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The aim of this work is to develop a system of surgical treatment of intra- and periarticular fractures of lower limb bones for improving the results and reducing the number of postoperative complications. Material and methods Short- and long term results of surgical treatment of 390 patients with periand intraarticular lower limb fractures treated at a trauma department 1 of hospital # 24 in the period between 2010 and 2014 were analyzed according to a similar schedule of requirements to recovery of anatomic and functional parameters of the hip, knee and ankle joint. There were 198 men (50.8 %) and 192 women (49.2 %). Radiological, clinical and statistical research methods were used. Statistical methods included estimation of significance of differences for parametric and non-parametric criteria, assessment of the relationship signs on the Pearson’s coefficient of linear correlation. To study the results of hip treatment the Harris Hip Score (H.W. Harris, 1969) was used, in the region of the knee – P.S. Rasmussen scale (1973), and in the ankle – of E. Mazur (2006) which include subjective and objective criteria. Results Good functional outcomes were obtained in 87.1 % of femoral neck fractures, in extra-articular fractures of the proximal femur – in 76.2 %, in intra-articular fractures of the distal femur – in 75.0 %, intra-articular fractures of the proximal tibia – in 78.3 %, intra-articular fractures of the distal tibia in 96.6 % of cases. Conclusion Implementation in the clinical practice of the system of surgical treatment of peri- and intraarticular fractures, including improved diagnostics, practical orientation of injury systematization, algorithms for clinical diagnostic search, consecutive use of external and internal osteosynthesis, rational technique of joint arthroplasty, new technologies of osteosynthesis with a differentiated choice of metal fixators, a modified proximal femoral metal fixator, approaches to joints, methods for bone defect plasty; all these factors combined with the method of perioperative management of patients and early active rehabilitation achieved the prevalence of excellent and good anatomical and functional results for each studied location of injurie in main subgroups in comparison with the control ones.

Purpose Improve results of surgical management of intra-articular impression distal radius fractures (DRF). Material and methods Retrospective study of 69 patients with intra-articular impression DRF surgically treated between 2011 and 2015 was performed. Inclusion criteria were impression intra-articular epimetaphyseal or metadiaphyseal defects seen on CT scan, open reduction and plating, and follow-up period of at least 36 months. Two groups of patients were identified to compare the effectiveness of new surgical technologies and bone grafting of impression defect applied in index group (n = 35) and conventional surgical technology with no graft in the control group (n = 34). Radiological, clinical and statistical methods of study were used. Parametric and non-parametric statistical tests were employed to evaluate significant differences. The difference between radial inclination (RI) and palmar tilt (PT) was measured to assess reduction persisted. DASH questionnaire (1996) was an outcome measure used for functional assessment. Results Intra-articular impression DRF were mostly seen in older adults and females with mean age of 48.9 ± 16.3 years. There were 14 (20.3 %) male and 55 (79.7 %) female patients. D.L. Fernandez type II fracture was most common (43.5 %). RI radiometric parameters measured 13.34 ± 0.43 ° in index group and 9.33° ± 0.51°(p = 0.003) in the control group at 3-month follow-up. RI was noted to decrease in the control group and showed maximum values of 3.71° ± 0.31°, p < 0.05 at 3-month follow-up. Excellent and good results were observed in index group at 36-month follow-up measuring DASH score of 94.2 % vs. 61.8 %, p < 0.05. Conclusion Surgical repair of intra-articular impression DRF combined with new approach and modern bone grafting materials facilitated restoration of optimal radiometric parameters of the distal radius with bone graft preventing secondary impression and providing reliable bone fixation with the possibility of early rehabilitation.

From 2008 to 2014, 298 patients with traumatic cancellous bone were treated in N.V. Sklifosovsky Research Institute for Emergency Medicine of Moscow Healthcare Department. The bone graft substitutes used were an autograft from the iliac crest, allogenic grafts (non-demineralized cancellous bone, collagen type 1 sponge with bone chips, combined perforated non-dematerialized cancellous bone with collagen type 1 sponge).Long-term outcomes after allografting did not differ from the outcomes of the treatment with the iliac crest autograft. The allograft of non-demineralized cancellous bone has long-lasting mechanical strength, which in combination with osteosynthesis provides a stable fixation, and early weight bearing. Despite a lower mechanical strength, the collagentype 1 sponge with bone chips has a more pronounced osteoconductive effect. We have created and applied a combined perforated non-demineralized cancellous bone with collagen type 1 sponge that has good mechanical properties and a pronounced osteoconductive effect.