BackgroundIntra-articular adhesion is one of the common complications of post knee surgery and injury. The formation of joint adhesion can lead to serious dysfunction. Rosuvastatin (ROS) is a new 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitor, with multiple biological effects. In our study, the object was to evaluate the effectiveness of ROS in the prevention of post-operative knee adhesion in rats.Material/MethodsFemoral condyle exposing surgery was performed on 45 healthy Sprague Dawley rats. Gelatin sponges soaked with 20 mg/kg of ROS, 10 mg/kg of ROS, or saline were used to cover the surgical site. The post-operative knee joints were fixed in a flexed position with micro Kirschner wires for four weeks. ROS effectiveness for treating intra-articular adhesion was determined with visual score evaluation, hydroxyproline content, histological analyses, immunohistochemistry, and inflammatory and vascular endothelial growth factors expression.ResultsThe animals’ recovery was stable after surgery. The hydroxyproline content, visual score, and inflammatory vascular growth factors expression levels suggested that, compared with the control group, the ROS treatment groups showed better outcomes. ROS prevented joint adhesion formation, collagen deposition, and vascularization at the surgical site, and also inhibited inflammatory activity post-operatively. Compared with the 10 mg/kg ROS group, the 20 mg/kg ROS group showed significantly better outcomes.ConclusionsThe local application of ROS reduced intra-articular adhesion formation, collagen deposition, and vascularization at the surgical site, and inhibited inflammatory activity post-operatively. These results suggested optimal concentration of ROS to be 20 mg/kg.
Background.Treatment tactics of proximal humerus fractures remains a matter of dispute due to multiple cases of unsatisfactory outcomes and high rate of postoperative complications.The aim of the study—to evaluate midterm outcomes of intramedullary fixation for treatment the proximal humerus fractures in comparison with plate fixation.Material and Methods.The authors evaluated treatment outcomes of 175 patients with proximal humerus fractures who underwent surgery in the period from 2012 to 2017. Depending on the fixation method the patients were divided into two groups: the main group consisted of 107 patients who underwent intramedullary fixation by a nail of third generation; a comparison group — consisting of 68 patients who underwent fixation by a locking plate with angular stability.Results.In one year after intramedullary nail fixation the authors observed the excellent and good outcomes on Constant scale in 83.2% of cases, satisfactory — 12.1%, unsatisfactory — 4.7%. Patients who underwent plate fixation demonstrated the following outcomes: excellent and good — 73.5%, satisfactory — 17.7%, unsatisfactory — in 8.8%. Constant score increase was equal in the main and control groups and varied depending on the fracture type.Conclusion.Intramedullary nailing is an option for treatment of all fracture types of proximal humerus as well as for the cases of combined humeral neck and diaphysis fractures. Functional recovery parameters were higher in the main group of patients after intramedullary nailing.
The question of the performance of one step operation in patients with concomitant and multiple trauma from the point of view of the choice of surgical intervention time, sequence and type of operation is considered. The advantages of one step operation include: one narcosis, one postoperative period, decrease of the risk of posttraumatic and postoperative complications, easing of treatment and nursing at intensive care unit as well as earlier rehabilitation. Criteria for the detection of the surgery time, sequence and type of operative intervention for individual patient with polytrauma were elaborated. Between 1998 and 2002, 282 one-step operations (71 emergency operations (within 5 hours after trauma), 135 urgent operations (within the first 3 days after trauma) and 76 delayed operations (within 10-14 days after trauma)) were performed at Moscow clinical Hospital #1 named after IV. I. Pirogov.
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