N.N. Priorov Journal of Traumatology and Orthopedics

Peer-review medical journal published quarterly since 1994.

Editor-in-Chief

  • Professor Sergey P. Mironov, MD, PhD

About

The journal covers current issues of modern traumatology and orthopaedics, such as multiple and combined (including firearms) damage to the musculoskeletal system, joint and spine pathology, metabolic osteopathy, skeletal system diseases, tumors and tumor-like processes. The journal is wellcome for articles with results of experimental pathophysiological, morphological and biomechanical studies in traumatology and orthopaedics, as well as methods of pharmacological correction descriptions, an also anesthesiological aid and rehabilitation in case of diseases and damages of movement and support organs.

The main sections

  • Original studies
  • Clinical case reports
  • Reviews
  • Short communications

Publications

  • quarterly since 1994
  • continuously in Online First (Ahead-of-Print) mode

Distribution

  • articles published online in Online First mobe are available in Open Access;
  • regular issues available for subscription within embargo period (Delay Open Access) for 12 monthes;
  • preprins, accepted manuscripts and not final versions of articles may be openly distributed by authors (we support Green Open Access);
  • there are Gold Open Access option for authors to be shoose.

Indexing:

  • Russian Science Citation Index (Web of Science)
  • Google Scholar
  • Ulrich's Periodicals directory
  • WorldCat

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Current Issue

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Vol 29, No 1 (2022)

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Clinical case

Surgical treatment of post-traumatic instability of the shoulder joint in athletes
Orletskiy A.K., Timchenko D.O., Gordeev N.A., Zharikov V.A., Kozlova E.S., Krylov S.V.
Abstract

BACKGROUND: Surgical treatment of post-traumatic instability of the shoulder jointinvolves the use of various surgical techniques: open Latarjet procedure, Bristow–Latarjet operation, which was first performed in Russia at CITO named after N.N. Priorov, the founder of the clinic for sports and ballet trauma, Professor Zoya S. Mironova, also use soft tissue stabilization with anchors, etc. However, in recent years, the Latarjet arthroscopic operation has become a priority choice in the treatment of post-traumatic instability of the shoulder joint.

AIM: To improve the results and reduce the frequency of postoperative complications, reduce the time of surgical intervention, as well as evaluate the technical difficulties, nuances and improve the surgical technique when performing the arthroscopic Latarjet procedure in professional athletes and amateurs with post-traumatic defects of the shoulder joint.

MATERIALS AND METHODS: During the period from 2015 to 2021, 50 Latarjet arthroscopic procedure were performed in athletes with post-traumatic defects of the glenoid cavity of the scapula.

RESULTS: To improve postoperative results, during the Latarjet arthroscopic operation, when positioning the bone autograft, we focused on the 5 o’clock in the anterior inferior section of the glenoid cavity of the scapula, which allowed us to maintain the range of motion, namely abduction, flexion and external rotation and bring it almost to the previous level in 96% of patients, the pain syndrome also regressed to 0.8±0.21 points. Fixation of the capsular-ligamentary apparatus exarticularly allowed to reduce the likelihood of relapse, fracture of the bone autograft, and the development of deforming osteoarthritis of the shoulder joint in the near future.

CONCLUSIONS: The arthroscopic Latarjet procedure in the treatment of post-traumatic injuries of the shoulder joint is gaining popularity due to the fact that, using low-traumatic approaches, it is possible to correctly position the bone autograft on the anterior-inferior region of the articular surface of the scapula, without subsequent restrictions on the functional component of the shoulder joint.

N.N. Priorov Journal of Traumatology and Orthopedics. 2022;29(1):5-18
pages 5-18 views

Original studies

Analysis of long-term results of operative treatment of pathologically thickened mediopathellar synovial knee fold
Ochkurenko A.A., Yeltsin A.G., Mininkov D.S., Gorokhvodatsky A.V., Kurpyakov A.P.
Abstract

BACKGROUND: The mediopatellar synovial fold (MPSF) of the knee joint is normally a thin and elastic structure, but under the influence of various factors, the MPSF thickens and turns into a fibrous cord, which injures nearby structures and clinically manifests with pain. One of the effective methods of treating MPSF in pediatric patients is an arthroscopic excision of the fold.

AIM: Evaluation of long-term results of arthroscopic treatment of patients with pathologically thickened MPSF of the knee joint.

MATERIALS AND METHODS: There was conducted an analysis of primary medical documentation, which included the study of hospital records and case histories of 73 patients. The survey questionnaires (based on VAS and WOMAC scales) were sent to these patients. Responses were received from 35 patients who were included in the study.

RESULTS: When evaluating the long-term results of surgical intervention in 35 operated patients in 29 (82.1%) patients, it was found out that there were no exacerbations in postoperative period and, at the time of the data collecting, there weer no complaints for the pain syndrome. Dysplasia of the femoral condyle of type A and B was diagnosed in these patients. At the time of the evaluation, 6 (18.9%) patients had pain syndrome with decreased function of the knee joint. In these patients, dysplasia of the femoral condyle corresponded to type C in 4 cases, types D and B – in 1 case.

CONCLUSION: At the early stages of the disease, it is necessary to carry out a detailed differential diagnosis to identify the pathology of the knee joint. Attention should be paid to the combination of a pathologically thickened MPSS with dysplasia of the femoral condyle, which can lead not only to complications of conservative therapy and ineffectiveness of surgery, but also to the development of patellofemoral arthrosis.

N.N. Priorov Journal of Traumatology and Orthopedics. 2022;29(1):19-24
pages 19-24 views
Comparative characteristics of sagittal balance in normal children and with spondylolisthesis
Kuleshov A.A., Vetrile M.S., Zakharin V.R., Ovsyankin A.V., Kuzminova E.S., Lisyansky I.N., Makarov S.N., Strunina U.V.
Abstract

BACKGROUND: The measurement of sagittal parameters is an important part of preoperative planning and is also used to evaluate the results of surgical treatment. It is known that in spondylolisthesis (especially at high degrees) the sagittal parameters of the spine differ from those in healthy people. The difference in spinal-pelvic parameters in children and adults without orthopedic pathology has also been proven. One of the tasks of surgical treatment of spondylolisthesis is the restoration of sagittal balance or its maximum approximation to normal values. However, today there is no single accepted norm of sagittal parameters for children, therefore, the question of the optimal tactics of surgical treatment of spondylolisthesis in children remains open.

AIM: To determine the parameters of the sagittal balance in normal children and in children with spondylolisthesis.

MATERIAL AND METHODS: A retrospective analysis of postural radiographs of 68 children was performed. Patients were divided into 2 groups: group I — 43 patients from 8 to 17 years old without spinal pathology. Group II — 25 patients with spondylolisthesis from 8 to 17 years old. For each patient, the main spinal and pelvic parameters (PT; PI; SS; LL; PI-LL; TK) were measured and statistical analysis of the data was performed.

RESULTS: The study proved that the main parameters of the sagittal balance (PI, PT, SS, LL, TK, PI-LL) in children and adults without pathological deformities of the spinal column are statistically significantly different. Also, there are statistically significant differences between the parameters of the sagittal balance in children and adolescents without spinal pathology and with spondylolisthesis (PI, PT, SS, LL, TK, SFD, PI-LL). In patients with high grade spondylolisthesis, the parameters of thoracic kyphosis and lumbar lordosis are significantly reduced, which should be assessed as a compensatory mechanism for maintaining the vertical position of the body. Children with spondylolisthesis are characterized by a significantly higher PI value.

CONCLUSION: The sagittal parameters of the spine in children and adults are different, therefore, for correct preoperative planning, it is necessary to establish the norm of sagittal parameters for children. It is also necessary to take into account the high value of PI in children and adolescents with spondylolisthesis, which may be the etiological factor of this disease. The existing formulas for measuring sagittal balance for children with spondylolisthesis should be used with caution, because a high PI can lead to unreliable theoretical values of PT, SS, LL and TK. The cause of sagittal imbalance can be not only high degrees of spondylolisthesis, but also the tight hamstrings.

N.N. Priorov Journal of Traumatology and Orthopedics. 2022;29(1):25-33
pages 25-33 views
Analysis of long-term functional results of surgical treatment of spondylolisthesis in middle-aged and elderly patients
Gvozdev N.S., Shchurova E.N., Prudnikova O.G.
Abstract

BACKGROUND: Insufficient attention has been paid to the analysis of the use of instrumental methods of examination in assessment the long-term results of surgical treatment of spondylolisthesis in middle-aged and elderly patients.

AIM: To show the peculiarities of strength characteristics of lower limb muscles and temperature and pain sensitivity in the dermatomes of the cauda equina roots in middle-aged and elderly patients in the distant terms after surgical treatment of spondylolisthesis depending on the etiology of the disease.

MATERIALS AND METHODS: An analysis of the results of functional studies of 21 patients with spondylolisthesis aged 41 to 74 years (12 with degenerative, 9 with isthmic) is presented. The research done before treatment and 75–99 months after surgery. The following research methods were used: analysis clinical (neurological status), visual analog scale (VAS), Oswestry Disability Index (ODI), radiology (functional X-ray examination), magnetic resonance imaging, anthropometry, the lower limb muscles dynamometry, esthesiometry, statistical.

RESULTS: In the long term after surgical treatment, patients with isthmic spondylolisthesis had a predominant increase in the moment of force in all muscle groups (39–75% of cases). Negative dynamics prevailed in the group of patients with degenerative spondylolisthesis — a decrease in muscle strength characteristics in 50–94% of cases. According to esthesiometry, more pronounced negative changes in the values of temperature and pain sensitivity thresholds were observed in patients with degenerative spondylolisthesis.

CONCLUSION: The analysis of muscle strength characteristics and esthesiometry data determined a different degree of compensation and recovery during surgical treatment of patients with spondylolisthesis, depending on the etiology of the disease.

N.N. Priorov Journal of Traumatology and Orthopedics. 2022;29(1):35-45
pages 35-45 views
Characteristics of the psoas minor muscle in modeling lateral interbody spondylodesis of the lumbar spine
Filimonova G.N., Diuriagina O.V., Antonov N.I., Ryabykh S.O.
Abstract

ВACKGROUND: For the treatment of degenerative diseases of the spine, various deformities, a minimally invasive technique of lateral lumbar interbody fusion is used, which minimizes the risks of spinal cord injury. In the development of these pathologies, the most important role is assigned to the paraspinal muscles, the histological features of which are insufficiently elucidated in the relevant literature when modeling spondylodesis.

АIM: To investigate the effect of lateral interbody vertebral fusion (spondylodesis) when introducing titanium implants on the histostructure of the psoas minor muscle.

МATERIALS AND METHODS: Experiments were performed in 14 mongrel dogs, 3 individuals — the control group (norm). The аnimals underwent discectomy at the level of L4–5, L5–6 vertebrae through the lateral approach on the right, and interbody titanium implants were installed. The lumbar spine was stabilized with an external fixator for 30 days. Paraffin muscle sections were stained with hematoxylin-eosin, according to Masson.

RESULTS: During the experiment, an increased variety of myosymplast diameters, loss of polygonality of their profiles, fibrosis of the interstitial space, and sclerotization of the vascular membranes were observed in the psoas minor muscle. The volume density of endomysium in both muscles increased 1.5 times relative to the norm after 6 months Other parameters decreased: the volume of myosymplasts was 95%, that of microvessels — 73% on the left, 83% on the right. On the other hand, the degree of fatty infiltration increased, amounting to 276% on the left and 394% — on the right of the normal parameters. After 18 months, the bulk density of muscle fibers on the left was restored to the value in the control, on the right it was only 95%. The degree of sclerotization in the muscle on the left is 133%, on the right — 161% of the norm; the index of fatty infiltration was 146% on the left and 339% on the right of the normal parameter.

CONCLUSION: pathohistological changes in the psoas minor during lateral interbody fusion are more pronounced on the side of the operative approach, which necessitates minimizing trauma to the paravertebral muscles during operations in order to prevent sclerotization and fatty involution of muscle tissue.

N.N. Priorov Journal of Traumatology and Orthopedics. 2022;29(1):47-56
pages 47-56 views
Efficacy of necrosis decompression techniques in the treatment of early stages of avascular necrosis of the femoral head
Panin M.A., Zagorodniy N.V., Boiko A.V., Petrosyan A.S.
Abstract

BACKGROUND: There is no consensus on the methods of surgical treatment of early stages of avascular necrosis (AVN) of the femoral head. Decompression of the necrotic zone in different variations is the most widely used, but the effectiveness of it is debated.

AIM: We evaluated the effectiveness of classic decompression of the necrotic zone and decompression using a percutaneous expandable reamer combined with bone graft.

MATERIAL AND METHODS: Fifty patients were included in our study. The inclusion criteria were decompression of the necrotic zone in AVN of the femoral head at stages I–II and the possibility of assessing the effectiveness of surgical treatment after 12 months. Depending on the method of decompression, the patients were divided into two groups. Group 1 included 25 patients who underwent decompression using a percutaneous expandable reamer combined with bone graft. Group 2 consisted of patients who underwent classic decompression of the necrosis area. The groups were comparable in all major clinical characteristics. The efficacy of surgical interventions was assessed after 12 months by comparing pre- and postoperative assessment of the functional state of the hip joint using the Harris Hip Score and the intensity of pain syndrome using the visual analog score (VAS). The main criterion for ineffectiveness of AVN decompression of the femoral head was the need for total hip arthroplasty.

RESULTS: Twelve months after surgical treatment of femoral head AVN, group 1 patients average Harris Hip Score was 63.9, group 2 patients average Harris Hip Score was 74.1 (versus 59.1 and 63.9 before surgery, respectively); VAS was 2.7 in both groups (versus 5.5 and 4.8 before surgery, respectively). Three patients (12%) from group 1 and four patients (16%) from group 2 underwent total hip arthroplasty, to persisting pain syndrome and progression of osteonecrosis of the femoral head to the subchondral fracture stage. The differences between the groups were statistically insignificant.

CONCLUSION: Decompression of the necrosis zone is an effective method of treatment of stages I and II of AVN of the femoral head, significantly reducing the intensity of pain syndrome and slightly improving the functional characteristics of the hip joint. Studies in this direction should be continued with the involvement of more profiled patients and with the analysis of the effectiveness of other joint-preserving surgical techniques.

N.N. Priorov Journal of Traumatology and Orthopedics. 2022;29(1):57-64
pages 57-64 views

Reviews

Consequences of COVID-19 for the musculoskeletal and peripheral nervous systems. Diagnosis of complications (literature review)
Matveeva N.Y., Makarova E.V., Eskin N.A., Sokolova T.V.
Abstract

COVID-19 disease does not only lead to impaired respiratory function. Post-COVID complications are multiple with the involvement of many body systems, including the musculoskeletal system and the peripheral nervous system. Diseases of the musculoskeletal system include myalgia, myositis, rhabdomyolysis, acute arthralgia, arthritis, bone osteoporosis. Damage to the peripheral nervous system caused by coronavirus infection includes plexopathy due to lying down, poly-neuropathy, Guillain–Barre syndrome. This descriptive literature review discusses the effects of COVID-19 on the musculoskeletal system and the peripheral nervous system of patients. Data are presented on the use of diagnostic tools such as computed tomography, magnetic resonance imaging, and ultrasound scans to detect pathology.

N.N. Priorov Journal of Traumatology and Orthopedics. 2022;29(1):65-77
pages 65-77 views
Pathogenetic aspects of aseptic peri-implant and paraprosthetic complications in traumatology (review)
Barkhatova N.A., Kiselev A.S., Kiselev I.S., Barkhatova E.I.
Abstract

The use of metal implants and joint prosthetics occupy an important place in modern traumatology and orthopedics. With the increasing proportion of surgical methods for treating bone fractures and joint diseases, complications develop more frequently. Along with early and late wound infections, there are various response changes in tissues in the area of the implant of an abacterial nature. The results of clinical and experimental studies in the development of fibro-proliferative, immuno-allergic and granulomatous tissue changes around implants determine the important role of macrophages, fibroblasts, cells of the immune system, the peculiarities of the pathophysiology of which this article is devoted to.

N.N. Priorov Journal of Traumatology and Orthopedics. 2022;29(1):79-86
pages 79-86 views

Clinical guidelines

Coxarthrosis. Clinic, diagnosis and treatment: clinical guidelines (abridged version)
Tikhilov R.M., Lila A.M., Kochish A.Y., Alekseeva L.I., Shubnyakov I.I., Denisov A.O., Bozhkova S.A., Stafeev D.V., Builova T.V., Bodrova R.A., Tsykunov M.B., Israelyan Y.A.
Abstract

Coxarthrosis is a heterogeneous group of diseases with various etiologies and similar biological, morphological, clinical manifestations and outcomes, which are based on damage to all components of the joint: cartilage, subchondral bone, synovium, ligaments, capsule, and periarticular muscles. Clinical guidelines are the main working tool of a practicing physician, both a specialist and a narrow practice doctor. Conciseness, structuredness of information about a particular nosology, methods of its diagnosis and treatment, based on the principles of evidence-based medicine, allow to give in a short time one or another answer to a question of interest to a specialist, to achieve maximum efficiency and personalization of treatment. These clinical guidelines include data on the classification, clinical presentation, diagnosis, and treatment of coxarthrosis. In addition, they provide methods for the rehabilitation of patients with this pathology.

N.N. Priorov Journal of Traumatology and Orthopedics. 2022;29(1):87-112
pages 87-112 views


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