Vol. 4 No. 4 (2024): EUROASIAN HEALTH JOURNAL

This article presents an analysis of the results of road traffic injuries in the Kyrgyz Republic in comparison with other countries in the period from 2019 to 2023, where indicators such as road accident statistics, causes and mortality from car accidents were considered. The article also noted a number of the main reasons why accidents occur on the roads. Reasons include driving at high speed, driving into the oncoming lane, driving under the influence of alcohol and failure to comply with traffic rules. According to the authors, this trend is also influenced by a number of factors, including an increase in the number of vehicles, as well as a low level of driving culture. The most vulnerable road users, both among those injured and among those killed, are pedestrians and passengers (approximately 70% passengers and pedestrians to 30% drivers). The work analyzes the main causes of accidents and injuries on the roads, factors affecting the level of traffic safety, and measures taken by government agencies to reduce the number of accidents. Particular attention is paid to statistical data and trends in the field of road safety in recent years, which allows us to draw conclusions about the current state and the effectiveness of measures to improve the situation.

One of the new modern and evidence-based treatment methods in the world for cerebral palsy is botulinum therapy, which was first used in the Kyrgyz Republic on the basis of the Bishkek Research Center of Traumatology and Orthopedics in the Department of Pediatric Orthopedics in 2020. On this basis, we examined 69 children suffering from cerebral palsy who received a course of botulinum therapy in the period from 2021 to 2023. The scientific value of this work can become the basis for the further development of the botulinum toxin therapy method for children suffering from cerebral palsy, while significantly reducing orthopedic complications that often occur with this pathology, and also contribute to the development of science in the field of medicine in the country. After the use of botulinum toxin type A, changes in spasticity were assessed using the Ashworth and Motor Function Classification System scales; before and after therapy, a video and photo analysis of the patients’ range of motion was performed. As a result of the study and evaluation of the use of botulinum therapy, positive dynamics of indicators in the motor sphere were noted in children suffering from cerebral palsy.

Fractures of the distal metaepiphysis of the radius remain an urgent problem of modern traumatology and orthopedics not only in the Kyrgyz Republic but throughout the world, the reason for this is an increase in average life expectancy, urbanization, pronounced osteoporosis in postmenopausal women, an increase in the general well-being of people, an increase in the number of cars per capita, consequently, an increase in the number of car accidents on the roads of large cities, villages, as well as the popularity of dangerous "sports" like kok-boru, parkour, new types of transportation high-speed bicycles, scooters that many citizens are fond of, most of the victims are people of working age (18-59 years old) who need full recovery and rehabilitation in a short period. The frequency of fractures of the forearm bones, including fractures in the projection of the distal metaepiphysis of the radius, occupy a significant position in the structure of injuries. Despite the variety of surgical treatment methods, the percentage of unsatisfactory results remains high. This is due not only to the severity of the injury, the complexity of the anatomical structure and the subtlety of the physiological functions of the hand, but also to the large number of errors allowed in the diagnosis, choice of treatment method and management tactics of patients with fractures of the distal metaepiphysis of the radius. Considering that most complications after treatment of fractures of the distal metaepiphysis of the radius are associated with prolonged immobilization of the wrist joint, a minimally invasive method is needed in which sufficient fixation of fragments, even in patients with osteoporosis, will prevent the likelihood of secondary displacement and allow patients to begin movements in the operated joint in the coming days after surgery, in connection with which in a Clinical emergency hospital The help of G. Bishkek clinical studies and observations of patients with traumatic injuries of the distal metaepiphysis of the radius and a comparative analysis of the data obtained from various treatment methods are carried out.

Among the body systems, a hemostasis system that provides liquid state of the blood is one of the most labile systems. This is the reason for any effects on the body both external and internal factors resulted to the disorders in the dynamic balance status between the coagulation and fibrinolytic components of the hemostatic system. It makes this issue study very important. Moreover, an urgency of this issue study is deeper by the fact that the mountain landscape in the Kyrgyz Republic is about 90%. Approximately 20% of the population lives in mountain areas, and 30% lives in the foothills. All the studies we have conducted in the conditions of high mountains based on Tuya-Ashuu at the altitude of 3.200 meters above the sea level. In addition, the issues of providing the musculoskeletal system with oxygen, the direct manifestation of this system, are largely determined by the functional state of the hemostasis system, therefore, the study of structural and functional changes in the bone tissue of the body, adapting to high altitude conditions, and the process of bone generation in the body. in the mountains when they are damaged are of great importance. In parallel, the hemostasis system, of course, affects not only the functional state, but also the regenerative capabilities of tissues and organs. In this case, regeneration of skeletal bones is, on the one hand, not only one of the most important sections of modern traumatology but also, on the other hand, an integral part of a single general biological process of restructuring

The goal of this research is the study of cell immunity features for traumas in high mountain regions at different period of stay in adapted and unadapted to the high mountain regions animals. We studied one hundred and forty white laboratory rats of both gender at a height of 3200 meters above sea level in high mountain regions of Too-Ashuu base. By the end of the experiment, the concentration of main lymphocyte subpopulations in the studied animals of the control group returned to the initial values, while in the animals of the main group these data remain significantly increased. It was found that in unadapted to the high mountain region animals the dynamics of main lymphocyte subpopulations for traumas had multidirectional character. It was also determined that the complex effect of high mountain factors and traumas have an impact on the cell-mediated response, causing an increase or decrease the concentration of one or another lymphocyte subpopulations. In turn, this indicated the multidirectional suppressive or stimulating effect of abovementioned factors on the immune system. Differences, found out under study in the composition of main lymphocyte subpopulations indicate the irregular its involvement in the osteanagenesis regeneration in the high mountain regions on the different stages of experiment on the ground of modeled bone fractures.

In an experiment in low-altitude conditions, the features of changes in the structure of bone tissue in the area of a gunshot fracture of the diaphysis of the tibia were studied. Experimental studies were conducted in 2015, on adult mongrel dogs, for which, in low-altitude conditions (Bishkek city, 780 meters above sea level), a model of a gunshot fracture of the tibia was reproduced with the application of an Ilizarov apparatus. Morphological examination was carried out over a period of 2 months using standard histological methods. In bone tissue, the number of vessels, osteons, bone cells, and the area of osteon channels were determined. All stages of preparation processing were carried out in accordance with the principles of quantitative methods for studying histological objects. In the experiment, complete consolidation of the fracture was obtained. The method of stable, non-focal compression - distraction osteosynthesis provides optimal conditions for regeneration and restoration of the damaged limb. It was revealed that when using the compression-distraction method according to G.A. Ilizarov, a pronounced angiogenic effect and an improvementin reparative processes are observed. The results obtained confirm the need to use the method of extrafocal compression-distraction osteosynthesis to accelerate the healing of gunshot fractures of
long bones. Since the previous series of our work presented extensive experimental material on the peculiarities of bone tissue regeneration with stable osteosynthesis in high altitude conditions. This series of experiments was carried out to obtain basic digital data on the state of the bone and soft tissues of the limb for a comparative study of their reaction in low-altitude conditions.

The most widely used devices for lengthening are A.I. Bliskunova and G.A. Ilizarov. The negative aspects of these methods include the length of time the bulky apparatus is placed on the limb being lengthened, secondary displacement, the development of pin osteomyelitis, contractures of adjacent joints, the high-tech and high cost of implants and instruments, and the requirements for highly qualified orthopedic surgeons. We have developed and introduced into clinical practice a method of combined lengthening of the long bones of the lower limb (invention patent KR No. 140 dated 08/19/2011, certificates for rationalization proposals No. 41/12 dated November 30, 2012, No. 45/12 dated 12/04. 2012). The technique is based on a combination of two methods of fixation and distraction of bone fragments: a transosseous extrafocal osteosynthesis device and external osteosynthesis. In the conditions of the City Clinical Emergency Hospital in Bishkek, this technique was applied to 49 patients; the average age was 23.8 years. The combination of extrafocal osteosynthesis (Ilizarov apparatus) and a bone plate of an original design made it possible to improve the final results of lengthening. The number of complications encountered when using traditional methods has also decreased (wire osteomyelitis, mixing of bone fragments, the formation of weak bone regenerate, pseudarthrosis, desmo- and myogenic contractures).

In BSRCTO and ICHEMA in the Department of Spine Pathology from 2015 to 2024, 573 patients with trauma and chronic injuries of the thoracic and lumbar spine were surgically treated using various techniques of ventral and dorsal stabilization.
Among the 573 operated patients, there were 396 males (69.1%) and 177 females (30.9%). The age range of patients was from 18 years to 68 years. In the preoperative period, patients underwent review spondylographies, computed tomography (CT), and magnetic resonance imaging (MRI).
Patients with a long-standing injury underwent needle electroneuromyography to evaluate nerve- muscle conduction.
Based on the findings, injuries were categorized according to F. Magerl et al. and by F. Denis. Local kyphosis was measured, which averaged 20.1º ± 2.7º. All patients (n-573) were categorized into 4 groups according to the method of the performed operative technique. The efficacy of each of the techniques was evaluated with the determination of specific indications for their application and the peculiarities in the use of devices for fixation of the damaged segments were studied.
The degree of regression of neurological disorders was assessed according to N. Frankel, before
and after surgical intervention, where there is a gradation into groups according to the degree of severity and manifestation of motor and sensory disorders. Also, the intensity of pain syndrome was determined using the visual analog scale (VAS) and the Oswestry Disability Index (ODI).
The post-operative clinical results of treatment were controlled in all operated patients: good results were obtained in 467 (81.5%) cases; satisfactory - in 87 (15.2%), unsatisfactory - in 19 (3.3%). After 1 year and more clinical results were evaluated in 359 (62.6%) patients; good results were obtained in 301 (83.4%), satisfactory - in 58 (16.2%).

A clinical case describes a nontrivial surgical treatment of meningioma of the lumbar spinal cord, when neurological symptoms due to spinal canal stenosis seemed to have regressed, but the patient's main complaint of persistent pain in the coccyx region forced us to apply repeated treatment of the pain syndrome with NSAIDs. It should be noted that meningiomas of the spinal cord account for 15-30% of all primary spinal tumors. Meningiomas in 85-90% of observations are noted in women aged 50-70 years. Meningiomas of the thoracic and lumbar spine are incapsulated, well delimited from the surrounding structures, up to 2-3 cm in size, irregular oval, located at the level of 1 - 2 segments of the spinal cord. The most frequent, debut clinical manifestation of spinal cord meningiomas is sensory disorders in the form of hypoesthesia, paresthesia, observed in 56% of patients, which was observed in our patient too. Regardless of the segmental localization of meningiomas, superficial sensitivity disorders are observed more often than loss of deep sensitivity. However, persistent pain syndrome in the coccyx region puzzled us a bit in terms of choosing further treatment tactics. We tried an arsenal of local injection therapy, ranging from sacral and presacral blockade, to acupuncture, shockwave therapy and anesthetic applications by electrophoresis. And what is extraordinary, only by applying surgical intervention-resection of the coccyx, it was possible to achieve a persistent remission of coccygodynia. Long-term follow-up examination convinced us of the correctness of using coccygodynia resection.

The social significance of spinal hemangiomas is determined by the high prevalence rate, reaching 10-11.5% among the working population group of 35-45 years of age, 2/3 of which are women. For a long time, the absence of a clear clinical picture made diagnosis difficult; hemangiomas were described only during autopsies as one of the causes of pathological fractures of the vertebral bodies. With the introduction of radiation research methods into clinical practice, spinal hemangiomas have moved from the category of random findings to the category of pressing problems of modern medicine. Percutaneous vertebroplasty involves the injection of polymethyl methacrylate into the vertebral body in order to increase the strength of bone tissue, prevent a decrease in the height of the vertebral bodies and achieve an analgesic and antitumor effect. Vertebroplasty is used in the treatment of patients with aggressive hemangiomas of the vertebral bodies, as well as compression fractures of the vertebral bodies due to trauma or bone pathology. The paper presents percutaneous vertobroplasty for hemangiomas of the thoracic and lumbar vertebral bodies. The age range of patients varied from 25 to 63 years. For diagnosis, we use radiography, CT and MRI. The surgical treatment was carried out using a device we developed.

Flat feet in childhood is one of the most common reasons for using orthopedics. While the physiological mobile flat foot requires no active treatment and is prone to correction as it grows, flatfoot with a significant degree of flattening of the arch of the foot in most cases are the reason for the formation of degenerative changes in the joints of the foot with the development of persistent pain syndrome, reduced resistance to physical activity, deterioration in the quality of life of the patient. In the treatment of flat feet, preference is given to surgical methods. Attenuated arthroeresis is a minimally invasive technique used to correct the flattening of the longitudinal arch of the foot. This article analyzes this treatment method in children with flat-walgus deformation of the feet. The purpose of the study is to analyze the early and remote clinical and radiological results of treatment of children with flat-valgus deformation of the foot, operated on the basis of the technique of confirmed arthroeresis using a metal implant. An analysis of the results of treatment of 10 children with flat-walgus deformation of feet of different etiology, operated on the basis of the method of confirmed arthroeresis using a metal implant, was conducted. A total of 19 foot operations were performed. In all children, the flattening of the longitudinal arch of the foot was rigid, 8 (16 stop / 84.2%) children showed initial signs of degenerative-dystrophic changes in the joints of the foot. In most cases, when a metal implant is inserted into the sinus, it achieves the desired correction. The implementation of the technique of confirmed arthroeresis in the treatment of children with flat- valgus deformation of the feet allowed in most cases to obtain a good clinical and radiological result. The outcome of treatment was considered excellent in 89.5% of cases. Surgical correction made it possible to eliminate the use of expensive orthopedic shoes, to relieve pain syndrome during physical activity, to increase the submerged space, to obtain a stable sheer position of the calcaneal bone in the posterior part of the foot. Attenuated arthroeresis is a minimally invasive surgical intervention, allowing to achieve a more advantageous spatial ratio in the middle and back of the feet and relieve pain syndrome, abandon expensive orthopedic shoes in everyday life.

A study on functional osteosynthesis of a patellar fracture is being conducted in the emergency department of the Bishkek Clinical Emergency Hospital. For fractures without displacement or with displacement of less than 0.5 cm, conservative treatment is indicated - fixation of the limb with a splint for a period of 2-3 weeks. A fracture of the patella with a displacement of fragments by more than 0.5 mm is an indication for surgery. There are many modifications of surgical treatment, including the use of circular wire cerclages, transverse screws, multiple wire cerclages or Kirschner wires inserted at a distance from each other and purse-string sutures. The prognosis after surgery is usually favorable, the functions of the limb are completely restored. The duration of disability depends on the severity of the injury and ranges from 2 months for uncomplicated patellar fractures to 3 months for fractures with damage to the quadriceps tendon. But the frequency of complications after surgical treatment of a patellar fracture remains quite high; due to insufficient juxtaposition of bone fragments, diastasis, insufficient stability, lack of rigidity between fragments lead to non-union of bone fragments and false joint. This, in turn, leads to repeated operations and thereby extends the period of disability for an indefinite period.

This research paper presents an analysis of the treatment outcomes of 52 patients with polysegmental fractures of the long bones of the lower extremities. The study is based on the analysis of clinical data collected from patients who underwent surgical treatment at the Bishkek Scientific Research Center of Traumatology and Orthopedics. The main characteristics of these patients were studied, including the prevalence of different types of fractures. According to the author's data, the most common are bilateral fractures of both tibiae (36.5%) and ipsilateral fractures of the femur and tibia (23.1%). Special attention was given to evaluating the effectiveness of the treatment methodology used, which is based on delayed simultaneous intramedullary nailing of the femur and interosseous nailing of the tibia with the use of an external fixation device. As a result of applying this approach, successful clinical recovery was achieved in 88.9% of cases, confirming its effectiveness in the comprehensive treatment of polysegmental fractures of the lower extremities. The results of the study provide important information for clinicians involved in the treatment of lower extremity fractures in order to optimize the choice of surgical intervention techniques and improve the quality of medical care for this category of patients. The advantages of early mobilization and active participation of the patient in the recovery process are described, and data on the timing and stages of rehabilitation are presented.

Currently, according to the current literature, there is no universally accepted protocol for the treatment of patients with proximal humerus fractures. According to various authors, the risk of delayed consolidation and formation of a false joint reaches 10% of cases. Fractures of the proximal humerus are common injuries, with the majority being over 60 years of age. There are many conservative and operative methods to treat such injuries, such as immobilisation and early initiation of movement, percutaneous osteosynthesis with spokes, osteosynthesis with plates and pins, and prosthetic shoulder joints. The authors studied the results of treatment of fragility fractures of the proximal part of the humerus in 35 patients treated at KBSMP. The aim of this study was to report the results of surgical treatment of proximal humerus fractures.
The gold standard of treatment according to our data is osteosynthesis with T- and LCP-plates. Out of 28 patients followed up in the long term, 13 (46.5%) had an excellent treatment result, 8 (28.6%) had a good treatment result, 5 (17.8%) had a satisfactory treatment result, and 2 (7.1%) had an unsatisfactory treatment result. The positive result of treatment was 92.1 per cent.

Intra-articular fractures of the distal humerus, despite a significant number of various modern methods of treatment, leave a high proportion of unsatisfactory results 15-40%, and patients are recognized as disabled in 18-20% of cases. Among the injuries of distal epiphysial cartilage of long bones, fractures of the distal humerus occupy a special place, representing one of the most difficult problems of fracture treatment. Making up a rather significant part of all intra-articular fractures (19%), they often lead to the impossibility of self-care due to very modest functional results of treatment and a high number of complications, which, according to various data, are up to 67%. Fractures of the distal humerus are from 0.5% to 15.3% of all humerus fractures and are a rather severe injury both in the system of their treatment and in terms of predicting long-term functional results due to the polymorphism, difficulty of repositioning and ensuring reliable fixation of the fragments. The accuracy of repositioning and stability of the external fixation determines the possibility of early functional rehabilitation of the elbow joint in the postoperative period, which ultimately has an exceptional value in the professional and domestic reintegration of the patient. The issues of treatment of patients with fractures of distal humerus remain relevant for modern traumatology due to the high number of unsatisfactory treatment outcomes, which is up to 60%.

This article is devoted to our own method of treating fatty thromboembolism in a clinical emergency hospital for fractures of long tubular bones of the limb, including complex anticoagulant and fibrino-thrombolytic therapy using heparin, fibrinolysin, aspirin and rheopolyglucin, as well as vascular drugs and antispasmodics, where additional hypolipidemic, decongestant, antienzymatic, dehydration, antibacterial therapy, using vaselip, pentoxifylline, magnesium sulfate, fraxiparine, furosemide, cephalosporin. The article examines the effectiveness and safety of the developed method of treating fat thromboembolism in fractures of long tubular bones of the extremities. Clinical cases and research results are highlighted that demonstrate the effectiveness and safety of the selected methods in the context of minimizing risks to patients. The presented data indicate a significant improvement in the prognosis for patients with fat thromboembolism in the context of long bone fractures, which makes this study relevant in medical practice. Results confirming the effectiveness and safety of this approach are demonstrated, and the prospects for its use in clinical practice are discussed. This article is intended to provide practicing physicians and specialists in the field of orthopedics and traumatology with a comprehensive understanding and modern approaches to the treatment of this complication.

This article presents an analysis of the results of surgical interventions in 119 patients with trochanteric fractures of the femur, who underwent hemiarthroplasty of the hip joint in the trauma departments of the Clinical Hospital of Emergency Medicine (CHEMS), formerly the Bishkek Scientific Research Center of Traumatology and Orthopedics (BSRCTO) from 2019 to the present. According to the WHO age of patient classification, the number of cases in elderly people was twice as high as in the elderly. This is due to the appearance of osteoporosis among older age groups of people, with an improvement in life and a sharp increase in the number of elderly people. Despite the prevalence of the use of primary arthroplasty in the treatment of femoral neck fractures, its use for injuries to the trochanteric region remains an open question and is being actively studied by many authors from foreign countries. Transtrochanteric femur fractures in elderly and senile individuals are very common and can be treated with a variety of fixation techniques such as internal fixation and arthroplasty. Today, surgeons concluded that hemiarthroplasty of the hip joint is rapidly regenerating and necessary in the treatment of trochanteric fractures of the femur in older people.

In the period from 2006 to 2021, 377 patients with dysplastic coxarthrosis aged 16 to 68 years who underwent total hip replacement using endoprostheses from foreign companies were under our supervision at the Bishkek Research Center of Traumatology and Orthopedics. The follow- up period ranged from 6 months to 15 years. All patients with dysplastic coxarthrosis, in accordance with the J.F. Crowe classification, are divided into three subgroups that determine the degree of dysplasia depending on the subluxation (magnitude of proximal migration) of the femoral head. The first subgroup included 176 patients who underwent 230 total hip replacement operations on the background of grade I dysplasia, the second – 132 patients with grade II and III dysplasia who underwent endoprosthesis of 152 joints, and the third subgroup ‒ 69 patients who underwent 70 hip replacement on the background of grade IV dysplasia (with high dislocation hips).
In order to solve the problem of hip replacement with defects in the coverage of the acetabular component with bone tissue, we have developed and put into practice a method of mathematical calculation in which a mathematical model is created with the help of which the optimal size of the working surface of the acetabulum for the acetabular component of the endoprosthesis is calculated as a percentage.
Statistical analysis of the data obtained and assessment of the outcomes of treatment of patients with dysplastic coxarthrosis using the method of total endoprosthetics revealed positive dynamics in 84.6% of observations.

This work describes various treatment methods for periprosthetic fractures of the proximal femur. The aim of the research is to analyze the methods of osteosynthesis in operative treatment. The study applied instrumental and clinical methods. An analysis of surgical treatment methods for patients using cerclage wire, bone plates, and revision endoprosthetics during the operation has been conducted. Additionally, data from both near and distant results have been analyzed. Comparative descriptions of the obtained results were made. The scientific value of this work may serve as a basis for the further development of methods and techniques for fixing fractures, and contribute to the advancement of science. The practical significance lies in achieving rigid fixation of fractures during surgery, which provides the opportunity for early rehabilitation of adjacent joints and restoration of limb function. The economic significance lies in the need to analyze the data of the obtained results in treatment, and to choose a treatment strategy that does not negatively impact the patient's financial situation and the state healthcare economy. In conclusion, it should be noted that considering the intramedullary component's placement, methods and techniques for rigid fixation of fractures should be developed.

The work is based on the analysis of experiments conducted on 32 dogs modeling firearm fractures using the Ilizarov apparatus. The experiment was carried out in 2015 in the high- mountain scientific base Too Ashuu. The relevance of the study is due to the unique physiological and environmental characteristics of high mountain regions, which significantly affect the healing process of bone tissue. The article analyzes the results of surgical interventions, assesses the degree of restoration of anatomical integrity and functional activity of the limbs, and also examines the features of adaptation to a high-altitude environment. The results demonstrate that the method of stable osteosynthesis creates optimal conditions for the recovery of damaged limbs. Ensuring close contact and immobility leads to minimal pathological reactions from the vessels, thereby preventing their re-injury. This promotes improved tissue nutrition, accelerated recovery of muscle fibers, and complete regeneration of bone tissue. The dynamics of healing are analyzed, including parameters of bone tissue regeneration, callus formation, the degree of inflammatory reactions, as well as complications that arise during the treatment process. The findings may be useful for the development and improvement of fracture treatment techniques in extreme conditions and in the context of injuries caused by firearms.

This study is devoted to repeated operations for degenerative diseases of the lumbosacral spine. The study included 65 patients who were divided into two comparative groups. Group I consisted of 36 patients aged from 29 to 60, average age 43 years, operated on using the TLIF technique. There were 17 men (47.3%), 19 women (52.7%). Group II included 30 patients aged from 23 to 67 years, average age 43.3 years, operated on using the OLIF technique. The ratio of men to women in this group was 14 (46.6%): 16 (44.4%). As a result of a comparative analysis, VAS and ODI scores in group II are better than in group I, p < 0.001. Thus, OLIF as a method of reoperation makes it possible to completely remove the disc in case of recurrent disc herniation, avoids repeated incision of the paravertebral muscles, there is less postoperative pain and blood loss during surgery, and a low risk of injury to the spinal cord and roots as a result of traction.

Spinal fractures are considered a significant cause of disability and a socioeconomic problem. The incidence of spinal injuries tends to increase with age, due to decreased bone density and increased high-energy injuries. In this study, we assessed the frequency, etiology, nature of thoracolumbar spine injuries and their treatment methods in the Bishkek Clinical Emergency Hospital. Clinical and radiological data of 90 patients with thoracolumbar spine fractures admitted to the hospital from 2022 to 2023 were analyzed, the mechanism of injury, the level of damage, the nature of the fracture and treatment methods were assessed. The average age of the patients was 50.24±19.21 years; men accounted for 51.6%. Compression injuries accounted for (96.5%), with the most common location being fractures of the thoracolumbar spine. Low-energy injuries accounted for half of all fractures. Concomitant neurological damage was detected in 4.5% of patients and was more common in younger patients. Pathological fractures occurred in 13.4% and were more common in older people and women. Thus, road accidents and falls from height were the most common causes of spinal fractures in patients under 40 years of age. However, 60% of fractures occurred in women and were caused by a simple fall from their own height, reflecting the high prevalence of impaired bone mineral density among women and older people. Therefore, to reduce the risk of spinal injury, it is necessary to recommend compliance with road safety and labor safety measures in high-rise buildings, as well as safety measures for older people at home and on the street.

We observed 94 patients with gonarthrosis. Clinical observations were presented in two groups: control and main. The reasons for unsatisfactory outcomes of high corrective osteotomy of the tibia were studied based on literature data and our own material. A device for rigid fixation of bone fragments after high corrective osteotomy of the tibia has been developed and introduced into clinical practice, which allows, due to a special spacer, controlled correction of deformity and maintaining a given correction angle. The proposed device consists of a metal T-shaped locking plate with angular stability of screws and a spacer. A comparative analysis of the immediate and long-term results of surgical treatment of patients operated on using the developed device and known fixatives was carried out. In the main group, the average results were 4.7 points higher compared to the control group. The effectiveness of treatment in the main group was 17.4%, and in the control group 10.5%. The scientific research work carried out confirmed the advantages of the developed new device over traditional fixators. This is reflected in precise, controlled correction of varus deformity during surgery and stable fixation of fragments until complete consolidation. The absence of complications such as overcorrection and insufficient correction, as well as complications associated with unstable fixation.

The purpose of this study was to develop a comprehensive rehabilitation program adapted for patients with spinal cord injury (SCI) in the intermediate and late periods of recovery. The study included 87 patients (63% men, 37% women) aged 19 to 68 years who underwent surgical correction. A comprehensive assessment was carried out, including an analysis of complaints, medical history, somatic and neurological status, as well as spinal biomechanics.
The rehabilitation protocol included drug therapy, kinesiotherapy, massage, balneotherapy, physiotherapy, thermal treatment and acupuncture. The results showed significant effectiveness: 79% of patients achieved significant improvement and 21% achieved partial functional recovery. There were no unsatisfactory outcomes recorded.
The discussion highlights the importance of a systems approach to rehabilitation that takes into account the phases of injury and the individual needs of patients. The study highlights the critical role of early and comprehensive intervention in improving patient outcomes and preventing residual effects and complications.
In conclusion, the study supports the effectiveness of a multifactorial rehabilitation approach in improving functional and social outcomes in patients with spinal cord injury (SCI) in the intermediate and late recovery periods.

We analyzed the conservative and surgical treatment of 769 patients with stable and unstable pelvic fractures. The study group included patients with fractures of all types according to the ASIF classification. The average follow-up period after surgery was 1 year. Treatment results were assessed based on a clinical examination, analysis of radiographs, and the Mattis rating scale. Good results (76%) were obtained in patients with pelvic fractures type B3, C2, according to the classification of A.O. The number of satisfactory and unsatisfactory results – 15% and 9%, respectively – was obtained in patients in the group with the most severe type C3 injuries. Complications in the form of suppuration, impaired stability of fixation with loss of reposition were observed in 5 people (9%), two patients from group 3 died. The data obtained allow us to conclude that immersion osteosynthesis using various structures, performed as early as possible (damage control) remains today the gold standard in the treatment of unstable pelvic fractures. The greatest number of complications was observed in the group of vertically unstable C3 pelvic fractures. The obtained data correlate to a certain extent with the data of domestic and foreign literature.

This study presents an original method for surgical correction of femoral neck fractures in elderly and senile patients. The main emphasis is on the use of hemiarthroplasty of the hip joint as an effective way to restore the anatomical and functional characteristics of the joint. This article reviews the technical aspects of the procedure, clinical observations, and long-term patient outcomes with an extended follow-up period. The presented approach demonstrates the prospects for improving the surgical treatment of this type of fractures in age groups, which makes it a significant contribution to the practice of orthopedic surgery. This article is devoted to the original method of hemiarthroplasty of the hip joint for a fracture of the femoral neck in elderly and elderly people, its stages of implementation, which ensure tight attachment of the hip joint capsule to the anatomical site to further prevent dislocation of the endoprosthesis in the postoperative period and early supportability on the operated limb. Conclusion: after hemiarthroplasty, fixation of the posterior part of the hip joint capsule, tunneling, suturing the hip joint capsule through the tunnel tightly and hermetically strengthens them, and prevents dislocation (dislocation) in the postoperative period. The method we proposed for suturing the hip joint capsule is easy to use, does not require special training of a doctor, and promotes rapid recovery and rehabilitation of the operated limb.

The work is devoted to the topical issue of modern orthopedics, surgical treatment of gonarthrosis with varus deformity. The purpose of the study is to minimize intraoperative traumatization, reduce the loss of correction of the tibial axis, reduce the time of onset of bone block and early rehabilitation of patients in the postoperative period, and we were also tasked with developing a device that provides rigid stabilization of bone fragments. More than 85 patients were operated on, who underwent high transverse osteotomy of the tibia and traced the immediate and long-term results. The use of this technique is advisable in young patients with deforming arthrosis of the knee joints of the second or third stage. The experience of corrective tibial osteotomy using bone plates in the form of a "butterfly" allows us to recommend it for wide use in clinical practice. This is expressed in stable fixation, the absence of complications such as migration of plastic. The minimally invasive surgical correction in the initial stages of gonarthrosis in adults with the use of a mini-plate with high clinical and radiological reliability has shown that this technique in the overwhelming majority of cases gives favorable results.

The authors studied the results of osteosynthesis in 96 patients with ununited fractures and pseudoarthrosis of long bones of the skeleton who received treatment in the traumatology department of the KBSMP. Of these, 54 (51.84%) were men, 42 (40.32%) were women, their age ranged from 14 to 70 years. An analysis of the mistakes made and recommendations for their prevention were carried out.
Errors that occur during the treatment of patients with limb fractures are a common cause of unfavorable outcomes. Despite the special attention of specialist doctors, the number of errors and complications does not decrease. After unwanted doctor mistakes, the most frequently developing complication leading to disability is: formation of a pseudarthrosis, failure of metal osteosynthesis due to migration or fracture of the fixator, development of osteomyelitis with subsequent bone defect, post-traumatic arthrosis with joint stiffness (post-traumatic contracture).

In this study, the results of surgical treatment of 86 patients suffering from calcaneal fractures at the BNICTO were analyzed. The main aspect of the study was to study the effectiveness of a new minimally invasive method of fracture fixation proposed by the authors of the article. This method has proven to be particularly effective in reducing infectious complications in the postoperative period, which is important, especially in patients with a traumatic soft tissue defect in the area of the fracture site, as well as in those who suffer from diabetes mellitus, diseases of the cardiovascular system and internal organs. This method also contributes to the earlier start of patient rehabilitation, which significantly reduces the financial burden on patients and reduces the duration of antibiotic therapy. A special feature of the developed device is its ability to provide accurate and low-traumatic comparison of heel bone fragments and perform minimally invasive osteosynthesis. The simplicity and practicality of its use make this method especially attractive for orthopedic traumatologists who seek to improve the results of treatment of this pathology. Thus, the results of the study confirm the promise and significance of introducing this new method into clinical practice to improve the quality of surgical treatment of calcaneal fractures and reduce complications after operation.

Infectious complications are a serious problem in the treatment of long bone fractures. They can lead to significant weakening of recovery and even prolonged hospitalization for the patient. In this regard, the implementation of competent prevention and timely treatment of infectious complications is important. In this article, we analyzed the development of infectious complications in patients who underwent surgical interventions for fractures of the limbs and also after the installation of endoprostheses at the Talas Regional United Hospital. Peri-implant and periprosthetic infectious complications were observed in 20 patients; all patients underwent bacteriological examination of wound smears before and during surgery. Antibiotic prophylaxis was carried out taking into account culture and sensitivity to the antibiotic. Only in 3 cases was it possible to save the implant and stop the infection process; in all other cases, the implants and endopotheses were removed with arthrodesis of the joints and the use of an external fixation device. The wounds were kept open to prevent the accumulation of purulent discharge from the wounds. An analysis of strategies for the prevention and treatment of infectious complications in the treatment of long bone fractures was carried out. The results of previous studies, medical recommendations and clinical practices in this area were analyzed.

Based on our own experience and international recommendations, the work outlines the basic principles of infusion-transfusion therapy for blood loss and hemarogic shock in polytrauma. Numerous works in all fields of clinical medicine are devoted to the replacement therapy of acute blood loss, the possibilities of its correction and various methods. The thought of this indicates both the severity of the problem and the lack of consensus on ways to solve it. Our work reflects the main characteristics of transfusion therapy for acute mass traumatic blood loss. Special attention is paid to the changes in the concept of transfusion therapy that have occurred over the past 10 years. The importance of the provision on the need for early infusion of high doses of FFB and timely use of platelet concentrate as the most effective therapeutic measures to prevent the progression of acute disseminated intravascular coagulation is emphasized. It is concluded that excessive administration of saline solution is unacceptable in conditions of frequent development of metabolic acidosis in victims. We will consider the issue of introducing the proposed massive transfusion protocol into clinical practice in territorial hospitals of the Kyrgyz Republic.

The problem of surgical treatment of fractures of the proximal end of the humerus is one of the most pressing in traumatology and orthopedics.
Proximal humerus fractures account for 80% of all humerus fractures. For fractures of the proximal end of the humerus, various types of osteosynthesis are used, using various plates, intraosseous rods, screws, knitting needles, metal forks, wire loops, etc. These fixators, as a rule, cannot provide sufficiently strong osteosynthesis of the proximal end of the humerus, and therefore,after operations, additional external immobilization of the damaged limb is carried out with plaster casts and scarves, especially in elderly and senile patients.
In surgical practice, it is known to use metal structures and implants made of material with thermomechanical shape memory, the advantage of which is the high biocompatibility of the materials, good fixation, providing compression for the entire period of treatment, and the fact that repeated operations to remove these metal structures are not required.
The experience of surgical treatment of injuries of the proximal end of the humerus with fixators with thermomechanical shape memory is presented, 6 patients with fractures of the proximal end of the humerus with displacement of fragments, the age of the patients ranged from 15 to 72 years, in our trauma department of the Clinical Emergency Hospital in the period 2023-24. Of the 6 patients monitored, we received positive results as excellent, good, satisfactory in 5 (83.4%) patients, and in 1 (16.6%) as an unsatisfactory result of the treatment.

С юбилеем! 60 лет Джумабекову Сабырбеку Артисбековичу