N.N. Priorov Journal of Traumatology and Orthopedics

BACKGROUND: Knee osteoarthritis is a common degenerative–dystrophic disease of the musculoskeletal system, affecting 10%–20% of the global population, leading to incapacitation in 8%–21% of cases, and requiring a comprehensive treatment approach. In cases of ineffective conservative treatment or upon verification of terminal stages of osteoarthritis (Kellgren–Lawrence grades III and IV), total knee arthroplasty is recommended. Despite a high rate of favorable outcomes, 10%–30% of patients remain dissatisfied with the results of surgery. In this context, the use of a newly developed prehabilitation method in patients undergoing total knee arthroplasty may directly influence treatment outcomes by improving clinical and functional joint parameters and remarkably enhancing postoperative quality of life.

AIM: The work aimed to evaluate the effectiveness of a new prehabilitation method in patients undergoing total knee arthroplasty.

METHODS: A prospective, non-blinded, non-randomized, controlled, single-center interventional case–control study analyzed treatment outcomes in 64 patients with verified terminal-stage knee osteoarthritis who underwent total knee arthroplasty with the use of the developed prehabilitation method. Patients selected for participation in the study were allocated to two clinical groups: group 1 (control) and group 2 (main). Group 1 consisted of 33 patients, and group 2 included 31 patients. Comparative analysis and assessment of treatment effectiveness were performed 72 hours before surgery and subsequently 72 hours, 4 weeks, and 12 weeks after total knee arthroplasty using objective and subjective assessment methods.

RESULTS: Comparative analysis of treatment outcomes demonstrated significant differences and positive trends in clinical and functional parameters associated with the use of the developed prehabilitation protocol in both groups at all follow-up time points. Changes in the Western Ontario and McMaster Universities Osteoarthritis Index, Visual Analog Scale for pain, and the Two-Minute Walking Test 4 and 12 weeks postoperatively were more pronounced in the second group, with values of 24.0 and 15.0 points (p < 0.001), 4.0 and 1.0 points (p < 0.001), and 142.68 ± 15.91 m and 154.06 ± 11.73 m (p < 0.001), respectively.

CONCLUSION: The proposed prehabilitation method for total knee arthroplasty promotes complete clinical and functional recovery of the knee joint within 12 weeks after surgery and leads to an improvement in patients’ quality of life in both the short and long term.

BACKGROUND: Lower limb lengthening using external fixation devices combined with elastic intramedullary reinforcement offers several advantages over the classical approach. This technique excludes injury to the growth plates in children; the elasticity of intramedullary rods does not contradict the principle of gradual distraction, thereby ensuring high precision of limb reconstruction; and after removal of the external fixation device, elastic rods retained within the medullary canal enhance the mechanical strength of the lengthened bone.

AIM: The work aimed to evaluate the effectiveness of lower limb lengthening outcomes in patients with congenital limb shortening treated using combined techniques, depending on the type of elastic intramedullary rods used: titanium rods with composite calcium phosphate coating versus uncoated rods.

METHODS: The study included 65 patients with a mean age of 12.6 years (5–22 years). Femoral lengthening was performed in 19 patients, monofocal tibial lengthening in 30 patients, and bifocal tibial lengthening in 16 patients. Treatment was carried out at the Ilizarov National Medical Research Center for Traumatology and Orthopedics between 2017 and 2020. Only patients with congenital limb shortening were included in the analysis. Treatment outcomes were assessed 12 months after removal of the external fixation device.

RESULTS: Three patient groups were formed according to the type of lengthening performed: monofocal femoral lengthening, monofocal tibial lengthening, and bifocal tibial lengthening. Two-way analysis of variance revealed a significant combined effect of rod type (p = 0.036) and patient age (p = 0.038) on the external fixation index in bifocal tibial lengthening. For the first time, the absence of a significant effect of hydroxyapatite coating on the external fixation index was demonstrated between the compared groups during limb lengthening performed using titanium intramedullary rods either with or without hydroxyapatite coating. Three cases of deformity or fracture at the lengthening site required unplanned surgical intervention, as well as one case of fracture of the regenerate bone at the junction of intramedullary rods.

CONCLUSION: In congenital lower limb shortening not associated with pathological bone formation, there was no difference in external fixation index between groups treated with titanium elastic intramedullary rods and those treated with hydroxyapatite-coated rods. The diameter of the intramedullary rods is a key factor in preventing fractures and deformities following limb lengthening.

BACKGROUND: Pseudarthrosis of long bones following fractures represents a significant challenge in modern traumatology and orthopedics due to pronounced functional impairment of the affected limb and prolonged treatment duration. Novel approaches in regenerative medicine and orthobiologics provide promising opportunities to correct osteogenic insufficiency in the nonunion site, particularly after repeated surgical interventions.

AIM: The work aimed to evaluate the prospects for clinical application of bone grafts containing genes encoding vascular endothelial growth factor (VEGF) and bone morphogenetic protein-2 (BMP-2) delivered via a plasmid construct for the treatment of patients with pseudarthrosis.

METHODS: The plasmid construct pBudKan-coVEGF165A-coBMP2 was generated using standard molecular genetic techniques. Gene-activated demineralized bone allografts were produced by combining demineralized bone allografts with the plasmid construct. A single-center, prospective, uncontrolled cohort study included evaluation of experimental surgical treatment in 47 patients with long-bone pseudarthrosis who underwent bone grafting with the prepared grafts using either plate osteosynthesis or an external fixation device. Radiographic methods and the Non-Union Scoring System (NUSS) score were used to determine treatment strategy. Postoperative outcomes were evaluated by clinical examination, radiographic methods, and the Regenerating Bone defects using New biomedical Engineering (REBORNE) score.

RESULTS: Treatment outcomes were monitored for 12 months in 46 patients. Positive treatment results were achieved in 95.7% of cases: 41 patients (89.1%) demonstrated complete bone union (REBORNE score = 4) after 6 months, and 3 patients (6.5%) after 12 months.

CONCLUSION: The use of gene-activated demineralized bone allografts containing a plasmid construct simultaneously encoding VEGF and BMP-2 for bone grafting in patients with long-standing ununited fractures and prior unsuccessful treatment attempts resulted in a high rate of successful bone union (95.7%).

BACKGROUND: Selection of the optimal autograft for anterior cruciate ligament reconstruction remains one of the key challenges in contemporary orthopedics. Despite accumulated experience with traditional graft sources, comparative evaluation of the mechanical properties of different harvesting techniques for both the quadriceps tendon and the peroneus longus tendon remains insufficiently studied. This limits objective selection of an optimal graft combining high mechanical strength with minimal donor-site morbidity.

AIM: This study aimed to compare mechanical strength and elastic–deformation characteristics of grafts derived from the peroneus longus tendon, full-thickness quadriceps tendon, and superficial layer of the quadriceps tendon under controlled experimental biomechanical testing (uniaxial quasi-static tensile loading to failure).

METHODS: An experimental, controlled, laboratory biomechanical study was conducted on tendon specimens obtained from cadaveric material of 24 donors (mean age 50 ± 5 years). Specimens were allocated into three groups, 8 specimens each: peroneus longus tendon grafts, superficial-layer quadriceps tendon grafts, and full-thickness quadriceps tendon grafts. Mechanical testing was performed using a universal testing machine under uniaxial quasi-static tensile loading to failure at a deformation rate of 0.17 mm/s. The following parameters were assessed: ultimate load to failure, elastic modulus, stiffness, elongation at failure, and failure mode.

RESULTS: Grafts derived from the superficial layer of the quadriceps tendon demonstrated the highest ultimate load to failure (1043.2 ± 4.2 N), stiffness (155.9 ± 13.0 N/mm), and elastic modulus (94.5 ± 8.6 MPa), significantly exceeding both other groups (p < 0.001). Full-thickness quadriceps tendon grafts showed intermediate strength values (ultimate load 728 ± 39 N; elastic modulus 52.8 ± 9.4 MPa; stiffness 83.5 ± 15.4 N/mm), comparable to peroneus longus tendon grafts (ultimate load 908 ± 74 N; elastic modulus 78.2 ± 9.2 MPa; stiffness 101.1 ± 11.7 N/mm). Peroneus longus tendon grafts demonstrated the greatest elongation at failure (35.9% ± 8.8%), significantly exceeding that of superficial-layer quadriceps tendon grafts (23.5% ± 2.7%; p < 0.001) and full-thickness quadriceps tendon grafts (26.6% ± 4.4%; p < 0.01). No adverse reactions related to the studied intervention were observed.

CONCLUSION: Grafts harvested from the superficial layer of the quadriceps tendon exhibit superior mechanical strength and may be considered a promising autograft option, combining sufficient biomechanical properties with potentially lower donor-site morbidity compared with full-thickness tendon harvesting.

BACKGROUND: To successfully meet approved state-assigned healthcare volumes, healthcare organizations utilize key organizational tools, including planning, structured allocation of healthcare volumes, and management of core processes such as patient selection, communication, and hospitalization using digital technologies.

AIM: The work aimed to present an organizational model for managing hospitalization processes and outpatient visits in the Federal Center for Traumatology using digital technologies.

METHODS: This was a single-center, retrospective, comprehensive study to analyze the implementation of planned volumes of 95,260 cases of specialized medical care, including high-technology care, delivered over a 12-year period (2012–2024) in the fields of traumatology and orthopedics and neurosurgery, using a medical information system and a digital patient registry.

RESULTS: The types and baseline rates of patient no-shows for hospitalization were identified. The rate of informed no-shows was 37.9 ± 0.4 per 100 scheduled patients, whereas the rate of uninformed no-shows was 18.4 ± 0.4 per 100 patients presenting to the admission department. The rate of repeated no-shows was 1.6 ± 0.1, and the rate of unscheduled patient arrivals was 6.0 ± 0.1. The rate of hospital admission refusals over the 12-year study period (2012–2024) was 6.4 ± 0.1 per 100 patients presenting to the admission department. Over the 5-year period (2020–2024), the rate of unconfirmed indications for surgery was 7.5 ± 0.1 per 100 patients. A comparative analysis of two 5-year periods (2013–2017 vs. 2018–2022) demonstrated a 1.4-fold increase in the mean 5-year rate of hospital admission refusals (t = 13.6; p < 0.0001). During a 5-year period (2020–2024), the hospitalization rate among patients aged ≥ 75 years was 6.3 ± 0.1, and among patients with diabetes mellitus, it was 13.4 ± 0.2 per 100 treated patients. The baseline rate of outpatient no-shows was 17.6 ± 0.2 per 100 scheduled appointments.

CONCLUSION: Given the identified types and rates of patient no-shows for hospitalization and outpatient visits, it is advisable to implement optimized patient communication strategies and a standardized method for forecasting completed hospital admissions. The availability of an operational reserve within the digital patient registry allows for rapid replacement of no-show patients. The implemented patient communication model was found effective, demonstrating a 5.1-fold decrease in the outpatient no-show rate (per 100 scheduled appointments) (t = 4.1; p < 0.001), from 17.1 in 2022 to 3.4 in the first quarter of 2025, and a 2.1-fold decrease in the rate of uninformed no-shows for hospitalization (per 100 patients presenting to the admission department) (t = 5.1; p < 0.001), from 18.4 in 2022 to 8.6 in 2024.

BACKGROUND: The international scientific data lacks comprehensive pathomorphological studies evaluating both muscles and nerves in a compression model of muscle injury.

AIM: This study aimed to assess histopathological changes in the tibialis anterior muscle and peroneal nerve of rats after standardized experimental compression of the lower leg resulting in the formation of a compression groove (closed partial crush injury).

METHODS: An interventional (experimental), single-center, prospective, controlled, randomized, double-blind study was conducted. Compression syndrome of the right upper third of the lower leg was modeled in 24 male Wistar rats by complete clamping with a surgical forceps for 60 seconds. Animals were euthanized on days 7, 14, 21, and 28 postoperatively. Histomorphometric analysis was performed using the VideoTesT Master-Morphology 4.0 software on digital images of paraffin-embedded muscle sections (5 μm) and semithin nerve sections (1 μm). The control group consisted of 10 intact male rats.

RESULTS: At days 7, 14, and 21, the numerical density of muscle fibers per 1 mm² was threefold higher than in controls (p < 0.001); at day 28, it slightly decreased but remained 2.5-fold higher than control values (p < 0.001). Muscle fiber diameters were reduced 2.5-fold at day 7 (p < 0.001), 1.7-fold at days 14 and 21 (p < 0.001), and 1.6-fold at the end of the experiment (p < 0.001). The numerical density of endomysial microvessels and intramuscular nuclei exceeded control values by 2.2-fold (p = 0.005) and 2.7-fold (p = 0.00005) at day 21, and by 1.8-fold (p = 0.0007) and 2.4-fold (p = 0.008) at day 28, respectively. The vascularization index remained decreased throughout the experiment, indicating insufficient muscle perfusion. In the peroneal nerve, reductions in the diameters of myelinated fibers, their axons, and myelin sheath thickness were 23% (p = 0.012), 22% (p = 0.00005), and 23% (p = 0.0002) at day 7, and 11% (p = 0.000001), 15% (p = 0.00003), and 4% (p = 0.0005) at day 14, respectively. At later time points, no significant differences were detected; however, the distribution of fiber diameters remained unimodal (normally bimodal). The muscle and nerve structure damage and impaired perfusion observed in this injury model provide a suitable experimental platform for testing cellular, biological, and pharmacological agents aimed at restoring muscle volume and function.

CONCLUSION: The findings suggest that the development of novel therapeutic strategies for compression-type muscle injury should target not only myogenesis but also angiogenesis and neurogenesis.

INTRODUCTION: The problems of bowstringing deformity management strategies in cases after flexor tendon surgery are not often if ever discussed in Russian-language medical literature.

CASES DESCRIPTION: Our experience comprises 25 patients to whom bowstringing deformity correction was carried out in 29 digits. Our findings at surgery and flexor tendon bed exploration let us to point out the two types of bowstringing deformity: with additional loss of extension from iatrogenic longitudinal scar shortening in 22 of our 29 cases (76%) and with no pathology of the skin as 7 cases of 29 (24%) exhibited. In most cases, flexor tendons were found embedded in the skin velum, sutured over intact pulleys; exploration confirmed anatomical integrity of the A2 pulley, despite complete collapse of the underlying canal opening. The developed surgical strategy was based on a staged treatment principle. Correction of cicatricial deformity of the palmar skin was performed as the first stage, after that the two-stage deep flexor tendon grafting procedure was performed with silicone implant insertion initially. In cases of long-standing arthrogenic contractures, external fixation devise at separate stage was mounted and graduated distraction was performed in 2 of 29 fingers (7%). In the course of silicone rod insertion procedure, we succeeded in preserving of the intact A2 and A4 in all cases owing to author-developed pulley transverse cutting in parts technique. Reconstruction of previously damaged A2 pulley was required in 4 cases. Pulley reconstruction was performed using the technique described by Okutsu et al. (1987) and Dy, Daluiski (2013), with a minor modification.

CONCLUSION: The outcomes of patients' treatment and results of bowstringing deformity correction are indicative of the developed surgical treatment protocol effectiveness. Bowstringing deformity responsible not only for the grip loss but also for cosmetic implication was corrected completely with no recurrence tendency in all 29 cases. Out of 23 cases, full finger motion was restored in 1 case (4.5%), good functional recovery in 15 cases (65%) was achieved, and fair recovery in 7 cases (30.5%). In 6 cases, patients declined tendon grafting.

Fractures of the distal metaphyseal–epiphyseal region of the radius are among the most common injuries and have accompanied humankind throughout its history. The earliest descriptions of this type of injury are found in the works of Hippocrates, who interpreted it as a dislocation of the wrist joint. This opinion persisted for nearly two thousand years. Subsequently, the works of Galen, Palladius, Celsus, Duverney, and Fabricius contain detailed analyses of the direction of hand displacement and the associated impairment of finger function. Many clinical observations, anatomical dissections, and experimental studies conducted by the renowned surgeons of the past gradually dispelled this misconception. The priority in elucidating the true nature of this injury is most often given to Abraham Colles, whose name is associated with the most prevalent type of distal radius fracture. However, earlier attempts at accurate interpretation had also been recorded. Thus, at the beginning of the 18th century, Jean-Louis Petit noted that some wrist dislocations were actually fractures of the distal radius. The French surgeon Claude Pouteau was the first to clearly conclude that this injury represented a fracture rather than a dislocation. He explicitly pointed out the widespread diagnostic error. Undoubtedly, under the influence of the French surgery school, fundamental changes occurred in medical science in the early 19th century. Guillaume Dupuytren and his contemporaries made a substantial contribution to understanding the true mechanism, diagnosis, and treatment of distal radius fractures. The discovery of X-rays enabled clinicians to appreciate the diversity and complexity of these injuries. Although external immobilization remained the predominant treatment method for distal radial metaphyseal–epiphyseal fractures for many centuries, advances in internal fixation techniques over recent decades have led to substantial success in their management. This article presents a historical review of evolving concepts in the diagnosis and treatment of patients with distal metaphyseal–epiphyseal fractures of the radius, from ancient times up to the discovery of X-rays.

Optimal rotational alignment of the femoral component is critical in total knee arthroplasty. The measured resection technique, gap-balancing technique, and hybrid approach are available intraoperative methods for determining femoral rotation; however, each has distinct advantages and limitations. This review aimed to examine the potential of preoperative planning, assess the impact of femoral component malrotation and its acceptable limits on surgical outcomes, and determine the feasibility of using standard intraoperative methods for establishing femoral component rotation as a reference approach in total knee arthroplasty. The systematic review was planned and conducted in accordance with PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. The review reports study characteristics, the number of patients dissatisfied with surgical outcomes, and the specific features of preoperative, intraoperative, and postoperative methods used to determine femoral component rotation in total knee arthroplasty. Initially, 354 articles meeting the main search criteria were identified. Overall, outcomes from 2132 total knee arthroplasties reported in the retrieved publications were analyzed. A total of 149 patients were dissatisfied with surgical outcomes because of anterior knee pain. As modern imaging technologies continue to advance rapidly, the use of more contemporary preoperative assessment methods is becoming increasingly relevant to improve clinical outcomes. Although visual and manual techniques may appear effective, they may be associated with a risk of femoral component malrotation exceeding 3°, which to some extent limits their use in clinical practice. The use of costly imaging modalities, such as computed tomography or magnetic resonance imaging, is not a standard procedure for postoperative screening assessment of implant position.

Plantar fasciitis is a common musculoskeletal disorder associated with inflammatory and degenerative changes of the plantar fascia and characterized by intense heel pain. It affects approximately 10% of the population, occurs more frequently in women, and typically presents between 45 and 60 years of age. The main risk factors for plantar fasciitis include female sex, overweight and obesity, excessive mechanical load on the feet (related to sports activity, occupational strain, and congenital or acquired biomechanical abnormalities), and type 2 diabetes mellitus. Its primary clinical manifestation is heel pain of startup and mechanical character. The disorder typically follows a cyclical course and resolves favorably in 80%–90% of cases within 6–12 months after onset. The diagnosis of plantar fasciitis is established based on clinical presentation, medical history, and physical examination. Radiographic identification of a heel spur (inferior calcaneal osteophyte, which may be associated with plantar fasciitis) has limited diagnostic value, as do magnetic resonance imaging findings of plantar fascia and enthesis involvement. Plantar fasciitis may be a manifestation of systemic rheumatic diseases, particularly spondyloarthritis. Differential diagnosis requires exclusion of disorders such as foot osteoarthritis, plantar heel bursitis, Haglund deformity, Sever disease, plantar fibromatosis (Ledderhose disease), calcaneal fracture, plantar nerve neuropathy, tarsal tunnel syndrome, and L5–S1 radiculopathy. Treatment of plantar fasciitis as an independent condition includes orthotic management, physical therapy (with extracorporeal shock wave therapy being the most effective), nonsteroidal anti-inflammatory drugs, and local injection therapy with glucocorticoids, hyaluronic acid, platelet-rich plasma, and botulinum toxin type A.

The skin and the musculoskeletal system of the human body share far more similarities and physiological interconnections than may appear at first glance. Having comparable composition, functions, and regulatory mechanisms, the skin and the musculoskeletal system are closely linked in terms of both physiological interactions and pathophysiological processes. In addition to their anatomical and physiological relationships, the skin and the musculoskeletal system are often affected simultaneously, forming part of the symptom complex of several hereditary syndromes, which further indicates a close biological relationship between these organs. The skin and bone tissue may also be concurrently involved as a result of a primary dermatological or orthopedic condition. The study of the anatomical, physiological, and clinical relationship between the skin and the musculoskeletal system may have substantial practical importance in addressing both dermatological and orthopedic conditions. Rational interdisciplinary collaboration between dermatologists and orthopedic surgeons can facilitate faster achievement of positive clinical outcomes, reduce rehabilitation time, prevent the development of comorbid disorders, and prolong disease remission. Altogether, this may lead to shorter overall patient management, recovery, and improvement in quality of life. This article presents data on the relationship and interactions between the skin and the musculoskeletal system under normal and pathological conditions and attempts to classify combined disorders, describing dermatologic–orthopedic disorders in both hereditary syndromes and diseases as well as acquired conditions of various etiologies. In addition, the term orthopedic dermatology is proposed to denote an interdisciplinary field of medical knowledge aimed at addressing clinical problems associated with the combined involvement of the skin and bone tissue.

This article presents a brief biographical overview and highlights the scientific achievements of Anton G. Nazarenko, Doctor of Sciences in Medicine, Corresponding Member of the Russian Academy of Sciences, Director of the N.N. Priorov National Medical Research Center of Traumatology and Orthopedics Ministry of Health of the Russian Federation, and Editor-in-Chief of N.N. Priorov Journal of Traumatology and Orthopedics, along with congratulations on his 50^th anniversary.