Vol 9, No 1 (2002)

Articles

Orthopedic morbidity and organization of specialized care for children in Saint Petersburg

Pozdnykin Y.I., Solovyov K.S., Davydov T.A.

Abstract

Demographic indices, structure and dynamics of orthopaedic morbidity in children and adolescents of St. Petersburg are presented. During 10 years (from 1991) total number and the number of primary visits in connection with osseous-muscular diseases increased 2,5-3 times. In children the rate of orthopaedic pathology among total morbidity increased from 0.7 to 2.1% and in adolescents — from 8,2 to 16%o. The problems of organization of specilaized outpatient care as well as hospital and rehabilitation care for the children with loco-motor system pathology were considered.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(1):3-6
pages 3-6 views

Injuries of the thoracic and lumbar spine due to juvenile osteoporosis

Merkulov V.N., Rodionova S.S., Ilyin V.K., Zhigacheva A.V., Lapkin S.V.

Abstract

Complex examination of 123 children with back pain and wedge-shaped vertebra body deformity (according to X-ray data) showed that those changes were the manifestation of juvenile osteoporosis in 10,5%) of cases. Diagnosis of juvenile osteoporosis was confirmed by the decrease of bone mass by 10%) and over versus the norm. It was detected using DEXA. Conformity of that bone loss to osteoporosis was proved by comparative histomorphometry of bioptate from the upper flaring portion of the ileum in patients with BMD loss. Comparison of histomorphometry data and activity of the bone marrow stromal cell clonning showed that BMD loss was connected with the decrease of bone formation; the later was stipulated by genetic defect of osteoblasts cellprecursors. Those changes preceded to bone mass loss that could be detected by invasive or noninvasive methods. The possibility of pharmacological correction of bone mass deficit in children was shown.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(1):7-11
pages 7-11 views

Conservative treatment of congenital clubfoot in children

Malakhov O.A., Vilensky V.Y., Shtulman D.A.

Abstract

In outpatient department of CITO 207 children with clubfoot were treated by Vilenskiy's functional technique. After application of plaster bandage from the middle third of the femur to the toes the influence was directed on the certain muscle groups. Then step-by-step application of fixative tutors from polymeric materials (polivik) was used. There were 3 groups of patients: 1st group — 126 patients were treated starting from the first month of life; I Ind group — 57 patients, aged 2—5 years,, after failed treatment at other hospitals; Illrd group — 24 patients with recurrence of the deformity after conservative treatment. Follow up ranged from 1 to 25 years. Good results were achieved in 94 cases (74.6%>) (I group), 31 (54.4%) (II group) and in 9 patients (37.5%)) (IIIgroup). Satisfactory results were noted in 15 (11.9%)), 8 (14%)), 5 (20.8%)) patients, respectively, and unsatisfactory results in 17 (13.4%)), 18 (31.6%)) and 10 (41.6%>), respectively.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(1):12-16
pages 12-16 views

Mistakes in the treatment of congenital radial clubhand in children

Prokopovich V.S.

Abstract

There were 194 patients, aged 8 months-16 years, with congenital talipomanus radioflexa who had 254 deformity of upper extremity. Operative treatment was performed on 232 exptremities. Good results were achieved in 69%), satisfactory — in 22%o of cases. In 9%o of patients (21 upper extremities) partial or complete relapses of deformity requiring repeated surgical correction were detected. Failed outcomes were due to inadequate preoperative planning, technical and methodic mistakes. Analysis showed if those errors were avoided, the significant decrease of deformity relapses rate could be achieved.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(1):17-21
pages 17-21 views

Clinical and radiological parallels in congenital gigantism of the hand in children

Shvedovchenko I.V., Bergaliev A.N., Sosnenko O.N.

Abstract

Analysis of clinical manifestations of congenital wrist gygantism was performed in 67 children. Working classification of that pathology that facilitated the choice of surgical tactics was suggested. The following examination methods were used: roentgenologic (39 patients), rheovasographic (33) and radionuclide (12). Scintigraphic data of blood circulation and osteogenisis was detected to conform the clinical forms of the disease. Neither roentgenography nor rheovasography showed that correlation. The advantages of radionuclide method are its relative simplicity, sufficient informativeness and trustworthiness, low radiation load as well as possibility to obtain the data concerning bone tissue, growth zones and blood circulation of damaged segment.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(1):21-25
pages 21-25 views

Residual stability of the craniovertebral segment in its various injuries

Vetrila S.T., Kolesov S.V., Gavryushenko N.S.

Abstract

Residual stability of craniovertebral segment in the most common injuries (odontoid process fractures, ring fractures of C2, Atlas fractures, etc.) was sudied in experiment. The study was performed in 7 cadaveral craniovertebral blocks. The range of movement before and after injuires modelling, the estimation of force that caused the vertebrae displacement using special loading test device were detected. It was shown that in any injury without vertebrae dislocation craniovertebral segment possessed the residual stability. The minor stability was noted in odontoid prosess fractures of II and III types and «butcher’s»fractures, the major stability was in the intervertebral disc injuries of C2-C3 and occipital condyle fractures. On the base of experimental and clinical data the conclusion was done that fixation of cervical spine using head support with frontal fixative or halo apparatus were indicated for cranivertebral segement injuries without vertebrae dislocation. In dislocation of vertebrae it was necessary to reduce the dislocation and open surgical intervention for stabilization.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(1):25-29
pages 25-29 views

Comparative analysis of the results of treatment of patients with extensive defects of the tibia using various technologies for fragment lengthening

Borzunov D.Y., Kuftyrev L.M.

Abstract

The comparative analysis of the efficacy of surgical and rehabilitation management for the substitution of vast tibia defects using various methods for fragment lenthening was performed. The tibia defect was over 7 cm. Technique of multilevel fragment lenthening gave the better restoration of bone defect with simultaneous decrease of rehabilitation terms and stages, in comparison with onelevel fragment lengthening.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(1):29-34
pages 29-34 views

Treatment of comminuted diaphyseal fractures of the femur using closed blocking intramedullary osteosynthesis

Suvalyan M.A.

Abstract

During 1996-2000 at the Department of Urgent Traumatology of Loco-Motor System (Scientific Research Institute of Emergency Care named after N.V. Sklifosovskiy) intramedullar osteosynthesis using AO/ASIF blocked pin was performed in 20 patients with comminuted femur fractures (21 fractures). This method gives stabile fixation of fragments that allows to stand up and walk using crutches on 5-10 days after operation. Mean term of load bearing restoration and moving extremity function was 4.5 months. One patient had delayed fragments consolidation. No complications such as suppuration, extremity shortening, angle and rotation deformity were observed.

 

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(1):40-44
pages 40-44 views

Influence of fetal bone tissue on reparative bone regeneration (experimental study)

Omelyanenko N.P., Malakhov O.A., Karpov I.N., Sukhikh G.T., Kozhevnikov O.V.

Abstract

The study was performed in 48 rabbits. After 1 cm resection of central part of radius diaphysis the defect was substituted with fragments of fetal tissue. Sixteen rabbits made up a control group. It was shown that fetal bone tissue stimulated reparative bone regeneration. Its fragments were not the centers of osteogenesis but bone development started within preserved periosteum and endosteum, i.e. in the location of cambial cells of osteodifferone. There were several stages of damaged bone full value structure restoration: 1) filling of the defect with fibrillar connective tissue surrounding the fragments of fetal bone tissue; 2) development of reticulo-fibrotic bone regenerate with fragments of fetal bone tissue; 3) remodeling and formation of laminar bone regenerate; 4) restoration of medullar canal with bone marrow. Restoration of damaged radius structure was accompanied by periosteal reaction and focal resorption of undamaged ulnar both at the defect level and outside the defect. In control group full value restoration of damaged bone was observed in no case

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(1):35-40
pages 35-40 views

Biomechanical substantiation of compression osteosynthesis in near- and intra-articular fractures

Kallaev T.N., Kallaev N.O.

Abstract

Dynamic compressive osteosynthesis using elaborated special device was performed in 182 patients with peri- and intraarticular fractures of various localisation. The biomechanical background of that osteosynthesis was presented on the models of intraarticular fractures. Dosed compression osteosynthesis provides gentle compression on the fragmets taking into account biological resorption in the site of fragments contact till the time of fracture healing. Fixation stability allows to combine the immobilization and rehabilitation periods that decreases the terms of motion restoration in joint, the risk of contracture formation and development of deforming arthrosis. Good and satisfactory anatomical and functional results were achieved in 96.2% of patients

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(1):44-48
pages 44-48 views

The use of new generation non-steroidal anti-inflammatory drugs in traumatology and orthopedics

Musalatov K.A., Silin L.L., Brovkin S.V.

Abstract

Efficacy of nonsteroidal anti-inflammatory drug of new generation - nimesil was studied in complex treatment of degenerative joint diseases (on coxarthrosis model), acute traumatic injuries (on knee hemarthorosis model) and after minor invasive operations (arthoroscopy). One hundred thirty three patients were studied. Seventy four patients were on nimesil therapy, 59 patients were in control group (treatment without nonsteroidal anti-inflammatory drugs or diclofenac intake). It was detected that nimesil possesses anti-inflammatory, analgetic and antipyretic effect. Besides, better comfortness of treatment, acceleration of pathlogic symptoms regression and faster functional restoration were noted. Assessment of nimesil versus diclofenac in comparable patient groups was shown its higher efficacy and better tolerance.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(1):49-53
pages 49-53 views

Cytoprotective preparations for the correction of the toxic effect of acrylic bone cement (experimental study)

Mamaeva E.G., Anisimova L.O., Netylko G.I., Mashkov V.M., Eropkina E.M., Churilova I.V.

Abstract

Toxic effect of the methylmetacrylate monomer bone cement was studied in vivo at the experimental model. Marked changes of metabolism and inner organs structure of rabbits was detected. Efficacy of antioxidant and antihypoxant therapy for the decrease of unfourable side action of methylmetacrylate was shown.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(1):58-62
pages 58-62 views

Alkaptonuria and ochronotic arthropathy

Trotsenko V.V., Nuzhdin V.I., Popova T.P., Kagramanov S.V., Kudinov O.A., Bavashev A.S.

Abstract

Four cases of operative treatment for ochronosis arthropathy in patients with alcaptonuria are presented. In 3 patients hip joint and in 1 patient knee joint were affected. Prior to surgery all patients were treated conservatively. Two patients successfully underwent total hip replacement. Intertrochanteric femur osteotomy was performed in 1 case. In the fourth patient arthroplasty of knee joint with allograft from rib cartilage failed due to suppurative arthritis resulted in joint resection and arthrodesis.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(1):63-66
pages 63-66 views

Purulent-inflammatory processes in the area of the hip joint in traumatological and orthopedic patients: microbiological aspects

Pkhakadze T.Y., Urazgildeev Z.I., Malovichko V.V., Okropiridze G.G., Savostyanova O.V.

Abstract

Microbiological studies of operative materials (tissues and pyogenic masses) from 139 patients (88 patients with suppurative in the surrounding tissues of hip implants and 51 patients with chronic osteomyelitis of proximal femur) were performed. Two hundred sixteen strains of microorganisms were detected. In both groups of patients Gram-positive aerobic bacteria prevailed — 58,35 and 57%), respectively. Detection rate of Gram-negative aerobic microflora (14.75 and 15.2%o) and anaerobic bacteria (26.9 and 27.8%) was practically equal. The results of the study of antibiotics resistance enabled to determine the antibacterial drugs of choice for the treatment of pyo-inflammatory process.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(1):66-69
pages 66-69 views

A decade of experience in hip arthroplasty in dysplastic coxarthrosis

Abeltsev V.P.

Abstract

One hundred ninety two patients, aged 25—78, with dysplastic coxarthrosis underwent total hip replacement (46 out of them bilateral). Technical peculiarities of operations were given. Depending on the character and severity of hip damages the implants of various design were used, if necessary the plasty of spongy bone autografts was performed. At follow up under 10 years in 96% of patients the significant improvement of state was noted. In 3 cases revision total hip replacement was performed, i.e. in 2 cases due to acetabular component loosening and in 1 case due to implant loosening

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(1):54-57
pages 54-57 views

Treatment of stale fractures of the neck of the metacarpal bones with an external fixation rod

Goloborodko S.A.

Abstract

In 32 patients with closed old metacarpal bone neck fractures the treatment by ligamentotaxis type was performed using external rod fixation device. Fracture consolidation was achieved in all cases. Preoperatively the displacement angle ranged from 50 to 20° (mean 35°), prior to the device disassembling the displacement angle varied from 25 to 5° (mean 5°). During fixation the displacement increased in one patient only.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(1):70-72
pages 70-72 views

Measuring device for diagnosing ankle injuries

Brusenskaya E.I.

Abstract

The measuring device for diagnosis of ankle injuries is presented. Using that device it was possible to determine and compare the polar coordinates of certain points in healthy and injured joints on direct and lateral radiograms. The device enabled to increase the accuracy of diagnosis, allow to quantitatively assess the degree of bone fragment displacement and trauma severity.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(1):72-75
pages 72-75 views

Radiation sterilization of demineralized bone grafts in the light of hepatitis B and C infection prevention

Lekishvili M.V., Isaev E.I., Ponomarev V.I., Vasiliev M.G.

Abstract

Donor compact bone specimens infected by В, C hepatitis were exposed to the influence of fast electron flow in increasing doses (from 15 to 50 kGy) for the detection of minimum dose of radiation sterilization. The study of specimens on HBV and HCV markers showed that 50 and 36 kGy were close to minimum doses required for the inactivation of antigen structures of В, C hepatitis, respectively. The danger of virus hepatitis transmission by demineralized bone grafts is present if conventional normative doses of radiation sterilization (up to 35 kGy) are applied. Taking into account the side effect of radiation sterilization on the microstructure of bone grafts it is necessary to continue the search of methods for the preservation of plastic (conductive and inductive) bone properties during sterilization by fast electron flow in 50 kGy dose.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(1):75-77
pages 75-77 views

Lectures

Prevention and treatment of complications of polytrauma in the postresuscitation period

Sokolov V.A.

Abstract

Almost all patients with polytraumas transferred from the intensive care unit to specialized hospitals have general or local complications that determine the tactics and methods of treatment of injuries, and with insufficient diagnosis and prevention, lead to an aggravation of the severity of the condition of the victims, up to the need to return them to the intensive care unit. Among the patients who "survive" before being transferred from the intensive care unit, 80% are patients with injuries of the musculoskeletal system, and they are sent to the trauma department. Thus, the prevention and treatment of post-resuscitation complications in the vast majority of cases is the prerogative of traumatologists. Practice shows that traumatologists are not sufficiently prepared for this, as a result of which they make diagnostic and therapeutic-tactical errors.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(1):78-84
pages 78-84 views

SCIENTIFIC REVIEWS

Venous thromboembolic complications in lower limb injuries and hip and knee arthroplasty

Matveeva N.Y., Eskin N.A., Natsvlishvili Z.G., Mikhailova L.K.

Abstract

Pulmonary embolism (PE) is one of the most important problems of modern medicine: in developed countries, about 500 thousand patients die from it every year [3, 7]. According to a number of studies [8, 18, 62], based on the results of autopsies performed in surgical hospitals, at least 20% of deaths are associated with pulmonary embolism, while about half of the patients could be saved with timely diagnosis of venous thrombosis and adequate therapeutic and preventive measures [3, 7, 19, 70]. It seems to us relevant to discuss the problem of venous thromboembolic complications (VTEC) in traumatology and orthopedics, especially since traumatic injuries of the extremities and surgical interventions on them are high-risk situations for the development of venous thrombosis and pulmonary embolism [2].

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(1):85-88
pages 85-88 views

Clinical guidelines - a tool for quality assurance of care for patients with low back pain

Nazarenko G.I., Polubentseva E.I., Cherkashov A.M.

Abstract

A serious problem in clinical medicine today is the impossibility of applying all available knowledge to a particular patient in the conditions of a continuously growing flow of information. Hence, a qualitative transition from the banal accumulation of information to the search for specific tools that make it possible to single out only constructive solutions is natural. On the one hand, many often fundamentally new methods of diagnosing and treating various diseases are constantly appearing. On the other hand, their usefulness in correct scientific analysis is not always obvious. In this regard, it is sometimes difficult for a doctor to form a single diagnostic and therapeutic concept. The basis for resolving these contradictions is the so-called evidence-based medicine, which takes into account and promotes the dissemination of only those treatment methods whose effectiveness has been proven by strictly scientific, standardized and unified statistical methods. A tool that helps the practitioner in making a clinical decision and the relevant principles of evidence-based medicine are the "Clinical guidelines" (in the English literature "Clinical guidelines"). This is a document that is compiled by a team of authors, which, as a rule, includes several dozen leading specialists in a particular field of medicine from different countries.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(1):89-91
pages 89-91 views

Reviews, literature review

A.H. Mahson, H.E. Makhson. Adequate surgery for tumors of the extremities. Realnoe Vremya Publishing House, Moscow, 2001

Demichev N.P., Tarasov A.N.

Abstract

Among the numerous recent journal, monographic and dissertation works devoted to the treatment of bone tumors, the book “Adequate surgery of limb tumors” by A.N. Makhson and N.E. Makhson - authoritative specialists who have made a significant contribution to the development of bone oncology. It is a logical continuation of the monograph “Adequate Surgery for Tumors of the Shoulder and Pelvic Girdle” published in 1998 by the same authors. Both books are based on the concept of an adequate operation developed by the authors, which provides for a combination of oncological principles of radical and ablastic surgery with the maximum possible preservation of limb function and the patient's quality of life. In recent years, the term "adequate surgery" has become familiar and understandable to specialists, it is becoming more and more common and invariably associated with specific names. The reviewed monograph summarizes many years of experience of brilliant clinical surgeons, presents the results of the creative development and practical use of methods for adequate treatment of patients with limb tumors in a specialized onco-orthopedic department of a multidisciplinary oncology hospital. The book is beautifully illustrated (77 drawings), which greatly facilitates reading. The material is presented in an accessible way. The monograph consists of an introduction, 7 chapters and a conclusion. The list of references includes 36 domestic and 12 foreign sources.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(1):91-92
pages 91-92 views

Obituary

Mstislav Vasilievich Volkov

Abstract

Domestic traumatology and orthopedics, the Russian Academy of Medical Sciences suffered a heavy loss: on December 11, 2001, an outstanding orthopedic traumatologist, Academician of the Russian Academy of Medical Sciences, laureate of the State Prizes of the USSR and the Government of the Russian Federation, Honored Scientist, Professor Mstislav Vasilievich Volkov, died on December 11, 2001 at the age of 79 .

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(1):95-95
pages 95-95 views


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