Introduction. Tactics of treatment of fractures of the metacarpal bones are sufficiently covered in domestic and foreign literature, however, the search for modern methods of the most effective fixation of fractures of the hand bones is still ongoing. The fixator should ensure the stability of bone fragments, have sufficient strength and undergo biodegradation after fusion, eliminate the need for repeated surgery. Purpose of the study: to evaluate results of fixation of 2-5 metacarpal fractures using bioabsorbable implants.
Materials and methods: there was a retrospective study of 40 patients who had displaced closed fractures of 2-5 metacarpal bones. We performed surgical treatment: open reduction of the metacarpal fracture and internal fixation with bioabsorbable implants (Bioretec Activa Pin). Patients were examined before, 3 and 12 months after surgery.
Results: All patients had union of metacarpal fracture 3 months after surgery. The function of the hand has improved, when evaluated on the DASH scale from 62 to 9.2 (p≤0.05). The pain level (VAS) was significantly decreased from 72 to 13.5 (p≤0.05). All parameters were comparable by 12 months after surgery.
Conclusions: bioabsorbable implants are reliable way for internal fixation of fractures of 2-5 metacarpal bones with displaced fragments. Method is no need to remove the fixator.
Simple chronic instability of the elbow joint is one of the urgent problems in modern traumatology due to the fact that the standard tactics of managing patients with traumatic injuries of the elbow joint due to dislocation, which amounts to its elimination, immobilization of the upper limb and subsequent development of movements in the joint, most often does not take into account damage to specific soft tissue structures. With untimely treatment for qualified help, with late or unsuccessful attempts to eliminate dislocation of the bones of the forearm, less often with chronic traumatization of the ligamentous apparatus of the elbow joint during some types of occupation, one of the most unpleasant complications may form, namely, chronic instability. This article discusses the main types of chronic instability of the elbow joint, analyzes approaches to the management of patients with simple chronic instability. Despite the not very high occurrence of this pathology, the effectiveness of modern surgical treatment options aimed at reconstruction of the ligamentous apparatus of the elbow joint, the percentage of unsatisfactory results of treatment of simple chronic recurrent and persistent instability of the elbow joint remains high.
Purpose. Analysis of surgical aspects of the experience of 13 years of percutaneous endoscopic microgastrostomy for enteral therapeutic provision of patients with parkinsonism.
Methods. The 4-year follow-up group (2012-2021) included 20 patients aged 55 to 72 years with severe Parkinson's disease, mostly men. From 2008 to 2012, patients underwent microgastrostomy installation using a Frezenius kit. Levodopa carbidopa was injected into the jejunum through a micro-drainage gastrostomy.
Results. During the 1st year of gastrostomy functioning, the following complications developed: gastric juice leakage onto the skin with the skin maceration development (2 cases), the hypergranulation development around the gastrostomy (3 cases), the gastrostomy support ring prolapse into subcutaneous fat with an abscess development (2 patients). By the end of the 4th year follow-up, 3 more patients had gastrostomy prolapse into subcutaneous tissue without suppuration. On the micro-drainage part complications were observed in the form of the bezoar formation at the tube end and micro-drainage nodulation in the stomach with the lumen obturation. The author used different methods of prevention and complications treatment in each individual case. To prevent gastric juice leakage and the proliferation of hypergranulations, tube fixation correction and local treatment are necessary; to prevent prolapse of the gastrostomy support ring, it is advisable to use a prolene mesh gasket. A gastrostomy change l with proper care is advisable 1 time in 3-4 years, micro-drainage at least 1 time in 2 years to prevent the bezoar formation on the catheter and its rupture.
Conclusion. Puncture microgastrostomy performed under endoscopic control can be effectively used for a long time to inject nutritional mixtures and medicines into the gastrointestinal tract.
Abdominal plastic is one of the most common operations in the field of plastic surgery. The main goal of abdominal plastic is to improve the body contours in the area of the anterior abdominal wall, by excising excessive skin and fat tissues, suturing diastasis of the direct abdominal muscles. Although abdominal plastic is considered a safe surgery with a high level of positive outcomes, there are still various kinds of complications, the treatment of which requires the use of modern methods. The work is based on the analysis of literature data on abdominal plastic and analysis of the postoperative period of 172 patients operated on in plastic surgery clinics in Krasnoyarsk from 2017 to 2020. Statistical data on abdominal plastic prevalence among aesthetic procedures were analyzed. Based on the identified data, it is shown that various types of abdominal plastic are quite in demand, which dictates the need to study possible complications after surgery, and modern methods of treating complications. The article analyzes common types of complications after abdominal plastics and describes the algorithms for treating these complications. A comparative analysis of the incidence of complications in plastic surgery clinics in Krasnoyarsk was carried out with data from European plastic surgery clinics. Complications after abdominal plastic vary in severity and in the effect they have on aesthetic outcomes. Most complications can be treated in an outpatient setting, following modern standards, with satisfactory results.
Relevance. To evaluate the effectiveness of X-ray endovascular embolization of the portal vein branch in terms of preparation for extensive liver resections. Materials and methods. A retrospective analysis of 74 right-sided hemihepatectomies performed in one stage (classical, n = 54) or in two stages (X-ray endovascular embolization of the right portal vein followed by liver resection was performed, n = 20).
Results. X-ray endovascular embolization of the right portal vein was accompanied by a significant increase in the planned liver remainder by an average of 37.3 %. This made it possible to reduce the volume of intraoperative blood loss, the incidence of postresection hepatic failure from 43.1 to 15.9 %, and postoperative mortality from 9.3 to 5.0 %.
Conclusions. Preoperative X-ray endovascular embolization of the right portal vein leads to vicarious enlargement of the left lobe of the liver. This makes it possible to reliably reduce the incidence of post-resection hepatic failure after right-sided hemihepatectomy and, accordingly, reduce the frequency of deaths.
Aim: to describe the epidemiology, possible causes and predisposing factors for the development of slipped capital femoral epiphysis. To follow the evolution of classifications. Analyze indications for surgical treatment, as well as types of surgical treatment.
Materials and methods: this review article analyzes the data of Russian and foreign literature on the etiology, pathogenesis, diagnosis and treatment of slipped capital femoral epiphysis.
Results: in view of the frequent distribution in the population, high risks of disability in pediatric patients, the issue of treatment of slipped capital femoral epiphysis remains very relevant. Many methods of surgical treatment have been proposed depending on the stage of the disease, however, they have their own advantages and disadvantages.
Conclusions: Conservative treatment in the long term did not show good results, generally accepted, according to most sources of literature, surgical treatment is considered. The gold standard in the surgical treatment of the disease does not exist today, and the methods and tactics of treatment are being improved.
Intra- and postoperative complications in the surgical treatment of nodular and multinodular euthyroid goiter make up from 0.3 to 8.0% of the number of operated patients. Depending on the clinical picture, data of morphological, radiation, laboratory studies, various types of surgical interventions are used.
The objective was to analyze the causes and search for ways to prevent and treat the ntraoperative and postoperative complications in the surgical treatment of patients with nodular and multinodular euthyroid goiter.
Methods and materials. There was conducted the analysis of the techniques and results of surgical treatment of 303 patients with nodular euthyroid goiter and 377 patients with multinodular euthyroid goiter, divided into two groups: the main group (352 patients) and comparison (328 patients).
Results. The immediate and long-term results of the treatment of patients were studied with the detailing of specific and nonspecific complications by groups. Methods for optimizing diagnostic and treatment technologies have been developed, immediate and long-term results of treatment have been evaluated.
Conclusion. The use of improved technologies has reduced the number of intraoperative and postoperative complications and improved treatment results.
