ORTHOPAEDICS TRAUMATOLOGY and PROSTHETICS

FEATURES OF SURGICAL TREATMENT OF COMBINED GUNSHOT WOUNDS OF THE HIP JOINT

Sun, 21 Dec 2025 00:00:00 +0200

A retrospective analysis of surgical treatment is given 7 patients with combined gunshot wounds pelvis and hip joint. Objective. Analyze the results and determine the features of treatment of victims with gunshot wounds to the pelvis and hip joint. Methods. Patients with combined gunshot wounds to the pelvis and hip joint were distributed according to age, the nature of the fracture of the bone, current of the pelvis and proximal thigh, the nature of injuries to the internal organs of the abdominal cavity and pelvis, main nerves, the duration of the total hip arthroplasty (THA), the presence of infectious complications during treatment with the release of pathogen, the period of observation and the assessment on the scale Harris Hip Score (HHS). Analysis of combined firearms wounds of the pelvis and hip joint were carried out comprehensively with the involvement of a multidisciplinary team of specialists (abdominal and vascular surgeons, traumatologist, urologist, proctologist). Results. On the basis of statistical analysis, it was found that among 7 patients with average age 41.1 years, THA was completed in 5/7 (71 %). Medium term to THA (among those who underwent arthroplasty) was 17.0 months. Infectious complications were observed in 57 % of patients: Klebsiella pneumoniae and Klebsiella pneumoniae, Pseudomonas aeruginosa. In case of detected infection or questionable sterility, a two-stage treatment strategy is needed, that has better performance infection control after eradication of infection. Conclusions. In our opinion, the treatment algorithms in the case of gunshot wounds joint injuries of the hip joint will make it possible to reduce the level of infectious complications and improve the reproduction of results of treatment in this category of victims.

DESTRUCTION OF BONE AND SURROUNDING TISSUES IN CASE OF GUNSHOT FRACTURES OF LONG BONES OF THE EXTREMITIES (CLINICAL AND RADIOLOGICAL CLASSIFICATION). FIRST REPORT

Sun, 21 Dec 2025 00:00:00 +0200

Objective. To determine the nature of the destruction of the bone and surrounding tissues in gunshot fractures of the long bones of the extremities and to create their clinical and radiological classification. Material and methods. 123 cases with gunshot fractures of the long bones of the extremities (127 fractures) were studied. The number of intermediate fragments, the magnitude of their transverse displacement, the length of the bone destruction zone, the shape and size of the soft tissue wound were studied. During the operation, the state of the anatomical connection of the fragments with the periosteum and muscles was assessed. Based on known data on the mass and speed of traumatic agents, calculations of their energy that occur during the action of a bullet and a hit by a moving car were made. Results. 97 % of the victims had multifragment fractures, among them 50 % had 2–3 intermediate fragments, 30 % — 4–6 and 22 % — 7 or more, or a primary bone defect was formed. Based on the number of formed intermediate fragments, the magnitude of their transverse displacement and the presence (or absence) of anatomical connection with living tissues, we distinguished three types of gunshot fracture: 1 — with slight or moderate transverse displacement of the intermediate and main fragments (within the diameter of the bone and with preservation of the longitudinal orientation); 2 — with significant transverse displacement of one or more intermediate fragments (in the direction of the projectile movement) with loss of anatomical connection with the periosteum and formation of a parietal defect of the bone and a wound of medium or large size; 3 — with excessive transverse displacement of all intermediate fragments (in the direction of the projectile movement) with loss of their anatomical connection with the periosteum and formation of a complete transverse defect of the bone. It was found that in the majority (66%) of gunshot fractures, despite the presence of a soft tissue wound, the intermediate and main fragments retain an anatomical connection with the periosteum and muscles, and this is of great importance in choosing treatment tactics.

APPLICATION OF SURGICAL TECHNOLOGIES FOR THE TREATMENT OF VICTIMS WITH LONG BONE DEFECTS DUE TO MODERN COMBAT TRAUMA

Serhiy Guryev, Serhiy Hariyan, Vitalii Kushnir, Oleksandr Tsybulsky — Sun, 21 Dec 2025 00:00:00 +0200

Modern combat operations cause severe injuries to humans due to the impact of new, more intense means of destruction. Objective. To determine the general structure of the application of medical technologies for the surgical treatment of victims with defects of long bones due to modern combat trauma. Materials and methods. The study is of a cohort nature, conducted in accordance with the requirements and criteria of evidencebased medicine with the level of evidence II b Oxford. The study array consisted of 115 cases of long bone defects in victims with combat trauma. This study was conducted in compliance with the requirements of the Declaration of Helsinki, approved by the Bioethics Commission of the State Research Institute «Ukrainian Scientific and Practical Center of Emergency Medical Care and Disaster Medicine of the Ministry of Health of Ukraine». Results. The study found that in the general population of victims with long bone defects due to combat trauma, the following technologies were most often used: retrograde bone transport 29.35 %, Masquelet technology 27.17 %, antegrade bone transport 21.74 %. It was also found that only Masquelet technology is used in the surgical treatment of long bone defects of all limb segments. The choice of technology for the treatment of long bone defects probably depends on the limb segment. All of the listed technologies were used on the distal segment of the lower limb, but to varying degrees. Conclusions. In the treatment of long bone defects due to modern combat trauma, technologies are diverse, including both the latest and classic approaches. Masquelet technology is the method of choice for surgical treatment of victims of modern combat trauma with bone defects of the long bones of the upper limb and the proximal segment of the lower limb. Antegrade transport technology is the method of choice for the distal segment of the lower limb. The use of a specific technology for surgical treatment of bone defects due to modern combat trauma evidently depends on the characteristics of the affected segment. Further careful research is needed to reliably explain this fact.

ANALYSIS OF THE APPLICATION OF THE MASCULÉ TECHNIQUE IN THE TREATMENT OF CRITICAL TIBIAL DEFECTS AFTER GUNSHOT WOUNDS COMPLICATED BY OSTEOMYELITIS

Sun, 21 Dec 2025 00:00:00 +0200

Despite significant progress in the development of medicine, post-traumatic osteomyelitis remains one of the biggest problems in the treatment of patients in the orthopedic and traumatology specialty. The Masquelet technique has been most often used in the treatment of chronic osteomyelitis in recent years. Given the high relevance of this problem in foreign and domestic literature, we decided to analyze our own results of treatment of patients after gunshot, shrapnel or mine-explosive wounds of the lower extremities, namely with the presence of critical tibial defects complicated by osteomyelitis under the conditions of using the Masquelet technique. Purpose. To analyze the results of application and determine the clinical and laboratory dependencies of the Masquelet technique in the case of replacement of critical tibial defects after gunshot wounds complicated by osteomyelitis. Methods. The study analyzed 153 patients with critical tibial defects after gunshot wounds complicated by osteomyelitis. Results. With the correct use of the Masquelet technology, bone graft reconstruction was achieved in all patients, the average period was (168.08 ± 62.0) days. Among the shortcomings, it is worth noting the significant dependence of the consolidation period on the condition of the soft tissues, as well as on the pathological pathogen (the presence of Klebsiella pneumoniae or Pseudomonas aureginos in the wound). The terms of consolidation and reconstruction of the bone graft were significantly extended due to these factors. However, the issue of replacing critical bone defects of the tibia after gunshot wounds complicated by osteomyelitis requires further study and comparison of existing techniques.

BIOMECHANICAL STUDY OF A COMBINED FIXATION SYSTEM FOR GUNSHOT FEMORAL FRACTURES

Igor Lurin, Olexandr Burianov, Yurii Yarmolyuk, Bohdan Matviichuk — Sun, 21 Dec 2025 00:00:00 +0200

Gunshot injuries of the femur in combat settings are associated with high-energy trauma and unstable diaphyseal fractures (81.4 %), which require fixation methods with increased demands for mechanical rigidity. Objective. To investigate the stress-strain state of a computer model of the femur with a comminuted fracture fixed with an intramedullary spacer and an external fixation device using pins of 5 mm and 6 mm in diameter. Methods. A three-dimensional model of a diaphyseal comminuted femoral fracture and two models of combined fixation («external fixator + intramedullary spacer») with four pins of 5 mm and 6 mm diameter were created. Biomechanical analysis was performed using the finite element method. The evaluated parameters included displacement, stress, and strain under a static load of 400 N. Results. Numerical analysis of the stressstrain state demonstrated that both studied constructs with 5-mm and 6-mm pins provide sufficient fixation stiffness. Increasing the pin diameter to 6 mm resulted in reduced maximal displacements and peak stresses, indicating a biomechanical advantage of the «bone – intramedullary spacer + external fixator with 6-mm pins» system. Conclusions. The conducted numerical stress-strain analysis showed that despite adequate stability provided by both fixation systems, the «bone + intramedullary spacer + external fixator with 6-mm pins» construct has a biomechanical advantage over the construct with 5-mm pins in terms of maximal displacement, stress, and strain values.

ANALYSIS OF THE PREVALENCE AND RISK FACTORS FOR VENOUS THROMBOEMBOLIC COMPLICATIONS IN PATIENTS WITH PROXIMAL FEMORAL FRACTURES

Mykola Ankin, Viktoriia Ladyka, Fadi Akhmad — Sun, 21 Dec 2025 00:00:00 +0200

Due to the increasing incidence of PFA fractures and the associated morbidity and disability, the treatment and rehabilitation of patients with this pathology is a global problem of modern traumatology and orthopedics. Objective. To determine the incidence of venous thromboembolic complications in the setting of proximal femoral fractures, the presence of additional risk factors, and the possibility of using the Caprini score to identify surgical patients at “extremely high risk” of venous thromboembolism (VTE). Methods. The examination and treatment results of 153 (58 men, 95 women) patients aged 23 to 94 years (average 69.95±15.83 years) with proximal femoral fracture were studied. Results. The incidence of acute venous thromboembolic complications among patients with proximal femoral fractures is 13.7 %. The vast majority (98 %) of patients in this category have additional risk factors for VTE development, in addition to femoral fracture. A Caprini score of 10 points is associated with an increase in the risk of VTE development in patients with proximal femoral fractures by 11.7 times (95 % CI [1.25–109.3]), 11 points — by 23.7 times (95 % CI [2.25–250.2]), 12 points — by 45.1 times (95 % CI [4.42–461.0]), 13 and more points — by 79 times (95 % CI [8.95– 697.4]) compared with the presence of 5–8 points. Conclusions. The Caprini score was found to identify patients at “extremely high risk” of developing VTE. The cut–off level of the Caprini score > 10 points allowed identifying patients at “extremely high risk” of thrombosis (AUROC 0.845; 95 % CI 0.769–0.922).

Radiographic features of knee osteoarthritis in the lateral view depending on joint line obliquity

Sun, 21 Dec 2025 00:00:00 +0200

Objective. To evaluate the radiographic features of sagittal knee joint morphology in osteoarthritis, taking into account the joint line obliquity determined using an original method (mJLO). Methods. 62 lateral knee radiographs of 45 patients with medial knee osteoarthritis were analyzed. The following radiographic parameters were assessed: posterior distal femoral angle (PDFA); posterior condylar offset ratio (PCOR); posterior tibial slope (PTS); tuberosity-modified tibial slope (TMTS); and tibial tuberosity inflection angle (TTIA). The mJLO was calculated as aMPTA + aLDFA + 6°. Values of mJLO < 177° were defined as apex distal (AD), 177°–183° as apex neutral (AN), and > 183° as apex proximal (AP). Statistical significance was defined as p ≤ 0.05. Results. AD was found in 43 patients (69.35 %), AN in 16 (25.81 %), and AP in 3 (4.84 %). Higher mJLO values and more proximal joint line orientation were associated with lower PDFA (τ = – 0.25, p = 0.004) and PCOR (τ = – 0.22, p = 0.01). Patients with PDFA > 88° had significantly higher odds of AD (OR = 3.63; CI: 1.20–12.33; p = 0.02), as did those with PTS > 8° (OR = 5.22; CI: 1.65–19.40; p = 0.004). Conversely, AD was less likely in patients with PDFA < 78° (OR = 0.08; CI: 0.01–0.34; p = 0.0005) and PTS 3°–8° (OR = 0.25; CI: 0.07–0.76; p = 0.01). Patients with PTS > 8° had a lower odds of AN (OR = 0.28; CI: 0.07–0.90; p = 0.03). Significantly higher odds of AP were observed i n i ndividuals w ith P DFA < 7 8° ( OR = 4 9.00; C I: 4.17–6846.81; p = 0.001) and PCOR < 0.44 (OR = 11.67; CI: 1.06–1596.60; p = 0.04), whereas PCOR > 0.44 decreased the likelihood of this obliquity type (OR = 0.09; CI: 0.0006–0.94; p = 0.04).

MODERN CONCEPTS OF DIAGNOSTICS OF POSTEROLATERAL CORNER KNEE INJURIES

Maxim Golovakha, Yevhen Bilykh, Andrii Bezverkhyi — Sun, 21 Dec 2025 00:00:00 +0200

Injuries to the posterolateral corner (PLC) of the knee are usually not initially apparent, and diagnosis and treatment require a full understanding of the functional interactions of their structures, as well as a specific history and complete physical examination. Objective. To summarize current concepts regarding the anatomy, biomechanics, and diagnosis of PLC injuries of the knee and to outline directions for improving the diagnostic algorithm. Materials and methods. A narrative review of publications indexed in PubMed, Scopus, and Google Scholar was conducted, focusing on anatomical and biomechanical characteristics, clinical manifestations, imaging modalities, and classification systems for PLC injuries. Results. The lateral collateral ligament, popliteofibular ligament, popliteus tendon, posterolateral capsule, and associated musculotendinous complexes were identified as the key static and dynamic stabilizers resisting varus stress and external rotation of the tibia. PLC injuries are rarely isolated; more commonly, they occur in combination with anterior or posterior cruciate ligament tears and, if not diagnosed in a timely manner, lead to chronic instability and increased load on the medial compartment of the knee. Clinical stress tests and varus stress radiography provide an approximate assessment of instability; however, existing classification systems do not fully capture the variety of injury patterns and their combinations, while the sensitivity of conventional MRI, particularly in chronic cases, remains limited. Arthroscopy may serve as an additional method for intra-articular evaluation. Conclusions. Accurate diagnosis of PLC injuries requires a standardized, multimodal approach with precise identification of the injured structures. The development of an integrated, differentiated diagnostic algorithm supported by machine-learning – based artificial intelligence tools appears to be a promising strategy for improving early detection and optimizing treatment planning.

PROGNOSTIC FACTORS IN THE TREATMENT OF FOCAL OSTEOCHONDRAL LESIONS OF THE KNEE AND ANKLE

Taras Omelchenko, Yevhenii Levytskyi — Sun, 21 Dec 2025 00:00:00 +0200

Osteochondral lesions of the knee and ankle joints are a common pathology that often results in decreased physical activity and early osteoarthritis. Despite the wide range of available surgical techniques, their efficacy varies considerably. Identifying prognostic factors is essential for optimizing treatment strategies. Studying and taking into account the factors that determine the outcome of treatment is a relevant issue in terms of improving the efficiency of providing care to patients in this category. Objective. To identify prognostic factors and informativeness coefficients in treatment of patients with osteochondral lesions. Methods. A retrospective study included 390 patients with focal osteochondral lesions treated with arthroscopic debridement, microfracture, drilling, or osteochondral autograft transplantation. Treatment effectiveness was evaluated using 21 clinical and morphological parameters and functional scores (Lysholm, AOFAS, SF-36, NRS) at 12–36-month follow-up. Statistical analysis included Bayesian probabilistic methods adapted for clinical research, Kulback’s information measure to assess information coefficients, and a heterogeneous sequential procedure based on Wald analysis to determine prognostic coefficients. Results. Positive outcomes were observed in 284 patients (72.8 %), while 106 (27.2 %) had negative outcomes. Key prognostic factors included age, body mass index, lesion size, Kellgren & Lawrence osteoarthritis stage, lesion chronicity, limb axis deviations, and prior surgical history. Conclusions. The identified prognostic and informativeness coefficients have practical value for establishing an individualized approach to selecting the optimal treatment strategy and improving long-term outcomes.

ANALYSIS OF THE RESULTS OF SURGICAL TREATMENT OF PATIENTS WITH THE CONSEQUENCES OF OBSTETRIC DUCHENNE-ERB PARALYSIS

Sun, 21 Dec 2025 00:00:00 +0200

To improve upper limb function in obstetric palsy, a number of surgical techniques have been proposed worldwide. However, achieving the desired rehabilitation effect is not always possible. Objective. To analyze the treatment outcomes in patients with the sequelae of Duchenne–Erb obstetric palsy depending on the severity of pathology, the diagnostic methods applied, and the chosen surgical tactics. Methods. A retrospective and prospective study was conducted to evaluate the treatment outcomes of children with Duchenne–Erb obstetric palsy who underwent surgery at the Pediatric Orthopedics Department of the SI «Sytenko Institute of Spine and Joint Pathology of the National Academy of Medical Sciences of Ukraine». The retrospective group consisted of 6 patients; the prospective group included 16 patients, divided into two subgroups of eight: Group I — without bony deformities; Group II — with secondary bony deformities. Tendon-muscle transfers were performed in Group I, while a two-stage surgical intervention was applied in Group II. Parents of the children completed questionnaires. Results. In the retrospective group, after L’Episcopo surgery, an improvement in the function of the affected limb according to the Mallet scale was observed in two patients, while in the prospective group (in the long-term postoperative period) improvements were recorded in 10 cases. Group II demonstrated more pronounced and statistically significant positive changes in upper-limb function (p < 0.05). The frequency of functional improvement according to the Mallet scale between the prospective and retrospective groups did not reach statistical significance (p > 0.05). Differences in postoperative muscle strength between Groups I and II were not statistically significant (p > 0.05). After treatment, parents’ assessment of their child’s functional status increased by (5.1 ± 1.3) points, satisfaction with life — by (4.3 ± 1.3) points, and overall quality of life — by (9.4 ± 2.6) points (p < 0.001). Conclusions. A differentiated approach to choosing treatment tactics allows not only improving the function of the affected limb but also enhancing patients’ quality of life, improving their psycho-emotional state, and increasing life satisfaction.

THE EFFECT OF DEPTH OF ANESTHESIA ON THE INCIDENCE OF EARLY POSTOPERATIVE COMPLICATIONS DURING SURGERY IN THE BEACH CHAIR POSITION

Kseniia Lyzohub, Dmytro Morozenko — Sun, 21 Dec 2025 00:00:00 +0200

Objective: To investigate the effect of BIS-controlled anesthesia depth on hemodynamic changes and early postoperative complications during shoulder surgery in the BCP. Methods. The prospective study involved 50 patients who underwent shoulder surgery in the BCP. Group Ι (n = 25) — patients whose BIS values were maintained intraoperatively within the range of 40– 48, Group ΙΙ (n = 25) — patients whose BIS monitoring values were maintained at the level of 49–57. Intraoperative BIS fluctuations beyond the range of 40–60 were not allowed in patients of both groups. The average age of patients in the Ι group was 43.2 ± 12.5 years, in the ΙΙ group — 41.8 ± 10.2 years. After induction of propofol/fentanyl in a standard dosage, tracheal intubation, the patient was transferred to the BCP. For postoperative pain relief, patients received paracetamol and non-steroidal anti-inflammatory drugs without the use of narcotic analgesics. BIS monitoring with COVIDEN was used to control the depth of sedation. The Minimental state examination (MMSE) scale and the number linking test were used to assess cognitive impairment 24 hours before surgery and 2 days after surgery. Pain was assessed using a visual analogue scale (VAS). Results. Haemodynamic parameters were assessed before induction, after induction, and 20 minutes after positioning. Patients in group Ι had a significantly higher pulse rate (79.04 ± 7.51 vs. 72.76 ± 9.46 mm Hg, p < 0.05). No significant changes in MMSE and number binding test were found when comparing pre- and postoperative indicators. Significant differences in the intensity of pain syndrome were found between the groups: 3.72 ± 1.06 vs. 5.11 ± 0.90 points on the first day after surgery (p < 0.001). In group 1, 12.0 % of patients experienced postoperative nausea and vomiting on day 1, compared to 20.0 % in group 2. The time of extubation showed a significant difference between groups 1 and 2: 19.08 ± 2.87 versus 15.30 ± 2.55 points (p < 0.001). Conclusions. Maintaining the level of sedation under BIS monitoring at 49–57 in patients during surgery in NSP conditions is accompanied by less postoperative pain and a lower incidence of PONV.

RESULTS OF SURGICAL TREATMENT OF DEGENERATIVE LUMBAR SCOLIOSIS IN ADULTS

Andriy Mezentsev, Dmytro Petrenko, Dmytro Demchenko — Sun, 21 Dec 2025 00:00:00 +0200

Degenerative lumbar scoliosis represents a significant medical and social issue, most frequently diagnosed in patients over 50 years of age. The condition may present as a primary deformity (scoliosis de novo) or as a progression of idiopathic scoliosis. Its clinical course varies from asymptomatic cases to severe pain syndromes, neurological deficits, and loss of trunk balance. Objective. To evaluate the outcomes of surgical treatment in patients with degenerative lumbar scoliosis and to assess the effectiveness of deformity correction and functional recovery. Methods. A retrospective analysis was conducted in 37 patients aged 48–73 years (mean age, 56.6 years). The assessment included clinical examination, radiographic parameters (Cobb angle, PI-LL, SVA, PT, Th1PA, L1PA), and Oswestry Disability Index and Visual Analog Scale (VAS) scores. All patients underwent transpedicular fixation with posterior column osteotomy; in some cases, spinal canal decompression was additionally performed. The mean length of instrumented fusion was 5.1 segments. Comorbidities and postoperative complications were also analyzed. Results. The mean Cobb angle decreased from 47.7° preoperatively to 20.7° at 3 months and 23.7° at 1 year. Sagittal and coronal balance parameters approached reference values, indicating the achievement of solid fusion. The Oswestry Disability Index improved from 52.1 % (severe disability) to 22.7 % (mild disability) at 1 year. VAS scores demonstrated a significant reduction in pain: from 67.2 mm (back) and 69.2 mm (leg) to 19.3 mm and 21.5 mm, respectively. Postoperative complications occurred in 48.6 % of patients, most commonly wound healing disorders and transient neurological deficits, but did not significantly affect final outcomes. Conclusions. Notably, substantial functional improvement was achieved only one year after surgery.

DEGENERATIVE CHANGES IN RAT ANKLE CARTILAGE INDUCED BY VARUS EXTRA-ARTICULAR FEMORAL DEFORMATION

Kostiantyn Romanenko, Nataliya Ashukina, Valentyna Maltseva — Sun, 21 Dec 2025 00:00:00 +0200

Objective. To evaluate the structure of ankle joint articular cartilage in rats following experimentally induced deformation of the middle third of the femur over a six-month observation period. Methods. An experimental study was conducted on 18 sixmonthold male rats divided into two groups. In the experimental group, extra-articular femoral deformation was modeled by inserting a Kirschner wire fragment bent at a 35° angle into the medullary cavity; the control group remained intact. Animals were evaluated at 1, 3, and 6 months. Structural changes in the articular cartilage were assessed using the Osteoarthritis Research Society International (OARSI) scale, and the height of the articular cartilage of the ankle joint was measured. Results. At 1 month, structural changes were observed only in the talar cartilage, corresponding to OARSI grades 0–1. At 3 months, changes in the tibial cartilage corresponded to grades 1–2, in the talar cartilage to grades 1–3, and in the contralateral limb to grades 0–1 for both surfaces. At 6 months, tibial cartilage changes reached grade 2, talar cartilage grade 2–3, and the contralateral limb grade 1–2. Cartilage height in rats with deformity decreased 1.2-fold from the 3rd month (p < 0.001) and did not differ from the contralateral limb at 6 months. Compared with intact rats, talar and tibial cartilage height in rats with deformity also decreased from the 3rd month by 1.4-fold (p < 0.001) and 1.1-fold (p = 0.022), respectively. Conclusions. Extra-articular deformation of the middle third of the femur induces degenerative changes in talar articular cartilage beginning at 1 month, and in tibial cartilage from 3 months after modeling.

DETERMINATION OF THE SAFETY AND EFFECTIVENESS OF CARBOXYTHERAPY IN IN VIVO MODELS OF OSTEOARTHRITIS AND TENDON INFLAMMATION

Viktor Shtroblia, Ruslan Lutsenko — Sun, 21 Dec 2025 00:00:00 +0200

Local administration of carbon dioxide (carboxytherapy) is regarded as a promising approach for modulating inflammation, improving microcirculation, and stimulating reparative processes. However, traditional subcutaneous CO₂ delivery techniques are associated with variability of local effects, risk of mechanical tissue irritation, and insufficient standardization of administration parameters, which limits reproducibility of experimental findings. These limitations highlight the need to develop optimized CO₂ delivery techniques with controlled administration and improved safety. Objective. To evaluate the efficacy and safety of subcutaneous administration of a CO₂+ NaHCO₃ gas-buffer mixture in preclinical models of acute inflammation and monoiodoacetate (MIA)-induced osteoarthritis. Methods. The study was conducted in rats using formalin- and carrageenaninduced models of acute inflammation and a monoiodoacetic acid–induced osteoarthritis model. Animals received subcutaneous injections of a CO₂ + NaHCO₃ mixture (1:1) in small volumes; comparisons were performed against the classical subcutaneous CO₂ administration protocol described by Raymundo et al. Results. In acute inflammation models, administration of the CO₂ + NaHCO₃ mixture significantly reduced edema severity (p < 0.001). In the MIA-induced osteoarthritis model, treatment resulted in a statistically significant decrease in TNF-α and IL-6 levels and an increase in TGF-β1 concentration (all p < 0.001), indicating anti-inflammatory activity and modulatory effects on systemic inflammatory markers. Conclusions. The subcutaneous administration technique of the CO₂ + NaHCO₃ mixture investigated in this study demonstrated anti-inflammatory activity and a favorable safety profile in preclinical models, supporting the rationale for further research into its potential application for degenerative-inflammatory disorders of the musculoskeletal system.

RESEARCH INTO THE EFFECTIVENESS OF USING A TOURNIQUET TO STOP BLEEDING «SICH-TOURNIQUET»

Sun, 21 Dec 2025 00:00:00 +0200

The experience of combat medics in the conditions of full-scale Russian aggression against Ukraine has demonstrated a huge amount of massive bleeding in the event of combat trauma. The operation of tourniquets is a fundamental element of modern tactical medicine. Objective. To assess the effectiveness of the tourniquet for stopping bleeding «SICH-Tourniquet» and to build a mathematical model that would allow predicting the pressure under the tourniquet based on individual anthropometric and hemodynamic parameters of a person. Materials. The study involved 130 volunteers aged 10 to 73 years, including 20 children. The gender distribution was as follows: 55 (42.3 %) men and 55 (42.3 %) women, as well as 20 children (10–17 years; 7 girls, 13 boys) Results. Observation included measurement of hemodynamic parameters, assessment of application time, pain syndrome, capillary test, effectiveness of dry and wet tourniquet, as well as durability during repeated use. It was found that the tourniquet provides complete occlusion of arterial blood flow in both the upper and lower extremities, without significant difference from its position. Correlation and regression analysis allowed us to identify key factors that influence effective compression pressure. For the upper extremities, the following statistically significant predictors were: gender, arm circumference, and body mass index. For the lower extremities, the following had the greatest influence: age, hip circumference, and diastolic pressure. Conclusions. Simplified models suitable for predicting pressure in field conditions were created. «SICH-Tourniquet» demonstrated high efficiency, reliability and safety, particularly in the pediatric group. The resulting mathematical models can be used to optimize individual compression selection in tactical and emergency medical care.