dislocations and dislocation-fractures as well as impossibility of reduction of scapoid bone. In case of wrist joint instability temporary Stabilization of wrist joint by К-wires should be performed. In old injuries two-step treatment was recommended: 1st step - distraction of the wrist joint; 2nd step - open reduction of dislocation and dislocation-fracture and osteosynthesis of the scapoid bone. Good and satisfactory results were achieved in 91% of cases.

N.N. Priorov Journal of Traumatology and Orthopedics. 1997;4(2):33-36
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Surgical prevention of purulent complications in open long bone fractures

Klyukvin I.Y., Okhotskiy V.P., Bialik I.F., Burdyga F.A., Ryabova S.S., Burykina I.A.


Thirty three patients with open diaphysial fractures of II-III severity degree (according to Baylik’s classification) are presented. All patients were subjected to primary debridement, stable submersed or extrafocal osteosynthesis. Active combined drainage of fracture zone and soft tissue wound by the authors’ technique was included in the treatment. Application expediency of that method was grounded. Hemorheological examinations allowed to work out tactics of local and general use of rheological and inticoagulant medicines for the improvement of microcirculation in injured tissues. Authors’ complex of treatment gave the possibility to achieve good results in 87.7% of cases.

N.N. Priorov Journal of Traumatology and Orthopedics. 1997;4(2):37-41
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Postoperative relapses of knee joint instability and their prevention

Orletsky A.K., Mironova Z.S.


One of the causes of postoperative relapses in capsuloligamentous knee joint injuries is destruction of the autograft used. Development conditions and possible localization of impingement syndrome associated with intra-articular stabilizing operations are presented. A number of preventive factors the performance of which during surgery would decrease the complication rate is suggested. These factors include: correct topic disposition of intraosseous tunnels, polishing of the cutting surfaces of formed canals in femur and tibia, resection of medial surface of external tibial condyle, stretching of autograft before its application, etc.

N.N. Priorov Journal of Traumatology and Orthopedics. 1997;4(2):41-43
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Heterotopic ossification as a complication of muscle rupture in athletes

Mironov S.P., Fedotov T.M., Berchenko G.N.


Authors observed 3 cases of heterotopic ossification that was a rare complication of the rupture of low limb muscles in top football-players Clinical manifestations, results of examinations were presented. Indications for operative treatment were defined. Peculiarities of surgical intervention and postoperative management were shown. After operative treatment all patients returned to their previous sports loads.

N.N. Priorov Journal of Traumatology and Orthopedics. 1997;4(2):43-48
pages 43-48 views

Electrostimulation of thigh quadriceps in injuries of knee joint ligaments (comparative assessment of the technikues efficfcy)

Tsykunov M.B., Kosov I.S.


Comparative analysis of the efficacy of various methods for thigh quagriceps electrostimulation in knee joint ligament injuries are presented. Sixty patients, aged 17-30, were divided into 5 groups depending on the stimulation method used: 1st group - electrostimulation with module VIF («ЕТМ», France); 2nd group (control) - electrostimulation with «Stimul-01»; 3rd group - electrostimulation at walking with motion corrector (CSRIPD, Russia); 4th group - selective electrostimulation of vastus latissimus at walking with corrector; 5th - dynamic electrostimulation using VIF with contra-action. Efficacy was evaluated by increase of force (dynamometric test) and tonus (by Szirmai). Results shoed the highest efficacy of dynamic slimulation with additional contra-action.

N.N. Priorov Journal of Traumatology and Orthopedics. 1997;4(2):48-51
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30-year experience with magneto therapy in traumatology and orthopaedics

Degen I.L.


Based on results of experimental work and study of magneto therapy effect on healthy volunteers the clinical application of magneto therapy in traumatology and orthopaedics was elaborated. 3479 patients with various diseases of loco-motor system such as bone fractures, Legg-Calve- Perthes disease, humeroscapular periarteritis, humeral epicondylitis, tendovaginitis, Dupuytren’s contracture, keloid scars, tendo calcaneous bursitis, posttraumatic edema of extremities, radiculalgia, acute thrombophlebitis of lower limbs, obliterating endarteritis, arthroses and periartritis, etc., were treated by magneto therapy using devices both of author’s design and custom «Polus» as well as magnetoplates (firstly in clinical practice). Results of treatment testified high efficacy of magneto therapy and shoed the advantages of that safe and painless method as compared with other methods of treatment.

N.N. Priorov Journal of Traumatology and Orthopedics. 1997;4(2):51-55
pages 51-55 views

Histopathologic characteristic of hip joint tissues in mechanical trauma

Bushuev Y.I., Yezhov Y.I., Yezhov I.Y.


The effects of dosed-force shock on the femoral head and greater trochanter were studied in 24 rabbits. Histologic specimens were analyzed 3, 7, 14, 30 days and 3, 6, 9 months after trauma. Mechanical damage of articular cartilage of the femoral head and acetabulum was detected. That damage was combined with the necrosis of cartilaginous tissue and microfractures of spongy bone of the femoral head. Repair of the damaged cartilage was of abortive pattern and did not provide filling of the defect with hyaline cartilage.

N.N. Priorov Journal of Traumatology and Orthopedics. 1997;4(2):56-59
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Removal of taiga ticks from human skin

Zolotov A.S.


The problem of removing taiga ticks at first glance may seem unimportant. However, in the Far East, in Siberia, in the Urals, the bites of these insects remain a mass phenomenon. It is not always easy to remove a tick, and this explains the frequent visits of affected patients to a traumatologist.

N.N. Priorov Journal of Traumatology and Orthopedics. 1997;4(2):60-60
pages 60-60 views


Criteria and methods for assessing the damaging effect of impulsive dynamic factors (literature review and own data)

Bogdanov G.N., Neshev N.I., Shaposhnikov Y.G.


Among the traumatogenic factors of various nature, a special place is occupied by a group of impulse dynamic effects caused by short-term high-energy effectors, the damaging effect of which is associated with the rapid transfer of a large amount of mechanical energy to tissues and organs. The development of experimental methods for determining the nature of energy distribution in individual anatomical and morphological structures and diagnosing the severity of the lesion is a very urgent problem that is of undoubted interest to a wide range of doctors, and especially traumatologists.

N.N. Priorov Journal of Traumatology and Orthopedics. 1997;4(2):61-64
pages 61-64 views

Modern approaches to optimizing engraftment of free vascularized autografts (literature review and own data)

Grishin I.G., Krupatkin A.P., Fedotov S.A.


Despite the high level of engraftment of free vascularized autografts (SVA), the frequency of postoperative complications (marginal necrosis, including due to hematomas, secondary infection, edema and tissue tension, compression of the vascular pedicle, thrombosis of vascular anastomoses) is 20% or more [4] . In our opinion, the main ways to optimize the engraftment of SVA are not only the prevention of technical errors during and after the operation, but also the development of tactics for the pharmacological prevention of tissue death at the postischemic reperfusion stage, taking into account the most significant pathogenesis factors that are relatively independent of the individual course of the postoperative period.

N.N. Priorov Journal of Traumatology and Orthopedics. 1997;4(2):65-70
pages 65-70 views


Society of Traumatologists-Orthopedists and Prosthetists of Moscow and the Moscow Region. 687th meeting (27.03.97) Reports


A.M. Borovikov, A.M. Ivanov, A.P. Kuzhekin, V.E. Kudryashov, A.V. Gnezdilov, A.S. Vitenzon, S.F. Kragin, B.G. Spivak (Central Institute of Prosthetics and Prosthetics): "TsNIIPP is a center for the medical rehabilitation of people with disabilities with lesions of the musculoskeletal system." The Central Research Institute of Prosthetics and Prosthetics is a scientific, medical and technical complex, the subject of which is the restoration or improvement of musculoskeletal functions and body shapes lost as a result of injuries, congenital, acquired diseases or age-related degeneration. The purpose of medical and technical rehabilitation is to improve the quality of life of people with disabilities without age restrictions. The Center combines modern neurophysiological, angiological, orthopedic-traumatological diagnostics, reconstructive orthopedic and plastic surgery with a wide use of microsurgical techniques, the use of physical methods of treatment, modern means of prosthetic and orthopedic and auxiliary equipment for the disabled within a single functional system. Long-standing traditions of restorative treatment and prosthetics, a good understanding of the specifics of the patient population, the absence of limits and restrictions in methods and terms are the advantages of the center.

N.N. Priorov Journal of Traumatology and Orthopedics. 1997;4(2):70-71
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Gennady Alekseevich Onoprienko


60 years have passed since the birth of Gennady Alekseevich Onoprienko, Honored Scientist of the Russian Federation, Corresponding Member of the Russian Academy of Medical Sciences, full member of the International Academy of Informatization and the Academy of Medical and Technical Sciences of the Russian Federation, laureate of the Prize of the Government of the Russian Federation.

N.N. Priorov Journal of Traumatology and Orthopedics. 1997;4(2):72-73
pages 72-73 views

Vadim Vladimirovich Azolov


May 28 marks the 60th anniversary of the laureate of the USSR State Prize, full member of the Russian Academy of Engineering, Doctor of Medical Sciences, Professor Vadim Vladimirovich Azolov.

N.N. Priorov Journal of Traumatology and Orthopedics. 1997;4(2):74-75
pages 74-75 views

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