Vol 32, No 2 (2025)

BACKGROUND: Osteoid osteomas are benign bone-forming tumors that frequently affect the spine. The primary treatment method is surgical removal of the neoplasm. However, if osteoid osteomas are anatomically difficult to access, surgical intervention may require extensive resection of unaffected bone, resulting in loss of vertebral support and the need for further stabilization. Alternative techniques, such as percutaneous radiofrequency ablation and laser thermal ablation, are highly effective; however, their use is limited due to the proximity of the spinal cord and neural structures. Therefore, advanced navigation systems, as well as minimally invasive and endoscopic approaches, are required to enable localized osteoid osteoma resection without destabilizing the spinal segment. This approach prevents damage to supporting structures, especially when the tumor is located in the middle supporting column of the vertebra, eliminating the need for internal fixation.

AIM: The work aimed to review surgical treatment options in children with confirmed spinal osteoid osteomas and to assess the outcomes of minimally invasive and open surgeries, including in patients with lesions in the middle supporting column.

METHODS: The study included 36 patients diagnosed with spinal osteoid osteoma. The age range was 8 to 18 years. Surgical outcomes were evaluated based on the chosen approach, extent of resection, and the use of internal fixation.

RESULTS: Radiofrequency ablation was successfully performed in four patients with lesions located in thermally accessible areas. Open surgeries were performed in 32 cases. The most challenging cases were reported in seven patients with tumors located in the middle supporting column. Patients who underwent minimally invasive procedures had a shorter recovery period than those who had conventional (open) surgery.

CONCLUSION: A personalized surgical strategy, taking into account tumor location and optimal access route, with the use of advanced minimally invasive techniques, allows for optimal treatment outcomes in children with spinal osteoid osteomas. This approach ensures complete tumor resection with minimal surgical intervention, while preserving spinal column function.

BACKGROUND: There is currently no mandatory set of preoperative examinations for patients undergoing elective lumbar spine surgery for degenerative disorders, making it difficult to account for critical predictors and achieve predictable clinical and radiological outcomes.

AIM: The work aimed to define the scope of preoperative examinations in patients scheduled for decompression and stabilization surgery for degenerative lumbar spine disease.

METHODS: A retrospective cohort analysis was performed to identify predictors of successful outcomes following single-level decompression and stabilization. Based on the identified predictors and their threshold values, a set of essential preoperative examinations for decompression and stabilization surgery planning was developed. The effectiveness of the predictive model and the feasibility of the proposed set of preoperative examinations were assessed in a prospective patient cohort.

RESULTS: Multivariate analysis identified the following as significant predictors of treatment success: preoperative ODI score, preoperative HADS score, DN4 score, presence of interbody fusion, postoperative lower lumbar lordosis angle, bone mineral density in HU, and postoperative segmental angle. The threshold value for lower lumbar lordosis (Low LL, L4–S1) was 26° (sensitivity, 71.7%; specificity, 91.3%); the segmental angle (SL) threshold was 7° (sensitivity, 87.9%; specificity, 70.6%). The proposed set of essential preoperative examinations for single-level decompression and stabilization surgery planning includes clinical scales (ODI, HADS, DN4), standing spinal radiographs, and lumbar CT and MRI. This set of essential preoperative examinations resulted in a 9.3% increase in clinical success rate (from 74.8% to 84.1%).

CONCLUSION: The set of essential preoperative examinations includes three questionnaires (ODI, HADS, and DN4) and three imaging modalities (standing radiographs, lumbar CT, and lumbar MRI), all of which are typically available at specialized spinal surgery centers. This set is recommended for routine use by spine surgeons, given its role in achieving predictable success following single-level decompression and stabilization surgery of the lumbar spine.

BACKGROUND: Reverse shoulder arthroplasty is an effective surgical treatment for severe degenerative and post-traumatic conditions of the shoulder joint. However, despite its proven clinical efficacy, the optimal scope of medical rehabilitation required to maximize functional outcomes and quality of life remains unclear.

AIM: This study aimed to assess the efficacy of a specialized medical rehabilitation program after reverse shoulder arthroplasty based on modern techniques, including isokinetic dynamometry and biofeedback training.

METHODS: A comparative cohort study was conducted in 33 patients with omarthrosis who underwent reverse shoulder arthroplasty. The patients were divided into two groups. The treatment group (n = 17) underwent a structured rehabilitation program developed by the authors, whereas the control group (n = 16) did not receive organized rehabilitation. The primary endpoint was recovery of shoulder joint function, including range of motion, muscle strength, coordination, and patient-reported quality of life. Assessment methods included goniometry, isokinetic dynamometry, evaluation of complex coordinated movement abilities, volumetric analysis of upper limb motion using a spherical motion sector, and patient questionnaires (DASH, PSS, SF-36).

RESULTS: Patients who underwent the medical rehabilitation program had significantly better functional outcomes than the control group. Abduction range was 150° [150°–160°] in the treatment group vs. 107.5° [93.75°–140°] in the control group (p < 0.001). Flexion range was 160° [150°–165°] in the treatment group vs. 120° [107.5°–133.8°] in the control group (p < 0.001). External rotation range was also greater in the treatment group: 45° [40°–55°] vs. 25° [20°–36.3°], p < 0.001. Abduction strength reached 23.6 Nm [19.3–32.4] in the treatment group vs. 16.7 Nm [9.93–20.6] in the control group (p = 0.005). The spherical motion sector volume in the treatment group was 230,778 cm³ [207,921–268,565], exceeding that of the control group: 126,952 cm³ [107,894.25–151,971.3], p = 0.001. Correlation analysis revealed a strong positive relationship between shoulder joint range of motion and coordination parameters (r = 0.78, p < 0.001), as well as muscle strength (r = 0.71, p < 0.001). Moreover, higher patient-reported satisfaction scores (SF-36) were associated with increased muscle strength and greater external rotation range (r = 0.63, p = 0.002).

CONCLUSION: Implementing a comprehensive, personalized rehabilitation program after shoulder arthroplasty significantly improves functional outcomes. Optimized medical rehabilitation programs will improve the quality of medical care and long-term clinical outcomes in patients following reverse shoulder arthroplasty.

BACKGROUND: Currently, there is no etiological treatment for chronic nonbacterial osteomyelitis. The insufficient efficacy of all available treatment modalities remains a major concern. Among the most effective approaches are genetically engineered therapy and bisphosphonate treatment. Pamidronate is the most frequently reported option in scientific publications. However, given pamidronates’ lower efficacy compared to zoledronic acid, we developed a treatment protocol that includes zoledronic acid at a dose of 0.05 mg/kg every 3 months, three infusions in total, along with active vitamin D metabolites and calcium carbonate.

AIM: This study aimed to demonstrate the efficacy of zoledronic acid in the treatment of chronic nonbacterial osteomyelitis.

METHODS: The study included 22 children aged 6 to 17 years. A prospective pilot study was conducted to assess the efficacy of zoledronic acid in children with chronic recurrent multifocal osteomyelitis. All patients underwent biopsy with morphological and microbiological verification of the diagnosis, as well as laboratory and imaging assessments before and 3, 6, and 12 months after treatment. Clinical disease activity was assessed using a visual analog scale for pain and the PedsQL 4.0 quality of life questionnaire.

RESULTS: Preliminary treatment outcomes in patients receiving this regimen are promising. Pain was significantly reduced, quality of life improved, and the number of bone lesions decreased, with clinical remission achieved in all patients.

CONCLUSION: Zoledronic acid rapidly inhibits osteoclast activity, leading to both clinical and radiological remission, as evidenced by decreased pain, reduction of bone marrow edema on MRI, and sclerosis of lytic lesions. Given the reduced osteoclast activity in the post-injection period, this therapy must be combined with active vitamin D metabolites and calcium carbonate to maintain calcium-phosphorus homeostasis.

BACKGROUND: An osteoporosis (OP) diagnosis technique based on routine CT examinations, which allows detecting radiological signs of OP, is currently being actively implemented. Given the issue of underdiagnosed compression fractures (CFs) on CT images, radiologists could benefit from artificial intelligence (AI) services.

AIM: This study aimed to assess the potential use of AI services for OP diagnosis based on routine CT findings for opportunistic screening.

METHODS: The project involved three health facilities (HFs). Chest CT scans obtained in these HFs between October 2022 and October 2023 in patients over 50 years of age were selected, in which AI services detected signs of OP (CFs and/or reduced vertebral bone density). All cases were re-evaluated by radiologists to identify potential errors made by the service. The final list of patients eligible for dual-energy X-ray absorptiometry (DXA) to confirm osteoporosis was provided to attending physicians in each participating HF.

RESULTS: Over a 12-month period, AI services analyzed 5394 CT scans. CFs and/or reduced vertebral bone density were identified in 1125 patients. Patients with a previously confirmed OP, as well as those who refused or were unable to undergo further testing, were excluded. A total of 66 patients underwent DXA. Age ranged from 54 to 86 years; the median (Q1–Q3) age was 70 (62–74) years; the male to female ratio was 21% and 79%, respectively. According to DXA findings, bone mineral density (BMD) values consistent with OP, osteopenia, and normal BMD were reported in 26 patients (39.4%), 37 patients (56.1%), and 3 patients (4.5%), respectively. Diagnostic performance metrics were calculated for both DXA and CT-based vertebral bone density assessment, with sensitivity of 0.71 vs. 0.91, specificity of 0.80 vs. 0.55, and accuracy of 0.76 vs. 0.67, respectively. Significant differences were observed between osteoporosis, osteopenia, and normal BMD groups, as well as between age-norm groups and those identified by AI services (p < 0.001).

CONCLUSION: The results support the use of AI services for diagnosing OP based on routine CT examinations as part of opportunistic screening.

BACKGROUND: The development of fracture-related infection disrupts osteoreparative processes at the fracture site, which may result in the need for repeated surgical interventions. It is well known that the etiology of fracture-related infection involves microorganisms, whose spectrum may vary considerably across healthcare facilities. Staphylococcus aureus and coagulase-negative staphylococci are the predominant pathogens in this condition, whereas Gram-negative bacteria, anaerobes, and fungi are less common.

AIM: The work is aimed to determine the spectrum and changes of major pathogens in patients with long bone fracture-related infection and post-traumatic chronic osteomyelitis treated with external osteosynthesis from 2019 to 2024.

METHODS: A single-center retrospective analysis was conducted based on microbiological findings in 247 patients with long bone fracture-related infection and chronic osteomyelitis as its sequela, all treated with external osteosynthesis. The spectrum of major pathogens and their changes over time were examined. The statistical analysis was performed using Pearson’s chi-square(χ²) test.

RESULTS: Positive cultures were obtained in 70.4% of cases, whereas 29.6% were negative. A total of 230 microorganisms were identified: 158 (68.7%) Gram-positive, 71 (30.9%) Gram-negative, and 1 (0.4%) fungal isolate. Monomicrobial infections were revealed in 76.4% of cases, whereas in 23.6% of cases, the infection was polymicrobial. A microbial shift was observed in 18.4% of patients: in 15.5% during treatment and in 2.9% upon recurrence.

DISCUSSION: The major causative pathogens of fracture-related infection were S. aureus (36.9%), S. epidermidis (10%), K. pneumoniae (9.1%), E. faecalis (7.8%), A. baumannii (6.1%), P. aeruginosa (4.3%), E. cloacae and Corynebacterium (3.5% each). Between 2019 and 2024, the incidence of MRSE and E. faecalis increased from 0.6% to 5.7% and 8.2%, respectively; Corynebacterium from 0% to 3.2%; K. pneumoniae from 2.8% to 12.7%; and E. cloacae from 1.4% to 9.9%. A microbial shift during treatment was observed in patients with open fractures and extensive soft tissue defects. Microbial composition showed unpredictable variation. In cases of recurrence, the primary isolate was often replaced by MSSA, E. faecalis, or Corynebacterium.

CONCLUSION: Despite an increasing proportion of MRSE, E. faecalis, Corynebacterium, K. pneumoniae, and E. cloacae in the etiological structure of fracture-related infection, S. aureus remains the predominant pathogen.

BACKGROUND: Chronic subtalar dislocation can develop in patients with severe, long-standing flatfoot or in those with neuroarthropathy or neglected trauma. We report a rare case of chronic subtalar dislocation, wherein treatment was effectively performed employing subtalar joint complex arthrodesis, involving the talo-navicular and talo-calcaneal joints and cuboido-talar pseudoarthrisis.

CLINICAL CASE DESCRIPTION: A 55-year-old female patient was referred to the specialist orthopedic clinic with complaints of progressively worsening right ankle pain for 12 months. She had been diagnosed with acquired flatfoot five years prior, which had since deteriorated. Computed tomography revealed lateral dislocations of both the subtalar and talonavicular joints. A single-stage surgery using cannulated screws was performed for achieving arthrodesis. Within just 4.5 months of this procedure, the patient was able to bear weight and walk independently.

CONCLUSION: Incorporating talo-cuboid fusion is crucial for a stable outcome. The outcome seems to be unaffected by subtalar dislocation duration, provided the soft tissue and skin coverage are manageable.

Partial-thickness tears of the rotator cuff (RC) of the shoulder joint (SJ) are a common condition that causes pain and limits SJ function, significantly reducing quality of life. The prevalence of such tears reaches up to 32% among SJ injuries and disorders. Among all isolated RC tendon injuries, supraspinatus tendon lesions are predominant, accounting for up to 13%. This work aimed to conduct a systematic review of research assessing radiographic parameters of SJ bone anatomy as risk factors for RC injury, as well as the outcomes of surgical treatment for partial-thickness RC tears. A search was conducted in the eLIBRARY, PubMed, and Scopus databases. The search depth was 10 years (2013–2023). The inclusion criteria for the quantitative analysis were a mean follow-up duration of at least 6 months and a minimum of 10 cases per study. Following a keyword-based screening, 18 publications were included in the quantitative analysis. The most significant radiographic risk factors for RC tears included the critical shoulder angle (CSA), lateral acromial angle (LAA), and acromial index (AI). Two principal surgical techniques for managing Ellman grade III partial-thickness RC tears were identified: tear completion and transtendinous tendon repair. Both techniques yielded satisfactory outcomes; however, it remains unclear which method should be preferred. Although the majority of studies report a direct association between CSA and RC injury, this parameter requires further investigation, as angular values obtained from radiographs without adherence to the Suter–Henninger protocol may differ significantly from those obtained in accordance with the protocol, as well as from CT or MRI findings. The majority of publications did not consider parameters like LAA and AI to be key predictors of RC injury. The analyzed outcomes of surgical treatment for partial-thickness RC tears showed no significant differences despite the use of different surgical techniques, such as tear completion and transtendinous tendon repair. However, this issue requires further investigation, including subsequent assessment of tendon healing quality based on MRI findings.

Body temperature is one of the key indicators for diagnosing a variety of surgical and trauma-related conditions. Infrared thermography is one of the most relevant and widely used methods in modern clinical practice. This technique has not yet received general acceptance, and its use is currently underrepresented in the scientific community. The aim of this study was to analyze existing data on the practical significance and role of medical thermography in diagnosing and predicting postoperative complications in trauma patients. An analysis of both Russian and international publications was conducted to explore the potential and future prospects of medical thermography in current trauma practice. In orthopedic and trauma practice, infrared thermography is more commonly used to diagnose chronic musculoskeletal conditions such as scoliosis, osteoporosis, and osteochondrosis. In acute traumatic injuries, it is more commonly used for intraoperative and postoperative monitoring to prevent complications or enable their early detection, as treatment outcomes largely depend on timely and adequate diagnosis and identification of the primary injury. Opinions within the scientific community on the use of medical thermography remain divided. On the one hand, the vast majority of researchers studying the potential of medical thermography consider it a valuable supplement to conventional imaging methods. However, despite its numerous advantages and significant application potential, the technique has yet to be widely adopted. Infrared thermography is a promising diagnostic tool in modern medicine, especially in traumatology. Conducting more studies to explore its capabilities could help raise awareness and promote its integration into trauma care practice.

On May 16, 2025, Professor Vyacheslav Vasilievich Klyuchevsky, the prominent traumatologist and orthopedist, Honored Scientist of the Russian Federation, founder of the Yaroslavl School of Traumatology and Orthopedics, honorary member of the Association of Traumatologists and Orthopedists of Russia, Doctor of Sciences in Medicine, passed away at the age of 86 years. His students, followers, and colleagues mourn this profound and irreparable loss.