Vol 16, No 2 (2009)

Articles
Potentialities of Surgical Treatment for Acetabular Fractures Using Low-Invasive Techniques
Solod E.I., Lazarev A.F., Lazarev A.A., Gudushauri Y.G., Kakabadze M.G., Roskidaylo A.S., Dan I.M., Solod E.I., Lazarev A.F., Lazarev A.A., Gudushauri Y.G., Kakabadze M.G., Roskidailo A.S., Dan I.M.
Abstract
Original technique of percutaneous osteosynthesis was applied for the treatment of 24 patients with acetabular columns fractures. The achieved results were compared to the results of osteosynthesis performed using open direct reposition of bone fragments (39 patients). The efficacy of low-invasive surgery in acetabular column fractures with regard to provision of fragments consolidation, prevention of femoral head aseptic necrosis development and achievement of early medical and social rehabilitation of patients was showed. Maintenance of fragments blood supply, use of minimal surgical approach and closed reposition are considered to be the progressive direction of internal osteosynthesis development.
N.N. Priorov Journal of Traumatology and Orthopedics. 2009;16(2):3-9
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Low Invasive Internal Osteosynthesis in Fractures of Tibial Plateau
Zagorodniy N.V., Lomtatidze E.S., Nikitin S.S., Semenistyy A.Y., Fedoruk G.V., Volna A.A., Frolov A.V., Zagorodniy N.V., Lomtatidze E.S., Nikitin S.S., Semenistyi A.Y., Fedoruk G.V., Volna A.A., Frolov A.V.
Abstract
Outcomes of surgical treatment of 97 patients with intraarticular fractures of proximal tibial metaepiphysis were analyzed. In all patients internal osteosynthesis without arthrotomy and under either electro-optical transducer or arthroscopic control was performed. Cannulated screws and plates with angular stability were used for osteosynthesis. In fractures with impression of articular surface plasty of bone tissue defects using either autograft from the upper flaring portion of the ilium or -tricalcium phosphate was performed. In postoperative period partial weight bearing on the operated extremity was allowed starting from the 6th week. Complete weight bearing in fractures with impression was allowed in 10 week and in 6 weeks - in fractures without impression. Treatment results were followed up at terms from 6 to 70 months (mean - 35 months). Roentgenologic and functional evaluation was performed by Rusmussen and Resnik-Niwoyama systems. Achieved roentgenologic results were excellent in 57.7% of patients, good - in 24.7%, satisfactory - in 15.5% and unsatisfactory in 2.1% of patients. It was showed that at treatment of such fractures the application of modern fixators and arthroscopic control enabled to perform adequate reposition of the articular surface and visualize injuries of intraarticular structures. Plasty of subchondral bone defects and application of plates with angular stability eliminated the probability of secondary displacement of fragments thus creating the possibility of early functional treatment and rehabilitation.
N.N. Priorov Journal of Traumatology and Orthopedics. 2009;16(2):10-14
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Treatment of Patients with Clavicle Fractures and Their Sequelae on the Basis of Biomechanical Conception of Bone Fragments Fixation
Pichkhadze I.M., Matsakyan A.M., Kuz'menkov K.A., Zhadin A.V., Tsiskarashvili A.V., Pichkhadze I.M., Matsakyan A.M., Kuzmenkov K.A., Zhadin A.V., Tsiskarashvili A.V.
Abstract
Basing on the results of theoretical analysis and experimental studies, biomechanical characteristics (resistance to displacement) of clavicle fragments of various length were determined. With regard for obtained data the requirements and indications to the application of various osteosynthesis techniques (transosseous, epiosseous, intramedullar) in different types of fractures were formulated. Treatment of clavicular fractures and their sequelae in accordance with biomecha-nical conception of fragments fixation was performed in 223 patients. Long term results were evaluated in 178 patients. Excellent results were achieved in 135 (75.9%) cases, good - in 26 (14.6%), satisfactory - in 10 (5.6%) and unsatisfactory - in 7 (3.9%) of cases. The results of the study showed that at observance of all biomechanical principles of bone fragments fixation it was possible to improve the outcomes of clavicular fractures treatment and to reduce the rate of complications considerably.
N.N. Priorov Journal of Traumatology and Orthopedics. 2009;16(2):15-21
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Surgical Treatment of Patients with Dislocations of the Acromial End of the Clavicle
Kopysova V.A., Nysambaev S.Z., Agishev R.G., Egorov A.G., Nevolin A.S., Shcheglov O.V., Kopysova V.A., Nysambaev S.Z., Agishev R.G., Egorov A.G., Nevolin A.S., Shcheglov O.V.
Abstract
Treatment results of 404 patients with dislocations and fracture-dislocations of the acromial end of the clavicle were analyzed. Depending on the severity and remoteness of ligamentous system injury the most rational methods for clavicle fixation using devices with shape memory effect were determined. In 158 (39.1%) patients with II degree of clavicle dislocation by Tossy transarticular fixation using devices with shape memory effect was performed. In 177 (43.8%) cases clavicular-coracoid fixator was used to stabilize the clavicle in sagittal plane. In 54 (13.4%) patients with old clavicular dislocations of II-III degree and in repeated interventions combined fixation by S-shaped clip with protective leg and clavicular-coracoid device was performed. Treatment results were assessed at terms 1 - 8 years. In patients with fresh clavicular acromial end dislocations of II degree the effective treatment method was the reconstruction of ligamentous system in combination with transarticular fixation of the clavicle by S-shaped tightening clip (89.7% of good results). In repeated interventions and clavicular acromial end dislocations of III degree the fixation with clavicular-coracoid device and combined fixation without plasty of the ligaments gave good results in 79.1% of cases.
N.N. Priorov Journal of Traumatology and Orthopedics. 2009;16(2):22-28
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Reconstruction of Deltoid Ligament Using Low Invasive Surgical Technique at Treatment of Ankle Joint Fractures
Kazantsev A.B., Golubev V.G., Chekeres P.P., Putyatin S.M., Kashurnikov Y.M., Sherstnev R.A., Kazantsev A.B., Golubev V.G., Chekeres P.P., Putyatin S.M., Kashurnikov Y.M., Sherstyov P.A.
Abstract
Comparative analysis of treatment results of 68 patients with malleolus fractures and injury of deltoid ligament was performed. Depending on the treatment technique all patients were subdivided into four groups. Main group - surgical treatment of fractures and reconstruction of deltoid ligament with Twinflix screw (n=30), comparative groups - surgical treatment of fractures with transcutaneous suturing of deltoid ligament (n=10) and ligament plasty with Р -shaped sutures (n=8); control group - conservative treatment of fractures and deltoid ligament injury (n=20). Follow-up time made up 6 months - 2 years. Evaluation of treatment results was performed by adopted scale of American Orthopaedic Foot and Ankle Society. Patients were examined using clinical and roentgenologic methods as well as ultrasound and rheovasography. In the main group excellent result was achieved in 23.1%, good result - in 65.3%, satisfactory - in 11.6% of patients. In control group they made up 16.8%, 61.2% and 19.5%, respectively, with poor result in 2.5% of patients. It was demonstrated that application of low invasive osteosynthesis in combination with reconstruction of deltoid ligament using Twinfix screw reduced considerably the probability of posttraumatic arthrosis development as well as provided for complete restoration of the ligament with preservation of its elastic properties and joint stability.
N.N. Priorov Journal of Traumatology and Orthopedics. 2009;16(2):29-33
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Peculiarities of Treatment of Patients with Complicated Compression Fractures of Thoracic and Lumbar Spine Vertebral Bodies on the Background of Osteoporosis
Vetrile S.T., Kuleshov A.A., Darchiya L.Y., Vetrile S.T., Kuleshov A.A., Darchiya L.Y.
Abstract
Experience in surgical treatment of 11 patients (1998-2008) with complicated compression fractures of the thoracic and lumbar spine vertebral bodies on the background of osteoporosis has been presented. Mean age of patients was 58 years (from 37 to 74 years). The treatment consisted of the adequate decompression of spinal canal followed by correction and multilevel fixation of the spine with CDI system. Decision on the fixation extent was made with regard for the degree of bone mineral density and vertebral body injury. Follow up period made up 1-10 years. Long term treatment results were assessed clinically and roentgenologically. Correction of kyphosis was noted in all cases. In the late period slight loss of the achieved correction (within 12°) was observed but the patients did not complained of spinal pains. In patients operated on in early terms (up to 2 months) after neurologic complications development the more rapid regress of neurologic symptoms was noted. It was shown that differentiated approach to the choice of surgical technique enabled to achieve favorable results.
N.N. Priorov Journal of Traumatology and Orthopedics. 2009;16(2):34-39
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Tactics of Surgical Treatment for Degenerative-Dystrophic Diseases of Lumbosacral Spine in Elderly and Senile Patients
Kavalerskiy G.M., Makirov S.K., Chenskiy M.D., Boev M.V., Cherepanov V.G., Ternovoy K.S., Lisitskiy I.Y., Amin F.I., Korkunov A.L., Sergeev O.A., Kavalerskiy G.M., Makirov S.K., Chenskiy M.D., Boev M.V., Cherepanov V.G., Ternovoi K.S., Lisitskiy I.Y., Amin F.I., Korkunov A.L., Sergeev O.A.
Abstract
Surgical treatment outcomes on 87 patients aged 60-83 years operated on for degenerative-dystrophic diseases of lumbosacral spine have been presented. Depending on the stage of pathologic process and compressive factor direction, different types of decompressive stabilizing surgical interventions were performed in compliance with the elaborated tactics of surgical treatment. Evaluation of the results showed significant decrease in pain sensations (by Visual Analog Scale) and increase in the indices of daily activity (by Oswestry Disability Index) both in early (under 3 months) and late (up to 36 months) postoperative periods, that led to significant improvement of the life quality in elderly patients. The achieved results confirmed the efficacy of the elaborated differentiated approach to surgical treatment of that group of patients.
N.N. Priorov Journal of Traumatology and Orthopedics. 2009;16(2):40-46
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Surgical Treatment of Patho- logic Cervical Vertebrae Fractures
Protsenko A.I., Karanadze A.N., Gordeev G.G., Fazilov S.K., Nikuradze V.K., Protsenko A.I., Karanadze A.N., Gordeev G.G., Fazilov S.K., Nikuradze V.K.
Abstract
Experience in treatment of 32 patients with pathologic fractures of cervical vertebrae is presented. The fracture was preceded with vertebrae destruction caused by tumor metastatic spreading (18 patients), nonspecific spondylitis (12) and fibrocystic dysplasia (2). In all cases the injury resulted from sharp bending of the neck including 2 patients in whom the fracture developed during manual manipulation. Clinically the fracture was manifested by myelopathy of various degrees, pronounced local or radicular pain syndrome. In all patients substitution of the destructed vertebral body by the carbonic graft with collapanoplasty was performed. Pain syndrome was arrested in all patients; complete regress of myelopathy was achieved in 27 patients, the partial one - in 5 patients. Osteocarbonic block was formed in all cases, average duration of its formation made up 10 weeks.
N.N. Priorov Journal of Traumatology and Orthopedics. 2009;16(2):47-50
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Hip Joint Arthrography with Double Contrast in Children and Adolescents
Mayorov A.N., Morozov A.K., Mayorov A.N., Morozov A.K.
Abstract
Experience in use of hip joint double contrast arthrography in 207 patients (236 joints), aged 2-14 years, with Perthes disease and various forms of hip dysplasia was analyzed. Basing on the study of contrast arthrograms the roentgenologic signs reflecting the joint state in the abovementioned pathology were detected and described. It was stated that the data of contrast examination enabled to work out in details the notion of hip joint pathology with regard for soft tissues condition and in some cases were the most important when choosing the treatment tactics. Diagnostic signs, which were to be taken into account while working out the surgical intervention protocol - that is of great practical importance, were determined.
N.N. Priorov Journal of Traumatology and Orthopedics. 2009;16(2):51-56
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Treatment of Congenital Hip Dysplasia in Early Childhood Using Periacetabular and Combined Wire Tunneling Technique
Shevtsov V.I., Makushin V.D., Chirkova N.G., Shevtsov V.I., Makushin V.D., Chirkova N.G.
Abstract
The influence of periacetabular and combined wire tunneling upon hip bones development in congenital hip dysplasia in 34 children, aged 8-36 months, was studied. Evaluation of the treatment results by dynamics of roentgenologic parameters showed that periacetabular and combined wire tunneling possessed a trophostimulating effect. Differentiated application of these techniques enables to avoid radical reconstructive operations on the ilium and femur in the early childhood or to delay their performance.
N.N. Priorov Journal of Traumatology and Orthopedics. 2009;16(2):57-61
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Efficacy of Acetabulum Transposition at Treatment of Dysplastic Coxarthrosis in Children and Adolescents
Kamosko M.M., Kamosko M.M.
Abstract
Experience in treatment of 254 children of higher forms age and adolescents with dysplastic coxarthrosis (278 joints) is presented. It is shown that in cases of single-step reduction of hip dislocation with following rigid immobilization as well as inadequate application of intraarticular interventions the more early development and rapid progression of degenerative-dystrophic changes in the hip joint is typical. In the overwhelming majority of cases transposition of the acetabulum following triple pelvic osteotomy enables to achieve the regress of clinical manifestations and degenerative-dystrophic changes in patients with I and II stages of dysplastic coxarthrosis. Efficacy of intervention to a considerable extend depends upon the initial state of the hip joint.
N.N. Priorov Journal of Traumatology and Orthopedics. 2009;16(2):62-66
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Algorithm for Early Diagnosis and Treatment Tactics of Diseases Accompanied by Coxalgia in Children
Lobov I.L., Kul'banskaya S.E., Uronova M.A., Lobov I.L., Kulbanskaya S.E., Uronova M.A.
Abstract
Examination and treatment of 524 children with coxalgia has been performed. Algorithm for early diagnosis of various hip joint diseases accompanied by coxalgia has been elaborated. The factors causing hip joint response resulting in different pathology including Leg-Calve-Perthes disease have been determined. In the majority of cases application of modified splint in combination with drug therapy enabled to normalize blood circulation in the affected joint and prevent the development of secondary deformities of the femoral head.
N.N. Priorov Journal of Traumatology and Orthopedics. 2009;16(2):67-71
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Outcomes of Surgical Treatment of Fractures in Concomitant and Multiple Injuries in Children
Musaev T.S., Tolipov N.N., Masharipov F.A., Musaev T.S., Tolipov N.N., Masharipov F.A.
Abstract
Outcomes of surgical treatment of 72 children with concomitant (55) and multiple (17) injuries of locomotor system were analyzed. In 53 patients (group 1) surgical interventions for bone fractures were performed in early terms (within 3 days after trauma), in 19 patients (group 2) the interventions were postponed. In group 1 good and satisfactory result was achieved in 92% of patients (63 segments), in group 2 - in 85.2% of patients (23 segments). Duration of hospitalization made up in two groups 11.5 and 14.5 days, respectively. Application of pirod external fixation devices facilitated the treatment course due to the reduction of treatment duration and traumatization, as well as use of more simple technique of long bones and pelvis osteosynthesis.
N.N. Priorov Journal of Traumatology and Orthopedics. 2009;16(2):72-75
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Transthecal Anesthesia of Fingers
Zolotov A.S., Popov R.Y., Zolotova Y.A., Zolotov A.S., Popov R.Y., Zolotova Y.A.
Abstract
First experience in transthecal anesthesia application for the treatment of 62 patients with different fingers injuries was analyzed. That method showed its efficacy in 52 (83.9%) cases. The level of anesthesia on the palmar surface of the finger corresponded to the injection point, on the dorsal one - to the middle of the main phalanx. Incomplete transthecal block was observed in cases when the injuries or their sequelae resulted in disturbance of tendon sheath leak-proofness (or permeability) as well as in interventions on a thumb.
N.N. Priorov Journal of Traumatology and Orthopedics. 2009;16(2):76-78
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On Expediency of Lengthening of the Foot as Anatomical Segment
Tenilin N.A., Bogos'yan A.B., Batalov O.A., Vlasov M.V., Tenilin N.A., Bogosyan A.B., Batalov O.A., Vlasov M.V.
Abstract
The work is based on the analysis of treatment results of 19 patients with 2 - 6 cm shortening of the foot. Foot lengthening was performed at the level of tarsal bones with Ilizarov apparatus. Due to great number of various complications (up to 4 per patient), which required additional surgical interventions as well as unsatisfactory short- and long-terms functional results, made the authors to conclude that lengthening of the foot as an entire anatomic segment was not expedient. Certain theoretical propositions in favor of higher functional suitability of the shor-tened foot in rigid ankle joint contracture adduced.
N.N. Priorov Journal of Traumatology and Orthopedics. 2009;16(2):79-84
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Formation of Bone and Foci of Ectopic Hemopoiesis at Joint Application of Calcium Scaffolds with Bone Marrow Cells or Cultivated Mesenchymal Stromal Cells
Shipunova I.N., Svinareva D.A., Petrova T.V., Ryashentsev M.M., Mamonov V.E., Drize N.I., Shipunova I.N., Svinaryova D.A., Petrova T.V., Ryashentsev M.M., Mamonov V.E., Drize N.I.
Abstract
Potential application of calcium scaffolds in combination with either bone marrow or adherent cell layers from long-term cultures containing mesenchymal stem cell for the induction of bone tissue growth was studied in mice. Two scaffolds, i.e. Osteoset® and Prodens® were tested on the model of ectopic grafting under the skin and renal capsule of mice. It was demonstrated that Prodens® and less effectively Osteoset® could be used for the induction of bone growth in combination with bone marrow cells but even more effectively in combination with cultivated mesenchymal stromal cells. Both the site of transplantation and preliminary induction of bone differentiation of stromal cells exerted a great influence upon the process of bone formation.
N.N. Priorov Journal of Traumatology and Orthopedics. 2009;16(2):85-90
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Anatomic and Surgical Approaches to Treatment of Sympathetically Dependant Syndromes of Upper Extremities
Krupatkin A.I., Es'kin N.A., Golubev V.G., Kutepov I.A., Merkulov M.V., Fedotov E.Y., Zeynalov V.T., Kuz'michev V.A., Krupatkin A.I., Eskin N.A., Golubev V.G., Kutepov I.A., Merkulov M.V., Fedotov E.Y., Zeinalov V.T., Kuzmichyov V.A.
N.N. Priorov Journal of Traumatology and Orthopedics. 2009;16(2):91-95
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In commemoration of 90th anniversary of Prof. A.I. Kazmin
- -.
N.N. Priorov Journal of Traumatology and Orthopedics. 2009;16(2):96-96
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