Barkov O. Improvement of diagnostics and treatment of extensor contractures of the knee joint that arose after diaphyseal fractures of the femur (experimental-clinical study).

Object: extension contractures of the knee joint after diaphyseal fractures of the femur. Aim: substantiate, develop and conduct clinical testing of new diagnostic criteria and improve surgical methods in the treatment of patients with persistent extensor contractures of the knee joint. Methods: clinical, X-ray, magnetic resonance imaging, ultrasound, morphometric (organometric), histological, statistical. It has been experimentally shown that after injury to the femur of rabbits, the structure of vastus intermedius is disturbed within 3-5 weeks. It reveals significant areas of connective tissue that replaces muscle fibers, resulting in loss of muscle stretch and the development of knee joint contractures. The nature of the symptom of "obstacle strike", which is that when bending at the knee joint when stopping movement, an acoustic signal arises from the sharp tension of the muscles of the leg extension, which have lost their elastic properties (ability to stretch) . And for the first time, a simple and affordable way to visualize and record this symptom is offered. New diagnostic criteria for determining the stability of knee extensor contractures were developed and applied in practice, with the help of which it is possible to diagnose stable extensor contractures and establish indications for their surgical treatment (patents of Ukraine for utility model No. 125155; No. 132107). A method of visualization and recording, an informative "symptom of an obstruction strike" with the help of a smartphone and the installed program "Sound oscilloscope" for Android, which can be used by doctors in practice in the diagnosis of persistent extensor contractures of the knee joint, have been developed. Improved methods of surgical treatment of patients with persistent knee extensor contractures after diaphyseal femur fractures using the technique of replacement of the knee capsule defects and restoration of the stability of the patella, as well as reliable joint of the tendons m. vastus lateralis et medialis with tendon m. rectus femoris (patents of Ukraine No. 108263; No. 115828). This made it possible to improve the results of surgical treatment of persistent extensor contractures of the knee. The results of the study were introduced into the clinical practice of the State Institution "Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine", the Communal non-profit enterprise "Kirovograd Regional Hospital of the Kirovograd Regional Council", the State Institution "Specialized Medical Unit No. 19" of the Ministry of Health of Ukraine. Тraumatology and Orthopaedics.