Vol 6, No 3 (1999)

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.

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.

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.

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.

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.

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.

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.

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.