The work is devoted to the problem of prediction and differentiated approach to the choice of treatment method for osteoreparation disorders. Fracture healing complications are associated with high socio-economic costs, low efficacy of cost-effective treatment, long-term rehabilitation and a high rate of unsatisfactory functional outcomes. The aim of the work was to improve the treatment results of patients with fracture healing complications by predicting and early diagnosis of reparative osteogenesis disorders and a differentiated approach to choosing a treatment method based on clinical and experimental justification. To accomplish this goal, an experimental study of the efficiency of nonoperative stimulation of the healing processes in conditions of unstable osteosynthesis was performed and a comparative analysis of the clinical results of surgical treatment of patients with delayed union and nonunion of tubular bones with the results of using extracorporeal shockwave therapy. As a result of the experiment on the basis of X-ray and morphological parameters that characterize the processes of fracture healing, the positive effect of using of extracorporeal shockwave therapy in the formation of regenerate has been proved («Patent of Ukraine for utility model No. 132502», 2019). The best qualitative and quantitative characteristics of the newly formed bone tissue under the influence of the acoustic wave of the ESWT were established. In addition, there was a preventive effect of using of extracorporeal shockwave therapy on the formation of osteoreparation disorders, even under conditions of unstable fixation (r=-0.54, p=0.0003). At the first stage of the clinical part of the work in the case-control study, the frequency and structure of the main risk factors of fracture healing disorders was assessed, their role in predicting osteoreparative disorders was determined. Patients with fractures fractures healing complications have a significantly higher rates of risk factors and a higher risk of osteoreparative disorders (p<0.000001). The highest prognostic value was found in factors such as smoking (OR=3.26, CІ (1.51-7.02), р=0.002), the presence of diabetes mellitus (OR=5.04, CІ (1.03-24.66), р=0.02), peripheral vascular diseases (OR=5.67, CІ (1.97-16.29), р=0.0003), systemic connective tissue diseases (OR=5.70, CІ (1.18-27.51), р=0.01), hypothyroidism (OR=5.04, CІ (1.03-24.66), р=0.02), anemia (OR=4.22, CІ (1.44-12.34), р=0.004), using of glucocorticosteroids (OR=5.14, CІ (1.37-19.20), р=0.006), anticoagulants (OR=2.50, CІ (1.24-5.04), р=0.009), non-steroidal anti-inflammatory drugs (OR=6.95, CІ (2.75-17.57), р=0.000005) for reasons not related to the trauma and its consequences. The presence of open fracture (OR=3.91, CІ (1.52-10.08), р=0.02), average energy (OR=3.84, CІ (1.61-9.13), р=0.001) and high energy (OR=4.09, CІ (1.72-9.71), р=0.0007) mechanisms are also associated with increased risk of delayed union and nonunion. By comparative analysis of the clinical results of surgical treatment and the use of the nonoperative stimulation method of reparative osteogenesis, the high efficiency of the use of extracorporeal shockwave therapy fracture healing disorders and the possibility of using method as an alternative treatment for delayed union and nonunion of tubular bones was proved. Patients treated with extracorporeal shockwave therapy as the main treatment method have significantly improved the pain intensity (p=0.03), anatomical shortening of the segment (p=0.007) and recovery (p=0.02), compared with similar indicators of the control group. As a result of nonoperative stimulation, healing was achieved in 75.0 % of patients with osteoreparation disorders. On the basis of the results of the study, the necessity of a differentiated approach to the use of extracorporeal shockwave therapy in case of nonunion has been proved, taking into account their ability to biological recovery («Patent of Ukraine for invention No. 120010», 2019; «Patent of Ukraine for utility model No. 132819», 2019). As a result of clinical observations in patients with saved ability of nonunion to biological recovery, there were significantly better results of using technique in terms of severity of pain (p<0.000001), restriction of volume of movements (p=0.006), radiological parameters (p=0.009), recovery indicators (p=0.007) and total treatment outcomes (p=0.00002), compared with the results of patients with nonunion without ability to recovery. Union without using surgical techniques has been achieved in 87.50 % of patients with nonunion with saved ability to recover. As an independent method of treatment of nonunion without biological recovery ability, the method of extracorporeal shockwave therapy is ineffective.
