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Vol 24, No 1 (2017)


State of Specialized Trauma and Orthopaedic Care in the Russian Federation

Es’kin N.A., Andreeva T.M.


The state of specialized outpatient and hospital care to patients with injuries and orthopaedic pathology is analyzed. Dynamics of the traumatism and musculoskeletal system rates for in 2011- 2015 is presented. The measures for the perfection of specialized care to trauma and orthopaedic patients are proposed.
N.N. Priorov Journal of Traumatology and Orthopedics. 2017;24(1):5-11
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Treatment of Comminuted Intraarticular Fracture of Distal Radius with Arthroscopic Reposition of Fragments under External Fixation

Dubrov V.E., Grechukhin D.A., Maksimov B.I., Shantrukov P.A.


Introduction. Use of arthroscopically assisted reduction of bone fragments in comminuted intraarticular fractures of the distal radius (DR) remains ambiguous. The purpose of the study was to determine the expediency and efficacy of arthroscopy in surgical treatment of comminuted DR frac- tures especially under conditions of wrist joint (WJ) external fixation. Patients and methods. Sixty eight patients (mean age 38±14.1 years) with comminuted intraar- ticular DR fractures (type B3-C3 by AO/ASIF) were operated on. In 34 out of them arthroscopic support of osteosynthesis was used. Treatment results were assessed in 3, 6 and 12 months by DASH questioner, X-ray examination data, grip strength and range of motion in WJ. Results. It was stated that WJ arthroscopy improved the diagnosis of joint injuries (injury of tri- angular fibro-cartilage complex was diagnosed in 29 (83.5%), scapholunate ligament - in 12 (35.5%), lunotriquetral ligament - in 4 (11.8%) cases) and the quality of bone fragments reposition (displacement of intraarticular fragments over 1 mm after primary reposition was arthroscopically diagnosed in 21 (61.8%) cases, statistically significant improves the early postoperative (first 3 months after surgery, p<0.05) but did not affect the long term treatment results.
N.N. Priorov Journal of Traumatology and Orthopedics. 2017;24(1):12-19
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Anatomical Reconstruction of Finger Flexors in Scary FibroOsseous Canals

Chernyakova Y.M.


Introduction. Healing of finger flexor tendons after reconstructive operations takes place under the conditions of scary changes in fibro-osseous canals. Determining factor for the functional outcome is the intensity of commissural process around the flexor tendon. The problem of conventional treatment is the impossibility to ensure the ingrowth of fibrous tissue into the scar zone with simultaneous formation of smooth canal wall. Patients and methods. Eighty six patients with 94 finger flexor tendon injuries along the fibroosseous canals were operated on. Eighteen operations with primary delayed deep flexor tendon suture, 8 operations with repeated suture and 7 operations of tendon tenolysis after primary suture were supplemented with the proposed method of temporary isolation of the reconstructed tendon within a dissected polymeric tube. The tube isolates the tendon from blood clots, forms the smooth canal wall. Results. Finger function was assessed in 6 and 12 months. After operations supplemented by temporary isolation of the tendon within the polymeric tubes excellent and good results were achieved at shorter terms, no tenolysis was required and one-step tenoplasty could be performed instead of two-step reconstruction.
N.N. Priorov Journal of Traumatology and Orthopedics. 2017;24(1):20-26
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Experience in the use of Distal Fixation Femoral Component Use in Revision Hip Arthroplasty

Zagorodniy N.V., Ivanov A.V., Kagramanov S.V., Chragyan G.A., Nikolaev I.A.


Purpose . To evaluate the efficacy of revision hip arthroplasty with use of distal fixation revision femoral component. Patients and methods. From June 2004 through October 2015 one hundred thirteen revision arthroplasties were performed in patients with type 3A, 3B and 4 femoral defects by Paprovsky classification. Solution, Wagner SL and Cerafit revision femoral components for distal fixation were used. In the majority of cases (87) the cause of revision intervention was aseptic instability of the femoral component. In 60 cases revision was performed for cementless femoral components, in 53 - for cement components. Results. Follow up period made up from 1 to 12 years. In 83.2% of cases excellent, good and satisfactory treatment results, i.e. pain syndrome remission, restoration of joint movements and extremity weight bearing ability were achieved. Conclusion. Wagner SL, Solution and Cerafit modular revision stems ensure acceptable clinical treatment results and can be the implants of choice for hip femoral component revision arthroplasty in types 3A, 3B and 4 femoral defects by Paprovsky.
N.N. Priorov Journal of Traumatology and Orthopedics. 2017;24(1):27-31
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Use of Modified Arthroscopic Ankle Joint Stabilization for the Treatment of Chronic Lateral Instability

Matsakyan A.M., Kesyan G.A., Ochkurenko A.A., Butaev B.G., Shirmazanyan A.G., Protsko V.G.


Comparative analysis of the results of anatomic restoration of capsuloligamentous system in chronic lateral ankle instability using low invasive arthroscopic techniques was performed. Patients and methods. Forty seven patients (17 - 60 years old) with chronic lateral ankle instability were operated on. In 20 patients a standard “ArthroBrostrum” technique with a use of 2-3 biocomposite fixatives and in 27 patients - the modified arthroscopic intervention with use of 1 titanium anchor was performed. Treatment efficacy was evaluated by AOFAS score. Results. One year after surgery treatment results were followed up in 39 patients: excellent results were achieved in 7 (36.84%), good - in 7 (36.84%), satisfactory - in 3 (15.79%) and poor - in 2 patients after standard technique and in 8 (40.00%), 7 (35.00%), 4 (20.00%) and 1 (5.00%) after modified method, respectively. Conclusion. Thus modified arthroscopic technique is in no way inferior to a standard “ArthroBrostrum” intervention having certain advantages (use of 1 versus 3 fixatives, possibility of intraoperative X-ray control, and shortening of the operation duration). So it could be recommended for the treatment of patients with lateral ankle instability.
N.N. Priorov Journal of Traumatology and Orthopedics. 2017;24(1):32-36
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Treatment of Benign Bone and Joint Tumors and TumorLike Diseases Using Alloplasty and Collagen Containing Material (Clinical and Experimental Study)

Zorya V.I., Krasil’nikov A.A., Chemyanov I.G., Matveev A.G.


Purpose. Improvement of surgical treatment results in patients with benign bone and joint tumors and tumor-like diseases. Materials and methods. Evaluation of the efficacy of plastic collagen containing material for bone defect plasty was performed in 58 Chinchilla rabbits (3-4 kg). In animals from study group the bone defect was filled with collost. Histological examination of the samples was performed in 14, 30, 60 and 90 days after operation. During the period from 2007 to 2015 ninety eight patients, aged 14-75 years, with benign bone and joint tumors and tumor-like diseases were operated on. In all cases postresection defect (1-50 см_) plasty was performed by the proposed combined method that included the use of frozen allograft and collost. During subsequent follow up the potentiality of pathologic process relapse was determined as well as the dynamics of bone structure restoration, extremity function and bone anatomic shape were assessed. Results. Pathomorphologic picture of experimental samples showed that collast accelerated the bone regenerate maturity in the place of a defect. In 1 year after surgery 74 patients (75%) showed good results - in 8 (11.2%), satisfactory - in 62 (84.1%), poor - in 3 (4.7%) cases and in 3 years after operation (57 patients) - 28 (49.1%), 28 (49.1%) and 1 (1.7%) case respectively. Examination of 56 patients (57.1%) in 5 years after intervention revealed good results in 48 (85.4%) and poor - in 8 (14.6%) cases. Conclusion. Study results allow recommending the proposed method of plasty using the allograft and collost for the substitution of vast postresection defects in patients with benign bone and joint tumors and tumor-like diseases.
N.N. Priorov Journal of Traumatology and Orthopedics. 2017;24(1):37-46
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Draft Recommendations. Pharmacotherapy for the Prevention of Repeated Fractures in Patients with Osteoporosis after Surgical Treatment of Pathologic Proximal Femur Fracture

Mironov S.P., Rodionova S.S., Torgashin A.N.


Treatment of pathologic proximal femur fractures complicating the course of systemic osteoporosis is most often limited by surgical intervention as until now trauma and orthopaedic surgeons have no concrete recommendations on pharmacologic correction of metabolism disorders typical to the pathology, that aggravate in the postoperative period due to operative trauma. Proposed draft recommendations are a part of National clinical recommendations “Treatment for pathologic fractures of skeleton bones complicating the course of osteoporosis”. This issue of recommendations is only applicable to pharmacotherapy directed to the correction of bone tissue remodeling with regard for the fracture localization and volume of surgical intervention. Present recommendations are intended for the improvement of patients’ life quality, reduction of present and future losses from pathologic fracture as well as the prevention of repeated fractures.
N.N. Priorov Journal of Traumatology and Orthopedics. 2017;24(1):47-57
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On Preparation of Illustrations for Scientific Publications on Traumatology and Orthopaedics

Ivanov P.A., Nevedrov A.V., Kalenskiy V.O., Bondarev V.B., Zadneprovskiy N.N.


Inadequate attention is paid to the preparation of quality illustrations for scientific publications on traumatology and orthopaedics. Review of the quality of 1221 pictures in three typical journals shows that the majority of patients’ photographs are made against the bad background, with presence of foreign objects, and the photos are made from the angle that does not allow making a reliable picture of function restoration. X-ray examination results and intraoperative photographs are not without disadvantages. Recommendations that can considerably improve the quality of the presenting illustrations and its informational content are given.
N.N. Priorov Journal of Traumatology and Orthopedics. 2017;24(1):58-65
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Surgical Treatment of C2 Odontoid Process Intussusception in Combination with Type I Chiari Malformation

Shkarubo A.N., Kuleshov A.A., Chernov I.V., Shakhnovich V.A., Mitrofanova E.V., Vetrile M.S., Lisyanskiy I.N., Gromov I.S.


Type I Chiari malformation is often accompanied by congenital developmental abnormalities such as platybasia, basilar impression and C2 odontoid process retroflexion that may cause anterior compression of brainstem structures and upper cervical segments of spinal cord. Formerly the conventional method was posterior decompression even in presence of anterior brainstem compression. This article presents on a kinetic example the tactics of one-step treatment of patients with type I Chiari malformation accompanied by basilar impression and C2 odontoid process retroflexion via transoral approach only that was used for both decompression and C1-C2 segment anterior stabilization. Surgical intervention enabled to achieve the decompression of brainstem structures and upper cervical segments of spinal cord, normalization liquor dynamics and subsequent redislocation of cerebellar tonsils to normal position (above the Chamberlain line).
N.N. Priorov Journal of Traumatology and Orthopedics. 2017;24(1):66-72
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Surgical Treatment for Severe Decompensated Neuromuscular Scoliosis in Patient with Spinal Muscular Atrophy type II

Baklanov A.N., Shaboldin A.N., Barchenko B.Y.


Treatment results for 16 years old patient with grade 4 thoracolumbar scoliosis on the background of Type II spinal muscular atrophy are presented. One step surgical treatment via dorsal approach was performed: posterior corrective two-rodtranspedicular corporal screw C7 - S1 fusion with fixationof iliac bones by transpedicular system with bone autoplasty + osteomatrix. Surgical intervention resulted in the formation of satisfactory trunk balance, reduction of pelvic distortion and improvement of the patient’s quality of life.
N.N. Priorov Journal of Traumatology and Orthopedics. 2017;24(1):73-76
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Legg- CalvePerthes Disease: Etiology, Pathogenesis Diagnosis and Treatment

Kozhevnikov O.V., Lysikov V.A., Ivanov A.V.


Etiology, pathogenesis, diagnosis and treatment for Legg-Calve-Perthes Disease were studied. Basic methods of conservative and surgical treatment were presented. For the elaboration of more effective treatment techniques the better understanding of the pathogenesis of femoral head deformation is required.
N.N. Priorov Journal of Traumatology and Orthopedics. 2017;24(1):77-87
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