Aims. To evaluate the efficacy of the modified Stoppa approach for surgical treatment of pelvic bone injuries based on clinical (sex distribution, fracture type), surgical (duration of operation, intraoperative blood loss, incision length, quality of reduction), and functional outcome (hip joint function). Materials and methods. A total of 31 patient were included in a retrospective cohort study from 2019 until March 2022 with various injuries of acetabulum in the N.D. Batpenov National Scientific Center of Traumatology and Orthopaedics (NSCTO).The inclusion criteria for this study were: patients with acetabulum injuries, and who underwent surgical interventions using one of two surgical approaches (modified Stoppa, ilioinguinal approaches), patients over 18 years old. Exclusion criteria: other operative approaches to pelvic bones and patients under 18 years of age. 21 patients underwent surgery with the use of modified Stoppa approach (group A) and 10 surgeries were performed using the ilioinguinal approach (group B). Efficiency was evaluated by comparison of duration of surgical procedures, amount of blood lossbetween groups, size of skin incision, quality of reduction and functional outcomes. Results. There are males – 18(58.1%), females – 13(41.9%) in the study. The clinical study results showed that average volume of intraoperative blood loss and size of skin incision were significantly less during Stoppa approach then ilioinguinal approach though average duration of surgical procedures did not reveal significant differences between two groups. Average duration of surgical procedures did not reveal significant differences between two groups – 109.5 min (±54.7) among group A and 126 min (±58.9) in group B. The volume of intraoperative blood loss averaged 338±254.5 ml of blood for the total sample. The volume of intraoperative blood loss was 525.0 ±322.5 ml of blood in group B, which is more than twice the estimated blood loss for group A (250 ±157.3 ml). When using a Stoppa approach, the length of the cutaneous surgical incision averaged at 8.8 ± 1.5 cm, while with an ilioinguinal approach, this value was estimated at 20.6 ± 8.5 cm, which suggests a favorable cosmetic effect of Stoppa approach. Conclusion. The positive results obtained with the modified Stoppa approach, which are reflected in a reduction in the length of the skin incision and the amount of intraoperative blood loss, suggest that the use of this approach in clinical practice provides an opportunity to improve the surgical treatment of acetabular fractures by obtaining variability in the study of surgical approach. Nevertheless, the frequency and complexity of the occurring pelvic bone injuries dictate the need for further search and improvement of more optimal access options for surgical treatment.

Introduction: Distal clavicle fractures are uncommon and present clinical challenges due to complex anatomy and instability. Standard fixation plates often fail to match the clavicle’s contour, requiring bending that may weaken fixation and cause irritation. Case Presentation: A 39-year-old male sustained a Neer type IIb distal clavicle fracture after a fall on the right shoulder. Clinical and radiographic evaluation revealed a comminuted fracture with pain and restricted motion. Management and Outcomes: Open reduction and internal fixation with a newly designed anatomical plate were performed under general anesthesia using seven locking screws. Rehabilitation began early, and recovery was uneventful. At two months, radiographs confirmed union and alignment, with full, pain-free motion and improved Constant and ASES scores. Conclusion: The newly developed anatomical plate provided stable fixation and excellent functional recovery. Further studies with larger cohorts and longer follow-up are required to validate long-term efficacy.

Clavicle fractures are among the most common injuries of the upper limb, particularly among individuals with active lifestyles.Traditional treatment methods include conservative therapy and surgical interventions, with plate osteosynthesis being the most effective approach for complex fractures. However, standard plates do not always conform to the intricate anatomical shape of the clavicle, increasing the risk of complications, such as implant deformation and fixation failure. Therefore, the development and optimization of anatomically adapted plates capable of minimizing complications and ensuring stable fixation remain relevant challenges.Objective: to perform mathematical modeling of a domestically developed plate for the osteosynthesis of clavicle fractures.Methods. This study employed the finite element method (FEM) for biomechanical analysis of the "plate–clavicle" system. Solid models of the plate and clavicle were created using Autodesk Inventor PRO and converted into finite element models in the APM FEM (COMPASS3D) environment. Applied loads included bending, compressive, and torsional moments, simulating real mechanical forces. The analysis was conducted to evaluate stresses, displacements, and the safety factor of the construction under various conditions.Results. The modeling demonstrated that the optimized plate ensures a uniform distribution of stresses, reducing the risk of localized overloads at the screw attachment points and fracture site. Stress values within the structure remained below the yield strength of the titanium alloy, while displacements were within acceptable limits. The safety factor indicated high structural reliability, even under maximum loads.Additionally, the analysis revealed that the plate allows for minimal physiological movements, promoting faster patient rehabilitation.Conclusion. The optimized design of the clavicle osteosynthesis plate exhibits high mechanical stability and the ability to withstand significant loads without the risk of structural failure. The proposed plate can be recommended for clinical application due to its reliablefixation, reduced risk of complications, and potential to shorten patient rehabilitation periods.

Мезоннев сынығы – сирек кездесетін тобықтың күрделі сынуы. Ол ішкі тобықтың сынуы, төменгі жілікаралық синдесмотикалық кешенінің жарақаты және проксимальды асық жілігі шыбығының сынуы секілді жарақаттар триадасымен сипатталады. Бұл мақалада баспалдақтан құлағаннан кейін Мезоннев сынығын алған 53 жастағы әйелдің клиникалық жағдайы сипатталды. Физикалық тексеру кезінде сол жақ тобық буынында ауырсыну мен ісіну анықталды, рентгенограммада сол жақ тобықтың ішкі және артқы бөлігінің сынықтары анықталды. Гипстік иммобилизация түрінде консервативті ем алғанына қарамастан, 11 күннен кейін науқас сол жақ тобығының және проксимальды асық жілігі шыбығының ауырсынуымен қайтадан ауруханаға түседі. Рентгеннограмма зерттеулері ішкі тобықтың сынуы, төменгі жілікаралық синдесмотикалық кешенінің жарақаты және проксимальды асық жілігі шыбығының сынуымен жүретін Мезоннев сынығын растады. Науқасқа сол жақ тобыққа ашық репозиция және ішкі фиксация отасы сәтті түрде жасалды. Бұл жағдай клиникалық тәжірибеде назардан тыс қалуы мүмкін Мезоннев сынығы сияқты сирек және күрделі сынықтарды дәл диагностикалау үшін мұқият қарау, пальпация жасау және рентгенологиялық тексеру маңыздылығын көрсетеді. Сондықтан, науқастарға уақтылы және тиісті емдеуді қамтамасыз ету үшін тобық жарақаттары бар жағдайда Мезоннев сынығын әрқашан ескеру керек.