Vol 27, No 4 (2020)

The article presents a clinical case of step-up surgical treatment of spinal canal stenosis at the craniovertebral and thoracolumbar level in a patient with mucopolysaccharidosis (MPS) type VI. The treatment method gives an opportunity to achieve a satisfactory result at the background of severe metabolic disease.

Introduction. Reviews dedicated to surgical treatment of the first carpo-metacarpal joint repeatedly state that the evaluation of arthroplasty results is difficult. This is due to the small clinical study groups and the lack of description of all types of outcomes.

The aim of the study is to analyze obtained early and midterm results of ceramic CMC-arthroplasty. The endoprosthesis are represented with unbound proximal and distal components made of ceramic material. The interaction of the head and cup is represented with no intersecting forces that impede on the multi-axial movement. The surgical technique of CMC-1 joint arthroplasty prescribes the installation of components by the press-fit fixation. There is a brief emphasis on the features of the joint and contributing factors for the development of risarthrosis. Early results are described. Cases of unsatisfactory outcomes are described separately.

Materials and methods. The study group included patients from 33 to 72 years. The total number of observers was 28 people. We performed revision endoprosthetics in 2 cases (7%), which were associated with aseptic instability of the proximal component according to the osteoporosis. It obvious that endoprosthetics is the only method of orthopedic care that allows maintain mobility and achieve stability of the destroyed CMC joint. Evaluation of the results was carried out by clinical and instrumental methods.

Results. It cannot be denied that the CMC arthroplasty is the only method of orthopedic care that allows to preserve mobility and achieve stability of the broken joint.

Conclusion. Arthroplasty of the carpo-metacarpal joint with ceramic implants is a promising method of orthopedic care, that allows to restore the function of the hand.

Knee arthroplasty is recognized as the “gold standard” in the treatment of stage III–IV degenerative diseases and the consequences of traumatic injuries. The number of surgeries is growing, and the number of complications after considered interventions is growing as well. Frequency of peripheral nerve neuropathies is not high, but damage to the peroneal nerve after total arthroplasty of the knee joint can lead to severe dysfunction of the lower limb, decrease in daily activity and the patient’s quality of life. The article analyzes the treatment results of 254 patients after primary and secondary knee arthroplasty. Signs of damage to the peroneal nerve upon admission to the second stage of rehabilitation were identified in 3.9% of cases. The clinical and functional examination performed in dynamics showed that the presence of neuropathy of the peroneal nerve aggravated the severity of the existing functional disorders in patients after knee arthroplasty. It has been established that complex intensive rehabilitation treatment, which should begin immediately after the diagnosis is made and be carried out intermittently for at least six months, restore the function of the affected nerve in 75% of cases.

Introduction: Chronic post-traumatic osteomyelitis is a complex problem of modern traumatology and orthopedics, affecting, in addition to medical, social and economic aspects of healthcare. When planning treatment, it is necessary to take into account the metabolic state of the bone tissue, since the effect of an infectious pathogen goes far beyond the “classical” lytic process, disrupting the balance of bone formation and bone resorption in various ways. The study is devoted to the study of the dynamics of parameters reflecting the metabolism of bone tissue in patients receiving complex therapy for chronic post-traumatic osteomyelitis of long bones.

Aim: To study the dynamics of metabolic disorders of bone tissue in patients with orthopedic infection of long bones and large joints under conditions of ongoing complex etiotropic and compensatory therapy for 6 months, the timing of bone tissue consolidation — within 2 years from the moment of surgery.

Materials and methods: The study was prospective, observational, comparative, exploratory, involving 138 patients with post-traumatic chronic osteomyelitis of the long bones. Complex therapy included a combination of surgical treatment with antibacterial, anti-inflammatory therapy and drug correction of the revealed disorders of bone metabolism. The timing of the consolidation of bone defects after treatment and the dynamics of indicators of bone metabolism were studied.

Results: The similarity of the periods of consolidation of different segments in the conditions of the described therapy was shown; the time period corresponding to the most pronounced dynamics of changes (correction) of violations was determined (3 months from the beginning of treatment); shows the effectiveness of metabolic therapy for the treatment of osteoarticular infections in various anatomical segments of the extremities. The results corresponds both to the results of the previous study and to the pathophysiological aspects of bone metabolism described in the literature.

Conclusion: the timing of consolidation in the treatment of metabolic disorders is generally similar; the greatest changes in the parameters of bone metabolism are recorded within 3 months after the start of therapy. Also, the metabolic therapy regimen can be considered as universal for all segments.

The analysis of modern domestic and foreign literature on the issues of surgical treatment of patients with diaphyseal forearm fractures is presented in the article, the main problems at these injuries are noted. The analysis has been carried out on the basis of databases of medical publications of CyberLeninka, eLibrary, PubMed and biliary databases. The treatment of complicated diaphyseal forearm fractures in the form of nonunions, pseudoarthrosis, defects and malunion is serious problem in traumatology and orthopaedics, because according to the literature data, unsatisfactory results in the treatment of this pathology reach 20–47%. This problem requires the development and implementation of modern functional methods of treatment, which would allow to combine the period of restoration of segment integrity with the period of rehabilitation without risk of osteosynthesis instability and nonunion. The problem of choosing the optimal tactics and methods of surgical fixation of these lesions remains a subject for discussion, which is the basis for scientific research on optimization of tactics and methods of surgical treatment of patients with consequences of diaphyseal forearm fractures.

The staff of the Federal State Budgetary Institution “National Medical Research Center of Pediatric Traumatology and Orthopedics named after G.I. Turner ”, the Russian Ministry of Health expresses condolences to the family and colleagues of Karina Surenovna. The bright memory of her will remain in our hearts, and her work will continue.