Vol 30, No 3 (2023)

BACKGROUND: Proximal interphalangeal joint intra-articular fractures are a prevalent problem in traumatology and orthopedics. Damage typically develops at the base of the middle phalanx due to a collision with the head of the proximal phalanx. As a result, the finger’s function declines significantly, which inevitably impacts the function of the entire brush. Compared with long-standing injuries, treating patients with this pathology in the acute period of injury is more likely to result in limb function restoration. Suppose an intra-articular fracture is underestimated or missed in the early stages. In that case, the doctor may eventually encounter chronic pain syndrome, joint and/or stiffness, and more time-consuming treatment procedures. There are many methods of treatment for both “acute” and long-standing injuries, each with advantages and disadvantages.

OBJECTIVE: To describe, in our opinion, the most effective modalities of therapy for patients with these injuries in the early stages (up to 4 weeks from the time of injury) and long-term periods (more than 4 weeks).

MATERIALS AND METHODS: The Suzuki external fixation spoke device (pins and rubber traction system [PRTS]) was used to treat 26 patients with fractures and dislocations of the base of the middle phalanx of the three-phalangeal fingers of the hand in the acute period of injury. Arthroplasty of the base of the middle phalanx with a hook bone graft (hemihamate) with its modifications was used in the treatment of 23 patients with inadequately fused intra-articular fractures of the base of the middle phalanx of the three-phalangeal fingers of the hand. All patients underwent physical examinations, X-rays, and/or CT scans to diagnose and confirm or clarify the nature of the damage. All patients developed passive/active movements early in the operated section during the postoperative period.

RESULTS: The patient estimated the VAS pain syndrome at 4–6 points on the scale; however, after 6–8 weeks, this indicator was 0–1 points. After 6–8 weeks, the amplitude of movements in the proximal interphalangeal joint of the fingers from the average of 30–50° after 6–8 weeks, was reached the average of 15–95°. There was a 15–20° extensor contracture in two patients.

CONCLUSION: The treatment of patients with intra-articular fractures and fracture-dislocations in the proximal interphalangeal joint of the three-phalangeal fingers of the hand, as well as their consequences, is a complex current problem in traumatology and orthopedics with no one-word universal solution. To select treatment strategies, a comprehensive evaluation of the patient, correct verification and interpretation of the existing damage, and a thorough understanding of the anatomy of the fingers and the hand are required.

BACKGROUND: One of the most prevalent foot abnormalities is valgus deformity of the first toe. Many procedures have been proposed to correct this deformity, but one of the most Scarf osteotomy of the first metatarsal bone, which is complemented by the Akin osteotomy of the proximal phalanx of the first finger, is one of the most widely used. This publication analyzes the mid-term effect of repairing the deformity of the first toe using the methods described above.

AIMS: To evaluate the mid-term outcomes of hallux valgus correction using Scarf osteotomy and the combination of Scarf and Akin osteotomies to the literature.

MATERIALS AND METHODS: This is a cross-sectional, observational study. From January to December 2017, 129 patients (147 ft.) received forefoot deformity. Clinical and radiographic parameters were studied using the AOFAS, FFI, and VAS scales and questions related to the subjective assessment of patients by the treatment.

RESULTS: The study’s findings revealed an increase in AOFAS scores from 59.0 (16–88, SD=18.6) before surgery to 85.0 (53–100, SD=13.3; p <0.001) 5 yr later. The VAS scores fell from 5.7 (0–10, SD=2.2) to 2.4 (0–5, SD=1.4; p <0.001). After surgery, the FFI scale score decreased from 40.9 (10–78, SD=18.1) to 11.3 (0–19, SD=5.0; p <0.001). According to the survey, 96.7% of patients would agree to a second operation, 96.9% of those who had surgery would recommend it to their relatives, and 94.6% were satisfied with the aesthetic result of the operation. Most patients (95.4%) were satisfied with the treatment in terms of the disappearance of pain and discomfort. The functional results of the surgical surgery were satisfactory to 98.4% of the patients who were consulted. Radiographic HVA, IMA angle, and Hardy and Clapham sesamoid position scores all indicated favorable mid-term outcomes with no deformity recurrence. In 46.3% of patients (68 patients), there was limited mobility in the first metatarsophalangeal joint. A complication in superficial soft tissue irritation occurred in four patients (2.7%). Iatrogenic varus deviation of one toe was observed in one patient. Metal fixators were removed from patients in 34 patients (23.1%). The removal was completed within a year in 17 cases (11.6%).

CONCLUSIONS: Scarf osteotomy, alone or in combination with Akin osteotomy, is a successful treatment for hallux valgus.

BACKGROUND: Ankle injuries of various nature — bruises, sprains, tears, dislocations and subluxations, and fractures — account for 20–30% of all musculoskeletal system injuries. The most common ankle injuries are a tear and sprain. The difficulty in treating fractures in this location is due to the need for accurate repositioning of the articular surface and stable fixation of fragments. The actual task is to train roentgenologists in the field. The inclusion of medical personnel in the educational process at all levels of training simulation courses aids in the reduction of errors, reduction of problems, and the improvement of the quality of medical treatment provided to the public.

OBJECTIVE: This study aims to develop and create a simulator that simulates human bone structure and soft tissues and allows roentgenologists to get through training and instruction radiological examinations of an ankle joint and a foot.

MATERIALS AND METHODS: The following stages of the simulator’s development have been completed: acquiring ankle bone samples, creating a mold for casting, and constructing the simulator. The results of computer and magnetic resonance imaging were used to construct bone samples, from which a computerized 3D model of the bones of the foot and ankle joint was obtained. Using additive technologies, anatomically correct reproductions of human foot and ankle bones were made. At the next stage, a three-dimensional digital model was developed, and a mold for casting the finished product was made. Bone samples collected in a single structure were placed inside the mold. Next, a step-by-step filling of the form with a soft gel-like material was performed. In this case, a self-vulcanizing silicone rubber composition is selected, which, after solidification, imitates human soft tissues.

RESULTS: During the course of the study, a prototype medical simulator was created that models human bone structure and soft tissues and allows roentgenologists to practice performing ankle joint and foot roentgenography.

CONCLUSION: Because of its high anatomical accuracy, ease of use, and mass production potential, the developed simulator can be widely employed in the teaching of roentgenologists.

Albert Hoffa’s is associated with three popular eponymous terms: the infrapatellar fat pad (Hoffa’s fat pad), the pathology of this anatomical development (Hoffa’s disease), and a frontal fracture of the lateral condyle of the femur (Hoffa’s fracture). Issues of priority about the mentioned eponyms continue to be debated. The authors searched for information in domestic and foreign publications, traumatology and orthopedics manuals, periodicals, and Internet resources — Scopus, WoS, Google Scholar, and eLibrary — to collect reliable data on the history of the emergence of the eponyms “Hoff’s fatty body,” “Hoff’s disease,” “Hoff’s fracture” and to determine the role of the German orthopedist and his priority in the origin of these copyright names. Professor John Goodsir’s paper in 1855 contains one of the earliest mentions of the infrapatellar fat pad but without revealing the anatomy and morphology of the structure itself. In 1904, Albert Hoffa published an article describing fully the syntopic and macroscopic anatomy of the infrapatellar fat pad and the disease associated with infrapatellar fat pad pathology. A German physician, Friedrich Busch, first described the frontal fracture of the lateral condyle of the femur in 1869. A similar was described by Albert Hoffa in the first edition of the “Textbook of Fractures and Dislocations for Doctors and Students” in 1888. Albert Hoffa’s priority in describing the infrapatellar fat pad and its pathology is recognized by representatives of various medical specialties. As for the frontal fracture of the lateral condyle of the femur, Albert Hoffa may only be considered a co-author of the frontal fracture of the lateral condyle of the femur.