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Резюме В течение последних десятилетий проблема лечения множественных переломов костей конечностей находится в центре внимания большинства травматологов-ортопедов в нашей стране и за рубежом. Актуальность проблемы определяется ещё и тем, что характер травм и их последствий меняется с тенденцией к утяжелению. Качественные изменения структуры травматизма обусловлены ростом уровня множественных и сочетанных травм. Применение у пациентов с переломами длинных трубчатых костей конечностей методики последовательного остеосинтеза, предполагает первичную стабилизацию костных отломков аппаратом внешней фиксации и повторный погружной остеосинтез, когда удаётся добиться стабилизации состояния пациента. Имеются различные стержневые и спицевые аппараты для фиксации, одни из них именно для фиксации (необходимо снимать перед операцией), некоторые для предварительной репозиции перелома во время операции (необходимо снять скелетное вытяжение или гипсовую повязку и наложить аппарат, что добавляет этапы). Предлагаемая методика отличается простотой сборки и наложения, а также лёгкостью конструкции, что обеспечивает мобильность пациента и позволяет после стабилизации состояния пациента без помех произвести окончательный погружной остеосинтез.

The article describes the main clinical risk factors for development of VTEC and the results of treatment in the Republic of Sakha (Yakutia) (RS(Y)). The main risk factors for VTEC development were oncological diseases in 75 (25.5%) patients (15 of them with newly diagnosed cancer and 60 patients on the background of chemotherapy) and trauma of the musculoskeletal system in 55 (18.7%) patients. In the structure of DVT of the lower limbs, an occlusion was most often (38.2%) found in the ilealfemoral segments. PE was detected in 21 (7.1%) patients. According to the results of the study, conservative methods of DVT treatment slightly prevailed over surgical methods (59.7% versus 40.2%) Personalized anticoagulant therapy based on the results of pharmacogenetic testing for a specific patient increases the effectiveness and safety of treatment. Catheter-directed thrombolytic therapy for massive and submassive PE is the preferred method in the absence of contraindications for surgical hospitals. In patients with ascending varicotrombosis, phlebectomy combined with excision of thrombosed tributaries speeds up recovery and reduces the time until discharge from the hospital.

Bone fractures of the skeleton with a minor injury is a clinical manifestation of osteoporosis and its population-based marker. The incidence of hip fracture varies in different geographic areas and ethnic groups. The aim was to study incidence of hip fractures in patients older than 40 years in the Republic of Sakha (Yakutia, Russian federation) in 2011-2013 and to compare the data with the previous study at the same region performed in 1997-2003. Material and methods. The study is a part of a multi-center international project «Epidemiological study of osteoporotic fractures in Eurasia (EVA).» It was a retrospective study followed by a prospective one. In the retrospective part the information on hip fracture cases registered in the official documents of the orthopedic service in 2011-2012 was collected. The prospective part was conducted in 2013, it was aimed at the identification of the patients with a hip fracture, applied not only in orthopedic department but also to other medical professionals, such as general practitioners. Results. Overall, in three years 426 hip fractures were reported in the city of Yakutsk. The total number of fractures in women was 286 (67.1%), in men - 140 (32.9%). We observed the increase in hip fracture incidence in 2013 (192 cases per 100,000 population in men and 283 per 100,000 in women 50 years old and older) which was 12% higher than in 2011 and 2012. We owe it to improved registration of hip fractures in the group of women 85 years old and older. The hip fracture incidence in this study significantly exceed the data of previous study 15 years ago. Conclusion. In recent years, there is an increase in incidence rates of hip fracture in Yakutsk due to improved hospitalization rates in orthopedic service.