Vol 6, No 4 (1999)

Original study articles

Biologic feedback as a perspective direction for rehabilitation in traumatic and orthopedic disturbances of motor function

Mironov S.P., Tsykunov M.B., Kosov I.S.


Efficacy of biologic feedback for the treatment of motional Disturbances in locomotor system injury is scientifically stipulated. Principles of the method application are shown; means and methods of biocontrol with feedback are defined.

N.N. Priorov Journal of Traumatology and Orthopedics. 1999;6(4):3-8
pages 3-8 views

Extrafocal osteosynthesis using anchor-pin device for the treatment of united fractures and pseudoarthroses of humerus

Afaunov A.A., Afaunov A.I.


Extrafocal Osteosynthesis using monolateral anchorpin device is suggested for the treatment of patients with ununited fractures and pseudoarthroses of the humerus. The main transosseous element of the device are the anchor bunches of two or three pins the tips of which perforate the soft tissues and the underlying cortical layer of the bone fragments from only one side. Intraosteally the pins form the angle of 60° - 100°. Fiveor sixmillimeter rods could serve as the repositioning elements. The outer construction of the device is presented by pin-holders of three types, threading bars of different length, external reposition unit, rectangular strips and the arms for the mounting of repositioning rods. The device is compact and possesses high potentialities for reposition. The device provides reliable osteosynthesis and thus enables the early postoperative loading of the extremity. The method was used for the treatment of 24 patients with ununited fractures and 36 patients with pseudoarthrosis of the humerus. Longterm results (one year after operation) are studied in 17 and 26 patients, respectively. In ununited fractures good results are obtained in 82.3% and satisfactory in 17.7% of cases, in pseudoarthrosis - in 80.8% and 19.2%, respectively.

N.N. Priorov Journal of Traumatology and Orthopedics. 1999;6(4):9-13
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Classification of shoulder joint instability

Tyazhlov A.A.


Multilevel etiologic pathogenetic classification of shoulder joint instability that reflects hierarchic structure of pathologic process is elaborated. Classification is formed by the discrete model. Depending on the aim it gives the possibility to use the separate semantic blocks both for clinical practice (nosologic and diagnostic levels) and for scientific studies (etiologic and pathogenetic levels).

N.N. Priorov Journal of Traumatology and Orthopedics. 1999;6(4):13-17
pages 13-17 views

Extraosseous compression-dynamic osteosynthesis for the treatment of forearm bone fractures

Zorya V.I., Lirtsman V.M., Ulyanov A.V.


Special plate is suggested to provide extraosseous compression-dynamic osteosynthesis. The plate consists of two parts: base and rack. Longitudinal shift of the rack relative to the base is made by the rotation of the key which has a gear tenon on its end. The tenon and base are connected by gear transmission. Shift of the rack enables to put two bones fragments nearer and achieve their tightness and compression. Conditions for fracture healing are obtained.

N.N. Priorov Journal of Traumatology and Orthopedics. 1999;6(4):18-21
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Treatment of children with diaphyseal femur fractures by closed intramedullar osteosynthesis

Rozinov V.M., Yandiev S.I., Burkin I.A., Saveliev V.B., Chogovadze G.A., Pligina E.G.


The experience in treatment of 54 children with diaphyseal femur fractures by closed antegrade intramedullar osteosynthesis is presented The possibility of realization of closed intramedullar osteosynthesis excluding proximal femur growth zone damage is experimentally grounded. It is defined that echography provides all necessary information and allows to limit the irradiation load on the patients and medical staff. Original set of instruments for closed intramedullar osteosynthesis is suggested; recommendations on implant choice depending on the child’s age are given. The method is shown to provide a good anatomic functional result in overwhelming majority of children with diaphyseal femur fractures and to give 2.3-3 times decrease of the duration of inpatient treatment and rehabilitation period as compared with conservative treatment.

N.N. Priorov Journal of Traumatology and Orthopedics. 1999;6(4):21-27
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Total hiparthroplasty by implants of new generation

Zagorodnyy N.V.


Six hundred twenty four consecutive total hiparthroplasties with cement (565 hips), press-fit (35 hips) and hybrid (24 hips) fixation were performed. There were 89 men and 433 women, mean age 52.1 (range from 18 to 84 years). Author reviewed a series of 238 hiparthroplasties with follow-upfrom 12 to 72 months. At control examination the average Harris hipscore was 85.9 (before operation - 30.4). Based on clinical and radiologic data as well as on densitometry, morphologic and biomechanic analysis the success rate of the total hiparthroplasty was 96.6% with no difference between russian and foreign implants.

N.N. Priorov Journal of Traumatology and Orthopedics. 1999;6(4):28-34
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Use of low-molecular heparine for the prevention of venous thromboses and embolisms in total hipreplacement

Plotkin G.L., Petrov A.N., Nikolayeva I.P., Domashenko A.A.


Thromboembolic complications are consided to be the most common cause of patients mortality with the femur fructures. The use of low-molecular weitght heparine (clexane) is the most adequate concerning effectiveness, safety and simplicity. The activization of biochemical processes of erythrocytes membranes by clexan has been recently found. It facilitates the onset of the oxygen dissociation mechanism, improves oxygen supply to the tissues and its better diffusion. The blood circulation system transforms into hypodynamic regimen, optimising the bodys activity.

N.N. Priorov Journal of Traumatology and Orthopedics. 1999;6(4):34-38
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Evaluation of joint function in hiparthritis with harris score and gait analysis

Mitskevich V.A., Zhilyaev A.A., Popova T.P.


Harris hipevaluation score and gait analysis are compared in patients with hiparthritis. The degree of gait abnormality depends not only on joint degeneration but on the compensation provided by the contralateral extremity as well. As Harris score changes the degree of pain and the degree of gait disturbance is changed. The dynamics of clinical evaluation is correlated with gait parameters. Such data as force reaction and gait rhythm may be used to choose the optimal treatment. The higher the force response and gait rhythm asymmetry is the greater becomes the force reaction variability from stepto step. With the progression of hiparthritis the force reaction of the damaged leg is not only decreased but becomes inconstant.

N.N. Priorov Journal of Traumatology and Orthopedics. 1999;6(4):38-43
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Long term outcomes of conservative treatment for femoral head osteochondropathy

Divakov M.G., Boloboshko K.B.


In patients with femoral head osteochondropathy the long term outcomes of conservative treatment were studied. There were 3 groups of patients: 57 patients who were treated at orthopedic sanatoriums for children; 33 outpatients and 35 patients without treatment. Clinical and radiographic data in three studied groups were compared and likeness of data was obtained. Correlation analysis was performed to detect the factors which statistically reliably defined the long term outcomes. The highest correlation rates were found for disease onset age (-0.47) and the following radiographic data: proximal acetabular index (+0.22), inclination angle of acetabular roof (-0.28) and coefficient of the conformity of femoral head surface and acetabulum (+0.26). Multiple linear regression was used to determine the prognostic index for every patient with femoral head osteochondropathy. There were three degrees of probability of unfavorable long term outcomes in conservative treatment or without therapy and 3 groups of patients with good, doubtful or unfavorable outcomes, respectively. Suggested prognosis method allowed a differential choice of treatment method including surgical correction. In good and unfavorable prognosis the pattern of conservative treatment does not influence the long term outcome so prolonged sanatorium treatment is not expedient.

N.N. Priorov Journal of Traumatology and Orthopedics. 1999;6(4):44-48
pages 44-48 views

Comparison of fixation stability in modern devices for transosseous osteosynthesis

Gorodnichenko A.I., Gavryushenko N.S., Kazakov M.E., Kernichansky V.M.


At the Test Laboratory of CITO five modern devices for transosseous osteosynthesis were studied to evaluate the fixation stability in comminuted fractures. Firmness was defined in compression, twisting as well as frontal and sagittal bends. In all planes the highest level of fixation stability was found in RAPFIS device. Design peculiarity of that device provided the additional increase of fixation stability by roads insertion into bone fragments at an angle and diminution of the «bonefixative» distance (console) that almost 3 times improve the fixation stability.

N.N. Priorov Journal of Traumatology and Orthopedics. 1999;6(4):49-52
pages 49-52 views

Biorhythms of bone tissue metabolic processes and diagnostic evaluation by dexa

Kornilov N.V., Avrunin A.S., Sinyukova I.V., Kazemirsky V.E.


Fifty two patients with dysplastic coxarthrosis, aged 14-23, were examined using dual photon X-ray absorptiometry. Changes in bone mineral density had fluctuating pattern. On the base of experimental data a calculating experiment was performed. It showed that coincidence of trend direction obtained at random with true tendency defined by approximation of all dynamic row was only 58% in reiterated examination, 63% - in thrice-repeated examination and 69% - in five -times examination. Hence, even five-times examination is not enough for the exact diagnosis of metabolic disturbances of bone tissue and objective control of the effective treatment and more examinations are required.

N.N. Priorov Journal of Traumatology and Orthopedics. 1999;6(4):52-56
pages 52-56 views

Morphologic characteristics of early stages of reparative process in substitution of skull defects by dosed distraction (report 1)

Shevtsov V.I., Chirkova A.M., Dyachkov A.N.


Experimental study was performed to detect the peculiarities of reparative process in bone defects. In 131 adult mongrel dogs skull defects were performed with their following substitution using dosed distraction by Ilizarov. In the 1st series of experiments the defect was substituted by dosed transfer of full-thickness bone graft on the nutritive pedicle. In the 2nd series free bone graft was used for the defect substitution. In this report the results of morphologic examination of dog’s skull in predistraction period is done. In both series the development of the reparative processes analogous to those in the long bones at transosseous osteosynthesis is detected.

N.N. Priorov Journal of Traumatology and Orthopedics. 1999;6(4):56-61
pages 56-61 views

Orthopedic morbidity of children in Russia, organization of specialized service and prespectives of its perfection

Pozdnikin Y.I., Solov'yeva K.S.


Unfavourable present demographic process, decrease of indices of children’s physical development, increase of congenital and acquired orthopedic pathology as well as the increase of total number of disabled children make high demands of the organization of specialized service in Russia. In general the orthopedic service for children meets the modern requirements. Its further development is foreseen by the Order of the Russin Health Ministry # 140 «About the measures on the perfection of traumatologic and orthopedic service». The urgent goals are the following: early detection of the pathology and early adequate treatment; continuity and succession of rendering aid in outpatient departments, hospitals and rehabilitation institutions; introduction of diagnostic and treatment standards into clinical practice. To improve the pediatric orthpedic service it is necessary to increase the possibilities for rehabilitation treatment, the complex of sanitary measures for children’s population aimed at the prevention of orthopedic pathology.

N.N. Priorov Journal of Traumatology and Orthopedics. 1999;6(4):61-64
pages 61-64 views

From Practical Experience

The case of stable post-traumatic deformity of the pelvic ring

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


We have not found descriptions of such cases of severe deformity of the pelvic ring that developed after a rupture of the pubic symphysis obtained in childhood and subsequent surgical intervention in the available literature, and therefore we consider it appropriate to share our observation.

N.N. Priorov Journal of Traumatology and Orthopedics. 1999;6(4):64-66
pages 64-66 views

Desmoplastic fibroma (desmoid) of the femur: 2 cases

Makhson A.N., Makhson N.E., Shupak M.Y.


Desmoplastic fibroma (extra-abdominal desmoid) was first identified as an independent nosological form in 1958 by H.L. Jaffe [6]. This tumor differs significantly in its course from the desmoid of the abdominal wall. It has a pronounced ability to infiltrate the surrounding tissues, there are frequent cases of tumor spread to the vessels and nerves. The disease usually affects soft tissues. Extra-abdominal desmoids often occur in the area of ​​the shoulder, chest wall, back, and scapula [1, 6]. Desmoplastic bone fibromas are extremely rare. So, R. Buhm et al. [5] described two cases of this tumor affecting the tibia. According to their data, by 1996 only a few dozen cases of bone lesions were presented in the literature. N.P. Petrovichev [3] described the case of femoral desmoid. In the book by S.T. Zatsepin "Saved surgery for bone tumors" [2] reports on operations on the forearm in two patients with recurrence of desmoplastic fibroma. Surgical interventions were accompanied by resection of the bones of the forearm. The observations are interesting, but in neither case are there any clinical or radiological data that could indicate damage to the bones of the forearm by desmoid, and the author himself does not indicate this. We did not find other publications on desmoplastic bone fibroma in the domestic literature. According to N.N. Petrovichev with reference to the work of H.J. Spjut, published in 1971, only 6 cases of femoral injury were described in the literature by that time.

N.N. Priorov Journal of Traumatology and Orthopedics. 1999;6(4):66-68
pages 66-68 views

Reviews, literature review

V.V. Klyuchevsky. "Surgery of injuries" (Guide for paramedics, surgeons and traumatologists of district hospitals). Publishing house DIA-press, Yaroslavl, 1999

Okhotskiy V.P.


Professor V.V. For almost a quarter of a century, Klyuchevsky has been head of the Department of Traumatology, Orthopedics and Military Field Surgery at the Yaroslavl Medical Academy. The Orthopedic and Trauma Center headed by him has 10 specialized departments for the treatment of patients with any injuries of the musculoskeletal system, head, chest, abdomen, pelvis, spine, as well as departments for thermal injuries, microsurgery and plastic surgery.

N.N. Priorov Journal of Traumatology and Orthopedics. 1999;6(4):69-70
pages 69-70 views


Report on the meeting of pediatric orthopedic traumatologists of Russia "Technology standards for specialized care for children with injuries and diseases of the musculoskeletal system"

Malakhov O.A., Stuzhina V.T., Solov'yeva K.S.


The meeting of pediatric orthopedic traumatologists, held on September 16-17, 1999 in Rostov-on-Don, was organized by the Research Children's Orthopedic Institute. G.I. Turner (St. Petersburg) and the Department of Health of the Rostov Region with the active assistance of the staff of the Department of Traumatology and Orthopedics of the Rostov Medical University and CITO named after. N.N. Priorov. 84 specialists from 32 administrative territories of Russia (including 14 doctors and 24 candidates of medical sciences) arrived to participate in it. The most representative were the groups from St. Petersburg (26 people) and Moscow (15). Some of the proposed participants of the meeting could not come due to the difficult financial situation of institutions (Tula, Saratov, Izhevsk, Ufa, N.-Novgorod, Vladimir, etc.).

N.N. Priorov Journal of Traumatology and Orthopedics. 1999;6(4):71-72
pages 71-72 views

Report on the IV Plenum of the Association of Traumatologists and Orthopedists of Russia and the conference "Diagnostics and Treatment of Polytraumas"

Pronskikh A.A., Fedorov Y.S.


The problem of polytrauma is increasingly becoming the subject of discussion in various medical forums and pages of special publications. However, many of its questions remain unresolved. This dictates the need to identify priority areas, the development of which will help a huge army of practitioners who constantly face serious injuries in their work.

N.N. Priorov Journal of Traumatology and Orthopedics. 1999;6(4):72-74
pages 72-74 views


Vyacheslav Vasilievich Klyuchevsky


On September 4, 1999, the head of the Department of Traumatology, Orthopedics and Military Field Surgery of the Yaroslavl Medical Academy, Honored Scientist of Russia, Doctor of Medical Sciences Professor Vyacheslav Vasilyevich Klyuchevsky turned 60.

N.N. Priorov Journal of Traumatology and Orthopedics. 1999;6(4):75-76
pages 75-76 views

Viktor Vladimirovich Trotsenko


November 24, 1999 marked the 60th anniversary of V.V. Trotsenko - Doctor of Medical Sciences, Deputy Director of the Central Institute of Traumatology and Orthopedics. N.N. Priorov on scientific work.

N.N. Priorov Journal of Traumatology and Orthopedics. 1999;6(4):76-77
pages 76-77 views


Viktor Nikolaevich Burdygin


On November 8, 1999, at the age of 62, after a serious illness, the head of the Department of Bone Pathology for Adults of the CITO named after V.I. N.N. Priorov, winner of the State Prize of the Russian Federation, Doctor of Medical Sciences, Professor Viktor Nikolaevich Burdygin.

N.N. Priorov Journal of Traumatology and Orthopedics. 1999;6(4):78-78
pages 78-78 views

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