Relevance. Fractures of the distal metaepiphysis of the radial bone among all fractures range from 11% to 30%. Unsatisfactory results of treatment in patients over 70 years old are found in 44% of cases. Timely and adequate rehabilitation treatment is important for obtaining good results in the treatment of such patients. Objective: to improve the results of the treatment of patients with fractures of the distal metaepiphysis of the radial bone based on early comprehensive individual rehabilitation treatment. Materials and methods. 97 patients with displaced fractures of the distal metaepiphysis of the radius were observed. Among them, 67 are women (69.1%), over 50 years old – 64 (66%). Used conservative treatment with a sparing technique of one-stage reduction. Upon completion of the correction, according to the indications, measures were prescribed for the prevention of neurodystrophic syndrome, depending on the likelihood of its development (according to the temperature gradient of the fingers of the extremities) in the form of drug therapy. Massage, kinesiotherapy, and physiotherapy began on the second day. The pain intensity was determined using a visual analog scale. The nature of pain was determined by the DN4 questionnaire (questionnaire for the diagnosis of neuropathic pain). For subjective unified assessment of hand function in the long term after a hand injury, I used a specific questionnaire DASH (Disability of the Arm, Shoulder and Hand Outcome Measure) – a questionnaire of outcomes and disability of the hand and hand. Results. Rehabilitation treatment at admission and at the early outpatient stage was complex, individual, taking into account the periods of illness. The debris correction was painless, low-traumatic, rational fixing bandages were used. The volume of drug therapy was determined by the value of the temperature gradient of the fingers. Conclusion. The proposed method for the rehabilitation of patients with fractures of the distal metaepiphysis of the radius is highly effective: good and satisfactory (according to the DASH scale) results were obtained in 97.8% of cases, unsatisfactory – in 2.2%.
Relevance. To date, there is no final solution to the theoretical and practical issues of the problem of external fixation in the treatment of long bone fractures. Objective. To determine the rational methods of completing ring retainer (RF) in the treatment of nonunions of the shin bones after fractures of long bones on the basis of clinical and experimental substantiation of the choice, taking into account the peculiarities of the assembly of the apparatus and the implementation of the connection "apparatus-fragments of non-union". Materials and methods. In the experimental part, Sawbones® synthetic composite bone was used. The rigidity of fixation of bone fragments of the RF of the wire-rod type was studied. We tested and compared 5 different options for fixation of bone fragments in RF. The samples were tested in 4 modes: compression along the axis of the bone; compression on the head of the bone; twisting; bending. The strength and deformation characteristics of the materials were determined with a maximum force of up to 5 kN using the TIRATEST-2151 universal testing machine. They chose the most optimal configuration of the RF. Then, in the clinical part, the clinical effectiveness of the optimal structures was evaluated based on the analysis of their use in 12 patients with non-union of the shin bones. Results. Optimal structures have been determined from the point of view of integral rigidity of the structure. The greatest rigidity was the RF system No. 3, in which 3 spokes are used: 2 of them are held at an angle, 1 - in the plane of the ring. In the case of an increase in the number of spokes, the stiffness of the system increased. When tested in compression along the axis of the bone, the stiffness of System No. 3 is 6.5% greater than that of System No. 2 and 12.5 % greater than System No. 1, in which only 2 spokes are used. Fixing the spokes at an angle to the plane of the ring also increases the rigidity of the system. When tested in compression along the axis of the bone, the stiffness of System No. 3 is 6.5 % greater than that of System No. 2. The stiffening rib affects the stiffness of the entire system. But the bend became the most sensitive. Flexural stiffness decreased by 23 % and compression by 8.5 %. Debris removal during bending increased by 1.5-1.8 times. Conclusion. The best indicators of fixation rigidity have options for the arrangement of spokes with a cross not only in the frontal, but also in the sagittal planes. The stability of the fixation of the rod is significantly increased by mounting the "stiffness triangle". The obtained clinical data indicate the promising application of improved ring fixators.
Relevance. Today there is no generally accepted scope of treatment for nonunion of the tibia. Treatment results are often unsatisfactory. The incomplete process of bone tissue repair is due to the presence of metabolic changes and vascular disorders. This suggests that the use of anti-clotting drugs in the complex treatment may contribute to better treatment results. Objective: to study the effectiveness of the use of antiplatelet drugs bemiparin and tranexamic acid in the complex repair of bone tissue. Materials and methods. 36 patients with tibia nonunion were treated. Complex therapy included surgical treatment (rehabilitation of inflammation and, if present, fistula sequestrectomy), fixation of fragments with ring fixators, antibacterial therapy according to generally accepted principles, conservative therapy of vascular disorders, correction of homeostasis. The comparison group consisted of 42 victims. To correct homeostasis before surgery, 750 mg of tranexamic acid solution was administered intravenously to reduce the risk of bleeding. In 6 hours after surgery, in order to prevent thrombosis, a prophylactic dose of bemiparin (Cibor) 25000 units was administered. The administration was carried out for 7 days. The state of blood homeostasis was assessed on 1, 3 and 7 days after surgery by the following indicators: platelet count, level of soluble fibrin-monomer complexes, prothrombin time, activated partial thromboplastin time, international normalized ratio. The condition of the tibia was assessed by the following indicators: the presence of fluid in the subfascial space, the condition of the fascia, muscles and blood vessels (assessed by ultrasound); asymmetry of the temperature of the feet and legs of healthy and injured limbs (using an infrared non-contact thermometer); the value of intratissue pressure on the tibia (using the Striker apparatus at certain points). The results of tibia treatment after fractures were evaluated using the anatomical and functional scale Modified Functional Evaluation System by Karlstrom-Olerud. Results. There was no significant blood loss during surgery and thromboembolic complications. Clinical data and indicators of intrafascial pressure in the outer and superficial posterior fascial compartments indicated the development of local hypertensive ischemic syndrome. The dynamics of foot thermoasymmetry, ultrasound data are characteristic of subcompensated functional disorders with the theoretical possibility of their recovery. The obtained data indicate a violation of blood flow with a high risk of possible thrombosis, which is an objective basis for the appointment of low molecular weight heparin. The dynamics of most of the examined indicators of blood homeostasis during the prescribed therapy did not differ statistically, but there was a tendency to shift the indicators to the recommended safe zone. Conclusions. Clinical data indicate the high efficacy of Cibor in the complex therapy of septic nonunions.
Резюме. В работе редставлены ре ультаты лечения больны травматическим остеомиелитом конечно-стей с учетом сте ени ора ения и выра енности ре аративны роцессов.Ключевые слова: остеомиелит, лечебная тактика.