APPLICATION OF MINI-PLATES AND MINI-SCREWS IN TREATMENT OF PATIENTS WITH RADIAL HEAD FRACTURES.

An article presents an experience of application of compression headless mini-screws (Gerbert's screws) and mini-plates in treatment of radial head fractures. The authors showed advantages and disadvantages of given methods of treatment in 41 patients. Gerbert's screws were used in 32 cases and miniplates were applied in 9 patients. Mini-plates in combination with Gerbert's screws were used in 4 patients. There weren't noted complications in early postoperative period. Patients (27­84%) with Gerbert's screws were followed up in terms more than 6 months. Mean score was 91 according to the scale of Mayo Elbow Performance Score. Results of application of mini-plates were followed up in terms more than 6 months in 7 (77%) patients. Mean score of Mayo Elbow Performance Score consisted of 72. Based on the analysis of results, the authors concluded that the application of mini-screws in radial head fractures allowed doctors to obtain a good anatomical and functional result. Osteosynthesis by mini-plates didn't always support the secure fixation of all fractures due to strictly given positioning on the head of radial bone. In case of osteosynthesis of splintered fractures of Mason type III, it should be reasonable to combine mini-plates and Gerbert's screws.

FEATURES OF REHABILITATION OF THE PATIENTS AFTER NONINFECTIOUS COMPLICATIONS OF TOTAL HIP ARTHROPLASTY.

The authors analyzed noninfectious complications (dislocation of endoprosthesis head, periprosthesis fractures) in 8 patients out of 40 with hip arthroplasty. There were estimated clinical, biomechanical results and quality of life of the patients. An application of the external fixator-orthezes should be recommended in order to prevent complications of hip replacement. The wearing of brace is considered to be reasonable after revision interventions.

[SURGICAL TECHNIQUE OF BLOCKING INTRAMEDULLARY OSTEOSYNTHESIS OF FOREARM FRACTURES].

An introduction of blocking osteosynthesis was recently included into practice of treatment of forearm fractures. The forearm has a very difficult biomechanics and extremely important functional value. There are really high requirements to accuracy of reposition and stability of forearm fracture fixation. The blocking osteosynthesis successfully combines fixation stability with functionality, although its performance technique isn't so simple, that forces experts to use other methods of fixation. It is possible successfully use advantages of the method by studying and keeping variety of operation nuances of blocking osteosynthesis on forearm in order to restore anatomy, biomechanics and obtain the stable fixation. The period of rehabilitation could be combined with period of union of bones in this case without postoperative complications such as nonunion of bones, construction fractures and instability of osteosynthesis. The method would be optimal provided that a surgeon masters the technique of construction implantation. There are maximum advantages in treatment of complicated fractures (nonunion of bones, false joint and defects) due to functionality of the method.

[APPLICATION OF COMPRESSION MINI-SCREWS IN TREATMENT OF PATIENTS WITH INJURY OF ELBOW JOINT BONES].

A case report presents the experience of application of compression pileateless mini-screws (Gerbert's screws) in treatment of intra-articular fractures, which formed the elbow joint (44 cases). There were performed 32 operations concerning fracture of head of radius, 10 operations on the occasion of fractures of distal section of the humerus and 2 operations on the coronoid process. Long-term treatment results were followed-up in 31 patients during more than 6 months. On basis of analysis of treatment results the authors made a conclusion that the application of mini-screws in case of bone fractures, which formed the elbow joint, allowed realization of stable osteosynthesis after anatomic reposition of articular surfaces, obtaining good anatomical and functional result and shortened the terms of patient's treatment.

[METHOD OF OSTEOSYNTHESIS OF SUPRACONDULAR FRACTURES OF THE HUMERUS].

A treatment of fractures of distal metadiaphysis of the humeral bone remains an actual problem of modern traumatology at present time. This is associated with immediate proximity of the radial nerve and risk of iatrogenic injury in external fixation, presence of short distal fragment, comminuted nature of fracture, complexity of treatment method selection, need of extensible approach. Biomechanical features of different fixators were analyzed in consideration of presence of short distal fragment, traumatic of. external fixation and risk of iatrogenic injury of the nerve. The authors suggested the method of osteosynthesis of the humerus by using blocking osteosynthesis with preliminary extension of intra-medullary canal of distal fragment for obtaining stable osteosynthesis (priority No 2014105323 from 14.02.2014). The proposed method allowed avoiding the iatrogenic neuropathy of the radial nerve, providing the stability of fixation higher, than in case of external fixation. It excludes the need of external immobilization and combines the period of bony union with the period of rehabilitation and socially integrates the patient in minimal terms.

[THERAPEUTIC APPROACH TO HUMERAL BONE FRACTURES COMPLICATED BY PERIPHERAL NERVE TRAUMA].

On the basis of treatment results of 28 patients, the authors suggested that the clinical method of diagnostics allowed performance of topical diagnostics of injury using bedside test. It would help to choose a therapeutic approach in each clinical case.

[Advantages of blocking intramedullary osteosynthesis in treatment of patients with fractures of the forearm bones].

The blocking intramedullary osteosynthesis (BIO) of the forearm bones possesses quite a number of advantages in comparison with the bone and transosseous methods. The BIO allows the restoration of the anatomy and biomechanics of the forearm, it shortens the term of disability and restores the function of the extremity in proximate terms. The BIO of the forearm bones consists of great number of nuances, each of them is really important. It is necessary to have the X-ray unit with electron-optical image for the intraoperative monitoring of operation stages and to follow the well-defined algorithm of technology of performing BIO of the forearm bones with special reference to all possible features of anatomy.

[Treatment of patients with open complicated forearm fractures].

The blocking osteosynthesis is preferable in the case of open forearm fractures of the I degree. The treatment of patients with open comminuted complicated forearm fractures should be reasonable to perform in two stages: at the first stage, healing of soft tissues with fixation in the apparatus of external fixation should be obtained. At the second stage, the conversion of external fixator on interlocking nail with single-stage performance of osteoplasty as needed should be carried out. The presented experience of treatment of healing failure, pseudoarthroses and forearm bone defects by developed method allows the practical application of the method to be recommended.

[Application of compressing mini-screws in treatment of patients with intra-articular fractures].

The authors present an experience with the application of compressing headless mini-screws (Herbert screws) in treatment of intra-articular fractures in 37 patients. The mini-screws were used both singly and in combination with other metallic constructions. Long-term results of the treatment were followed up in 21 patients (6 months), in 14 of them excellent results were noted, in 5--good, in 1--satisfactory and in 1--unsatisfactory results. One complication was notes as the formation of a false articulation of the radius neck. An analysis of the results showed that the application of mini-screws allowed performing stable osteosynthesis after anatomical reposition of the articular surfaces, obtaining good anatomical and functional results and shorter period of treatment.

[Long-term results of endoprosthesis of the hip joint with Plus-Endoprosthetic prosthesis].

An experience and results with using endoprosthesis of the hip joint with Plus-Endoprosthetic prosthesis in 937 (1018 operations) patients were analyzed. The period of follow-up observations was 12 years. Distinctive characteristics of the endoprosthesis are described. Specific behavior of this construction in patients with diseases and damages of the hip joint are shown. Results and complications of the endoprosthesis operations are analyzed. In whole, excellent and good results were obtained in 99.42% of cases, satisfactory - in 0.47%, unsatisfactory - in 0.11%.

[Experience with treatment of gonarthrosis by the method of arthroscopic sanation of the joint].

The authors made an analysis of treatment of 165 patients during 12 months, arthroscopic sanation of the joint being used in 75 patients. The technique of operation is described in comparison with traditional therapy in patients after arthroscopic sanation. In 76% of the patients there was improvement of the joint functions (traditional therapy gave improvement in 45.6%).

[Graded treatment of dysplastic coxarthrosis].

An experience with treatment of 321 patients allowed the authors to substantiate expedience of graded performing different reconstructive procedures, such as transposition of catyloid cavity, pelvic osteotomy after Hiary, femur osteotomy, endoprosthesis. These operations allow postponement of the time of articulation replacement and minimization of revision procedures.

[Integral evaluation of homeostasis in patients with degenerative-dystrophic diseases of the hip joint after endoprosthesis].

The work presents a method of complex evaluation of homeostasis in patients with degenerative-dystrophic diseases of the hip joints after total endoprosthesis on the basis of mathematical integration of different laboratory indices allowing objective assessment of the state of the regulatory-metabolic status of the patient after operation of endoprosthesis, detection of disturbances of adaptive reaction to the operative trauma and, thus, prevision of the development of postoperative complications. The integral characterization is given of the periods of postaggression reaction using the proposed method. The interval of integral indices is determined which is characteristic of non-complicated postoperative period, depending on the time since the moment of operation.

[Assessment of the results of two-stage operative treatment of patients with congenital dysplasia of the hip joint].

Clinical material including 138 patients who had undergone 169 reconstructive operations was analyzed. The considered methods of reconstruction of the cotyloid cavity (triple osteotomy and Chiari osteotomy) taking into account "preparing" to endoprosthesing create favorable conditions for implantation of the cotyloid component. The triple pelvic osteotomy using the technologies of transposition of the cotyloid cavity, from a position of endoprosthesis, is the most adaptive method of surgical treatment as compared with pelvic osteotomy after Ciari.

[Surgical treatment of patients with fractures of distal metaepiphysis of the radial bone].

Traumatologic emergency to patients with primary unstable, comminuted, intraarticular fractures of distal metaepiphysis of the radial bone (DMRB) should be provided in steady-state conditions, using reliable methods of reposition and retention of the fixed bone fragments. The strategy of treatments of fractures of DMRB first consisting in closed reposition and in surgery in case of failure or secondary displacement is thought to be outdated. In patients with symptoms of unstable fractures active surgical strategy should be used before complications appear.

[Potentialities of blocking osteosynthesis for metaphyseal fractures of the humeral bone].

A method of blocking intramedullary osteosynthesis of metaphyseal fractures of the humeral bone is proposed. Its special features are: retrograde implantation of a nail from the antecubital fossa of the humeral bone, blocking the nail with distal blocking screws and proximal blocking screws which are fixed in the nail at the expense of threaded connection. This method gives exact reposition, absolute stability of fixation, possibility of early load and rehabilitation.

[Treatment of metaphyseal fractures of shin bones by the method of blocking osteosynthesis].

The proposed method of reposition and polyaxial stabilization of fragments for intramedullary meallosynthesis of fractures of long tubular bones allows blocking osteosynthesis to be successfully used in treatment of complex metaphyseal fractures of shin bones. It results in strong fixation of the fragments, makes it possible to successfully eliminate residual deformities after introduction of the nail and to avoid the development of them in future under the influence of loading. The method provides early functioning of the interfacing joints, early axial loading, shorter period of disability, the absence of external immobilization.

[Use of blocking osteosynthesis for metaphyseal fractures of the femoral bone].

An analysis of treatment of 95 patients allowed the authors believe that antegrade blocking osteosynthesis gives a reliable fixation of fragments in cases of fractures of distal metaphysic of the femoral bone and prevents the development of extension contracture in the knee joint. It gives a good functional result.

[Functional method of treatment of fractures of long tubular bones--blocked intramedullary osteosynthesis].

The blocked intramedullary osteosynthesis of tubular bones, including the cases with multiple and combined traumas, is an up-to-date and minimally traumatic method that allows durable stabilization and dynamic fixation of complex fractures. Our results show high efficiency of this minimally traumatic method since it gives high stability of osteosynthesis, early functioning of adjoining joints, early axis loading, shorter period of disablement, the absence of external immobilization. Perfection of the technology and design of the nails allows successful use of the method for metaphysis localizations.

[Outpatient treatment of patients with fractures of hand tubular bones].

Results of treatment of 282 patients with 288 fractures of tubular bones of the hand were analyzed. In 190 (67.4%) cases conservative methods of treatment were used, in 92 (32.6%)--surgical methods. In cases of fractures without displacement plaster immobilization was used, in patients with stable fractures of finger phalanx and metacarpal bones with fragment displacement we made closed reposition and plaster immobilization. We applied intramedullary osteosynthesis with Kirschner's wire after closed reposition in unstable oblique and transverse fractures with fragment displacement. In open fractures of distal phalanx thin wires were used for intramedullary osteosynthesis. External fixation with Ilizarov's instrumentation was applied in patients with intraarticular fractures, with fractures healed in improper position and in patients with posttraumatic bone deformity. Using the surgical method in out-patient practice reduced the amount of hospitalized patients. Special methods of rehabilitation decreased the period of management and earlier returned the patients to active life.