Pavlychko Y. Treatment of multifragmental fractures of the proximal part of the humeral bone at the level of the surgical neck

The thesis is dedicated to improvement of treatment results of multifragmental fractures of the proximal part of the humeral bone by using a new noninvasive fixator, which was devised taking into account peculiarities of the blood supply and technique of the surgical performance. To determine the blood supply disorder of the proximal part of the humerus in different character of damage, there was made an experiment on the corpse material followed by preparation of the corrosive preparation. The peculiarities of the blood supply to the head of the humerus depending on the character of damage were determined by computer modeling. The devised technology of surgical treatment of multifragmental fractures of the proximal part of the humeral bone with the aid of a new device allows to fix bone fragments noninvasively and stably. To determine stability of osteosynthesis of the proximal part of the humerus, a comparative analysis was made of the strength property of the proposed fixator and a plane with angle stability. The experiment showed that in compression the proposed fixator exceeded the plate with angle stability 2.913 times. In applying the angle load in the sagittal plane the proposed fixator was 1.013 times more stable that synthesis by the plate with angle stability. There was made the analysis of the archive and clinical materials of treatment of 61 patients with multifragmental fractures of the proximal part of the humerus at the level of the surgical neck that were treated in the traumatological departments of the Municipal clinical hospital N11 for the period of 2008-2012. The application of the devised fixator for treatment of multifragmental fractures of the proximal part of the humerus and complex of rehabilitation measures allowed to improve results of treatment according to the system of functional assessment (Neer) by 34.91 %.