Relevance. Adequate blood circulation in the tissues during healing of fractures is a factor in achieving positive results in the treatment of patients. Purpose of the study. In an in vivo experiment, to study the features of the temperature response and blood circulation in the area of fusion of the primary and repeated fractures of the tibia during the growth period. Material and methods. Rats (n = 36) model a fracture of the tibia, recorded by the outer structure. In series 1, fixation continued until union. In series 2, 21 days after the operation, refracture was modeled and re-fixed until union. We studied blood circulation and tissue temperature in the projection of the fracture: in the norm; 21 and 35 days after fracture or refractory; 28 days after termination of fixation. Results. The temperature and blood circulation were of the same type, but of different severity. Three types of reaction were identified: 1) reduced blood flow velocity and tissue temperature, increased venous outflow; 2) increased blood flow velocity, unchanged venous outflow, reduced tissue temperature; 3) a slight decrease in blood flow velocity, increased venous outflow, a slight increase in tissue temperature. By the end of fixation in series 1, the parameters returned to normal. In series 2, 28 days after the termination of fixation in animals with the first and second types of hemodynamics, the temperature of tissues and venous outflow returned to normal, and the blood flow rate decreased. In the third type, the temperature of the tissues returned to normal, the venous outflow increased, and the rate of blood flow increased. Conclusion. When the primary fracture is fought, the blood circulation and tissue temperature normalized to the end of the fixation, and with refracturas a month after the termination of the fixation, the changes were preserved.
Objective To compare outcomes of non-union in forearm fractures treated with the use of a comprehensive surgical approach considering the injury pattern and localization. Material and methods Based on treatment approaches the cases were categorized into 3 groups with proximal forearm fractures (group I, n = 28; 33.8 %), mid-shaft and distal forearm fractures (group II, n = 32; 38.5 %), and controls (group III, n = 23; 27.7 %). Group I included patients with hypertrophic nonunion (HTNU) of the forearm bones treated with bone graft and plating. Group II consisted of atrophic nonunion, HTNU of the forearm bones repaired with the Ilizarov external fixation. A single 3 mL local injection of autologous bone marrow and a kukumazim solution of 50 PU were used to induce bone fusion in the patients of the two groups. The control group included non-unions with no considerations to the fracture pattern and localization. All patients underwent physical, radiological examinations and laboratory tests. Results The control group showed 8.7 % poor and 69.5 % good outcomes at a long term, whereas 3.6 % results were rated as poor and 82.1 % as good in group I, with 3.1 % poor and 87.6 % good outcomes in group II. The ratings can be associated with a differentiated surgical approach considering the injury pattern and localization, the use of kukumazim proteolytic enzymes and autologous bone marrow injection. Conclusion Optimization of surgical treatments and considerations for injury pattern and localization allowed for a 2.8-time (3.1 %) decrease in poor outcomes and a 30 % reduction in the limb immobilization period.
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