The experience in treatment and rehabilitation of 100 patients with suppuration following total hip replacement and 60 patients with chronic osteomyelitis of proximal femur and acetabulum is presented. Patients' age ranged from 10 to 84 years. Removal of unstable metallic constructions (implant or fixator) and radical resection fistulosequestrnecrectomia by Girdlestone were performed in all patients. In postoperative period the complex program for the elimination of purulent process and rehabilitation measures were carried out. That program foresaw active and expedient control for compensation of the affected joint function. In all patients purulent inflammatory process was eliminated, weight-bearing hip joint neoarthosis with satisfactory function was formed. According to authors' opinion the formation of weight-bearing neoarthrosis is an adequate alternative to both revision joint replacement and arthrodesis in purulent process in proximal femur and acetabulum.

Use of biocomposed material Collapan (Company Intermedapatit, Russia) for the filling of bone defects after sequestrectomy was evaluated in 92 patients with chronic osteomyelitis of different localization. In 76 patients surgical wounds healed by first intention, in 16 patients by second intention. Four patients had recurrence of purulent process in the term from 4 to 18 months after operation. Morphologic and histologic study of tissue specimens obtained during reoperation showed that inserted collapan induced antibacterial background, served as the matrix of newly forming bone tissue and activated the osteogenesis.

In 63 patients with suppurative bone process the activity of N-acetyl-fi-D-glucosaminidaze lysosomal enzyme in urine as well as oxyproline and hexuronic acids excretion were evaluated. Significant changes in metabolism of collagen and proteoglycans of osseous organic matrix were detected and it was confirmed by high excretion of their structural components. The more active and vaster the suppurative process was the more quantitative excretion of collagen and glu- cosaminoglycans and higher enzyme activity were. The suggestion was formulated that high excretion of N-acetyl-fl-D-glucosaminidaze in urine noted in the patients with suppurative inflammatory complications was the indicator of pathologic changes in tubular apparatus of kidney. The detection of excretion of the connective tissue metabolites (oxyproline and hexuronic acids) could be used for the diagnostic and prognostic evaluation of the disease severity and for the choice of method for the treatment of suppurative process.

The experience in complex one-step treatment of306patients with ununited fractures, pseudoarthrosis and defects of long bones as sequelae of traumatic (260 patients) and gunshot (46 patients) injuries complicated by osteomyelitis was presented. Complex treatment included radical fistulosequestrnecrectomy up to vast resection with simultaneous mono-, bi- or polyfocal osteosynthesis by pin-, rod or pin-rod external fixation devices; various types of dermatoplasty (when required); stimulation osteogenesis; general and local target antibacterial therapy; adequate postoperative drainage; correction of immune status and metabolic therapy; rehabilitation. That method enabled to decrease more than twice the rate ofpostoperative recurrent of osteomyelitic process; considerably decrease the duration and improve outcomes of treatment.

The treatment results of gunshot fractures with nerve trunk injuries of upper extremity bones were summarized for the period from 1995 to 2000. Thirty patients had the injury at the level of humeral segment, 15 patients — at the level of forearm and 4 patients were with injuries of the elbow joint. The debridement and extrafocal osteosynthesis with early, i.e. 4 weeks after trauma, surgical interventions on bone fragments and nerve trunks were performed. In anatomically safe nerve trunk, neurolysis and bone fragment compression using special device were carried out. In nerve injury, resection of bone fragment ends with following stable osteosynthesis and perineural suturing of nerve was performed. In fractures of forearm bones with large defect of nerve trunk the autografting of nerve was done. In early postoperative period complex drug therapy was prescribed. After fracture healing physiotherapy, massage and exercise therapy was started. Long-term results showed that 82% of patients had positive outcomes. Duration of treatment using suggested tactics was shorter in comparison with traditional multy-step method.