Aim: To analyze results of proposed reverse transosal suture. Materials: 264 cases (187 patients; 143 men, 44 women, age between 5 to 75 y. o.) of tendon fixation to distal phalanx by proposed technique was accepted in our research, after two stages flexor tendon grafting, in 2008—2019. On 2nd day after surgery - early full amplitude movement rehabilitation protocol (modification of Kleinart technique) was applied. Results: In an interim analysis of 109 patients treatment results, we noted complications associated with a transossal tendon suture to distal phalanx in 7.5 % (8/159) of cases: infectious complication — 1 case, serious nail growth disorders — 1, slight deformation of the nail plate — 5 cases, periodic pain in distant period — 1 case. To avoid complications associated with nail plate disorders, suture technique was modified by displacing the transcutaneous canal to the side of the nail germinal zone without incision on the back of the finger. No deformation of the nail plate was observed after changing of suture technique. Conclusions: flexor digitorum profundus tendon fixation technique minimizes trauma to surrounding tissues. Strong internal fixation of the tendon gives the possibility of early movements. Intermediate material analysis made it possible to change the suture technique to effectively eliminate the most common complications.
Objective. To determine a role of «wide awake» аnesthesia for improvement of results of tendon–muscular transpositions on the hand. Маterials and methods. During 2016 – 2017 yrs a «wide awake» аnesthesia was applied in 32 patients, suffering consequences of the upper extremity and ageing 16 – 68 years. Median age of the patients have constituted (38.7 ± 14.7) years. Results. The results of a “local awake аnesthesia without placing a tourniquet” while performing a tendon–muscular transpositions and the mobilization operations on the hand were estimated. Conclusion. High efficacy of a «wide awake» аnesthesia in nonvolume function–creating interventions, performed with addition of sliding and active structures and necessitating close intraoperative cooperation with the patient, was proved.
Summary. During the period of rapid industrialization, there was a need to create a new approaches to treat hand injuries due to rapid development of metallurgical, mining and engineer industry, which were accompanied by a high level of injuries with a significant amount of disability in the second half of 20th century, in Donetsk, Dnipropetrovsk and Kharkiv regions. New stage in the development of hand surgery and microsurgery in Ukraine began in the 80’s: the Department of Microsurgery and Reconstructive Surgery of the Upper Extremity under the direction of I. Antoniuk was opened on the basis of the SI “Institute of Traumatology and Orthopedics of NAMS of Ukraine” in Kyiv in 1982. Development of hand surgery in the western regions of Ukraine began in the 90’s. In Lviv, on the initiative of O. Toropovskyi, on the basis of the City Hospital No 8, a Center of Microsurgery and Surgery of the Hand was created. In Zakarpattia (Uzhhorod) since 1997, on the initiative of V. Haiovich and A. Pogoriliak, microsurgery and hand surgery service was established, which is now under the care of the Combustiology Department. In Volyn (Lutsk), hand surgery service is transmitted to the initiative group, also working at the City Combustiology Center. In Ivano-Frankivsk, Chernivtsi, Ternopil and Rivne, initiative groups in the field of hand surgery service have been formed in the structure of orthopedics and traumatology departments. 2005 was marked by the opening of another center for surgery of the hand in Luhansk on the initiative of V. Ivchenko and under the guidance of V. Golovchenko, whose surgeons owned microsurgical equipment and provided highly skilled assistance to the population of this region. Ukrainian Hand Surgery Society (UHSS) was created in 2012, and led by Professor S. Strafun, as a result of collaboration of all hand surgery centers. In 2014, UHSS was accepted into the Federation of European Societies for the Surgery of the Hand (FESSH).
Summary. Brachial plexus injuries is a severe and debilitating trauma characterized by gross impairment of upper extremity function. Mostly this is the trauma of young active people of working age, which often leads to significant loss of upper extremity function and disability of the patient. On October 10, 2019, at the XVIII Congress of Orthopedists Traumatologists of Ukraine held in Ivano-Frankivsk, a round table was held on the basic issues of diagnosis and treatment of patients with brachial plexus injuries, and a multidisciplinary consensus was adopted on the basic principles of diagnosis and treatment of brachial plexus injuries. During the round table, the issues of determining risk groups for brachial plexus injury (patients with polytrauma, road trafic accident, patients with injuries of the shoulder girdle area, dislocations of the shoulder, open lesions of the shoulder girdle and subclavian area, patients with atypical pain in the shoulder, patients that lost upper extremity function after surgery in the supraclavicular and subclavian area, neck, mastectomy, radiation therapy) and the protocol of clinical examination of patients (which must include the possibility of active movements in the joints of the upper limb and stabilization of the scapula; it is obligatory to determine the strength of the muscles of the affected limb in comparison with the healthy one, to determine sensitivity in the corresponding areas of autonomous innervation of the roots; also it is important to determine Horner syndrome) were discussed. Also, the place and time of additional diagnostics methods (emergency ultrasound and radiography, after 3 weeks – needle and stimulation electroneuromyography (ENMG), MRI of the brachial plexus or cervical spine, CT myelography) and an algorithm for the supervision of patients with a brachial plexus injury were adopted; the centers of brachial plexus surgery were specified. All this later formed the basis of multidisciplinary consensus.
Summary. Analysis of the restrictions in the amplitude of movements in the joints is traditionally considered from the standpoint of individual nosologies that cause them, but the systemic results of the inverse syndromological approach to the study of contractures are published only sporadically. Objective: to determine the structure, causes, nature, and severity of contractures of the upper extremity joints. Materials and Methods. The structure of contractures of the upper extremity joints as the consequences of injuries and diseases was analyzed on a large array of patients (16,710 patients). Distribution by location, etiology, severity of contracture, gender and age, and relationships between type and localization of contracture were assessed. The dynamics of the development of contractures and the number of necessary surgical interventions was traced. Results. Restriction of movements in the upper extremity joints was registered in 5,450 out of 16,710 (32.6%) patients; among them there were 3,485 male (63.9%) and 1,965 (36.1%) female patients. During reconstructive treatment, 7,892 surgeries were performed. Most often these were contractures of the finger joints (42.5%), then shoulder (26.9%), elbow (13.4%), carpal joint (13.3%), less often – radioulnar contractures (3.9%). The elbow, radioulnar and carpal joint contractures most often are caused by osteo-cartilaginous lesions; a polyetiological component is typical for the finger joints. The shoulder joint contractures may be caused evenly by desmogenic, myogenic, or osteo-cartilaginous lesions. Most of the joint contractures are of moderate severity. Contractures of the fingers require multi-stage surgical treatment (1.91±1.35 surgeries); one-stage treatment is used for contractures of the shoulder joint (1.34±0.81 surgeries). The most polystructural lesions were combat wounds, ischemic, and finger contractures (2.53±1.22; 2.52±1.34 and 2.5±1.24 structures, respectively), and the least – radioulnar contractures (1.59±1.34 structures). Radioulnar contractures in 37.3% of cases are accompanied by contractures of the fingers, but vice versa only in 1.2%. It was noted that contractures of the radioulnar joints are often accompanied by restriction of movements in the elbow and wrist joints – in 34.9 and 56.6% of cases, respectively. At the same time, the inverse dependence of the combination of contractures in the wrist and elbow joints with radioulnar joints is not very high – 4.2% and 6% of cases, respectively. Conclusions. In patients who are hospitalized for highly specialized surgical treatment of pathology of the upper extremity, contractures of its joints are moderate and severe, characterized by polyetiology, and, in most cases, caused by disorders of osteo-cartilaginous structures and their combination with desmogenic, tenogenic, and myogenic lesions. Specific relationships are traced in localization and mutual burden of contractures, rapidity of their progression. As a rule, upper limb contractures are chronic ones and require multi-stage surgical treatment.
Summary. Damage to the brachial plexus (brachial plexopathy) is considered one of the most severe pathologies of the upper limb, which can lead to gross impairment of function and permanent disability of the patient. Today, MRI diagnostics is the first-line method for visualizing normal anatomy and pathological conditions of the brachial plexus (BP). Objective: to optimize the diagnosis of BP pathology based on the study of diagnostic capabilities of magnetic resonance imaging (MRI). Materials and Methods. A retrospective analysis of MRI data of 62 patients with traumatic injury of the BP (group 1) and 23 patients with lesions of non-traumatic genesis (group 2) was performed. The MRI examination was performed on a PHILIPS Achieva magnetic resonance tomograph with a magnetic field strength of 1.5 T using sequences of T1 and T2 weighted images (33), a 3DT2 DRIVE sequence with a high degree of resolution, and STIR sequences in axial, sagittal and coronal projections. Results. The MRI picture of brachial plexopathies was quite diverse and depended on the etiology of the lesion, the level and severity of damage to neural structures. When analyzing the MRI studies of patients of group 1, preganglionic lesion was detected in 39 patients (62.9%); 8 patients (12.9%) had trunks lesion and 15 patients (24.2%) had cords lesion. In group 2, BP dysfunction associated with detected MRI signs of a tumor of nerve structures or infiltration and/or compression of the brachial plexus by a tumor of other organs or a metastasis was detected in 21 patients (84%); BP dysfunction resulted from radiation therapy in 2 patients (8.7%) and from the disease – neuralgic amytrophy – in 2 patients (8.7%). The use of MRI made it possible to carry out a differential diagnosis of pathology and to determine the nature, extent and degree of severity of damage to nervous structures. Conclusions. MRI examination is an effective method of diagnosing the brachial plexus pathology, which makes it possible to determine the level, extent and severity of the damage, and to justify the further treatment of this category of patients at the early stages.
Relevance. Peripheral nerve injuries are potentially disabling lesions, which account for about 2-3% of all injuries. In order to study the clinical manifestations of limb denervation in the early and late stages, we conducted an experimental study. Objective: in the experiment, to study the effect of bone marrow aspirate injection into the target muscles on denervation-reinnervation processes by studying the clinical manifestations of denervation (presence of trophic ulcers, edema, or muscle wasting). Materials and Methods. The experiment was performed on 36 rabbits, which were divided into four groups: a group of pseudo-operated animals, group 1 (neurotomy and sciatic nerve suture), group 2 (on-time injection of bone marrow aspirate), and group 3 (delayed injection of bone marrow aspirate). Detection of hypotrophy or edema of the tibia was performed by determining the percentage of leg circumference of the operated on and intact limbs. Clinical manifestations of limb denervation were recorded during the examination of experimental animals before their euthanasia. Results. When comparing the number of complications in group 1 and group 2, more complications of the denervation process was observed in group 1. At the same time, no difference was found between group 1 and group 3, as well as between group 2 and group 3. When comparing the indicators of hypotrophy, the difference between group 1 and group 2, as well as a significant difference (p<0.05) between group 1 and group 3, with a predominance of hypotrophy in group 2 and group 3 were revealed. Conclusions. The injection of bone marrow aspirate into the target muscles during surgery and in the early stages of reinnervation helped to reduce the clinical manifestations of the denervation process. Delayed administration of bone marrow aspirate to target muscles significantly (p<0.05) helped to reduce edema of denervated target muscles.
Актуальність. Найбільш часта травма плечового суглоба — це вивих плеча. Частота вивихів плеча, за даними літератури, становить 2 % від усіх видів травм населення світу. «Нещаслива тріада» плеча зустрічається в 9–18 % випадків серед передніх вивихів плеча. Мета роботи: створення алгоритму діагностики «нещасливої тріади» плеча для покращання результатів лікування цієї патології. Матеріали та методи. У ДУ «Інститут травматології та ортопедії НАМН України» в період із 2000 по 2018 рік було проведене лікування 492 пацієнтів із вивихом плеча, серед них у 28 була діагностована «нещаслива тріада» плеча. Усі пацієнти були оглянуті клінічно, виконана мануальна оцінка функції дельтоподібного м’яза й чутливості еполетної зони, рентгенографія, комп’ютерна томографія, ультразвукове дослідження (УЗД), магнітно-резонансна томографія (МРТ) і електронейроміографія. Результати. При підозрі на передній вивих плеча мануально оцінюємо функцію дельтоподібного м’яза й чутливість в еполетній зоні. Під загальним знеболюванням виконуємо вправлення вивиху. У подальшому проводимо контроль оцінки функції дельтоподібного м’яза й чутливості еполетної зони. У разі порушення — оцінюємо функцію кисті. Виконуємо УЗД або МРТ плечового суглоба (а за необхідності — МРТ плечового сплетення). Візуалізація на УЗД або МРТ розриву ротаторної манжети плеча в комбінації з порушенням функції дельтоподібного м’яза дає нам підстави до встановлення діагнозу «нещасливої тріади» плеча. Висновки. «Нещаслива тріада» плеча — тяжка травма плечового суглоба, що призводить до тривалої втрати працездатності, а в деяких випадках — і до інвалідизації хворих. Діагностика «нещасливої тріади» плеча пізніше від 8 тижнів із моменту травми значно погіршує результати подальшого лікування цієї патології. Розроблений нами алгоритм діагностики «нещасливої тріади» плеча дозволяє поставити діагноз у ранні терміни після травми, що дає можливість розраховувати на більш повне відновлення функції.
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