Vol 6, No 4 (1999)

Efficacy of biologic feedback for the treatment of motional Disturbances in locomotor system injury is scientifically stipulated. Principles of the method application are shown; means and methods of biocontrol with feedback are defined.

Multilevel etiologic pathogenetic classification of shoulder joint instability that reflects hierarchic structure of pathologic process is elaborated. Classification is formed by the discrete model. Depending on the aim it gives the possibility to use the separate semantic blocks both for clinical practice (nosologic and diagnostic levels) and for scientific studies (etiologic and pathogenetic levels).

The experience in treatment of 54 children with diaphyseal femur fractures by closed antegrade intramedullar osteosynthesis is presented The possibility of realization of closed intramedullar osteosynthesis excluding proximal femur growth zone damage is experimentally grounded. It is defined that echography provides all necessary information and allows to limit the irradiation load on the patients and medical staff. Original set of instruments for closed intramedullar osteosynthesis is suggested; recommendations on implant choice depending on the child’s age are given. The method is shown to provide a good anatomic functional result in overwhelming majority of children with diaphyseal femur fractures and to give 2.3-3 times decrease of the duration of inpatient treatment and rehabilitation period as compared with conservative treatment.

Thromboembolic complications are consided to be the most common cause of patients mortality with the femur fructures. The use of low-molecular weitght heparine (clexane) is the most adequate concerning effectiveness, safety and simplicity. The activization of biochemical processes of erythrocytes membranes by clexan has been recently found. It facilitates the onset of the oxygen dissociation mechanism, improves oxygen supply to the tissues and its better diffusion. The blood circulation system transforms into hypodynamic regimen, optimising the bodys activity.

In patients with femoral head osteochondropathy the long term outcomes of conservative treatment were studied. There were 3 groups of patients: 57 patients who were treated at orthopedic sanatoriums for children; 33 outpatients and 35 patients without treatment. Clinical and radiographic data in three studied groups were compared and likeness of data was obtained. Correlation analysis was performed to detect the factors which statistically reliably defined the long term outcomes. The highest correlation rates were found for disease onset age (-0.47) and the following radiographic data: proximal acetabular index (+0.22), inclination angle of acetabular roof (-0.28) and coefficient of the conformity of femoral head surface and acetabulum (+0.26). Multiple linear regression was used to determine the prognostic index for every patient with femoral head osteochondropathy. There were three degrees of probability of unfavorable long term outcomes in conservative treatment or without therapy and 3 groups of patients with good, doubtful or unfavorable outcomes, respectively. Suggested prognosis method allowed a differential choice of treatment method including surgical correction. In good and unfavorable prognosis the pattern of conservative treatment does not influence the long term outcome so prolonged sanatorium treatment is not expedient.

Fifty two patients with dysplastic coxarthrosis, aged 14-23, were examined using dual photon X-ray absorptiometry. Changes in bone mineral density had fluctuating pattern. On the base of experimental data a calculating experiment was performed. It showed that coincidence of trend direction obtained at random with true tendency defined by approximation of all dynamic row was only 58% in reiterated examination, 63% - in thrice-repeated examination and 69% - in five -times examination. Hence, even five-times examination is not enough for the exact diagnosis of metabolic disturbances of bone tissue and objective control of the effective treatment and more examinations are required.

Unfavourable present demographic process, decrease of indices of children’s physical development, increase of congenital and acquired orthopedic pathology as well as the increase of total number of disabled children make high demands of the organization of specialized service in Russia. In general the orthopedic service for children meets the modern requirements. Its further development is foreseen by the Order of the Russin Health Ministry # 140 «About the measures on the perfection of traumatologic and orthopedic service». The urgent goals are the following: early detection of the pathology and early adequate treatment; continuity and succession of rendering aid in outpatient departments, hospitals and rehabilitation institutions; introduction of diagnostic and treatment standards into clinical practice. To improve the pediatric orthpedic service it is necessary to increase the possibilities for rehabilitation treatment, the complex of sanitary measures for children’s population aimed at the prevention of orthopedic pathology.

We have not found descriptions of such cases of severe deformity of the pelvic ring that developed after a rupture of the pubic symphysis obtained in childhood and subsequent surgical intervention in the available literature, and therefore we consider it appropriate to share our observation.

Professor V.V. For almost a quarter of a century, Klyuchevsky has been head of the Department of Traumatology, Orthopedics and Military Field Surgery at the Yaroslavl Medical Academy. The Orthopedic and Trauma Center headed by him has 10 specialized departments for the treatment of patients with any injuries of the musculoskeletal system, head, chest, abdomen, pelvis, spine, as well as departments for thermal injuries, microsurgery and plastic surgery.

The meeting of pediatric orthopedic traumatologists, held on September 16-17, 1999 in Rostov-on-Don, was organized by the Research Children's Orthopedic Institute. G.I. Turner (St. Petersburg) and the Department of Health of the Rostov Region with the active assistance of the staff of the Department of Traumatology and Orthopedics of the Rostov Medical University and CITO named after. N.N. Priorov. 84 specialists from 32 administrative territories of Russia (including 14 doctors and 24 candidates of medical sciences) arrived to participate in it. The most representative were the groups from St. Petersburg (26 people) and Moscow (15). Some of the proposed participants of the meeting could not come due to the difficult financial situation of institutions (Tula, Saratov, Izhevsk, Ufa, N.-Novgorod, Vladimir, etc.).

On September 4, 1999, the head of the Department of Traumatology, Orthopedics and Military Field Surgery of the Yaroslavl Medical Academy, Honored Scientist of Russia, Doctor of Medical Sciences Professor Vyacheslav Vasilyevich Klyuchevsky turned 60.

On November 8, 1999, at the age of 62, after a serious illness, the head of the Department of Bone Pathology for Adults of the CITO named after V.I. N.N. Priorov, winner of the State Prize of the Russian Federation, Doctor of Medical Sciences, Professor Viktor Nikolaevich Burdygin.