Grygoruk V. The treatment tactics at the adjoining and contrlateral fractures of the lower extremities bones

Object: adjacent and contralateral fractures of long bones of the bottom extremities. Purpose: improvement of results of treatment of victims with adjacent and contralateral fractures of bones of the bottom extremities by biomechanical justification of optimum methods of an osteosynthesis and development of scientific and reasonable algorithm of medical tactics. Methods: clinical, radiological, mathematical modeling of biomechanical model of fractures of bones of the bottom extremity, statistical. It is the first time when on the basis of mathematical modeling of biomechanical model in case of adjacent and contralateral fractures of the bottom extremities investigated the tension in bone tissue depending on localization of a fracture and an osteosynthesis method. It is established that the most unstable is the fracture of the top third of a femur fracture and fractures of the bottom third of bones of the shin. The most stability in implant bone system for fractures of femoral and tibial bones is reached by application of the blocked intramedullary cores; at impossibility of performance of an osteosynthesis of the cores to the fractures of an middle and top third of a femur applied a supraosseal osteosynthesis, to the fractures of the bottom third of a femoral and tibial bone is proposed the device on a spoke basis by Ilizarova. It is the first time when the author proved and developed the algorithm of medical actions for patients with adjacent and contralateral fractures of long bones of the bottom extremities (the patent of Ukraine No. 57016) which provides staging of providing the help to such patient depending on an assessment of weight traumatized on a scale of forecasts of lethal consequences of ISS and receipt time in a hospital that allowed to increase efficiency of treatment and considerably to reduce quantity of disregeneration, to improve their quality of life. The developed technique is simple in the performance, widely available not only for specialized traumatologic clinics, but also for the general surgical hospitals. Results of dissertation research are introduced in clinical practice of KZOZ "Regional Clinical Hospital - the Center of Emergency Medical Care and Medicine of Accidents", KZOZ "City clinical hospital of ambulance and emergency medical service named by prof. of the O.I. Mishchaninova" Kharkov, Ukrainian scientific and practical center of emergency medical care and medicine of accidents Kiev; in educational process on chair of traumatology and orthopedics of the MOZ Kharkov national medical university of Ukraine and anesthesiology, traumatology and extreme medical care Educational and scientific to institute of postgraduates formation of the MOZ Kharkov national medical university of Ukraine. Traumatology and orthopedics.