The main method of surgical treatment of patients with post-traumatic disorders of bone regeneration is the use of bone grafting. Until now, the optimal plastic material has been a bone autograft, which use involves additional trauma to the patient. Alternative materials that are used for grafting have only an osteoconductive effect, of varying effectiveness. To optimize the properties of plastic materials, giving them an osteostimulating effect, they can be used in combination with biologically active substances. A source of biologically active substances can be platelet-rich plasma, platelet lysate and red bone marrow. This literature review includes a description of three main methods to stimulate osteogenesis. The first part examines the mechanism of action of platelet-rich plasma, indications and contraindications for its use, describes the results of treatment when platelet-rich plasma is used to stimulate osteogenesis. Platelet-rich plasma is a product of a human native blood obtained by centrifugation. The output is a high concentration of platelets in a small volume of plasma, which contain growth factors and cytokines that have a direct effect on the regeneration process. Local platelet-rich plasma therapy is performed to stimulate osteogenesis. Autologous platelet-rich plasma with growth factors contained in α-granules of platelets is injected into an allogeneic graft or into a fracture zone. The aim of this article is to summarize the results of treatment using platelet-rich plasma to improve bone regenerative potential in orthopaedics.

Background. The preferred treatment for intra-articular displaced fractures is open reduction and internal fixation. The need to obtain a better visualization of the fracture geometry made it necessary to develop a large number of new approaches and their modifications.Material and methods. The study included 186 patients with an intra-articular fracture of the distal humerus, who underwent plate osteosynthesis using the standard technique. The main group included 112 patients who were operated on using ETTA. The comparison group included 74 patients with a similar type of fracture, who were operated on using chevron olecranon osteotomy. The groups were comparable in terms of age, gender, mechanism of injury, and nature of the fracture. Long-term results were evaluated in 186 patients (minimum follow-up period – 12 months).Results. Comparative analysis revealed that the time of surgery was reduced by an average of 20 minutes (p=0.03) in the main group. The immediate and medium-term results were assessed according to the data of physical examinations, control radiography, dynamics of the increase in the amplitude of motion in the elbow joint. The results were comparable. When assessing complications, the migration of fixators was detected in 5.5% in the main group and 16% in the comparison group. In the comparison group, failure of union of the olecranon after osteotomy, migration of wires with skin perforation, and reactive bursitis were observed.Conclusion. 1. The extended transtriceps approach provides good visualization for fixing fractures of the distal humerus. 2. Evaluation of treatment results confirms that osteosynthesis using this access allows to reduce the time and trauma of the operation, to avoid complications associated with osteotomy of the olecranon, and to carry out successful postoperative rehabilitation, achieving good functional results.

The previous two articles described the use of platelet-rich plasma and platelet lysate. This part of the literature review examines the mechanism of red bone marrow action, indications and contraindications for its use. The results of treatment for delayed consolidation of bone fractures are also described. Hematopoietic stem cells give rise to all cellular components of the circulating blood, such as red blood cells, lymphocytes, neutrophils, and platelets. The most rational way to stimulate bone regeneration is to use the patient's own biological material. The aim of this article is to summarize the results of treatment using autologus bone marrow to improve bone regenerative potential in orthopaedics.

In the previous article, we talked about the use of platelet-rich plasma. One of the promising ways to stimulate the processes of repair and regeneration in the tissues of the damaged organ in different types of pathology is the use of platelet-rich plasma lysate. This part of the literature review covers the mechanism of action of platelet-rich plasma lysate, indications and contraindications for its use, describes the results of treatment when platelet-rich plasma lysate is used to stimulate osteogenesis. The preparation technology provides for the removal of all cellular components from the plasma, so it becomes possible to store the obtained graft for a long time. The procedure for the preparation of platelet lysate allows the simultaneous isolation of all growth factors from the cells, since the platelet lysis occurs. Lysate of platelet concentrates can be considered as a preparation that contains a complete set of stimulating growth factors. Under the influence of the lysate, the proliferation of latent osteoblasts is resumed, the signaling pathways of angiogenesis are activated, the secretion of the factors accelerating angiogenesis is stimulated, the differentiation of osteoblasts and the formation of bone tissue are triggered. The aim of this article is to summarize the results of treatment using autologous platelet lysate to improve bone regenerative potential in orthopaedics. In a final article, we shall look at the ways to use autologous red bone marrow.

BACKGROUND: A proximal humerus fracture (PHF) is quite common and accounts for approximately 5% of all fractures. During surgery, these fractures make it difficult to correctly reattach the bone fragments. Various special techniques are needed for repositioning and stable fixation of the fragments. When considering the most effective ways to facilitate fracture repositioning and prevent secondary displacement, we paid attention to the publications on the use of the fibula graft. AIM: To evaluate the effectiveness of a new allogeneic bone-collagen graft from the fibula head in PHF osteosynthesis with a plate having angular stability in conditions of bone tissue deficit. MATERIALS AND METHODS: An original bone-collagen allogeneic graft from the proximal part of the fibula was developed. We carried out a comparative analysis of the treatment results in patients operated on using the fibula head allograft (group O 48 patients, subgroup O1 - 35 patients; period - not less than 1 year after surgery) and the group without using augmentation graft (group K 32 patients). The results were assessed using clinical, radiological, and standardized Constant Shoulder Score; the statistical analysis was also performed. RESULTS: No patient in group O developed secondary dislocation, while in group K it was noted in 5 (16%) patients. Head collapse developed in 3 patients (7%) in group O and 8 (25%) in group K. Surgery time was shorter in group O than in group K. The mean Constant Scholder Score in subgroup O1 was 78 and in group K 70. Thinning in the cortical layer of the graft and the border disappearance between the spongy part of the graft and the bone tissue of the humeral head were noted in all patients during multispiral CT scanning over time, which was considered a sign of graft remodeling and lysis. CONCLUSION: In severe PHF with bone deficit, it is possible to perform organ preseration surgery regardless of the patients age and obtain functional results satisfying both the patient and the physician. Our suggested method of severe PHF surgical treatment combined with bone deficit facilitates repositioning, reduces operation time, and decreases the number of complications.