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Аугментация костных дефектов дистального отдела большеберцовой кости синтетическим b-трикальций фосфатом и ксенопластическим материалом «Остеоматрикс» при хирургическом лечении внутрисуставных импрессионных переломов С.М. Кутепов, Е.А. Волокитина, М.В. Гилев, Ю.В. Антониади, Е.В. Помогаева ФГБОУ ВО «Уральский государственный медицинский университет» Минздрава РФ, г. Екатеринбург Augmentation of distal tibial defects with synthetic b-tricalcium phasphate and Osteomatrix xenoplastic material in surgical treatment of intra-articular impression fractures

The paper presents an analysis of the provision of specialized trauma care to trauma patients using the example of the trauma hospital of an urban multidisciplinary hospital for the period from 2017 to 2019, describing the algorithm for providing specialized medical care to trauma patients at the hospital stage implemented in clinical practice. Implementation of the developed algorithm for providing specialized care to patients with trauma allows us to significantly reduce the length of hospital stay, decrease the average bed-day rates in trauma departments, increase surgical activity, and reduce postoperative mortality in the trauma hospital.

Treatment results for 109 patients (mean age 56 ± 1.7 years) with monocondylar impression tibial plateau fractures (ITPF) are presented. Patients from the control group (n=63) were operated on during the period from 2008 to 1010, patients from the main group (n=46) - from 2011 to 2013. Patients from the main group were treated with regard for injury localization relative to plateau center according to proposed operational classification of impression fractures (by CT data) and algorithm to choose the osteosynthesis technique depending on the anatomic and morphologic peculiarities of the intra-articular injury. In patients from the main group the evaluation by Rasmussen scale 36 months after intervention showed excellent results in 15 (38.4%), good - in 22 (56.4%), satisfactory - in 5 (12.8%) of patients, no poor results were recorded, and in patients from the control group - in 6 (11.5%), 8 (15.3%), 36 (69.3%) and 3 (5,8%) patients, respectively. Three (7.6%) complications (secondary displacement of fragments (2), knee contracture (1)) were observed in the main group, and 11 (20.9%) in the control group (20.9%) - local infectious inflammatory process (4), secondary displacement of plateau fragments (6), condylar sag (1). Perfected tactics of treatment of patients with ITPF enabled to achieve 3.48 times more excellent and good results (p<0.05).