Vol 5, No 1 (1998)


Primary Sacrum Tumors in Adults: Diagnostic Problems

Burdigin V.N., Morozov A.K., Belayeva A.A.


One hundred fifty patients, age 16-77, were examined. Forty five out of them had malignant tumors or metastatic lesions of sacrum; 105 patients had benign tumors, tumor-like diseases and inflammatory processes (3). All patients were operated on. Diagnosis was verified morphologically. Analysis of clinical-radiological symptomatology and of the results of special radiation diagnostic methods (CT, MRT) were performed. Clinical manifestations of sacrum tumors have no specific features, careful examination of a patient and anamnesis study give the possibility to detect the process pattern, but not the nosologic form. In 75,8% of patients radiologic and especially CT and MRT data allowed to determine nosologic form preoperatively. Authors emphasized that CT and MRT was the method of choice for examination of patients with sacrum tumors. The attention was directed to the necessity of the increase oncologic alertness among neurologists and orthopaedic surgeons. If sacrum tumor is suspected the patient must be referred to special medical institute which are equipped with modern radiation diagnosis systems.

N.N. Priorov Journal of Traumatology and Orthopedics. 1998;5(1):3-12
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Desmoid Fibroma: are We Ready to Avoid the Surgical Treatment?

Chissov V.I., Dar’aylova S.L., Boyko A.V., Koroleva L.A.


Thirty years experience of treatment of soft tissue desmoid fibroma (Moscow Oncologic Institute) is presented. Efficacy of surgical treatment versus combined and radiation therapy was studied. The rate of relapse of extraabdominal desmoids after surgical treatment was 94%, after combined treatment with preoperative radiation therapy the relapse rate decreased up to 27.5% but after postoperative radiation therapy up to 53%. After radiation therapy the relapse rate was 15.7%. However radiation therapy has limitations related the necessity of massive tumor irradiation and application of high doses of irradiation that may cause postradiation affect of tissues. During subsequent search the original method of chemiotherapy (tamoxiphen, vinblastin, methotrecoat) was tested. This method allows to achieve the persistent remission in 81.3% of patients. Principles of therapeutic tactics in desmoid fibromas are formulated.

N.N. Priorov Journal of Traumatology and Orthopedics. 1998;5(1):12-17
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Reconstruction and Plastic Surgery in Orthopaedic Oncology

Makhson A.N.


Author speaks an active supporter of the wide application of plastic surgery methods in clinical oncology. The experience of Department of Plastic and reconstructive Surgery at Moscow Municipal Clinical Oncologic Hospital has showed that application of different microsurgical technique of autotransplantation allowed to significantly widen the indications to organsaving operations in malignant tumors of loco-motor system, considerably improve both oncologic and functional results of treatment.

N.N. Priorov Journal of Traumatology and Orthopedics. 1998;5(1):17-20
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Application of Irradiated Bone Replants in Surgical Treatment of Osteogenic Sarcoma in Children

Bizer V.A., Kurilchik A.A., Sidorchenkov V.O.


Ten children, aged 8-16, with osteogenic sarcoma received complex treatment which included distant gammairradiation in total focal dose of 36 Gy with chemotherapy (Pt drugs) and subsequent surgical intervention. Operation was performed 3-6 months after chemotherapy in case of stabilization of local tumor process and absence of metastases. Peculiarity of surgical tactics consisted in the following: in the operating room the resected bone with tumor (often it was the distal articular end of the femur) was subjected to single electronic bunch irradiation in 60 Gy dose and after that it was replanted. X-ray control showed that the reconstruction of irradiated replants implanted into irradiated tissues developed slowly and did not complete by the 3rd observation year. However, it did not prevent the replant from functioning as a prosthesis. In 30% of patients postoperative complications, i.e. suppuration, were noted. Four patients died. Six patients are alive, 4 out of them have follow-up period over 2 years and 2 patients — over 3 years. Authors conclude that in appropriate indications and simulataneous irradiation autobone-replants can be used for the substitution of bone defects.

N.N. Priorov Journal of Traumatology and Orthopedics. 1998;5(1):20-24
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Extirpation of Humerus and Endoprosthetics in Total and Subtotal Tumor and Tumor-Like Lesions as the Alternative to Amputation

Palshin G.A.


The experience of operative treatment of 31 patients with total and subtotal tumor and tumor-like lesions of humerus for the period from 1967 to 1997 is presented. The perfection of total humerus replacement is reflected in chronological order on the materials of the Clinic of Bone Pathology, CITO, Moscow. The indications to extirpation are given. The peculiarities of operative technique and the elaboration of design of endoprosthesis to reduce the duration of operation and to improve the functional results are described. In 31 patients results of total replacement of humerus are given. In spite of high percentage of postoperative complications (infection - 6.5%, postoperative neuritis - 3,2, dislocation of endoprosthesis - 6.5%, relapse of the disease - 22.6%) endoprosthesis is an adequate operation improving the quality of life of patients.

N.N. Priorov Journal of Traumatology and Orthopedics. 1998;5(1):24-28
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Orthopaedic Treatment of Pathological fractures in Extremity Bones Metastases

Lomtatidze E.S., Ermolaev E.K., Lomtatidze V.K.


The results of surgical treatment of 8 patients with pathological fractures of the bones of lower and upper extremities in cancer metastases zones is presented. After metastasis removal fixation of fragments was performed by AO technique using metallic devices and filling of bone defect with bone cement. Total joint replacement (hip joint and shoulder) was performed in 2 patients. In all operated patients the pain syndrome was arrested, complete or partial restoration of extremity function was achieved. Of the 8 patients 5 patients died, 3 patients are alive. Mean survival time was 20 months (from 2 to 39 months). No recurrence of metastasis in the region of fixed fractures, failure of osteosynthesis, endoprosthesis instability was noted.

N.N. Priorov Journal of Traumatology and Orthopedics. 1998;5(1):28-31
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Diagnosis of Osteofibrous Dysplasy in Children

Snetkov A.I., Berchenko G.N., Nechvolodova O.L., Savkina L.F.


The first description in Russian literature of osteofibrous dysplasy in children is presented. It is grounded on the analysis of diagnostic peculiarities and treatment of 24 patients in the period from 1966 to 1996 The main diagnostic criteria by clinical, radiologic and pathomorphologic features are given. Osteofibrous dysplasy is a rare and insufficiently studied disease affecting mainly tibia in children of the first ten years. It has dysplastic congenital nature and is similar to the biastomatosis process. Saber-like deformity of the affected segment prevails in clinical picture. This deformity may be of different degree of manifestation and accompanied by painless. Eccentric intracortical location of pathologic focus is typical of radiologic picture. Morphologic examination is the main diagnostic method. Histologic study shows architectonics «zone» of the pathologic focus which consists of fibrous tissue with bone trabeculae inclusion (bone trabeculae with laminar structure) mainly surrounded by active osteoblasts.

N.N. Priorov Journal of Traumatology and Orthopedics. 1998;5(1):31-34
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Treatment of Solitary Bone Cysts in Children and Adolescents

Tenilin N.A., Bogosyan A.B., Sosnin A.G.


The result of treatment of 115 patients with bone cysts of different localization is analysed. In 73 patients the segmental or marginal resection was performed. Fifteen years follow-up period showed inadequcy of surgical interventions related to pathology nature so far as recurrence occurred in 10-12% of cases; besides muscular hypotrophy and shortening of operated segment developed. Authors consider that puncture methods are the most rational method for treatment. Elaborated method of persistent through drainage of pathologic cavity and drip of medicines allowed to receive the excellent and good results in 93% of cases. To observe the reparative process side by side with X-ray examination sonography method is suggested. The marker of osteolysis activity is the ferritine concentration in cyst. Its level is directly poportional to process activity, i.e. in active and recurrent cysts ferritine concentration is ten times higher than in serum and reduces to norm in residual bone cavities.

N.N. Priorov Journal of Traumatology and Orthopedics. 1998;5(1):34-37
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Conservative Treatment of Chronic Recurrent Multifocal Osteomyelitis in Children

Berezhniy A.P., Ochkurenko A.A.


The experience in diagnosis (52 patients) and treatment (35 patients) of chronic recurrent multifocal osteomyelitis in children is presented. In 17 patients conservative treatment was accompanied by surgical intervention. Eighteen patients received the conservative treatment only. Analysis covering medical documentation and authors’ observation showed that antibacterial therapy that was performed both before hospitalization of patients to CITO (20 patients) and at the institute (21 patients) was ineffective. Original scheme of conservative treatment with application of hormonal, nonsteroid antiinflammatory and metabolic therapy is given. Long term complex therapy proved sufficiently high efficacy of that treatment method and allowed to overcome the pessimism in prognosis of that disease.

N.N. Priorov Journal of Traumatology and Orthopedics. 1998;5(1):37-43
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Early Diagnosis and Choice of Curative Tactics in Legg-Calve-Pertes’ Disease

Batalov O.A., Bogosayn A.B., Musikhina I.V., Tenilin N.A., Sosnin A.G., Permaykov M.V., Vashkevich D.B., Vvedenskiy P.S., Kochemasov V.M.


The experience of diagnosis and treatment of 155 children with Legg-Calve-Perthes’ disease (LCPD) is presented. The high efficacy of sonography and radiothermometry in diagnosis of the early LCPD stages is showed. Sixty two patients were treated conservatively and 93 patients were operated on. Conservative treatment was used in patients with I—III LCPD stages when interrelations of joint elements were in norm. The following therapeutic remedies were used: hyperbaric oxygenation, acupuncture as well as drug therapy by new scheme. Indications to operative treatment, i.e. intervention in proximal femur or pelvic bones, were the incongruency of articular surfaces and failure of conservative treatment during 6 months even in normal interrelation of articular elements. Given scheme of diagnosis and treatment of LCPD allowed to achieve good and satisfactory results in 92.3% of patients.

N.N. Priorov Journal of Traumatology and Orthopedics. 1998;5(1):43-47
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Compression- Distraction in the Correction of Shortening and Deformity of Extremities on Dischondroplasy

Banakov V.V., Lipkin S.I., Samkov A.S.


The aim of the study was to determine the significance of extrafocal osteosynthesis in the treatment of patients with dischondroplasy as well as the affect of distraction on chondromatosis foci. In 59 patients, age 6-17, extrafocal osteosynthesis was applied for correction of shortening and deformity of forearm (11), humerus (12), lower extremities (36). Three forms of dischondroplasy were distinguished: dysplastic, tumorlike, mixed. The technique of distraction osteosynthesis was changed depending upon the dischondroplasy form. Good results were achieved in 89% of patients. Histologic examination of dischondroplastic foci was performed at the different stages of surgical treatment. It revealed that no distraction neither led to ossification of chondromatosis focus nor stimulated its growth. By authors’ opinion the extrafocal compression-distraction osteosynthesis is the method of choice in treatment of patients with dischondroplasy.

N.N. Priorov Journal of Traumatology and Orthopedics. 1998;5(1):47-51
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Hemimelie Epiphyseal Displasya - Rare Systemic Disease of Skeleton

Kotov V.L., Batrakov S.Y.


The experience of treatment of 22 patients, aged 1-16, with HED is presented. Analysis of clinical manifestations and radiographic data was performed. The peculiarity of surgical tactics depending on the localisation and severity of the lesion are showed. Authors consider that in spite of recurrences the early economic resections to reconstruct the shape of the epiphysis are preferable with the purpose of prevention of deforming arthrosis and secondary deformities of extremity.

N.N. Priorov Journal of Traumatology and Orthopedics. 1998;5(1):51-55
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About Tactics of Correction in Clubfoot

Volkov S.E., Malakhov O.A., Zakharov E.S., Maksimov I.A.


Two hundred eighty six patients with clubfoot were examined to detect the rational tactics and method of treatment. It is showed that radiographic or MRT examination of foot is necessary for objective estimation of total bone-articular correction of the deformity. Absence of improvement during conservative treatment is the indication to operative treatment. Traditional method of conservative correction of varus gives efficacy at every stage of treatment during the first 6 changes of plaster bandage only. Equine correction should be performed surgically. Choice of operative tactics depends on the degree of residual foot deformity. If equine and varus is preserved talus reposition with internal fixation is indicated; when equine is preserved the posterior or posteromedial tenoligamentocapsulotomy is indicated.

N.N. Priorov Journal of Traumatology and Orthopedics. 1998;5(1):56-60
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From Practical Experience

About Primary Malignant Chondroblastoma

Shavirin A.B., Lipkin S.I.


According to the WHO histological classification of tumors (1972), chondroblastoma of bone belongs to benign cartilage-forming tumors. However, later literature data indicate the possibility of its malignancy. T.P. Vinogradova mentions its malignant form along with benign chondroblastoma, noting that "each benign form of tumor, as a rule, has its malignant analogue". There are 20 cases of malignant chondroblastoma described in the world literature and there are brief mentions of another 8 such cases. The work of V.N. Burdygin, A.K. Morozov and S.I. Lipkin [1] reports 6 own observations, A.K. Morozov reports 8 malignant chondroblastomas out of 113 studied, the publication of S.I. Lipkin - about 13 malignant chondroblastomas and 3 clear cell chondrosarcomas, which probably arose on the basis of chondroblastoma malignancy; according to V.L. Kotov and S.I. Lipkin, in 13 of 225 patients with chondroblastoma the tumor was verified as malignant.

N.N. Priorov Journal of Traumatology and Orthopedics. 1998;5(1):61-62
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Synovial Sarcoma with Limited Lesions of Lateral Condyle of the Femur (Case Report)

Tschupak M.Y., Denisov K.A.


Patient I., 46 years old, admitted to Hospital No. 62 on March 28, 1997, complaining of constant pains in the left knee joint and some restriction of movements in it. Swelling of the lateral condyle of the femur had appeared 6 months earlier, which was followed by pain, for which the patient applied to the local outpatient clinic. The patient was diagnosed with osteoarthritis, underwent physiotherapy, nonsteroidal anti-inflammatory drugs. However, the pain was increasing. X-ray of the knee joint was performed, which revealed destruction of the external condyle of the left femur. The patient was hospitalized.

N.N. Priorov Journal of Traumatology and Orthopedics. 1998;5(1):63-64
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Towards Formation and Development of Orthopaedic and Traumatologic Care to Population (Commemorating the 90th anniversary of the foundation of Kharkov Scientific Research Institute of Orthopaedics and Traumatology named after M.I.Sitenko)

Korzh N.A., Yaremenko D.A.


At the beginning of the twentieth century, industrial injuries began to grow simultaneously with the intensive development of industry. In 1904 the Russian government was forced to introduce a law on insurance of workers against accidents. This entailed a significant increase in expenses of plant and factory owners for the payment of life annuities to the injured, which forced them to reconsider their attitude to the prevention of injuries and treatment of patients with injuries of the musculoskeletal system received at work, which in most cases led to disabling injuries.

N.N. Priorov Journal of Traumatology and Orthopedics. 1998;5(1):65-68
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Development of V.N. Blochin and his Contribution to Orthopaedics and Surgery of the Hand (Commemorating the 100th anniversary of birthday)

Shinkarenko I.N.


It is 100 years since the birthday of the RSFSR Honored Scientist, Doctor of Medicine, Professor Vladimir Nikolayevich Blokhin, an outstanding scientist, one of the founders of modern Russian traumatology, orthopedics, plastic surgery and hand surgery.

N.N. Priorov Journal of Traumatology and Orthopedics. 1998;5(1):69-70
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V.N. Merkulov


January 2, 1998 was the fiftieth anniversary of the birth of Professor Vladimir Nikolaevich Merkulov, Head of the Children's Traumatology Clinic at CITO.

N.N. Priorov Journal of Traumatology and Orthopedics. 1998;5(1):71-71
pages 71-71 views

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