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Vol 28, No 4 (2021)

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Original studies

Long-term results of reconstructive surgery in posttraumatic deformities of the proximal epymetaphysis of the tibia

Malyshev E.E., Zykin A.A., Gorbatov R.O., Trifonov A.M., Illarionova T.V.

Abstract

BACKGROUND: Tibial plateau fractures (TPF) are common and account for up to 1% of all fractures. The most unfavorable results of their treatment occur with nonunion, malunion, and malunion of TPF fractures. Unfavorable functional results of treatment are due to the occurrence of stiffness in the joint, the development of post-traumatic osteoarthritis, instability in the joint and the presence of infectious complications. In this case, there are indications for surgical treatment of intraarticular fractures of TPF.

AIM: to evaluate long-term results and factors leading to knee arthroplasty after reconstructive surgery for post-traumatic deformities of the proximal tibial epimetaphysis.

MATERIALS AND METHODS: The long-term (in terms of 5 to 10 years) treatment results were assessed in 46 patients with malunion of intra-articular fractures of the tibial plateau, operated in the period from 2010 to 2015.The average age of patients was 47.6±11 years. We considered both cases of neglected conservative treatment (87%) and cases with unsuccessful surgical fixation (13%).

RESULTS: The KOOS pain score was 75.0 [66.6; 94.0] points, which corresponds to a good result. Satisfactory results were observed during the examination on the basis of “daily physical activity” (66.1 [51.5; 85.3] points) and on the basis of “symptoms and stiffness” (65.4 [53.6; 86.0] points). Average scores for the attribute “physical activity while playing sports, games and entertainment” and for the attribute “quality of life” — 53.75 [25.0; 81.0] and 53.8 [25.0; 81.0] points, respectively, were assessed as unsatisfactory. In terms of up to 10 years, 5 out of 46 patients (10.9%) underwent knee arthroplasty. A statistically significant relationship was determined between the varus deformity more than 3° persisting after reconstructive surgery (r=0.664, p <0.0001), the time period between injury and reconstructive surgery (r=0.262, p=0.007) and the appearance of indications for TKA.

CONCLUSION: The study revealed a statistically significant direct correlation relationships between persisting varus deformity more than 3°, as well as a long time interval between injury and the performed reconstructive surgery with the emergence of indications for arthroplasty.

N.N. Priorov Journal of Traumatology and Orthopedics. 2021;28(4):5-12
pages 5-12 views

The significance of clinical and instrumental methods for the diagnosis of multiple injuries in road accidents at an early hospital stage

Yarygin N.V., Parshikov M.V., Govorova N.V., Perekhodov S.N., Govorov M.V., Chemyanov I.G., Prosvirin A.A.

Abstract

BACKGROUND: By reason of the high urbanization of the population the mortality rate in combined injury cases remains stably high, despite the CT-scans have appeared in the arsenal of many hospitals. There are a lot of questions: how to reduce the time of diagnosis in favor of therapeutic measures, determine the sequence of actions in different situations?

AIM: To determine the degree of informativeness of clinical and instrumental methods for diagnosing combined injuries in an accident.

MATERIALS AND METHODS: Were done a retrospective analysis of the results of treatment of 517 patients with combined trauma delivered to the emergency department of the Omsk City Clinical Hospital and the V.P. Demikhovs City Clinical Hospital of the Moscow for 2017–2019. All patients were examined by a multidisciplinary team using modern diagnostic methods including laparoscopic examination, CT according to the whole body program.

RESULTS: The results of the data analysis showed that clinical examination, radiography and ultrasound do not allow the diagnosis to be carried out in full, revealing up to 80% of all injuries.

CONCLUSION: FAST protocol has a high degree of informativeness at the early hospital stage (efficiency 83%, reliability 81%). When using modern computed tomographs with subsequent digital analysis of reconstructions, the value of performing radiographs in an urgent situation decreases. MSCT is the “gold standard” in the diagnosis of combined trauma, has a high diagnostic efficiency compared to other methods of radiation diagnostics.

N.N. Priorov Journal of Traumatology and Orthopedics. 2021;28(4):13-20
pages 13-20 views

Reviews

Mooring traumatism

Shapovalov K.A., Shapovalova P.K.

Abstract

BACKGROUND: Mooring operations are a “hotbed” of specific injuries on all floating craft without exception.

AIM: Analysis of mooring injuries of the members of vessel's crew of water transport.

MATERIAL AND METHODS: The analysis of the treatment of 224 patients from the number of the sailing crew, who received industrial injuries with the loss of ability to work when mooring ships while performing voyage tasks in the Northern water basin. Analytical and statistical methods were used.

RESULTS: In the Northern region, mooring injuries most often occur on river transport (46.7%) and sea (36.3%) vessels, on which transportation is intense, loading and unloading can occur at different berths within the same port, which increases the frequency of mooring operations during short transitions and, accordingly, the likelihood of mooring injuries. Outpatient treatment due to mooring injuries was received by 50.8% of the sailing crew. The second half of the mooring injuries required emergency hospitalization, long-term treatment in the surgical department and further rehabilitation at the outpatient stage.

CONCLUSION: In the general structure of industrial injuries of the floating composition of the Northern water basin, various injuries during mooring of ships account for 10.1% of cases.

Risk factors and circumstances creating threats to the health, working capacity and life of the floating personnel associated with mooring operations are: 1) fleet — river transport, sea transport; 2) profession — sailor, sailor-minder; 3) age — up to 30 years; 4) production experience — 1–12 months. The average period of disability for mooring injuries is 48.0 working days, a bed-day for hospitalization in the surgical department — 20.6.

Returned to professional work after rehabilitation due to mooring injuries 94.0% of the injured from the amphibious crew. The primary exit of the victims to the II disability group was 1.3%; group III — 2.2%; 2.5% of mooring injuries were fatal.

N.N. Priorov Journal of Traumatology and Orthopedics. 2021;28(4):21-30
pages 21-30 views

Surgery of unstable pelvic ring injuries. Trends, issues and perspectives

Zakirov R.I., Ahtyamov I.F.

Abstract

Unstable pelvic ring injures can lead to unsatisfactory long-term results of up to 60% on average. Incorrect interpretation of radiological results, underestimation of the severity of pelvic injures during polytrauma lead to the rejection of urgent stabilization of the pelvis. Despite the presence of many effective methods of stabilization of the pelvic ring injures, a rather large percentage of reoperations remains both as a result of relapse displacement an as a result of nonunion of fracture and loss of fixation. The review is devoted to the analysis of the problem of diagnosis, treatment and the result of applying various methods of stabilization of the pelvic ring.

N.N. Priorov Journal of Traumatology and Orthopedics. 2021;28(4):31-38
pages 31-38 views

Traditional and modern approaches to the choice of implants in the treatment of fresh acetabulum fractures (literature review)

Kolesnik A.I., Donchenko S.V., Solodilov I.M., Ivanov D.A., Surikov V.V., Yarmamedov D.M.

Abstract

One of the modern approaches aimed at improving the results of treatment of acetabulum fractures (AF) is the development of new fixators for columns and fragments of explosives. The frequency of AF fractures is from 2 to 22% of all pelvic injuries. The main cause of this injury is road accidents. In the treatment of AF fractures, open reposition and internal fixation with the use of various types of fixators, including plates made using additive technologies, are widely used. A fairly wide range of used and developed retainer designs is noted, from standard pelvic reconstructive plates, cables, wires, to modern plate designs. There is a clear trend of specialists in the widespread use of additive technologies that provide the manufacture of individual implants for the treatment of complex fractures of the AF. Analysis of the sources used has shown that reconstructive pelvic plates and cannulated screws are currently the unsurpassed leader in fixing columns and fragments of AF. More and more additive technologies are being introduced into the development and manufacture of individual plates and other fixing structures.

N.N. Priorov Journal of Traumatology and Orthopedics. 2021;28(4):39-47
pages 39-47 views

Clinical guidelines

Fractures of the proximal femur. Clinical features, diagnosis and treatment (Clinical guidelines, abridged version)

Dubrov V.E., Shelupaev A.A., Arutyunov G.P., Belov M.V., Bogopolskaya A.S., Bozhkova S.A., Boyarkov A.V., Vorontsova T.N., Gilfanov S.I., Gubin A.V., Zagorodni N.V., Zlobina Y.S., Koryachkin V.A., Kostyuk G.P., Litvina E.A., Protsenko D.N., Runikhina N.K., Solomyannik I.A., Stafeev D.V., Tikhilov R.M., Tkacheva O.N., Tsykunov M.B., Shubnyakov I.I.

Abstract

Proximal femoral fractures (PFF) are one of the most common reasons for admission of patients to a traumatological and orthopedic hospital. For the vast majority of patients with PFF, such injury means a loss of the previous degree of mobility.

Clinical guidelines are the main working tool of a practicing physician, both a specialist and a narrow practice doctor. Conciseness, structuredness of information about a particular nosology, methods of its diagnosis and treatment, based on the principles of evidence-based medicine, allow to give in a short time one or another answer to a question of interest to a specialist, to achieve maximum efficiency and personalization of treatment. These clinical guidelines include data on the classification, clinical presentation, diagnosis, and treatment of proximal femoral fractures. In addition, they provide methods for the rehabilitation of patients with this pathology.

N.N. Priorov Journal of Traumatology and Orthopedics. 2021;28(4):49-89
pages 49-89 views

Anniversary

Congratulations to Professor Nikolay V. Zagorodniy on his 70th birthday!

Abstract

Brief biographical information and scientific achievements of Nikolay V. Zagorodniy, congratulations on the 70th anniversary.

N.N. Priorov Journal of Traumatology and Orthopedics. 2021;28(4):91-93
pages 91-93 views


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