Personification of the tactics of the treatment of pseudoarthrosis of long bones, taking into account the previous stages of the treatment and a comorbidity

The paper presents two clinical cases demonstrating modern approaches and possibilities of personification of the therapeutic tactics of surgical rehabilitation of patients with defect-pseudoarthrosis of long bones. Both patients had a complex comorbid status and had previously been operated on repeatedly without success. The aim is to demonstrate the personification of the approach to the compensation of defects of long bones, taking into account the previous stages of treatment and concomitant pathology. A comprehensive study of the materials of outpatient and inpatient patient records, the results of clinical, instrumental and laboratory research methods was carried out, the proposed operational manuals are described in detail. The polyprophilic composition of the medical team of rehabilitation participants, a balanced and balanced tactical and technological approach in the aspect of "risks/possible result" in each of the above observations allowed us to calculate and achieve a good anatomical and functional outcome. Evaluating the tactics and stages of osteosynthesis in this case, we note that before the occurrence of complications against the background of COVID-19 in the form of a recurrence of pseudoarthrosis, the therapeutic measures taken were fairly standard, since the use of osteosynthesis capabilities in such situations is almost routine. However, the resulting failure required the development of personalized tactics for a new stage of treatment. The authors hope that the chosen extraordinary tactics and technology will bring long-awaited success in treatment, the first evidence of which can be considered the beginning of osteogenesis in the area of the junction of fragments after 2.5 months of surgery. The main factors of success are the personification of the approach, based on taking into account both local characteristics and the existing comorbid, as well as social aspects, a reasonable choice of the sequence and scope of surgical techniques and means of fixation, a team approach involving plastic surgeons, rehabilitologists and specialists of other interested profiles. In some cases, in the presence of serious risks and threats, the desire to achieve the maximum possible recovery should be deliberately sacrificed in favor of a certain clinical compromise that functionally suits the patient.

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