Vol 22, No 4 (2015)

Long-term results of radical thoracoplasty via small incisions with fixation of sternocostal complex by shape memory metal plate were studied. Total number of 263 patients, aged 2.5 - 45 years, with funnel chest deformity (FCD) were operated using that technique. Out of them 118 patients were under 18 years and 145 - over 18 years. In adult patients in children good results were achieved in 97.7% and 90.5% of cases, respectively. During the process of plate removal in children it was possible to correct residual chest deformity and achieve good results. In childhood radical thoracoplasty is indicated only to the patients with severe 2-3 stages of FCD and “least” FCD forms should be corrected at the mature age.

Long term surgical treatment results were studied for 30 patients (10 male and 20 female) with two- and three-fragment proximal humeral fractures with short intramedullary nail. Mean age of patients was 68.8 (37-84) years. All patients were examined clinically and roentgenologically. In postoperative period secondary varus deformity was observed in18 (60%) patients and made up 4.3° at an average. Roentgenologic signs of delayed fracture consolidation due to the loss of reposition and decrease of neck-shaft angle under 120° were observed in one case. Evaluation by ASES scale made up 90.73±7.01 points, by SST scale - 10.47±1.41 points. Treatment results for three-fragment fractures were not as good as for two-fragment ones however the difference was not statistically significant ( p >0.05). Obtained data showed the high efficacy of short straight intramedullary nail application in two- and three-fragment proximal humeral fractures.

Conservative treatment results are presented for 328 patients with I-II stages of femoral head avascular necrosis (FHAN) at 3 years follow up term. Uni- or bilateral coxarthrosis was observed in 157 patients. Patients were on intraarticular injections of perfotran (1st group; n=102) or perfotran+dimexide mixture (2nd group; n=226). Clinical and functional hip joint condition was evaluated by Harris Hip Score. Positive dynamics was noted in all patients however in group 2 it was more marked: absence of negative dynamics was recorded in 204 (90.2%) patients; restorative process, by MRI examination results, was noted in 105 (46.5%) patients; significant reduction of pain syndrome was achieved. Algorithm for the management of patients with early stages of FHAN was proposed.

Prospective study of zolendronic acid efficacy was performed in 112 patients with systemic osteoporosis. Study results confirmed the presence of patients who did not response to the treatment: in 15.7 % of observations reduction of mineral bone density (BMD) continued to progress. No significant differences in initial deviations of resorption and bone formation markers, peculiarities of calcium homeostasis were detected in “non respondents”. At the same time by the 12th month after treatment initiation the relationship between BMD increase with preservation of marked decrease of resorption marker (deoxypyridinoline) and bone formation marker (osteocalcin) was noted, that pointed out the expediency of prognostic model creation. Evaluation of the influence of certain risk factors (age, results of blood and urine biochemical tests, data of densitometry including the results of femoral neck BMD in some patients) using discriminant analysis showed that 81.5% of patients were correctly referred to the groups of patients who responded and not responded to treatment. Out of all initially studied parameters the most significant were 7 that in 78.6% of cases (method sensitivity) enabled to identify the patients with negative treatment effect and in 82.1% of cases (method specificity) - with positive treatment effect.

Description of the most common approaches used in intraarticular fractures of elbow joint bones is presented. Advantages and disadvantages of every approach are noted. Preferences of the authors in the choice of specific approach are indicated and substantiated.

Treatment results for 38 patients aged 18-45 years with acute traumatic lateral patellar dislocation are presented. In 2 months after arthroscopic intervention 3 intraarticular injections of synovial fluid substitute were performed to all patients. Results were assessed by IKDS questionnaires and Tegner Lysholm Knee Scoring Scale in 2 (prior to injections), 6 and 9 months after operation. Mean point by IKDC scale made up 38±2.1 before surgery, 56±3.5 in two months, 73±3.7 in 6 and 85±3.4 in 9 months (p<0.05) after intervention. By Tegner Lysholm Knee Scoring Scale those values made up 54±3.1, 62±2.1, 71±2.4 and 80±2.6, respectively (p<0.05). Applied treatment tactics enabled to achieve excellent and good results in long term postoperative period in 93% of patients.

Clinical observation of patients with posttraumatic deforming arthrosis of subtalar joint resulted from calcaneus fracture and preoperatively diagnosed closed old dislocation of left foot peroneal tendons is presented. The necessity of thorough examination of patients with hindfoot injuries and expediency of surgical interventions not only on the bony but also on the soft tissue structures is substantiated. Such interventions will provide for the restoration of the normal anatomical position of peroneal tendons.

Student years of the Honoured Science Worker of RSFSR, Academician of the Academy of Medical Sciences (AMS), Soviet trauma- and orthopaedic surgeon, the founder of the Central Institute of Traumatology and Orthopaedics N.N. Priorov are presented. The atmosphere of student life with its everyday troubles, living conditions, university studies, lack of money, unemployment, revolutionary sentiments and yearning of young people for knowledge as well as the desire of teachers to share their experience to young generation is shown.