Aim: To develop a rehabilitation protocol for patients with the unstable ankle joint injuries by doing comparative analysis between HSEF functional results and the traditional method. Materials and Methods: The study was performed on 61 patients with the unstable ankle trans- or supra-syndesmotic fractures. Patients were divided into two equal groups where I = main and II = control due to the age, distribution and disorders. 10 patients from the group I were operated using HSEF, the other 51 were selected for the traditional osteosynthesis (plate and positioning screw). For the monitoring of osteosynthesis quality was used The Foot and Ankle Disability Index (FADI) scale. Nonparametric statistical analysis was completed using Statistica 13.0 computer software. Results: After application of HSEF method authors of this paper created original rehabilitation protocol. Limitations in the rehabilitation process (e.g., not weightbearing) on 42}3 day in the control group II caused a significant gap in the results of ankle joint functional recovery. On day56}3, the main group I overreached the control group II by 1.5 (p3<0.001). With each FU 1-3 of the main group I, the total sum of points according to FADI (subscale of sports activity) steadily increased by 5, and with FU 3 on the 56}3 day, reached 16 points. Positive quantitative dynamics in scores were the characteristic of patients from both groups (advantage of the group I was insignificant (by 2 points) (p4<0.001)), although none of them reached the normal (32 points) at the final term (FU 4). Conclusion:Provided results proved the effectiveness of the developed rehabilitation protocol. It enhanced patients recovery up to 1-2 weeks.
Summary. Relevance. Despite many surgical techniques that use modern metal fixators, treatment of elderly patients with fractures of the proximal part of the hip still remains relevant. Objective: to evaluate the functional results of surgical treatment of elderly patients with transtrochanteric fractures of the femur using a cephalomedullary locking nail (PFNA). Materials and Methods. The study involved 193 elderly patients (mean age 76.2±10.3 years) with transtrochanteric fractures of the femur type 31 A1-A2.1-1.3 (AO/OTA) after osteosynthesis by PFNA cephalomedullar fixator. The functional outcome of the treatment was determined after 1, 3, 12, and 36 months by Harris Hip Score (HHS), radiographic signs of bone union, and the presence of complications. The risk of recurrent trochanteric fractures over the next 10 years was calculated by adapted FRAX scale. Results. Positive changes were found by HSS, in the dynamics: 51.6 after 1 month, 60.2 after 3 months, 79.7 after 12 months, and 84.4 after 36 months. Within 6 months after the surgery, the following changes were found: secondary displacement of bone fragments with the “cut-out” eruption of the cervical blade in 2.3% (n=3), migration of the cervical component outward in 4.7% (n=6), and inflammation of surgical wound in 3.9% (n=5) of cases. Retrospectively, the average FRAX score was assessed (22.12±1.76). Conclusions. Stable functional osteosynthesis of transtrochanteric fractures of the femur using PFNA combined with early dosed loading on the injured limb allowed to obtain satisfactory functional results in 95.4% of cases. Secondary displacement of bone fragments with the “cut-out” effect requires a detailed analysis of all possible endo- and exogenous factors and identification of the most significant ones. The 10-year risk of recurrent fractures in patients with trochanteric fractures significantly increases over the age of 70, especially in females, and accounts for the majority of osteoporotic fractures.
сучасному етапі розвитку медицини важливо розглядати травматичну хворобу як комплекс складних біохімічних та імунологічних реакцій, що призводять до тяжких змін гомеостазу та поліорганної недостатності. Мета дослідженнявивчити динаміку активації ІЛ-8 при множинній скелетній травмі із застосуванням інтрамедулярного остеосинтезу та можливості корекції ускладнень. Матеріали та методи дослідження. Дослідження виконали на 87 дорослих щурах-самцях лінії Vistar масою 180-230 г. Тварини були розподілені на три експериментальні групи: I-множинна скелетна травма, IIмножинна скелетна травма + інтрамедулярний остеосинтез, ІІІмножинна скелетна травма + інтрамедулярний остеосинтез + ліпін. Усім тваринам провели моделювання множинної скелетної травми за власною методикою. Остеосинтез інтрамедулярною спицею виконали через 3 години після травми. Ліпін вводили тричі. Усім тваринам визначили кількісні показники ІL-8 на 6, 24, 72, 168-й год після травми з допомогою ІФА із використанням діагностичного набору фірми «Вектор-Бест». Результати. У групі І пік активації ІЛ-8 наставав на 72-й год після травми, у ІІ групі максимальні зміни виникали раніше-на 24-й год. Динаміка зменшення цитокінового «шторму»: у групі І на 168-й год наставало вірогідне зменшення кількості ІЛ-8, близьке до встановленої норми, тоді як в групі ІІ динаміка була менш виражена. У ІІІ групі показники ІЛ-8 були найнижчими. Ключові слова: інтерлейкін-8, множинна скелетна травма, остеосинтез.
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