[Treatment of diaphyseal femoral fractures with extramedullary compressive-dynamic osteosynthesis].

Since 2000 year 39 patients with diaphyseal femoral fractures have been treated using the technique of extramedullary compressive-dynamic osteosynthesis. Treatment is finished in 25 patients, 11 of them resumed their previous activities, while 14 did not. They are under follow-up and demonstrate different stages of fracture consolidation. The constructed device meets the requirements of extramedullary fixation and develops the necessary compression of the fracture zone. The flexible partly transfers the load to the fracture area, stimulating, thus, regeneration and consolidation of the lesion.

[The strategy of rehabilitative treatment following surgical intervention in patients with pseudoarthrosis of the extremities].

The objective of the present study was to analyse results of the treatment of 267 patients with pseudoarthrosis of the extremities and to use them for the development of criteria for the choice of methods for rehabilitative therapy. It was shown that stability of fixation of bone fragments by metal devices in patients with false joints (unlike fractures) varies depending on bone tissue condition. With this in mind, the patients receiving rehabilitative treatment were allocated to three groups differing in the degree of immobilization in the postoperative period. One group included the patients who did not need immobilization of the affected extremity. The other comprised those requiring immobilization only in case of axial load. Patients of the third group needed immobilization throughout the entire period until the completion of fragment consolidation. The results thus obtained were used to develop tactical schemes of combined treatment of patients using up-to-date orthotic techniques. It is proposed to divide the postsurgery treatment schedule into the following periods: early postoperative, early rehabilitative, the onset of active functional loading, and the period of functional and vocational rehabilitation. Such a differentiation is believed to enhance efficiency of the above rehabilitative strategy and facilitate the adequate choice of combined remedial treatments. Excellent and good outcome of rehabilitation with the use of this technology have been achieved in 98.9% of the patents.

[The bone regeneration process under chymotrypsin exposure (an experimental study)]. / Protsess regeneratsii kosti pod vozdeistviem khimotripsina (éksperimental'noe issledovanie).

Disturbance of femur diaphysis compact substance was induced experimentally in rabbits. In the course of the operation single administration of crystalline chimotripsin into the wound was performed and its influence on bony structures regeneration was studied. Methods of light and scanning electron microscopy revealed that reparative processes started earlier and were more active than that in control. This promotes regenerate formation and complete healing of bone defect. Intramuscular administration of proteolytic enzyme does not exert essential influence on bone regeneration.

[The transosseous approach to the hip joint in reconstructive operations]. / Chreskostnyi dostup k tazobedrennomu sustavu pri rekonstruktivnykh operatsiiakh.

The authors noted a number of peculiarities and positive moments in case of application of hip joint transosseous access after Kulish with 87 patients, aged 14-64 years, with deforming coxarthrosis, femoral head aseptic necrosis, coxa vara, congenital hip dislocation and femoral head epiphyseolysis. The access is simple, effective, comparatively low traumatic and can be successfully applied in hip joint reconstructive orthopedics.

[Treatment of post-traumatic coxa vara in adolescents and adults]. / Lechenie posttravmaticheskoi coxa vara u podrostkov i vzroslykh.

The authors have proposed a method of surgical treatment of posttraumatic coxa vara. The treatment was given to 19 patients aged 16 to 43 years. The essence of the operation consists in oblique intertrochanteric osteotomy of the femur, osteotomy of the lesser trochanter and a muscular pedicle graft formation from the lesser trochanter which is used in grafting the defect observed after the correction of the spatial position of the proximal end of the femur.

[Roentgenotopographic forms of aseptic necrosis of the femur head in adults]. / Rentgenotopograficheskie formy asepticheskogo nekroza golovki bedrennoi kosti u vzroslykh.

On the basis of the data of X-ray examination of 378 patients (466 joints) with aseptic necrosis of the femoral head and their surgical treatment (314 patients) the authors have distinguished four roentgenotopographic forms of avascular lesions: peripheral, central, segmental and total. Certain dependence of the localization of the necrotic focus on a number of determined etiologic factors has been pointed out, such as the character of the preceding injury and the type the hip lesion, supercooling or the patient's occupation. The authors believe that the choice of the most adequate type of surgical intervention should be based not only on the stage of the process, but also on the size and the localization of the femoral head lesion.

[Subchondral autoplasty of the femur head in stage II aseptic necrosis in adults]. / Subkhondral'naia autoplastika golovki bedrennoi kosti pri asepticheskom nekroze II stadii u vzroslykh.

A method of the operative treatment of the II stage of aseptic necrosis of the femur by subchondral autoplasty (with bone chips with crystal chymotrypsin) is described. In 18 of 22 patients operated upon good results were noted, in 3 patients results were satisfactory during 2-5 years.