Efremova O. Modification of osteoplastic below-knee Pirogoff amputation with express-prosthetics.

Object of study: patients with Pirogoff below knee stumps. Aim of study: increasing of functionality and reduction of terms of preparation of Pirogoff osseoplastic below knee stumps for management with a definitive prosthesis. Methods of study: clinical, X-ray, anthropometric, biomechanical statistical. A new method of Pirogoff below-knee amputation with forming of Г-shaped autotransplantat of the calcaneus and preserving of skin wall of plantar surface of the heel on the stump end with decortication of tibial distal posterior margin, and with using external fixation compressive device of a pin-rod type was worked out. Designs of express- and therapeutic training below-knee prostheses for Pirogoff amputations that allow to provide early loading on the operated extremity were proposed. The developed and introduced into clinical practice method of Pirogoff osseoplastic below-knee amputation with stable fixation of calcaneal autotransplantat to tibial and fibular stump bones using the developed intrabonecompressive pin-rod device of external fixation allows to increase the site of contact of calcaneal autotransplantat with the tibial bone and to provide the skin wall of heel plantar surface as a supporting site, to form a more appropriate to loads Pirogoff below-knee stump. Us-ing of compressive pin-rod device for Pirogoff osseoplastic below-knee amputation occurs to be an effective method of stable fixation of a calcaneus, because it prevents displace-ment of heel autotransplantat, allows to provide early func-tional loading of the operated extremity and gives an op-portunity to the patient to use an express-prosthesis with a correct stump socket. The use of our compressive pin-rod device allows to provide express- and therapeutic training prosthetic management, assists in reduction of terms of con-solidation of bone fragments and early rehabilitation of in-valids. The proposed designs of express- and therapeutic training Pirogoff below-knee prostheses allow to carry early loading on a truncated limb, to provide mobility of the pa-tient and development of early gait pattern, to decrease terms of medical rehabilitation and to improve conditions of social and daily living rehabilitation. The developed method of Pirogoff osseoplastic was put into practice in three de-partments of Ukrainian Research Institute for Prosthetics, in a traumatologic department of Communal health care es-tablishment of a city clinical universal hospital N 25, in a traumatologic department of Communal health care estab-lishment of a city clinical universal hospital N 17 of the Malishev Plant, in the Institute for Vertebral and Joint Pa-thology by N.I.Sitenko of the Academy of Medical Sciences of Ukraine, in the Institute for Medical Radiology by S.P.Grigoriev of the Academy of Medical Sciences of Ukraine. Traumayology and orthopedics.