Vol 12, No 1 (2005)

On the base of experience in treatment of 646 patients with polytrauma (1995—2004) the necessity to use damage control was for the treatment of long bone fractures was proved. The principle of damage control assumes subdivision of surgical treatment of patients with severe polytrauma into two steps. At the I st step only minimum traumatic procedures were performed. At the 2 nd step major surgical interventions were performed. According to trauma severity and individual response all patients were divided into four groups: stable, borderline, unstable and critical. In patients with stable and borderline conditions major surgical procedures did not result in aggravation of patient's state, therefore one-step surgical treatment was used. In patients with unstable and critical conditions no surgical methods of fixation of long bone fractures were applied at the I st step. In the last two groups definitive fracture fixation were performed at the 2' d step within 4—14 days after injury. The application of damage control allows improving the results of treatment, reducing the rate of complication and lethal outcomes in patients with severe polytrauma.

In treatment of 87 patients (main group) with diaphysial shin fractures new techniques and devices for optimization of transosseous extrafocal osteosynthesis by Ilizarov were applied. All techniques and devices, i.e. devices for the perfection of Ilizarov apparatus stability, for bone fragment reposition, console compression arrangement for extrafocal osteosynthesis in commi­nuted fractures, devices for damper compression of bone fragments, for prevention of lower extremity edema at extrafocal osteosynthesis, for provision of early axial loading in Ilizarov apparatus, for activization of osteogenesis using asymmetrical dynamic compression were elabo­rated by the author. Control group (108 patients) was treated by traditional Ilizarov technique. Treatment results were assessed at terms from 4 months to 2 years. Data of clinical, X-ray and functional examinations as well as terms of fracture healing, duration of hospitalization and terms of working ability restoration were better in the main group as compared to the control one. In the main group good results were achieved in 47.1%c, satisfactory — in 49.4%, poor — in 3.5% of cases, in control group — 30.6%, 63.0%, 6.4%, respectively. Author believes that further perfection of Ilizarov technique is reasonable.

During the period from 2002 to 2004 fifty six patients with tibial condyles fractures (57 fractures) were operated on. In 41 (71.9%) cases osteosynthesis was performed after arthroscopic diagno­sis. In 38 (66.7%) patients with fractures of types B2, ВЗ, C2 and C3 by AO classification bone defect plasty using porous nikelide-titanum implant was performed. In 8 (14.0%) patients with fractures of type B2 porous implant was used to fix the lifted tibial plato without additional metal fixative. Depending on the type of fracture cannulated screws (17 fractures, 29.8%), AO support­ive plates (31 fractures, 54.4%), staple (1 fractures, 1.8%) were applied. Postoperative immobi­lization was performed by hinged orthesis with adjustable angle of movements and plaster splint. Treatment results were observed at terms from 6 months to 2 years in 47 patients (48 fractures). Excellent result was achieved in 43.8%, good — in 47.9%, satisfactory — in 8.3% of cases.

Analysis of natural causes of knee arthrofibrosis development after arthroscopic ACL reconstruc­tion and its prevention is presented. Classification of arthrofibrosis basing on the arthroscopic, clinical and MRT examination results is given. Clinical-arthroscopic manifestations and mor­phologic picture of various forms of arthrofibrosis, particularly "infrapatellar contracture" and «cyclops» syndromes, are considered in details. Preventive recommendations are worked out.

Total knee arthroplasty in destructive sequelae of tuberculosis and nonspecific gonitis was performed in 51 patients. Indications to total knee arthroplasty were presented. Scheme of pre- and postoperative antibacterial therapy was elaborated. At 4.5 year follow up good and satisfac­tory results were achieved in 91.9% of cases.

Correlation between clinical radiologic manifestations and changes of stabilometric data and mineral density of bone tissue in proximal femur was studied. It was detected that displacement of median position of gravity center in frontal plane took place in healthy side and depended on the stage of coxarthrosis. DEXA showed that decrease of mineral density of bone tissue in femoral neck was more significant at the injured side.

The experience in surgical treatment of 36 children with various forms of congenital malfor­mation of the tibia (38 extremities) is presented. Use of complex surgical treatment enabled to create the optimum static and dynamic conditions for the extremity function with preservation of all its segments. In all forms of tibia malformation manifestation the foot deformities and flexion contractures have been corrected in early age (conservatively after 1 month, surgically — from 6—10 months).

Method of the wrist joint «folk» reconstruction using microsurgical grafting of 2 nd metatarsal bone has been suggested for the reconstruction of distal forearm in children with malformation or absence of the radius and talipomanus which has developed as a result of the abovementioned pathology. The graft includes the growth zone and this prevents the deformity recurrence.