Kubash V. Diagnosis and treatment of posttraumatic osteomyelitis of long bones in patients with iodine deficiency

Object: bone repair after the treatment by high-intensity diode laser, posttraumatic osteomyelitis/ Aim: to improve treatment outcomes for patients with posttraumatic osteomyelitis of long bones of the extremities who live in iodine deficient areas by elaborating a set of measures involving surgical procedures, medical therapy and applying a high-intensity diode laser to a bone. Methods: general clinical examination; laboratory; determination of thyroid hormones; radiographic; ultrasound diagnostics; morphological with morphometry, biochemical; biomechanical (mathematical modeling); statistical. For the first time, it was shown experimentally that when affected by high-intensity laser irradiation the region of structural damage in the bone marrow is significantly larger than that in the cortical bone or trabeculae. The signs of restoration of damaged structures were determined already on the 7th day after the action of a laser with a thermal effect. For the first time, it was proved that contact action of a laser which has 980 nm wavelength and 10-18 W radiation power does not interfere with the regeneration course of the bone. New knowledge concerning phase and time peculiarities of the progression of ossification after high-intensity diode laser irradiation was obtained. For the first time, based on the study of mathematical three-dimensional models it was demonstrated that the bone conventionally damaged by osteomyelitis and stabilized with a fixation device endures maximum destructive loads whose values are nearly identical with those of the undamaged bone. The research findings contributed to the scientific knowledge concerning the redistribution of loads in different regions of the femoral bone taking into consideration the loss of some of its portions due to damage caused by pathology ("osteomyelitis" by convention). New knowledge which was obtained also concerns changes in the content of metabolic values in patients with posttraumatic osteomyelitis of long bones of the extremities who were admitted form endemic iodine deficiency regions in the course of treatment. . According to the results of experimental, biomechanical and clinical research, the management of treatment of patients with chronic posttraumatic osteomyelitis against the background of iodine deficiency was offered, which makes it possible to improve the treatment outcomes and improve the life quality of patients belonging to this serious category. The lymphatic vessel contrasting technique with the help of fluorescent dye for cannulation and further administration of antibacterial substances was elaborated (Patent № 116883, Ukraine). The developed method of sanation of a sequestral cavity of the bone affected by osteomyelitis (Patent № 124210, Ukraine) with laser irradiation makes it possible to increase the efficiency of the sanation of the locus and improve the quality of treatment. The results of the research were introduced into the clinical practice of KZ "Skolivsʹky District Hospital", Trans Carpathian Regional Clinical Hospital named after Andrew Novak, KP "Regional Clinical Hospital named O.F. Herbachevsʹkoho", Zhytomyr Regional Council, Mizhhirska Regional Clinical Hospital, KZ "Tyachiv district hospital", Vynohradiv District Hospital, Irshava District Hospital. Traumatology and Orthopaedics.