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Arthroplasty is the most widely used surgical technique for bone tumors of the upper limbs. However, it should be noted that the functional outcomes after endoprosthetic reconstruction for malignant bone tumors of the upper limb does not always satisfy patients and often lead to impaired working capacity of patients, and their disability. The need to improve functional outcomes determines the practical and socio-economic significance of the research. The purpose of the study was to evaluate the impact of a complex of rehabilitation measures on the quality of life of patients after surgery with endoprosthetic reconstruction for malignant bone tumors of the upper limb. Material and Methods. The treatment and rehabilitation outcomes in 146 patients were analyzed. There were 88 (60 %) men and 58 (40 %) women with an average age of 47 years (range, 19–75 years). The tumor was localized in the proximal humerus in 98 (67 %) patients, in the diaphysis in 18 (12 %), in bones that make up the elbow joint in 16 (11 %) and in the distal radius in 14 (9.6 %) patients. Results. Our rehabilitation technique improved functional outcomes after endoprosthetic reconstruction for all tumor localizations. The musculoskeletal Tumor Society (MSTS) score was improved by 10 % (75 vs 65 %) for arthroplasty of the shoulder joint, for the wrist joint by 8 (80 vs 72 %). The rehabilitation technique allowed significant improvement of MSTS score for arthroplasty of the humeral diaphysis and bones making up the elbow joint (from 76 to 95 % and from 68 to 82 %, respectively). Conclusion. Rehabilitation measures play an important role in optimizing quality of life of patients after surgical treatment of bone tumors of the upper limb with arthroplasty, helping to improve functional outcomes.

Relevance. Fractures of the diaphysis of the humerus account for 1–5% of the total number of traumatic skeletal injuries and 20% of the number of humerus injuries. At the same time, in modern society there is no tendency to reduce traumatism, therefore, the number of surgical interventions aimed at restoring the integrity of the bone does not decrease. Over the decades, approaches to tactics and choice of drugs for correction of defects for fusion and restoration of motor function of the limb have been changing. Physicians from different countries have tried to use both auto- and allografts, with the results they achieved significantly increasing the chances of survival of the transplanted material. The multitude of studies conducted in different countries only confirms their high relevance, which makes the task of pseudarthrosis treatment one of the most important, but at the same time one of the most difficult in traumatology and orthopedics injuries.Objective. To study the application of bone autotransplantation for the treatment of false joints of the diaphysis of the humerus diaphysis.Materials and methods. A review of the literature sources published in the last 5 years on the problem of application of bone autografting methods for false joints of the humerus diaphysis was carried out.Results. Disruption of the process of humerus fusion and formation of a false joint make surgical intervention inevitable, and the results of treatment directly depend on the determination of the correct indications for a certain type of surgical intervention and competent implementation of the treatment plan. The chosen treatment tactics allow successful restoration of the anatomy and function of the damaged segment. There are many different methods of surgical treatment of false joints. The main purpose of bone-plastic materials application in traumatology and orthopedics is optimization of reparative osteogenesis.Conclusion. Over the last decades, clinical practice has changed many approaches to the tactics and choice of therapeutic means to restore bone integrity, as well as to restore the supporting and motor functions of the traumatized limb. Analysis of the data obtained from the literature has shown that the best results in the treatment of false joints of the humerus diaphysis were demonstrated by the techniques combining the use of bone autoplasty and additional metal structures.

Background: The need to minimize the immobilization of the elbow joint in multifragmental fractures of the distal metaepiphysis of the humerus is confirmed by a number of factors, including the complexity of its anatomical structure, the uniqueness of biomechanics, as well as the limited ability of hyaline cartilage to regenerate. The restoration of the motor potential of the limb in multifragmentary fractures of the distal metaepiphysis of the humerus determines the priority of the treatment technique, which allows the patient to return to his usual lifestyle in the near future.Objective: Demonstration of the effectiveness of percutaneous spinal osteosynthesis with wires in fractures of distal metaepiphysis of the humerus in adolescent children.Clinical cases: This paper describes two clinical cases in adolescent children with multifragmentary fractures (open and closed) of the distal part of humerus (12В and 13С according to the AO classification). In both cases, the treatment consisted of sequential application of skeletal traction, for fragments traction and their mobility increase, then closed reposition of fragments under the control of electron-optical converter with metal osteosynthesis with wires. Moreover, taking into consideration the U- and T-shape nature of the fractures, the first stage of reposition included stabilization and fixation of the distal fragments to each other and then to the proximal fragment.Conclusion: In our opinion, it is the combination of traditional methods of treatment (application of skeletal traction system), modern technologies (EOC control), alternative (atypical) options for using metal structures that allow achieving good functional treatment results in this category of patients.

Introduction Treatment of a patient with an open comminuted humerus fracture and an extensive bone defect is challenging and associated with high risk of a poor outcome, infection resulting from skin and soft tissue injury and considerable bone transport. The objective of the study is to demonstrate the experience with an open comminuted humerus fracture and an extensive bone defect treated with staged use of transosseous fixation with rod-andwire device, autologous fibula graft and internal wiring. Material and methods We report a case of an open humerus fracture and an extensive bone defect treated with a bone replacement technique and followed up to 4 years. Results and discussion The limb was temporarily fixed with external fixation device extrafocally using wires and rods. A 24 cm autograft was harvested from the fibula. Osteosynthesis of the humerus and autografting were produced with the graft fixed using smooth wires and external fixation was provided using wires and rods. With consolidation of the humerus achieved, the external fixation device was dismantled and transosseous wires removed. Anatomical length of the segment was restored. Conclusion Combined techniques and technical means of external fixation, autologous graft, internal fixation with smooth wires facilitated complete restoration of the injured limb avoiding complications with a good clinical outcome.

Introduction Periarticular injuries in children include types I and II fractures according to the Salter-Harris classification and metaphyseal fractures. In most cases, conservative treatment is an effective method, but in some cases, surgical treatment, including external fixation, is the method of choice. Purpose Discussion of the principles of using the Ilizarov apparatus in the treatment of children with periarticular fractures of various locations, its advantages and disadvantages. Materials and methods We present the principles and features of the Ilizarov surgical techniques for treatment of children with periarticular fractures of the distal humerus, femur, radius and tibia. Discussion The methods of osteosynthesis for pediatric periarticular fractures imply transphyseal introduction of fixators that have a potential threat of iatrogenic damage to the growth plate in contrast to external fixation which performance implies that transosseous elements do not injure the growth zone, providing stable fixation of bone fragments in combination with early functional recovery of the damaged segment which is a key advantage over other methods. Conclusion The use of the Ilizarov apparatus enables to achieve the desired result in the treatment of pediatric periarticular fractures and has a number of advantages over other methods of surgical treatment.

Introduction Modern technologies for treating patients with fractures of the humerus using metal structures (various options for free and non-free bone autoplasty, dynamic plates DCP, LCP, intramedullary locked osteosynthesis, external fixation devices) do not always guarantee restoration of the integrity of the segment. Patient's fibula as an autologous osteoplastic material assists in achieving adequate contact of the ends of the fragments, prevents secondary displacement, and creates conditions for bone formation. Material and methods We retrospectively evaluated the results of restorative treatment in four patients of the same sex, with the same etiology of pseudoarthrosis, and failure of previous operations in whom a free fibular autograft was used for humerus reconstruction at one medical institution. A new method of humerus reconstruction in hypotrophic pseudoarthrosis patented in the Russian Federation is described in detail. Results and discussion Capabilities of any dynamic internal system are limited in time and effects. The external fixation device allows for controlled fixation of the fragments of the humerus and maintains it in the required mode until the consolidation of the fragments. The fibular graft, implanted into the bone marrow cavity in the area of the junction of fragments, plays the role of an interface and additionally reinforces the humerus, preventing secondary displacement that may be caused by compression forces created with the fixator. The autogenous osteoplastic substance formed in interfragmental gap and along the periphery is a substrate for local osteoplastic intervention that stimulates osteogenesis. Conclusion A free bone autograft shaped as a cylindrical fibular fragment s implanted into the zone of active angio- and osteogenesis. The coaptation zone of fragments of the humerus is reinforced with an implant intraosseously along its length to eliminate the risk of secondary displacement of the fragments by creating compression with an external fixator. The use of an external fixation device provides contact in the area of the bone wound and maintains compression between the ends of the humerus fragments until bony fusion.

Background Minimally invasive plate osteosynthesis (MIPO) corresponds to the modern principles of "biological" fixation as it implies closed reduction and plate insertion causing minimal iatrogenic trauma. However, the lack of direct visualization increases the risk of damage to important anatomical structures. Purpose To develop recommendations in the use of MIPO for diaphyseal fractures of the humerus from anterolateral approaches to prevent possible complications and improve the results. Methods 16 shoulders of fresh cadavers were included in the study. In all cases, MIPO was performed with a straight plate (10–12 holes) and screws (2 proximal and 2 distal) using two anteriolateral approaches. Complete revision of the shoulder area was carried out in order to determine the accuracy of plate location and the relationship between the implant, neurovascular structures and bone landmarks. Results No damage or compression of the neurovascular and tendomuscular humerus structures was revealed. The average distance from the acromion to n. axillaris was 5.8 ± 0.66 mm (range from 4.9 to 6.9 mm). The average distance from the lateral epicondyle of the humerus to n. musculocutaneus was 56.5 ± 4.66 mm (from 49 to 63 mm). We observed the difference in location at the extreme pronation (5.1 ± 0.33 mm, from 4.5 to 5.7 mm) and supination positions of the forearm (5.8 ± 0.6 mm, from 5.1 to 6.1 mm) measuring the distance between the edge of the plate and n. radialis. The average distance between the distal medial edge of the plate and a. brachialis, n. medianus was 17.1 ± 2.7 mm (from 13 to 21 mm). Conclusions Based on the obtained data, we offer MIPO recommendations for anterolateral accesses in diaphyseal fractures of the humerus. Compliance with the proposed recommendations will reduce the risk of iatrogenic damage and improve the results of humeral fractures treatment.

Background. To conduct a comparative analysis of the results of treatment of patients with humerus epimetaphysis fractures in the Republican Clinical Hospital No 4 from 2016 to 2018. Materials and methods. A retrospective analysis of the case histories of 76 patients with epimetaphysis of the humerus fractures, who were treated in the Department of Traumatology, was carried out. The structure of morbidity by gender, age, type of fracture, treatment, complications was analyzed. Depending on the type of treatment, patients are divided into groups: patients who received conservative treatment, patients who underwent surgery with “traditional” plates, patients who underwent surgery with LCP plates. Results. It was found that epimetaphysis of the humerus fracture was more often detected in women; more often two-fragment lesions of the epimetaphysis were detected. The most satisfactory treatment result and the least number of complications were observed in the study group, in which patients underwent osteosynthesis with plates with angular stability. Conclusion. It was found that the best results and the least number of complications were observed in the group of patients who was treated with plates with angular stability.

A clinical case of a 70-year-old female patient with periprosthetic humeral fracture is reported. A new distal posterior humeral plate devised at our institution for nonunions and comminuted fractures of the distal humerus was used in the case. The treatment resulted in fracture healing and functional recovery of the limb at the pre-periprosthetic fracture level. Technical features of the fixator and surgical technique are described in details with cortical allograft practice used to augment thin cortical bone around the stem.

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Objective: to determine the incidence of complications after treatment of shaft fractures according to the inter-regional Specialized Traumatological Medical and Social Expert Commission in Kharkiv and Kharkiv region. Methods: we studied the incidence of nonunions, osteomyelitis, radial nerve neuropathy in 773 patients with shaft fracture of the extremities, who underwent primary examination at the MSEC for the period 01.01.2016-31.12.2018. Among them, 96% were patients of preretirement age. There were 461 patients with tibia fractures, forearm -- 49, femur -- 173, humerus -- 90. The frequency of nonunion in subgroups is analyzed depending on the method of fragments fixation. Results: after bone fragments osteosynthesis at isolated tibia fractures nonunion was found in 11.9% of cases, at intramedullary blocking nail -- 16.0%, external rod fixators -- 3.0%, Ilizarov fixator -- 18.4%, plaster cast bracing -- 7.6%. After treatment of femur fracture with plate osteosynthesis, nonunion was found in 9.4%, after intramedullary nailing -- in 12.8%. At humerus fractures and forearm fractures which were treated with plate osteosynthesis, nonunion was recorded in 19.0 and 28.6% of patients respectively, and radial nerve neuropathy - was observed in 25.0 and 26.4%. The incidence of osteomyelitis at internal osteosynthesis was 2.9- 7.7%.Conclusions: osteosynthesis was used in 36.6% of cases of tibia shaft fractures and was the most common used method of fragments fixation in isolated shaft fractures: 64.9% -- femur; 75.6% -- humerus; 100.0% -- forearm bone fragments. The second most frequent method of fixation was intramedullary nailing osteosynthesis. The main complication of treatment was fragments nonunion, and in the case of plate osteosynthesis at humerus and forearm fractures was radial nerve neuropathy. [ABSTRACT FROM AUTHOR]

ABSTRACT. Traumatic radial nerve palsy is a frequent complication of humerus fractures. Significant amount of unacceptable results of treatment for this impairment motivates the physicians for ongoing investigation on optimization of diagnostic and therapeutic procedures. In this article we discuss various ideas of diagnosis and treatment of traumatic neuropathies, methods and terms of treatment for fractures of the humerus, complicated by radial nerve palsy.

In the article reported the results of analysis of the treatment of 531 patients with fracture of the proximal humeral. As part of the study it was shown that using of the external osteosyntesis provides good results, which are not depend on bone mineral density. The results of the conservative treatment depend on premorbid condition of the osseous tissue. Whence external osteosyntesis is more convenient, the method of intramedullary fixation provides better results, and conservative treatment is reasonable for elder year class with normal bone mineral density.

The article provides information about habits of the routes to the proximal humeral for people with different constitution. The clinical studies were made on 55 corpses, which were put in order of constitution, body mass and shoulder-elbow length. Results of studies have shown us that for people with normal body mass better to use anterior approach in a case of fracture with breaking of the proximal humerus, transdeltoid rout for people with transvers fractures of collum and low bone mineral density. As for people with subnormal body an anterior approach is more convenient than transdeltoid rout, and for patients with overweight and lipotrophy of the I degree selection of the rout depends on character of the fracture and optimal method of the osteosynthesis.

Objective: to substantiate, develop and implement a more reliable combined endoprosthesis fixation system for replacement of postresectional defects of the proximal humerus, reduction in the number of complications from the endoprosthesis and improvement of the results of tumor joint replacement. Methods: finite element models of the «endoprosthesis - humerus» system with different fixation methods (combined and intramedullary only) have been developed, investigated for tension, bending and twisting. In an experiment on 20 white rats, the situation was modeled after tumor resection of the long-bone diaphysis and replacement of the defect with a modular endoprosthesis. The animals were divided into two groups: in the experimental, an endoprosthesis was installed with a combined fixation system, in the control one -- with intramedullary. Twelve patients with tumor lesion of the proximal humerus were operated: in 3 an endoprosthesis with intramedullary fixation was implanted, in 9 patients with a combined implant. The observation period is up to 7 years. Results: on mathematical models it is determined that the use of an additional fixation system can significantly reduce the load on the «critical zone» due to its redistribution to extracortical plates. In vivo experiment, the stability of fixation and a significant reduction in the number of complications with the use of combined fixation was demonstrated. On the basis of the theoretical and experimental data obtained, the proximal humeral endoprosthesis with a combined fixation system was developed and implemented into practice. In patients operated on with the proposed fixation system, complications associated with the endoprosthesis were not revealed. Conclusions: the use of the developed endoprosthesis with extra-cortical fixation to replace the post-exposure defects of the proximal humerus makes it possible to reduce the risk of complications associated with the implant. Key words: proximal humerus, stress-strain state, malignant bone tumors, modular endoprosthesis, replacement of postresection defects. [ABSTRACT FROM AUTHOR]

We performed the analysis of proximal humerus fracture surgical treatment results. Reasons of unsatisfactory results of multifragmental fractures surgical reduction revealed. The new construction for multifragmental fractures fixation invented and patented. Our experiments proved this construction to increase the stability of humerus multifragmental fractures fixation.

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.

In the present paper the authors share their experience of thermovision diagnosis of gigantocellular tumors and bone cysts, acquired in numerous clinical cases (65 patients). In parallel with thermographic investigations, traditional methods of ++clinico-roentgenologic and morphologic diagnosis have been carried out with the purpose of verification. The authors make an objective evaluation of infrared thermography possibilities, singling out its known advantages alongside with its drawbacks, absence of high specificity, that conditions the expediency of thermography application in the complex of examination.

Initial immunologic status in children suffering osteogenic sarcoma was retrospectively evaluated versus such parameters as site and extent of tumor, and clinical course. A complex of disorders in the immunologic system was established in osteogenic sarcoma patients. Such characteristics as levels of active, theophylline--sensitive and levamisole--reactivated T-cells were found clinically valuable and prognostically significant. These parameters may betray response of high- and low-affinity E-receptors of lymphocytes to serum factors of tumor growth.

The interim results of the use of high-dose methotrexate with leucovorin rescue for the treatment of 26 patients with osteogenic sarcoma are discussed. Preoperative chemotherapy was followed by marked regression of primary tumor in one out of seven patients with localized disease. In that group, metastasis-free period lasted 2, 3, 10+, 12, 17+ and 24+ months. Response was observed in two out of 19 (10.6%) cases of metastases. Toxic side-effects were moderate and were mainly nausea (38.5% of patients), vomiting (26.9%), elevation of serum transaminase levels (38.5%) and fever (30.7% of cases).

The results of clinical and roentgen-morphological studies on 17 cases of multipotent primary sarcoma of the bone are presented. The difficulties of the tumor recognition are due to the fact that it occurs rarely, has no specific clinical-roentgenological picture and shows marked tissue polymorphism. Most frequent are differentiations of the type of osteogenic sarcoma, chondrosarcoma, reticulosarcoma with simultaneous combination with areas having the structure of Ewing's tumor, or extensive fields of undifferentiated primitive tumor cells. Further studies are necessary to decide whether or not this tumor is an independent form among other known skeletal neoplasias.

Under analysis were results of the treatment of 91 patients with false joints of the humeral bone. The most frequent cause of the false joint of the shoulder was established to be insufficient immobilization and unstable osteosynthesis. Different operations were fulfilled in 84 patients, seven patients were treated conservatively. The conservative treatment gave unsatisfactory results. A conclusion is made that best method for the treatment of false joints of the humeral bone is a stable osteosynthesis with periosteal compressing fixators of A. A. Krylov's plate type in combination with a bone plate.