Проаналізовані результати хірургічного лікування 9 пацієнтів (17 плеснофалангових суглобів) із застосуванням остеотомії за Weil. В усіх випадках було діагностовано метатарзалгію та відсутність плеснової параболи за прямою рентгенограмою. Результати оцінювали за схемою AOFAS та візуальною аналоговою шкалою в строки 6–27 місяців (у середньому 18,4 ± 4,5 місяця). Значимість різниці між середніми оцінена за допомогою двовибіркового t-тесту (α = 0,05). Функція стопи до та після операції становила 50,3 ± 5,7/82,8 ± 2,9 бала (p < 0,001), рівень болю — 6,5 ± 0,4/1,3 ± 0,1 см (p < 0,001). Остеотомія за Weil є ефективною хірургічною операцією, що сприяє суттєвому зменшенню больового синдрому та покращенню функції стопи.

Summary. The pain after amputations is a global problem of modern medicine. There are three distinct clinical entities that can form the postamputation pain: phantom limb pain (PLP), phantom sensations (PSs), and residual limb pain (RLP). PLP and PSs are pathophysiological phenomena, which need complex conservative treatment. RLP is a local condition that arises from neuroma, excessive scarring, osteophites, etc. and can be resolved by surgery. Objective: to analyze the results of surgical treatment of patients with symptomatic neuromas after lower limb amputations (LLA). Materials and Methods. The study included 43 patients with symptomatic neuromas 3–10 years after LLA. There were 40 male and 3 female patients (mean age 33.9±3 years). Amputations were caused by trauma (33 cases), mine-blast injury (7 cases), diabetes (1 case), and oncology (2 cases). The level of amputation was thigh (3 cases), knee (1 case), and ankle (39 cases). The pain intensity was measured by the VAS (Visually Analog Scale) and prosthesis using by the ALAC (Artificial Limb and Appliance Centre, USA) scale. Results. RLP had 43 patients (100%), PLP – 8 (8.6%), and PSs – 35 (81.4%) patients. The average level of pain was 7.4±0.9. Prosthesis was used in 74.4% (32 patients), but 11 of them used prosthesis for cosmetic or transportation reasons (levels I and II by the ALAC scale). Complications after surgery were presented by hematoma (3 cases), marginal skin necrosis (2 cases), and tearing of m. gastrocnemius from the tibia after the fall on the stump (1 case). The results were assessed in 35 patients in terms from 1 to 15 years. The pain severity decreased from 7.4±0.9 to 3.2±0.6 (p˂0.05; two-sample t-test). The number of RLP cases decreased to 11 (31.4%), but the number of PLP and PSs cases did not significantly change (PLP – 5 cases or 14.3%; PSs – 27 cases or 77.1%). The prosthesis using rised to 100% due to functionality (III–VI levels by the ALAC scale). Conclusions. Surgical method is the main treatment of symptomatic neuromas after LLA. The surgery must expect proximal neurotomy and, if need, reamputation and stump reconstruction. This approach helps to reduce pain and improves the functional ability of persons with LLA.

Summary. Tissue defects of the anterior surface of the lower leg and the knee joint is a severe problem at the treatment of orthopedic patients. Objective. Analysis of the results of using the medial gastrocnemius flap (MGF) in orthopedic patients; highlighting peculiarities of surgical technique. Materials and Methods. 8 patients (10 cases) who underwent the transposition of the MGF. The age of the patients was 19–74 years (on average 40.5±5.7 years); there were 6 males and 2 females. The list of cases: open fractures – 2 cases, combat injury – 2 patients (3 cases), skin necrosis after osteosynthesis – 3 patients (4 cases), and skin necrosis after total knee replacement – 1 case. The results of treatment were assessed in terms 9 months – 10 years by the Lysholm scale. Results. Autodermoplasty during MGF transposition was performed in two cases and after a few days in others. In cases with open fractures, the osteosynthesis and external fixators reassembly were done; conversion of osteosynthesis was performed one month after autodermoplasty. In cases of skin necrosis after osteosynthesis and total arthroplasty, the implants were never removed. Knee function according to the Lysholm scale ranged from 70 to 100 points (mean 88.2±3.3). Conclusions. The transposition of the MGF for the replacement of tissue defects of the anterior surface of the lower leg and knee joint is an effective method in orthopedic surgery, which helps to solve the problem of infectious complications and to save the supporting-kinematic function of the lower extremity.

Summary. Triple arthrodesis (TA) is a final surgical decision in treatment of the acquired flat foot (FF). Objective: to study late outcomes of TA in the acquired FF; to establish factors influencing functional outcome of treatment. Materials and Methods. The study included 51 patients (56 feet) with acquired FF at the age 32 – 77 years (54.7±1.2 years). Vertical and horizontal talometatarsal angles (TMA), as well as calcaneal inclination angle were determined by standing radiographs of the foot. The severity of osteoarthritis of the ankle joint (AJ) was assessed according to the Kellgren-Lawrence classification; range of motion in the AJ was determined according to the 0-pass method. Foot function was assessed by the dynamics of indicators: AOFAS scale (hindfoot and ankle joint), FFI (Italian version), quality of life (Roles and Maudsley scale), and VAS (pain). Establishment of factors influencing the outcome of treatment was performed using regression-correlation and factor analysis. Results. Long-term results were studied in 32 cases. Cases of non-unions were registered at the following levels: talonavicular (2) and calcaneocuboidea (2). The dynamics of skiological indicators was significantly positive (p˂0.05; unpaired t-test). According to the AOFAS scale, 2 excellent, 19 good and 11 satisfactory results of treatment were obtained. Significant influence of pain level (inverse dependence) and range of foot extension (direct dependence) on the result (regression analysis) were determined, as well as significant effect of ankle osteoarthritis on the function of the foot (Fisher’s exact test; 0.002). Conclusions. TA in the treatment of acquired FF is an effective surgery that provides favorable results in cases of severe deformity, degenerative changes in the joints, and contraindications to extra-articular corrective osteotomies.