[Objective roentgenologic diagnostics of anterior cruciform ligamentous disruption in servicemen].

The article is dedicated to the method of roentgenological diagnostics, developed at military traumatology and orthopaedics department of the S.M. Kirov Military medical academy, which allows objectively assessing degree of knee joint instability in consequence of anterior cruciform ligamentous disruption.

Revision anterior cruciate ligament of knee reconstruction in case of anterolateral rotation knee instability in servicemen.

To identify the reasons for the high rate of revision operations after primary reconstruction of the anterior cruciate ligament analyzed the causes of recurrent anterolateral rotary instability of the knee in the military personnel. From 208 operations (2006-2011) performed according to transtibial method in 21 cases (10, 1%) recurrence of instability, requiring revision joint stabilization . From 484 reconstructions of the anterior cruciate ligament (2011-2015) according to transportal anatomical reconstruction technique revision performed in 11 cases (2.3%). It was established that the main cause of recurrent anterolateral rotary instability were non-anatomical bone channels conduction and violation of the physical exertion during the recovery period.

[Mistakes and complications in internal osteosynthesis in patients with fractures of long bones].

Authors analyzed unsatisfied anatomical and functional treatment results of 118 patients after the internal osteosynthesis for fractures of long bones of extremities, which required ion performed revision surgery. Patients were examined clinically and instrumental before revision osteosynthesis, in short-term and long-term period after the operation. Authors systemized revealed mistakes into 4 groups and found out that the most frequent were tactical and technical (84.7%) mistakes, much less--diagnostic and organizational. Developed algorithm of preoperative evaluation, planning, technology, revision reconstructive operations allowed shortening recover time of anatomy and function to the average in 92.6% of patients.

[Professor Sergey Stepanovich Tkachenko (to the 90-th anniversary of the birth)].

The article is dedicated to the memory of the outstanding Russian trauma-orthopedist, scientist and educator, former head of the department of military traumatology and orthopedics military medical academy, doctor of medicine, professor, major-general of medical service S.S. Tkachenko.

[Formation of vascularized bone grafts and their use for treatment of pseudoarthroses and bone defects].

An analysis of 135 transplant surgeries of vascularised bone grafts in treatment of pseudoarthroses and defects of the clavicle, humerous, ulnar, radial, metacarpal,wrist and fingers bones was made. The fusion was noticed in 130 operated patients. The earlier removal of immobilization (in 2), the repeated trauma (in 2) and osteomyelitis of the transplanted graft, which required its removal in 1 patient, were the causes of failure in 5 (3.7%) patients.

[First aid to persons with explosion trauma].

Modern organization providing medical aid to victims of explosion trauma in peace time, the success of which largely depends on the timely and professional interaction among the structures involeved into emergency relief operation is represented in the article. Content and sequence of events providing emergency medical and first medical aid to victims of the explosions, and the appropriateness of allocation affected groups, based on the predicted effectiveness of medical care is analyzed. The algorithm, currently used by ambulance crews, of assistance to victims with explosion and order evacuations is analyzed. The content of therapeutic measures in receipt of the wounded on the steps of skilled and specialized surgical care in accordance with the idea of a separation surgery on three stages (damage control). The content of the main levels of damage control orthopedics is introduced.

[Outlook of surgical treatment of servicemen with pathology of knee joint in the specialized orthopedo-traumatology department].

Analyzed data from annual reports of major trauma districts, chiefs of departments of hospitals and centers and reviewed the frequency and structure of surgical interventions on the knee, made in the last 5 years (2005-2010) in health care facilities the Defense Ministry. The frequency of the most typical injuries and diseases of the knee joint in different categories of servicemen. An integrated laboratory and endoscopic examination of patients with reactive arthritis, associated with latent urogenital infection and how the underlying disease and disease associated surgical pathology knee. Formulated evidence-based recommendations for improving the organization of surgical treatment of soldiers with the pathology of the knee.

[Blasting damage in manmade disasters and terrorist attacks].

In the present case of explosive injuries in peacetime, when suddenly there are usually accidental or intentional explosions methane in mines, tanks with gas or explosives, fuel tanks or gas content, gas tanks, gas pipelines, product pipelines, as well as the explosion of military ordnance--grenades, mines, fuses, shells, and accidentally found child or maliciously used by terrorists. Collected statistical data on manmade disasters in coal mines and explosive injuries in terrorist attacks, the physical parameters of which were able to identify only approximately and type of damage incurred,mostly multiple and combinative combined and presented significant challenges in health care. The reasons and circumstances of the explosion in peacetime, gave a detailed description of the damaging factors, mechanisms, and characteristics arise from injuries suffered in the blast injuries. We describe the pathogenesis of blast injury, basic and clinical manifestations of lesions in the explosions.

[Specific traumatologic care forwounded and injured with fractures of long bones of extremities].

The efficiency of the system to assist victims with fractures of long bones in the Russian Defense Ministry is estimated. With the help of analytic hierarchy process a system-morphological and multi-criteria are defined and explored options for implementing 21 functions of the system. The result of scientific study was mathematical basis selected and adjusted for the nine criteria of the most effective alternative version of the implementation of the system to assist injured with fractures of long bones. On the basis of information was developed the concept of trauma service of Defense Ministry of Russia.

[Modern approach to reconstruction of the anterior cruciate ligament in military personnel].

Analyzed data from annual reports of major trauma districts, chiefs of departments of hospitals and centers and reviewed the frequency and structure of surgical interventions on the knee, made in the last 5 years (2005-2010). In health care facilities the Defense Ministry. The frequency of the most typical injuries and diseases of the knee joint in different categories of servicemen and revealed the leading role the anterior cruciate ligament rupture. Analyzed stages of the evolution of anterior cruciate ligament reconstruction techniques in a specialized hospital department artrologicheskom Military Traumatology and Orthopedics MMA and a comparative characteristic of modern surgical approaches, providing anatomical and isometric position of the graft, as well as the minimal invasiveness of intervention with preservation of the sources of blood supply and potential revascularization autograft. Makes proposals for improving the organization of treatment of surgical pathology at the knee joint military operation and orthopedic trauma and military departments of medical institutions.

[The concept of development of the orthopedic and traumatological care in the Armed Forces of the Russian Federation].

The main directions of further improving the quality of trauma care in the Armed Forces of the Russian Federation are: 1) improving the organization of orthopedic and trauma care in military medical establishments of the Ministry of Defence of the Russian Federation taking into account their level of medical-diagnostic capabilities, the licensing of military-medical institutions and certification; 2) regular supply of differentiated trauma unit medical supplies and equipment; 3) ensuring a high level of training and upgrading of specialists in the first place, senior management.

[Selection of a rational method of surgical treatment of patients with proximal femoral fractures].

In the military hospital of traumatology and orthopaedics, Military Medical Academy from 2007 to 2009, was operated on 88 patients with fractures of the proximal femur, whose average age was 77.4 +/- 3.8 years. Selection of the optimal surgical procedure was performed according to the type of fracture of the proximal femur and bone quality (presence or absence of osteoporosis and its degree of severity). In addition, when choosing a surgical treatment to take into account patients' age, time elapsed since injury, general condition, the presence and severity of manifestations related diseases, as well as the patient's request for quality of life. Excellent functional results in this clinical group were obtained in 19.4% patients, good--in 16.1% patients, satisfactory--in 25.8% cases and 38.7% victims were regarded as unsatisfactory.

[Surgical complications following operative treatment of abdominal obesity in type 2 diabetes mellitus patients].

Results of surgical treatment of 211 patients consisting of 109 patients with DM2 and 102 patients without DM2 were studied. All patients underwent lipoaspiration or abdominoplasty. The aim was to assess the influence of type 2 diabetes mellitus on the frequency and structure of complications after surgery. The risk of anemia and local complications increases after surgical correction of abdominal obesity which are temporary and do not have significant influence on the clinical outcome. There were no cases of clinical manifestations of pulmonary embolism and fat embolism.

[Characteristic of combat trauma and treatment of gunshot fractures of long bones of the limbs]. / Kharakteristika boevoi travmy i lechebnye meropriiatiia pri ognestrel'nykh perelomakh dlinnykh kostei konechnostei.

Treatment of the patients with gunshot fractures of extremity long bones is one of the main problems of field surgery. The complex study of medical records obtained from 718 servicemen with gunshot fractures of extremity long bones who participated in counter-terrorist operation in the Republic of Chechnia (1994-1996) allowed to evaluate character and severity of the injuries, content of the treatment measures conducted at the stages of medical evacuation. The peculiarities of fighting trauma were the following: the high frequency of combined (22.5%) and multiple (25.9%) injuries, the high share of multi-fragmentation and splintered (76.4%), intra-articular fractures (17.3%), the primary defects of bones (7.1%) and soft tissues (4.8%), the injuries of main vessels (12.1%) and nerves (18.5%). Owing to the short periods of evacuation to the stage of specialized medical care (up to 18.2 +/- 5.3 h), high share of preserving variant of primary surgical treatment (82.3%); high quality of medical immobilization at the expense of wide introduction of functionally stable external osteosynthesis (51.2% of the casualties) it was possible to improve the treatment results.

[Clinico-anatomical grounds of using flaps with the axial type of blood supply in treatment of patients with open (gunshot) fractures of the crus]. / Kliniko-anatomicheskoe obosnovanie ispol'zovaniia loskutov s osevym tipom krovosnabzheniia pri lechenii bol'nykh s otkrytymi (ognestrel'nymi) perelomami kostei goleni.

The main aim and task of the investigation was to present clinico-anatomical substantiation for plastic operations with the application of flaps with the axial type of blood circulation in treatment of this category of patients. The investigation included 348 clinical cases (for exact statistical data); 65 volunteers (for the assessment of physiological parameters) and 16 topographo-anatomical preparations (variants of the vascular network of the leg). The methods of clinical and rentgenological control were used. The work consisted of 4 stages: 1) clinico-statistical analysis by the materials of 348 clinical observations which allowed to establish the dependence of functional results of the treatment on the sizes of leg soft tissue defects; 2) topographo-anatomical investigations which allowed the topography of the leg vessels to be associated with the typical disposition of the flaps with the axial type of blood supply; 3) physiological investigation using ultrasonic dopplerography and active distance thermography on whose basis the methods were created for exact identification of the sites of the outlet of cutaneous arteries and finding the zones of optimal blood supply of the complex skin flaps being formed; 4) clinical approbation of the results of the investigation. The operations performed on 15 patients have demonstrated high effectiveness the new developed means of preoperative planning.

[Treatment of servicemen with pelvic injuries at the stage of medical evacuation during local military conflicts (Report II)]. / Lechenie voennosluzhashchikh s povrezhdeniiami taza na étapakh meditsinskoi évakuatsii v sovremennykh lokal'nykh voennykh konfliktakh (Soobshchenie vtoroe).

Basing on the analysis of medical record data obtained from servicemen with pelvic unstable injuries the authors evaluate the results and effectiveness of the used treatment methods and give the recommendations how to improve medical care rendered such category of casualties at the stages of medical evacuation. The analysis of treatment results obtained in the casualties with pelvic unstable injuries shoes high frequency (up to 24.4%) of unsatisfactory results among which not eliminate deformations of pelvic ring (14.3%), disordered walk (20.4%) and painful syndrome (18.8%) prevailed. In the structure of treatment measures during the local armed conflicts in Afghan and Chechnyathe conservative methods of hipbone immobilization (and even in the cases of pelvic unstable injuries) prevailed. Osteosynthesis with external apparatus was used only in 2.1% of the cases. Such treatment tactics resulted in the large number of unsatisfactory anatomical and functional outcomes of medical rehabilitation (46.8%), changes in servicemen fitness category (30.3%) their discharge and disability. To make the treatment of such category of casualties more effective it is necessary to conduct the appropriate surgical stabilization of pelvic fractures at the stage of specialized medical care with the use of modern methods of external and internal osteosynthesis.