FEATURES OF HIP JOINT ARTHROPLASTY IN PATIENTS AFTER OSTEOSYNTHESIS OF THE ACETABULAR FRACTURES

Objective. To analyze the late complications after osteosynthesis of the acetabular fractures that led to reoperations; to determine the features of surgical intervention and the choice of the acetabular component during endoprosthetics in these patients. Methods. From 2009 to 2015, the results of endoprosthetics in patients (n=35) who underwent primary osteosynthesis of the acetabulum and subsequently hip arthroplasty were evaluated at the Orthopedic and Trauma Center of Kiev Regional Clinical Hospital. To assess damage volume, the Letournel-Judet classification was used. 5 years after the endoprosthetics to evaluate functional outcomes the the Harris Hip Scale (HHS) and radiographic method have been used. Results. The initial preoperative assessment in 35 patients using Harris Hip Scale showed results: 64 (58-71) Ме (LQ; UQ) points. A year after endoprosthetics when examining 33 (94.3%) patients the Harris scale improved the results to 81 (74-88) points (p_0-1<0.001). 5 years after arthroplasty the Harris scale was 85 (77-92) points (p_0-5<0.001). After 5 years in 31 (88.6%) patients a radiographic evaluation showed stable integration of the acetabular component without any signs of attenuation in 1-3 zones according to the De Lee and Charnley classification. Conclusion. The most effective way to treat the recent acetabular fractures with fragment displacement is considered to be the early osteosynthesis with anatomical reposition of fragments, which with the development of degenerative changes in the operated joint, makes it possible to perform endoprosthetics using a full-fledged bone mass for immersion of the acetabular component. Careful planning of the operation, preliminary removal of metal fixators, which can affect the placement of the acetabular component, as well as increase the risk of postoperative complications, allows achieving good results. What this paper adds For the first time the late complications after osteosynthesis of the acetabular fractures, which led to reoperations, have been analyzed; the features of surgical intervention and the choice of the acetabular component during endoprosthetics in such patients have been determined. The most effective method for treating recent acetabular fractures with fragment displacement has been studied in detail - early osteosynthesis with anatomical reposition of fragments, which, with the development of degenerative changes in the operated joint, makes possible to perform endoprosthetics using full bone mass for immersion of the acetabular component.

Experience in Treatment of Skeleton Trauma Combined with Craniocerebral Injuriesin Children

Experience in treatment of 125 children with limb fractures combined with craniocerebral injuries is presented. Algorithm of diagnostic measures to improve the quality of diagnosis was elaborated. Seventy one patients (56.8%) were treated conservatively: 54 patients with skeletal traction, 6 patients with adhesive plaster traction, 11 - with plaster of Paris traction. Fifty four patients (43.2%) underwent surgical treatment: 25 patients had intramedullar osteosynthesis, 24 patients - fixation of fragments by pins, 5 patients - by llizarov device. Long term results were assessed at 7-7years follow-up. Results showed the efficacy of osteosynthesis in relation to skeletal traction. However, at early posttraumatic period when craniocerebral injury is extremely severe, surgical treatment should be limited by skeletal traction and plaster of Paris immobilization. Use of early osteosynthesis gives the decrease of hospitalization term by 7.8 day and fixation terms - by 10.2 day.