Epidemiology of Hip Fractures in Two Regions of Ukraine.

Worldwide, the number of hip fractures, the most important osteoporotic complication in the elderly, continues to increase in line with the ageing of the population. In some countries, however, including the Ukraine, data on the incidence of hip fracture are limited. This article describes the first analysis to characterize the incidence of hip fracture in the Ukrainian population from the age of 40 years. It is based on data from two regional studies, namely, the Vinnitsa city study and the STOP study, which were performed during 1997-2002 and 2011-2012 years, respectively. Hip fracture incidence rates were demonstrated to increase with increasing age. The rates were higher among younger men than women, however, with a female preponderance from the age of 65 years upwards. The incidence of hip fractures in Ukraine is 255.5 per 100,000 for women aged 50 years and older and 197.8 per 100,000 for men of the corresponding age. Overall, the incidence of hip fracture was comparable with data from neighboring countries, such as Poland and Romania. Hip fractures constitute a serious healthcare problem in Ukraine, and changes in healthcare are required to improve the management and long-term care of osteoporosis and its complications.

Epidemiology of hip fracture and the development of FRAX in Ukraine.

A country-specific FRAX model has been developed for the Ukraine to replace the Austrian model hitherto used. Comparison of the Austrian and Ukrainian models indicated that the former markedly overestimated fracture probability whilst correctly stratifying risk. INTRODUCTION: FRAX has been used to estimate osteoporotic fracture risk since 2009. Rather than using a surrogate model, the Austrian version of FRAX was adopted for clinical practice. Since then, data have become available on hip fracture incidence in the Ukraine. METHODS: The incidence of hip fracture was computed from three regional estimates and used to construct a country-specific FRAX model for the Ukraine. The model characteristics were compared with those of the Austrian FRAX model, previously used in Ukraine by using all combinations of six risk factors and eight values of BMD (total number of combinations =512). RESULTS: The relationship between the probabilities of a major fracture derived from the two versions of FRAX indicated a close correlation between the two estimates (r > 0.95). The Ukrainian version, however, gave markedly lower probabilities than the Austrian model at all ages. For a major osteoporotic fracture, the median probability was lower by 25% at age 50 years and the difference increased with age. At the age of 60, 70 and 80 years, the median value was lower by 30, 53 and 65%, respectively. Similar findings were observed for men and for hip fracture. CONCLUSION: The Ukrainian FRAX model should enhance accuracy of determining fracture probability among the Ukrainian population and help to guide decisions about treatment. The study also indicates that the use of surrogate FRAX models or models from other countries, whilst correctly stratifying risk, may markedly over or underestimate the absolute fracture probability.

[Disability due to traumas and diseases of a knee joint].

The invalidism structure was analyzed for patients, suffering consequences of traumas and diseases of a knee joint (KJ). The primary invalidism level because of traumas and diseases of a KJ have constituted in 2013 yr 12.4%. The cause of invalidism in men is predominantly a one-side gonarthrosis, and in women--a bilateral one--due to concurrent aggravating causes (dishormonal changes, excessive body mass). The invalidism indices enhancement is caused by absence of a dispensary follow-up, insufficient treatment on various stages of the disease course, severity and irreversibility of pathological process in a KJ, socio-economic factors, low rehabilitational potential, prognosticated impossibility to conduct a professional-labour rehabilitation in a prepensionable and pensionable age.

[Biomechanical aspects of efficiency of Latarjet's surgery for habitual dislocation of the shoulder in the bones fractures].

Biomechanical substantiation of efficiency of the Latarjet's operation in patients, suffering habitual dislocation of the shoulder while osteal tissue affection, was done, basing on retrospective analysis of clinico-roentgenological indices and the magnet resonance tomography (MRI) data. The data were compared among patients, to whom for habitual dislocation of the shoulder a stabilization of the shoulder joint was performed in accordance to Latarjet's method, and the results of biomechanical experiment--determination of the stress-strain state (SSS) of the shoulder joint structures in conditions of defect of the joint depression of scapula (JDS) and the Hill-Sax damage, using the method of a definitely-elemental (DE) imitational computeric modelling. In the upper extremity abduction by 90 degrees the maximal indices of SSS on surface of JDS, while presence of the defect, measuring 30% of common area, before the Latarjet's operation have exceeded their postoperative values by 198.7%; while abduction of upper extremity by 90 degrees and its external rotation by 45 degrees--by 286.8%; while abduction of the upper extremity by 90 degrees and its external rotation by 90 degrees--by 346.5%.

[Impact of duration and the injuries severity of the extremities peripheral nerves on activity of enzymes of energetic metabolism and content of electrolytes in biological material of patients].

Activity of such enzymes, as creatinkinase and lactatdehydrogenase, as well as contents of electrolytes (Na+, K+, Ca2+), were analyzed in biological material (the blood serum and muscular tissue) of patients with the trauma consequences in the extremities nerves. Depending on severity of the disease and duration of pathological process in patients, the changes in indices of energetic metabolism in the extremities were registered, witnessed by results of the activity measurements of certain enzymes-markers and the electrolytes contents.

[Surgical treatment of patients with consequences of combined trauma of upper extremity complicated by purulent infection]. / Khirurhichne likuvannia khvorykh z naslidkamy poiednanoï travmy verkhn'oï kintsivky, uskladnenoï hniinoiu infektsiieiu.

Result of treatment of 256 patients with consequences of combined trauma of upper extremity was analyzed. In 83 (32.4%) patients the purulent-necrotic complications occurred, caused by mistakes committed on the treatment process phase, especially during rendering the primary aid. It had promoted occurrence of the joint's contracture and ancilosis, osteomyelitis, ischemic contracture and the skin defects as well. Approach to the treatment conduction was in accordance with general principles of the patients orthopedic rehabilitation with consequences of combined trauma of upper extremity. Sanation of purulent focus was performed in 19 patients and microvascular transplantation of tissues--in 13 before restorational procedure was done.

[The use of vobenzym in the comprehensive treatment of patients with digital flexor tendon injury]. / Primenenie preparata vobénzim v komplekse lecheniia bol'nykh s povrezhdeniem sukhozhilii sgibatelei pal'tsev kisti.

The results of treatment of 56 patients with tendons of digital flexors were analyzed. In 28 of them in complex of treatment vobenzim was included, and an early active mobilization as well. Considerable antiinflammatory, antioedematous, secondarily analgetic effect of preparation, its application in early period permitted to realize active movements, to reach high functional result of treatment of patients' were noted.

[The causes of unsatisfactory results of treatment of open trauma of the hand under conditions of central regional hospital]. / Prychyny nezadovil'noho rezul'tatu likuvannia vidkrytoï travmy kysti v umovakh tsentral'noï raionnoï likarni.

The main causes, influencing the result of treatment of open trauma of the hand were established. The unsatisfactory result rate was 39.4%.

[The use of muscle and skin-muscle grafts in treating patients with ischemic contracture of the foot]. / Vykorystannia m'iazovykh ta shkirno-m'iazovykh transplantativ pry likuvanni khvorykh z ishemichnoiu kontrakturoiu stopy.

For the first time in the native literature the results of the microsurgical transplantation of composed complexes of tissues, including muscle, application for the treatment of patients with an ischemic contracture of the foot were analysed. The recommendations suggesting the complex of tissues choice are given. Complications after the flaps transplantation performance were analysed.

Analysis of the electromyographic activity of human elbow joint muscles during slow linear flexion movements in isotorque conditions.

Electromyograms were recorded by surface electrodes from the mm. biceps brachii (caput longum et breve), brachioradialis and triceps brachii (caput longum) in 10 healthy human subjects during slow linear movements in the elbow joint against a weak extending torque. The test movements were carried out under visual control through combining on a monitor screen a signal from a joint angle sensor with an appropriate command generated by a computer. The movements were fulfilled against a weak constant extending torque (0.5-2.5 Nm) and the extensor muscles were inactive. Surface electromyograms were full-wave rectified, filtered and averaged within sets of 10 identical tests. For the test movements in the range from 20 degrees to 100 degrees (0 degrees corresponds to a completely extended joint in these designations) the dynamic components of the efferent commands to actively contracted muscles frequently had a well-expressed monotonous increase. The electromyography intensity during movement quite often increased exponentially in all three investigated flexors. At the same time, the averaged electromyograms in one or two muscles could contain non-monotonous oscillations, thus showing a well-expressed decrease in the intensity of the efferent inflow within a middle range of a movement phase. The non-monotonous oscillations could occur in some subjects under minimal loads (0.5-0.75 Nm); they usually appeared initially only in one muscle, whereas the frequency of their occurrence was not high. The probability of finding the non-monotonous oscillations in the electromyograms from the muscles under study increased with heightening the extending load. Under the loads of 2.0-2.5 Nm this type of reaction could be found in almost half of all records (for the three muscles in each of the 10 subjects under testing). The presence of noticeable non-monotonous components in the electromyograms of the elbow flexors during their contraction is probably connected to their biomechanical arrangement within the joint. It is known that the arms of the forces generated by elbow flexors are maximal in the middle range of joint angles and decrease with a change in angle in both directions. Thus, we can suppose that non-monotonous decrement components in the electromyograms of the elbow flexors are presumably connected with an obvious necessity for a subject to decrease the excitatory efferent inflow to the muscles in the middle range of the joint angles. The pattern of electromyograms in the flexors acting around the joint was also dependent on a redistribution of activity between agonists. In the subjects showing stable non-monotonous components on the averaged electromyogram records in two agonists, a redistribution of the activity between these muscles has been demonstrated when phases of the electromyogram diminishing in one of them coincided with the appropriate increments in the other.

[Neurolysis and neuroplasty in patients with ischemic contracture of the foot]. / Nevroliz ta neiroplastyka u khvorykh z ishemichnoiu kontrakturoiu stopy.

The results of operative treatment of 24 patients with an ischemic foot contracture were analyzed, of them in 14 the reactive-restorational period of the disease was diagnosed and in 10--the residual one. The severity degree of contracture was determined according to classification of their own. The indication for operation were established basing on the results of clinical investigations and of electroneuromyography. In 18 patients the neurolysis of the leg nervous trunks was performed, in 6--interfascicular neuroplasty according to Millesi.

[Restoration of flexion of the elbow joint in patients with old injuries of the brachial plexus]. / Vidnovlennia zhinannia v likt'ovomu suhlobi u khvorykh z zastarilym poshkodzhenniam plechovoho spletinnia.

Examination of 23 patients with complete disorder of the flexion function due to irreversible injury of plexus brachialis. The translocation of m. triceps brachii in 8 patients, m. latissimus dorsi--in 8, m. sternocleidomastoideus--in 5, m. pectoralis major transposition was conducted in 1-5 years after the injury for the m. biceps brachii function substitution. The most complete restoration of flexion in articulation ulnaris was achieved after m. latissimus dorsi transposition. Good result was achieved after m. triceps brachii transposition conduction.

[The renewal of movement of the brachial joint in patients with brachial plexus injuries]. / Vidnovlennia rukhiv plecha u khorykh z travmoiu plechovoho spletinnia.

The operative treatment results of 45 injured persons with plexus brachialis trauma, functional disorder of muscle, providing the shoulder movements, is summarized. Orthopedic correction was done in 21 patients. Conduction of brachial joint arthrodesis (9 observations) proved to be the most effective one. M. serratus anterior functional potential determines the operation efficacy. M. deltoideus isolated restoration in patients with muscles-rotators paralysis do not permit to do the functionally significant movements in brachial joint. N. axillaris neurotization conduction is nonexpedient if muscles-rotators activity restoration is impossible.

[Reconstruction of the I carpo-metacarpal joint by transplantation of the II metatarsophalangeal joint on the neuro-vascular pedicle]. / Rekonstruktsiia I zapiastno-piastnogo sustava s ispol'zovaniem peresadki II pliusnefalangovogo sustava na sosudisto-nervnoi nozhke.

In the article are presented the results of treatment of a patient with the consequences of severe damage of hand. As the basic method of treatment there was used free microneurovascular autotransplantation of tissue complexes. The main attention was paid to the problem of reconstruction of the I carpometacarpal joint by transplantation of the II metatarsophalangeal articulation on the neurovascular pedicle. There was achieved a favourable anatomic and functional result. There are indicated the advantages of the given method in case of irreversible destruction of the I carpometacarpal joint.