Introduction The full-scale war with Russia on the territory of Ukraine has revealed several problems related to care of the wounded. In this article, we summarize the mechanisms of injury and injuries sustained for the period February to April 2022, focusing on extremity injuries. Materials and methodsWe compared these to a period of lower-intensity warfare in 2014-2021. In both cases, we report patients treated by the National Military Medical Clinical Center (NMMCC) in Kyiv. We also sought to evaluate the care of the wounded from an organizational viewpoint, taking into account the four-level system of care also used by the North Atlantic Treaty Organization (NATO). Third, we sought to understand lessons learned that could improve the care of the wounded. Conclusion During the 2022 conflict, the percentage of patients with extremity wounds who had long bone fractures increased and the percentage of people with long bone fractures who had bone defects increased, compared with 2014-2021. This may be due to the higher blast energy from the weapons used in the current conflict. Second, we adapted the four-level NATO system of care. Level 2 (first level hospital) care was provided by civilian hospitals close to the fighting, rather than mobile military hospitals. Level 3 (specialized) and 4 (highly specialized) care were combined into one hospital (NMMCC). This is the first description of flexible use of NATO's four levels. Finally, a major lesson learned was the need to improve use of damage control surgery. Dedicated to the heroic deeds of Ukrainian doctors in the name of life!.

Introduction: Mirror therapy requires a minimum of equipment, is relatively simple to perform and effective for various pathological conditions. The effect of mirror therapy on body schema disturbances registered in complex regional pain syndrome type I (CRPS I) patients has not yet been determined. Methods: The study is based on the analysis of the treatment results of 30 patients with CRPS I, developed as a result of the distal radius fractures, with help of mirror therapy together with exercise therapy and medications. The control group consisted of 20 patients with CRPS I developed as a result of the distal radius fractures treated only with exercise therapy and medications. We evaluated the results before the treatment, after 3 days and after 6 weeks of treatment according to The Bath CRPS Body Perception Disturbance Scale. Results: A total of 83.33% patients experienced the positive effect of mirror therapy on the perception of the 'body schema' after 6 weeks of treatment, and 35% underwent standard treatment without mirror therapy. The positive effect was statistically significant for the first five points of the Bath scale after 6 weeks of treatment compared to the control group. Improvements observed in some patients after 3 days of treatment were less pronounced and statistically insignificant. Conclusion: Mirror therapy can improve the perception of the body schema as an element of integrated treatment of CRPS I developed after fractures of the distal radius less than 3 years duration.

Objective: The present work was led by a multidisciplinary panel of experts and proposes an extensive review on the use of prescription crystalline glucosamine sulfate (pCGS) in the multimodal treatment of osteoarthritis (OA) applicable in Ukraine and other Commonwealth of Independent States (CIS) countries. Methods: A panel of rheumatologists, orthopedic surgeons, and field experts from Ukraine and CIS regions discussed the management of OA. Literature was systematically searched using Medline, EMBASE, CIHNAL, and Cochrane Library databases. The 2-day meeting critically reviewed the available literature, treatment algorithms, pharmacoeconomic aspects, and real-world instances to form a multimodal approach based both on real-life clinical practice and systematic literature research for the management of OA in Ukraine and CIS countries. Expert Opinion: pCGS plays a pivotal role in the stepwise approach to OA treatment. If it is necessary (step 1), the combined use of pCGS with paracetamol and topical nonsteroidal anti-inflammatory drugs (NSAIDs) has been recommended. If symptoms persist, oral NSAIDs and intra-articular (IA) hyaluronic acid or corticosteroids are added to the therapy (step 2) of pCGS in the patients. In case of insufficient relief and severe OA (step 3), pCGS along with oral NSAIDs, IA corticosteroids, and duloxetine have been recommended. Patient stratification with regular monitoring and careful alterations in treatment were advocated. Conclusions: This expert opinion article recommends a modified approach to the existing guidelines incorporating pCGS in treatment modality of OA in Ukraine and CIS countries. Extensive use of pCGS targets early symptomatic relief in OA while limiting the adverse effects due to long-term use of analgesics and NSAIDs.

Сустав. Хрящ. КоллагенРезюме. Статья посвящена одной из актуальных проблем медицины -остеоартрозу. Рассмотрена роль коллагена в функционировании суставов, акцентировано внимание на целесообразности применения средств, содержащих коллаген, при остеоартрозе. Эффективность и безопасность гидролизованного коллагена и пептидов коллагена при остеоартрозе показана в многочисленных клинических исследованиях. Продемонстрировано, что достижение позитивных изменений в структуре хряща при остеоартрозе, достижение эффективного уровня уменьшения боли, улучшение показателей физической активности и качества жизни возможны при использовании коллагена в суточной дозе 10 г на протяжении 1-3 месяцев.

Êîìïüþòåðíîå ìîäåëèðîâàíèå ýíäîïðîòåçèðîâàíèÿ òàçîáåäðåííîãî ñóñòàâà ñ èñïîëüçîâàíèåì òðàáåêóëÿðíî-áèîíè÷åñêîãî áåäðåííîãî êîìïîíåíòà Ðhysiohip Резюме. Наиболее частой причиной ревизионного эндопротезирования является асептическая нестабильность компонентов. Разработки по предупреждению подобных ситуаций заключаются в совершенствовании конструкций эндопротезов, применении материалов с механическими характеристиками, близкими к свойствам кости. В статье представлены результаты кратко-и долгосрочного прогнозирования последствий имплантации трабекулярно-бионического бедренного компонента Physiohip эндопротеза тазобедренного сустава при компьютерном моделировании. Выполнено объемное моделирование и конечно-элементный анализ взаимодействия кости с имплантатом в условиях физиологического нагружения. Механические свойства кости описаны моделью неоднородной ортотропной среды, параметры которой определяются путем обработки данных компьютерной томографии. Получены численные данные о напряженном состоянии и распределении энергии деформации кости в зоне протезирования. Результат передачи нагрузки на кость через ножку эндопротеза Physiohip при долгосрочной стабилизации близок к физиологическому. Эти сведения дают основания считать трабекулярно-бионическую ножку довольно эффективным средством эндопротезирования тазобедренного сустава.