Vol 22, No 3 (2015)


Treatment of Lower Limb Fractures in Children with Multiple and Concomitant Injuries

Timofeev V.V., Bondarenko A.V., Podsonnyi A.A.


Treatment results for 306 children (1-17 years) with lower limb fractures accompanied by multiple and concomitant injuries were studied during 2005 - 2014. Comparative assessment of conservative treatment, transcutaneous osteosynthesis with external fixation devices and internal fixation was performed. The number of complications, duration and number of hospitalizations, total duration of treatment, long-term results and quality of life at terms from 1 to 3 years after injury were evaluated. Indications to the application of every osteosynthesis technique were determined.
N.N. Priorov Journal of Traumatology and Orthopedics. 2015;22(3):5-12
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Evaluation of the Resources tibialis anterior muscle of the shin in Patients with Achondroplasia during Lengthening (Ultrasound Examination)

Menshchikova T.I., Aranovich A.M.


The purpose of the study was the determination of echo signs of the resourcesof tibialis anterior muscle of the shin in patients (6-18 years old) with achondroplasia. The patients were examined before treatment and in the process of shin lengthening ondays 10, 20, 30, 60 and 90 after distraction initiation with Ilizarov apparatus. Mean lengthening made up 9±2cm. Ultrasound examination was performed on VOLUSON-730PRO (Austria) and AVISUS Hitachi (Japan) systems. Echo signs indicative of the reduction of the resources of tibialis anterior muscle of the shin during lengthening, i.e. violation of typical muscular striation, change in the direction of muscular fibers bands, thinningof intermuscular septum, decrease in contractile muscular response by 90±5% and increase in acoustic density by 45% as compared with the initial level, were identified. At the exhaustion of reserve potential of tibialis anterior muscle of the shin the effect of “frosted glass” was visualized, with the exception of patients with achondroplasia aged 6-1- years in whom marked destructive changes in tibialis anterior muscle of the shin during the first months of distraction were associated not only with tissue alteration but with insufficient physiological maturity of the organism.
N.N. Priorov Journal of Traumatology and Orthopedics. 2015;22(3):13-19
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Risk Factors for Recurrence of Shoulder Instability after Bankart Lesion Arthroscopic Treatment

Belyak E.A., Kubashev A.A., Lazko F.L., Abdulkhabirov M.A., Ptitsyn K.A., Prizov A.P., Kulikova O.I., Savitskyi P.P., Ismailov D.A., Men’shikov V.V.


Analysis of treatment results for 408 patients (17-48 years old) with posttraumatic anterior shoulder instability was performed. In all cases arthroscopic Bankart repair with the use of suture anchors was performed from 1997 to 2013. Follow up period made up 5.7±1.2 years. Recurrent instability was observed in 45 (11%) patients. Comparison of patients with and without recurrent shoulder instability enabled to identify the following risk factors: high-level of sports activity (78.0% vs 27,8%, p <0.001), Hill-Sachs lesion (82.2% vs 55.1%, p<0.001), glenoid bone deficit (88.9% vs 48,2%, p<0.001), joint laxity syndrome (33.3% vs 3,6%, p<0.001). Preoperative diagnosis of the above mentioned risk factors will enable to optimize treatment tactics for the patients with anterior shoulder instability.
N.N. Priorov Journal of Traumatology and Orthopedics. 2015;22(3):20-25
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Method for Glenoid Bone Defect Plasty in Recurrent Shoulder Instability

Prokhorenko V.M., Fomenko S.M., Filipenko P.V.


Technique for glenoid bone defect plasty in posttraumatic shoulder instability using the porous titanium nickelide (Ti-Ni) graft is presented. This method is an alternative to Latarjet operation and autoplasty with the graft from the iliac crest. The shape and size of the graft was determined by MSCT data and the graft was sawed out from cylindrical billets with diameter of about 2.5 cm and wall thickness - 1 cm. Two screw holes were drilled and the graft was placed into the defect. That technique was applied in 6 patients with long lasting history of recurrent anterior instability and instability relapses after shoulder stabilization using other surgical techniques. Preoperative shoulder functional state by Rowe scale averaged 35.0 points versus 93.3 points after operation. One year follow up showed no cases of instability relapse. The advantages of this technique are the possibility of accurate glenoid anatomic shape reconstruction, absence of graft resorption and reduction of intervention duration.
N.N. Priorov Journal of Traumatology and Orthopedics. 2015;22(3):26-29
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Optimization of Ultrasound Examination in Diagnosis of Knee Injuries

Pitsyn I.A.


Comparative assessment of arthroscopic and ultrasound examination data were performed in 393 patients (400 knee joints). For the perfection of diagnosis quality a principle of “feedback” (cooperation) between examiners was used. Basing on the analysis of the achieved results the reasons for sonographic and ultrasound results (objective and subjective) incompatibility were determined and real diagnostic value of ultrasound examination was estimated for every intraarticular knee structure separately.
N.N. Priorov Journal of Traumatology and Orthopedics. 2015;22(3):30-35
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Outcomes of Reconstructive Surgery for Defects of the Articular Ends of Bones Using Home Joint Implants

Mironov S.P., Balberkin A.V., Shavyrin D.A., Karpov V.N., Kolondaev A.F., Snetkov D.A.


Long-term outcomes of reconstructive operations for substitution of post-resection defects of the articular ends of tubular bones that form the hip, knee and shoulder joints using home endoprosthesis were studied. The study included 344 patients who were treated at CITO department of bone pathology from 2004 to 2014. Substitution of the defect was performed in 236 and 108 cases for the knee, hip joints, respectively. Indications for surgical intervention were: bone tumors; previously performed arthroplasty failure; defects of the articular ends after failed traumatologic and orthopaedic operations; severe forms of knee arthroses. Functional results (MSTS scale), survival of constructions, inflammatory complications were analyzed and comparative evaluation with imported analogues was performed. General functional outcomes and rate of complications correspond to the data on application of new oncologic and modular endoprostheses presented in foreign literature.
N.N. Priorov Journal of Traumatology and Orthopedics. 2015;22(3):36-40
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Tribochemical Component of Oxidative Stress Development at Artificial Joints Implantation. Part 5. Pro-oxidative Properties and Interrelation of Titanium and Non-Metallic Orthopaedic Material Wear Particles with Antioxidants

Bulgakov V.G., Tatarinov V.F., Gavryushenko N.S.


Radical-forming ability of artificial wear particles of BT6 titanium alloy and nonmetallic materials was studied using modelling reaction of cumene oxidation. It was stated that alloy particles initiate formation of radicals and consecutive repeated cumene oxidation by metallic particles took place with significantly higher rate of radicals’ formation. Particles of nonmetallic materials (polyethylene, corundum ceramics, carbon nanocomposite) are inert and do not possess radical-forming ability that ensures their advantage in prevention of possible development of adverse free radical reactions in surrounding implant tissues.
N.N. Priorov Journal of Traumatology and Orthopedics. 2015;22(3):41-44
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V.M. Lirtsman

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N.N. Priorov Journal of Traumatology and Orthopedics. 2015;22(3):45-45
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Carbonic Nano-Structural Grafts - Innovation Product for Traumatology and Orthopaedics.Part 1: Experimental Study Results

Mironov S.P., Shevtsov V.I., Kononovich N.A., Stepanov M.A., Gorbach E.N., Golubev G.S., Sergeev K.S., Arkhipenko V.I., Grin’ A.A., Skryabin V.L., Reznik L.B., Shatokhin V.D., Baimuratov A.A.


Study of the general organism response to carbonic nano-structural grafts, their osteoinductive properties, possibilities of bone defects substitution and acceleration of the distraction regenerate formation was performed. Four series of experiments were performed on 69 animals (Chinchilla rabbits and adult mongrel dogs). Laboratory and roentgenologic data showed that study grafts possessed pronounced osteoconductive properties, were not toxic and did not cause rejection response. Their application ensured the formation of strong osteo-carbonic block at the interface bone-implant. Distraction regenerate achieved required strength in 37 days after carbonic graft implantation into the bed formed in the regenerate. That enabled to discontinue external fixation with the apparatus.
N.N. Priorov Journal of Traumatology and Orthopedics. 2015;22(3):46-53
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Potentialities of Minimally Invasive Osteosynthesis in Treatment of Malleolus Fractures

Solod E.I., Lazarev A.F., Ermolaev E.G.


Treatment results for 71 patients with malleolus fractures are presented. In 32 patients (comparative group) surgery was performed by AO/ASIF technique after edema resolution. Thirty nine patients from the main group were operated on by our minimally invasive technique using V-shaped pins and threaded pins on the next day after admission independently on the presence of edema in the ankle joint region. All patients were operated on at terms from 1 to 3 weeks after injury. Duration of hospitalization averaged 16 and 10 days, restoration of joint function made up 6 and 2 weeks for the patients from the comparative and main group, respectively. Complications were observed only in patients from the comparative group, i.e. marginal skin necrosis in 8 (25%), inflammatory complications in 5 (15.6%), metal fixator migration in 1 (3.1%) and fracture nonunion in 4 (12.5%) patients. Outcomes were assessed by AOFAS Ankle- Hindfoot Scale. Mean point made up 90.3 in the main group and 88.6 in the comparative jnt. In the experimental part of the study the strength (tensile and shear) of 3 types of osteosynthesis for medial malleolus fracture were compared: with either 2 cannulated screws, V-shaped pin or 2 biodegradable screws of glycolized lactic acid was compared. Although the osteosynthesis of medial malleolus with V-shaped pin was the least strong it met the requirements of internal osteosynthesis.
N.N. Priorov Journal of Traumatology and Orthopedics. 2015;22(3):54-59
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Prevention of Venous Thromboembolic Complications in Wounded with Gunshot Femur Fractures

Zubritskyi V.F., Koltovich A.P., Nikolaev K.N., Kapustin S.I., Dvortsevoy S.N., Vardanyan A.V., Borodin I.A.


Analysis of different measures for the prevention of venous thromboembolic complications (VTEC) in 128 wounded with gunshot femur fractures was performed. Patients from control group (58) received pharmacologic prevention only at the step of specialized medical care provision. In the main group (70) combined VTEC prevention was provided at both the step of expert and specialized care. Rate of lower extremity deep vein thrombosis (LEDVT) made up 27.1% in the main group and 55.2% (p<0.05) in the control one. Pulmonary embolism was recorded in 1.6% of wounded from the control group. Laboratory examinations showed the presence of thrombinemia within 30 days of hospital treatment that is indicative of the necessity of long term complex VTEC prevention. Study of the allele polymorphism of genes participating in thrombogenesis process revealed congenital thrombophilias in 61.9% of wounded.
N.N. Priorov Journal of Traumatology and Orthopedics. 2015;22(3):60-65
pages 60-65 views

S.N. Izmalkov

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N.N. Priorov Journal of Traumatology and Orthopedics. 2015;22(3):66-66
pages 66-66 views

Influence of Preoperative Antioxidant-Antihypoxant Infusion on the Indices of Central Hemodynamics in Elderly Patients during Anesthesia and Surgical Intervention for Femur Fracture

Vasil’kov V.G., Marinchev V.N., Karpov A.F., Emelina N.G.


The problem of the safety of elderly patients at surgical intervention for femur fracture is broached. Different types of anesthesia (regional and general) exert both direct and indirect influence on hemodynamics parameters. Ninety patients (mean age 68±4.2 years) were divided into 2 groups depending on the type of anesthesia: epidural and general anesthesia based on proforol and sevoflurane with caudal block. In every group different infusion solutions (Ringer’s solution, 10% Refortan, Mafusol, Cardioxipin) were used prior to anesthesia. The following parameters of central hemodynamics were studied: mean arterial pressure, heart rate, cardiac output and cardiac index, stroke volume index, total vascular resistance. The least changes in hemodynamics were observed when general anesthesia based on proforol and sevoflurane in combination with ropovicain caudal block and cardioxipin preinfusion were used.
N.N. Priorov Journal of Traumatology and Orthopedics. 2015;22(3):67-72
pages 67-72 views

Modeling of a Different Volume Spinal Cord Injury in Rats and Methods for Evaluation of Lost Functions Restoration

Mironov S.P., Kolesov S.V., Stepanov G.A., Sazhnev M.L., Gubin S.P., Ionin Y.V., Motin V.G., Panteleev A.A.


The method for modelling of a different volume spinal cord injury to study potentialities for its regeneration is presented. The work was performed on 80 laboratory rats divided into 5 groups according to the volume of inflicted injury. Original instrument with restrictors for the infliction of the accurate and measured by volume spinal cord injuries was elaborated. The degree of function restoration was evaluated by the results of visual assessment of the movements in animals’ hind paws, records of induced potentials of the cerebral cortex region and by BBB scale. In every separate group the obtained indices were distributed uniformly that indicated justifiability and reproducibility of the elaborated model of incomplete spinal cord injury.
N.N. Priorov Journal of Traumatology and Orthopedics. 2015;22(3):73-77
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Idiopathic Multifocal Osteolysis: Case of Surgical Treatment

Pozdeev A.P., Zakhar’yan E.A., Buklaev D.S., Krasnogorskiy I.N., Zubairov T.F.


Idiopathic osteolysis is a rare disorder characterized by spontaneous, massive and progressive resorption of bone tissue. Massive osteolysis results from proliferation of blood and lymphatic vessels with thin walls, resembling capillaries, in the bone and surrounding soft tissues. Literature review on this problem and clinical case of a patient successfully operated on using the technique elaborated at our clinic are presented. Surgical interventions enabled to achieve the restoration of tubular bones integrity and ensured conditions for independent patient’s movement. Possibility of the performance of reconstructive surgical interventions for the restoration of limb weight bearing ability that is reasonable to combine with bisphosphonate therapy.
N.N. Priorov Journal of Traumatology and Orthopedics. 2015;22(3):78-83
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Surgical Treatment of Severe Forefoot Deformity

Usol’tsev I.V., Leonova S.N., Kosareva M.A.


Treatment results of 61 years old patient with severe forefoot deformity - right-side transverse-longitudinal stage II platypodia: right-side II-III degree deforming arthrosis of 1st metatarsophalangeal joint, hallus valgus with subluxation, combined 1st metatarsophalangeal joint contracture, pain syndrome, are presented. Surgical treatment included operation by Schede, lateral release of 1stmetatarsophalangeal joint, SCARF osteotomy of 1st metatarsal bone, Akin osteotomy of proximal hallux phalanx and tenoplasty of dorsal hallux flexor. As a result correction of right forefoot deformity was achieved, pain syndrome was arrested and weight bearing ability of the right foot was restored.
N.N. Priorov Journal of Traumatology and Orthopedics. 2015;22(3):84-85
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Surgical Stabilization of the Chest in Multiple and Floating Rib Fractures

Benyan A.S.


One of the complicated problems at the interface of thoracic surgery and traumatology is the treatment of multiple and floating rib fractures. Its urgency is determined by the high rate of complications and level of mortality. Analysis of surgical stabilization techniques in multiple and floating rib fractures is performed. Both the methods of historical significance and widely used at present are described. Data on the efficacy of various stabilization techniques are presented.
N.N. Priorov Journal of Traumatology and Orthopedics. 2015;22(3):86-92
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Scoliosis and Syringomyelia

Mikhailovskiy M.V., Stupak V.V., Belozyorov V.V.


High rate of both scoliotic deformities in patients with syringomyelia (up to 74.4%) and syringomyelia in patients with scoliosis (up to 9.7%) explains the interest of specialists to the patients with combination of such diseases. The literature review covers the modern approaches to the diagnosis and treatment, the problems in determination of treatment tactics, particularly the priority of neurosurgical intervention and intervention for scoliosis correction.
N.N. Priorov Journal of Traumatology and Orthopedics. 2015;22(3):93-95
pages 93-95 views

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