Strafun O. Surgical treatment and rehabilitation of patients with elbow joint injuries and their consequences

The thesis is devoted to increase of efficiency of surgical treatment and rehabilitation of patients with injuries of an elbow joint and their consequences, development of diagnostic and treatment algorithms, and also systems of postoperative rehabilitation and prognosing. Based on histological studies, it was found that the combined use of regeneration stimulating factors (platelet-enriched plasma and concentrated bone marrow aspirate) after tissues of the elbow joint injury contributes to a significant increase (2.3 times, p <0.05) in the total incidence of exostoses, bone regenerates and heterotopic ossifications. Based on biomechanical modeling, it is determined that with increasing magnitude of the defect of the radial bone head on the background of damage to the collateral ligaments of the elbow joint a proportional violation of the stability of the elbow joint is observed. In this case, damage to the medial collateral ligament leads to a more significant violation of the stability of the elbow joint than damage to the lateral collateral ligament. In order to develop differentiated tactics for the treatment of patients with fractures of the radial head, an analysis of the results of surgical treatment was performed. It is established that osteosynthesis of the radial bone head should be the main way to treat fractures of type 2-4 according to Mason. In the case of damage to the radial bone head of type 2 according to Mason, preference should be given to osteosynthesis with screws, and if damage of types 3 and 4 according to Mason - microplates with microscrews. Removal of the radial head is contraindicated in combination with a fracture of the head with dislocation of the elbow bones, damage to the medial and / or lateral collateral ligament, fracture of the proximal part of the ulna (especially the coronal process) and ipsilateral damage to the wrist. Removal of the head of the radial bone is permissible only in isolated multifragmentary fractures under conditions of impossibility to perform prosthetics and preserve the integrity of the medial and lateral collateral ligaments. On the basis of clinical and instrumental researches the differentiated tactics of treatment of fractures of a radial bone head depending on damage severity, existing concomitant pathology and age of the patient is worked out. Active surgical tactics in the treatment of severe gunshot polystructural injuries in the elbow joint was improved. The subacute course of the fire compartment syndrome was described for the first time. A system of dosed postoperative rehabilitation with fixation of the limb in the achieved positions was developed, which allows significant improving of the volume of active flexion-extension movements in the elbow joint (p = 0.001). It is proved that the probability of achieving the optimal result of treatment when using dosed motor postoperative rehabilitation is three times higher than in the control group (OR = 3.29 (1.4 - 8.7)). The developed system for predicting the course of injuries in the elbow joint allows discreet and comprehensive assessment of the effects of negative factors, such as: "terrible triad" "floating elbow", dislocations of the forearm bones and contractures as the most effective causes that significantly reduce the rehabilitation potential of the patient. Quantitative system of positive or negative factors affect allows with high probability (p = 0.0001) to predict the course of the treatment process.