Приведен клинический пример лечения пациентки 29 лет с оскольчатым переломом диафиза плечевой кости, сопутствующим ятрогенным повреждением локтевого и лучевого нерва после двух оперативных вмешательств по месту жительства с использованием стержневого аппарата Илизарова. Выполнено оперативное вмешательство: демонтаж аппарата, реостеосинтез спицевым аппаратом Илизарова. Пункционная установка эпиневральных электродов. В послеоперационном периоде получала курс электростимуляции по электродам и накожным отведениям на протяжении 2 месяцев, сосудистую терапию, витамины группы В, прозерин, ЛФК, массаж. Электроды удалены на 57 сутки после установки. Срок фиксации в аппарате -139 дней. Функция лучезапястного сустава, первого пальца и чувствительность кисти восстановлены. Ключевые слова: плечевая кость, оскольчатый перелом, локтевой нерв, лучевой нерв, нейропатия, остеосинтез, аппарат Илизарова, эпиневральные электроды.The authors presented a clinical case of a female patient, 29 years old, who admitted with comminuted humeral shaft fracture, concomitant iatrogenic injury of the ulnar and radial nerve after two surgeries made at the place of residence using the Ilizarov rod fixator. They performed the following surgical intervention: the fixator dismounting, re-osteosynthesis with the Ilizarov wire fixator. Epineural electrodes were fitted using punctures. Postoperatively the patient underwent a course of electrical stimulation by electrodes and skin leads for two months, vascular therapy, exercise therapy, massage, she received Group B vitamins, Prozerinum. The electrodes were removed on Day 57 after fitting. The fixation period using the fixator was 139 days. The function of the wrist, that of the first finger, and the hand sensitivity recovered. Keywords: humerus, comminuted fracture, ulnar nerve, radial nerve, neuropathy, osteosynthesis, the Ilizarov fixator, epineural electrodes.Во всех странах мира в связи с урбанизацией, по-вышением числа средств передвижения и связанным с этим увеличением дорожно-транспортных происше-ствий отмечается рост травматизма [1, 2].По данным некоторых авторов, переломы диафи-за плечевой кости от всех переломов костей скеле-та составляют 2,2-2,9 % [3, 4] и 4-18 % -от общего числа переломов длинных костей [5]. Наблюдаются такие переломы преимущественно (60-70 %) у лиц молодого возраста, ведущих активный образ жизни [6, 7, 8]. При упомянутых травмах достаточно ча-стым осложнением является повреждение лучевого нерва той или иной степени выраженности [9]. Но, помимо посттравматических нейропатий, встречают-ся еще ятрогенные повреждения стволов нервов. В большинстве случаев это происходит при нарушении технологии оперативного вмешательства выбранного метода лечения. При чрескостном остеосинтезе -это, в основном, проведение спиц, стержней в опасных зо-нах оперируемого сегмента. Появление такого ослож-нения увеличивает как срок стационарного лечения больных, так и его общий период.Приводимый клинический пример иллюстрирует случай нейропатии периферических нервов у паци-ентки с переломом диафиза пл...

Based on the literature data analysis a hypothesis was made that specific features of humeral diaphyseal fractures consolidation process in result of Ilizarov method treatment depend on their quantitative characteristics.Purpose of the study – to develop quantitative characteristics of diaphyseal humerus fractures and to analyze their correlation to the terms of bone fragments healing.Materials and methods. The authors studied X-rays of forty one patient with diaphyseal humerus fractures; age of patients ranged from 21 to 60 years (median – 37 years), there were 19 male and 22 female patients. The authors worked out the formulas using Weasis software for quantitative characteristics of diaphyseal humerus fractures: distance of the fracture site from proximal metaphysis of the humerus, extension of the fracture line and degree of bone fragments displacement. During statistical analysis of the recorded data the average standard deviation, median, minimum, maximum, 25th percentile and 75th percentile were calculated. The Shapiro-Wilk test was used to check consistency of recorded data with normal distribution of characteristics. Correlation analysis was performed by calculation of Kendall and Pearson coefficients. Statistical processing of reported data was done by means of unpaired criteria: non-parametric Wilcoxon test and parametric Student t-test. When comparing two samples a null hypothesis was rejected at the level of test significance p≤0.05. The authors utilized Microsoft Office Excel 2007 and AtteStat, version 13.1.Results. Statistical analysis of the samples including comminuted and spiral fractures of humeral diaphysis demonstrated that the level of the fracture was within 40.9±19.9% and distributed from 11.6% to 72.4% along the diaphysis. Correlation analysis demonstrated statistically valid moderate negative relation between the level of fracture site and consolidation period (Pearson correlation coefficient r = -0.46; р = 0.0091). There is a statistically valid positive moderate relation between extension of the fracture line and consolidation period (Pearson correlation coefficient r = 0.43; р = 0.015). Statistically valid positive and weak relation was observed between the value of “post-reduction displacement” of bone fragments and consolidation period (Kendall correlation coefficient τ = 0.25; p = 0.045). Within the group of comminuted and spiral diaphyseal fractures of the humerus the authors observed a statistically valid longer consolidation period in the sample with diaphyseal fractures, located up to 48.4% away from the proximal end of the humerus as compared to the sample of fractures, located below the indicated border. Conclusions. Consolidation period of the diaphyseal humerus fractures demonstrated statistically valid correlation with the following characteristics of the fracture: 1) fracture location: the closer to the distal end of the humerus the shorter is consolidation term; 2) extension of the fracture site: the longer is the fracture line the longer is consolidation period; 3) post-reduction degree of bone fragments displacement: the larger is the degree of displacement the longer is consolidation period. The correlations observed during the study are true for diaphyseal humerus fractures located within 11 to 72% away from the proximal end of the humerus.

Surgical treatment of patients with acute ankle trauma by transosseous osteosynthesis method was presented in the article. Malleolar fracture, injury of tibiofibular syndesmosis, subluxation in ankle joint and dislocation of foot were observed in our cases. Fracture of malleolus was described according to AO/OTA fracture classification in each case. In these patients we used osteosynthesis method by Ilizarov (original frame). Patients could load and use the operated limb in the Ilizarov fixator from the first days after the injury. The length of fixation of the limb by the Ilizarov fixator in the described cases was 45-58 days. In the presented clinical cases our approach in the treatment of this pathology is shown namely preference is given to closed fracture repositioning and elimination of subluxation/ dislocation without open access to bones and joints. Open access is possible with repeated attempts of closed reposition in the fixator or splintered fractures of the bones of the ankle joint. Initial range of motions in ankle joint in the described patients recovered in 4 weeks after removal of the Ilizarov fixator and training with a physiotherapist and massage therapist. Functional outcome was assessed using the American Orthopaedic Foot and Ankle Society (AOFAS), the American Academy of Orthopaedic Surgeons (AAOS) and VAS-pain scales. The goal of this paper is to show capabilities and our approach in closed reduction of malleolar fractures with injury of tibiofibular syndesmosis by Ilizarov technique.

Evaluation of the bone regenerate maturation in 21 patients, aged 27 - 66 years, with closed shoulder fractures was performed in the course of treatment by Ilizarov technique according to the rate of blood supply velocity at functional load and by the value of that load. Examination was performed in 1 and 2 weeks as well as in 1 and 2 months after fixation. Within the first 2 weeks the bone fragments micro mobility at 10 kgF axial load on the extremity made up 194±42 µm. Subsequently as the regenerate became compact the bone fragments micro mobility decreased up to 53±13 µm (p≤0.02). During the fixation period the load tolerance increased from 5 to 15 kgF. The threshold of load tolerance was detected by the occurrence of unpleasant feel- ings the regenerate zone and increased rate of blood circulation in the vessels. At the end of fixation period the rate of blood circulation was decreased by 2 times and practically did not change at increasing loads confirming the formation of the protection system for circulatory bed in the bone regenerate.

Evaluation of the bone regenerate maturation in 21 patients, aged 27 – 66 years, with closed shoulder fractures was performed in the course of treatment by Ilizarov technique according to the rate of blood supply velocity at functional load and by the value of that load. Examination was performed in 1 and 2 weeks as well as in 1 and 2 months after fixation. Within the first 2 weeks the bone fragments micro mobility at 10 kgF axial load on the extremity made up 194±42 µm. Subsequently as the regenerate became compact the bone fragments micro mobility decreased up to 53±13 µm (p≤0.02). During the fixation period the load tolerance increased from 5 to 15 kgF. The threshold of load tolerance was detected by the occurrence of unpleasant feelings the regenerate zone and increased rate of blood circulation in the vessels. At the end of fixation period the rate of blood circulation was decreased by 2 times and practically did not change at increasing loads confirming the formation of the protection system for circulatory bed in the bone regenerate.