Vol 21, No 1 (2014)

Articles
Temporary Noninvasive Pelvic Stabilization
Samokhvalov I.M., Borisov M.B., Denisenko V.V., Grebnev A.R., Ganin E.V.
Abstract
Pelvic ring stabilization is the basic emergency care measure in unstable pelvic injuries. The purpose of the work was to determine the efficacy of pelvic bandage in patients with unstable pelvic fractures and persistent intrapelvic hemorrhage. Thirty seven patients were divided into 2 groups. In study group (n=19) primary pelvic stabilization was performed using extempore pelvic bandage; in patients from control group (n=18) external fixation devices were applied. Duration of pelvic fixation procedure, hemodynamics and quality of reposition were assessed. Duration of pelvic bandage application was significantly lower than that required for pelvic external fixation - 2.4±0.8 min versus 29±3.2 min. That advantage enabled to use the bandage before the diagnosis was completed and other injuries were eliminated - in 6.0±2.1 min after patient’s admission while the time before the application of external fixation device made up 86.0±5.6 min ( p < 0.001). Application of pelvic bandage enabled to stabilize blood pressure in the course diagnostic and treatment measures. In some cases pelvic roentgenography revealed excessive internal rotation when bandage was applied. So, application of pelvic bandage is a simple, effective, rapid method for temporary pelvic fixation.
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(1):6-11
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Efficacy of Various Arrangements of Pelvic External Rod Fixators in Polytraumatized Patients at Resuscitation Step
Ivanov P.A., Zadneprovskiy N.N.
Abstract
Application of external fixators (EF) in pelvic fractures is one of the important components of antishock therapy in patients with polytrauma. However various fixation techniques possess certain advantages and disadvantages. Comparative analysis of 4 most commonly used variants of pelvic EF mounting, i.e. classic - via upper flaring portion of the ilium, supra-acetabular, orthogonal - combination of screws passes through the wings and supra-acetabular region, and subcristal, that were applied in 32, 48, 13 and 3 patients, was performed. Results of the analysis showed that supra-acetabular pelvic fixation technique a preferable one due to its high efficacy and lower rate of complications as compared to other external fixation methods.
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(1):12-18
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Emergent Stabilization of Pelvic Bones Fractures in Polytrauma
Litvina E.A.
Abstract
Principle aspects of the management of patients with concomitant pelvic injury and injuries of other localization from the standpoint of modern treatment concept Damage control are discussed. Special attention are paid to the techniques for pelvic ring fixation, arrest of intrapelvic hemorrhage, sequence of surgical interventions depending on the pattern of concomitant injuries. The necessity of emergent pelvic injuries fixation with external devices as well as the fractures of other localization in the acute period until stabilization of patient’s general condition is substantiated
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(1):19-25
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Treatment of Vertically Unstable Pelvic Ring Injuries in Patients with Complicated Pelvic Trauma
Ushakov S.A., Lukin S.Y., Nikol’skiy A.V.
Abstract
The purpose of the work was to improve the treatment results for patients with complicated pelvic injury using differentiated application of transosseous and internal osteosynthesis. Retrospective analysis of treatment results is presented for 52 patients with vertically unstable pelvic ring injuries and concomitant abdominal injuries. Clinical cases demonstrate the variants of clinical decision depending on the type of injury, degree of pelvic ring instability, pattern of concomitant abdominal injuries. Protocol of patient management in such injuries is suggested.
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(1):26-31
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Surgical Treatment of Old Pelvic Ring and Lower Urinary Tract Injuries in Men
Lazarev A.F., Gudushayri Y.G., Verzin A.V., Solod E.I., Kakabadze M.G., Roskidailo A.S., Stoyukhin S.S.
Abstract
Surgical treatment results for 56 men with old pelvic bones and junctions injuries complicated or associated with either strictures or obliteration of membranous and bulbomembranous urethral segment are presented for the period from 2002 to 2013. Terms after trauma made up from 1 month to 6 years, mean age of patients - 36 (16-66) years. All patients were admitted with epicystoma and history of 3-5 failed surgical interventions directed to uresis restoration. The pattern of pathologic mobility, degree of pelvic ring injury, length of urethral defect, and connec- tion of urethra with either bone fragments or displaced pelvic bones were assessed during complex urologic and traumatologic examination. Treatment tactics, i.e. one- or two-step, was chosen depending on the diagnosed injuries. In two-step treatment tactics orthopaedic step always preceded the urologic one (urethra plasty) that followed in about 2 months after primary intervention. Observation terms made up from 1 month to 6 years. Loco-motor function was restored in all patients, urination - in 54 of 56 patients. Thus, elaborated method of surgical treatment for old concomitant pelvic ring and lower urinary tract injuries showed high efficacy in patients with posttraumatic urethral stricture or obliteration
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(1):32-38
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Techniques for Final Pelvic Ring Fixation Based on the Method of Finite Element Modeling
Donchenko S.V., Dubrov V.E., Golubyatnikov A.V., Chernyaev A.V., Kuz’kin I.A., Alekseev D.V., Lebedev A.F.
Abstract
Method of finite element modeling was used for mathematic modeling of pelvic fractures and various variants of anterior and posterior pelvic ring fixation with reconstructive plates, cannu- lated sacroiliac screws and pelvic screws. Four most common types of fracture were simulated. Stress-deformed conditions of metal constructions for every type of fracture and variant of its fixation were determined. Study results enabled to determine the optimum fixation techniques in various types of fractures, to confirm the significance of both anterior and posterior pelvic stabilization, as well as to substantiate the possibility of early rehabilitation with full weight bearing in such severe patients
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(1):38-44
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Effect of Autologous Plasma, Ascorbic Acid and Glucose Local Infusions on Pelvic Fracture Healing in Experiment
Silant’eva T.A., Krasnov V.V.
Abstract
The efficacy of reparative osteogenesis stimulation by local infusion of autologous plasma in combination with ascorbic acid and glucose solutions was experimentally demonstrated in ani- mals (dogs) using the models of transverse acetabular ( n =20) and iliac shaft fracture ( n= 6). Either intraarticular or intraosseous solution infusions via injection system with automatic drug pump were performed from 2nd to 5th day after transverse osteotomy, reposition and stable external fixation. Fixator was dismounted on 21st postoperative day. In control series of experiment (intraarticular and intraosseous infusion of saline) fibrocartilagenous junction was formed and bone deformity due to secondary bone fragments displacement was noted after device removal. In experimental series primary pelvic bone fragments consolidation was observed in 14 days after operation and no displacement of fragments occurred after external fixation device removal.
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(1):45-51
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Complicated Cases of Knee Arthroplasty
Zagorodniy N.V., Kagramanov S.V., Kudinov O.A., Nikolaev I.A., Chragyan G.A., Ivanov A.V., Kilasoniya I.D.
Abstract
Experience in treatment of 190 patients (mean age 61 years) with marked (> 15°) knee deformity due to various pathology (idiopathic gonarthrosis, rheumatoid arthritis, posttraumatic gonarthrosis) is presented. In 19 cases revision interventions for aseptic instability of implant were performed. In all cases «Smith & Nephew» RT-PLUS system of either standard or modular modification was used. In 183 (96.3%) cases satisfactory results were noted: steady remission of chronic pain syndrome was achieved, limb axis, joint mobility and weight bearing ability were restored, conditions for early loading and mobilization were provided. All that promoted the improvement of patients’ life quality. Complications included 1 case of periprosthetic fracture, 5 cases of deep purulent inflammation 2 of which required implant removal with creation of arthrodesis in functionally favorable position, and 3 cases of arthrofibrosis. As a whole the achieved results enable to recommend the use of RT-PLUS system in complicated cases of arthroplasty.
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(1):52-56
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Efficacy of Analgesic Therapy after Hip and Knee Arthroplasty
Markov P.V., Pal’shin G.A., Komissarov A.N.
Abstract
Efficacy of pain syndrome drug therapy using aceclofenac in combination with tolperisone after total knee and hip arthroplasty was studied. Study included 100 patients. Patients from group 1 ( n =30) received ketorolac, from group 2 (n=35) - aceclofenac, from group 3 (n=35) - aceclofenac in combination with tolperisone, for 3 postoperative days in recommended doses. Severity of pain syndrome by VAS, range of motion, and dynamics of soft tissue edema was assessed. It was shown that combined therapy with aceclofenac and tolperisone was more effective in pain syndrome reduction, contributed to more marked regress of soft tissue edema and more complete restoration of movements as compared to monotherapy with nonsteroid anti- inflammatory drugs.
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(1):57-60
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Arthroplasty Using Autologous Multipotent Mesenchymal Cells and Collagen Membrane Chondro-Gide
Bryanskiy A.I., Kulyaba T.A., Kornilov N.N., Rumakin V.P., Gornostaev V.S.
Abstract
Surgical treatment results for 13 patients with local deep defects of the articular surface of femoral condyle are presented. Surgical treatment was performed in two steps. At first step diagnostic arthroscopy with removal of loose intraarticular bodies, resection of injured menisci and harvesting of fat body tissues for multipotent mesenchymal stromal cells (MMSC) isolation were applied. Second step consisted of knee arthroplasty; zone of defect was covered with collagen membrane Chondro-Gide under which MMSC were implanted. Control arthroscopy with biopsy of articular surface fragment in the zone of defect restoration was performed to four patients (30.8%) 2 years after arthroplasty. It is shown that after surgical intervention cartilage regeneration goes on owing to fibrillar cartilage formation. In 2 years follow up good results were achieved in 92.3% of cases that proved the efficacy of the elaborated technique for restoration of knee joint function and slowing down of degenerative-dystrophic changes development
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(1):62-66
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Posterior Interosseous Artery Flap for Hand Reconstruction
Golubev I.O., Grishin V.M., Maksimov A.A., Merkulov M.V., Bushuev O.M., Kutepov I.A., Yulov R.V.
Abstract
Results of hand reconstructions with posterior interosseous artery flap were analyzed for 37 patients (25 males and 12 females) aged from 13 month to 56 years. The reasons for plasty were the following: acute trauma with soft tissue defect - 6 cases, posttraumatic hand and fingers deformity - 18 cases, hand pathology - 5 cases, congenital hand deformities - 8 cases. In 26 patients plasty with posterior interosseous artery flap was performed in combination with other techniques of hand microsurgical reconstruction. At terms up to 3 weeks the flap settled nicely in 35 (94.6%) patients, in 2 patients partial necrosis of the flap was observed. In 1 year after operation all patients and/or their relatives were satisfied with the cosmetic view of hand and donor site on the forearm.
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(1):67-71
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In Vivo Study of Tricomponent Resorbable Calcium Phosphate Bone Cement Based on Tricalcium Phosphate
Mamonov N.R., Chemis N.R., Drize N.R., Proskurina N.R., Kryazhkov I.I., Komlev V.S.
Abstract
Results of experimental morphologic study of tricomponent resorbable calcium phosphate bone cement (CPhC), based on tricalcium phosphate for the filling of defect as a temporary bearing resorbable matrix are presented. Study was performed on soviet chinchilla rabbits weighting 3200-3500 g. The model of critical spongy bone defect was used. At different observation terms (6, 9 and 12 months) gradual substitution of biomaterial with newly formed bone tissue from periphery to the center was observed with complete cement resorption 12 months after surgery. By mechanic characteristics newly formed bone in the defect was stronger than the surrounding trabecular one. It was stated that material possessed hemostatic effect and moderate toxicity. Peripheral bone marrow maintained its cellularity at all terms, gradually filling intertrabecular space of newly formed bone. Achieved data enable to recommend wide used of CPhC for bone defects substitution.
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(1):72-77
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Structural Parameters of Proximal Femur in Evaluation of Its Strength
Rodionova S.S., Torgashin A.N., Solod E.I., Morozova N.S., Morozov A.K., Lapkina S.V.
Abstract
Comparative assessment of software HAS for Hologic densitometer was performed in two groups of osteoporotic patients (mean age 60.4 years) with and without proximal femur fractures. The area of cross-section, cross-section moment of inertia, axial moment of section resistance, cortical bone thickness and coefficient of bending were assessed in three zones of the femur (narrow part of the neck, intertrochanteric and diaphyseal zones). Results of linear discriminant analysis showed that totality of 9 out of 15 geometric parameters assessed by that program enabled with 100% probability to differentiate patients with and without fractures and gave the background to introduce that method into clinical practice for timely detection of patients with high risk of proximal femur fracture.
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(1):77-81
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Microsurgical Reconstruction of Soft Tissues in Elbow Arthroplasty
Kalantyrskaya V.A., Golubev I.O., Afonina E.A.
Abstract
Case report on a patient with severe traumatic elbow joint destruction in whom consecutive restoration of common integument (with free Latissimus dorsi musculocutaneous flap) and elbow arthroplasty were performed is presented
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(1):82-83
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Surgical Correction of Severe Secondary Anterior Foot Deformity
Privalov A.M.
Abstract
Clinical case of successful correction of severe iatrogenic foot deformity following several failed operations for transverse platypodia correction is presented. Application of several surgical techniques totality in combination with restoration of foot bones anatomical arrangement enabled to achieve positive result.
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(1):84-85
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Efficacy of Autologous Growth Factors Application in Musculo-Skeletal System Injuries and Diseases
Mironov S.P., Ochkurenko A.A., Kesyan G.A., Savel’ev S.N., Arkad’ev A.A., Zbarag N.N.
Abstract
Literature review on the assessment of the efficacy of platelet rich autoplasma for the treatment of various musculo-skeletal system diseases - tendinopathy, osteoarthrosis, injuries of ligaments, tendons, muscles and bones is presented. Platelet rich autoplasma contains growth factors and secretory proteins that can start up remodeling and restorative processes in pathologic tissues. The method showed itself to be effective, safe, free from side effects and complications. Most of the research workers consider it reasonable to conduct randomized controlled studies in order to receive reliably data on this methods efficacy.
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(1):86-93
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G.P. Kotel'nikov
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N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(1):94-94
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