Vol 22, No 4 (2015)


Results of Thoracoplasty via Small Incisions with Fixation of Sternocostal Complex by Shape Memory Metal Plate in Funnel Chest Deformity

Korolyov P.A., Kozhevnikov O.V., Rudakov S.S., Kolerov M.Y., Lysikov V.A.


Long-term results of radical thoracoplasty via small incisions with fixation of sternocostal complex by shape memory metal plate were studied. Total number of 263 patients, aged 2.5 - 45 years, with funnel chest deformity (FCD) were operated using that technique. Out of them 118 patients were under 18 years and 145 - over 18 years. In adult patients in children good results were achieved in 97.7% and 90.5% of cases, respectively. During the process of plate removal in children it was possible to correct residual chest deformity and achieve good results. In childhood radical thoracoplasty is indicated only to the patients with severe 2-3 stages of FCD and “least” FCD forms should be corrected at the mature age.
N.N. Priorov Journal of Traumatology and Orthopedics. 2015;22(4):5-9
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Postoperative Complications in Femoral Fracture Blocking Intramedullary Osteosynthesis

Plotnikov I.A., Bondarenko A.V.


Treatment results for 676 patients (out of them 487 with polytrauma) with 708 femoral fractures were analyzed. In all patients blocking intramedullary osteosynthesis was performed. The most common somatic complication was deep vein thrombosis - 128 (18.1%) observations that was more often diagnosed in patients with polytrauma ( p <0.05). Two hundred six (29.1%) local postoperative complications - 28 (3.9%) specific and 178 (25.2%) nonspecific were recorded. Specific complications were associated directly with the implant; development of nonspecific complications was determined by great number of factors: injury severity, type of fracture, patient’s general condition, peculiarities of rehabilitation period. In patients with polytrauma the rate of complications was statistically significantly ( p <0.005) higher than in patients with isolated femoral fracture. Measures for local complications prevention and correction were proposed.
N.N. Priorov Journal of Traumatology and Orthopedics. 2015;22(4):10-16
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Surgical Treatment of Proximal Humeral Fractures with Short Straight Intramedullary Nail

Bondarenko P.V., Zagorodniy N.V., Gil’fanov S.I., Semenistyi A.Y., Semenistyi A.A., Loginov A.N.


Long term surgical treatment results were studied for 30 patients (10 male and 20 female) with two- and three-fragment proximal humeral fractures with short intramedullary nail. Mean age of patients was 68.8 (37-84) years. All patients were examined clinically and roentgenologically. In postoperative period secondary varus deformity was observed in18 (60%) patients and made up 4.3° at an average. Roentgenologic signs of delayed fracture consolidation due to the loss of reposition and decrease of neck-shaft angle under 120° were observed in one case. Evaluation by ASES scale made up 90.73±7.01 points, by SST scale - 10.47±1.41 points. Treatment results for three-fragment fractures were not as good as for two-fragment ones however the difference was not statistically significant ( p >0.05). Obtained data showed the high efficacy of short straight intramedullary nail application in two- and three-fragment proximal humeral fractures.
N.N. Priorov Journal of Traumatology and Orthopedics. 2015;22(4):17-20
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Indirect Electroimpulse Myostimulation and Its Role in Treatment of Patients with Shin Bone Fractures

Obolenskiy V.N., Karpenko A.V., Zagorodniy N.V.


Prospective randomized controlled study to evaluate the efficacy of electric muscle stimulation (EMS) of calf muscles in prevention of venous thromboembolic complications (VTEC), shortening of treatment and rehabilitation terms in patients with shin bones fractures was performed. The study included 60 patients, aged 19-67 years, with isolated shin bones fractures. All patients were admitted at early (from 0.5 to 3 hours) terms after injury. For final fixation either intramedullary or plate osteosynthesis were used. All patients were on anticoagulant therapy for VTEC prevention. In the study group ( n =30) 2 séances of EMS, 3 hours each, were performed daily from the first day of hospitalization. In 30 patients from the control group EMS was not performed. It was shown that application of EMS ensured the shortening of treatment and rehabilitation terms, better quality of life and enabled to avoid VTEC development. Achieved preliminary data are indicative of the expediency of EMS application in traumatologic patients at early hospital stage.
N.N. Priorov Journal of Traumatology and Orthopedics. 2015;22(4):21-25
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Use of Perfotran at Conservative Treatment of Early Stages of Femoral Head Avascular Necrosis

Prokhorenko V.M., Shusharin A.G., Polovinka M.P.


Conservative treatment results are presented for 328 patients with I-II stages of femoral head avascular necrosis (FHAN) at 3 years follow up term. Uni- or bilateral coxarthrosis was observed in 157 patients. Patients were on intraarticular injections of perfotran (1st group; n=102) or perfotran+dimexide mixture (2nd group; n=226). Clinical and functional hip joint condition was evaluated by Harris Hip Score. Positive dynamics was noted in all patients however in group 2 it was more marked: absence of negative dynamics was recorded in 204 (90.2%) patients; restorative process, by MRI examination results, was noted in 105 (46.5%) patients; significant reduction of pain syndrome was achieved. Algorithm for the management of patients with early stages of FHAN was proposed.
N.N. Priorov Journal of Traumatology and Orthopedics. 2015;22(4):26-31
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Early Results of Clinical Use of Artromedullary Shunting in Degenerative Dystrophic Knee Joint Diseases

Tatarenkov V.I., Maksimov S.M., Bulgakov V.G., Gavryushenko N.S., Martynov D.V., Nechiporuk A.P., Shal’nev A.N.


Results of comparative study with participation of 69 patients (42-80 years old) with degenerative dystrophic changes of the knee joint are presented. In control group (n=46) only arthroscopic debridement was performed. In the main group (n=23) arthroscopic intervention was supplemented with insertion of arthromedullar implant that ensured the penetration of intraosseous content (artromedullary shunting) into joint cavity. Outcomes were evaluated in 3 and 6 months after surgery by KOOS scale and Leken algo-functional index. Positive dynamic that was observed in both groups within the first 3 months persisted in future and more significant changes were noted in patients from the main group (p<0.01). In 3 months after surgery 21% of patients from the main group and 57% of patients from the control group (p<0.01) were taken nonsteroidal anti-inflammatory drugs regularly. In 6 months after surgery those indices made up 15% and 45.6% of patients (p<0.05) respectively. Suggested technique of artromedullary shunting is directed to the correction of disorders related to the development of degenerative dystrophic knee joint changes and evaluation of its efficacy will be continued.
N.N. Priorov Journal of Traumatology and Orthopedics. 2015;22(4):32-38
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Efficacy of Zoledronic Acid in Patients with Systemic Osteoporosis and Problem of «Non Respondents» to the Treatment

Rodionova S.S., Buklemishev Y.V.


Prospective study of zolendronic acid efficacy was performed in 112 patients with systemic osteoporosis. Study results confirmed the presence of patients who did not response to the treatment: in 15.7 % of observations reduction of mineral bone density (BMD) continued to progress. No significant differences in initial deviations of resorption and bone formation markers, peculiarities of calcium homeostasis were detected in “non respondents”. At the same time by the 12th month after treatment initiation the relationship between BMD increase with preservation of marked decrease of resorption marker (deoxypyridinoline) and bone formation marker (osteocalcin) was noted, that pointed out the expediency of prognostic model creation. Evaluation of the influence of certain risk factors (age, results of blood and urine biochemical tests, data of densitometry including the results of femoral neck BMD in some patients) using discriminant analysis showed that 81.5% of patients were correctly referred to the groups of patients who responded and not responded to treatment. Out of all initially studied parameters the most significant were 7 that in 78.6% of cases (method sensitivity) enabled to identify the patients with negative treatment effect and in 82.1% of cases (method specificity) - with positive treatment effect.
N.N. Priorov Journal of Traumatology and Orthopedics. 2015;22(4):39-43
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Different Variants of Osteoblastoma Course in Children (Clinical, Roentgenologic, Morphologic Comparison)

Snetkov A.I., Morozov A.K., Berchenko G.N., Batrakov S.Y., Kravets I.M., Frantov A.R.


Osteoblastoma is a benign bone forming well vascularized tumor with unlimited growth potential. Experience in diagnosis and treatment of 85 children, aged 5 - 18 years, with osteioblastoma is presented. All patients were treated at CITO department of childhood bone pathology and orthopaedics during the period from 1985 to 2015. In 8 patients the course of the disease was aggressive. Results of clinical, roentgenologic and morphologic comparison as well as the analysis of literature data enables to demonstrate the validity of distinguishing the aggressive type of osteoblastoma that is characterized by peculiarities of clinical course and requires special approach to its treatment.
N.N. Priorov Journal of Traumatology and Orthopedics. 2015;22(4):44-51
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Biologic Characteristics of Bone Substituting Tissue Engineering Construction Based on Calcium Phosphate Ceramics, Autologous Mesenchymal Stromal Cells and Fibrin Hydrogel

Mamonov V.E., Chemis A.G., Komlev V.S., Berkovskiy A.L., Golubev E.M., Proskurina N.V., Sats N.V., Drize N.I.


Biological characteristics of bone substituting tissue engineering construction (TEC) that contained porous calcium phosphate ceramic granulate (CPC) of phase structure ((tricalcium phosphate (TCP)), fibrin hydrogel and autologous multipotent mesenchymal stromal cells (auto-MMSC) induced and non-induced to osteogenic differentiation were studied in vivo. The following characteristics of TEC were determined: ability to transfer within its structure the viable auto-MMSC with preservation of their regeneration potential; ability to osteogenesis only under conditions of orthotopic implantation; ability of induced to osteogenic differentiation auto-MMSC to participate in the reparative processes for not more than within 6 weeks after implantation; negative affect of fibrin hydrogel on the osteoinductive properties of CPC within TCP structure. It was shown that to provide osteogenesis in the implanted TEC not only the viable auto-MMSC but simultaneous presence of osteoinductive and osteoconductive factors was required. No bone formation in a critical bone defect and in ectopic implantation takes place without observance of these conditions.
N.N. Priorov Journal of Traumatology and Orthopedics. 2015;22(4):52-59
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Modeling of a Different Volume Spinal Cord Injury in Rats and Methods for Evaluation of Lost Functions Restoration (part 2)

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


The purpose of the study was to work out the methods for somatosensory evoked potentials registration under conditions of nerve paths injury in experiment. Evoked potentials were recorded in laboratory animals divided into 5 groups according to the volume of injury inflicted by the technique worked through previously. Potentials were recorded prior to intervention and on 1st, 7th, 14th, 21st, 30th and 45th postoperative day. On the 1st day sharp decrease of potential amplitudes was observed in groups with incomplete spinal cord injury. In groups with complete spinal cord injury no potentials were recorded. Slight restoration of nerve conductivity was observed only in rats with 50% spinal cord transection. Study results showed the efficacy of the technique in the assessment of spinal cord tissues conductivity and confirmed the absence of spontaneous nerve paths restoration after more than 50% of spinal cord transection.
N.N. Priorov Journal of Traumatology and Orthopedics. 2015;22(4):60-64
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Surgical Approaches at Treatment of Intraarticular Fractures of Elbow Joint Bones

Kalantyrskaya V.A., Golubev I.O.


Description of the most common approaches used in intraarticular fractures of elbow joint bones is presented. Advantages and disadvantages of every approach are noted. Preferences of the authors in the choice of specific approach are indicated and substantiated.
N.N. Priorov Journal of Traumatology and Orthopedics. 2015;22(4):65-69
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Our Experience in Treatment of Patients with Acute Traumatic Lateral Patellar Dislocation

Korolyov A.V., Afanas’ev A.P., Gerasimov D.O., Ryazantsev M.Y.


Treatment results for 38 patients aged 18-45 years with acute traumatic lateral patellar dislocation are presented. In 2 months after arthroscopic intervention 3 intraarticular injections of synovial fluid substitute were performed to all patients. Results were assessed by IKDS questionnaires and Tegner Lysholm Knee Scoring Scale in 2 (prior to injections), 6 and 9 months after operation. Mean point by IKDC scale made up 38±2.1 before surgery, 56±3.5 in two months, 73±3.7 in 6 and 85±3.4 in 9 months (p<0.05) after intervention. By Tegner Lysholm Knee Scoring Scale those values made up 54±3.1, 62±2.1, 71±2.4 and 80±2.6, respectively (p<0.05). Applied treatment tactics enabled to achieve excellent and good results in long term postoperative period in 93% of patients.
N.N. Priorov Journal of Traumatology and Orthopedics. 2015;22(4):70-73
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Peroneal Tendon Dislocations

Koryshkov N.A., Khodjiev A.S., Dzyuba A.M., Platonov S.M., Larionov S.V., Shcherbakov A.O.


Clinical observation of patients with posttraumatic deforming arthrosis of subtalar joint resulted from calcaneus fracture and preoperatively diagnosed closed old dislocation of left foot peroneal tendons is presented. The necessity of thorough examination of patients with hindfoot injuries and expediency of surgical interventions not only on the bony but also on the soft tissue structures is substantiated. Such interventions will provide for the restoration of the normal anatomical position of peroneal tendons.
N.N. Priorov Journal of Traumatology and Orthopedics. 2015;22(4):74-76
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Variants of Neurotization in Injuries of Brachial Plexus and Nerves of Upper Extremity

Zhuravlev S.A., Golubev I.O.


The most commonly used variants of neurotization on the upper extremity in various injuries of peripheral nerves or brachial plexus and results of their application are presented. Pledge of successful neurotization is thorough knowledge of topographic anatomy of peripheral nerve branches, skills in precision surgical technique and adequate postoperative rehabilitation.
N.N. Priorov Journal of Traumatology and Orthopedics. 2015;22(4):77-82
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Student Years of N.N. Priorov (in commemoration of the 130th anniversary of birth)

Baitinger V.F., Kurochkina O.S., Delich I.B.


Student years of the Honoured Science Worker of RSFSR, Academician of the Academy of Medical Sciences (AMS), Soviet trauma- and orthopaedic surgeon, the founder of the Central Institute of Traumatology and Orthopaedics N.N. Priorov are presented. The atmosphere of student life with its everyday troubles, living conditions, university studies, lack of money, unemployment, revolutionary sentiments and yearning of young people for knowledge as well as the desire of teachers to share their experience to young generation is shown.
N.N. Priorov Journal of Traumatology and Orthopedics. 2015;22(4):83-89
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History of the Organization of Medical Care during the Great Patriotic War of 1941-1945 (in commemoration for the 70th anniversary of the Victory)

Knopov M.S., Taranukha V.K.


Success in the treatment of wounded and patients in the medical and sanitary battalions, army and front-line base hospitals as well as on the home front was secured by realization of the system of step-by-step treatment with evacuation when indicated. Creation and application of that principally new advanced system of treatment-and-evacuation provision for combat operations was the great achievement of native public health and military medical service. Studies of many talented scientists in the field of treatment of gunshot wound, penetrating wounds, gunshot fractures of the extremities, wound complications as well as elaboration of diagnostic and treatment methods for wounded played an important role in the creation of the system for rendering adequate medical care.
N.N. Priorov Journal of Traumatology and Orthopedics. 2015;22(4):90-93
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Index of Articles Published in 1-4, 2015

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N.N. Priorov Journal of Traumatology and Orthopedics. 2015;22(4):94-96
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