Vol 21, No 3 (2014)

High social significance of traumatism in child population (2 nd place by the level of primary morbidity and 8 th one by the causes of disability) determines the priority of traumatologic and orthopaedic service development. Great importance is given to the prognosis of justified requirement in this type of medical care for the short term prospective. Study was performed basing on the analysis of official statistic data on Novosibirsk region for 2005-2012 as well as on the results of expert evaluation of traumatologic and orthopaedic service condition, problems and prospective of development. It is stated that provision of traumatologic and orthopaedic care availability to child population in Novosibirsk region requires 19 additional beds (5 traumatologic and 14 orthopaedic). Requirement in outpatient trauma and orthopaedic surgeons makes up 32 specialists. Complex analysis of traumatologic and orthopaedic service personnel showed the presence of internal potentials for its perfection. Realization of measures on raising the qualification of trauma and orthopaedic surgeons, general surgeons and child surgeons working in the field of pediatric traumatology and orthopaedics will not require additional personnel.

To elaborate a method of quantitative evaluation of instable spiral tibial bones fractures as the basis for differential approach to secondary displacement prevention, x-rays of 312 patients were analyzed and a series of experiments to study spiral fractures peculiarities was performed. The factors responsible for the instable pattern of spiral tibial fractures were detected. Quantitative index of the risk of secondary displacement was calculated and preventive measures were elaborated on their basis. Proposed recommendations on secondary displacement prevention were used as a basis for the treatment of 83 patients using Matsukidis - Shevtsov apparatus. Long-term treatment results were studied in 59 (71%) patients. Excellent and good results were achieved in 51 (86.5%) and 8 (13.5%) patients, respectively. Neither satisfactory nor poor results were observed.

Clinical analysis of gate in children with neurogenic feet deformities before and 1 year after musculotendinous transposition was performed. Study was performed using programmable hardware complex combined with dynamometric platform and electromyelograph. Temporal, kinematic and kinetic parameters of a stride cycle were determined. Degree of walking asymmetry was evaluated using asymmetry parameter. Besides the pattern of joint mobility disturbance and degree of muscular function loss or decrease were taken into account. Complex clinical analysis of walking enabled to detect and worked out in details the disturbances of injured extremity function before surgery as well as to establish the improvement of weight bearing ability of the injured extremity, decrease in compensatory overload of the collateral healthy extremity and lowering of asymmetry parameter after surgery.

Study of biocompatibility and antibacterial properties of argentum-containing tricalcium phosphate (TCPh) with various degree of substitution by argentum (TCPh-Ag) was performed on rat model. Biocompatibility was studied using subcutaneous implantation of TCPh-Ag (0.5). Antibacterial properties were studied in 5 subgroups (A-E), 5 animals in every group. At first step a distal femur defect was formed and infected by 24-hours cultures of clinical isolates of methicillin-resistant S. aureus. Second step (subgroups B-E) consisted of revision intervention with implantation of either TCPh or TCPh-Ag with various degree of substitution by argentum (0.04, 0.2 and 0.5) into infected defect. Histologic examination of tissue samples with subcutaneous implantation of TCPh-Ag (0.5) showed the absence of inflammatory and rejection reactions that was indicative of study material biocompatibility. Optimim degrees of Ag substitution were 0.2 and 0.5 that provide high antibacterial activity at monotherapy of femur bacterial infection in rats with minimum pronounced toxic effect on the surrounding tissues and bone marrow.

Surgical outcomes were analyzed for 108 patients with infectious complications developed at different terms after large joints arthroplasty. When complications develop in the early postoperative period than independently of the process depth and in stable implant components radical surgical debridement of the inflammation focus is indicated. In the rest of cases the removal of all implant components with subsequent either joint arthrodesis or revision arthroplasty using spacers of different modifications should be performed. We consider spacer application to be a method of choice as it enables to preserve extremity function and to perform revision arthroplasty in future.

Two clinical cases of peroneal nerve lesion (patients 13 and 16 years) resulted from intraneural ganglion are presented. It is shown that only radical surgical intervention including resection of tibiofibular junction, removal of communicating canal and nerve decompression using cyst dissection (Spinner technique) could prevent ganglion relapse. In first patient completely lost peroneal nerve function was restored by musculotendinous transposition.