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Vol 28, No 3 (2021)

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Original studies

Problems with fixing chronic injuries of the anterior pelvic ring

Lazarev A.F., Solod E.I., Gudushauri Y.G., Kakabadze M.G., Roskidailo A.S., Kalinin E.I., Konovalov V.V., Marychev I.N.

Abstract

BACKGROUND: A separate problem is the surgical treatment of the pelvic joints, especially the pubic joint. Stabilization in the case of chronic pelvic injuries using standard methods used in the treatment of patients with acute pelvic injuries reveals cases of plate fatigue fractures, metal structures migrations and the need for repeated surgical interventions. In this regard, in order to fix injuries to the anterior pelvis in case of chronic injuries, it is necessary to use other, special tactical approaches to fixing bone fractures and joint ruptures, and to develop metal structures adapted for such cases.

AIM: To study of the features of fixation in chronic pelvic injuries and analysis of the results with various methods of fixation of the anterior pelvic ring in chronic cases.

MATERIALS AND METHODS: Under our supervision in the first department of the “FGBU NMITs TO im. NN Priorov” of the Ministry of Health of the Russian Federation for the period from 2000 to 2015. 117 patients were observed who underwent surgical treatment using standard reconstructive plates for chronic injuries of the anterior pelvis used in the surgical treatment of acute injuries of the pelvic ring.

RESULTS: Group No. 1, consisting of 65 patients who underwent fixation of the anterior half-ring with reconstructive plates, implanted in the standard way as in acute trauma, 12 patients (10.2%) had migration or fracture of metal structures for a period of 2 to 6 months from the date of surgery.

Group No. 2 consists of 52 patients who underwent fixation of the anterior pelvic semicircle with two plates located on the pubic bones mutually perpendicular to each other using the standard method. Destabilization of metal structures was detected in 7 patients (13.4%) with X-ray control in the period from 2 weeks to 2 months after the operation.

CONCLUSION: The standard approach to fixation of such injuries, as in acute (up to 3 weeks from the moment of injury), does not create conditions for stable fixation. In the first case, attention is drawn to the fact that after the plate fracture, the diastasis between the pubic bones increased to almost the same level as at the time of admission. From this, it can be concluded that the fibro-cicatricle process formed in traumatic foci creates a rigid deformation, and when restoring the anatomical integrity of the pelvic ring, with the use of bone osteosynthesis, the plate with chronic injuries experiences stronger loads than in acute trauma and causes a fatigue fracture of metal structures.

N.N. Priorov Journal of Traumatology and Orthopedics. 2021;28(3):5-12
pages 5-12 views

Surgical rehabilitation of patients with the consequences of pilon fractures

Grazhdanov K.A., Zuev P.P., Kauts O.A., Romanov N.I., Barabash Y.A., Kireev S.I., Norkin I.A.

Abstract

BACKGROUND: Pilon fracture is an intra-articular injury of tibia distal metaepiphysis; it’s often comminuted. Comprehensive reconstruction of the tibia articular surface and recovery of the axil in the affected extremity is of prime importance for the rehabilitation of patients with such pathology, so priority is given to reconstructive surgical techniques. Pilon injury often causes deforming arthrosis of the ankle joint that reduces its functions. It is ankle arthrodesis that is considered to be the preferred method of surgical rehabilitation in this clinical setting.

AIM: The presentation of successful outcomes in patients with consequences of intra-articular fractures of distal tibial metaepiphysis.

MATERIALS AND METHODS: Clinical and radiological methods were used to study the initial data and outcomes of 16 patients suffering from pilon fractures. The recovery of the supporting function of the foot and the level of pain syndrome after the treatment were evaluated with the Foot Functional Index questionnaire. Taking into account the obtained clinical and radiological data, all patients underwent bone-plastic arthrodesis of the ankle joint with correction of limb deformity. An intramedullary retrograde tibial lockable rod was used to fix the ankle joint.

RESULTS: It was established that the performance of bone-plastic arthrodesis of the ankle joint provides a complete restoration of the supporting function of the injured lower limb with the relief of pain in the period of 3–4 months after surgery.

CONCLUSION: The use of intramedullary retrograde rod with blocking for the fixation of the ankle joint does not require the use of additional immobilization, provides the possibility of early loading on the operated limb.

N.N. Priorov Journal of Traumatology and Orthopedics. 2021;28(3):13-19
pages 13-19 views

Treatment of horizontal dissection of the knee menisci with platelet-rich plasma (PRP). Literature review and analysis of own data

Lisitsyn M.P., Atlukhanov R.Y., Zaremuk A.M., Lisitsyna E.M.

Abstract

BACKGROUND: Treatment of damage to the inner layer of the meniscus of the knee joint that does not extend to the articular surface remains an open question. Subsequently, these injuries can cause a complete rupture of the meniscus that already requires surgical treatment. Existing methods of treatment at this stage of meniscus injury have not shown their effectiveness.

AIM: Study the effect of platelet-rich plasma (PRP) on meniscus regeneration.

MATERIALS AND METHODS: The analysis of the 15 patients treatment results with the PRP method, which effectively stimulates regenerative processes, was carried out. The effectiveness of the method was assessed using the following evaluation scales: visual analog scale (VAS), Lequesne scale, WOMAC index (Western Ontario and McMaster Universities Osteoarthritis Index), Lysholm scale, KSS scale (Knee Society Score) and magnetic resonance imaging (MRI).

RESULTS: According to the results of MRI performed after 6 months, there was no progression of meniscus damage after PRP therapy by all parameters.

CONCLUSION: The study showed an improvement in all rating scales. In addition, according to MRI data, after 6 months there was no progression of the degenerative process in the menisci. The presented method can be the first step in the treatment of this pathology.

N.N. Priorov Journal of Traumatology and Orthopedics. 2021;28(3):21-36
pages 21-36 views

Dynamic ultrasonic research mediopatellary synovial folding knee joint

Eskin N.A., Ochkurenko A.A., Kusova F.U., Kurpyakov A.P., Gorokhvodatsky A., Matveeva N.Y.

Abstract

BACKGROUND: One of the reasons for the formation of pain syndrome in the anterior part of the knee joint is a pathologically thickened mediopatellar synovial plica (MP). MP most often pathologically changes and as a result leads to changes in the nearby structures of the knee joint. However, there are difficulties in assessing the direct impact of MPSS on the articular cartilage of the patella and medial condyle of the femur, for this it is advisable to perform ultrasound examination using functional tests.

AIM: To study the effectiveness of ultrasound examination with the use of functional tests in the diagnosis of MP pathology, which are important in determining tactics and evaluating treatment results.

MATERIALS AND METHODS: The results of a comparative survey of 80 patients are presented. The first stage of the MRI was performed on patients, according to which the type of change in MP was evaluated. The second stage was ultrasound with the use of functional tests.

RESULTS: According to MRI data, type A was detected in 11, type B in 17, type C in 38 and type D in 14 patients. Ultrasound results showed that type A and B MP were not infringed in any case, and type C and D MP were infringed in 24 (63.2%) and 12 (85.7%) cases, respectively.

CONCLUSION: The study made it possible to determine not only the presence or absence of pathologically thickened MP, but also to assess the degree of its influence on nearby joint structures, such as thickness, the degree of vascularization of both the fold itself and the synovial membrane around it, the presence or absence of infringement during flexion and extension of the knee joint and SHELF syndrome, and therefore, the degree of its participation in the formation of pain syndrome.

N.N. Priorov Journal of Traumatology and Orthopedics. 2021;28(3):37-45
pages 37-45 views

Reconstructive surgeries and endoprosthetics of the elbow joint: indications, possibilities and prospects

Kesyan G.A., Arsen’ev I.G., Urazgil’deev R.Z., Karapetyan G.S., Shuyskiy A.A., Kesyan O.G., Levin A.N.

Abstract

BACKGROUND: Severe injuries of the elbow joint and their consequences are a serious problem in modern traumatology and orthopedics due to the large number of unsatisfactory treatment results, in particular, due to the lack of a differentiated approach to the choice of tactics and the method of surgery.

AIM: To evaluate the results of a differentiated approach to the choice of tactics and the method of surgical intervention in the treatment of patients with injuries and consequences of injuries of the elbow joint.

MATERIALS AND METHODS: The results of treatment of 245 patients with injuries and consequences of damage to the elbow joint were assessed within 11 years from the date of surgery. Six groups of patients were identified: group 1 — osteosynthesis of fractures of the elbow joint; 2nd — open arthrolysis without the imposition of Oganesyan’s hinged distraction apparatus (HDA); 3rd — open arthrolysis with the imposition of HDA; 4th — arthroscopic arthrolysis without HDA imposition; 5th — arthroscopic arthrolysis with the imposition of HDA; 6th — elbow arthroplasty.

RESULTS: In 93% of patients after osteosynthesis (1st group of patients), a good result was obtained (the deficit in the range of motion was not more than 10°, the average score on the DASH scale was 8). In patients after arthrolysis, there is a twofold increase in the range of motion (on average from 42°–50° to 114°–120°), and regardless of the method of arthrolysis (arthroscopic or open) and whether HDA was used or not. On the DASH scale, 89% of patients showed a decrease in points on average from 77 to 36. In the 6th group, an increase in the range of motion was noted on average from 45°–48° to 126°–135°, on the DASH scale — a decrease in points from 79–82 to 39–44 on average. Revision intervention was required in 28.4%.

CONCLUSION: The choice of the method of surgical treatment of injuries and the consequences of severe injuries of the elbow joint directly depends on the degree and nature of destruction of the bone-articular and soft tissue structures, the deficit in the range of motion in the joint.

N.N. Priorov Journal of Traumatology and Orthopedics. 2021;28(3):47-57
pages 47-57 views

Clinical case

Features and tactics of management of patients with joint hypermobility (Clinical observation)

Orletskiy A.K., Timchenko D.O., Kozlova E.S.

Abstract

There are not enough studies in the literature on the treatment of patients with impaired collagen homeostasis. Dysplastic changes in the bone and ligamentous structures of the shoulder joint are a risk factor for the development of chronic instability and can be one of the reasons for relapses after surgery. Orthopedic disorders of this pathology should be corrected by operative or conservative techniques for each patient individually.

The choice of treatment tactics for patients with chronic post-traumatic multiplanar instability of the shoulder joint against the background of connective tissue dysplasia.

Surgical treatment was used, the duration of wearing the orthosis on the shoulder joint area was increased in order to ensure the centering of the humeral head, and a rehabilitation program was proposed.

N.N. Priorov Journal of Traumatology and Orthopedics. 2021;28(3):59-64
pages 59-64 views

Reviews

Complications in adolescent idiopathic scoliosis surgery. Review

Koroteev V.V., Krestyashin V.M., Vybornov D.Y., Tarasov N.I., Semenov A.V., Gorelova P.A., Karlova N.A.

Abstract

To days debates about most frequent complications after adolescent idiopathic surgery and its risk factors remains to persist. Taking into account rising possibilities of orthopaedic surgery departments worldwide to reduce AIS patients’ hospital length of stay, strong need in strict knowledge about types and frequency of abovementioned complications and its risk factors is emerging. This knowledge can help clinicians in prediction of complications development and can aid in better diagnostics and treatment. Two main groups of complications were described thoroughly in current review: non-neurologic and neurologic. Both frequently developing and rare complications were described including superior mesenteric artery syndrome and deep infections.

There an obvious tendency of the rate of complications after AIS surgery to decline during last two decades from 5.7% in 2000–2003 to 4.95% in 2007 and to 0.98% in 2016. Despite that fact these complications still remain to be a big burden for clinicians. Major risk factors for its development include concomitant renal diseases, large intraoperative blood loss, substantial increase of anesthesia and surgery duration, stainless steel rods implementation combined or anterior only approach and refuse of intraoperative neuromonitoring.

N.N. Priorov Journal of Traumatology and Orthopedics. 2021;28(3):65-73
pages 65-73 views

Current trends and prospects for total elbow arthroplasty (literature review)

Kesyan G.A., Arsen’ev I.G., Urazgil’deev R.Z., Karapetyan G.S., Levin A.N., Kesyan O.G., Shuyskiy A.A.

Abstract

The article presents an analysis of foreign and domestic literature on total elbow arthroplasty, as well as revision arthroplasty. The literature review was carried out on the Internet platforms PubMed, Google Scholar, Science Research Portal, eLibrary, CyberLeninka, rsl.ru. The main directions in research work were determined: indications for endoprosthetics of the elbow joint, implant design, complications and revision surgery. The problem of elbow arthroplasty remains relevant for modern traumatology and orthopedics due to the large number of complications and unsatisfactory results of both primary and revision arthroplasty. Based on the analysis of the literature, the following conclusions were drawn: the rejection of fully connected, rigid systems due to the high frequency of aseptic loosening, the need for further research in the direction of implant design, improvement of the operation technique, determination of strict indications for elbow arthroplasty depending on the pathology, age of the patient and his physical activity, determination of indications for the use of various types of endoprostheses depending on nosology, improvement of technology and development of new methods of revision arthroplasty of the elbow joint.

N.N. Priorov Journal of Traumatology and Orthopedics. 2021;28(3):75-92
pages 75-92 views

Current views on the management of congenital dislocation of the knee based on current data on the outcomes of orthopedic treatment in these patients

Kruglov I.Y., Rumyantsev N.Y., Agranovich O.E., Omarov G.G., Kagantsov I.M., Rumiantceva N.N.

Abstract

Despite the rapid progress in medicine, today there is no clear protocol for the management of patients with such a rare disease as congenital dislocation of the knee (CDK). Analysis of the data shows that in the main percentage of cases, after ineffective conservative treatment, patients undergo late surgical intervention, which entails great number of complications and does not improve outcomes. This trend is associated with the lack of strict time limits for the start of medical care due to the lack of guidelines regulating the work.

Aim of the study was study modern approaches to conservative and surgical treatment of patients with congenital dislocation of the knee based on a systematic analysis of the literature.

Systematic analysis of literature sources on databases PubMed, Scopus, eLibrary, CyberLeninka, bibliography of key articles.

Preparing the preliminary plan of correction and early initiation of treatment of congenital dislocation of the knee significantly increases the rate of positive outcomes of this disease. It is worth noting that using a less invasive approach to initiating treatment of congenital dislocation of the knee avoids a number of complications. Based not only on the classification of the stage of the severity, but also on the degree of contracture of the quadriceps muscle, it is possible to determine the possibilities of restoring the work of the joint, which proves the need to improve the knowledge gained.

There is a need to organize the provision of medical care to patients with congenital dislocation of the knee on the basis of improved classifications that correspond to modern ideas about the outcomes of orthopedic treatment in patients with CDK.

N.N. Priorov Journal of Traumatology and Orthopedics. 2021;28(3):93-100
pages 93-100 views

Short Messages

6th Congress of Traumatologists and Orthopedists of the Far Eastern Federal District

Miromanov A.M., Davydov S.O.

Abstract

The short message provides information on the 6th Congress of Traumatologists and Orthopedists of the Far Eastern Federal District held on September 16–17, 2021 in Chita together with the All-Russian Scientific and Practical Conference with international participation “Traumatology, Orthopedics, and Rehabilitation Medicine of the Far East: Achievements, problems, prospects”. The work of the 6th Congress was held in a dynamic and fruitful format, which made it possible to achieve the goals set: modern issues of prevention, diagnosis, treatment of injuries, diseases and conditions of the musculoskeletal system, medical rehabilitation of patients were considered, which made it possible to improve existing or master new knowledge, skills, and abilities and the competence of students to carry out high-quality professional activities in the specialty “Traumato-logy and Orthopedics”, which will ultimately form labor functions in accordance with the professional standard “Traumatologist-orthopedist”. At the end of the Congress, the delegates adopted a resolution reflecting the most problematic aspects of the service, the solution of which will significantly increase the availability and quality of the provision of traumatological and orthopedic care in the Far Eastern Federal District.

N.N. Priorov Journal of Traumatology and Orthopedics. 2021;28(3):101-106
pages 101-106 views


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