Vol 3, No 4 (1996)

Articles

Staged Treatment of Osteochondrodysplasias in Children

Berezhniy A.L., Volkov M.V., Snetkov A.I., Kotov V.L., Mikhailova L.K., Samkov A.S., Banakov V.V., Morgun V.A., Ochkurenko A.A., Frantov R.B.

Abstract

The study has been based on the experience of treatment of 1371 patients with various forms of osteochon- drodysplasias. Progredient pattern of the majority of oste- ochondrodysplasias development required the planning of complex management from the birth up to the age of 16 years. Conservative management preceding surgical procedures included the following steps: prevention, correction of deformity, treatment of complications, medicine therapy. Surgical management was multi-staged, the number of operations was stipulated by the rate of inevitable relapses of deformities, arthrosis development. Original techniques of surgical interventions were elaborated for every form of osteochondrodysplasias, first of all epiphyseal ones.

N.N. Priorov Journal of Traumatology and Orthopedics. 1996;3(4):4-7
pages 4-7 views

Surgical Correction of Spine Deformities in Systemic Diseases

Pozdnikin Y.I.

Abstract

Since 1987 thirty two patients with neurofibromatosis Recklinhausen’s disease, 24 patients with Marfan’s syndrome, 11 patients with Ehlers-Danlos syndrome and 14 patients with rare forms of hereditary systemic diseases were operated on for kyphotic-scoliotic deformities. Treatment difficulties were stipulated by the severity deformity, local or general osteoporosis, concomitant pathology of the inner organs and another skeleton segments, as well as high rate of neurologic disorders. High level of correction and firm stability are provided by surgical treatment that includes diskectomy, corporodesis, craniotibial traction, correction and fixation by Harrington-Luque, posterior spondylodesis.

N.N. Priorov Journal of Traumatology and Orthopedics. 1996;3(4):7-11
pages 7-11 views

Therapeutic Management for Congenital Hip Joint Dislocation in Children

Filyushkin N.Y., Morgun V.A.

Abstract

The study of the treatment outcomes of 45 children (56 joints), aged 10 months - 4 years, with congenital hip joint dislocation has been performed. The follow up period was 7 years. The choice criteria for conservative or surgical treatment are analysed. Several signs detected by functional arthrography which allow to substantiate the therapeutic management are presented. Fourteen inpatients received various conservative manipulations depending on peculiarity of the pathology. The conclusion is made about the necessity of the correction of residual dysplastic hip deformities and acetabulum using extraar- ticular interventions. Surgical treatment was performed in 42 cases. Good and excellent results were obtained in 78% of cases, satisfactory results - in 22% of cases. Authors consider that in initial severe malformation of acetabulum, the presence of anatomic impediment for reduction as well as in low marginal dislocation the open reduction with detorsion-varus-forming osteotomy of the femur and simultaneous reconstruction of the supra-acetabular region by Salter is an efficient and reliable procedure.

N.N. Priorov Journal of Traumatology and Orthopedics. 1996;3(4):11-16
pages 11-16 views

Medial Elbow Instability in Athletes

Mironov S.P., Burmakova G.M.

Abstract

In Sports and Ballet Trauma Department of CITO 52 sportsmen of high qualification with medial elbow instability were treated from 1983 to 1995. Clinical signs and methods of examination are presented. The authors define three degrees of elbow instability resulted from medial collateral ligament insufficiency. This classification is taken as a principle for the choice of treatment tacktics. In 28 patients with instability of degree 1 the lateral stability of the joint was restored conservatively (remedial gymnastics to strengthen the surrounding muscles with special attention to the medial head of the triceps, electrostimulation, novocaine blockade along the ligament). Sixteen patients out of that group underwent the revision of elbow joint with chondroplasty and removal of loose bodies. Instability of degrees 2 and 3 was the indication to surgical treatment. Damaged capsular ligamentous system was sutured by dublicatums technique. In 3 patients autograft from triceps tendon was used to strengthen the medial wall of the elbow joint. Forty six patients were examined within 1-6 years after treatment; function elbow and sports activity were restored completely in all patients.

N.N. Priorov Journal of Traumatology and Orthopedics. 1996;3(4):16-23
pages 16-23 views

Total Replacement in Posttraumatic Defects

Nuzhdin V.I., Khoranov Y.G., Popova T.P., Gorokhov V.Y.

Abstract

The authors report on 40 patients with severe post- traumatic defects of bone tissue who underwent total elbow replacement using Sivash prosthesis. The prosthesis design promotes the restoration of flexion-extension in elbow joint within the limits 180-70 degrees and rotation up to 45 degrees. Good results were achieved in 31 patients. In 9 patients the implants were removed because of late suppuration and instability. In 4 patients out of 9 revision was performed and good results were achieved. The authors consider that method could be recommended for the application in traumatologic and orthopaedic clinics.

N.N. Priorov Journal of Traumatology and Orthopedics. 1996;3(4):23-26
pages 23-26 views

Principle Problems of Tactics of Surgical Treatment for the Pelvic Ring Fracture

Cherkes-Zade D.I., Lazarev A.F.

Abstract

The study is based on the analysis of 596 cases of combined pelvic injury. Their clear differetiation was performed depending on the pattern and severity of the injury and the disturbance of the functional links between the segments of the pelvic ring, predominant injury, duration of shock, volume of blood loss and other factors. The indications for surgical correction of fractures in different terms after trauma are defined. Complex of diagnostic, resuscitation,surgical and rehabilitation procedures including the wide set of low traumatic methods of surgical correction for structural disturbances of the pelvic ring is substantiated. The use of the elaborated tactics allowed to decrease the acute pelvic injury mortality up to 4,6%, permanent disablement due to acetabulum cavity fractures - three times (from 37,5% up to 12%), To avoid completely the disablement resulting from the injuries of the pelvic ring alone, to shorten the total treatment duration twice in comparison to the routine methods of treatment. In 96% of patients good and satisfactory results were achieved.

N.N. Priorov Journal of Traumatology and Orthopedics. 1996;3(4):27-33
pages 27-33 views

Basis for Improved Osteosynthesis in Supraisthmic Tibia Fractures Using Pivots with Rectangular Transverse Section

Kluchevskiy V.V., Litvinov I.I., Dzhurko A.D.

Abstract

On the base of anatomic study of 300 cross-sections from 30 tibias the author conclude that in suproisthmic tibia fractures the pivot should be inserted into the nondrilled canal of bone fragments. Besides the pivot should be located more medially than tuberosity of the tibia and along the axis of the canal in isthmic region. To prevent the pivot wedging and fragments splitting the plane of wide sides of the pivot should be combined with the plane which is parallel to the medial side of the tibia independently on the fracture level. Modified pivot is suggested. Its proximal end has an additional crook towards the narrow sides. Pivot was applied in 18 patients and excellent results by Shvarzberg system score were achieved.

N.N. Priorov Journal of Traumatology and Orthopedics. 1996;3(4):33-35
pages 33-35 views

Total Resection of Long Bone in Malignant Tumors

Makhson A.N., Makhson N.E.

Abstract

The experience of total resection of long bones in 32 patients with malignant and metastatic tumors is presented. When tumor was located in the femur the bone defect was filled in by Sivash’s implant complex; when the tumor was located in the shoulder - individual custom polymeric implants were applied. After clavicular extirpation no defect was filled in, however it did not affect functional disability of the hand and when the patient was dressed the cosmetic defect was not seen. In vast damage of the humerus diaphysis and intact epiphyses the authors recommend to perform diaphysis resection followed by the application of autograft from fibula on microvascular anasthomosis. After those operation the hand function was completely preserved. In patients with metastatic damage total resection of long bone was carried out in case of solitary metastase as well as in multiple metastases with pathologic fractures or with the risk of pathologic fractures. The indications for total resection of the femur in metastatic tumors should be strictly limited because of severity of the operation. Total resection of long bone with correct planning and careful operative technique versus amputation and exarticulation gives the same oncologic outcome and herewith provides significantly higher of patient’s life.

N.N. Priorov Journal of Traumatology and Orthopedics. 1996;3(4):36-40
pages 36-40 views

Anaerobic Purulent Complications in Patients with Injuries and Orthpaedic Pathology

Urazgildeev Z.I., Makhson N.E., Mel'nikova V.M., Okropiridze G.G., Raskidailo A.S.

Abstract

Results of microbiologie examinations for the detection of anaerobic nonesporulation microflora in trauma and orthopaedic patients with purulent processes are analysed. Out of 308 patients with purulent processes in bones and joints of pelvis and lower limbs anaerobes are detected in 40.6% of cases, i.e. anaerobes only - in 7.5% and anaerobic-aerobic assocoations - in 33.1%. In chronic gunshot osteomyelitis anaerobes are determined most often (in 84.6% of examined patients). Out of 110 patients with suspision to sepsis obligate anaerobes are isolated in 21.8%. Among determined anaerobes coccous microflora makes up 44.16%, bacteroides - 18.7%, fusobacteria - 3.2%, Clostridium - 7.53%, Gram-positive nonesporulation bacilli - 26.41%. Methods of microbiologie diagnosis for anaerobic microflora using both imported and native equipment are described. Peculiarities of clinical manifestation and treatment of anaerobic purulent processes are presented too.

N.N. Priorov Journal of Traumatology and Orthopedics. 1996;3(4):44-48
pages 44-48 views

Pain Syndrome in Deforming Arthrosis of Large Joints: Pathogenesis and Treatment

Kamenev Y.F., Berglesov M.A., Batpenov N.D., Nadgeriev V.M., Shitikov V.A., Lyalin L.L., Tskhakaya D.C., Toporov Y.A., Malakhovskiy D.E.

Abstract

Mechanisms of pain syndrome development in deforming arthrosis of large joints is considered with the regard for synovia changes in the injuried joint, dynamics of bone chronaxy as well as the development of extraarticular changes during the late stage of pathology. Components of pain syndrome and sequence of their development manifestation as far as the severity of the disease aggravates are defined. Peculiarities of the pathologic algesic system being formed in this condition are considered. Therapeutic management at various components of pain syndrome as well as the estimation of its efficacy is given.

N.N. Priorov Journal of Traumatology and Orthopedics. 1996;3(4):48-52
pages 48-52 views

Modern Principles of Chemoprophylaxis of Postoperative Complications in Trauma and Orthopaedic Patients

Zubkov M.N., Okropiridze G.G., Savost'yanova O.V.

Abstract

The basic preconditions and rational schemes of intraoperative chemoprophylaxis of purulent complications are considered. The leading role of Staphylococcus in the infection pathology of loco-motor system (in 77% of patients, aged after 18, with osteomyelitis and infection of soft tissue) is taken into account. The comparative analysis of the results of the 1st (cefazolin) and 2nd (zinacef) generation cephalosporins application is performed at reconstructive operations in the comparable groups of patients. With due regard for the significant rate of Staphylococcus resistence to cefazolin in vitro (up to 25- 42% of isolates in patients with different diseases) and considerably lower resistence to zinacef (under 10%) the authors consider the later to be more preferable for the prevention of suppurative complications in traumatology and orthopaedics.

N.N. Priorov Journal of Traumatology and Orthopedics. 1996;3(4):40-44
pages 40-44 views

Ultrasound Methods in Traumatology and Orthopaedics

Eskin N.A., Krupatkin A.I., Gorbatenko S.A.

Abstract

Data on ultrasound diagnosis in traumatology and orthopaedics (ultrasound semiotics of diseases and injuries of soft tissues of loco-motor system in children and adults, ultrasound dopplergraphy (USDG) in posttraumatic vascular disorders of limbs) are presented.The main ultrasound sings in injuries of shoulder, hip and knee (meniscography) joints are given. The field of USDG application in traumatology and orthopaedics as well as peculiarities of arterial and venous components of dopplergram in vascular injuries are examined. The importance of USDG in microsurgery of loco-motor system is emphasized.

N.N. Priorov Journal of Traumatology and Orthopedics. 1996;3(4):52-58
pages 52-58 views

Dynamics of Thermographic Indices in Rheumatoid Damage of Knee Joint Before and After Mobilizing Operations

Trotsenko V.V.

Abstract

Thermographic indices were studied in 35 patients, aged 23-56, with 3-4 stage rheumatoid damage of the knee joint before and after mobilizing operations. It was detected that local inflammatory process achieved its maximum and involved total joint structure in the stage of expanded development of flexor contracture. In ankylosis of the joint thermoradiation decreased abruptly and while the minimum weight-bearing function (fibrous ankylosis) was preserved thermographic indices were higher than in complete bone ankylosis. After surgical intervention thermoradiation increases abruptly that was stipulated by operative injury. During the next 2 years thermoradiation decreases but due to irreversible pathologic changes in the joint complete restoration never occured. In late terms after mobilizing operations (5-9 years) the repeated increase of thermoradiation was observed and it was connected with the additional degenerative dystrophic process that was as a rule accompanied by secondary arthrosis. As after joint mobilization restoration of thermoradiation indices continued during 2 years, rehabilitation measures were recommended for that period.

N.N. Priorov Journal of Traumatology and Orthopedics. 1996;3(4):59-62
pages 59-62 views

Morphologic Changes of Articular Cartilage after Surgical Affect by Laser Ray

Mikhailova L.N., Ivannikov S.V., Omelyanenko N.P.

Abstract

Influence of laser ray on the articular cartilage was studied in animal experiment (24 rabbits). Damaging affect of laser ray was directed to articular cartilage of knee joint and subchondral bone of the distal femur. Loading surface of internal condyle and nonloading surface of patellofemoral region were subjected to the affect of laser ray. All procedures were performed in aerial medium. For the detection of the value of laser damaging affect on surrounding tissues maximum working power of set «Lamin-1»- 70V was use. After laser affect the animals were killed on week one, two and three. Histologic examinations showed that under used power of the set laser affect effectively and maltraumatically dissected articular cartilage and subchondral bone.

N.N. Priorov Journal of Traumatology and Orthopedics. 1996;3(4):62-64
pages 62-64 views

V.A. Chernavskiy (commemorating the 100th anniversary)

Skoroglyadov A.V.

Abstract

December 29, 1996, marks the 100th anniversary of the birth of Viktor Alekseevich Chernavsky, an outstanding Russian traumatologist.
Born in Smolensk province, he graduated with a silver medal from Smolensk high school in 1915 and the same year entered the medical faculty of Moscow University. His studies were interrupted in 1918, when Victor joined the Red Army and was sent to the Southern Front, where, as part of the 40th Division, he worked as a paramedic, and then an acting doctor. After his demobilization in 1921, he continued his studies at the Medical Faculty of the University, from which he graduated in 1923.

N.N. Priorov Journal of Traumatology and Orthopedics. 1996;3(4):65-65
pages 65-65 views

Complex Conservative Differetial Treatment of Uncomplicated Spine Fractures

Kaptelin A.F., Cherkes-Zade D.I., Merkulov V.N.

Abstract

Much scientific research has been devoted to the diagnosis and treatment of uncomplicated forms of spinal compression fractures in adults and children, but the problem remains relevant.
The goal of treatment is to restore the shape of the injured vertebra and the functional qualities of the spine. The process of resorption, compaction, and remodeling of the spongy substance after trauma takes a long time, up to 3 months or more. It should also be kept in mind that, in addition to the spongy part of the vertebra, other structures are also subjected to traumatization. It should also be taken into account that as a result of fixation of a certain area of the spine during a compression fracture with the emergence of a wedge-shaped deformity (a block of several vertebrae), biomechanical conditions change, the compensatory load on other parts of the spine increases, and the possibility of extension of the spine, which is a unified kinematic system, decreases.

N.N. Priorov Journal of Traumatology and Orthopedics. 1996;3(4):66-68
pages 66-68 views

Obituary

A.F. Kaptelin

Abstract

On October 11, 1996 at 81 years old Honored Scientist of the RSFSR, Laureate of the State Prize, Professor Alexei Fyodorovich Kaptelin passed away.

N.N. Priorov Journal of Traumatology and Orthopedics. 1996;3(4):68-68
pages 68-68 views

I.A. Movshovich

Abstract

A remarkable doctor and a wonderful man passed away: Ilya Aronovich Movshovich died on November 16, 1996 at the age of 73. An outstanding surgeon orthopedist-traumatologist, Doctor of Medicine, Professor, head of the orthopedic-traumatology clinic at the Botkin Moscow City Clinical Hospital, passed away from us. He is an orthopaedic traumatologist and Head of the Orthopaedic and Traumatology Clinic of Botkin Moscow City Clinical Hospital and Moscow Joint Endoprosthesis Center, Honored Scientist of the Russian Federation, USSR State Prize Winner, Moscow City Hall Prize Winner, N.I. Pirogov Prize Winner. He is an honorary member of scientific societies of orthopedic surgeons in Germany, Czech Republic, Yugoslavia, full member of the International Federation of Orthopaedic Surgeons, honorary professor of Purkinje University.

N.N. Priorov Journal of Traumatology and Orthopedics. 1996;3(4):69-69
pages 69-69 views

Information

All-Ressian Scientific Practical Conference «Problems of Spine and Spine Cord Surgery»

Fomichev N.G., Ramikh E.A., Kuznetsova L.G., Kiskevich M.I.

Abstract

The conference held in April 2-4, 1996 in Novosibirsk was dedicated to the 50-year Anniversary of Novosibirsk SRIST, the 75-year Anniversary of the Honored Scientist of Russian Federation, Professor Ya.L. Tsivyan, the 80-year Anniversary of the Honored Scientist of Russian Federation, Professor K.I. Kharitonova. The conference was attended by 163 delegates representing various scientific branches and schools from many cities of the Russian Federation (including leading specialists from Moscow and St. Petersburg) and from near and far abroad countries. The participation in the conference of guests from the USA, Great Britain, Belgium, Austria, and Bulgaria testified to the importance of the problems under consideration; the speeches of foreign specialists aroused interest and lively discussion.

N.N. Priorov Journal of Traumatology and Orthopedics. 1996;3(4):70-70
pages 70-70 views


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