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Vol 29, No 4 (2022)

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Original study articles

Surgical treatment of chronic vertically unstable pelvic ring injuries

Kuleshov A.A., Aganesov N.A., Vetrile M.S., Lazarev A.F., Gudushauri Y.G., Solod E.I., Lisyansky I.N., Makarov S.N.


BACKGROUND: The initial severity of patients with vertically unstable pelvic injuries often does not allow to perform timely reconstructive surgical intervention. Thus, the number of chronic injuries increases. Treatment of patients with long-term pelvic ring damage (after 3 weeks from injury) with significant vertical displacement (over 20 mm) is a problem of its own.

AIM: To analyze the immediate and long-term results obtained in patients with unresectable and chronic vertical unstable pelvic ring injuries.

MATERIALS AND METHODS: The results for 58 patients treated at the Priorov National Medical Research Center with chronic vertically unstable damage to the pelvic ring in the period from 2017 to 2022 were analyzed. Clinical and radiological diagnostic methods, as well as the Majeed questionnaire, were used to assess the treatment results.

RESULTS: The follow-up period for the patients ranged from 1 to 3 years (2.1 years on average). All patients after surgical treatment showed pain syndrome regression in the posterior pelvic area, decreased pain in sitting and standing positions, which improved their quality of life. All patients were able to move independently, to self-care after the treatment. Excellent results according to Majeed questionnaire one year after surgery were achieved in 4 (8.2%) patients, good — in 40 (81.6%), acceptable — in 5 (10.2%), there were no unsatisfactory results.

CONCLUSION: The vertebral-pelvic fixation technique allows specialists to effectively treat long-standing vertically pelvic ring unstable injuries and perform one-stage repositioning and stable fixation of the posterior pelvic ring.

N.N. Priorov Journal of Traumatology and Orthopedics. 2022;29(4):335-344
pages 335-344 views

Total hip arthroplasty in the treatment of severe stages of osteonecrosis of the femoral head and osteoarthritis: results and complications

Panin M.A., Zagorodniy N.V., Boiko A.V., Petrosyan A.S.


BACKGROUND: Nowadays total hip arthroplasty (THA) is the method of choice for the treatment of late stages osteonecrosis of the femoral head (OFH) and osteoarthritis (OA) of the hip joint.

OBJECTIVE: To evaluate the efficacy and complication pattern of THA in late stages of OFH and OA.

MATERIALS AND METHODS: The study included 74 patients who underwent primary THA for OA stages III–IV (Kellgren and Lawrence classification) and for OFH stages III–IV (ARCO classification). Group 1 included 34 patients with OFH stages III–IV, and group 2 — 40 patients with OA stages III–IV. The groups were comparable by gender and age. All patients underwent implantation of endoprosthesis components using press-fit fixation with a metal–polyethylene articulation. Treatment results were assessed with regard to the incidence of complications and functional results at 3, 6 months, 1 and 3 years after THA.

RESULTS: In our study, the survival rate of components after THA within 3 years after implantation was 100%. No cases of periprosthetic fracture, periprosthetic infection, and aseptic instability of endoprosthesis components were observed in both groups. The surface inflammation of the postoperative wound was detected in 1 (2.9%) patient in the OFH group and in 1 (2.5%) patient in OA group. Dislocation of the endoprosthesis occurred in 1 patient with OFH; there were no such findings in the OA group. The frequency of peri-implant osteolysis was twice lower (2.5%) in patients with OA compared to OFH group (5.8%). There were no statistically significant differences in the functional results dynamics before and after surgery between the groups (Harris score). The average Harris scale score in patients with OFH was 63 and reached 94 after 3 years; in OA group — 58 and 94, respectively.

CONCLUSION: THA is an alternative method in the treatment of severe hip arthroplasty. Endoprosthetics using a cementless endoprosthesis with a metal–polyethylene articulation demonstrated high efficacy as well as a low number of complications among patients with OFH and OA. We found no significant difference in THA results in terms of survival, postoperative complications, and functional outcome in patients with OFH and OA. Longer postoperative follow-up is advisable, which may allow us to establish some differences in treatment outcomes.

N.N. Priorov Journal of Traumatology and Orthopedics. 2022;29(4):345-353
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Early results of revision acetabular endoprosthetics using individual designs

Aleksanyan H.A., Chragyan H.A., Kagramanov S.V., Ivanov A.V., Ukolov K.Y., Polevoy E.V.


BACKGROUND: 3D-printed implants are one of the options for acetabulum reconstruction. The popularity of this technique is increasing every year.

AIM: To evaluate the early clinical, radiological and functional results of revision arthroplasty using individual acetabular components in patients with acetabulum bone defects.

MATERIALS AND METHODS: Revision endoprosthetics was performed in 50 patients. There were 36 female and 14 male patients. The patients’ mean age was 60.4±13.4 (23–89) years. According to the Paprosky classification, the defects in 1 case corresponded to type IIC, in 12 cases to type IIIA, in 37 cases to type IIIB, including 8 cases with violation of the acetabulum integrity. Hip joint function was assessed using the Harris Hip Score (HHS), pain severity using the Visual Analogue Scale (VAS), and social adjustment using the Western Ontario and McMaster Universities Arthritis Index (WOMAC).

RESULTS: Significant improvement was obtained on all assessment scales. The HHS score improved on average from 33.6 to 87.1 points, the VAS scale from 78.1 to 4.7 points, and the WOMAC from 75.8 to 11.6 points. There were 8 cases (21%) with complications in total. In one case with a violation of the acetabulum integrity we observed migration of the sciatic bone from the lower flange of the construct.

CONCLUSION: Thus, the results of the acetabulum reconstruction using individually fabricated acetabular components are promising.

N.N. Priorov Journal of Traumatology and Orthopedics. 2022;29(4):355-365
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Surgical treatment of proximal humerus fractures with using the original allogeneic fibula graft: retrospective cohort study

Vaza A.Y., Fain A.M., Skuratovskaya K.I., Titov R.S., Borovkova N.V., Gnetetskiy S.F., Sharifullin F.A., Fain A.A.


BACKGROUND: A proximal humerus fracture (PHF) is quite common and accounts for approximately 5% of all fractures. During surgery, these fractures make it difficult to correctly reattach the bone fragments. Various special techniques are needed for repositioning and stable fixation of the fragments. When considering the most effective ways to facilitate fracture repositioning and prevent secondary displacement, we paid attention to the publications on the use of the fibula graft.

AIM: To evaluate the effectiveness of a new allogeneic bone-collagen graft from the fibula head in PHF osteosynthesis with a plate having angular stability in conditions of bone tissue deficit.

MATERIALS AND METHODS: An original bone-collagen allogeneic graft from the proximal part of the fibula was developed. We carried out a comparative analysis of the treatment results in patients operated on using the fibula head allograft (group O — 48 patients, subgroup O1 - 35 patients; period - not less than 1 year after surgery) and the group without using augmentation graft (group K — 32 patients). The results were assessed using clinical, radiological, and standardized Constant Shoulder Score; the statistical analysis was also performed.

RESULTS: No patient in group O developed secondary dislocation, while in group K it was noted in 5 (16%) patients. Head collapse developed in 3 patients (7%) in group O and 8 (25%) in group K. Surgery time was shorter in group O than in group K. The mean Constant Scholder Score in subgroup O1 was 78 and in group K 70. Thinning in the cortical layer of the graft and the border disappearance between the spongy part of the graft and the bone tissue of the humeral head were noted in all patients during multispiral CT scanning over time, which was considered a sign of graft remodeling and lysis.

CONCLUSION: In severe PHF with bone deficit, it is possible to perform organ preseration surgery regardless of the patient’s age and obtain functional results satisfying both the patient and the physician. Our suggested method of severe PHF surgical treatment combined with bone deficit facilitates repositioning, reduces operation time, and decreases the number of complications.

N.N. Priorov Journal of Traumatology and Orthopedics. 2022;29(4):367-378
pages 367-378 views

Characteristics of m. Psoas minor and m. Sacrocaudalis (coccygeus) dorsalis lateralis in simultaneous modeling of lateral interbodial spinnylodesis and posterior sacro-iliac joint arthodesis

Filimonova G.N., Diuriagina O.V., Antonov N.I., Stogov M.V., Ryabykh S.O., Tushina N.V.


BACKGROUND: Simultaneous surgical interventions on the spine with the use of high-tech instruments and minimally invasive access techniques allow to eliminate several problems all at once, to activate patients at an early date and to reduce the number of complications.

AIM: To evaluate morphological changes to evaluate morphological changes in the m. Psoas minor and m. Sacrocaudalis dorsalis lateralis during simultaneous modeling of lateral interbody fusion and posterior sacroiliac joint arthrodesis

MATERIALS AND METHODS: Experiments were carried out on 14 outbred dogs; 3 animals formed a control group. The animals underwent consecutive lateral interbody fusion of the lumbar spine and posterior arthrodesis of the sacroiliac joint. The lumbar spine and sacroiliac joint were stabilized with external fixation device. Paraffin sections of muscles were stained with hematoxylin-eosin, according to Van Gieson, and Masson. Biochemical analysis of blood serum was performed during the experiment.

RESULTS: The morphological study of the muscles revealed pathohistological features such as an increase in the variety of myosymplast diameters, loss of their profiles polygonality, massive fibers fatty degeneration, endo- and perimysial fibrosis, sclerotization of vessel membranes, obliteration of their lumens. At the end of the experiment, the degree of the small lumbar muscle fibrosis was 161% and of the sacrocaudal dorsal lateral muscle fibrosis was 240% of the control parameters (p < 0.05); the rate of the muscle fatty infiltration was 339 and 310% of the normal value, respectively. The sacroiliac-caudal dorsal lateral muscle underwent more marked changes, especially in the early stages of the experiment. A significant increase in the enzymes activity, skeletal muscle damage markers was detected on the 14th day after surgery.

CONCLUSION: Simultaneous surgical interventions on the spine should minimize mechanical effects on the paravertebral muscles and use techniques to stimulate their function in the postoperative period, which will reduce the processes of fibrogenesis and fat involution as well as provide an overall shorter rehabilitation period for the target patients.

N.N. Priorov Journal of Traumatology and Orthopedics. 2022;29(4):379-390
pages 379-390 views

Clinical case reports

Combined endoscopic treatment of patient with «terrible triade»: decompression of brachial plexus in thoracic aperture and interscalene space and arthroscopic subacromial spacer implantation. Clinical case

Belyak E.A., Paskhin D.L., Lazko F.L., Prizov A.P., Lazko M.F., Zagorodniy N.V., Menshikov V.V.


BACKGROUND: Brachial plexus injury (plexopathy) is a fairly common problem in neurology, neurosurgery, traumatology and orthopedics. Compression of the brachial plexus usually develops in a narrow anatomical space: in the area of the small pectoral muscle, thoracic aperture, interspinous space. In several cases there is a combination of plexopathy and shoulder joint pathology. In a failure of conservative treatment, surgical intervention such as revision and decompression of the brachial plexus can be used. The development of endoscopic methods of decompression allows the minimization of soft tissue trauma, reduces the risk of complications, and accelerates and facilitates the recovery period.

CLINICAL CASE DESCRIPTION: Our aim was to describe a clinical case and monitor the results of combined endoscopic intervention in a patient with the "terrible triad": endoscopic decompression of the brachial plexus in the thoracic aperture and interlumbar space and arthroscopy of the shoulder joint with subacromial spacer placement at 6 months after surgery. Patient M., aged 64 years, with the consequences of right shoulder joint trauma: dislocation of the humeral head, damage of the shoulder rotator cuff and development of posttraumatic plexopathy of the right brachial plexus. The patient underwent repeated courses of conservative treatment without any pronounced effect for 1 year after injury. To confirm the diagnosis, the patient underwent electroneuromyography and ultrasound examination of the brachial plexus on the right side and magnetic resonance imaging of the right shoulder joint. After the examination, the patient underwent combined endoscopic intervention: arthroscopy of the shoulder joint with subacromial spacer placement and endoscopic decompression of the brachial plexus in the thoracic aperture and interlumbar space. According to the visual analogue scale (VAS) the intensity of pain syndrome before surgery was 7 cm, 6 months after surgery the intensity of pain decreased to 1 cm according to VAS. According to the disabilities of the arm, shoulder and hand scale (DASH), the degree of upper extremity dysfunction before surgery was 48 points; 6 months after surgery, it decreased to 16 points. The British Medical Research Council scale (BMRC) rated the degree of motor impairment at 3 preoperatively and 0 postoperatively. The degree of sensory impairment according to the Seddon Nerve Damage Rating Scale was 2 preoperatively and 3+ postoperatively. Range of motion in the shoulder joint before surgery: flexion — 110°, abduction — 95°, external rotation — 15°. Six months after surgery: flexion — 165°, abduction — 165°, external rotation — 45°.

CONCLUSION: The findings allow us to characterize the technique of one-stage arthroscopy of the shoulder joint and endoscopic decompression of the brachial plexus in the thoracic aperture and interlumbar space as low-traumatic and effective, creating conditions for restoration of the shoulder joint and upper extremity function as well as elimination of pain syndrome in the upper extremity.

N.N. Priorov Journal of Traumatology and Orthopedics. 2022;29(4):391-401
pages 391-401 views

Experience of successful treatment of a patient with chronic non-bacterial osteomyelitis (clinical case)

Tairov G.N., Toptygina A.P., Ochkurenko A.A., Buklemishev Y.V., Karpov I.N.


BACKGROUND: Chronic nonbacterial osteomyelitis is a rare autoinflammatory bone disease with periods of relapses and remissions. No etiotropic therapy, diagnostic and treatment standards exist, patients are observed by rheumatologists, immunologists, and orthopedist. They receive symptomatic, anti-inflammatory treatment, broad-spectrum antibiotics, immunosuppressants to control inflammation, which helps to prevent new or to reduce existing pathological foci.

CLINICAL CASE DESCRIPTION: This article describes the effect of immune therapy and osteotropic treatment with zoledronic acid combination in a patient with chronic non-bacterial osteomyelitis. In a clinical observation involving comprehensive examination, including radiological (radiography, computed tomography and magnetic resonance imaging) and laboratory methods, a positive outcome was achieved using conservative methods of treatment in a patient with chronic non-bacterial sternum osteomyelitis.

CONCLUSION: Thus, a combination of bisphosphonates and immunotherapy may be promising in the treatment of chronic non-bacterial osteomyelitis. However, it is unknown as to how long the remission will last and what treatment program is necessary for the final disease resolution.

N.N. Priorov Journal of Traumatology and Orthopedics. 2022;29(4):403-411
pages 403-411 views


Two-stage flexor tendon reconstruction of the fingers in chronic injuries: the history of this a unique method of treatment

Zolotov A.S., Dyachkova J.D., Sidorenko I.S., Mbeki J.A.


In 1965 the American surgeon J.M. Hunter published a pioneering work on a new method of treatment (in 2 stages) of finger flexor tendons complex injuries using a special artificial tendon implant at the 1st stage to prepare the fibrosynovial canal. After replacement of the prosthesis with a tendon graft, the walls of the new case provided a nourishing and sliding surface for the tendon graft. The method of two-stage tendon grafting was widely used all over the world. The followers of J.M. Hunter's method are constantly modifying (not substantially) the original method and continue discussions about this treatment method. However, the basic principles of two-stage tendoplasty formulated by the American surgeon remain relevant to this day. The authors analyzed the changes in the treatment tactics and technique of two-stage tendoplasty that occurred during the last decades. J.M. Hunter provided hand surgeons with a unique method of treatment, which made it possible to help the most complex patients who were previously considered incurable.

N.N. Priorov Journal of Traumatology and Orthopedics. 2022;29(4):413-422
pages 413-422 views

Short communications

Report on the work of the XII All-Russian Congress of Traumatologists and Orthopedists (December 1–3, 2022, Moscow)

Mironov S.P., Ochkurenko A.A., Perminov V.A., Trofimova A.I.


The XII All-Russian Congress of Traumatology and Orthopedics took place in Moscow on December 1–3, 2022. The main goal of the Congress was to review innovative approaches in the diagnosis and treatment of musculoskeletal system injuries and diseases by leading specialists, scientific researchers and practicing orthopedic traumatologists and orthopedists.

N.N. Priorov Journal of Traumatology and Orthopedics. 2022;29(4):423-431
pages 423-431 views

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