Vol 9, No 2 (2002)


Surgical treatment of ruptures of the pubic symphysis and sacroiliac joint in multiple and concomitant trauma

Sokolov V.A., Shchetkin V.A.


Experience in operative treatment of severe unstable fracture of pelvic ring is presented. There were 91 patients with polytrauma. Biomechanical characteristics of pelvic bones and joints of different injury severity was given. Priorities of main diagnostic and curative management were defined in patients with concomitant pelvic injury. Efficacy of AO type external fixation device for the pelvic fracture stabilization in acute period was shown. In pubic symphisis rupture with diastasis over 3 sm. the method of internal fixation by modified plate was used. In old fractures osteosynthesis with alloplasty was carried out. In 79 patients follow up ranged from 1 to 10 years. Good results were achieved in 62 patients (78.5%), satisfactory results in 11 patients (13.9%)).

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(2):3-8
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The use of anti-shock suit "chestnut" in the treatment of severe concomitant trauma

Kolesnikov V.V., Onishchenko N.S., Dushkin O.F.


Antishock «Kashtan» costume was used in complex treatment of 31 injureds with severe comcomitant trauma (in 13 patients — at prehospital stage, in 18 — at hospital stage). Application of «Kashtan» gave the possibility to decrease the lethality up to 25.8%. Timely use of antishock costume was shown to provide the stabilization of hemodynamics, prolong the «golden hour» (the period of relative compensation), prevent the torpid shock development, perform required surgical intervention and to improve the outcomes. Indications and contrindications to «Kashtan» use are given.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(2):9-13
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The reaction of the body during the implementation of the spokes of transosseous fixation devices in biologically active zones

Mironov S.P., Oganesyan O.V., Zilov V.G., Novikov E.B., Ivannikov S.V.


Connection between complications (local and general) and lesions as well as prolonged irritation of biologically active zones by pins during external intraosseous osteosynthesis was detected and proved. Preventive measures of those complications were elaborated. Those preventive measures included insertion of pins beyond active zones after preliminary marking of active points (or canal). Observance of those rules provided decrease of the complication rate by 1.6 times when hinge-distraction devices were used and decrease by 1.8 times in application of reposition- fixation devices. When complications occurred the most radical treatment was either removal of pin that injured the biologically active point or reinsertion of that pin beyond the zone. Analysis of 770 cases (320 patients with hinge-distraction devices and 450 patients with reposition- fixation devices) was taken as a principle of that work.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(2):14-18
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Biologically and mechanically compatible titanium nickelide implants in the treatment of injuries of the thoracic and lumbar spine

Ilyin A.A., Kollerov M.Y., Sergeev S.V., Country N.V., Radnaev E.B., Nevzorov A.M., Jojua A.V.


Based on the concept of «biomechanic and biochemic» compatibility of nikelide Ti implants with body tissues the application of devices with form memory effect as well as superelasticity for the treatment of uncomplicated compressive fractures of thoracic and lumbar spine was substantiated. Fixators played the role of so called «endoprostheses» for the injured posterior ligamentous apparatus resulted from superelasticity. In cases without severe disorders of spine mobility in postoperative period those fixators allowed early activization and rehabilitation of patients. On the basis of clinical outcomes of 32 patients with vertebral body fractures efficacy of posterior fixation by nikelide Ti brackets has been proven.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(2):19-26
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Arthroscopic diagnosis and treatment of intra-articular injuries of the elbow joint in children

Ilyin A.S., Merkulov V.N., Morozov A.K., Eskin N.A.


Experience in elbow arthroscopy in children (36 patients, 5-16 years) was presented in native literature for the first time. Diagnostic arthroscopy was performed in 4 cases, diagnostic arthroscopy + miniarthrotomy — in 3 cases, diagnostic and operative arthroscopy — in 29 cases. Comparative assessment of radiologic, ultrasound, CT and arthroscopic data showed evident preference of arthroscopy for the diagnosis of intra-articular elbow injuries in children. Main and additional portals decreasing the probability of neurovascular structure injury were suggested. The technique of diagnostic and operative arthroscopy was determined. The indications for the elbow arthroscopy in children were defined. In 91.7% of patients the positive outcomes with complete or almost complete restoration of elbow function were achieved.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(2):26-29
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The first experience in the treatment of closed fractures of the metacarpal bones with the use of a short plaster cast

Migulev I.Y., Semiletov G.A., Mirzoyan A.S.


Method of conservative treatment of closed II-V metacarpal bone fractures was suggested. It included closed reposition of bone fragments and fixation by short plaster dressing. That dressing was a sugar-tongs plaster splint spreading from the palm to the back of the wrist via ulnar (radius) margin of hand. Careful modeling of plaster dressing with fulcrums on the palm and the back of the wrist provided stable fixation of bone fragments. That method of treatment was applied in 129 patients with closed fractures of II— V metacarpal bones. Complete bone fragments reduction was obtained in 81 patients (62.8%)), significant improvement — in 39 patients (30.2%). Secondary displacement of bone fragments in plaster dressing was noted in 8 cases (6.2%)). At 1.5—2 months follow up the results were excellent in 65% of patients, good results were achieved in 16.5%o of cases and satisfactory results in 18.5%). Unsatisfactory results were not observed.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(2):30-33
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Stabilometry as a method for assessing proprioception in injuries of the capsular-ligamentous apparatus of the knee joint

Vetrila V.S., Kosov I.S., Orletsky A.K.


Method of stabilometric examination is suggested to evaluate the rate of proprioceptive control loss for body balance in patients with knee injury. For the improvement of stabilometric information additional functional tests were elaborated. The example of their application is given.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(2):34-37
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Pain monitoring to determine the optimal timing of activation of patients after reconstructive surgery for transverse flatfoot

Kuzmin V.I.


In 30 patients with flat foot and hallux valgus reconstructive operations by CITO and Shev- ron’s techniques were performed on both feet. Pain monitoring using «Card of pain audit» was carried out at rest and under load. In 15 patients feet loading was started on the 6 postoperative day and in other 15 patients — on the 4 day. Pain audit showed that the optimum time for the patient activization was the 4th postoperative day with use of special postoperative shoes and without plaster dressing and additional support. Use of computer system «Balance test» was shown to be a perspective for the objective evaluation of postoperative weight-bearing ability, efficacy of patient activization as well as for the acceleration of patient adaptation to postoperative loads.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(2):38-42
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Long-term results of rehabilitation of patients after surgical treatment of intra-articular fractures of the knee joint (preliminary report)

Akhtyamov I.F., Krivoshapko G.M., Krivoshapko S.V.


Retrospective analysis of long-term results of surgical treatment for intra-articular knee fractures was presented. There were 52 patients who were treated at Inter-regional Traumatologic Department of Elabuga CRH from 1996 to 2000. The age of patients ranged from 15 to 89 years. Overwhelming majority of patients (73,1%)) was able to work, i.e. from 18 to 60 years. In 18 patients long-term results of rehabilitation were good, in 32 the results were satisfactory and in 2 cases — unsatisfactory. In 53,8% of patients the limb function was restored completely. Due to marked posttraumatic knee contractures 2 patients were declared invalid of group III. The authors attributed it to the underestimation of the rehabilitation importance and the absence of complex approach to the treatment of that group of patients.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(2):42-46
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Transposition of the fibula on the supplying vascular pedicle for plasty of defects in the distal femur

Davis A.E., Golubev V.G.


After preliminary experimental study the bone plasty with vascularised fibular graft was performed to 9 patients with distal femur defects from 1 to 18 cm. Taking into account the advantages and shortcoming of the procedure several variants for transposition of vascularised fibular grafts were elaborated. They included gradual lengthening of vascular pedicle, use of doubled fibular graft to increase the mechanical strength. In all patients the restoration of weight-bearing ability of the limb was achieved by 1 year after surgery.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(2):46-49
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Reconstruction of the distal humerus in non-united and improperly fused intra-articular fractures using periosteal-cortical autografts on a vascular pedicle

Milanov N.O., Zelyanin A.S., Simakov V.I.


Method of reconstruction of distal humerus in ununited and incorrectly consolidated intraarticular fractures was presented. There were 4 patients. To achieve successful reposition of fragments and the restoration of congruence of the articular surfaces, reduction of replaced fragments with correction osteotomy (1 patients) was required. Vascularized periosteal-cortical radius autograft rotated on a vascular pedicle was used as a source of osteogenesis. Radiologic signs of consolidation were noted by 8—10 weeks. Function of the reconstructed joint meets the requirements of the professional and everyday needs of patient.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(2):49-53
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Thrombosis of deep veins of the lower extremities in patients undergoing hip arthroplasty

Matveeva N.Y., Eskin N.A., Natsvlishvili Z.G.


Ultrasound scan was used to examine 73 patients after total hip replacement. In 39 patients contrast phlebography (distal ascending or retrograde iliocavagraphy) was also performed. Deep vein thrombosis was detected in 14 (19,2%)) patients including proximal (10 patients) and distal (4 patients) thrombosis. Comparison of two methods showed no significant difference in sensitivity and specificity when detecting the proximal deep vein thrombosis. In diagnosis of distal deep vein thrombosis ultrasound scan gave 75%o of sensitivity and 100%o of specificity in comparison to phlebography.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(2):54-57
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Tactics of surgical treatment of congenital pathology of the hand in children

Alpatov V.N.


Results of surgical treatment for congenital hand pathology in children were presented. There were 355 patients with the following pathology: polydactyly (136 patients; syndactyly (125 patients); amniotic disease (26 patients); clinidactyly (25 patients); and other rear forms of congenital hand pathology (23 patients). Five hundred ninety two operations were performed. In symmetric thumb doubling Bilaut-Cloquet operation performed in 2—3 years old children was shown to be effective. In asymmetric thumb doubling it was necessary to remove the additional thumb and simultaneously to correct the axis of the main thumb. That operation should be performed in children of 1—2 years old. Separation of fingers using triangular flaps and combined skin plasty was carried out in children of 5-6 years of age. In children under 5-6 years the separation of fingers should be performed when finger axis has been deformed during the growth. Indication to axis correction was its deformity by 15—20°. Excision of circular amniotic strangulation should be performed using one step advancement of triangular flaps. In severe hand malformations which required multistep surgical interventions the treatment should be started as early as possible.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(2):58-62
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Polyostotic form of metaphyseal fibrous bone defect in children

Snetkov A.I., Berchenko G.N., Morozov A.K., Batrakov S.Y., Pavlov R.N.


Fourteen patients, 8—16 years, with polyossal form of metaphyseal fibrous bone defect (MFBD) were treated. The most rear variant of polyossal form of MFBD, i.e. Jaffe-Campanacci syndrome, was described for the first time in native literature. Two variants of pathologic focus localization, i.e. subperiosteal and intracortical, were detected by radiologic examination. Histologic pictures of mono- and polyossal forms of MFBD were identical. However, in Jaffe- Campanacci syndrome marked polymorphism of one-nucleiform cellular elements was observed. Differentiation-diagnostic signs of polyossal form of MFBD were defined. In most cases the conservative treatment was used, 3 patients were treated surgically.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(2):63-68
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Evaluation of psycho-vegetative disorders in cervical pain syndromes during treatment using manual therapy

Galliamova A.F., Mashkin M.V., Novikov Y.O.


Psychovegetal disturbances resulted in the aggravation of blood supply of highest vegetal centers due to involvement of pathologic process in a. vertebralis and its sympathic plexus significantly affected the manifestation of cervical pain syndromes. Complex examination of 124 patients with cervical pain syndrome was performed to study the influence of manual therapy. Clinical, neuro- orthopaedic, radiologic, miotonometric and rheographic methods were used. Manifestation and dynamics of psychovegetal disturbances were studied using pulsometry, psychologic tests and questionnaires. Manual therapy as well as correction of biomechanic disorders were detected to relieve psychovegetal changes and to be a pathogenetic curative method.


N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(2):70-73
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Neurovascular component of the dystrophic process and the development of osteonecrosis in Perthes disease

Krupatkin A.I., Malakhov O.A., Ivanov A.V.


In 60 patients with reactive synovitis and Perthes disease the thermographic evaluation of neurovascular interconnection was performed. The importance of neurodynamic tissue regulation disturbances of the hip region including microvasculature in pathogenesis of preradiologic lesions transition into the decompensation phase with osteonecrosis development was shown. It was noted that important moment in osteonecrosis development was the achievement of threshold level of neurodynamic vascular regulation disturbances with the involvement of enormous number of neurons from the adjusted segments and loosing of hamper mechanism. Prevention of volume spreading of tissue and neurodystrophic reaction at preradiologic phase is of essential significance for the prevention of process of transition into osteonecrosis phase.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(2):73-77
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Dynamics of synovitis activity after intraarticular administration of xefocam in patients with rheumatoid arthritis

Fedina T.P., Olyunin Y.A., Pushkov O.V., Apenysheva N.P., Balabanova R.M.


The aim of the study was to assess the efficacy of intra-articular injection of lornoxicam (xefocam, Nycomed) in patients with rheumatoid arthritis. Xefocam was injected into knee joints of 15 patients with rheumatoid arthritis, 8 mg once a week for the period of 3 weeks. The following parameters were assessed: pronouncement of arthralgia, joint tenderness at palpation, circumference of knee joint on the level of the upper patellar margin. Prior and post treatment ultrasonography and thermography were used. Significant clinical improvement was observed in 11 patients. In 3 cases the dynamics was less positive and in 1 patients the effect of single dose drug injection was preserved for less than one week. Arthralgia manifestation (p<0.01), joint tenderness at palpation (p<0.01) and joint circumference (p<0.05) showed reliable decrease. Ultrasonography showed reliable decrease the synovial membrane thickness. Xefocam injection could be successfully used to suppress moderate inflammatory joint changes in patients with rheumatoid arthritis when there are no strict indications to local steroid therapy.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(2):78-80
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Peculiarities of treatment of patients with gunshot fractures of the leg in Yemen

Al Junaid A.M.


Retrospective analysis of treatment of 232 wounded with gunshot crus fractures was presented. All patients were treated at Jemen Central Hospital ALTAWRA (Sana) from 1966 to 2000. Out of all patients 94%> had missile wounds and 6%) comminuted wounds. All wounded were admitted to Hospital during 24 hours after injury. Peculiarities of wound treatment were the following: injured limb after application of author's stabilizing reposition device if necessary was washed by soap-saline solution. Primary debridement was more active compared to classic one and included removal of small osseous fragments and resection of large osseous fragment ends. In 66%) of wounded no complications were observed during postoperative period and healing by first intention was noted. In 8,4%) of patients healing by granulation occurred. In 15% of cases wound suppuration was limited by soft tissues. Osteomyelitis was diagnosed in 8,6% of patients. In 2%> of cases crus gangrene followed by vascular thrombosis was developed.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(2):80-83
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Short communications

Shoulder-costal dissociation

Zolotov A.S.


The term "scapular-costal dissociation" (literally - separation) appeared relatively recently [4]. It means a traumatic rupture of the scapular-costal junction with damage to the muscles, ligaments, the collarbone or its joints, the main blood vessels and the brachial plexus. Only the skin remains intact. In this regard, the second name of this injury is “closed traumatic amputation of the scapula” [1]. This injury occurs infrequently, mainly in road traffic accidents. Many victims die at the scene. Most authors have only a few clinical observations of scapular-costal dissociation, so each case of such damage is of particular interest.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(2):83-85
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Acroosteolysis (Jackey syndrome): analysis of clinical observation

Chernov A.P., Pankratov A.S., Ogurtsov D.A.


Acroosteolysis is a rare congenital disease of the musculoskeletal system, first described by Harnasch in 1950. The disease is hereditary. Sporadic cases of the disease are sometimes observed. Men are affected 2-3 times more often than women [1].

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(2):85-86
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Metastasis of gastric cancer in the femur in a 17-year-old patient (case report)

Makhson A.N., Pavlenko T.V., Pugachev K.K.


Primary gastric cancer is an extremely rare finding in young people. This applies to both children and adolescents [7, 9] and is true even for a sample of patients up to 40 years of age. According to McGill et al. [8], gastric cancer accounts for only 0.05% of malignant tumors of the gastrointestinal tract in children and adolescents. It is generally accepted that the manifestations of stomach cancer in young people practically do not differ from those in older age groups. Usually, developing gastric carcinoma proceeds under the guise of peptic ulcer and the correct diagnosis is made only in the later stages, which determines an extremely unfavorable prognosis for this disease. Histologically, gastric cancer in such patients is most often an undifferentiated adenogenic cancer with a diffuse-infiltrative type of growth.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(2):87-88
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A case of successful treatment of a patient with severe catatrauma

Levichev E.A.


Cranioabdominal injury is characterized by a simultaneous disorder of the higher regulatory (brain) and executive (abdominal organs) systems. The condition of patients with these types of injuries is much more severe than with an isolated abdominal injury. If with a severe isolated abdominal injury, traumatic shock develops in 61% of the victims, then with a combined cranioabdominal injury - in 89%. Simultaneous damage to the organs of the abdominal cavity and the skull introduces its own characteristics into the diagnosis and treatment of both abdominal and craniocerebral trauma.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(2):88-89
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Reviews, literature review

Yu.O. Novikov Dorsalgia Publishing house "Medicine", Moscow, 2001. 160

Tsykunov M.B.


A monograph by Professor Yu.O. Novikov "Dorsalgia", dedicated to one of the urgent problems of practical healthcare - the diagnosis and treatment of back pain. The book reflects the ideas of modern researchers about this problem, highlights the issues of etiology, pathogenesis and classification, the influence of adverse factors on the course of the disease. The publication is illustrated with 68 figures and 25 tables, which greatly facilitates the perception of the material.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(2):89-90
pages 89-90 views

M.F. Egorov, A.P. Chernov, M.S. Nekrasov. Orthopedic cosmetology. Publishing Center "Fedorov", Moscow, 2000. 192

Savin A.M.


A book with such a beautiful title appeared on the reader's desk. The desire to have a beautiful body, beautiful legs is inherent in every civilized person, and the Russians are no exception here, despite the many difficult problems of their existence.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(2):90-91
pages 90-91 views


In the city of Lorenz Beler

Zolotov A.S.


I was lucky - I won a grant from the Soros Foundation for an internship in traumatology at the Austrian Hospital in Vienna. The Trauma Clinic, which consists of four 30-bed departments, is located in a huge general hospital, which can be compared to a city. On the ground floor of this "city" there are cafes, restaurants, a hairdresser, a bank, a currency exchange office, a post office, a library for employees, a library for patients, three churches (for Christians, Jews and Muslims), various shops, etc. You can live in this “city” for weeks, without going anywhere and without feeling the need for anything. I did not see only pharmacy kiosks. Probably they are not needed if the hospital has everything. Even "Canadian" crutches are given to all victims for free. And there are a lot of patients with injuries (together with outpatients) - up to 200 per day. Fresh fractures try to operate in the first hours after the injury. All operations on the bones are accompanied by control with the help of an image intensifier from Siemens. Any type of osteosynthesis tends to be performed through small incisions. External fixation devices are widely used, including Ilizarov devices. In general, to the name of our brilliant compatriot G.I. Ilizarov are treated with great respect. The clinic staff is multinational. The leader is Professor Vilmos Vechey, originally from Hungary. Before the tragic events of 1956 in Budapest, he wore a red tie and managed to be a pioneer. Then he emigrated with his parents to Austria, where he made a brilliant career. There are doctors from Iran, India, Ukraine on the staff.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(2):91-92
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Congratulations to the hero of the day!


On May 18, 2002, ANATOLY LVOVICH KRICHEVSKY, Doctor of Medical Sciences, professor, full member of the International Academy of Shape Memory Implants, President of the Association of Traumatologists and Orthopedists of Kuzbass, Deputy Director of the Kemerovo Center for Disaster Medicine, celebrated his 70th birthday. 45 years of his life were devoted to medical, pedagogical and scientific activities, which brought him wide fame not only in our country, but also abroad.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(2):13-13
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Georgy Stepanovich Yumashev


On March 21, 2002 Georgy Stepanovich Yumashev died. An outstanding orthopedic traumatologist, corresponding member of the Russian Academy of Medical Sciences, Honored Inventor of the USSR, laureate of the State Prize, one of those who stood at the origins of the development of domestic traumatology and orthopedics, has passed away.

N.N. Priorov Journal of Traumatology and Orthopedics. 2002;9(2):93-94
pages 93-94 views

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