Expansion of vein thrombosis and embolism remains a serious problem in traumatology and orthopedics up to the present day. Maintaining the balance between the efficiency of thromboprophylaxis and the danger of post operative hemorrhage can be achieved only when the prevention medication, its dose and the duration of use have been correctly chosen. An anticoagulant of the new generation (Pradaxa), per oral direct thrombin inhibitors dabigatran etexilate to the utmost complies with the above specified requirements that are why the authors decided in favor of its use in everyday clinical practice. A primary test for open use of dabigatran in 48 patients who underwent hip or knee arthroplasty has been carried out. Taking into account the highest risk of thromboembolic complications after large joints plasty, the method of mechanical prophylaxis DVT - electro neurostimulation of shin muscles has been introduced into clinical practice. According to the results of follow-up of the patients, who received different anticoagulants, the algorithm of an anticoagulant’s choice has been developed in various kinds of clinical situations with the possibility of changing injectable preparation to per oral forms. Convenience of per oral administration and predictability of dabigatran effect made it possible to provide consistency of hospital and out-patient stages of treatment, which also contributed to the reduction of thromboembolic complications, especially at an out-patient stage.

Aim. To evaluate the qualitative and quantitative changes in the surgical approaches to the treatment of traumatic injuries of the proximal femur. Methods. Conducted was an analysis of the introduction of modern methods of surgical treatment of patients with injuries of the proximal femur for the period from 2004 to 2010. Discussed were the variants of osteosynthesis and endoprosthetic hip replacement for fractures of the neck and the trochanteric region of the femur in 1007 injured patients. Results. Over the period of 4 years it became possible to double the surgical activity of the trauma department through systematic personnel training and through the use of new structure-designs for osteosynthesis and arthroplasty. The main problem was recognized to be the lack of a system of surgical treatment and rehabilitation of such a complex group of patients. Conclusion. The analysis of results showed the need for development of specific standards of treatment of patients with fractures of the proximal femur both in Kazan city and at the level of the Republic of Tatarstan.

Цель. Сравнительное морфологическое исследование ответной реакции костной ткани на чрескостное введение в диафизы большеберцовых костей экспериментальных крыс имплантатов из меди (Cu), медицинской стали 12X18H9T, стали 12X18H9T с вариантами покрытий нитридами титана и гафния (TiN+HfN), а также нитридами титана и циркония (TiN+ZrN). Материалы и методы. Были созданы 4 группы крыс, из которых 2 группы сравнения (12Х18Н9Т и Cu) и 2 опытных (TiN+HfN и TiN+ZrN) с вышеуказанными имплантатами. В конце каждого срока опытного наблюдения проводили гистологическое исследование участков большеберцовых костей, непосредственно контактировавших с имплантатами. Результаты. Полученные результаты показали, что восстановление травмированной имплантатом кости и костного мозга в группах с имплантатами из стали 12Х18Н9Т происходило без участия грануляционной и хрящевой тканей, а с имплантатами из стали с покрытием нитридами титана и гафния (TiN+HfN) происходило без осложнений и в более ранние сроки. В то же время в группах, где были применены медные имплантаты (Cu), имплантаты из стали с покрытием из комбинации нитридов титана и циркония (TiN+ZrN), регистрировались явления некроза, деструкция и лизис костной ткани, а восстановление происходило вторично через хрящевую ткань. Заключение. Наносимые на имплантаты покрытия из комбинации нитридов титана и гафния (TiN+HfN) придают имплантатам химическую и биологическую инертность и могут быть рекомендованы для внедрения в клиническую практику. Ключевые слова: крыса, имплантат, нитрид титана и гафния, нитрид титана и циркония. Purpose.A comparative morphological study of bone tissue responsiveness to transosseous insertion of the implants made of copper (Cu), 12X18H9T medical steel, 12X18H9T steel with variant coatings of titanium and hafnium nitrides (TiN + HfN), as well as with those of titanium and zirconium nitrides (TiN + ZrN) into the tibial shafts of experimental rats. Materials and Methods. Four (4) groups of rats were formed including two (2) groups of comparison (12Х18Н9Т and Cu) and two (2) experimental groups (TiN+HfN and TiN+ZrN) with the above implants. Histological investigation of the tibial parts directly contacted with the implants performed at the end of each period of experimental observation. Results. The obtained results demonstrated the restoration of the bone injured with the implant, and bone marrow in groups with the implants of 12X18H9T steel to occur without granulation and cartilaginous tissues, while that with the implants of steel coated with titanium and hafnium nitrides (TiN + HfN) to occur free of complications and in earlier periods. At the same time, cases of necrosis, bone tissue destruction and lysis registered in the groups of using the implants of copper (Cu), the implants of steel with the coating of combined titanium and zirconium nitrides (TiN + ZrN), and the recovery process was secondary via the cartilaginous tissue. Conclusion. The applied coatings of combined TiN+HfN give the implants chemical and biological inertness, and they can be recommended...

Simulation of intramedullary osteosynthesis was performed at experimental tibia fracture in 30 rabbits, 6-7 months aged. In main group pins from medical steel coated by mixture of titanium nitride and hafnium were used, in comparative group pins without coating were used. Comparative study of certain biochemical blood indices, P and Ca content was performed. It was shown that application of implants coated by titanium nitride and hafnium that possessed high firmness and chemical stability did not cause additional reactive changes in experimental animals as compared with implants of medical steel. It confirmed the prospects of bioinert titanium nitride and hafnium coated nanotechnologic implants application for prevention of possible individual intolerance of metals.

Biocompatibility of implants made of steel 12X18H9T, steel 12X18H9T coated with titanium and hafnium nitrides, and steel 12X18H9T coated with titanium and zirconium nitrides was studied in rats. Implants that represented pins 8-10 mm long and 0.5 mm in diameter were inserted intramedullary into the middle third of the tibia after drilling. The ends of pins were turned down and placed under the skin. The wound was sutured tightly. Dynamics of body weight and temperature as well as the condition of the hair, eyes, oral and nasal mucosa were assessed on days 10, 30, 60 and 90 after implantation. It was shown that implants coated with titanium and hafnium nitrides caused minimum systemic and local reactions while implantation of pins coated with titanium and zirconium nitrides resulted in the development of more pronounced inflammatory changes on both the local and systemic level.