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Vol 26, No 1 (2019)

Articles
Reconstruction of a hip socket using trabecular metal components
Zagorodny N.V., Alexanyan O.A., Cragan G.A., Kagramanov S.V., Iwunze B.U.
Abstract
Introduction. Fixation of the acetabular component in patients with bone defects of the acetabulum is a difficult task due to the insufficient quantity and poor quality of the remaining bone tissue. During the last few years in our country in arthroplasty of the acetabulum with severe bone defects were actively used implants made of trabecular metal. Purpose of study: was to evaluate short-term clinical and radiological results of the usage of trabecular metal components in patients with bone defects in revision and primary hip replacement. Patients and methods. 59 surgeries were performed using components of trabecular metal, 53 of them were performed on the instability of the hip prosthesis, 2 - post-traumatic hip dysplasia, 2 - aseptic necrosis of the femoral head, 2 - high dislocation of the femoral head. Among the operated there were 37 women and 22 men, the average age was 58.2±19.9 years. According to the Paprosky classification, defects in 12 cases corresponded to type IIA, in 14 - type IIB, in 6 - type II, in 19 - type IIIA, in 7 - type IIIB. The structural features of these implants, made of tantalum in a carbon skeleton with uniform porosity, similar to the structure of bone tissue, provide an increased coefficient of friction, thereby contributing to the rapid growth of bone tissue in the implant structure. Results. The average follow-up period was 14 months. The average preoperative assessment of the hip joint by Harris Hip Score (HHS) was 43 points (from 14 to 86). After surgery, the average HHS improved to 88.7 (69 to 100). 1 patient had hemorrhagic discharge after surgery. On the 7th day an audit was performed. In 2 cases, paresis of the peroneal portion of the sciatic nerve developed after surgery. There were no cases of recurrent dislocations, deep infection, pulmonary embolism or death as a result of operations. Conclusion. Taking into account the mechanical properties, tantalum implants allow to achieve a stable primary fixation with the restoration of the center of rotation of the hip joint and eliminate the risks associated with the use of allografts. Conflict of interest: the authors state no conflict of interest Funding: the study was performed with no external funding
N.N. Priorov Journal of Traumatology and Orthopedics. 2019;26(1):5-10
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Surgical treatment and rehabilitation capabilities of patients with patellar fractures
Solod E.I., Zagorodniy N.V., Lazarev A.F., Tsykunov M.B., Abdulhabirov M.A., Hijazin V.H.
Abstract
Relevance. Fractures of the patella represent about 1% of all fractures of the bones. Among surgeons there is no a single approach to the treatment of patients with many fragmentary patellar fractures. After surgical treatment of patients with patellar fractures, various complications could be observed. Aside from that, there is no consensus on the treatment of complex fractures of the patella, and in practice, trauma physicians use a variety of methods of osteosynthesis of the patella. In the light of the foregoing, the study of long-term results of patients after patellar fractures is of particular relevance. Purpose of study: to examine the results of patients after surgical treatment of patellar fractures with a view to devising best practices for its osteosynthesis. Patients and methods. A study of the results of treatment of 78 patients with patellar fractures was conducted. The following groups were identified depending on the type of surgery and the nature of the fracture: Weber osteosynthesis in fragmentary fractures; «cruciform osteosynthesis» and other identical options of osteosynthesis with spokes and wires at three or more fragmented fractures of the patella; combination osteosynthesis. A comparative analysis of the results of treatment of patients after partial patellectomy and osteosynthesis of the patella with spokes and tightening wire loops was conducted. We evaluated the results on the KOOS scale with clinical examination and x-ray examination of patients. Beyond that, we have supplemented this scale with the patients’ own opinion on the evaluation of the results of their treatment. Results. The average follow-up period was 22 months. A comparative analysis of the groups of patients after surgical treatment of patellar fractures on the KOOS scale showed the best results in osteosynthesis of transverse two-fragment patellar fractures by Weber’y - 72%. The results of treatment of patients with many fragmentary patellar fractures using 3-5 spokes and 2-3 wires was - 64%; after the rehabilitation of the lower pole was - 68%) and after partial patellectomy -51%. Conclusion. If a patient has three-fragmented patellar fractures, reasonable results could be achieved by using 3 spokes and 2 tightening wire loops. With four or more fragmentary fractures of the patella, the optimal method for its osteosynthesis is the use of a «cruciform» method with 4 or more spokes in combination with two or three wire loops. The use of patellectomy with subsequent fixation of the blocking wire loop should be avoided in all types of patellar fractures. Key words: patellar fracture, osteosynhesis, surgical treatment Conflict of interest: the authors state no conflict of interest Funding: the study was performed with no external funding
N.N. Priorov Journal of Traumatology and Orthopedics. 2019;26(1):11-16
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Midterm surgical treatment outcomes of unstable distal radius fractures
Yeghiazaryan K.A., Ratiev A.P., Grigoriev A.V., Germanov A.V., Danilov M.A., Chebotarev V.V.
Abstract
Background. Fracture of the distal radius is the most common injures bones of the forearm. Multifragmentary articular injures have occupied a special place among all fractures of the distal radius This factor due to the severity of the injury wrist joint, young patients and difficult rehabilitation. Purpose of study: Improvement results surgical treatment unstable fractures of the distal radius. Patients and methods. All patients were depended into two groups: The first group consisted of 34 patients. The first stage of treatment include close reduction and external fixations. If after external fixation we have persisting fractures dislocation, we take conversion external fixation, open reduction and plate fixation. The second group were included 30 person. In this group we take open reduction and plate fixation. Results. 6 or 12 month after surgery in 1 group we have receiver 87% excellent results. In the the second group we have received 77% excellent results. In the first group 2 cases have slow fractures consolidation, infection complication not found. In the second group we have 2 complication: CRPS and infection. Conclusion. Results in two groups of patients are assessed as good and excellent. The results of the study showed that external fixation in first stage of treatment allows to achieved better restoration radiocarpal joint anatomy (except for type B fractures), and without secondaly displacement tendency. The last fact is very important for patient with delayed the second stage of treatment. This patients with multiple injuries, open fractures and presence of an infected wound and etc. The second stage of treatment consisted of open reduction and plate fixation. Achieved full anatomy restoration radiocarpal joint with possible early rehabilitation. Conflict of interest: the authors state no conflict of interest Funding: the study was performed with no external funding
N.N. Priorov Journal of Traumatology and Orthopedics. 2019;26(1):17-26
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Surgical treatment of congenital pseudoarthrosis of the clavicle in children
Pozdeev A.P., Belousova E.A., Sosnenko O.N.
Abstract
Introduction. In the literature the issue of indications for surgical treatment of CPC (congenital pseudoarthrosis of the clavicle) is exposed to discussion. Also, there are no accurate age indications for surgery. The conducted research has shown that the course of CPC is accompanied by clavicle shortening as well as by bone fragments deformation in 60% of the cases, which has a significant effect on the planning of surgery. Purpose of study: to develop a differentiated approach to the treatment of congenital pseudoarthrosis of the clavicle in children, taking into account the clinical and radiological picture. Patients and methods. 27 patients with the congenital pseudoarthrosis of the clavicle (CPC) aged from 4 up to 16 years old were operated. In 6 observations bone fragments deformation of the clavicle was absent, and in 21 observations various deformations occurred. The surgery included restoration of clavicle axis, replacement of bone tissue defect with bone autograft, fixation of bone fragments with a needle. Results. After the first surgery, bone fragments consolidation of the false joint was reached in 82% of the cases (22 patients); the recurrence of the false joint was observed in 18% (5 patients). Repeated surgeries were successfully performed on four of them; one patient is being observed on an outpatient basis. Conclusion. The results of the surgical treatment have shown that for the union of a false joint it is necessary to use differentiated approach to the adoption of surgical technique with regard to bone fragments deformation. Partially eliminated deformation and clavicle sternal bone fragment high standing served as the main reason for the recurrence of pseudoarthrosis. Conflict of interest: the authors state no conflict of interest Funding: the study was performed with financial support «Research Institute of pediatric traumatology and orthopedics G.I. Turner» Ministry of Health Russia
N.N. Priorov Journal of Traumatology and Orthopedics. 2019;26(1):27-34
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Surgery tactic in humeral nonunion
Golubev I.O., Sarukhanyan A.R., Merkulov M.M., Bushuev O.M., Shiryaeva G.N., Kutepov I.A., Maksimov A.A., Kapyrina M.V.
Abstract
Relevance. Humerus fractures comprise 5 to 8% of all. Nonunions are uncommon, although in cases of infection, poorly vascularized beds, and open, segmental, or severely comminuted fractures, secondary bony healing may still be compromised. In cases of decreased blood supply, the choice of a vascularised bone graft seems inevitable. Purpose of study: analysis of effectiveness and choosing indications for Vascularized bone grafts in humeral nonunion treatment. Patients and methods. 41 humeral nonunion surgery performed from 2010 to 2017 at a single institution: Vascularized fibular grafts were done in 38 and vascularized femoral condylar grafts used in 3 cases. ORIF performed in all cases. X-ray and CT-scan used for control in all patients. Results. After vascularized bone grafting union achieved in 36 cases (88%) in 4 to 6 month, with vascularized fibular grafts in 33 cases and with vascularized femoral condylar grafts in 3 cases. Conclusion. Any humeral nonunion case require individual treatment tactics. Using of vascularized bone grafts can be crucial in lack of local healing process and persistent nonunions of the humerus. Conflict of interest: the authors state no conflict of interest Funding: the study was performed with no external funding
N.N. Priorov Journal of Traumatology and Orthopedics. 2019;26(1):35-41
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Reconstructive plastic surgery in the treatment of desmoid fibroids of extraabdominal localization
Yadrina A.V., Karpenko V.Y., Novikova O.V., Bychkova N.M., Derzhavin V.A., Bukharov A.V.
Abstract
Desmoid fibroids (DF) are mesenchymal tumours consisting of differentiated fibroblasts and excessive amounts of collagen fibres. DF are extremely rare pathology, its frequency is 2-4 cases per 1 million people per year and it is less than 3% of all soft tissue tumours. The surgical method is the main in the treatment of DF, however, while a surgeon ensuring a negative border of resection, there are functional and cosmetic defects that require reconstruction. This study presents the results of surgical treatment of 40 patients with DF extraabdominal localization using reconstructive plastic surgery, as well as adjuvant drug treatment with a positive border of resection. Conflict of interest: the authors state no conflict of interest Funding: the study was performed with no external funding
N.N. Priorov Journal of Traumatology and Orthopedics. 2019;26(1):42-48
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Simultaneous surgical interventions in spinal surgery: a review of the literature and clinical caso for spondylolisthesis of the lumbar spine
Byvaltsev V.A., Kalinin A.A., Shepelev V.V., Badaguyev D.I.
Abstract
The article presents the first clinical case of surgical treatment of a patient with spondylolysis spondylolisthesis using a combination of minimally invasive surgical techniques and simultaneous operation. This intervention has significantly reduced the level of vertebral pain syndrome, improve the functional status in the postoperative period, effectively eliminate pathological mobility, provide early activation, to carry out a full rehabilitation in the shortest possible time and can be an operation of choice in patients with lumbar spondylolysis spondylolisthesis. Conflict of interest: the authors state no conflict ofinterest Funding: the study was performed with no extermal funding
N.N. Priorov Journal of Traumatology and Orthopedics. 2019;26(1):49-57
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Rehabilitation diagnosis in the pathology of the musculoskeletal system using categories of the international classification of functioning. Part 1
Tsykunov M.B.
Abstract
In accordance with the recommendations of the World Health Organization, the categories listed in the International Classification of Functioning (ICF) should be used to assess the structure, function, activity and participation. In recent years, the assessment of the state of the body is no longer possible without the use of scales, but a large number of them do not always allow specialists to understand each other. The creation of a unified system, which will collect various tools for assessing the patient’s condition, will provide serious assistance in the work of members of a multidisciplinary team in the process of medical rehabilitation. In addition, it will help in the formulation of rehabilitation diagnosis and in more accurate determination of rehabilitation potential. The dimension of a number of generally accepted scales to describe disorders of the musculoskeletal system does not coincide with the categories of ICF. This paper attempts to eliminate this contradiction. To describe a number of disorders that affect the function of the musculoskeletal system and are traditionally used in orthopedics, the category other or not described can be used. In the presented system of evaluation are given equal-weighted scale with the dimension adopted in the ICF. This system can be used as a basis for the preparation of medical rehabilitation programs and evaluation of their effectiveness. Conflict of interest: the authors state no conflict of interest Funding: the study was performed with no external funding
N.N. Priorov Journal of Traumatology and Orthopedics. 2019;26(1):58-66
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Gennady Petrovich Kotelnikov. 70th anniversary
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N.N. Priorov Journal of Traumatology and Orthopedics. 2019;26(1):67-68
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To the anniversary of Professor Y.I. Ezhov (75th anniversary)
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N.N. Priorov Journal of Traumatology and Orthopedics. 2019;26(1):69-71
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The life of the legendary Professor G.A. Albrecht: at the origins of prosthetics orthotics (to the 140th anniversary of the birth and the 85th anniversary of the death)
Morgoshiia T.S.
Abstract
The article noted that on 20 November 1907, awarded by the conference of the Academy degree of doctor of medicine, after public defence of a thesis on the theme: «pathology and treatment of lateral curvature of the knee». One after another began to appear in print: «the question of fluoroscopy and radiography gunshot injury», «traumatic separation of the lower epiphysis of the radius», «Apitizers as a method for the treatment of genu valgum», «Pathology and treatment of hallux valgus», «the technique of treatment of coxitis tuberculosae», «Isolated fracture of the trochleae humeri with a bloody reduction method, the technique of treatment of pseudoarthrosis autoplastic way.» German Alexandrovich considered the prosthesis as a special area of medicine and technology that have important national economic significance. The primary means of training was surgery. In addition, in medical institutions was to be made, fitting, final fitting of prosthetic devices and training in their use patients. Also provides a broad familiarization of surgeons with the essential requirements of the prosthesis. It was also noted that in 1928, the opening of the Institute for medical and orthopedic hospital with 30 beds in addition to the hostel with 50 places, intended for the waiting of prostheses. In this way organized a uniform system of preparation for prosthetics, supply of prostheses and learning to use them in a special institution, which has for this purpose the necessary medical and technical personnel and equipment. German Alexandrovich was a highly qualified physician, research worker and teacher is not unusual for the time, however, harmonically the current profile. After 10 years in the clinic of Professor G. I. Turner, he acquired a comprehensive knowledge of orthopedics, which formed the basis for his later activities. Having a brilliant operative technique, Albrecht has developed its own methods of arthrodesis of the ankle and knee joints, modification kinaesthesia operations on stumps of the upper arm and forearm, as well as highly desirable variation of talangsari the first metacarpal and the splitting of the stump of the forearm by Krukenberg. Conflict of interest: the authors state no conflict of interest Funding: the study was performed with no external funding
N.N. Priorov Journal of Traumatology and Orthopedics. 2019;26(1):72-76
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