Vol 21, No 4 (2014)

Articles
Step by Step Extra-Focal Fixation of Unstable Pelvis with Separate Anterior and Posterior Modules
Borozda I.V., Ganzhurov N.A., Kapustyanskiy A.A., Nikolaev R.V.
Abstract
Results of step by step treatment of 28 patients with disintegrative pelvic ring injuries are presented. In 14 patients (main group) step by step extra-focal pelvic fixation with application of anterior (antishock) and posterior modules was performed. In 14 patients (control group) osteosynthesis by external fixation device with circular support was used. Long-term results were assessed in1 year after injury. In control group residual deformity averaged 5 (4-7) mm and was noted in 10 (71.4%) patients. In the main group residual deformity was observed in 4 (28.6%) cases and averaged 2.5 (2-3) mm (p=0.0039). In the main group functional result by Majeed scale was also significantly better (p=0.000319). Excellent and good results were achieved in 9 (64.3%) and 5 (35.7%) of patients, respectively. In control group results were considered to be excellent in 3 (21.4%), good - in 6 (42.9%), satisfactory - in 4 (28.6) and poor - in 1 (7.1%) of cases. Advantage of the proposed transosseous osteosynthesis technique is the modular principle of the construction use that enables to perform separate fixation with anterior (antishock) module followed by final reposition of the pelvic ring with posterior module after stabilization of patient’s vital functions. This allows to increase the number of external pelvic fixation in patients with polytrauma.
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(4):5-14
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Surgical Correction of the Sequelae of Obstetric Pubic Symphysis Ruptures
Gudushayri Y.G., Lazarev A.F., Verzin A.V.
Abstract
Twenty eight patients with old postpartum ruptures of pubic symphysis complicated by functional bladder disorders were operated on during the period from 2000 to 2013. Time interval between vaginal delivery and pelvic ring stabilization made up from 1 month to 8 years. Clinical and roentgenologic examination enabled to detect predisposing factors for neurogenic, i.e. hyperactive bladder development that were treated surgically. In all cases plate osteosynthesis for pubic symphysis and fixation of sacroiliac joint with cannulated screws was performed. Subjective improvement of patients’ condition as well as the results of uroflowmetry and complex urodynamic investigation enabled to conclude that orthopaedic reconstruction of pelvic ring in old obstetric ruptures of pubic symphysis was an effective and reliable technique for the treatment of bladder dysfunction.
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(4):15-21
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Modified Technique of Arthroscopic Posterior Cruciate Ligament Reconstruction
Kuznetsov I.A., Fomin N.F., Shulepov D.A., Ryabinin M.V., Orlov Y.N., Salikhov M.R.
Abstract
Basing on the anatomic examination results the main principles of safe bone tunnels formation at arthroscopic plasty of posterior cruciate ligament (PCL) were formulated. Additional instrumentation of original design and original surgical technique directed to minimization of the risk of popliteal artery injury at tibial bone tunnel formation were proposed. During the period from 2010 through 2013 twenty one patients with PCL injuries were operated on at endoscopic surgery department. In 20 n patients treatment results were assessed in 6 and 12 months after intervention. Evaluation was performed by clinical results, IKDC forms, Lysholm - Gillquist score and visual pain scale. Preoperatively mean point by IKDC questionnaires was 46.80±18.07, by Lysholm - Gillquist score - 51.62±20.34 and in 6 months postoperatively - 68.64±10.13 and 73.84±11.16, respectively, that was statistically significant higher than prior to operation (p<0.05). One year after intervention positive dynamics was present (p<0.01): mean point by IKDC made up 77.23±8.03, by Lysholm - Gillquist - 81.08±8.64. Evaluation result by IKDC form was recognized in 11 (55%) patients as good (group A), in 6 (30%) - as close to good (group B), in 2 (10%) - as satisfactory (group C) and in 1 patient - as poor (group D). The use of perfected technique enabled to decrease the duration of surgical intervention by 27 minutes at average but the long-term treatment results were as good as after standard surgical intervention.
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(4):22-30
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Disturbance of Extensor Mechanism after Primary and Revision Knee Arthroplasty
Kavalerskiy G.M., Murylyov V.Y., Kholodaev M.Y., Rukin Y.A., Elizarov P.M., Rubin G.G.
Abstract
Rate of extensor mechanism complications after primary and revision knee arthroplasty reaches 12 %. Description and systematization of such complications by literature data is given. Our experience in treatment of 12 patients with such complications after primary knee and in 5 patients after revision knee arthroplasty that made up 1.0 and 13.9% of all interventions, respectively, is presented. Registered complications include para-patellar scars and ossification impingement (4), patellar lateralization (5), patellar dislocation (1), patellar tendon rupture (7). Treatment results in patients after primary arthroplasty are better than after revision intervention - 83.3 and 40% of positive results, respectively. It is shown that high rate (42.9%) of patellar tendon rupture are associated with deep periprosthetic infection. Besides, autoplasty with m. gracilis and m. semitendinosus shows its inefficiency in treatment of such complications.
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(4):31-37
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Use of Nitinol Rods in Surgical Treatment of Degenerative Scoliosis
Kolesov S.V., Shvets V.V., Kolobovskiy D.A., Kaz’min A.I., Morozova N.S.
Abstract
Seventy two patients, aged 39 - 84 years, with degenerative lumbar scoliosis were operated on. In 30 patients (1 st group) nitinol rods 5.5 mm in diameter and standard transpedicular screws were used. In 20 patients fixation at L1 - S1 and in 10 patients at L1 - L5 level was performed. In presence of spinal canal stenosis additional decompression was performed. Spinal fusion was not performed. Forty two patients (2 nd group) were treated by standard methods using titanium rods in combination with lumbosacral spinal fusion. Out of them in 20 patients fixation at L1 - S1 and in 22 patients at L1 - L5 level was performed. Results were followed up in 1.5 years after intervention at minimum. Correction of the deformity in two groups was almost equal and averaged 25° (from 10° to 38°). No one case of implant instability, bone tissue resorption around the screws and adjacent level involvement was recorded. Functional X-rays showed 21° of lumbar spine mobility (from 15° to30°) at average. In 2 nd group mobility in fixed segment was absent; pseudarthrosis was diagnosed in 3 and proximal kyphosis - in 1 patient. Revision intervention was required in 2 cases.
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(4):38-42
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Optimization of Postoperative Period Management in Patients with Axial Deformities of Lower Extremities
Teterin O.G., Makarov A.D., Petrov D.Y., Chernyavskiy M.A., Lemeshkin S.S.
Abstract
Peculiarities of postoperative period management are presented for 186 patients with axial lower limb deformities. In the main group (n=95) computer technologies to plan the outcomes and control the treatment course as well as drug prevention of possible complications, i.e. deep vein thrombosis and deformity relapse, were used. In control group (n=91) such measures were not used. Results were assessed at the stage of correction completion, after external fixation device removal and at terms from 1 to 3 years after discharge. In control group the indices of mean duration of correction (11.1±0.2 days), fixation (29.8±0.5 days) and overall term of treatment (47.9±0.6 days) were statistically significant (p<0.01) higher as compared to main group - 8.9±0.1, 20.4±0.5 and 36.1±0.5, respectively. Deep vein thrombosis developed in 2 patients from the control group, no such complication was observed in the main group. In the long-term period in the main group only excellent (29.7%) and good (70.3%) results were recorded, while in control group excellent results were achieved in12.8%, good - in 80%, satisfactory - in 4.3% and poor (deformity relapse) - in 2.9% of cases.
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(4):43-48
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Study of Motor Ability Indices and Postural Status in Patients with Hemihypoplasia
Mikhailova L.K., Eryomushkin M.A., Kosov I.S., Mikhailova S.A., Murav’yova N.V.
Abstract
One hundred seventeen patients with hemihypoplasia and discrepancy of lower limbs length of 1 - 3 cm were examined during the period from 2008 through 2013. Series of functional tests to evaluate conditional and coordination skills as well as stabilometry in European and American variants were performed. All patients demonstrated frontal postural disorders, marked weakness of the abdominal muscles and muscles of the back that resulted caused postural imbalance that resulted in formation of myofascial trigger points and development specific pain syndrome. Stabilometry and coordination tests results showed the predominance of proprioceptive body balance control over the visual one.
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(4):49-53
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Analysis of Orthopaedic Sequelae of Special Treatment of Malignant Tumors in Children
Petrichenko A.V., Bukreeva E.A., Korneeva A.V., Shavyrin I.A., Ochkurenko A.A., Kolesov S.V., Sharoev T.A., Ivanova N.M.
Abstract
Ninety five patients (mean age 13.72±4.2) with complaints on loco-motor system disorders after special treatment for malignant tumors were under observation of orthopaedic surgeon. The most common sequelae of treatment were muscular hypotrophy (66 children), I-III degree scoliosis (75), rigidity (61), bone metabolism disorder and osteopenia (47), one limb shortening even in presence of “growing” endoprosthesis (46). Individual rehabilitation course was performed in 43 (45.3%) children and resulted in increase of joint movement range, improvement of posture, and increase in muscular tension. Timely performed complex of rehabilitation measures enabled to correct sequelae of special treatment at early terms that significantly decreased disability of children, increases their social adaptation and quality of life.
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(4):54-58
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Clinical and Organization Approaches to Application of Innovative Medical Technologies at Rendering High-Tech Medical Care
Shalygina I.A., Pakhomov I.A., Sadovoy M.A., Prolhorenko V.M., Mamonova E.V.
Abstract
Rendering of high-tech medical care (HTMC) is one of the priority directions of the Ministry of Health of the Russian Federation. Search of new organizational approaches, elaboration and perfection of medical technologies, introduction of new materials continue. The purpose of the study was to evaluate the expediency of biodegradable constructions use at rendering HTMC to traumatologic and orthopaedic patients. Treatment results for 56 patients with various feet pathology (calcaneus fractures, feet joints deforming arthrosis, Hallus valgus) were analyzed retrospectively. In control group ( n =28) metal constructions and in the main group (n=28) biodegradable constructions were used for bone fragments fixation. In two groups surgical treatment results were comparable, however treatment of patients from the main group was accompanied by significant social and economic effect due to more effective work of the bed as no construction removal was performed and no expenditures for patient’s stay at the hospital and intensive care unit were required. All that contributed to the improvement of patients’ life quality.
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(4):59-63
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Osteosynthesis of Distal Humeral Metaepiphyseal Fractures Via Posterior Approach with Olecranon Preservation
Kalantyrskaya V.A., Golubev I.O.
Abstract
Eighteen patients with distal humeral metaepiphyseal fractures were operated on during the period from 2010 to 2013. Mean age of patients made up 43.1±8.4 (22-72) years, term after injury - 4.6±1.9 (2-11) days. According to AO classification C1 fractures were diagnosed in 13, C2 - in 3, C3 - in 2 patients. In all patients distal humeral metaepiphyseal osteosynthesis with two plates placed at 90° to each other was performed. Surgical intervention was performed without olecranon osteotomy and triceps tendon was kept intact. In 12 (66.7%) cases longitudinal dissection of the triceps in its middle third was performed. Residual intraarticular displacement averaged 0.2±0.03 mm. Long term results were assessed in 10 patients at an average 12 months after operation. Mean score by subjective and objective scales made up 4.3±0.3 and 4.2±0.3 points, respectively. Main advantages of the applied osteosynthesis technique were preservation of forearm extensor muscles integrity; absence of additional fixatives in olecranon zone; absence of the necessity to perform additional intervention to remove fixatives from the olecranon.
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(4):64-66
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Experience in Arthroscopic Treatment of Massive Rotator Cuff Injuries in Elderly Patients
Kubashev A.A., Lazko F.L., Belyak E.A., Prizov A.P., Lomtatidze E.S.
Abstract
Arthroscopic treatment results for 6 elderly patients (mean age 64 years) with massive (over 5 cm) nonreconstructable rotator cuff tear are presented. In all cases fatty degeneration of the rotator cuff tendon above 3 rd degree by Goutallier classification was present. In all patients elbow arthroscopy with implantation of InSpace Balloon into subacromial space was performed. Mean score by UCLA scale made up 14 (12-15) preoperatively and over 30 in 6 months after intervention that corresponded to a good and excellent result. Preliminary results indicate that applied technique is a simple, mini-invasive and effective intervention enabling to reduce pain and increase range of movements in this group of patients.
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(4):67-69
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Experience in Treatment of Total Hand Syndactyly in a Child with Apert Syndrome
Kozhevnikov O.V., Ivanov A.V., Gavrilova Y.V.
Abstract
Experience in surgical treatment of total hand syndactyly in a child with Apert syndrome is presented. Surgical technique that includes the application of МЦТ-01 apparatus, distraction period and interdigital space formation with local tissues, i.e. interchanging triangular or oblique-trapeziform flaps is described. Within 18 months interdigital spaces between II and III, III and IV, IV and V fingers were formed in turn. Besides marked cosmetic effect comparatively good functional result was achieved.
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(4):70-73
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Revision of Hip Endoprosthesis Acetabular Component without Removal of Previously Implanted Cup
Zagorodniy N.V., Bukhtin K.M., Chragyan G.A., Kagramanov S.V., Galaev K.I.
Abstract
Bone tissue deficit can be filled by various methods but all such methods increase the complicacy of surgical intervention and its volume that raises the risk of complications development. Experience in treatment of 77 years old patient with pains after revision hip arthroplasty is presented. Examination revealed wrong position of the stable acetabular component. Intraoperatively a decision was made to implant cemented cup without removing previously implanted one. That surgical technique enabled to eliminate pain syndrome, restore joint rotation center and biomechanics, to decrease intraoperative trauma, avoid use of allograft and conduct patient’s rehabilitation at terms common to primary joint replacement
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(4):73-74
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Clinical Study of the Influence of Implants Made of Different Metals on the Physical Status of Experimental Animals
Gatina E.B., Akhtyamov I.F., Shakirova F.V., Manirambona Z.K.
Abstract
Biocompatibility of implants made of steel 12X18H9T, steel 12X18H9T coated with titanium and hafnium nitrides, and steel 12X18H9T coated with titanium and zirconium nitrides was studied in rats. Implants that represented pins 8-10 mm long and 0.5 mm in diameter were inserted intramedullary into the middle third of the tibia after drilling. The ends of pins were turned down and placed under the skin. The wound was sutured tightly. Dynamics of body weight and temperature as well as the condition of the hair, eyes, oral and nasal mucosa were assessed on days 10, 30, 60 and 90 after implantation. It was shown that implants coated with titanium and hafnium nitrides caused minimum systemic and local reactions while implantation of pins coated with titanium and zirconium nitrides resulted in the development of more pronounced inflammatory changes on both the local and systemic level.
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(4):75-78
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Treatment of Type 1 Complex Regional Pain Syndrome in 14 Years Old Child
Merkulov V.N., Dorokhin A.I., Krupatkin A.I., Merkulov M.V., Avakova M.A.
Abstract
Case report on 14 years old girl with type 1 complex regional pain syndrome (CRPS) is presented. At first admission in 5.5 months after right hand injury and development of type 1 CRPS, paravasal sympathectomy on the right upper extremity was performed. Complete elimination of pain syndrome and restoration of the extremity function was achieved. Five and a half months after discharge the left foot and in 3 weeks later the right hand were injured. In both cases injuries were accompanied by pronounced CRPS clinical picture. At second admission in 6 weeks after foot injury interventional treatment with placement of catheters next to nerve trunks and bolus administration of antibiotics was performed for 1 week and enabled to achieve remission of the disease. It was noted that not only hypersymphaticotony but also psychological status of a patient were important for the disease development.
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(4):79-82
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Prospects for Local Application of Antiresorptive Drugs in Skeleton Bone Injuries and Diseases
Rodionova S.S., Lekishvili M.V., Sklyanchuk E.D., Torgashin A.N., Ryabov A.Y., Yurasova Y.B.
Abstract
Increase in bone tissue resorption intensity on the border “metal - bone” as a compulsory component of remodeling in systemic osteoporosis or other metabolic osteopathies may result in poor surgical treatment results. Present review is dedicated to the analysis of available data on the possibility of local bisphosphonates application for the depression of resorption process in the zone of surgical intervention. In some works it is noted that just the local use of bisphosphonates is more effective for the normalization of remodeling and provision of biologic stability of the implants.
N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(4):83-89
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Izrail' Isakovich Kon - 100 let so dnya rozhdeniya
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N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(4):90-92
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N.A. Ovsyankin
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N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(4):93
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Ukazateley statey za 2014 god
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N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(4):94-95
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