Garkusha M. Diagnostic and pathogenetic reasonable correction of structural and functional state of bone tissue in women with closed fractures of the distal forearm

Object: violation of the structural and functional state of the bone tissue in women with closed fractures of the distal forearm. The aim: to improve the diagnosis and correction of violations of the structural and functional state of the bone in postmenopausal women with closed fractures of the distal forearm. Methods: clinical, dual energy X-ray absorptiometry, computer software roentgenosteodensitometry with software "ARM-osteology," X-ray absorptiometry with software "Experimental animals", histomorphometric and statistical. For the first time in Ukraine it was found that women with closed fractures of the distal forearm as a result of low energy trauma occurs systemic violation of the structural and functional state of the bone tissue at both the peripheral and axial skeleton. Evidence of this is the reduction of the integral cortical index of intact limb as compared with the reference values of this index for the Ukrainian population of women: in the age group 30-39 years - 23.0%, 40-49 years - 17.2%, 50-59 - 12.1 %, 60-69 - 15.1 %, 70-79 - 19.1 %, and a reduction of bone mineral density in the lumbar spine by 12.7 % and the proximal femur by 15 % as compared with age-matched women without previous fractures. For the first time with the use of postmenopausal osteoporosis model (ovarioectomy) in rats by studying the structural and functional state of the bone tissue according to dual-energy X-ray absorptiometry, it was determined that treatment with a combination of calcium and vitamin D3 in supplement with hydroxyapatite complex provides a significantly greater increase in bone mineral density in dynamics on the level of total skeleton (17.85 %) compared with the control group (-1.56 %). For the first time using models metaepiphyseal and diaphyseal fractures in rats after ovariectomy by studying the structural organization of histomorphometric parameters of the regenerate has been found that treatment with composite medication of calcium and vitamin D3 in combination with the hydroxyapatite complex leads to the formation of full-fledged regenerate with high content of lamellar bone tissue in both cancellous (42.50 %) and compact (27.86 %) bone as compared with control animals group (34.14 % and 10.03 %, respectively). Scientific data have been supplemented: it was shown that the combined use of calcium and vitamin D3 in combination with hydroxyapatite complex for the treatment of patients with closed fractures of the distal forearm due to low-energy trauma significantly improves the structural and functional state of the bone tissue according to the integral cortical index at the level of the injured limb by 5.8 %. An algorithm for the diagnosis and correction of the structural and functional state of the bone tissue in women with closed fractures of the distal forearm bones, which allows you to improve the diagnosis, treatment and prevention of osteoporosis and its complications. Developed and put into practice recommendations on the use of a combined therapy with calcium and vitamin D3 (2 tablets per day) in combination with hydroxyapatite complex (two tablets per day) in postmenopausal women with a closed fracture of the distal forearm bone during 2 months after the fracture. Results of the study are introduced into the clinical practice of trauma clinic municipal health agency "Kharkiv City Clinical Hospital of Emergency Medical Care. prof. A.I. Meshchaninova", municipal health agency "Regional Clinical Hospital - Center for emergency medical care and disaster medicine" of the Kharkiv Regional Council, Department of Clinical Physiology and Pathology of the musculoskeletal system and the separation of age-related changes of the musculoskeletal system of the State Institution "Institute of Gerontology named D.F. Chebotarev of National Academy of Medical Sciences of Ukraine", the Research Institute of Traumatology and Orthopedics of Donetsk National Medical University named after М.Gorky Ministry of Health of Ukraine, Research Institute of Rehabilitation of Vinnitsa National Medical University named after N.I. Pirogov Ukrainian Ministry of Health, City Hospital ambulance Vinnytsia City Council. Traumatology and Orthopedics.