Vol 30, No 1 (2023)

BACKGROUND: The use of the microvascular flap in reconstructive surgery of complicated nonunions of the diaphysis of the humerus is highly valuable. Flaps with compromised blood supply are possible in up to 10% of cases and often lead to the failure of vascularized reconstruction. The combined skin + bone graft is a simple, useful, and reliable option for flap vitality control with a high success rate.

OBJECTIVE: To compare microvascular grafting with versus without monitoring the skin flap.

MATERIALS AND METHODS: Forty-one microvascular grafting was performed from 2010 to 2017 in patients with humeral non-union and bone defects in the Department of Microsurgery and Trauma of the Hand of Priorov National Medical Research Center of Traumatology and Orthopedics. A combined skin bone flap was used in 23 (56%) patients, and in 18 (44%) patients, grafting was performed without monitoring the skin flap Computed tomography and X-ray imaging were used to monitor non-union healing. The use of a signal skin flap is an effective way to control blood flow in the graft and improves treatment results.

RESULTS: In the group without monitoring of the skin flap, non-union healing was documented in 14 (77%) cases. In the group with monitoring of the skin flap, nonunion healing occurred in 22 (96%) cases.

CONCLUSION: Monitoring the skin flap is an effective option to ensure microvascular flap blood supply control and improves the outcomes in humeral nonunion healing.

BACKGROUND: Currently, researchers are interested in little-studied complications such as pain during intercourse, mainly in the pubic region, often combined with diastasis of the pubic symphysis. Our data and those of domestic and foreign authors presented the main problematic aspect, i.e., dysfunctions of the pubic symphysis. Literature data revealed the main reasons for the emergence of the above problems. The main complications of pelvic ring injuries, including sexual dysfunction in female patients, depending on the main causes, are considered.

OBJECTIVE: To improve the results of the treatment of the structural and functional disorders of pubic articulation in women.

MATERIALS AND METHODS: In the traumatology and orthopedic department No. 1 of the Priorov National Medical Research Center of Traumatology and Orthopedics (Moscow), 34 patients with pubic symphysis were examined. 26 (76.5%) patients underwent surgical treatment — metallodesis of the anterior pelvic half-ring with a plate, along with a defect plasty with osteoplastic biocomposite material for chronic postpartum ruptures and post-traumatic injuries of the pubic symphysis. The Majeed rating scale was used to determine sexual dysfunction and evaluate pelvic ring function.

RESULTS: Of 34 patients associated with chronic postpartum rupture or posttraumatic rupture of the pubic symphysis, 26 (76.5%) had sexual dysfunction; the time interval between natural childbirth and surgical treatment of the pelvic ring varied from 6 months to 10 years (mean 5.7 years), 12 (35.2%) patients developed moderate to severe accumulation symptoms from the lower urinary tract. 26 women underwent surgical intervention: metallodesis of the anterior pelvic half-ring which demonstrated the possibility of stopping dyspareunia.

CONCLUSION: Vertical or horizontal instability of the anterior pelvic ring leads to pelvic diaphragm failure in women, which in most cases causes dyspareunia.

BACKGROUND: If focal changes in the bones are detected, the radiologist must exclude or confirm the presence of a metastatic lesion. Although the semiotics of metastatic and non-oncological changes according to magnetic resonance imaging (MRI) data is well known, in practice, there may be various combinations of their characteristics that are influenced by other chronic diseases and parallel processes, which significantly complicate interpretation. The use of computer image analysis methods has great prospects and can improve the diagnostic accuracy of standard imaging methods.

OBJECTIVE: To improve the accuracy of diagnosing radiographic findings of focal changes in the spine using additional image evaluation by computer analysis algorithms.

MATERIALS AND METHODS: Thirty patients were examined, and 15 of them had metastatic bone lesions from breast cancer, and 15 had focal changes in the spine of a non-oncological nature. Computer analysis of focal changes in the vertebral bodies was conducted according to T₁WI, T₂WI, and STIR MRI sequences. For the computer analysis, the operator of the complexity of the image Arzela and histogram distribution of brightness were used.

RESULTS: The main differential indicators for hemangioma, conditionally normal areas of the bone marrow, and metastatic foci have been established. The Arzela data image complexity operator was approximately 0.07 for hemangioma, approximately 0.05 for metastases (mts), and approximately 0.04 for vertebrae. The brightness histogram operator was approximately 1.12 for haemangioma and approximately 0.94 for mts. Regarding the difference between indicators, the difference is 20%–25%, between hemangioma and bone marrow and 35% between mts and bone marrow, which make it possible to effectively use these indicators together with other markers.

CONCLUSION: The criteria for differential diagnosis obtained using radiomic analysis showed significant differences between focal changes in the vertebrae of various etiologies. From a mathematical point of view, they are advisory, and the doctor with experience remains at the center of the decision-making system.

BACKGROUND: Total knee arthroplasty (TKA) is one of the most common orthopedic surgeries; however, the annual increase in the number of TKAs predictably increases the number of revision interventions. The key reasons for revision TKA (reTKA) are aseptic instability, paraimplant infection, postoperative contractures, and periprosthetic fractures. The metaphyseal fixation in reTKA is performed with metaphyseal sleeves, trabecular metal reconstructive cones, or metaphyseal cones made of pure titanium.

CLINICAL CASES DESCRIPTION: This study aimed to investigate and demonstrate the outcomes of reTKAs performed according to our algorithm with various metaphyseal fixators (sleeves and cones). Systematic reviews and meta-analyses do not allow claiming the advantage of one or another metaphyseal fixator with complete certainty, and this issue remains debatable. We report clinical cases that demonstrate the potential of the suggested algorithm for choosing a metaphyseal fixator in TKA, which ensures successful supplements of bone defects, correct spatial orientation, and good clinical and functional outcomes.

CONCLUSION: This study reveals that this new algorithm for choosing a metaphyseal fixator in reTKAs allows for the correct selection of a replacement implant to ensure stable rotational and axial fixation.

We present a literature review devoted to the study of a craniovertebral malformation such as the «os odontoideum of C₂ vertebra». This is a rare anomaly that often results in atlantoaxial instability and, as a consequence, a wide range of clinical manifestations. The review is analytic and was conducted using medical literature databases and search resources, namely, PubMed (MEDLINE), Google Scholar, and eLibrary. The review focused on the definition of os odontoideum and its epidemiology, including the structure of craniovertebral junction pathologies. Features of the embryonic development of the craniovertebral junction, which are important in terms of the notion of the theories of the origin of os odontoideum, are described. The anatomical variants of the os odontoideum are presented, and a wide range of clinical manifestations of this pathological condition and approaches to its diagnosis are described.