Vol 21, No 3 (2014)

Articles
Direct Causes of Death in Road Traffic Accident Victims and Evaluation of the Efficacy of Three-Level Trauma Centers Activity in Chelyabinsk Region
Moskvichyova M.G., Shishkin E.V.
Abstract
Data on direct causes of death in road traffic accident (RTA) victims for Chelyabinsk region is presented for 2 periods, i.e. before (2008-2010) and after (2011-2013) organization of trauma center. Comparison of the level and structure of RTA death causes in two three-year periods showed no significant differences. Evaluation of the efficacy of trauma centers activity (2011 - 2013) that render medical care to RTA victims with multiple and concomitant injuries is performed. During three-year period of trauma centers activity the number of road traffic deaths resulted from multiple and concomitant injuries increased by 17.22%. No statistically significant changes in the rate of three main causes of RTA related death (multiple and concomitant injuries, head and chest injuries) were noted during the study period. Achieved results confirm the necessity to elaborate and introduce the monitoring that will enable to evaluate the efficacy and quality of trauma centers activity at all steps of medical care rendering including patients’ transportation.
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(3):5-9
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Methodic Approaches to Evaluation of Requirements in Traumatologic and Orthopaedic Care to Child Population in Novosibirsk Region
Myl’nikova T.A., Shalygina L.S., Gusev M.V., Ivaninskiy O.I., Tsytsorina I.A.
Abstract
High social significance of traumatism in child population (2 nd place by the level of primary morbidity and 8 th one by the causes of disability) determines the priority of traumatologic and orthopaedic service development. Great importance is given to the prognosis of justified requirement in this type of medical care for the short term prospective. Study was performed basing on the analysis of official statistic data on Novosibirsk region for 2005-2012 as well as on the results of expert evaluation of traumatologic and orthopaedic service condition, problems and prospective of development. It is stated that provision of traumatologic and orthopaedic care availability to child population in Novosibirsk region requires 19 additional beds (5 traumatologic and 14 orthopaedic). Requirement in outpatient trauma and orthopaedic surgeons makes up 32 specialists. Complex analysis of traumatologic and orthopaedic service personnel showed the presence of internal potentials for its perfection. Realization of measures on raising the qualification of trauma and orthopaedic surgeons, general surgeons and child surgeons working in the field of pediatric traumatology and orthopaedics will not require additional personnel.
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(3):10-14
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Congenital Abnormalities (developmental defects) and Musculoskeletal System Deformities in Children
Baindurashvili A.G., Solov’yova K.S., Zaletina A.V., Lapkin Y.A.
Abstract
Data of RF Health Ministry official statistics, Federal Genetic Register and Congenital Defects Monitoring Center, and St. Petersburg Diagnostic (Medical Genetic) Center were analyzed. It is stated that within XVII Class of ICD-10 “Congenital abnormalities (developmental defects), deformities and chromosomal disorders” congenital malformations (developmental defects) and musculoskeletal system (MSS) deformities make up 20 - 22% and handicapped children account for 25 - 28%. The rate of MSS abnormalities diagnosed in maternity hospitals is 4.0 - 4.4 per 1000 of newborns. Rate and structure of MSS malformations in newborns and handicapped children was studied and compared. The number of handicapped children with various forms of MSS congenital developmental defects changes with age that reflects both progression of disease and deformity relapse as well as treatment efficacy. Rate indices and data on the structures of various forms of congenital developmental defects may be used for disability prognostication when planning the requirements in treatment and rehabilitation.
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(3):15-20
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E.Sh. Lomtatidze
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N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(3):20-20
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Comparative Analysis of Short and Mid-Term Results of Primary Total Hip Replacement by Serial Cemented and Uncemented Fixation Implants
Prokhorenko V.M., Slobodskoy A.B., Mamedov A.A., Dunaev A.G., Voronin I.V., Badak I.S., Lezhnev A.G.
Abstract
Analysis of short-term (5 - 8 years) and mid-term (10 - 14 years) results of primary total hip replacement using cemented and uncemented fixation implants of foreign (Zimmer) and home (Endoservice) serial production. The study was based on the results of 2620 surgical interventions (2911 operations, out of them 1512 - with ESI, 1399 - with Zimmer implants) performed in two independent clinics. Revision intervention due to aseptic loosening of implant components was required in 62 (ESI) and 66 (Zimmer) cases and the terms of that complication development were practically the same. In 5 to 8 years after operation excellent, good and satisfactory results (70 - 100 points by Harris) were observed in 95.2% of patients operated on using ESI implants and in 94.8% of patients - with Zimmer implants. In 10 - 14 years the indices made up 89.2 and 88.2%, respectively. Thus, the results of different implants application were comparable
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(3):21-26
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Method for Quantitative Evaluation of Spiral Tibial Fractures
Matsukatov F.A., Martel’ I.I.
Abstract
To elaborate a method of quantitative evaluation of instable spiral tibial bones fractures as the basis for differential approach to secondary displacement prevention, x-rays of 312 patients were analyzed and a series of experiments to study spiral fractures peculiarities was performed. The factors responsible for the instable pattern of spiral tibial fractures were detected. Quantitative index of the risk of secondary displacement was calculated and preventive measures were elaborated on their basis. Proposed recommendations on secondary displacement prevention were used as a basis for the treatment of 83 patients using Matsukidis - Shevtsov apparatus. Long-term treatment results were studied in 59 (71%) patients. Excellent and good results were achieved in 51 (86.5%) and 8 (13.5%) patients, respectively. Neither satisfactory nor poor results were observed.
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(3):27-33
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Intramedullary Osteosynthesis by Fixion System at Treatment of Long Bones Diaphyseal Fractures
Yamkovoi A.D., Zorya V.I.
Abstract
Treatment results for 61 patients with diaphyseal fractures of long bones of the extremities are presented. Fractures of the humerus were diagnosed in18 (29.5%) patients, femur - in 22 (36.1%) and tibia - in 21 (34.4%) patients. In most cases fractures of A1, A2, A3 and B1 were observed. For osteosynthesis blocking and non-blocking Fixion intramedullary nails were used. Long-term results (1 - 1.5 years) were analyzed for 42 patients and showed excellent and good results in 93% of patients. Nonunion and deformity was observed in 7% of observations. The advantages of the technique included low traumatization, short duration of surgical intervention, minimum (up to 200 ml) blood loss.
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(3):34-39
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N.P. Abeltsev
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N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(3):39-39
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Vascularized Bone Autoplasty with Graft from Medial Femoral Epicondyle in Scaphoid Pseudarthrosis
Golubev I.O., Yulov R.V., Bushuev O.M., Merkulov M.V., Kutepov I.A., Maksimov A.A., Grishin V.M.
Abstract
Nineteen patients (16 - 49 years) with scaphoid pseudarthrosis were treated using vascularized bone autograft from medial femoral epicondyle. Mean term since scaphoid fracture made up 30.5 ± 21.2 months. In all cases avascular necrosis of the proximal fragment, scaphoid humpbach deformity and dorsal intercalated segment instability (DISI) were present. In 16 (84.2%) consolidation in the zone of scaphoid pseudarthrosis was achieved at terms from 8 to 12 weeks after operation. In 3 (15.8%) unsatisfactory results were observed. Average scapholunate angle correction made up 13°. Average force of feast and pinch grasps increased on the average by 2.5 and 1.5 times, respectively. One year after surgery the average estimation by DASH scale decreased by 9.6 points at average, from 27 to 13.4 points.
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(3):40-44
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Clinical Analysis of Gait and Assessment of Surgical Treatment Outcomes in Children with Neurogenic Feet Deformity
Kosov I.S., Merkulov V.N., Imyarov S.D., Mikhailova S.A.
Abstract
Clinical analysis of gate in children with neurogenic feet deformities before and 1 year after musculotendinous transposition was performed. Study was performed using programmable hardware complex combined with dynamometric platform and electromyelograph. Temporal, kinematic and kinetic parameters of a stride cycle were determined. Degree of walking asymmetry was evaluated using asymmetry parameter. Besides the pattern of joint mobility disturbance and degree of muscular function loss or decrease were taken into account. Complex clinical analysis of walking enabled to detect and worked out in details the disturbances of injured extremity function before surgery as well as to establish the improvement of weight bearing ability of the injured extremity, decrease in compensatory overload of the collateral healthy extremity and lowering of asymmetry parameter after surgery.
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(3):45-51
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Biochemical Indices at Assessment of Traumatic Disease Course in Multiple Fractures of Extremity Bones When Treated by Ilizarov Technique
Kireeva E.A., Stogov M.V., Samusenko D.V.
Abstract
Dynamics of concentration of the products of protein, carbohydrate, lipid and mineral metabolism in serum and daily urine was studied in 60 patients with multiple closed fractures of the extremities treated by Ilizarov technique. In the period of early traumatic disease complications alkaline phosphatase activity, calcium and hydroxyproline excretion, intensity of hypoproteinemia, hypocalcemia, hypocholesterinemia and hypotriglyceridemia increased in proportion to injury severity. Maximum changes in metabolic status during the period of early traumatic disease complications were observed in patients been operated on 2 nd - 3 rd days after injury. At early terms of traumatic disease the criteria for evaluation of multiple injury severity were the following: increase in alkaline phosphatase level, marked hypocalcemia and hypercalciuria. Long-term preservation of hypocalcemia and hypercalciuria on the background of blood urea increase at traumatic disease stages confirms the disturbance of osteoreparation and requires medicamental correction.
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(3):51-55
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Study of Biocompatibility and Antibacterial Properties of Argentum-Tricalcium Phosphate In Vivo
Khon V.E., Zagorodniy N.V., Mamonov V.E., Glasko E.N., Petrakova N.V., Shal’nev A.N., Pkhakadze T.Y., Komlev V.C.
Abstract
Study of biocompatibility and antibacterial properties of argentum-containing tricalcium phosphate (TCPh) with various degree of substitution by argentum (TCPh-Ag) was performed on rat model. Biocompatibility was studied using subcutaneous implantation of TCPh-Ag (0.5). Antibacterial properties were studied in 5 subgroups (A-E), 5 animals in every group. At first step a distal femur defect was formed and infected by 24-hours cultures of clinical isolates of methicillin-resistant S. aureus. Second step (subgroups B-E) consisted of revision intervention with implantation of either TCPh or TCPh-Ag with various degree of substitution by argentum (0.04, 0.2 and 0.5) into infected defect. Histologic examination of tissue samples with subcutaneous implantation of TCPh-Ag (0.5) showed the absence of inflammatory and rejection reactions that was indicative of study material biocompatibility. Optimim degrees of Ag substitution were 0.2 and 0.5 that provide high antibacterial activity at monotherapy of femur bacterial infection in rats with minimum pronounced toxic effect on the surrounding tissues and bone marrow.
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(3):56-61
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Reparative Bone Regeneration at Use of Local Antibacterial Carriers in Purulent Osteomyelitis (Experimental Study)
Erofeev S.A., Reznik L.B., Dzyuba G.F., Odarchenko D.I.
Abstract
Efficacy of reinforcing local antibacterial carriers use upon the degree and terms of reparative regeneration of bone tissue defects resulted from osteomyelitis process was assessed in animal experiment (36 rabbits). In study group ( n =18) surgical treatment consisted of osteomyelitis focus salvage resection and installation of reinforcing local antibacterial carrier based on polymethyl methacrylate. In control group ( n =18) radical resection of the osteomyelitis focus with adjacent soft tissue structures was performed. In study group growth of microorganisms was not detected already on 28 th postoperative day while in control group the complete depression of pathogenic microflora was achieved only by day 50. Roentgenologic and morphologic data showed marked reparative regeneration in the zone of defect with formation of functionally mature callus under the effect of antibacterial carrier at terms up to 16 weeks.
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(3):62-67
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Outcomes of Surgical Treatment of Infectious Complications after Large Joints Arthroplasty
Norkin I.A., Shpinyak S.P., Girkalo M.V., Barabash A.P.
Abstract
Surgical outcomes were analyzed for 108 patients with infectious complications developed at different terms after large joints arthroplasty. When complications develop in the early postoperative period than independently of the process depth and in stable implant components radical surgical debridement of the inflammation focus is indicated. In the rest of cases the removal of all implant components with subsequent either joint arthrodesis or revision arthroplasty using spacers of different modifications should be performed. We consider spacer application to be a method of choice as it enables to preserve extremity function and to perform revision arthroplasty in future.
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(3):67-71
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Surgical Treatment of Complicated Sacrum Fractures in Unstable Pelvic Injuries. Treatment Experience
Pak L.F., Volovik V.E., Li O.N., Goncharov I.A., An A.A.
Abstract
The majority of unstable pelvic injuries are accompanied by sacrum fractures of different localization. Experience in treatment of 8 patients with multiple concomitant injuries and sacrum fractures at the level of sacrum canal (Denis 3) is presented. All patients with acute condition were admitted into intensive care unit and underwent complex examination. At this step of intensive care the complexity of sacrum fractures and nerve injuries diagnosis is conditioned by the severity of patient’s condition. Patients with pelvic injuries require careful examination for detection of sacrum and nerve injuries in this region. However taking into account the multiplicity of injuries the emergency operation for nerve roots revision is not expedient. At rendering care to such patients the basic principles should be the conception of injuries control with preference given to stable and functional methods of fracture fixation. In our opinion all Denis 3 fractures with neurologic disorders require decompression-stabilizing operations that enable to mobilize patients, to determine and probably to improve the prognosis of neurologic pathology.
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(3):72-76
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Intraneural Ganglion as the Cause of Compression-Ischemic Lesion of Peroneal Nerve in Children
Merkulov V.N., Imyarov S.D., Dorokhin A.I.
Abstract
Two clinical cases of peroneal nerve lesion (patients 13 and 16 years) resulted from intraneural ganglion are presented. It is shown that only radical surgical intervention including resection of tibiofibular junction, removal of communicating canal and nerve decompression using cyst dissection (Spinner technique) could prevent ganglion relapse. In first patient completely lost peroneal nerve function was restored by musculotendinous transposition.
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(3):76-80
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Bone Cement and Local Antibiotic Therapy in Purulent Osteology
Akhtyamov I.F., Kuropatkin G.V., Gatina E.B., Kil’metov T.A., Eryomin I.K., Kurmangaliev E.D.
Abstract
In special literature more and more attention is paid to the problem of periprosthetic infection that is stipulated by increasing number of arthroplasties performed all over the world including Russia. Not declining rate of such complications is grounded by the conditions of intervention performance, concomitant diseases and peculiarities of pathogenic microflora. Unfortunately the conventional schemes of systemic therapy are not always applicable in purulent periprosthetic process development that requires local antibiotic delivery. Review of foreign literate is dedicated to the modern aspects of treatment by adding antibiotics to bone cement.
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(3):81-87
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Report of the X Jubilee All-Russian Congress of Trauma and Orthopaedic Surgeons
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N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(3):88-94
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S.A. Dzhumabekov
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N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(3):95-95
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