Vol 31, No 3 (2024)

Background: Evans calcaneal osteotomy is one of the recognized surgical techniques for the treatment of flat-valgus foot deformity in children over 12 years of age, which allows simultaneous multiplanar correction. Preoperative planning of the formed diastasis parameters to reduce the number of cases of hypo- and hypercorrection remains an urgent issue.

AIM: To evaluate the results of Evans calcaneal osteotomy using the developed method of preoperative planning and fixation with the individual H-shaped reconstructive plate.

MATERIALS AND METHODS: This study included 64 children aged 12–17 years with symptomatic planovalgus deformity, who were divided into two groups: in the main group, preoperative planning was used according to the developed method; in the control group for intraoperative control of correction was used only fluoroscopy and visual assessment. To study the effectiveness of the developed method, we used dynamic assessment of radiometric parameters and AOFAS questionnaire results before and after surgery. We also took into account the changes in the Foot Posture Index 6 and the Chippaux-Smirak and Stasheli podometric indices.

RESULTS: In comparison with the control group, the main group showed a reduction in the swelling period after surgery, as well as the timing of the onset of full limb support, and a significant decrease in the incomplete correction. Similar dynamics was observed when studying the groups according to the Foot Posture Index 6 scale and podometric indices.

CONCLUSION: The use of the developed method of preoperative planning during the Evans operation has shown its effectiveness for the treatment of flexible flatfoot deformity of the feet in adolescence.

Background: Many patients who visit orthopedic surgeons mainly complained of knee pain, which is often diagnosed as osteoarthritis affecting the medial compartment, whereas the lateral compartment and patello-femoral joint remain relatively unaffected.

AIM: This study aimed to establish criteria for patient selection and validate an evidence-based approach for selecting candidates for unicompartmental knee arthroplasty (UKA). Key considerations in patient selection for UKA include identifying the presence of bone-on-bone osteoarthritis in the medial compartment, ensuring a functionally normal anterior cruciate ligament, maintaining full-thickness cartilage in the lateral compartment, verifying a functionally normal medial collateral ligament, and confirming the absence of severe damage lateral to the patello-femoral joint.

MATERIALS AND METHODS: From a consecutive cohort of 390 patients with medial knee pain, preoperative radiographs of bilateral knee including anteroposterior/lateral/Rosenberg/20° valgus stress views were collected, and results were tabulated. Patients were categorized into appropriate groups. The suitability for UKA was determined based on the Oxford radiological decision aid, history, examination, and radiographic assessment including stress radiographs.

RESULTS: The Oxford radiological decision aid demonstrated 92% sensitivity and 88% specificity. According to the radiographic assessment, 49% of the knees were considered suitable for Oxford UKA (OUKA), whereas 51% were deemed unsuitable. Among the 51 knees identified as unsuitable for OUKA, 40% did not meet one radiographic criterion, 38% did not meet two criteria, 22% did not meet three criteria, and <1% did not meet four criteria.

CONCLUSION: The Oxford radiographic decision aid safely and reliably identifies the appropriate patients for meniscal-bearing UKA and achieves good results in this population. The widespread use of this radiological decision aid should improve the results of UKA.

Background: Musculoskeletal pain (MSP) has now become a non-infectious epidemic and is the second leading cause of disability, resulting in a significant loss of productivity among the able-bodied population in all industrialized countries. The main conditions most commonly encountered in outpatient appointments are spondyloarthritis (SA) of the lumbar spine and osteoarthritis (OA) of the knee. These diseases have similar pathogenesis and are accompanied by aseptic inflammation, involvement of muscules and ligaments, leading to the formation of various movement disorders, antinociceptive insufficiency, and peripheral and central sensitization. In this study, the results of magnetic resonance imaging (MRI) are presented, which can be used in early diagnosis of MSP, as well as dynamic control of treatment.

AIM: To evaluate neuroimaging signs in patients with SA and OA depending on the cause of the disease.

MATERIALS AND METHODS: Analytical one-stage study was performed with 158 patients with established clinical diagnosis of MSB, who were divided into four groups: primary knee OA (46 patients), posttraumatic OA (48 patients), spondylogenic OA (40 patients) and OA of 0–I stage (24 patients) To study neuroimaging signs the examination was performed on MRI devices Siemens Magnetom Aera 1.5T and General Electric Signa 1.5T.

RESULTS: MRI examination revealed stage III spondyloarthritis in 47.2% of patients, and stage II in 30.1%. Of the total number of patients, 33.3% had fragmentation of the inner and outer menisci of the knee joint, longitudinal damage of the inner meniscus was detected in 30.1% of cases and osteophytes of the knee joint in 30% of cases. Intervertebral disc sequestration (2.4%) and stage I spondyloarthrosis (7.3%) were the least common. When comparing the groups, more pronounced neuroimaging signs were detected in posttraumatic and primary OA, while they were significantly lower in spondylogenic genesis. No differences between the groups were found in the spine examination.

CONCLUSION: The study showed high informativeness of MRI in OA, which allows early diagnosis and differential diagnosis of the disease.

Background: It is known that bioceramic implants containing various calcium or silicon compounds in isolation demonstrate osteoconductive effect in the replacement of post-traumatic bone defects. The combined use of these elements in single material should potentiate the organotypic filling of the bone cavity by creating favorable ion microenvironment and staged biodegradation.

AIM: To identify the correlation of radiological indicators of the density of newly formed bone tissue and content of micro- and macronutrients in a bone defect when it is replaced by bioceramics with various mass ratio of calcium phosphate and silicate.

MATERIALS AND METHODS: The study was performed on male rabbits of the “white giant” breed, which, after receiving a standardized delimited metaphysical bone defect, implants with variable ratio of calcium phosphate and calcium silicate (in proportions of 40/60, 50/50 and 60/40 wt. %) were used to replace it. The results were evaluated using multispiral computed tomography and scanning electron microscopy energy dispersive analysis with detection by the method of correlation analysis of possible connections between the obtained data.

RESULTS: Quantitative indicators of calcium and phosphorus content in bone regenerate in all groups increased mainly in the period from 30 to 60 days, and silicon content, reaching maximum amounts by the 30th day of the experiment, subsequently decreased monotonously, which showed participation of this element in the starting regenerative processes, and its decrease served as a marker of organotypic restructuring. In the elemental analysis of newly formed bone tissue during implantation of bioceramics containing phosphate and calcium silicate in the proportion of 60/40 wt. %. The highest amounts of calcium, phosphorus and silicon and the highest density of newly formed bone tissue were noted, which had direct correlation, and this pattern was observed both in the early stages (30 days) and throughout the experimental study.

CONCLUSION: Analyzing the data obtained, it can be concluded that it is advisable to study the features of the course of reparative osteogenesis depending on the ionic environment, as well as the high potential of using synthetic bioceramics in general and the prospects of using implants on the basis of phosphate-silicate composites for bone defects replacement.

This is a literature review on kyphoscoliotic deformities with a high risk of severe primary neurological deficit. The review is integrative in nature and was conducted using medical literature databases and search resources such as PubMed, Google Scholar, and eLibrary. The following aspects are covered: the etiology and pathogenesis of neurological deficits caused by the natural progression of deformities, the main principles, and directions of surgical treatment for neurologically complicated spinal deformities. The scientific literature describes the primary mechanisms of neurological deficit development: mechanical compression and traction of the spinal cord, as well as impaired circulation at the apex of the deformity. Surgical methods for treating neurologically complicated kyphotic and scoliotic deformities have evolved with advancements in spinal instrumentation and approaches. In the first half of the 20^th century, various spinal canal decompression methods were described, including laminectomy, costotransversectomy, spinal cord mobilization, and spinal canal remodeling. In the second half of the 20^th century, the development and active use of spinal instrumentation (sublaminar hooks, pedicle screws) enabled simultaneous decompression, fixation, stabilization, and correction of spinal deformities. Combining different stabilization and deformity correction methods with concurrent spinal canal decompression creates the conditions for restoring spinal cord function, leading to a regression of neurological deficits and preventing severe patient disability.

Background: Surgical treatment of diabetic neuroosteoarthropathy is a complex area in traumatology — orthopedics not only because of severe biomechanical disorders and gross deformations of the distal segment of the lower limb, but also because these phenomena are accompanied by many disorders of the somatic status. Of particular importance is a pronounced decrease in bone mineral density. This case is intended to illustrate the features of the treatment of this pathology.

Clinical case description: A clinical case of treatment of a 34-year-old young female patient with type 1 diabetes mellitus, development of diabetic neuroosteoarthropathy (Charcot foot), and aseptic necrosis of the talus of the right foot is presented. From 2019–2020 conservative and surgical treatment was carried out aimed at stopping the active stage of Charcot foot, correcting deformity and stabilizing the distal segment of the limb (calcaneotibial arthrodesis). A satisfactory treatment result was achieved, complete activation 8 months after the operation. However, in 2021 The patient suffered a closed low-energy fracture of the distal metaphysis of the right tibia. Regarding this episode, the patient comes in at the stage of consolidation of a displaced fracture and complaints of recurrence of varus deformity, even greater shortening of the limb, and swelling of the ankle joint. The fact of injury is denied, which allows us to regard the existing fracture of the tibia as pathological. In this regard, an operation was performed: osteotomy of the fibula and tibia in the area of consolidation of the pathological fracture in order to correct the deformity and compensate for the existing shortening of the limb due to the formation of a distraction regenerate. During the treatment, malnutrition and delayed formation of bone regenerate were noted, which required prolonged use of an external fixation device and specific drug therapy aimed at stimulating osteogenesis and improving bone mineral density. At the end of the course, there was an increase in the mineral density of the tissue, the density of the regenerate radiologically and laboratory (control of bone formation markers) and a satisfactory functional result.

CONCLUSION: A successful result in this clinical case was achieved by combining orthopedic surgical and conservative treatment with specific drug therapy in a comorbid patient with reduced bone mineral density and a high probability of complications in a multidisciplinary approach.

BACKGROUND: The issue of full-thickness osteochondral defect replacement in the talus is highly relevant. Bone autografting has proven effective in treating patients with this pathology, but the method has its drawbacks. The implantation of two or more bone autografts in large osteochondral defects may result in reduced contact strength between the donor bone and the recipient’s surrounding bone, leading to the formation of cysts and autograft instability.

Clinical cases description: We present two clinical cases for your consideration. In the first case, chondroplasty of the talus was performed with mosaic implantation of bone autografts. Six months later, due to instability of the bone autograft accompanied by pain, ankle joint arthrodesis was performed. Six months postoperatively, the pain score on the VAS scale decreased from 7/10 to 3/10, the AOFAS score was 74/100, and the FAAM score was 70/84. In the second clinical case, a modified mosaic chondroplasty using AMIC technology with provisional fixation of bone autografts with a pin was performed. Six months later, CT scans showed osteointegration of the bone autografts without the formation of subchondral cysts. The questionnaires also demonstrated positive dynamics: the VAS score decreased from 7/10 to 1/10, the AOFAS score improved from 70/100 to 90/100, and the FAAM score increased from 72/100 to 83/84.

CONCLUSION: The leading criterion for a successful bone autograft procedure is the stability of the autograft, which is achieved through adequate graft length and secure fixation. The proposed method of provisional fixation of the bone autograft with a pin during mosaic chondroplasty is a reproducible, effective, and cost-efficient technique that ensures the stability of the bone autograft and maintains its press-fit contact with the talus.

The article presents historical information about the creation of the school of traumatology and orthopedics in Arkhangelsk, in memory of its founder V.F. Tsel (1898–1974), who made a huge contribution to the formation and development of the Northern Medical Institute itself, as well as his students and followers.

On 23 August 2024, Anatoly Nikolayevich Shalnev, Doctor of Medical Sciences, winner of the Russian Government Prize in the field of science and technology, one of the oldest employees of the National Medical Research Center of Traumatology and Orthopedics named after N.N. Priorov, passed away at the age of 82. The staff of National Medical Research Center of Traumatology and Orthopedics named after N.N. Priorov mourns the irreparable loss.