Development of a device for safe spatial orientation of the spokes of an extra-focal osteosynthesis apparatus

A special place in the methods of surgical treatment of bone fractures is occupied by transosseous osteosynthesis using external fixation devices.The aim of the study is to develop a device for the safe spatial orientation of the wires of the extrafocal osteosynthesis apparatus.Materials and methods. To develop a device for the spatial orientation of the external fixation spokes, a 3D model was designed with further reproduction on a 3D printer. The development of the device was carried out by placing the wires of the external fixation apparatus on 36 bones of the human lower jaw, on which a fracture in the angle was simulated.Results and discussion. The device for the spatial orientation of the spokes of the external fixation device for the lower jaw exoselet is partially reproduced using a 3D printer, which allows individualizing the device parts at the stages of preparation for surgery.Conclusions. Effect: control of the depth of immersion of osteofixers over the entire thickness of the bone and simplification of the choice of the optimal angle of mutual spatial orientation during their introduction and the greatest stable fixation of the fragments of the lower jaw during closed extrafocal osteosynthesis.

Experimental modeling of deforming osteoarthrosis of the knee in small rodents

The results of experimental work on modeling deforming osteoarthrosis of the knee joint in small rodents are presented. The pathogenetic basis of this process is a violation of the blood supply and the distribution of physiological load in the joint. Variants of rigid and non-rigid limb immobilization systems are proposed. The results of morphofunctional assessment are given, indicating a violation of the anatomical and histological structure of the metaphysis, pineal gland and metaepiphysis of the femur and tibia. The leading role in the development of deforming osteoarthritis of the knee belongs to the violation of the physiological distribution of the dynamic load on the joint, and the most vulnerable to the progression of this process are subchondral structures. Violation of regional blood circulation of the lower limb of the animal was achieved by crossing the femoral artery. Limb immobilization was carried out for 4 weeks. The results were evaluated by the severity of changes in the morphological structure of the operated joints and radiographic examination. The high mitotic activity of cellular elements, revealed as a result of histological examination in all groups of animals, indicates the rapid formation of vascular collaterals in rats. It was noted that with non-rigid immobilization of the joint with a plaster cast, the cartilaginous tissue of the articular surface becomes thinner, while the subchondral structures change slightly. With severe immobilization of the joint in the external fixation apparatus, significant changes are revealed precisely in the structure of subchondral structures. In animals subjected to a two-week rehabilitation period after dismantling the external fixation apparatus, a further progression of the pathological process was noted. Thus, with severe immobilization of the limb in the experiment, it was possible to obtain a stable joint deformation corresponding to the 3rd clinical and radiological stage of osteoarthritis.

Percutaneous puncture nephrostomy on the back of a patient with an external fixation apparatus on the bones of the pelvis following a road traffic accident

The article presents a rare clinical case of renal colic with a stone in the lower third of the ureter in the patient after a traffic accident with an external fixation device on the pelvic bones. A 41-year-old patient was hospitalized to the emergency urology department of the City Hospital No. 5 of Naberezhnye Chelny in 2019 with renal colic on the right. An ultrasound revealed right pelvocaliectasis of kidney. Pelvic survey (urogram) shows the shadow (9 mm in diameter) suspicious for renal calculus in the projection of the lower third of the right ureter. The pain was not relieved by analgesics. It was unsuccessfully attempted to stent the right ureter due to insurmountable obstacle at a distance of 4 cm from the ureteral orifice. Due to technical complexity (laying the patient in a lithotomy position and on the stomach or side was impossible due to a possible breakdown of the external fixation apparatus on the pelvic bones) percutaneous puncture nephrostomy was performed under ultrasound control in the supine position according to emergency indications. The pain was relieved. The patient was discharged home. After one month, the external fixation device for the pelvic bones was removed. The patient was hospitalized again. Ureteroscopy and contact ureterolithotripsy on the right ureter were performed routinely. Nephrostomy was removed. The patient recovered. The described case is of clinical interest as a rare combination of renal colic and the presence of an external fixation apparatus on the bones of the pelvis, which causes additional difficulties for the drainage of the urinary tract. Percutaneous puncture nephrostomy on the back with a roller in the ipsilateral kidney is a good alternative for urologists when to lay the patient on the stomach or side is impossible.

Pre-Operative Progressive Distraction in Old Transcapho-Peri-Lunate Dislocations

Three cases of 6- to 8-week-old transcapho-peri-lunate dislocation of the carpus were treated with pre-operative progressive distraction, using an external fixation apparatus for 1 week. Surgical reduction and osteosynthesis of the scaphoid was then easily performed.

New methods of the correction of cotyloid cavity dysplasia

New developments in surgery of displastic processes of cotyloid cavity tectum are presenj ted. Based on the progressive correction of pelvic component of the joint by the external fixation apparatus, these methods are sufficiently efficient and appropriate in children of school age. The variations of the correction of cotyloid cavity tectum are tested in the infantile department of the research center The recovery traumatology and orthopedics of Tatarstan and are found to be good. This paper is concerned with the detailed description of the operative interventions.