[STEROID-INDUCED OSTEONECROSES OF FEMORAL HEAD].

Avascular necrosis of the femoral head is a multifactorial disease with progressive development of severe secondary coxarthrosis. There are two types of necroses - secondary and idiopathic. The pathogenesis of necrosis is associated with local blood circulation disorders, coagulopathies and violation of bone tissue regeneration. Usage of Steroids is one of the most often and important causes of non-traumatic osteonecrosis of the femoral head. Postulated pathogenetic mechanisms of steroid-induced osteonecrosis (ON) of the femoral head includes fat cell hypertrophy, fat emboli and intravascular coagulation. MRI stays the main diagnostic method for detection of osteonecrosis in the early stages. Preservation of the native hip is the goal of treatment in young and active patients. Early diagnosis and intervention prior to collapse of the femoral head is the key to a successful outcome of joint preserving procedures. There are no specific biomarkers for diagnostic of ON and NO "golden standard" for its treatment, and frequently a multidisciplinary approach becomes necessary. Joint replacement procedure remains as a main method of treatment after failure of joint preserving procedures and in cases of the late-stages of ON, involving collapse of the femoral head and degenerative changes of the acetabulum. More recent reports of hip replacement surgeries while osteonecrosis of the femoral head, have shown excellent results, but implant longevity and following revision surgeries, still remain an outstanding problem. In this article, there is described one of the latest clinical cases of the steroid induced avascular necroses of femoral head, which took place in our clinic. Positive clinical outcome, that means full physical and social rehabilitation of the patient, treated by total hip replacement confirms effectiveness of this method in treatment of above mentioned pathology.

CORTICAL INTRAMEDULLARY FIBULAR GRAFT IN SURGICAL TREATMENT OF LONG BONES NONUNION.

Aim of the study is clinical evaluation of usage of cortical intramedular autografts, while treatment of long bones non-unions. During 2003-2013 years, in Traumatology Orthopedical Clinic "Syntese" and L.T.D. "Centre of Urgent Surgery and Traumatology" we have treated 35 patients with diafisial fractures of long bones by use of intramedular grafting. Among them were 12 cases of femoral fracture, 10 - cases of humeral and 13 cases of tibial fractures. Age distributions of patients was: from 16 years up to 30 years - 5 patients (14%): 31- 45 years 21 patients (60%), over 45 years - 9 patients (26%). Types of bone regeneration violation: research group: hypertrophic - 9 (26%), hypotrophic - 11 (31%), athrophyc - 22 (44%). Bone healing was reached in all cases. Average period of healing was 4.9 months. But it ranged from 4 up to 7.7 months. Not satisfactory result was found in 1case, satisfactory result in 2 cases, good result in 32 cases, condition of nearby joints was found as perfect in 72% of cases, good in 14% of cases, satisfactory in 12% and not satisfactory in 2% of cases. Usage of cortical fibular intramedular autografts, authentically increases range of positive results, while treatment of long bones non- unions.

[ANTIBIOTIC SENSITIVITY/RESISTANCE OF MICROBIAL STRAINS ISOLATED IN TRAUMATOLOGICAL DEPARTMENT].

In this article, there are given data of study for antibiotic sensitivity/resistance of gram-positive and gram-negative representatives of different microbial species, isolated from patients after primary hip replacement and osteosynthesis of long bones, which had post operative infectious complications, and also isolated from samples of traumatology department environment. Identification of sensitivity/resistance to antibiotics was performed with use of two methods - disc diffusion and serial dilution on solid nutrient media. It was found, that gram-positive, as well as gram-negative microorganisms had high level of resistance to several penicillins and aminoglycosides. Gram-positive microorganisms had high level of sensitivity to vancomycin, ciprofloxacin, amikacin, amoxiclav, cefazoline, cefuroxim, cefotaxim and cefepim. Gram-negative microorganisms had high level of sensitivity to representatives of ftorhinolones, carbapenems and several cephalosporins. Strains of Candida albicans, showed 100% resistance to nistatine and comparatively high level of sensitivity to such antifungal drugs as diflucan, ketakonasol and amphotericin B. Performed studies once more confirmed significance of microbiological laboratories, which have to be main components of infectious control to dial with infectious complications - performance of permanent microbiological monitoring in separately taken hospitals, that in particular enables effective rotation of antibacterial drugs in that hospitals.

[Structure of postoperative infectious complications while hip replacement operations and osteosynthesis of long bones].

In this article, there are given data of 1523 case histories for detection of postoperative infectious complications. Among them 653 cases were hip replacement surgeries and 870 cases were osteosynthesis of long bones. All of these operations were performed in department of traumatology in 2010-2014 years. With use of descriptive epidemiological method of research, for both types of surgical interventions were detected: most often reasons and indications for surgical treatment, prevalence of patients gender and age, incidence of early and late (both deep and superficial) postoperative infectious complications of surgical site, and also forms and incidence of common inflammatory diseases and statistically significant risk factors of there appearance.

[Microbial spectrum of nosocomial pneumonia in traumatological patients].

In this article there are given results of microbiological investigation of nosocomial pneumonia agents, microbial structure. Investigation was held in 727 cases of traumatological patients treated because of hip replacement or osteosinthesis of limbs. Complications with nosocomial pneumonia was found in 27 cases (3,7%). In 27 cases of diagnosed pneumonia, 66 microbial strains were isolated. In 4 cases (14,8%) was detected mono infection, different microbial association were isolated in 23 cases (85,2%) - 2 microbes in 7 and 3 microbes in 16 cases. Microbial structure was presented by: S.aureus (27,3%), Kl.pneumoniae (19.7%), S. pneumoniae (15,2%), A. baumanii (10,6%), E. coli (4,6%), enterobacter spp. (9,1%), P. aeruginosa (13,6%). Study of sensitiveness/resistance of separated stains to different groups of antibiotics showed, that micro organisms have high level of resistance to antibiotics and also pan-resistance. So, success of antimicrobial therapy depends on prompt and correct choice of antibiotics, based on aetiology of infection and sensitiveness to antibiotics. In cases of empirical administration, it is necessary to use antibiotics with high level of activity against pneumonia agents - carbapenems, and in case of high probability of MRSA - it is better to use linezolid or vancomicin.