[An integrated approach for early recovery of function in patients after fractures of the humerus in its proximal section]. / Kompleksnyi podkhod dlya rannego vosstanovleniya funktsii konechnosti u patsientov posle perelomov plechevoi kosti v ee proksimal'nom otdele.

The frequency of fractures of the proximal humerus (PH) is 4-5% of fractures of all human bones and can reach 80% of all bone injuries of the humerus. An analysis of the long-term results of the methods used to treat fractures of the proximal humerus showed the absence of a generally accepted universal method that provides consistently good results for all variants of fractures of the PH. PURPOSE OF THE STUDY: Creation of a complex highly effective system for the treatment of PH fractures, which includes a minimally invasive method of surgical treatment using the method of cephalomedullary osteosynthesis with direct locking pins and a highly specialized program of rehabilitation measures using a biofeedback (BFB) device, which will reduce the duration of treatment and improve the results of functional recovery injured limb. MATERIAL AND METHODS: The results of treatment of 214 patients with fractures of the proximal humerus were analyzed. Of these, in 122 (57%) patients (the main group) osteosynthesis was used with a direct cephalomedullary fixator with the possibility of blocking the screws in the nail in different planes. The comparison group included 92 (43.0%) patients treated using other surgical techniques. Rehabilitation measures were started in the early postoperative period (from the 2nd day) in both groups and included a complex of physiotherapeutic treatment, physical exercises in different modes, in addition in the main group of the study, training was performed using a device with biofeedback. RESULTS: It is shown that the used treatment approach allows to increase the frequency of achieving good and excellent (52.4% in the main group and 27.2% in the comparison group) results and reduce the frequency of unsatisfactory results of treatment (9.8% in the main group and 21.7% in the comparison group) on the Constant score. CONCLUSION: The data obtained prove the high efficiency of the developed complex method for the treatment of proximal humerus fractures and restoration of the function of the upper limb.

Experimental Substantiation of the Possibility of Wrist Joint Arthroscopy Under Distraction with External Fixation Apparatus.

In cases of splintered intra-articular distal radius fractures, it is important to accurately restore the joint surface. Wrist joint arthroscopy makes possible accurate assessment of intra-articular damage and reposition quality. The joint gap is to be enlarged for arthroscopy, but this can distort the topographic and anatomical relationships in the wrist joint. We performed a cadaveric study of changes in the topography of vessels and nerves and the risk of their traumatization under conditions of distraction with external fixation apparatus during arthroscopic portals formation. It was experimentally demonstrated that the use of external fixator did not limit the possibility of manipulation under arthroscopic control; distraction does not alter the topographic and anatomical relationships of the soft tissue elements in the wrist joint during arthroscopy.