卷 32, 编号 3 (2025)

BACKGROUND: Osteomyelitis remains a pressing problem due to its high recurrence rate and risk of serious complications. The situation is exacerbated by increasing antibiotic resistance, which reduces the effectiveness of conventional antibacterial therapy. In this context, the development of novel therapeutic strategies for osteomyelitis, especially in cases accompanied by critical bone loss, is of particular importance.

AIM: The work aimed to test an approach to the treatment of purulent-septic inflammation complicated by bone tissue loss using biocomposite bone implants impregnated with a gel exhibiting multifunctional pharmacological activity, providing local antibacterial, anti-inflammatory, and osteogenic effects. The efficacy of the approach was evaluated in a rat model of experimental osteomyelitis.

METHODS: The research methods included the development of polysaccharide gels with mechanical and rheological properties similar to those of soft tissues (G’ = 176–271 kPa, G’’ = 3.7–4.2 kPa), containing 250 mg/g of dry polymer of amikacin and vancomycin, 0.28 mg/mL of tenoxicam gel, and 12.83 ng/mL of a plasmid encoding bone morphogenetic protein (BMP), thereby ensuring the implants exert local antibacterial and targeted anti-inflammatory effects in combination with stimulation of bone tissue growth. Two types of nanoparticulate carriers of different diameters were introduced into the gel: hyaluronic gel nanoparticles with a bimodal size distribution (d = 100 and 3000 nm) for intracellular delivery of tenoxicam into phagocytic immunocompetent cells, and nanocapsules coated with a transfection agent (d = 50–100 nm) for transmembrane transport of the plasmid into non-phagocytic cells, whose ribosomes synthesize BMP-2, initiating differentiation via the osteogenic pathway. Antibiotics are released from the carrier only in response to bacterial attack on the implant via bacterial enzymes, ensuring a local concentration 200 times higher than the bactericidal threshold. Cytotoxicity, calculated per dry gel, was 1800 µg/mL. The minimum inhibitory concentration against Staphylococcus aureus 209P was 25 µg/mL, and the bactericidal concentration was 100 µg/mL.

RESULTS: Biocomposites impregnated with a drug-containing gel were found to effectively inhibit local bacterial infection, reduce the overall level of local aseptic inflammation, and promote bone regeneration in osteomyelitis.

CONCLUSION: The therapeutic approach to treating purulent-septic inflammation complicated by bone tissue loss using implants with multifunctional pharmacological activity should be regarded as promising.

BACKGROUND: Medical infrared thermography (MIT) is a method of recording thermal radiation from the surface of the human body, which allows to identify pathological conditions of the body at the preclinical stage, as well as to monitor the treatment and rehabilitation process over time. The advantages of this method include non-contact examination, non-invasiveness, harmlessness, lack of need for highly specialized personnel and expensive consumables.

AIM: To assess the condition of the lower extremities using medical infrared thermography.

MATERIALS AND METHODS: The present study refers to experimental, blinded, single-stage, selective, uncontrolled, single-center. The study included respondents aged 18–21 years with no history of somatic diseases of the lower extremities. During the study, thermographic images of the anterior and posterior surfaces of both lower extremities were performed, after which points were placed on each of them indicating the temperature of the specified areas. These points were selected according to the anatomical location of the vessels of the lower extremities. The main outcome is the average values of the percentage change in temperature; an additional one is the identification of the relationship between the percentage change in temperature and the volume of subcutaneous fat. The study duration is 2,5 months. The chi-square criterion was used to calculate the statistical significance of the study.

RESULTS: During this study, it was revealed that the physiological phenomenon of a decrease in temperature in the lower extremities from the proximal to the distal sections can be applied in practice (p <0.001). The graphs constructed in the course of the work proved that the percentage change in temperature does not depend on the state of subcutaneous fat, which differs from the temperature of anatomical points, the values of which completely depend on the volume of the fat layer in humans.

CONCLUSIONS: this study is the first step towards using average statistical data on the percentage change in temperature between anatomical points on the lower extremities in practice. Due to measurements, calculations and plotting, it has been proven that this method of thermographic examination is universal for people with different complexions and body mass index, which greatly simplifies its use in diagnostics by doctors of different specialties.

BACKGROUND: Various biomechanical options are used in surgical practice to fix osteochondral fragments, including support on a bone graft reinforced with subchondral wires, osteosynthesis with forked fixators, and specialized plates with screws placed directly under the articular surface fragments. In the work, a method of subchondral tensioned reinforcement was utilized.

AIM: The work aimed to evaluate and compare the fixation properties of different biomechanical osteosynthesis options for comminuted intra-articular fractures using porcine tibial bone models.

METHODS: An indented, single-center, non-blinded experimental study included two types of models that shared identical fracture configurations, bone defect parameters, and non-tensioned wire reinforcement: A, with the bone defect filled with a graft, and B, without a bone graft. The results of osteosynthesis in models A and B were examined: 1) plate osteosynthesis with support of the articular surface on a bone autograft, option A-I; 2) plate osteosynthesis with support of the articular surface on the plate’s fixing elements and the bone graft, option A-II; 3) plate osteosynthesis with fixation of articular surface fragments using U-shaped tensioned wires, option B-III; 4) osteosynthesis with fixation of the articular surface using tensioned subchondral wires in a modular plate-based fixation device, option B-IV. Testing was performed under static indentation on models from the proximal metaphyseal-epiphyseal region of porcine tibia.

RESULTS: The best fixation properties were observed in the tensioned subchondral reinforcement options B-III and B-IV compared with non-tensioned wire reinforcement (model A). When comparing the four biomechanical options, the best strength characteristics were observed in the variants with tensioned subchondral reinforcement: B-III and B-IV. In the study of Option A-II, the resistance of the biomechanical system to vertical load was lower than in Options B-III and B-IV. The worst variants were observed in option A-I.

CONCLUSION: The most effective fixation was achieved with tensioned subchondral reinforcement using U-shaped wires (B-III) and a modular plate-based fixation device (B-IV) without the use of an additional bone graft.

BACKGROUND: Infected wounds, including those resulting from blast and gunshot injuries as well as diabetic foot, are a significant medical concern due to the high risk of complications and the need for long-term care. Therefore, the search for effective and safe topical therapies remains relevant. We performed a comparative evaluation of the efficacy of selected combination antimicrobial drugs and an antiseptic in treating such wounds, analyzing their effects on tissue regeneration, microbial burden, and clinical outcomes.

AIM: The work aimed to assess the efficacy and safety of dioxomethyltetrahydropyrimidine + lidocaine + ofloxacin, dioxomethyltetrahydropyrimidine + chloramphenicol, and povidone-iodine in the treatment of infected wounds of various etiologies.

METHODS: A single-center, open-label, non-interventional, observational, randomized controlled study was conducted in 60 patients (40 with blast/gunshot injuries and 20 with diabetic foot). Three drug products were selected for comparison: dioxomethyltetrahydropyrimidine + lidocaine + ofloxacin (Oflomelid, Sintez, Russia); dioxomethyltetrahydropyrimidine + chloramphenicol (Levomecol, Nizhpharm, Russia); and povidone-iodine (Betadine, Egis, Hungary). Treatment involved daily wound care throughout the observation period. Treatment outcomes included changes in wound healing (area, depth, exudate volume), pain intensity, and microbiological and biochemical parameters.

RESULTS: Dioxomethyltetrahydropyrimidine + lidocaine + ofloxacin was associated with significantly greater changes in wound healing: reduction in wound area (p < 0.001) and depth (p = 0.008), and decreased exudate volume (72.7% of patients without exudate by visit 4). Pain reduction was also more pronounced in the dioxomethyltetrahydropyrimidine + lidocaine + ofloxacin group (p < 0.001). All therapies effectively suppressed the growth of Staphylococcus aureus; however, combination antimicrobial drugs outperformed the antiseptic by approximately 20%. Laboratory parameters improved in all groups, with antistreptolysin-O levels decreasing more significantly in the dioxomethyltetrahydropyrimidine + lidocaine + ofloxacin group (p = 0.009).

CONCLUSION: All evaluated therapies were effective and safe; however, dioxomethyltetrahydropyrimidine + lidocaine + ofloxacin demonstrated superior results for key outcomes: accelerated wound healing, reduced bacterial load, and improved subjective therapy assessments. This combination drug (antibiotic + regenerative agent + anesthetic) has the potential to become the treatment of choice for complex infected wounds, such as those caused by trauma or diabetic foot.

INTRODUCTION: Congenital radioulnar synostosis is a rare orphan condition that impairs a child’s ability to adapt to everyday life and causes difficulties in acquiring writing and hygiene skills. Parents of children with this condition typically note a pronated position of the forearm and hand, along with the absence of rotational movements in the forearm. The diagnosis is based on radiographs of the forearm, and the type of synostosis is determined according to the Cleary–Omer classification. There is no conservative treatment for this condition. Over 20 surgical techniques have been described, which makes the indications and choice of a particular surgical method a subject of ongoing debate.

CASE DESCRIPTION: This paper presents the clinical experience of treating congenital radioulnar synostosis in 12 children between January 2018 and March 2024. A total of 16 surgical procedures were performed: 14 derotational osteotomies at the synostosis level according to the Green technique with wire fixation, and 2 procedures using a combined method involving derotational osteotomy at the synostosis level with wire fixation and a corrective radial osteotomy in the middle third with plate fixation. The surgical technique and specific features of the fixation method are described in detail. Possible complications are discussed. Treatment outcomes were evaluated over a follow-up period ranging from 1 to 5 years postoperatively. All patients achieved functional positioning of the forearm in the neutral position, improved quality of life, and acquired new hygiene and learning skills. In the postoperative period, transient neuropathy of the deep branch of the radial nerve was observed in 5 out of 16 surgical interventions for congenital radioulnar synostosis, manifested by finger extensor paresis. One case of delayed consolidation was also noted following the two-level osteotomy.

CONCLUSION: Treatment of radioulnar synostosis at a younger age is less traumatic, as the deformity is not multiplanar and does not require additional corrective elements beyond forearm derotation. This procedure is effective in eliminating the pronated position of the limb and improving functional capacity without causing serious complications. Although the risk of complications increases with age at the time of correction, no statistically significant association was found. The current sample requires expansion for more accurate comparison of surgical techniques.

Recent advances in orthopedic technologies have significantly increased surgeons’ interest in robotic systems used for total knee arthroplasty. The use of robotic platforms in routine clinical practice enhances the precision of implant component positioning, improves soft tissue balance, and potentially shortens postoperative recovery time. This work aimed to provide a comparative overview of modern robotic systems utilized in primary total knee arthroplasty. A systematic search of scientific data was conducted in the PubMed, Scopus, ResearchGate, and eLIBRARY databases using relevant keywords in both Russian and English. The review includes randomized and non-randomized studies, meta-analyses, narrative reviews, and systematic reviews published over the past five years. Active and semi-active systems are identified and described in detail, along with their operating mechanisms, features of preoperative planning (image-based vs image-less), and differences between open and closed platforms. Comparative characteristics of the most widely used systems—ROSA, MAKO, VELYS, CORI, and Cuvis Joint—are presented, highlighting their advantages and limitations according to our opinion. The analysis demonstrates that none of the systems is universal; each has its own strengths and weaknesses, and the choice depends on the surgeon’s preferences, the team’s experience, and the capabilities of the medical institution. Despite the high cost of equipment and the need for specialized training, robotic technologies continue to develop rapidly and are being increasingly adopted in orthopedic surgery, including in Russia, underscoring their potential to improve treatment outcomes for patients with gonarthrosis.

Flatfoot deformity has historically been a complex problem, characterized by a combination of multiplanar deviations. To date, a wide range of classifications has been proposed, based on various principles—from posterior tibial tendon dysfunction, historically considered the primary cause of deformity, to segmentation by foot regions and specific types of deformities within them. A major challenge lies in the fact that foot deformity, as described below, does not follow a linear pattern, and various deformity combinations frequently occur, complicating its systematization. The work aimed to analyze existing and most widely used classifications of flatfoot deformity that have been proposed at different times and remain relevant in foot and ankle surgery, with emphasis on their features and limitations. A scientific data review was conducted using PubMed, eLIBRARY.RU, and CyberLeninka databases with the search terms классификация плосковальгусной деформации / classification of flatfoot deformity and flatfoot deformity. A total of 12 sources were selected for the review. The analyzed scientific data covered the period from 1988 to 2025. In the course of the review, an evident trend was identified toward more detailed segmentation of the deformity by different regions of the foot and the types of abnormalities within them. We observed a shift from hierarchical to faceted classifications, reflecting attempts to encompass the wide variability of deformities across all foot regions and their combinations encountered in clinical practice. And despite numerous attempts at systematization, there is still no universal classification that fully reflects all aspects of flatfoot deformity and satisfies the needs of clinicians in determining patient management strategies for this condition.

The use of radiolucent materials represents a relevant direction in the search for new technological solutions aimed at improving the performance characteristics of medical devices. This work presents a review and an analysis of the feasibility of using modern composite materials with radiolucent properties in external fixation devices (EFD). The most significant aspects of polymer composite application in medical devices are highlighted. The physical, mechanical, and radiological properties of composite materials best suited for the production of rod-beam and ring fixation systems are described. An additional advantage of radiolucent external fixation devices is their light weight, which is ensured by the lower density of polymer materials, serving as matrices for the composites used to manufacture EFD components, compared with metal alloys. The possibility of autoclave sterilization of polymer composite products is demonstrated, indicating their potential use as components of external fixation systems. Clinical cases involving external fixators with radiolucent components are reviewed, along with examples of commercially available (mass-produced) external fixation devices. The potential for 3D printing to be used in manufacturing EFD components is shown, although it is not currently considered a primary method for EFD production. Radiolucent external fixation devices made from modern composite materials enhance fracture reduction, allow for targeted radiotherapy at required doses, and improve radiographic visualization during intraoperative and postoperative periods. These benefits enable timely treatment adjustments and help reduce the risk of complications. This makes their development a promising scientific and industrial avenue aimed at solving specific clinical problems.

Today, traumatology and orthopedics are among the most important areas of medical care. Pirogov, Turner, Vreden, Chaklin, and Rozanov are traditionally recognized as the founders of these fields. Another figure who dedicated his life to the study of traumatology and orthopedics and deserves inclusion in this list is Nikolay N. Priorov. This work aims to present the most comprehensive information on the professional path of Academician Priorov as one of the founders of Russian traumatology and orthopedics, in honor of the 140th anniversary of his birth. The methodological foundation of the article includes a systemic approach based on the principles of historicism, objectivity, and scientific rigor, as well as general scientific methods (such as generalization, analysis, synthesis, and induction). The study is based on archival documents, scientific data, books, and articles. Priorov achieved outstanding success as a teacher, scientist, and physician. He held the titles of Doctor of Medical Sciences, Professor, Head of the Department of Traumatology and Orthopedics at several institutions, Academician of the USSR Academy of Medical Sciences, Honored Scientist of the Russian Soviet Federative Socialist Republic, Deputy Minister of Health of the USSR, founder of the Moscow and All-Union Societies of Traumatologists and Orthopedists, and a member of several international medical societies. One of his major achievements was the establishment of the Institute of Prosthetics and Treatment, which was later named after him. For 40 years, Academician Priorov served as its permanent director of this institution. Today, it is known as the Priorov National Medical Research Center for Traumatology and Orthopedics under the Ministry of Health of Russia. Of particular note is Priorov’s role as Chief Surgeon in the hospital directorates of the People’s Commissariat of Health during the Great Patriotic War. His work focused on organizing the treatment and rehabilitation of the wounded and disabled, with an emphasis on providing prosthetics and orthopedic devices as essential components of comprehensive rehabilitation. His experience in military medicine remains highly relevant today. For his contributions, Priorov was awarded two Orders of Lenin, the Order of the Red Star, the Order of the Badge of Honor, and numerous medals. This article provides new biographical details about Priorov, including his expeditions to Novaya Zemlya, Vaygach Island, and Yugorsky Shar, as well as the history of the foundation of the Central Institute of Traumatology and Orthopedics. This feature sets it apart from previous publications devoted to this outstanding scientist.

Edgar R. Mattis, doctor of sciences in medicine, passed away on september 4, 2025, at the age of 84. Dr. Mattis headed the patent group at the N.N. Priorov National Medical Research Center of Traumatology and Orthopedics for many years, making significant contributions to the scientific and technical development of these fields. His colleagues and students are devastated by this irreparable loss.