Vol 25, No 1 (2018)


Dependence of the outcomes of anterior cruciate ligament reconstruction on the tunnel positioning

Bantser S.A., Tikhilov R.M., Trachuk A.P., Bogopol’skiy O.E., Rybin A.V., Shulepov D.A., Salikhov M.R.


Purpose of study: based on the analysis of clinical and radiation data to determine the most favorable positioning of the bone tunnels at different techniques of anterior cruciate ligament (ACL) reconstruction. Study design: retrospective analysis. Patients and methods. Face-to-face and a remote examination was performed in 202 patients at terms from 1.5 to 5 years after primary ACL autoplasty using the graft from the popliteal muscle tendons. All patients were divided into 3 groups depending on the technique of the bone tunnels formation. The patients from the 1st group (n=109) were operated on using transtibial technique, from the 2nd (n=52) and 3rd (n=41) groups - using anteromedial technique with the positioning of the femoral tunnel in the central and anteromedial part of ACL attachment, respectively. Bone tunnels positioning was determined using CT with 3D reconstruction. Subjective evaluation was performed by IKDS-2000, KOOS and Lysholm knee score. To assess the tibiofemoral dislocation the anterior drawer, Lachman and pivot shift tests as well as arthrometry (comparison with the healthy side) were performed. Results. In patients from group 1 the tibial tunnel was positioned in the plane of either central or posterolateral part of ACL attachment. In groups 2 and 3 the tunnel was positioned closer to the anteromedial part. In the majority of patients form group 1 the femoral tunnel was positioned in the zone or slightly forwards of the anteromedial part of ACL femoral attachment, in group 2 - in the plane of central or posterolateral part, in group 3 - in the anteromedial part. In patients from the 1st and 2nd groups the subjective evaluation by IKDS-2000, KOOS and Lysholm knee score was comparable and much higher in the 3rd group (p<0.05). Objective evaluation showed positive manual tests results in 47 patients (62%) from the 1st group, 19 patients (51%) - 2nd group and 4 patients (11%) - 3rd group. Arthrometry showed the increase of anteroposterior tibiofemoral dislocation by 3.4±2.6 mm in the 1st group, 3.1±2.7 mm in the 2nd group and 1.2±1.4 mm. Statistical analysis did not reveal significant difference in knee stability between the patients from the 1st and 2nd groups. Conclusion. Positioning of the femoral tunnel in the plane of anteromedial part of ACL attachment ensures better surgical treatment functional results. In anteromedial technique the use of posterosuperior contour of the lateral femoral condyle as a reference point enables to improve the accuracy of femoral tunnel positioning as well as to minimize the error risk at intraoperative marking.
N.N. Priorov Journal of Traumatology and Orthopedics. 2018;25(1):5-12
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Analysis of the conservative treatment efficacy in patients with subacromial impingement syndrome

Emel’yanenko M.V., Lazko F.L., Gazhonova V.E., Krivoshey I.V.


Purpose: to evaluate the efficacy of the conservative treatment of patients with subacromial impingement syndrome (SIS) and supraspinatus muscle tendon (SMT) pathology using optimized clinical and beam algorithm. Patients and methods. Complex evaluation of the conservative treatment efficacy (physiotherapeutic treatment (PHT), exercise therapy (ET), shockwave therapy (SWT)) was performed in 128 patients - 67 (52.3%) men, 61 (47.7%) women with SIS. Mean age of patients was 59±8 years (24 - 82 yrs), follow up period - 9.6 ±5.6 months (maximum 18 mos). All patients underwent optimized complex clinical and beam examination. Treatment efficacy was evaluated in dynamics at terms 3, 6 and 9 months. Dynamics of pain syndrome and structural changes in STM regress was assessed depending on the type of treatment with calculation of correlation coefficient. Results. In 3 months positive effect of conservative treatment was noted in 67 (65%), in 6 months - in 78 (77%) and in 9 months - in 84 (82%) patients. High correlation of data obtained using the elaborated pain scale for a shoulder with the visual analogue scale data at treatment monitoring (r=0,89) as well as with the monitoring US data (r=0,94) was determined. The combination of SWT+ET+PHT or SWT+PHT showed good therapeutic effect in 3 months after treatment and by 6th month excellent result was recorded in 85% of cases. Due to the long rehabilitation period in operated patients in 3 and 6 months after intervention only the satisfactory result with mean point 3.02±0.12 and 3.52±0.14 respectively was achieved. Conclusion. Choice of treatment method should be based on the results of complex clinical beam examination. In patients with SIS and SMT pathology the most effective is a combined conservative treatment with SWT+ET+PHT or SWT+PHT. However a conservative treatment efficacy is significantly influenced by the SIS stage, anatomical structure of acromeonon as well as the type of SMT structural changes.
N.N. Priorov Journal of Traumatology and Orthopedics. 2018;25(1):13-21
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Risk factors of bone mineral density deficit and low-energy fractures in primary osteoporosis in men

Rodionova S.S., Khakimov U.R.


Purpose: to evaluate the role of well-known factors on the formation of bone mineral density (BMD) and risk of fractures in primary osteoporosis in men. Patients and methods. The influence of well-known osteoporosis risk factors such as age, smoking, alcohol consumption, obesity, genetic disorders in genes encoding COL1A1, COL1A2 and VDR-receptor products, history of low-energy fractures in first-line relatives upon the BMD value and risk of fractures was evaluated in 231 patients with primary osteoporosis. All patients were divided into three age groups according to the following forms of osteoporosis: 17-20 years (n=26) - juvenile form, 21-50 (n=103) - idiopathic form, patients over 51 years (n=102). To assess the influence of study factors on the risk of fractures the patients were subdivided into 5 groups according to fracture localization. Results. The relationship between BMD deficit and mutations in homozygous form of gene rs2412298 (encodes collagen), and the tendency to a reliable increase of BMD deficit in L1 - L4 vertebrae under polymorphism in homozygous form of 1800012 gene was noted that might be evidence of their contribution to the development of primary osteoporosis in men. At the same time, smoking, alcohol consumption, age, mutations in homozygous form of gene rs2412298 and a history of low-energy fractures in first-line relatives increased the risk of low-energy fractures of the vertebral bodies and proximal femur.
N.N. Priorov Journal of Traumatology and Orthopedics. 2018;25(1):22-29
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Numerical simulation of strain within the constructions for temporary hemiepiphyseodesis in patients with systemic skeletal dysplasias

Kenis V.M., Morenko E.S., Korshunov A.V., Kleimanov R.V.


Introduction. Guided growth (temporary hemiepiphyseodesis) methods for the correction of axial deformities at the knee joint level in children are used mainly in patients with idiopathic deformities. In patients with systemic skeletal dysplasias the use of these techniques does not take into account the peculiarities of the pathological process. Purpose of study: to evaluate with radiographs the incidence of incomplete plate-bone contact at temporary hemiepiphyseodesis; to assess tensely deforming condition of metal implants using numerical simulation of strain in patients with systemic skeletal dysplasias for the prognosis of their potential failure. Patients and methods. Postoperative radiographs were analyzed for 58 children with systemic skeletal dysplasias after temporary hemiepiphyseodesis (107 extremities, 188 plates; main group) and 50 patients with the deformities of other etiology (control group). Plate-metaphysis contact was considered to be incomplete if it exceeded 2 mm. To determine the plate strains and displacement during the process of bone growth the numerical simulation using COSMOL Multiphusics Software was performed. Results. Incomplete plate-bone contact was observed in 41 (22%) out of 188 constructions. Mean contact deficit made up 4.1±1.3 mm. In control group incomplete plate- bone contact (over 2 mm) was observed only in 3 (4.5%) cases (p<0.05). When a screw is not completely inserted into the bone, its’ the most loaded part is out of the bone and the risk of screw breakage in the contact zone occurs. That was showed by the data of numerical strain simulation. Conclusion. In temporary hemiepiphyseodesis the potentiality of incomplete plate-bone contact resulting from the anatomical peculiarities of epimetaphyseal zone is up to 22%. To improve the efficacy of the guided growth method in children with systemic skeletal dysplasias the elaboration of the constructions should take into account of epimetaphyseal zone configuration.
N.N. Priorov Journal of Traumatology and Orthopedics. 2018;25(1):30-35
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Surgical treatment for nontumorous diseases of craniovertebral region

Kuleshov A.A., Shkarubo A.N., Gromov I.S., Vetrile M.S., Lisyanskiy I.N., Makarov S.N., Chernov I.V., Mitrofanova E.V., Ponomarenko G.P.


Purpose: to evaluate the efficacy of surgical treatment for the non-tumorous diseases of the craniovertebral region. Patients and Methods. Forty five patients aged 4 - 63 years (mean age 27 years) with non-tumorous diseases of the craniovertebral region were operated on. Either one- or two-step surgical interventions for spinal cord decompression were performed. Early and long term results were evaluated by Frankel, JAO and River scales. In 5 cases the assessment of volumetric craniovertebral interrelationships (VCVI). Results. Good results were obtained in 43 (96%) patients at terms from 1 to 15 years. In 1 patient with mucopolysaccharidoses the aggravation of neurologic symptoms was observed and in 1 case a fatal outcome occurred. VCVI analysis showed a significant improvement of liquor dynamics right up to its normalization in the zone of decompression. Conclusion. Treatment of craniovertebral region diseases requires a differential approach. When necessary to eliminate ventral spinal cord compression it is expedient to perform either transoral or endoscopic transnasal decompression, or transoral spinal cord (myelencephalon) decompression with anterior stabilization by custom-made device (plate).
N.N. Priorov Journal of Traumatology and Orthopedics. 2018;25(1):36-41
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Experience in arthroscopic treatment of acute acromioclavicular joint injuries

Grigor’ev I.V., Zagorodniy N.V., Lazko F.L., Prizov A.P., Belyak E.A., Kubashev A.A., Lazko M.F.


Purpose of study: to evaluate surgical treatment results in patients with closed dislocation of the acromial end of the clavicle. Patients and methods. Eighteen patients, aged 23-54 years, with acute acromioclavicular joint injuries of III-IV type by Rockwood were operated on during 2015 - 2018. Surgical treatment was performed at terms up to 2 weeks after injury. Reduction of the acromial end of the clavicle, arthroscopic fixation and stabilization of acromioclavicular joint by TightRope system was performed. Postoperative follow-up was cjnducted in 4 and 6 weeks, 3 months and subsequently every 6 months after surgical intervention. To evaluate the results the Constant Score and radiographs were used. Results. Follow-up period made up 1 year. Functional result, i.e. range of motion and quality of life, by Constant Score was good already on day 14 after surgery and excellent (89.6±2.9 points) at the end of treatment course (2 months after intervention). Brachial plexopathy (reduction of the thumb and 2nd finger sensitivity and muscular force in the early postoperative period) was observed in 1 case. Six months conservative treatment resulted in positive effect. In 6 months range of motion in the operated joint was equal to that in a healthy one. Conclusion. Arthroscopic treatment of acromioclavicular joint injuries by TightRope system is a highly effective and minimum invasive method but requires experience and practical skills in shoulder arthroscopy.
N.N. Priorov Journal of Traumatology and Orthopedics. 2018;25(1):42-46
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Study of rivaroxaban for venous thromboembolism prophylaxis after lower extremity fractures in Russian clinical practice

Belov M.V.


The purpose of the study was to evaluate the efficacy and safety of rivaroxaban in patients after surgical treatment for the lower extremity fractures. Patients and methods. Retrospective multicenter study included 663 patients with femur fractures, 43 patients with complications after total hip arthroplasty (periprosthetic femur fractures, recurrent dislocation) and 10 patients with shinbone fractures. The majority (81.99%) of patients were elderly or senile. In postoperative period all patients received a standard prophylactic dose of anticoagulants. Out of them 75 (main group) - rivaroxaban (10 mg/day), 241 (control group) - other drugs (enoxaparin - 40 mg/day and dabigatran etexilate 150 or 220 mg/day). The efficacy of prophylaxis was assessed by clinical picture and Doppler ultrasound scans. Results. Average bed day made up 9.28. During hospitalization no cases of PE were recorded. In the main and control groups the rate of deep vein thrombosis with clinical manifestations made up 1.89 and 3.31%, respectively. No cases of fatal bleeding occurred. Signs of continuous bleeding in the area of surgical intervention (soaking dressings or recurring wound hematomas) in the main group was recorded rarely (3.15%) than in the control one (8.29%). Conclusion. Reduction of VTE rate with no increase in bleeding risk indicates the feasibility of rivaroxaban use for postoperative PE prophylaxis in patients with lower extremity fractures.
N.N. Priorov Journal of Traumatology and Orthopedics. 2018;25(1):47-51
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Treatment of a patient with mucopolysaccharidoses type II (Hunter syndrome) complicated by craniovertebral spinal canal stenosis

Mikhailova L.K., Kuleshov A.A., Vetrile M.S., Lisyanskiy I.N., Polyakova O.A., Pereverzev V.S., Makarov S.N.


Formation of spinal canal stenosis at T12-L1 level, rarely at the level of craniovertebral junction, is a typical spinal disorder in different types of mucopolysaccharidoses that is a serious complication due to tetraparesis and tetraplegia development. Clinical, roentgenologic and therapeutic aspects of the mucopolysaccharidoses type II course in a 23 months old boy as well as the results of two-step surgical treatment for the cervical spine stabilization and elimination of spinal canal stenosis at the level of craniovertebral junction are presented.
N.N. Priorov Journal of Traumatology and Orthopedics. 2018;25(1):52-56
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Peculiarities of intramedullary nailing in treatment of extraarticular proximal tibial fractures

Semenistyi A.A., Litvina E.A., Fedotova A.G., Mironov A.N.


From the biological and biochemical points of view closed blocking intramedullary osteosynthesis is an optimum technique for the treatment of extraarticular proximal tibial fractures. The disadvantage of the technique is the complexity of reposition achievement and maintenance. Great number of surgical methods and implants with different efficacy and safety has been proposed to solve these problems. The review presents the analysis of literature dedicated to different methods of reposition achievement and maintenance in intramedullary osteosynthesis of extraarticular proximal tibial fractures.
N.N. Priorov Journal of Traumatology and Orthopedics. 2018;25(1):57-65
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Vascularized bone grafts from the distal third of the femur. Present state of the matter

Kukin I.A., Golubev I.O.


The basic types of the medial and lateral femoral condyle grafts are considered. The most common variants of these grafts application and the donor site complications are presented. Peculiarities of femoral distal third vascular topography and their frequency obtained in the course of anatomic studied.
N.N. Priorov Journal of Traumatology and Orthopedics. 2018;25(1):66-71
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History of meniscal repair techniques development (foreign literature review)

Ryazantsev M.S., Magnitskaya N.E., Il’in D.O., Afanas’ev A.P., Frolov A.V., Korolyov A.V.


The analysis of the evolution of meniscal repair techniques starting of the arthrotomic interventions to procedures under arthroscopic control is presented. Long-term results as well as the surgical techniques are discussed.
N.N. Priorov Journal of Traumatology and Orthopedics. 2018;25(1):72-79
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Contribution of Guillaume Dupuytren (1777-1835) to Clinical Surgery and Traumatology (in commemoration of the 240th anniversary of the birth)

Morgoshiia T.S.


G. Dupuytren was a representative of an anatomic and physiologic direction as he deemed that the surgery should develop on the basis of the achievements of the anatomy and physiology. He rightfully earned a reputation of the best French surgeon that ensured him wealth, fame and titles. Principle theoretic and practical propositions and discoveries of G. Dupuytren are still the background of our knowledge in surgery. General theoretical and methodological principles of scientific cognition that were used by Dupuytren characterize him not only as a great surgeon and traumatologist, but an eminent scientist and thinker as well.
N.N. Priorov Journal of Traumatology and Orthopedics. 2018;25(1):80-83
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Plan of scientific and practical events in traumatology and orthopedics for 2018

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N.N. Priorov Journal of Traumatology and Orthopedics. 2018;25(1):84-85
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S.T. Vetrile

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N.N. Priorov Journal of Traumatology and Orthopedics. 2018;25(1):86-86
pages 86-86 views

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