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Objective: To optimize orthopedic care in patients with complicated course of metastatic lesions of the long bones., Material and Methods: There were 201 patients (72 men and 129 women) who underwent orthopedic care for metastatic lesions of the long bones for the period from 2006 to 2019. Breast cancer metastases were diagnosed in 71 (35%) cases, kidney cancer - 56 (28%) patients, prostate cancer - 19 (9%) cases, metastases without a primary identified focus - 15 (8%) patients. Other forms were observed in 40 (20%) patients. All patients were divided into two groups. The first group included 136 patients (68%) who underwent segmental resections with bone replacement. Of these, 100 (73%) patients had secondary lesions of the lower limb bones and 36 (27%) patients with metastatic lesions of the upper limb bones. A threat of pathologic fracture was in 63 (46%) cases, fracture - in 73 (54%) patients. The second group consisted of 65 (32%) patients who underwent immersion osteosynthesis. Of these, 47 (72%) patients had metastatic lesions of the lower limb bones and 18 (28%) patients had secondary lesions of the upper limb bones. A threat of pathologic fracture was in 24 (37%) patients, fracture - in 41 (63%) patients., Results: In the first group, mean surgery time was 140 min, in the second group - 120 min. Mean blood loss in the first group was 600 ml, in the second group - 300 ml. Patients were activated on the 3 rd postoperative day in both groups. We analyzed surgical, anatomical and functional results in both groups using MSTS, Watkins and Karnofsky's scales., Conclusion: Oncological replacement and osteosynthesis are the main methods of surgical treatment of secondary lesions of the long bones. However, our data emphasize advisability of bone replacement, since this method ensures the most adequate stabilization, pain syndrome relief and long-term improvement of the quality of life.

Aim: To present the results of treatment of long bones chronic osteomyelitis using local cement reinforcing antibacterial implant., Material and Methods: The implant is made intraoperatively using polymethylmethacrylate. It was used in main group (n=30), while conventional treatment was applied in comparison group (n=30)., Results: Better early and remote outcomes were shown in main group including more effective and earlier suppression of infectious process, more than 2-fold decrease of recurrent infection incidence, minimization of risk of pathological fracture due to internal reinforcement, early recovery of extremity's function, creation of favorable conditions for bone structures restoration, substitution of post-resection bone defect and following organotypic reorganization of bone tissue.

The objective of the present work was to study roentgenological, microscopic, and histomorphological changes in the bone and cartilage tissues under effect of different doses of gamma-ray radiation from Gammatron-2 (GUT Co 400) and betatron bremsstrahlung radiation (25 MeV). The total radiation dose varied from 9.6 Gy to 120 Gy per unit area during 5-8 weeks. The study included 210 patients at the age from 7 to 82 years (97 men and 113 women). Histomorphological studies were carried out using samples of bone and cartilage tissues taken from different body regions immediately after irradiation and throughout the follow-up period of up to 4 years 6 months. Control samples were the unexposed bone and cartilage tissues from the same subjects (n = 14). The tissues were stained either with eosin and hematoxylin or by Van Gieson's and Mallory's methods. Gomori's nonspecific staining was used to detect acid and alkaline phosphatase activities. Moreover, argyrophilic substance was identified in the cartilaginous tissue. Best's carmine was used for glycogen staining and Weigert's stain for elastic fibers. Metachromasia was revealed by toluidine blue staining and fat by the sudan III staining technique. In addition, the ultrastructure of cartilaginous tissue was investigated. Taken together, these methods made it possible to identify the signs of radiation-induced damage to the bone and cartilage tissues in conjunction with complications that are likely to develop at different periods after irradiation including such ones as spontaneous fractures, deforming arthrosis and radiation-induced tumours.

Computed tomography was used to study the X-ray morphological characteristics of femoral and humoral bone cysts and the course of a reparative process after surgery in 23 patients with varying activity of solitary bone cysts. Treatment using transosseous osteosynthesis, intraosseous armoring, and therapeutic and diagnostic punctures in patients with solitary bone cysts could yield the most active osteoproductive effect and cause a considerable increase in the density of cyst contents in active and activity-losing stages, which was most evident around the intraosseous wires. Patients with late-stage cysts were found to have an osteogenic effect, mainly in an area of osteotomy.

Surgery for pathological fracture of long tubular bones associated with metastatic cancer was given to 77 patients (1993-2000): segmental resection with endoprosthetic replacement - 26; intramedullary osteosynthesis - 17; perosseous extrafocal osteosynthesis - 34. No intraoperative complication was reported. Infection-related postoperative complications, mainly in perosseous osteosynthesis, developed in 5 (7%). All patients were self-sufficient on days 3-10 after operation.

The various concomitant pathology and osteoporosis creates difficulties for diagnostics, and treatment of tumors pathological spine fractures of elderly and senile patients. The authors represented the analysis of efficiency of diagnostics and surgical treatment of 33 patients. The peculiarity of surgical tactic includes low role of radical operations (corpor- and spondylectomy) and efficiency of stabilization with transpedicular fixation and wide decompression from posterior approach.

Metaloosteosynthesis of pathological fractures of bone on the background of bone tumors was carried out in 56 patients in the department of tumors of locomotion system. The good results of the treatment were obtained. In 42% of the cases it was possible to reconstruct the function of extremities. 53% of patients succeeded to avoid amputation or exarticulation of an extremity.

There were studied 453 young servicemen with dyshormonal strain bone disease in whom the hormonal status, state of carbohydrate and protein metabolism were investigated. It was established that in 92.9% of patients the growth hormone--somatotropic hormone (STH) was significantly decreased, production of thyroid hormones necessary for physiologic osteogenesis (T3 and T4) was impaired and albuminous fraction dissociation was revealed. The authors consider that in dyshormonal strain bone disease in young people the insufficiency of hormonal regulation of growth processes and bone regeneration is the primary factor while the physical strain is the additional secondary factor.

Prevalence and types of hip and spinal fractures were studied in Yaroslavl citizens aged > 50 years. In 1985 prevalence of hip fractures was 36.41 per 100000, in 1993-145, 84 per 100000. Maximal number of the fractures occurred in patients aged over 70 years. Fractures of the thoracic and lumbar spine were registered in 15.00 per 100000 with an increase in 1994. Osteoporotic hip fractures in the population sample occurred less frequently than fractures of the non-typical sites.

The author has analyzed the incidence of bone fractures in women of various age groups, residents of the Cheryomushki District of Moscow in 1988-1989, using the records of the traumatologic service of the district and the census data. The incidence of bone fractures was the highest in women aged over 45 (up to 2.5%), and was the higher the older the woman grew, 2/3 of all the fractures occurred in women aged 45-64. Analysis of the findings has confirmed that the developing postmenopausal osteoporosis, that was not diagnosed in time and therefore not prevented, contributed to the occurrence of bone fractures in women aged 45 to 65. The author emphasizes the necessity of studying osteoporosis incidence in various age groups and the share of this condition in women with fractures, making use of the monophoton absorptiometry.

Eighty-one patients with histiocytosis X involving the jaw bones were followed up for 30 years; the patients presented with involvement of the lungs, skin, mucosa, other bones of the skeleton, and diabetes insipidus signs. In 58 of the 81 patients eosinophilic granuloma eventuated in a generalized process: chronic xanthomatosis or Hand-Schüller-Christian's disease. This fact permits a conclusion that eosinophilic granuloma is an initial stage of the same systemic disease, histiocytosis X, and that subdivision of histiocytosis X into 3 forms, accepted in literature, is undesirable, for it erroneously presents the essence of the process. Therapeutic recommendations are given.

In the article is presented an experience of treatment of 201 patient with benign tumours and tumour-like bone affections, aggravated with pathologic fractures. The principal conclusion of the work--early operative treatment of the given pathology (with the exception of dystrophic bone cysts of some types) in contrast to the rooted wait-and-see surgical tactics.

The article elucidates certain questions of modern methods of diagnosis and treatment of tumors of long tubular bones complicated by pathological fractures. The methods were used for the treatment of 41 patients. The authors emphasize the importance of such methods as radio- and angiography, punctional and trepanobiopsy, measurement of the intraosseous pressure. The efficiency of the ultrasound resection in association with cryodestruction for the treatment of the diseases mentioned is reported.

The data on 53 cases of bone injuries caused by radiation treatment for cancer of the uterus were analysed. The clinico-roentgenological signs of osteoradionecrosis (33), pathological fracture and dislocation (13), osteomyelitis (5) and radiation-induced sarcoma of bone (2) were considered. Lesions were found to occur most frequently in the upper flaring portion of the ilium and bones of the hip joints. Regular X-ray examinations of the pelvic bones are necessary for early detection of radiation injuries as well as conservative treatment to prevent such grave complications as pathologic fracture and osteomyelitis.

Clinico-roentgenologic data on 33 cases of aneurysmal cyst of the bone (flat bones--12, spinal cord--21) were assessed. Such peculiarities of the aneurysmal cyst of flat bones as large size, cellular--trabecular structure and a peripheral periosteal "shell" were identified. Vertebral cysts involved processes, arches and body resulting in compression fracture. They sometimes extended to adjacent vertebrae and ribs. Vertebral cysts should be differentiated mainly from giant-cell tumors, metastases and myeloma.

Under study were 260 men with stress disease. Three clinical forms are distinguished: abortive, typical with incomplete processes and classical ones. The undertaken treatment resulted in recovery of 92% of the patients. In 8% there were permanent or periodical pains and dysfunction of the diseased extremity under physical stress.

The experience with the treatment of 328 children and juveniles with dystrophic bone cysts is analyzed. Nine patients were cured by conservative methods. The others were operated upon (excohleation--in 4 patients; marginal resection--in 244 patients, segmentary resection in 66 patients etc.). The advantages of the marginal resection and alloplasty by the method of "faggot" are shown.