Abstracts journal "Polytrauma" 4/2016

Secondary care organization

ASSESSMENT OF THE ACCESS OF HIGH-TECHNOLOGY MEDICAL CARE FOR THE POPULATION OF THE ALTAY TERRITORY WITH DISEASES OF THE MUSCULOSKELETAL SYSTEM

Grigoricheva L.D., Korenyak N.A.

Federal Center of Traumatology, Orthopedics and Endoprosthetics,

Barnaul, Russia

Objective – to evaluate the level of access to high-tech medical care with the profile of traumatology and orthopedics for the adult population of Altay region based on the analysis of incidence rate of musculoskeletal system diseases.

Materials and methods. A retrospective analysis of the dynamics of epidemiological values was conducted on the basis of the annual statistical reports of the Ministry of Health of the Russian Federation (the form No.12) during 2005-2014. We investigated the incidence (prevalence rate), primary incidence of diseases of the musculoskeletal system and osteoarthrosis among the adult population. We conducted the comparative study of the indices in the Russian Federation, the Siberian Federal District and Altay region.

Results. The Siberian Federal District and Altay region show the highest rates of incidence of diseases of the musculoskeletal system and arthrosis in the Russian Federation.

More than 15,000 patients from 34 subjects of Russia, mainly from the Siberian, Far East and Ural Federal Districts were operated in the institution during 2013-2015. About 10,000 patients from Altay region received high-technology medical care, including 46 % from rural areas. Since 2005 the number of high-tech operations in the profile of traumatology and orthopedics in Altay region has increased more than 35 times (from 172 to 6,095), including 28-fold increase for the inhabitants of the regions. The number of replacement procedures showed almost 5-fold increase and 2.5-fold increase for the residents of Altay region in 2011. The waiting periods for total hip replacement have reduced significantly. Since 2013 more than 2,200 replacement procedures were conducted for big joints in the residents of Altay region annually. It is1.9 times lower than the current needs and in 4.5 times less than estimated requirements.

Provision of high-tech traumatological and orthopedic medical care for the population of Altay region was 1.92 per 1000 in 2014, including replacement of big joints (1.05 per 1000) that 1.71 and 1.52 times higher than the average values in Russia.

Conclusion. Extension of the network of federal institutions has increased the availability of high-tech medical care, especially for the remote areas such as Siberia and the Far East. Equal access of this type of medical care for rural population is guaranteed in Altay region. Insufficiency of high-tech and resource-intensive types of medical care is one of the major problems in the healthcare system in Russia.

Key words: osteoarthrosis; incidence rate; prevalence rate; access; high-technology medical care; traumatology and orthopedics; endoprosthetics; Altay region.

Information about authors:

Grigoricheva L.G., candidate of medical science, chief physician, Federal Center of Traumatology, Orthopedics and Endoprosthetics, Barnaul, Russia.

Korenyak N.A., candidate of medical science, deputy chief physician of scientific and innovative activity, Federal Center of Traumatology, Orthopedics and Endoprosthetics, Barnaul, Russia.

Address for correspondence:

Korenyak N.A., Lyapidevskogo St., 1/3, Barnaul, Altay region, Russia, 656045

Tel: +7 (3852) 29-75-16; +7 (905) 985-61-96

E-mail: ninakorenyak@mail.ru

References:

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Original researches

Predictive significance of apolipoproteins A1 and B (apoA1 and apoB) in development of sepsis in patients with polytrauma

Ustyantseva I.M., Khokhlova O.I., Petukhova O.V., Zhevlakova Yu.A.

Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia

Objective – to estimate the clinical and predictive significance of blood levels of apolipoproteins in development of infection in patients with polytrauma.

Materials and methods. The analysis included 99 patients with polytrauma (APACHE-III > 80, ISS > 30), volume of probable blood loss > 20 % of circulating blood volume) who were retrospectively classified in relation to the criteria of ACCP/SCCM (1992): SIRS (n = 18), local infection (n = 36), sepsis (n = 27), severe sepsis (n = 12), septic shock (n = 6). The control group included 15 almost heathy persons (age of 20-50).

The study was conducted in concordance with the ethical principles of World Medical Association Declaration of Helsinki – Ethical Principles for Medical Research Involving Human Subjects 2013 with written consent for participation in the study and approval from the local ethical committee.

The identification of the microorganisms was conducted with the bacteriological analyzer Vitek 2 (bioMeireux, France). Serum levels of apolipoprotein A1 (ApoA1) and apolipoprotein B (ApoB) were measured with the analytic module platform Cobas 6000 SWA (Roche Diagnostics, Germany) with immune turbidimetric technique with use of agents from Roche Diagnostics (Germany).

The statistical analysis was conducted with IBM SPSS Statistics 20. Quantitative variables were presented as Me (LQ-UQ), where Me – median, (LQ-UQ) – interquartile range (LQ – 25 %, UQ – 75 % quartiles). Qualitative signs were presented as absolute and relative (%) values. Fisher’s exact test and χ²test were used for comparison of qualitative variables. Relationships were identified with multiple logistic regression. After identification of differences the procedure of Dunnet multiple comparisons was conducted (with use of SIRS group (in the first case) or control data (in the second case) as a comparison group). For estimation of diagnostic information capacity of the tests we used ROC-curve. Differences were considered as statistically significant with p < 0.05.

Results and discussion. Infectious complications were identified in 81 % of the patients. Sepsis was identified in 45 % on the days 8-10. Sepsis was characterized with gradual joining of multiresistant opportunistic gram-negative flora (Ps. Aeruginosa and Acinetobacter spp., 66.6 % of cases with Kl. Pneumoniae, 33.4 % – with MRSA). Examination of ApoB in the blood of the patients with polytrauma identified its significant decrease in all groups as compared with the control values (p = 0.02). Mean values of ApoB in the patients of the septic groups (sepsis, severe sepsis, septic shock) were lower than the lowest references. The maximal decrease in ApoB level was noted in the septic groups on the days 1-3 and 5-7. The strong correlation relationship was found between the level of ApoB in the serum and severity of systemic inflammatory response syndrome (Spearman rank correlation, p = 0.76, p < 0.001). The relationship between apolipoprotein AI and infection was not statistically significant with α = 0.05 (p = 0.051).

Conclusion. The study showed that the patients with polytrauma and the blood level of apolipoproteins B < 50 % of the lower reference, demonstrated the maximal risk of subsequent posttraumatic hospital infections. ApoB monitoring allows estimating the severity of developed ApoB (< 50 mg/dl). High diagnostic accuracy (100 %) of the threshold level of ApoB (< 50 mg/dl) (on the days 1-3 and 5-7 after trauma) allows its using as an early marker of septic complications determined by gram-negative microflora.

Key words: polytrauma; systemic inflammatory response syndrome; sepsis; apolipoprotein A1; apolipoprotein B.

Information about authors:

Ustyantseva I.M., doctor of biological science, professor, deputy chief physician of clinical laboratory diagnostics, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Khokhlova O.I., MD, PhD, professor, physician of clinical laboratory diagnostics, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Petukhova O.V., candidate of medical science, physician of clinical laboratory diagnostics, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Zhevlakova Yu.A., candidate of medical science, bacteriologist, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Address for correspondence:

Ustyantseva I.M., 7th district, 9, Leninsk-Kuznetsky, Kemerovo region, Russia, 652509

Regional Clinical Center of Miners’ Health Protection

Tel: +7 (384-56) 2-38-88

E-mail: irmaust@gnkc.kuzbass.net

REFERENCES:

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10. Ust'yantseva IM, Khokhlova O., Petukhova OV, Zhevlakova YA, Agaiaryan AH.

Predictive sighificance of markers of inflammation, lipopolysaccharide-binding protein and lactate in development of sepsis in patients with polytrauma. Polytrauma. 2014; 3:15-23. Russian

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New medical technologies

SURGICAL treatment of patients with aseptic necrosis of the femoral head at early stages

Agadzhanyan V.V., Pronskikh A.A., Davydov D.A., Protsenko S.V.

Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia

Objective – to present the developed technique of revascularization of the femoral head with use of the muscular pedicle autograft from the great trochanter in aseptic necrosis.

Materials and methods. The study was based on the analysis of the results of treatment of 108 patients with femoral head aseptic necrosis. The patients were operated with the original technique. The first group (72 patients) received operations at early and late stages of aseptic necrosis. The second group (36 patients) received surgical treatment only at initial stages of the process. The morphological study included 95 bone samples taken from the femoral heads resected during endoprosthetic procedures.

Results. The indications to surgery were determined on the basis of the clinical, radiologic and pathohistological examination. The investigation of the treatment outcomes of 92 patients allowed defying the indications to surgery and confirming the efficiency of surgery at stages 1 and 2 of aseptic necrosis of the femoral head. Joint functioning increased from 50.4 ± 3.7 to 89.9 ± 3.1. Progression of the process was identified only in one patient.

Conclusion. The offered revascularization of the femoral head is an efficient method of treatment of aseptic necrosis at early stages and prevention of coxarthrosis.

Key words: coxarthrosis; aseptic necrosis of the femora head; bone revascularization.

Information about authors:

Agadzhanyan V.V., MD, PhD, professor, chief physician, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Pronskikh A.A., MD, PhD, professor, chief of center of polytrauma, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Davydov D.A., physician of anatomic pathology department, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Protsenko S.V., traumatologist-orthopedist, department of traumatology and orthopedics No.1, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Address for correspondence:

Agadzhanyan V.V., 7th district, 9, Leninsk-Kuznetsky, Kemerovo region, Russia, 652509

Tel: +7 (384-56) 2-40-50

E-mail: info@gnkc.kuzbass.net

References:

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Anesthesiology and critical care medicine

The personalised aspects of development of venous tromboembolic complications IN polytrauma

Dorzheev V.V., Miromanov A.M., Davydov S.O., Miromanova N.A.,
Vitkovsky Yu.A.

Dorzheev V.V., Miromanov A.M., Davydov S.O., Miromanova N.A.,
Vitkovsky Yu.A.
Chita State Medical Academy,
Chita, Russia

Objective – to identify the personalised prognostic criteria of development of venous thromboembolic complications (VTEC) in patients with polytrauma.
Materials and methods. The complex (clinical, laboratory, instrumental) examination included 114 patients at the age from 20 till 40 with polytrauma. Polytrauma with ISS > 9 was a criterion for inclusion into the study. The first group was presented by 73 patients with an uncomplicated course of polytrauma. The second group included 41 patients with VTEC and polytrauma. The control group included 100 almost healthy men and women at the age from 20 till 40. Predictions of values of some dependent variables with known values of other variables were carried out by means of multiple regression analysis (STATISTICA 6.0).
Results. The multivariable stepwise regression analysis of the various values showed that identification of LPA (the step 1) was closely associated with thromboembolic complications in patients with polytrauma. Accuracy of prediction was increased with addition of the data about concentration of IL-2 (the step 2), level of D-dimer (the step 3), polymorphism of gene MTHFR (-677T) (the step 4), polymorphism of gene IL-10 (-1082G) (the step 5), APTT (the step 6), polymorphism of gene IL-2 (-330G) (the step 7) and polymorphism of gene FV (Leiden) (-1691A) (the step 8). Addition of other values to the selected ones did not show any significant increase in predictive power. The value of the multiple coefficient of correlation was 0.885, the coefficient of determination (R-square) – 0.78, the level of significance of the regression model – less than 0.0001.
Conclusion. Estimation of LPA, IL-2, D-dimer, APTT, as well as polymorphism of gene MTHFR-677Ñ>Ò, polymorphism of gene IL10-1082G>A, polymorphism of gene IL2-303Ò>G and polymorphism of gene FV (Leiden)-1691G>A in polytrauma can be used in the diagnostic process for the purpose of forecasting the development of hemocoagulative disturbances that will allow to execute individual preventive actions for prevention of development of thromboembolic complications.
Key words: polytrauma; venous thrombosis; genes; polymorphism; prediction.

Information about authors:
Dorzheev V.V., candidate of medical science, docent of chair of traumatology and orthopedics, Chita State Medical Academy, Chita, Russia.
Miromanov A.M., MD, PhD, docent, chief of chair of traumatology and orthopedics, Chita State Medical Academy, chief traumatologist-orthopedist of Health Ministry of Zabaikalye Territory, Chita, Russia.
Davydov S.O., MD, PhD, professor of chair of traumatology and orthopedics, Chita State Medical Academy, Chita, Russia.
Miromanova N.A., MD, PhD, docent, chief of chair of pediatric infections, Chita State Medical Academy, Chita, Russia.
Vitkovsky Yu.A., MD, PhD, professor, chief of chair of normal physiology, Chita State Medical Academy, Chita, Russia.
Address for correspondence:
Miromanov A.M., Gorkogo St., 39a, Chita, Russia, 672090
Chita State Medical Academy, chair of traumatology and orthopedics Tel: +7 (924) 386-18-16
E-mail: miromanov_a@mail.ru

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11. Miromanov AM, Namokonov EV Prognostic criteria of development of complications in fractures of bones of extremities. Chita : CSMA Publ., 2014. P.175. Russian
12. Mikhalevich IM Regression analysis (use in medical researches with application of Statistica) : the manual for doctors. Irkutsk : ISMACE Publ., 2012. 32 p. Russian
13. Kuznik BI, Tsybikov NN, Vitkovsky YuA. Uniform cellular and humoral system of protection of the body. Thrombosis, Hemostasis and Rheology. 2005; (2): 3-16. Russian

NEW VIEW OF PATHOGENESIS OF FAT EMBOLISM SYNDROME
Bocharov S.N., Lebed M.L., Kirpichenko M.G.

Bocharov S.N.^1, 2, Lebed M.L.¹, Kirpichenko M.G.¹
¹Irkutsk Scientific Center of Surgery and Traumatology,
²Irkutsk State Medical University,
Irkutsk, Russia

Objective – to study the features of lipid metabolism and its significance in hyperglobulinemia.
Materials and methods. The research included 85 patients after total hip replacement. Prevention of fat embolism was conducted with intravenous injection of Essentiale N solution. Detection and counting of fat globules were conducted using light microscopy of central vein blood plasma smear. Lipid fractions (VLDL, light LDL, HDL ), cholesterol, triglycerides, Apo-A and Apo-B levels, activity of plasma lipoprotein lipase were determined in venous blood samples.
Results. Fat hyperglobulinemia appears in 79 % of cases during total hip replacement. Risk of fat hyperglobulinemia, as compared to the intraoperative data, decreases only by the 3rd day after the surgery. Significant decrease in cholesterol level was detected right after the surgery and remained unchanged during first postoperative day; concentration of blood triglycerides increased. Decrease in the Apo-B level below normal values was detected right after the surgery and remained unchanged on the first day of postoperative period. Chylomicronemia level was significantly increased after the surgery and, despite of the decrease on the first day of postoperative period, remained on higher level than before surgery. VLDL level increased right after the surgery and remained unchanged to the first day after the surgery. During this time interval the HDL level decreased and remained significantly lower than the initial value despite its increase to the first day after the surgery.
Conclusion. The research proved the regularity in lipid metabolism changes in total hip replacement which are caused by functional hepatic failure. Also it allowed to create the own conceptual scheme of fat hyperglobulinemia/embolism process.
Key words: fat hyperglobulinemia/embolism syndrome; lipid metabolism; total hip replacement.

Information about authors:
Bocharov S.N., MD, PhD, professor, leading researcher of the scientific and clinical department of traumatology, chief of anesthesiology and critical care medicine department, Irkutsk Scientific Center of Surgery and Traumatology, assistant of chair of anesthesiology and resuscitation, Irkutsk State Medical University, Irkutsk, Russia.
Lebed M.L., MD, PhD, leading researcher, anesthesiologist-intensivist, Irkutsk Scientific Center of Surgery and Traumatology, Irkutsk, Russia.
Kirpichenko M.G., candidate of medical science, anesthesiologist-intensivist, Irkutsk Scientific Center of Surgery and Traumatology, Irkutsk, Russia.
Address for correspondence:
Bocharov S.N., Bortsov Revolyutsii St., 1, Irkutsk, Russia, 664003
Tel: +7 (3952) 29-03-68
Å-mail: bocharov@irk.ru

References
1.             Kosova E, Bergmark B, Piazza G. Fat embolism syndrome. Circulation. 2015; 131 (3): 317-320.
2.             Han YT, Tang J, Gao ZQ et al. Clinical features and neuroimaging findings in patients with cerebral fat embolism. Chin. Med. J. (Engl.).2016;129 (7): 874-876.
3.             Lin KY, Wang KC, Chen YL et al. Favorable outcome of cerebral fat embolism syndrome with a Glasgow coma scale of 3: a case report and review of the literature. Indian J. Surg. 2015; 77 (1): 46-48.
4.             Husebye EE, Lyberg T, Røise O. Bone marrow fat in the circulation: clinical entities and pathophysiological mechanisms. Injury. 2006; 37 (4): 8-18.
5.             Kornilov NV, Kustov VM. Fat embolism. Saint Petersburg: Morsar AV, 2001. 287p. Russian
6.             Kao SJ, Yeh DY, Chen HI. Clinical and pathological features of fat embolism with acute respiratory distress syndrome. Clin. Sci. (Lond.). 2007; (113): 279-285.
7.             Prakash S, Sen RK, Tripathy SK et al. Role of interleukin-6 as an early marker of fat embolism syndrome: a clinical study. Clin. Orthop. Relat. Res. 2013; (471): 2340-2346.
8.             Bocharov SN, Plakhotina EN, Tvorogova SS. Prevention and treatment of experimental fat globulinemia. In: Proceedings of IX Russian National Congress “Man and his Health”. Saint Petersburg, 2004. p. 18-19. Russian
9.             Bocharov SN, Plakhotina EN, Tvorogova SS et al. Method of prevention of fat embolism in perioperative period: Patent 2326676 of the Russian Federation. Appl. Dec. 12, 2006; publ. June 20, 2008, Bul. N. 17. 1 p.Russian
10.         Plakhotina EN, Bocharov SN. Fat embolism (pathogenesis, prevention, treatment). Novosibirsk: Nauka, 2009. P. 150. Russian
11.         Bocharov SN, Plakhotina EN, Tvorogova SS. Experimental study of efficacy of the prophylaxis and treatment of fat embolism syndrome. Abstract submission of 17thannual congress of European Society of Intensive Care Medicine. Berlin, 2004. P. 104.
12.         Kornilov NV, Voynovich AV, Kustov VM. Diagnostics of fat globulinemia in traumas and surgery of bones: methodical guidelines. Saint Petersburg, 2000. 24 p. Russian
13.         Rebrova OYu. Statistical analysis of medical data. Use of the application program package STATISTICA. Moscow: Media Sfera, 2003. P. 312. Russian

Efficiency of the criteria of initiation of renal replacement therapy in patients with polytrauma complicated by multiple organ dysfunction syndrome
Kravtsov S.A., Shatalin A.V., Skopintsev D.A., Malev V.A.

Kravtsov S.A., Shatalin A.V., Skopintsev D.A., Malev V.A.
Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia

Objective – to determine and to estimate the efficiency of the offered criteria of initiation of intermittent renal replacement therapy (RRT) in patients with polytrauma complicated by multiple organ dysfunction syndrome (MODS).
Materials and methods. The randomized study was based on the perspective and retrospective analysis of treatment of the patients with polytrauma (Injury Severity Score [ISS] = 41 ± 1.4) complicated by MODS (MOD = 19 ± 0.7, the probability of lethal outcome – 75 %). 42 patients were distributed into two representative groups with the computer software with the limited database. In the comparison group (20 patients) with increasing acute renal insufficiency the criteria of initiation of RRT were Ê⁺ ≥ 6 mmol/l, plasma creatinine ≥ 280 mcM/l, diuresis ≤ 20 ml per hour. The retrospective analysis of the case histories was conducted by means of lineal regression and found the most significant predictors of progressing MODS: Na⁺ ≥ 150 mmol/l, osmolarity ≥ 300 mOsm/l, increasing plasma toxicity according to concentration of medium-sized molecules ≥ 0.8. They were used as the main predictors in the study group (22 patients). Hourly diuresis was not a basic criterion for initiation of RRT in the main group, i.e. it was secondary.
Results. The amount of procedures of RRT was 12.4 ± 0.7 in the comparison group. Restoration of excretive renal function was on the day 19 ± 2 from the moment of initiation of RRT in 8 patients of this group. Diuresis increased to 107 ± 11 ml per hour, water-electrolyte and acid-base balance disorders decreased. The main hemodynamic parameters stabilized and the degree of respiratory support decreased. The mortality was 12 persons (60 %). The achievement of the similar results required 8 ± 0.53 sessions of hemodialysis in 11 patients of the study group. We observed earlier recovery of the concentration function of the kidneys and transition to polyuria (14 ± 2 days). The mortality was lower in the study group (8 patients, 36.8 % of the total amount of the patients in this group).
Conclusion. The indication to the dialysis methods of treatment is non-corrected hypernatraemia (level of Na⁺ in blood plasma ≥ 150 mmol/l) and hyperosmolarity (≥ 300). Such criteria allow more early initiation of RRT with decreasing amount of necessary procedures for elimination of acute renal insufficiency, achievement of constant stabilization of patients with polytrauma, 1.5-fold decrease in terms of treatment and more than 11 % decrease in the mortality.
Key words: polytrauma; multiple organ dysfunction syndrome; criteria of initiation of renal replacement therapy.

Information about authors:
Kravtsov S.A., MD, PhD, chief of center of critical care medicine, intensive care and anesthesiology, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.
Shatalin A.V., MD, PhD, deputy chief physician of medical issues, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.
Skopintsev D.A., anesthesiologist-intensivist, chief of intensive care unit, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.
Malev V.A., anesthesiologist-intensivist, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.
Address for correspondence:
Kravtsov S.A., 7th district, 9, Leninsk-Kuznetsky, Kemerovo region, Russia, 652509
Tel: +7 (384-56) 2-39-99
E-mail: info@gnkc.kuzbass.net

References:
1.      Agadzhanyan VV, Pronskikh AA, Ustyantseva IM, Agalaryan Akh, Kravtsov SA, Krylov YuM et al. Polytrauma. Novosibirsk: Nauka, 2003. 492 p. Russian
2.      Galfand BR, Protsenko DN, Podachin PV, Chubchenko SV, Lapshyna Iyu. Abdominal hypertension syndrome: the state of the problem. Medical alphabet. Emergency care. 2010; (3): 34-42. Russian
3.      Gumanenko EK, Kozlov VK. Polytrauma: traumatic disease, immune system dysfunction, the modern strategy of treatment. M.: GEOTAR Media, 2008. 608 p. Russian
4.      Kornilov NV, Kulik VI, Epstein GG et al. Organizational issues of arrangement of medical aid for patients with polytrauma. In: Diagnostics and treatment of polytrauma: the materials from 4th plenary meeting of Russian association of orthopedist-traumatologists. Leninsk-Kuznetsky, 1999. P. 38-39. Russian
5.      Marino PL. Intensive care : translated from English. Edited by Martynov AI. M., 1998. P. 170-173. Russian
6.      Biryukova LS, Purlo NV, Denisova EN et al. Use of continuous high volume hemofiltration for patients with sepsis and multiple organ dysfunction. Anesthesiology and Critical Care Medicine. 2005; (2): 69-72. Russian
7.      Zhidkov KP. Critical states (diagnostics and treatment). St. Petersburg : Morsar, 2000. 160 p. Russian
8.      Ronco Ñ, Intini VD, Bellomo R, Rici Z, Bonello M, Ratanarat R, et al. Substantiation of use of extracorporeal treatment methods for sepsis. Anesthesiology and Critical Care Medicine. 2005; (2): 87-91. Russian
9.      Sokolov VA. Multiple and associated injuries. M.: GEOTAR-Media, 2006. 512 p. Russian
10. Shabanov AK, Bulava GV, Kislukhina EV, Khubutiya MSh. Criteria of high risk of development of infectious pulmonary diseases in severe associated injury. Anesthesiology and Critical Care Medicine. 2015; (2): 16-19. Russian
11. Champion HR, Sacco WJ, Copes WS, Gann DS, Gennarelli TA, Flanagan ME. A revision of the Trauma Score. J Trauma. 1989; 29 (5): 623-629.
12. Boyd CR, Tolson MA, Copes WS. Evaluating trauma care: a TRISS method. Trauma Score and the Injury Severity Score. J Trauma. 1987; 27(4): 370-377.
13. Wong DT, Barrow PM, Gomez M, McGuire GP. A comparison of the Acute Physiology and Chronic Health Evaluation (APACHE) II score and the Trauma-Injury Severity Score (TRISS) for outcome assessment in intensive care unit trauma patients. Crit Care Med. 1996; 24 (10): 1642-1648.
14. Vincent JL, Moreno R, Takada J, Willatts S, De Mendonça A, Bruining H, et al. The SOFA Score to describe organ dysfunction /failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996; 22(7): 707-710.
15. Knaus WA, Zimmerman JE, Wagner DP, Draper EA, Lawrence DE. APACHE-acute physiology and chronic health evaluation: a physiologically based classification system. CritCare Med. 1981; 9 (8): 591-597.
16. Moreno R, Vincent JL, Matos R, Mendonça A, Cantraine F, Thijs L, et al. The use of maximum SOFA score to quantify organ dysfunction/failure in intensive care. Results of a prospective, multicentre study. Working Group on Sepsis related Problems of the ESICM. Intensive Care Med. 1999; 25(7): 686-696.
17. Damage Control Management in the Polytrauma Patient. Eds. Pape H.- C. et al. Springer Science+Business Media, LLC 2010. 463 ð.

Clinical aspects of surgery
Comparative efficiency of various techniques for complex treatment of patients with gunshot injuries to the extremities
Chililov A.M., Akhmedov B.A., Kozlov V.K.

Chililov A.M.¹, Akhmedov B.A.¹, Kozlov V.K.^2,3,4
¹Vishnevsky Institute of Surgery, Moscow, Russia
²Mechnikov North-Western State Medical University, Saint Petersburg
³Saint Petersburg State University, Saint Petersburg, Russia
⁴Novgorod State University named after Yaroslav the Wise, Veliky Novgorod, Russia

Objective – to substantiate the possibilities of increasing efficiency of complex treatment of patients with gunshot shaft fractures of long bones of the extremities by means of implementation of the modern low invasive technologies of internal osteosynthesis and technologies of pharmacotherapy with modern immune active drugs into clinical practice of civil healthcare.
Materials and methods. The prospective comparative study was based on the experience of complex treatment of 104 patients of Yemen republic who required for medical aid for treating the lower limb gunshot wounds of various severity. The gunshot injuries were characterized by shaft fractures of the long bones of the extremities and concurrent gunshot injuries to soft tissues. Men presented the main category of the patients (80.7 %). The age of the patients varied from 15 to 80, with the average age of 38.5 ± 5.7. Presence of gunshot fractures of the long bones of the extremities determined the use of various surgical techniques of single-step and staged treatment. For prevention of infectious diseases the patients with most severe fractures additionally received medicated immune-oriented therapy (besides the main pharmaceuticals of concurrent conservative treatment).
Results and discussion. The patients received the complex treatment in concordance with the various techniques of staged treatment: low energy fractures were treated with the conventional techniques with the external fixation devices as a final method of fracture union, or as early as possible primary low invasive and functionally stable osteosynthesis with LCP or BIOS; high energy fractures were initially treated with the external fixation devices, which were further replaced in delayed low invasive fixation with metal plates. The main point of improving the known techniques of complex treatment was the drive to synchroneity and minimal possibility of postsurgical trauma by means of wide use of modern fixation plates, as well as preventive immune correction of posttraumatic immune dysfunction for excluding the infectious complications of gunshot fractures. As result, the efficiency of complex treatment increased: invasiveness of surgical intervention showed two-fold decrease (p ≤ 0.01), as well as duration of hospital treatment (p ≤ 0.01); exclusion of recurrent osteosynthesis; sharp decrease in rate of complications resulting in disability (4-fold decrease in infectious complications and 40-fold decrease in non-infectious complications); reducing the duration of rehabilitation, significant improvement in quality of life of treated patients and achieving the fastest restoration of functioning of the injured extremity.
Conclusion. The technique has been improved and the algorithm for complex treatment of gunshot shaft fractures of long bones of the extremities has been offered during arrangement of specialized medical aid for civilian persons suffered in war conflicts. The technique for treating patients with gunshot fractures of the extremities, including saving surgical preparation, early low invasive and functionally stable osteosynthesis with modern implants, and non-specific immune prevention of infectious complications, was more efficient and cost saving in comparison with the conventional treatment technique with external fixing devices and non-use of immune active drugs as a part of conservative therapy.
Key words: gunshot fractures of extremities; tactics of surgical treatment; osteosynthesis; conservative therapy; immune correction.

Information about authors:
Akhmedov B.G., MD, PhD, head of department of orthopedics and arthrology, Vishnevsky Institute of Surgery, Moscow, Russia.
Chililov A.M., research associate of department of orthopedics and arthrology, Vishnevsky Institute of Surgery, Moscow, Russia.
Kozlov V.K., MD, PhD, professor; professor of chair of clinical and laboratory diagnostics, Mechnikov North-Western State Medical University, Saint Petersburg; professor of chair of maxillofacial surgery and surgical dentistry, Saint Petersburg State University; professor of chair of microbiology, immunology and infectious diseases, Novgorod State University named after Yaroslav the Wise, Veliky Novgorod, Russia.
Address for correspondence:
Kozlov V.K., Bolshaya Serpukhovskaya St., 27, Moscow, Russia, 117997
Vishnevsky Institute of Surgery
Tel: +7 (499) 236-57-07
E-mail: kvk52@mail.ru

REFERENCES:
1.        Akhmedov BA. Optimizing the methods of treatment of patients with gunshot fractures of bones of extremities : abstracts of dissertations of PhD in medicine. Saint Petersburg, 2010. 45 p. Russian
2.        Military field surgery. Edited by EK Gumanenko. Saint Petersburg. Saint Petersburg: GEOTAR-Media, 2008. 768 p. Russian
3.        The secrecy label has been removed: losses of USSR armed forces in wars, combats and conflicts. Eedited by GF Krivosheeva. M.: Voenizdat, 1993. 412 p. Russian
4.        Gushchev AB. The results of Gulf War. Foreign war review. 1991; (6): 3-13. Russian
5.        The experience of medical provision of troops in Afghanistan in 1979-1989, 5-volume edition. Vol. 3. Arrangement of surgical care for wounds in various locations. Eedited by IA Eryukhina, VI Khrupkina. M.: Burdenko State Military Clinical Hospital, 2003. 421 P. Russian
6.        Guidelines for military field surgery. M.: Ministry of Defense of the Russian Federation: Main Military and Medical Administration of Defense Ministry, 2000. 418 p. Russian
7.        Shapovalov VM. Combat injuries to the extremities: structure of injuries and features of patients’ condition in the period of local wars. Traumatology and Orthopedics of Russia. 2006; (2): 301-302. Russian
8.        Kozlov VK, Chililov AM, Akhmedov BA. The experience of complex treatment of patients with infectious complications of gunshot fractures of extremities. Surgery. 2015; (11): 53-58 Russian
9.        Mamaev VI. Optimization of surgical care of consequences of fractures with use of the predictive algorithms: abstracts of dissertations of doctor of medical science. Kurgan, 2010. 45 P. Russian
10.    Experience of soviet medicine in Great Patriotic War of 1941-1945. M.: Medgiz, 1952. Vol.16. Gunshot wounds and injuries to the extremities (complications). 644 P. Russian
11.    Polytrauma: traumatic disease, dysfunction of immune system. Modern strategy of treatment. Edited by EK Gumanenko, VK Kozlova. M.: GEOTAR-Media, 2008. 608 P. Russian
12.    Revskoy AK, Lyufing AA, Nikolenko VK. Gunshot wounds of extremities. M.: Meditsina, 2007. 298 P. Russian
13.    Agadzhanyan VV, Ustyantseva IM, Pronskikh AA, Novokshonov AV, Agalaryan AKh. Polytrauma. Septic complications. Novosibirsk: Nauka, 2005. 391 P. Russian
14.    Kozlov VK, Chililov AM, Akhmedov BA. The modern ideas of gunshot fractures of extremities: pathogenetic substantiation of searching the new directions and technologies of treatment of patients. Ukrainian Journal of Extreme Medicine named after Mozhaev. 2012; 13 (4): 19-31. Russian
15.    Atesalp AS, Yildiz C, Basbozkurt M, Gur E. Treatment of type IIIA open fractures with Ilizarov fixation and delayed primary closure in high-velocity gunshot wounds. Mil. Med. 2002; (167): 56.
16.    Dar GN, Tak SR, Kangoo KA, Dar FA, Ahmed ST. External fixation followed by delayed interlocking intramedullary nailing in high velocity gunshot wounds of the femur. Ulus Travma Acil Cerrahi Derg. 2009; (15): 8.
17.    Gustillo RB, Mendoza RM, Williams DN. Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J. Trauma. 1984; (24): 742.
18.    Clinical laboratory diagnostics. National manual. Vol.2. Edited by Dolgov VV, Menshikov VV. M.: GEOTAR-Media, 2012. 808 P. Russian
19.    Zurochka AV et al. Flow cytometry in medicine and biology. Ekaterinburg: the publishing office of Ural department of Russian Academy of Medical Science, 2013. 552 P. Russian

Clinical aspects of traumatology and orthopedics
THE ALGORITHM OF TREATMENT OF PATIENTS WITH HUMERORADIAL JOINT INJURY
Tyutyunnikov A.V., Reznik L.B., Gudinova Zh.V., Geger M.E.

Tyutyunnikov A.V.¹, Reznik L.B.², Gudinova Zh.V.², Geger M.E.¹

¹Clinical Medicosurgical Center,
²Omsk State Medical University,
Omsk, Russia

Objective – to improve the results of treatment of patients with injuries to the humeroradial joint area.
Materials and methods. In our study we have analyzed the results of treatment of 107 patients with lesions of humeroradial joint area, which were operated in the trauma department No.1, Clinical Medicosurgical Center, for the period of 2007-2014. Group distribution of patients with lesions of the proximal part of the radial bone was carried out with the classification of the Mason-Johnston. The patients with fractures of the capitellum were distributed in accordance to the classification of the Bryan-Morray. Depending on the type of injury we had performed the primary osteosynthesis or arthroplasty, including the using of the individual model of the radial head prosthesis.
Results. The analysis of long-term results of surgical treatment of patients with humeroradial joint lesions allowed to develop an algorithm of the individualized treatment, the use of which in 89 % of cases gives possibility to obtain "good" and "excellent" results, while its nonobservance resulted in “poor” outcomes in 11% of the patients. The using of our implant in Mason-Johnston III and type IV injury in combination with fractures of the proximal part of the ulna showed "excellent" and "good" (85-100 points on the MEPI) long-term results of surgical treatment, which were achieved in 95 % of the patients, that is better results than monoblock implants (85-95 points on the MEPI at 81.25%).
Conclusion. Applying the algorithm of individualized treatment of injuries of humeroradial joints allowed to get "good" and "excellent" results of surgical treatment in 89 % of cases, whereas nonobservance resulted in “poor” outcomes in 11 % of the patients. In the treatment of patients with unstable fractures of the head and neck of the radius of Mason-Johnston III and type IV in combination with fractures of the proximal part of the ulna using models of individual endoprosthesis of the radial head the "excellent" and "good" results (85-100 points on the MEPI) were achieved in 95 % of the patients. It was several times better than the results of using standard endoprothesis.
Key words: the algorithm of treatment; humeroradial joint; individual model; injuries.

Information about authors:
Tyutyunnikov A.V., traumatologist-orthopedist, traumatology department No.1, Clinical Medicosurgical Center, Omsk, Russia.
Reznik L.B., MD, PhD, professor, chief of chair of traumatology and orthopedics, Omsk State Medical Academy, Omsk, Russia.
Gudinova Zh.V., MD, PhD, professor, chief of chair of common hygiene with course of hygiene for children and adolescents, Omsk State Medical Academy, Omsk, Russia.
Geger M.E., chief of traumatology department No.1, Clinical Medicosurgical Center, Omsk, Russia.
Address for correspondence:
Tyutyunnikov A.V., SibNIISKhoz St., 7-100, Omsk, Russia, 644012
Tel: +7 (913) 976-61-10
Å-mail: tutundoc@inbox.ru

References:
Court-Brown CM, Caesar B. Epidemiology of adult fractures: a review.         Injury. 2006; 37 (8): 691-697.
Court-Brown CM, et al. The epidemiology of fractures. In: Rockwood and Green’s fractures in adults. Eds. R. W. Bucholz, Court-Brown C. M., Heckman J. D., Tornet P. 7th ed. Philadelphia, 2010. P. 53-84.
3.      Duckworth AD, Clement ND, Jenkins PJ, Aitken SA, Court-Brown CM, McQueen MM. The epidemiology of radial head and neck fractures. J. Hand Surg. Am. 2012. 37 ( 1): 112–119.
4.      Kalantyrskaya VA, Kliuchevsky VV. Operative treatment of the radial bone head fractures.Science, Culture, Education World. 2014. (6): 586-588.         Russian
5.      Zhabin GI, Fediunina SY, Ambrosenkov AV, Boyarov AA. Replacement of the radial bone head by bipolar endoprosthesis. Traumatology and Orthopaedics of Russia. 2011. (1): 42-46. Russian

Researches of young scientists
Analysis of proliferative activity and apoptosis of cells of femoral head bone tissue in various etiological forms of osteoarthrosis
Davydov D.A., Avdalyan A.M., Agadzhanyan V.V., Kirilova I.A., Ustyantseva I.M., Lushnikova E.L.

Davydov D.A.¹, Avdalyan A.M.², Agadzhanyan V.V.³, Kirilova I.A.¹, Ustyantseva I.M.³, Lushnikova E.L.⁴

¹Novosibirsk Scientific Research Institute of Traumatology and Orthopedics named after Ya.L. Tsyvyan,
Novosibirsk, Russia,
²Laboratory of Molecular and Genetic Characteristics of Tumors, Altay department of Blokhin Russian Oncologic Scientific Center,
Barnaul, Russia,
³Regional Clinical Center of Miners’ Health Protection,
Leninsk-Kuznetsky, Russia,
⁴Institute of Molecular Pathology and Pathomorphology,
Novosibirsk, Russia

Appearance of the new low invasive methods of treatment of patients with hip joint osteoarthrosis requires more profound understanding of the mechanisms of bone tissue remodeling. Research of such molecular and biological markers of the cellular cycle as Ki-67 and bcl-2 proteins allows estimating the bone tissue remodeling in the tissues of the femoral head in osteoarthrosis of various origin. Currently, many aspects of this issue require clarification.
Objective – to conduct the analysis of the transcription factors of the cells of bone tissues of the femoral head in various etiological forms of osteoarthrosis.
Materials and methods. The morphological study included 95 femoral heads removed during hip joint replacement in the patients with the clinically confirmed diagnosis of coxarthrosis of the stages 3-4. The patients were admitted to the department of traumatology and orthopedics of Regional Clinical Center of Miners’ Health Protection. The antibody Ki-67 was used for registration of proliferative activity of the cells (30-9, Ventana), as well as antibody p53 (DO-7, Ventana) for registration of cellular apoptosis of bone tissue and antibody bcl-2 (124, Ventana) for registration of antiapoptotic activity. The study was conducted with the light microscope (Nicon Ci-S, China) with use of the digital photo camera (Nicon DS-Fi2, Japan). The morphometric measurements were conducted with NIS-Elements BR 4.30.00.
Results and discussion. The performed estimation of expression of the transcriptional factors shows the special features of induction and inhibition of apoptosis, as well as proliferative activity in cells of bone tissues of the femoral head in various etiological forms of hip joint osteoarthrosis. For each nosologic form of coxarthrosis we found the most specific manifestations of the certain morphological, molecular and biological signs.
Conclusion. Therefore, one can suppose that synthesis of bone tissue in dysplastic osteoarthrosis is improved with search of therapy for increasing antiapoptotic activity of osteoblasts, with orientation to increasing antiapoptotic activity of osteoblasts, in postischemic arthrosis for increasing proliferative activity of osteoblasts, but posttraumatic osteoarthrosis requires increasing proliferative activity of osteoblasts and antiapoptotic activity of osteocytes.
Key words: Ki-67; p53; bcl-2; osteoblast; osteocyte; osteoclast; apoptosis; proliferation.

Information about authors:
Davydov D.A., junior research associate, laboratory and experimental department, Novosibirsk Scientific Research Institute of Traumatology and Orthopedics named after Ya.L. Tsyvyan, Novosibirsk, Russia.
Avdalyan A.M., MD, PhD, chief of laboratory, laboratory of molecular and genetic characteristics of tumors, Altay department of Blokhin Russian Oncologic Scientific Center, Barnaul, Russia.
Agadzhanyan V.V., MD, PhD, professor, chief physician, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.
Kirilova I.A., deputy director of scientific and innovative work, leading researcher, Novosibirsk Scientific Research Institute of Traumatology and Orthopedics named after Ya.L. Tsyvyan, Novosibirsk, Russia.
Ustyantseva I.M., doctor of biological science, professor, deputy chief physician of clinical and laboratory diagnostics, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.
Lushnikova E.L., doctor of biological science, director of Institute of Molecular Pathology and Pathomorphology, Novosibirsk, Russia.
Address for correspondence:
Davydov D.A., 7th district, 9, Leninsk-Kuznetsky, Kemerovo region, Russia, 652509
Tel: +7 (384-56) 9-55-80
E-mail: denis260586@rambler.ru

Case history
A CASE of successful replantation of the distal phalanx of the first finger in a child with traction mechanism of detachment
Afanasyev L.M., Guselnikov S.S., Shestova E.S.

Afanasyev L.M., Guselnikov S.S., Shestova E.S.
Regional Clinical Center of Miners’ Health Protection,
Leninsk-Kuznetsky, Russia

Replantation of the distal phalanx is a big problem from the view of restoration of very small vessels, especially veins.
Objective – to estimate the result of treatment of a child with traction detachment of the distal phalanx of the first finger with restoration of one artery and one vein.
Materials and methods. The child, age of 14, was admitted to the clinic 3 hours after the first left finger detached by the lathe cutter. In the Kemerovo hospital the patient received the dressing, and the finger was placed into three packages. Then the patient was transferred to our clinic.
Results. The procedures included replantation of the distal phalanx of the first finger with microsurgical suture of one artery, one vein, the nerves, tendons and pin osteosynthesis. An expected venous insufficiency appeared, which was successfully removed. Full engraftment of the finger was achieved.
Conclusion. Successful replantation of the fingers and their segments is possible in children with various types of injuries, including traction ones.
Key words: microsurgery; replantation of fingers in children.

Information about authors:
Afanasyev L.M., MD, PhD, chief of department of traumatology and orthopedics No.3, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.
Guselnikov S.S., traumatologist-orthopedist, department of traumatology and orthopedics No.3, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.
Shestova E.S., anesthesiologist-intensivist, department of anesthesiology and critical care medicine, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.
Address for correspondence:
Afanasyev L.M., 7th district, 9, Leninsk-Kuznetsky, Kemerovo region, Russia, 652509
Tel: +7 (384-56) 2-40-31
E-mail: info@gnkc.kuzbass.net

REFERENCES:
1. Afanasyev LM. Surgical tactics for treatment of patients with open concomitant injuries to the upper extremities and their conseguences. Dr. med. sci. diss. Leninsk-Kuznetskiy, 1999. 409 p. Russian
2. Belousov AE., Tkachenko SS. Microsurgery in traumatology. Leningrad : Medicine Publ., 1988. 224 p. Russian
3. O`Brien BM. Microvascular Reconstructive Surgery. Edinburg: Churchill Livingstone, 1977. 376 p.

Surgical treatment of massive injury to soft tissues in traumatic disruption of the lower extremity in a patient with polytrauma
Agalaryan A.Kh., Gilev Ya.Kh., Skopintsev D.A., Yakushin O.A., Rotkin E.A., Drugov A.S., Goncharov R.S.

Agalaryan A.Kh., Gilev Ya.Kh., Skopintsev D.A., Yakushin O.A., Rotkin E.A., Drugov A.S., Goncharov R.S.
Regional Clinical Center of Miners’ Health Protection,
Leninsk-Kuznetsky, Russia

Objective – to demonstrate the clinical case of successful surgical treatment of massive injury to soft tissues in traumatic disruption of the lower extremity in the patient with polytrauma.
Materials and methods. The patient L., age of 38, received the treatment of his industrial injury in Regional Clinical Center of Miners’ Health Protection from May 28, 2016 till August 12, 2016. His left lower extremity was involved in the whirling mechanism of the combined cutter loader during underground repairing works. At the moment of admission the total blood loss was 40 % of circulating blood volume, ISS – 32 points. The clinico-laboratorial methods and radial diagnostic methods were used.
Results. During hospital stay the patient received 5 surgical interventions including surgical preparation of the wounds of the perineum, the marsupium, the left hip, laparotomy, creation of hanging sigmostoma, staged sanitation and wound necrectomy, autodermoplasty of the wound of the left hip, sigmostoma closure. The total terms of hospital treatment were 76 bed-days including 45 bed-days in the intensive care unit. 5 months later the control examination showed independent movement without crutches, persistent erectile function.
Conclusion. Successful treatment of the patient was conditioned by timely transportation to the specialized hospital, where intensive anti-shock therapy with donor blood components (1:1 ratio) and staged surgical sanitation of the infected wound were conducted.
Key words: polytrauma; traumatic rupture of the extremity; injury to externalia.

Address for correspondence:
Agalaryan A.Kh., candidate of medical science, chief of surgery department, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.
Gilev Ya.Kh., traumatologist-orthopedist, department of traumatology andorthopedics No.2, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.
Skopintsev D.A., anesthesiologist-intensivist, chief of intensive care unit, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.
Yakushin O.A., neurosurgeon, neurosurgery department No.2, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.
Rotkin E.A., candidate of medical science, surgeon, surgery department, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.
Drugov A.S., surgeon, surgery department, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.
Goncharov R.S., surgeon, surgery department, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.
Address for correspondence:
Agalaryan A.Kh., 7th district, 9, Leninsk-Kuznetsky, Kemerovo region, Russia, 652509
Tel: + 7 (384-56) 9-55-05
E-mail: irmaust@gnkc.kuzbass.net

References:
1. Agadzhanyan VV, Pronskikh AA, Ustiantseva IM, Agalaryan AH, Kravtsov SA, Krylov YM. et al. Polytrauma. Novosibirsk: Science, 2003. 492 p. Russian
2. Sokolov VA. Multiple and combined injuries. M.: GEOTAR-Media, 2006. 512 p. Russian

Reviews
Biodegradable implants in orthopedics and traumatology. Our first experience
Agadzhanyan V.V., Pronskikh A.A., Demina V.A., Gomzyak V.I., Sedush N.G., Chvalun S.N.

Agadzhanyan V.V., Pronskikh A.A., Demina V.A., Gomzyak V.I., Sedush N.G., Chvalun S.N.
Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia
National Research Center “Kurchatov Institute”, Moscow, Russia

The article presents the review of various biodegradable polymers, their features and medical use. The requirements for biodegradable fixing devices have been stated, and the practical use in various skeletal regions has been analyzed. The result of the examination of the physical and chemical properties of biodegradable fixators and the first results of practical administration are given.
Objective – to perform the analysis of advantages and disadvantages of fixation devices based on biodegradable polymers and to identify the most appropriate regions for using; to analyze the first results of use of biodegradable constructs and to develop some perspective approaches to improvement in their features.
Materials and methods. The physical and chemical features of the biodegradable material were investigated with the methods of nuclear magnetic resonance, gel-permeation chromatography and differential scanning calorimetry. The efficiency of use of a biodegradable device was realized by means of the analysis of the results of 24 operations conducted in 2015.
Conclusion. Biodegradable fixing devices for traumatology and orthopedics do not require recurrent surgery for their extraction. They are biocompatible and do not cause adaptive bone remodeling accompanied by bone weakness. But as compared with metals, biodegradable polymer materials are characterized by worse physical and mechanical properties with limitation of the applicability of such fixing devices. For fully-featured transition from metal constructs to biodegradable ones it is necessary to develop some materials and products with improved features. A perspective approach is introduction of bioactive and strengthening components into the material that can promote recovery of a fracture and increase the strength of products.
Key words: biodegradable polymers; structure and features of polymers; osteosynthesis; traumatology and orthopedics.

Information about authors:
Agadzhanyan V.V., MD, PhD, professor, chief physician, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.
Kravtsov S.A., MD, PhD, chief of the center of critical care medicine, intensive care and anesthesiology, Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.
Demina V.A., experimental engineer, National Research Center “Kurchatov Institute”, Moscow, Russia.
Gomzyak V.I., clinical research assistant, National Research Center “Kurchatov Institute”, Moscow, Russia.
Sedush N.G., candidate of physico-mathematical science, experimental engineer, National Research Center “Kurchatov Institute”, Moscow, Russia.
Chvalun S.N., doctor of chemistry, deputy chief of scientific work, Kurchatov complex of NBICS technologies, National Research Center “Kurchatov Institute”, Moscow, Russia.
Address for correspondence:
Sedush N.G., Academica Kurchatova square, 1, Moscow, Russia, 123182
Tel: +7 (916) 774-40-06
E-mail: nsedush@gmail.com

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