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Aim: To improve surgical treatment of patients with multiple and flotating ribs fractures., Material and Methods: A comparative analysis of two groups of victims with rib fractures was carried out. 148 patients of the control group underwent conservative treatment, mechanical ventilation, skeletal traction. In 167 patients of the main group we used advanced surgical tactics based on differentiated, stepwise and combined chest stabilization including osteosynthesis of ribs and thoracoscopy., Results: Immediate results for each type of stabilization were evaluated. The most durable respiratory support was observed in case of ventilation alone - internal pneumatic stabilization without surgical stabilization. Osteosynthesis of the ribs had the best outcomes compared with other methods. An efficacy of developed tactics was confirmed by significantly reduced morbidity, mortality, mechanical ventilation time and ICU-stay in main group., Conclusion: Surgical tactics in patients with multiple and flotating fractures of the ribs is determined by type of ribs and internal organs damage, combined trauma severity and conditions of medical care. Differentiated, stepwise and combined chest stabilization by using of high-tech methods of medical care (osteosynthesis, thoracoscopy) improves the outcomes in these patients.

The authors describe the biotribological process, disclose mechanisms and time course of morphological changes in fractured bones as exemplified by interactions between the ends of fragments in an extension fracture of a rib. These changes result from contacts between fragments due to persistent respiration and parallel processes closely connected, friction and repair regeneration. The data on mechanisms and time course of morphological changes in a fractured bone may prove useful not only for forensic medicine specialists, but for traumatologists as well.

The results of treatment of 84 sufferers with a complicated thoracic trauma, using irradiation of the YAG-neodymium, argon, helium-neon and arsenide-gallium lasers, are presented. The techniques for the use of lasers for photocoagulation of defects of the lung and thoracic wall through a thoracoscope, endobronchial laser therapy and laser puncture is described. The expediency to use laser irradiation in the complex of treatment of a complicated thoracic trauma is shown.

A generalized experience with treatment of more than 1000 patients with wounds of the chest is presented. Bullet wounds prevailed. Methods of treatment of penetrating wounds of the chest are described.

The article deals with study of some patterns of long spongy rib bone destruction in static and dynamic load of thorax. Model of bone destruction is suggested. Multiple microfissures preceding formation of complete bone destruction were detected in border areas with fracture. They have peculiar mosaic depending on load conditions. Microfissure localization in relation to osteon structure of rib cortical lamina was stated. The results of investigations may have theoretical and applied value both in medicolegal and clinical traumatology.

Mechanisms of occurrence of thoracic lesions as well as characteristic features of repeated rib trauma in children with repeated blunt trauma were studied. Experimental data were compared with expert observations. It was stated that morphological features of repeated rib trauma in children are localized within the limits of substantia compacta or its superficial layers. There is also possibility for straightening primary incomplete fracture in repeated exposure and for forming secondary fracture, which depends on the type of force applied, its application area and direction of force action.

Classification of rib fractures in thoracic blunt trauma is suggested. Classification accounts for environmental conditions, types of thoracic lesions as well as differential features of fractures. Systematization provides for single terminology to define fractures, it helps to determine mechanogenesis of thoracic trauma and may serve as the basis for compiling diagnostical computer program.

The paper deals with differential diagnosis of an external exposure (blow, compression) from rib fractures in chest trauma. New informative parameters of bone microdestruction in fracture zones which may serve as expert criteria for conditions of their formation are proposed. Registration of microfissures in thickness of rib compact plates and spongy substance on both sides of the basic fracture, their character, direction and original mosaic makes it possible to determine the type of an external exposure blow, compression) with high accuracy.

Comparative characteristic of thoracic injuries in children and adults due to compression gives evidence that value of ultimate rib strain when rib lesion occur is diminishing with age. Therefore the chest in adults (as compared to children) is more heavily injured in case of compression. For all this the character and localization of injuries depend on value of operating loads and make it possible to determine common mechanisms of thoracic frame deformations.