Остеосинтез (osteosynthesis; греч. osteon (кость) + synthesis (соединение)) — это хирургическое соединение отломков костей в правильном положении с целью стабильной фиксации до полной их консолидации (костного сращения) и восстановления целости и функции кости. Обследовано 34 больных в возрасте 17–58 лет с гнойными осложнениями после остеосинтеза при переломах длинных костей, в том числе у 29 мужчин и 5 женщин. В сыворотке кpови больных определяли следующие биохимические показатели: активность коллагеназы, фpакции гидpоксипpолина, гликозаминогликаны, кальций, фосфор и электролиты (Na+, K+, Ca++).Результаты исследования показывают, что у больных с гнойными осложнениями после остеосинтеза длинных костей при рецидиве воспалительного процесса усиливается катаболическая фаза метаболизма основных компонентов органической основы костной ткани. Об этом свидетельствуют показатели, отражающие синтетическую и катаболическую фазы метаболизма основных компонентов соединительной ткани — коллагена и гликозаминогликанов. Данные, полученные при исследовании минерального обмена, отражают нарушения минерализации костной ткани, что подтверждается показателями содержания общего кальция, ионизированного кальция, фосфора и электролитов.

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Summary. In the treatment of patients with inflammatory and degenerative-dystrophic lesions of the joints, soft tissues and ligaments, local administration of drugs is often used in practice, usually (mainly) glucocorticoids. Objective: to determine the place and role of local administration of glucocorticoids in the occurrence and development of musculoskeletal infection. Materials and Methods. The peculiarities of the occurrence and development of infectious complications, their clinical manifestations, laboratory and anamnestic data after local administration of glucocorticoids in 56 patients aged 24 to 78 years were analyzed. Results. 44 patients had moderate and severe subcompensated comorbidities. Betamethasone was the most commonly used for injections (32 patients, 57.2%). Glucocorticoids were administered intra-articularly to 43 (76.8%) patients: knee joint (37.5%), shoulder (25.0%), ankle (7.1%), hip (3.6%), elbow and 1st metatarsophalangeal (1 case each). In other cases (bursitis, enthesitis, etc.), glucocorticoids were administered paraarticularly. It was a single injection only in 32%; the rest of patients were injected 2 – 20 times. In 96% of cases, monocultures were microbiologically isolated (S.aureus in 52%). At the time of hospitalization, the acute stage of the infectious process was detected in 22 (39.3%) patients, subacute in 16 (28.6%), and chronic active fistula phase in 18 (32.1%). All cases of clinically similar manifestations are systematized into groups of symptom complexes – clinical variants: 1) abscess and/or phlegmon of paraarticular soft tissues, necrotizing fasciitis; 2) septic bursitis; 3) septic arthritis (synovitis); 4) septic destructive arthritis; 5) osteomyelitis. Conclusions. We found no clinical differences depending on the drugs used. The most important reasons for the development of infectious complications are ignoring the principles of dosing, multiplicity and time intervals of administration, unreasonable repeated use, and the presence of serious subcompensated comorbidities, which should be considered as a relative contraindication and as a risk factor.

Summary. Relevance. Negative results of the anterior cruciate ligament (ACL) reconstruction occur in 10-20% of cases. The incidence of infectious arthritis can reach up to 1.7% and even up to 7.1%, according to the literature. However, ACL reconstruction can be complicated not only by infectious but also by reactive arthritis. Differential diagnosis between infectious and reactive arthritis is often hard to be done, but it is necessary for effective treatment. Objective: to determine the possible causes of the development of reactive and infectious arthritis after ACL reconstruction, peculiarities of their diagnostics and differential diagnostics. Materials and Methods. The literature data regarding the frequency of reactive and infectious arthritis after various methods of surgical treatment of ACL injury and the use of different types of implants, as well as laboratory indicators of the activity of the inflammatory process in the postoperative period and such indicators in reactive and infectious arthritis, were analyzed. We also analyzed literature data on the sensitivity and specificity of various methods of microbiological studies in patients with infectious synovitis or arthritis. Results. Numerous probable causes of a higher incidence of infectious arthritis in ACL reconstruction are suspected. Synthetic implants may be the cause of the development of reactive arthritis, according to a number of studies. Our experience in using different biodegradable fixators from various manufacturers suggest that the percentage of complications depends not only on the fact of the biodegradability of the implant, but on its composition, and even on the percentage of tricalcium phosphate or the manufacturer. Therefore, it is impossible to unambiguously state that biodegradable fixators are worse or better then metallic or non-biodegradable polymeric ones. However, on average, if we consider all existing fixators from various manufacturers, the number of complications when using biodegradable implants is higher. Diagnosis of reactive arthritis is often based on negative bacteriological findings. Given the not always high sensitivity of bacteriological inoculation of synovial fluid and the duration of the investigation, we cannot rely only on its results. Conclusions. The most difficult for differential diagnosis between infectious and reactive arthritis (synovitis) is acute synovitis after ACL reconstruction with normal results of bacteriological studies, but high biochemical parameters of inflammation. We suggest to suspect infectious arthritis after ACL reconstruction in the following hemogram values: 1) CRP >40-50 mg/l, 2) ESR >30-50 mm/h, 3) fibrinogen >800 mg/ml, 4) procalcitonin in blood plasma >0.5 ng/ml, 5) leukocytosis and left shift of the leukocyte formula, with the following synovial fluid test parameters: a) CRP >40-50 mg/l, b) leukocytosis with an increase in the percentage of polymorphonuclear leukocytes >75%.