Hryhoriev V. The use of the biological activity of autofibrin in the surgical treatment of fractures.

Object: the process of bone regeneration after the fracture under conditions of placement in the peri-fragmentation zone of autofibrin obtained by centrifuging blood. Aim: to improve the surgical treatment of limb fractures by substantiating and developing a technique for stimulating bone regeneration with autofibrin. Methods: clinical; x-ray; histological and immunohistochemical (for the study of a fibrin clot obtained by centrifugation of blood in-vitro, as well as peri-fragmental tissues obtained during the surgical fracture treatment) statistical. For the first time, immunohistochemical studies around fragmental tissues in a person with bone fracture showed that the highest concentration of vascular endothelial growth factor was observed on the day 1–5 after fracture in the fibrin septa of the fibrin-blood clot. Later, on the day 8–15 as the clot filled, VEGF expressed by endotheliocytes, fibroblasts, and osteoblasts. A positive reaction to transforming growth factor on days 1-5 was detected only in leukocytes, mesenchymal cells, and later in newly formed fibroblasts and osteoblasts. It was first found that bone regeneration occurs in patients with a fracture in the area where the fibrin clot obtained by the blood centrifugation was placed during surgery. The microstructural similarity of fibrin naturally formed around the bone fragment zone and fibrin obtained by blood centrifugation in vitro was established. The author has proved the possibility of obtaining a fibrin clot by in-vitro centrifugation of blood in a volume of 50 ml without the use of a preservative, and it has been established that two portions of fibrin can be obtained simultaneously using a venous catheter and a syringe with a volume of 50 ml. A technique of autofibrin grafting for surgical treatment of current fractures of long bones and non-united fractures has been developed. The technique involves such stages as: blood sampling and preparation of the fibrin clot, selection of the area for the placement of the clot depending on the segment, the nature of the fracture plane and the type of the fixation device. It is proved that it with a positive effect can be performed for diaphyseal fractures with large primary displacement of fragments, fractures with the formation of a bone defect and nonunion fractures. The results of the study were introduced into the clinical practice of the Municipal non-profit enterprise "Third Cherkasy City Emergency Hospital", the SI "Sytenko Institute of Spine and Joint Pathology of the National Academy of Medical Sciences of Ukraine", Municipal Non-Profit Enterprise of the Kharkiv Regional Council "Regional Clinical Trauma Hospital", Municipal Non-Profit Enterprise "Chuguiv Central District Hospital named after M.I. Kononenko" of Chuguiv district council of Kharkiv region, as well as in the educational process of the department of traumatology and orthopedics of Kharkiv medical academy of postgraduate education of the Ministry of Education and Science of Ukraine. Тraumatology and Orthopaedics.