[Objective roentgenologic diagnostics of anterior cruciform ligamentous disruption in servicemen].

The article is dedicated to the method of roentgenological diagnostics, developed at military traumatology and orthopaedics department of the S.M. Kirov Military medical academy, which allows objectively assessing degree of knee joint instability in consequence of anterior cruciform ligamentous disruption.

[An importance of early diagnosis in the course of knee joint instability treatment in military personnel].

The aim of the study was to determine the cause of the high frequency of meniscal tear coexisting rupture of the anterior cruciate ligament of the knee joint and to establish an optimal timing of surgical stabilization of the knee joint. Medical records of 476 patients who had surgery at the clinic of the Kirov Military Traumatology and Orthopedics of Military Medical Academy were studied. In 82 patients operation on the reconstruction of the anterior cruciate ligament was perormed in the early period after injury (up to 6 weeks), 347 patients were operated within a period exceeding 6 weeks. It was revealed that the soldiers who had the operation in the period after 6 weeks from the date of injury, secondary damage of meniscus and articular cartilage occured twice as much as in surgery performed during the acute phase. Thus, the reconstruction of the anterior cruciate ligament should be carried out in a specialized epartment in the early stages after injury, when not yet any secondary damage to the meniscus and articular cartilage.

[CORRELATION OF MORPHOMETRIC PARAMETERS IN THE STRUCTURE OF THE FEMORAL AND TIBIAL CONDYLES].

Morphometric characteristics of the condyles of the femur and tibia were studied in 100 skeletons of the lower limb of adult individuals of I and II periods of mature age. Longitudinal, transverse and vertical sizes were measured, and on the basis of these data the indexes of conformity of the condyles of these bones between themselves were calculated. The wide range of variant anatomy of the condyles of both bones was found, as well as the presence of pronounced individual features. In men all the dimensions studied of the condyles were larger than in women. The results of the measurements of the condyles for both bones revealed 3 variant forms: with a predominance of medial condyle dimensions, with equal sizes of the medial and lateral condyle, and with a predominance of size of the lateral condyle. Indexes of conformity of the femoral and tibial condyles, proposed by us, demonstrated that the longitudinal dimensions of the femoral condyles prevailed over the corresponding sizes of the tibial condyles, while their transverse dimensions were virtually identical.

[Plastic reconstruction of soft tissue defects of extremities resulted from gunshot with the help of triangular flap].

Plastic reconstruction of soft tissue defects of extremities' resulted from gunshot with the help of triangular flap. The authors suggested an original technique of plastic surgery of round and oval-shaped gunshot wounds of soft tissues with the use. of triangular flap. The core of technique is to move triangular skin flap in the form of the letter <> and <>. By moving this flap, as well as stretching and displacement of surrounding tissue. It is possible to close the occured defect. The authors describe 32 surgical interventions on the upper and lower limbs in 21 wounded, defect size ranged from 2x2 cm to 12x18 cm. Closure of defects was performed during the period from 5 to 22 days after injury. As a result of the treatment the primary wound healing was observed in 87,5% of cases. In 12,5% of the wounded was observed marginal necrosis that healed after the second intervention. and didn't require repeated plastic reconstruction. Patients didn't get rough tightening scars affecting joint movement after the ·plastic reconstruction. All patients achieved good cosmetic and functional results. The proposed method-has several advantages over dermatomal plastic reconstruction, and before transplanting islet skin-facial flap in free and non-free versions. It is technically easier and does not require special software and tools.

[Mistakes and complications in internal osteosynthesis in patients with fractures of long bones].

Authors analyzed unsatisfied anatomical and functional treatment results of 118 patients after the internal osteosynthesis for fractures of long bones of extremities, which required ion performed revision surgery. Patients were examined clinically and instrumental before revision osteosynthesis, in short-term and long-term period after the operation. Authors systemized revealed mistakes into 4 groups and found out that the most frequent were tactical and technical (84.7%) mistakes, much less--diagnostic and organizational. Developed algorithm of preoperative evaluation, planning, technology, revision reconstructive operations allowed shortening recover time of anatomy and function to the average in 92.6% of patients.

[Specific traumatologic care forwounded and injured with fractures of long bones of extremities].

The efficiency of the system to assist victims with fractures of long bones in the Russian Defense Ministry is estimated. With the help of analytic hierarchy process a system-morphological and multi-criteria are defined and explored options for implementing 21 functions of the system. The result of scientific study was mathematical basis selected and adjusted for the nine criteria of the most effective alternative version of the implementation of the system to assist injured with fractures of long bones. On the basis of information was developed the concept of trauma service of Defense Ministry of Russia.

[The concept of development of the orthopedic and traumatological care in the Armed Forces of the Russian Federation].

The main directions of further improving the quality of trauma care in the Armed Forces of the Russian Federation are: 1) improving the organization of orthopedic and trauma care in military medical establishments of the Ministry of Defence of the Russian Federation taking into account their level of medical-diagnostic capabilities, the licensing of military-medical institutions and certification; 2) regular supply of differentiated trauma unit medical supplies and equipment; 3) ensuring a high level of training and upgrading of specialists in the first place, senior management.

[Selection of a rational method of surgical treatment of patients with proximal femoral fractures].

In the military hospital of traumatology and orthopaedics, Military Medical Academy from 2007 to 2009, was operated on 88 patients with fractures of the proximal femur, whose average age was 77.4 +/- 3.8 years. Selection of the optimal surgical procedure was performed according to the type of fracture of the proximal femur and bone quality (presence or absence of osteoporosis and its degree of severity). In addition, when choosing a surgical treatment to take into account patients' age, time elapsed since injury, general condition, the presence and severity of manifestations related diseases, as well as the patient's request for quality of life. Excellent functional results in this clinical group were obtained in 19.4% patients, good--in 16.1% patients, satisfactory--in 25.8% cases and 38.7% victims were regarded as unsatisfactory.

[Clinico-anatomical grounds of using flaps with the axial type of blood supply in treatment of patients with open (gunshot) fractures of the crus]. / Kliniko-anatomicheskoe obosnovanie ispol'zovaniia loskutov s osevym tipom krovosnabzheniia pri lechenii bol'nykh s otkrytymi (ognestrel'nymi) perelomami kostei goleni.

The main aim and task of the investigation was to present clinico-anatomical substantiation for plastic operations with the application of flaps with the axial type of blood circulation in treatment of this category of patients. The investigation included 348 clinical cases (for exact statistical data); 65 volunteers (for the assessment of physiological parameters) and 16 topographo-anatomical preparations (variants of the vascular network of the leg). The methods of clinical and rentgenological control were used. The work consisted of 4 stages: 1) clinico-statistical analysis by the materials of 348 clinical observations which allowed to establish the dependence of functional results of the treatment on the sizes of leg soft tissue defects; 2) topographo-anatomical investigations which allowed the topography of the leg vessels to be associated with the typical disposition of the flaps with the axial type of blood supply; 3) physiological investigation using ultrasonic dopplerography and active distance thermography on whose basis the methods were created for exact identification of the sites of the outlet of cutaneous arteries and finding the zones of optimal blood supply of the complex skin flaps being formed; 4) clinical approbation of the results of the investigation. The operations performed on 15 patients have demonstrated high effectiveness the new developed means of preoperative planning.