Complications of Intramedullary Blocking Osteosynthesis of Bones of Limbs and Ways to Prevent Them

Summary. The main condition for preventing complications of intramedullary blocking osteosynthesis of long bones is following the tactical and technical principles of osteosynthesis and conscious rejection of such surgical techniques and manipulations that can lead to disturbances of the course of reparative processes of bone tissue. Objective. On the basis of the study and summary of the identified complications of intramedullary blocking osteosynthesis of diaphyseal fractures of bones of limbs, to determine ways to prevent complications of the reparation. Materials and Methods. The results of treatment of 403 patients who underwent intramedullary blocking osteosynthesis of the femur, tibia and humerus types A1-A3, B1–B3 and C2 by AO/ASIF were studied and analyzed. Results. Analyzing the technological complications that we have divided, depending on the consequences they led to, early (up to 2 weeks after surgery), late (2 weeks after surgery) and reparative, we found that the most common technological mistakes were incorrect preoperative planning and disruption of technology and surgery, which in 21.6% of cases led to instability of bone fragments in the fracture area, and the absence or disruption of recovery and rehabilitation of patients, which occurred in 26.3% of cases. Disorders of osteosynthesis technology, namely, significant intra-operative traumatization of bone fragments and soft tissues, and non-eliminated soft tissue interposition resulted in inappropriate consolidation of bone fragments in 39% and 13%, respectively. The main cause of reparative complications was bone marrow drilling, which was performed for 56% of the patients with delayed consolidation of bone fragments, 56.3% of the patients with false joints, and 48% of the patients with bone fractures. Conclusions. Strict following the tactical and technical principles of intramedullary blocking osteosynthesis and rejection of bone marrow drilling without indications will reduce the incidence of bone dysregeneration. The study of the effect of bone marrow drilling on reparative bone regeneration in intramedullary blocking osteosynthesis is actual and needs further deep analysis.

Psychotherapeutic and psychologic care in cases of treatment patients which survived extraordinary situations: fare in night-club in perm and suffered from explosions in moscow’ subway

Since 1997 in City Clinical Hospital №36 in Moscow acted the Department of Psychotherapy (DP). Psychotherapeutists and psychologists of DP contantly took place part in joint (together with internists) therapy the patients suffering from different extraordinary situations. So, 06.12.09 by airplanes of Minisry of Extraordinary Situations from Perm in Burn-Center of CCH №36 were delivered 12 patients. For our regret 3 patients died in the first days no come to consciousness. The others 9 patients have received intensive and long (22–97 bed-days) therapy in BC due to: burns from flame I-II-III-IV degree, 6–77% surface of body. Psychiatric diagnosis were: acute reaction on stress F43.0, posttraumatic stress-syndrom F43.1, disorder of adaptation F43.2 with/or not short depressive reaction 43.20 and also organic emotional labile (asthenic) disorder F06.6, organic disorder of personality F07.0, others organic disorders of personality and behavior F07.8. In result of therapy these patients by combustilogists and other internists with psychotherapeutists and psychologists (different kind of psychotherapy and psychocorrection) we received distinct improvement of somatopsychical state.In the morning 23.03.10 after explosions in two Moscow’ subway stations in CCH №36 were admitted 12 patients with diagnosis: mine-explosive, skeleton, burn and baro- traumas with concussions of brain, fractures of bones, termo-ingalation defeats and others. Psychiatric diagnosis: F43.0, F43.1, F 43.2, F 43. 20, F 06.6, F 07.0 F07.8 and also postcommotional syndrom F07.2. Rational and autogenic psychotherapy and psychological correction in all these patients added by Phenazepam and Azaphen resulted to improvement of somatopsychical state and quality of life.

Improvement of the method of reduction of bone fragments in diaphyseal fractures of the shin bones

Fractures of the shin bones are much more often than fractures of bones of other localization, complicated by the formation of false joints, constituting one of the main causes of primary disability in patients with traumatological profile. Early, low-traumatic and accurate reposition of fragments followed by stable immobilization significantly reduces the number of such complications.