Object: structural and functional changes in the adverse consequences of injuries of the ankle joint.
Aim: to improve outcomes of the patients with adverse consequences of injuries to their ankle joint based on the development and implementation of a system intended for diagnostics, rehabilitation, and forecasting remote results. Methods: clinical; experimental; biomechanical, medical and statistical. For the first time, a method for non-invasive determination of bone tissue elasticity modulus in the area of ankle joint has been elaborated based on the experimental natural stand and radiological studies. For the first time, the choice of fixation means upon conditions of corrective osteotomies on the level of tibial distal epimetaphysis has been grounded using natural stand studies and imitational computer simulation. For the first time, an original fixing device for metal osteosynthesis during correction osteotomy of a lateral ankle has been created to be used according to the author’s method. The imitational computer simulation has approved that the system "fibular bone with osteotomy – fixator" is specific with optimal values of stiffness and strength, which eliminates the need for any additional immobilization. Experimental studies on animals have approved the efficiency of cellular technologies (platelets rich plasma and bone marrow cells) for stimulation of metabolism and regeneration upon osteochondral lesions and defects of an ankle joint. For the first time, based on analyses of MRI, X-ray and clinical data, we have elaborated classification, grounded tactics and improved the method of managing patients with osteochondral lesions and defects of an ankle joint. For the first time, we have elaborated a method for correction osteotomy to a lateral ankle and created a system for a differentiated approach to the method of correction osteotomy of a shin in case of frontal deformities of an ankle joint. Based on the analytic, mathematical, and biomechanical methods, further developed was the grounding of the method of resection fusion in patients with terminal stages of post-traumatic degenerative-destruction changes in ankle joints. For the first time, on the ground of a multi-factor correlational-regressive analysis, developed was the system for forecasting the remote outcomes of the patients with the consequences of traumas to their ankle joint. The elaborated classification of osteochondral lesions and defects in the area of ankle joint, and the tactical algorithm allow differentiated approach to the choice of treatment tactic, highly efficient in the remote period. The developed method of correction osteotomy to a lateral ankle and the algorithm of a differentiated approach to the methods of shin supramalleolar osteotomies ensure fewer mistakes and complications while treatment and make it possible to improve the outcomes of the patients upon unfavorable consequences of ankle joint traumas. Modification to the method of resection fusion of the ankle and the developed algorithm of choice for fixing devices allows optimization of biomechanics and power-consumption of walking, reduces the loading on adjacent areas of locomotion system, and generally improves the remote functional results, reduces the share of complications and enhances the patients’ quality of life. The system, being elaborated to forecast the outcomes of patients with the consequents of injuries to an ankle joint, based on a multi-factor correlation-regression analysis of the remote results, allows choosing the most efficient individual tactics and avoiding wrong treatment of this category of patients. Implementation of the elaborated system of pre-surgical planning, reconstructive, recovery treatment and rehabilitation of the patients with the consequences of ankle joint injuries allows raising the efficiency of treatment, improving static-dynamic functions of an injured limb, reducing the share of complication, improving the patients’ quality of life. The results of the study were introduced into the clinical and pedagogical practice of the department of traumatology and orthopedics of the O.O. Bogomolets National Medical University of the Healthcare Ministry of Ukraine, the clinical practice of the Institute of Traumatology and Orthopedics of the National Academy of Medical Sciences of Ukraine, departments of traumatology and orthopedics of the Municipal institution of the Kiev regional council "Kiev Regional Clinical Hospital", the National Military Medical Clinical Center "Main Military Clinical Hospital" of the Ministry of Defense of Ukraine, Kiev City Clinical Hospital No. 17, Kiev Clinical Hospital for Railway Transport No. 1. Traumatology and Orthopaedics.
