OSTEOCHONDRAL AUTOLOGOUS TRANSPLANTATION VERSUS ARTHROSCOPIC DEBRIDEMENT WITH DRILLING IN THE TREATMENT OF TALAR OSTEOCHONDRAL LESIONS AND DEFECTS.

OBJECTIVE: The aim: To conduct a comparative analysis of the results of arthroscopic debridement with drilling (ADD) versus osteochondral autologous transplantation (OAT) in the treatment of talar osteochondral lesions and defects (OHLD) based on the assessment of the function of the ankle joint, the level of pain and changes in the range of movements (ROM) in the affected joint. PATIENTS AND METHODS: Materials and methods: The study included 40 patients with OHLD, with an average area of 3.14 cm2 and a depth of 1.15 cm, located in the posterior and middle medial part of the talus block. In the group 1 performed ADD. In group 2 - OAT. The results were evaluated before surgery, at 12 and 24 months. The level of pain to VAS, the function to AOFAS, the ROM in the joint were studied. RESULTS: Results: After treatment, there was a significant reduction in pain with the best result in group 2 (p<0.05). AOFAS showed that after 12 and 24 months the functional state of the joint in group 2 was better than in group 1 (p<0.01). After 12 months, ROM increased significantly in both groups. After 24 months, there was no increase in ROM in group 1, and in group 2 the growth was statistically significant (p<0.01), which confirmed the higher prospects and stability of the result when performing OAT. CONCLUSION: Conclusions: OAT is better than ADD for talar OHLD, provides maximum recovery of the joint surface, significantly reduces pain and improves ankle function.

FEATURES OF THE FEMORAL HEAD FRACTURES COMBINED WITH ACETABULUM POSTERIOR WALL FRACTURES SURGICAL TREATMENT.

OBJECTIVE: The aim: To conduct a thorough analysis of the surgical approach features in femoral head fractures combined with acetabulum posterior wall fractures; to analyze these patients' treatment results 12-36 months after the surgery; to determine the criteria affecting the satisfactory treatment results achievement in these injuries. PATIENTS AND METHODS: Materials and methods: The surgical treatment results were evaluated 13 and 36 months after the surgery. The retrospective analysis included 21 patients (17 men and 4 women) with femoral head fractures combined with the acetabulum posterior wall fractures. Pipkin and Brumback classifications were used to classify the fractures. RESULTS: Results: The results of acetabulum posterior wall fractures delayed treatment are significantly different to the ones treated with early osteosynthesis. The reasons for that are difficulties in anatomical repositioning, femoral head malnutrition due to its displacement or chronic subluxation, reduced blood supply to the fragments due to surgical manipulations during the approach. Thus, according to Matta criteria anatomical reposition of the fragments was achieved in 19 (90.5%) cases, imperfect reposition in 1 (4.8%) case, unsatisfactory reposition - in 1 (4.8%) patient. The treatment results' improvement after 3 years occurred due to hip joint replacement in 5 (23.8%) patients. CONCLUSION: Conclusions: The treatment results of femoral head fractures with acetabulum posterior wall fractures depends on the type of fracture, concomitant injuries, the timing, and method of removing the femoral head dislocation, and the surgical treatment method.