[Optimization of rehabilitation of elderly and senile patients with primary traumatic dislocation of the shoulder.]

Тhe aim of the study is to improve the treatment outcomes of elderly patients with primary traumatic shoulder dislocation by developing an atraumatic rehabilitation method. The study included 56 patients aged over 60 years with primary traumatic dislocation of the shoulder. The patients of the first group (29 patients) after the dislocation of the shoulder was corrected, functional treatment was performed using orthoses and a developed course of physical therapy. Patients of the second group (27 patients) were treated according to the traditional method with the use of plaster immobilization after the dislocation of the shoulder was corrected. Shoulder joint radiography, MRI, determination of potentials in biologically active points (BAT) during the first 2-3 days after dislocation were used to diagnose shoulder dislocation and assess outcomes. To assess the immediate results, the electrical potential in BAHT was studied after 1,3 and 6 months. In 70,3% of group 1 patients, positive outcomes were obtained after 3-6 months on the ASES scale, while in the second group such results were achieved only in 57,3% of patients, and on the UCLA scale 22,8 and 19,2%, respectively. Thus, the use of the proposed tactics of functional treatment makes it possible to significantly (p<0,05) improve outcomes in patients of the older age group.

[Optimization of trauma care to victims of older age groups with fractures of the proximal femur.]

The objective of the study was to improve the treatment outcome of patients of older age groups with fractures of the proximal femur by developing an algorithm for providing medical care while taking into account the nature of a fracture and the comorbid background of a patient. The article describes approaches to the choice of tactics and techniques of medical assistance to patients of older age groups with fractures of the proximal femur. 4 491 patients with fractures of the proximal femur who had been treated at the Hospital for War Veterans in Saint Petersburg from 2010 to 2019 were included for analysis. All the patients were divided into two groups depending on the tactics of the treatment used. Group 1 (2 082 patients) were treated in 2010-2014 using traditional methods. Group 2 (2 409 patients) were treated according to the developed algorithm while taking into account the nature of a fracture and the severity of comorbid pathology. The results were evaluated by the Leken's functional index, and the quality of life was assessed by WHO scale. In patients of the 1st group, good outcomes were achieved after a year in 126 (10,5%), after 3 years in 111 (9,1%), while in the second group after a year, excellent outcomes were achieved in 103 (6%) cases, good in 960 (55,7%), and after 3 years excellent in 87 (5,4%), good in 843 (52,3%). Thus, the use of the proposed algorithm for providing care to patients with fractures of the proximal femur significantly (p<0,001) improves the treatment outcomes for this category of patients.

NEW TECHNOLOGIES IN TREATMENT OF FRACTURES OF THE UPPER EXTREMITIES IN PATIENTS WITH SEVERE MULTIPLE AND POLYTRAUMA.

A comparative analysis of treatment results of fractures of long bones of the upper extremities was made in 172 victims with severe polytrauma. The traditional strategy of treatment was used in the first group. The new technologies such as prognostic tactics, method of Damage control orthopedics and low-invasive osteosynthesis developed by the authors were applied in the second group. The application of new technologies allowed doctors to improve the immediate and long-term results of surgery. The rate of lethality decreased in 1,6 times, incidence of complications reduced in 1,4 times. Hospital stay shortened in 2 times: for victims with favorable prognosis ­ on 7 days; for patients with unfavorable prognosis ­ on 13 days. The long-term results were studied in 154 (89,5%) patients. The common duration of treatment reduced on 30 days and the quantity of good results increased on 18,6%. The number of patients with vocational rehabilitation increased from 82,3 to 90,7%.

[Treatment of patients with damage of the hip joint and proximal section of the femur in polytrauma resulting in shock].

The research of efficiency of operative and conservative methods of treatment was conducted in 426 patients with damage of the hip joint, brought to the Dzhanelidze Research Institute of Emergency Medicine, Saint-Petersburg with severe mechanical shockogeneous trauma, resulted in shock since 1997 till 2008. The operative interventions were performed using the methods suggested by the authors. The results were estimated by Harris scale and showed significant advantages of operative methods over conservative ones.

[Treatment of disrupted pelvic ring in fertile women].

The article presents the data on frequency of disrupted pelvic ring in fertile women on the basis of the Djanelidze Research Institute of Emergency Medicine database from 2000 to 2005. Strategy of treatment, target dates of the pelvis fixation and removal of fixators are described depending on planning the pregnancy terms. In addition, approaches to childbirth, indications and contraindications to Caesarian section were studied on the basis of the Snegiryov maternity hospital database for the period from 2000 to 2006.