Traumatology and Orthopedics of Russia

SCImago Journal & Country Rank
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The peer-review medical journal was founded in 1993.

Founders

  • Vreden National Medical Research Center for Traumatology and Orthopedics (link)
  • Eco-Vector Publishing house (link)

Publisher

  • Eco-Vector Publishing house (link)

Editor-in-Chief

  • Rashid M. Tikhilov, MD, Dr. Sci. (Med.), Professor, corresponding member of the Russian Academy of Sciences
    ORCID iD: 0000-0003-0733-2414

About

The journal has been published since 1993 and is the first periodical in modern Russia that provides comprehensive coverage of current problems in traumatology and orthopedics. 

The journal's mission is to advance study results to clinical practice in order to improve and enhance trauma and orthopedic care for patients. In collaboration with leading clinicians and researchers, we aim to become the top Russian journal, providing national and international studies based on the principles of evidence-based medicine and increasing knowledge of the musculoskeletal system.

Goals and objectives of the journal:

  • to inform Russian and foreign readers about new experimental and clinical studies in traumatology and orthopedics;
  • to provide a platform for scientific discussions and consensus building on controversial aspects of diagnostics and treatment of musculoskeletal disorders in adults and children;
  • to promote wider cooperation between Russian and foreign specialists in traumatology and orthopedics in order to form a modern trauma and orthopedic practice.

 

Indexing


Publications

  • No APC
  • Platinum Open Access
  • Distribution with the CC BY 4.0 License
  • Quarterly publications
  • English and Russian full-text 

Announcements More Announcements...

 

'Traumatology and Orthopedics of Russia' journal accepted for indexing in SCOPUS

Posted: 20.07.2023

 

The 'Traumatology and Orthopedics of Russia' journal has been successfully evaluated and accepted for indexing in the SCOPUS database.

The Scopus Content Selection & Advisory Board (CSAB) has reviewed the journal and approved it for coverage. The message from CSAB was received on 06.04.2023.

Journal evaluation tracking URL: https://suggestor.step.scopus.com/progressTracker/?trackingID=BB218494DB461DC4 

All articles published in the journal from 2023 are subject for indexation.


 

Current Issue

Vol 30, No 3 (2024)

Editorials

History and formation of “Limb lengthening and reconstruction surgery — LLRS” as a subspecialty of orthopedic surgery
Green S.A., Solomin L.N.
Abstract

In 1998, the first meeting of members of the Association for the Study and Application of the Methods of Ilizarov (ASAMI) was held in the USA to introduce and popularize the methods developed in Kurgan by Professor G. Ilizarov and his staff. During 2005-2016, other communities worked in parallel with ASAMI, which went beyond the use of only the Ilizarov apparatus. Since 2017, the joint meetings have been called “Combined congress of the ASAMI-BR and ILLRS societies”. This actually became the basis for the definition of “Limb Lengthening and Reconstruction Surgery (LLRS)” as a subspecialty of orthopedic surgery that treats patients with nonunions, congenital and acquired long bone, large joints deformities of the upper and lower extremities. LLRS is based on the Ilizarov method and discovery (“Ilizarov effect”) with the rational use of external and internal fixation, osteotomy and soft tissue procedures. It takes at least three years for an orthopedic surgeon to become a specialist in the field of LLRS, and the education must be staged. A significant role in this is played by the ASAMI-BR & ILLRS congresses, ExFix & LLRS courses held in many countries, ExFix modules integrated into courses provided as part of the education of AO Trauma, as well as extensive world literature.

Traumatology and Orthopedics of Russia. 2024;30(3):5-11
pages 5-11 views

Clinical studies

Lower leg shortening technique in treatment of the wounded with gunshot tibial fractures
Artemev A.A., Kerimov A.A., Nelin M.N., Grigoryev M.A., Solovev J.S., Sysoev I.A.
Abstract

Background. The severity of gunshot wounds to the extremities is due to the formation of bone and soft tissue defects. The relevance of this publication is determined by the need to introduce simple and effective methods into the practice of providing assistance to the wounded. The technique under consideration fully satisfies these requirements.

The aims of the study: 1) to optimize the lower leg shortening technique and analyze the short-term results of its application in treatment of the wounded with gunshot tibial fractures; 2) to assess the indications for surgical restoration of the lower leg length after its shortening.

Methods. The study enrolled 45 wounded patients with gunshot fractures of the lower leg bones. Reconstructive interventions were performed on 51 segments. In the absence of purulent-necrotic lesions of the fragments ends, closed reduction and convergence to tight contact without resection were performed (13 cases, group I). In the case of necrosis of the fragments ends, resection and convergence were performed with significant shortening of the segment (38 cases, group II).

Results. The amount of shortening accounted for 4 cm [3; 6] in group I and 8 cm [7; 10] in group II (p<0.001). Due to the convergence of the fragments, the reduction of the soft tissue defect was 25 cm2 [11; 41] and 38 cm2 [20; 81] in group I and II respectively. In 2 (15.4%) patients in group I and 4 (10.5%) patients in group II no fusion occurred. In the remaining cases the fusion occurred, the consolidation period was 50 [45; 59] weeks in group I and 36.5 [29; 43] weeks in group II (p<0.001).

Conclusions. Depending on the condition of fragments ends, there are two possible options of the shortening technique: without resection and with resection of the fragments ends. Shortening without resection is possible in the absence of signs of fragment necrosis. The disadvantage is the risk of delayed fusion, the advantage is the ability to avoid traumatic intervention in the form of resection of the fragments ends. In case of the fragments ends necrosis, their transverse resection and convergence with the elimination of diastasis between them is necessary. The advantage of this shortening technique is the optimization of conditions and reduction of fusion time, the disadvantage is the formation of significant bone defects. The need for lengthening of the shortened segment does not always arise. Lengthening as a second stage after conducting rehabilitation is considered as an optimal choice.

Traumatology and Orthopedics of Russia. 2024;30(3):12-24
pages 12-24 views
Femoral malalignment deformity acute correction and gradual limb-lengthening by bifocal osteosynthesis with a monorail external fixator
Zhang K., Yu Y., Wang F., Zhang H., Li S., Cao Y., Kang Q., Xu J.
Abstract

Background. Patients with limb-length discrepancies often present with concomitant distal femoral varus or valgus deformities. With the development of distraction osteogenesis, both deformity correction and limb-lengthening can be performed simultaneously. This novel procedure is being increasingly preferred not only by experts due to the technical advance it implies, but also by patients.

The aim of this study was to identify the clinical efficacy of distal femoral malalignment deformity correction and gradual limb-lengthening by bifocal osteotomies.

Methods. We analyzed 32 femurs from 30 patients (mean age — 23.8 years) who had undergone bifocal osteotomies followed by the use of the monorail external fixator to correct the distal femoral malalignment deformity acutely and limb-length discrepancy gradually from June 2012 to May 2020. Pre-operative clinical and radiographic data were also obtained. During the follow-up period, deformity correction and bone healing were assessed, complications were identified, and functional outcomes were evaluated.

Results. The mean follow-up period was 57.2 months for all the patients. The mean mechanical axis deviation improved from 66.4 mm pre-operatively to 7.5 mm. In patients with varus deformity, the mean mechanical lateral distal femoral angle (mLDFA) decreased from 121.2° pre-operatively to 90.2° after surgery; whereas in patients with valgus deformity, the mean mLDFA improved from 59.2 to 87.1°. The magnitude of lengthening achieved averaged 6.3 cm, and the mean bone healing index was 34.8 days/cm. The final scores defined by the Association for the Study and Application of the Methods of Ilizarov (ASAMI)-Paley were excellent in 93.3% of patients.

Conclusions. Acute correction of femoral deformities and gradual lengthening with a monorail external fixator following bifocal osteotomies can be used to treat femoral shortening and distal malalignment deformity. Functional and cosmetic improvements are expected after surgery and post-operative rehabilitation.

Traumatology and Orthopedics of Russia. 2024;30(3):25-33
pages 25-33 views
Bone-periosteal-muscle flap for ulnar lengthening in children with congenital radial club hand
Avdeychik N.V., Grankin D.Y., Zakharyan E.A., Galkina N.S., Safonov A.V.
Abstract

Background. Congenital radial club hand is characterized by the underdevelopment of all forearm structures. Ulnar bone shortening ranges from 24.7% to 50.0% compared to the intact limb.

The aim of the study was to evaluate the outcomes of ulnar lengthening by distraction osteogenesis in patients with congenital radial club hand type IV who underwent osteotomy with the formation of a bone-periosteal-muscle flap, and to compare these results with the treatment outcomes of the patients who had standard (oblique) ulnar osteotomy.

Methods. The main group consisted of 20 patients who underwent osteotomy with the formation of a bone-periosteal-muscle flap during ulnar lengthening between 2019 and 2022. The control group included 19 patients (22 forearms) who underwent oblique ulnar osteotomy between 1998 and 2018. The following indicators were evaluated: length of the regenerate, distraction time, correction period, fixation index, osteosynthesis index, and complications.

Results. A lengthening of 4.1 cm was achieved (30.7% of the initial ulnar bone length). The correction of angular deformity was 71.4%. Greater correction was achieved with osteotomy in the proximal ulna. In the subgroup with proximal segment osteotomy, the distraction and osteosynthesis indices were 25.6 and 25.7 days/cm, respectively. In the mid-third osteotomy group, these indices were 42.3 and 42.6 days/cm, respectively. Complications were limited to inflammatory phenomena in 30% of cases. All patients in the main group exhibited successful regenerate formation. Thus, the bone fragment with a periosteal-muscle pedicle serves as an additional source of osteogenesis during distraction.

Conclusions. This study demonstrates the appropriateness of osteotomy with the formation of a bone-periosteal-muscle flap in children with congenital radial club hand. This technique allows for greater deformity correction, a shortened regenerate formation period, and a reduction in complications.

Traumatology and Orthopedics of Russia. 2024;30(3):34-43
pages 34-43 views
Treatment of children with forearm deformities using the Ortho-SUV navigation system
Ryzhikov D.V., Belousova E.A., Pozdeev A.P., Vissarionov S.V.
Abstract

Background. Children with congenital dysplastic skeletal disorders often develop various multi-axial bone deformities in the forearm during growth, most commonly occurring against the backdrop of polyosseous exostotic chondrodysplasia. The main surgical treatment method for these children is currently external fixation. To correct pronounced angular deformities of the forearm bones, the use of a passive computer navigation system can be advantageous.

The aim of the study is to compare the outcomes of correcting multi-axial deformities of the forearm bones in children using the Ortho-SUV navigation system versus without its use.

Methods. The study is based on the analysis of examination and treatment results of 36 patients aged 4 to 16 years with forearm deformities associated with exostotic chondrodysplasia. All patients were examined and treated between 2008 and 2022 and were divided into two groups: the main group and the control group. The main group consisted of 13 patients who underwent the correction of forearm bone angular deformities using the Ortho-SUV navigation system based on passive computer navigation. The control group included 23 patients who had their forearm bone deformities corrected in the operating room by reducing bone fragments with an external fixator without the use of the Ortho-SUV navigation system.

Results. Comparative assessment of the anatomical and functional outcomes in the studied groups showed that good results were achieved in 52.7% of cases (n = 19), most of them in the main group (n = 13). Satisfactory results were obtained only in the control group, where 17 (47.2%) patients experienced satisfactory outcomes.

Conclusion. The use of the Ortho-SUV navigation system for correcting multi-axial deformities of the forearm bones in children allows for highly precise, dosed correction of all components of the deformities, achieving good radiological and functional outcomes.

Traumatology and Orthopedics of Russia. 2024;30(3):44-54
pages 44-54 views
The Russian version of the Hip Preservation Surgery Expectations Survey: translation and cross-cultural adaptation
Cherkasov M.A., Spetsialnyi D.V., Bogopolskiy O.E., Efimov N.N., Goncharov M.Y., Stafeev D.V.
Abstract

Background. Patients’ preoperative expectations are one of the most significant factors affecting the satisfaction rates after organ-preserving surgeries performed in the hip area. To date, there are no validated Russian-language methods to assess the expectations from hip preservation surgeries.

The aim of the study is — to carry out cross-cultural adaptation of the Hip preservation surgery expectations survey, as well as to assess the validity of its Russian version.

Methods. In order to preserve validity of the survey, we carried out its cross-cultural adaptation including forward translation, back translation, and pilot testing (pretesting). Validity of the final Russian-language version was assessed by interviewing 40 patients, which underwent hip joint arthroscopy due to femoroacetabular impingement.

Results. Cronbach’s α has accounted for 0.945, indicating a high level of internal consistency. Intra-class correlation coefficient (ICC) has amounted to 0.82 (95% CI: 0.56-0.93), which corresponds to good correlation and demonstrates retest reliability. The “ceiling” and “floor” effects have not been detected.

Conclusions. The Russian version of the Hip preservation surgery expectations survey is a useful and simple tool to assess preoperative expectations of patients with diseases of the hip joint. The survey makes it possible to structure and document the expectations and may be used in clinical practice and scientific studies.

Traumatology and Orthopedics of Russia. 2024;30(3):55-64
pages 55-64 views
Facet joint denervation in the treatment of patients with degenerative deformities of the lumbar spine.
Ptashnikov D.A., Masevnin S.V., Lim E.N., Normatov S.G.
Abstract

Purpose.  Analysis of the results of surgical treatment of patients with degenerative deformities of the lumbar spine operated using percutaneous and endoscopic denervation techniques.

Methods. Design: a retrospective monocentre cohort study. Study group - 58 patients (m/f: 16/42). Median age 64 (60-69) years, minimum follow-up period - 2 years. In 28 cases endoscopic denervation of the lumbar facet joints at the apex of the deformity on both sides was performed (group A), in 30 cases percutaneous radiofrequency denervation in the appropriate volume was performed (group В). The effectiveness of the performed treatment was evaluated on the basis of the dynamics of pain syndrome (VAS), patients' quality of life (ODI), as well as the frequency of complications and repeated surgical interventions.

Results. The groups were comparable in terms of sex, age, body mass index, deformity size and pain level (p > 0.05). Mean operative duration and radiation exposure were significantly higher with endoscopic intervention (p < 0.001). The endoscopic denervation group showed an earlier reduction in back pain syndrome compared to the percutaneous intervention group (p < 0.001). No reduction of pain syndrome was noted in 8 (26.7%) patients after percutaneous denervation. Repeated denervation was performed during the two-year follow-up period in 18 patients (60%) of the percutaneous intervention group and in 2 patients (7.1%) of the endoscopic treatment group (p < 0.001).

The analysis of the factors associated with the efficacy of percutaneous denervation showed the significance of the magnitude of deformation in the frontal plane. Thus, the efficiency of the performed percutaneous treatment decreased at the deformity value of 30° and more with a sensitivity of 77% and specificity of 67%.

Conclusion. A more pronounced decrease in the intensity of back pain syndrome with preservation of the effect during the whole period of follow-up was noted in patients after endoscopic denervation. According to our data, the low efficacy of percutaneous denervation is due to the use of this technique in patients with severe deformity of the lumbar spine.

Traumatology and Orthopedics of Russia. 2024;30(3):65-74
pages 65-74 views

Theoretical and experimental studies

Experimental identification of the corrective capabilities of the spring technique in addressing multiapical femoral deformities
Solomin L.N., Golovenkin E.S., Sabirov F.K., Veshnyakova A.V.
Abstract

Background. The technique of multiapical deformities correction with several orthopedic hexapods (one for each apex of deformity) is accepted as a standard one. However, usage of two or more hexapods on one segment is uncomfortable for the patient. Besides, software calculation for each of them is difficult and laborious for an orthopedic surgeon. Application of only one orthopedic hexapod with one software calculation is the advantage of the spring technique (ST) of multiapical deformities correction. However, its application is hindered by the fact that the corrective capabilities of this technique have not been studied yet.

The aim of the study was to identify by the bench test the corrective capabilities of the spring technique and compare them with the capabilities of the standard one.

Methods. The bench test was performed using plastic models of the femur. One-ring modules were used to fix each of the bone fragments. Foam rubber discs were used to imitate soft tissues. The mobile ring was moved relative to the base one in translation, angulation, distraction and rotation. The movement was stopped if one of the struts reached its minimum or maximum length, as well as if one of them touched a frame, transosseous elements or “soft tissues”. The Mann-Whitney U-test was used for statistical analysis.

Results. When using all the six struts equipped with standard threaded rods, the corrective capabilities of the spring technique are 58-97% (on average 72%) lower than of the standard one. When replacing 2-6 (depending on the type of motion) threaded rods with longer ones, the capabilities of ST increases by 36-466% (on average 257%). This provides better result for ST in translation (in three directions), varus and recurvation angulation.

Conclusions. Corrective capabilities of the spring technique in 5 out of 11 types of motions are better than the capabilities of the standard technic if struts of the orthopedic hexapod are equipped with threaded rods of greater length.

Traumatology and Orthopedics of Russia. 2024;30(3):75-84
pages 75-84 views

Case Reports

Artificial deformity creation in treatment of soft tissue wounds and lower leg bones defect: a case report
Khominets V.V., Mikhailov S.V., Shchukin A.V., Nagornyi E.B., Zhumagaziev S.E., Tsoy D.R.
Abstract

Background. The problem of treating wounded patients with defects of soft tissues and bones of the extremities continues to be relevant. One of the ways to close soft tissue defects, especially in case of bone tissue loss, after open fractures of the extremities is acute shortening and creation of artificial angular deformity of the segment.

The aim of the study — to demonstrate the possibilities of acute shortening and angulation of the segment as a technique to replace soft tissue and bone defects in treatment of a patient with a gunshot wound to the lower leg.

Case description. A 30-year-old wounded man was admitted to the clinic with an extensive defect in soft tissues and bones of the lower leg in the middle third. To reduce the wound size, acute shortening and angulation of the lower leg was performed. The intentional angular deformation was 24º, shortening — up to 8 cm. The residual soft tissue wound defect was closed with local tissues and split skin autograft. The tibia was fixed by the Ilizarov hinge-distraction apparatus with following gradual correction of the angular deformity. After that, one performed osteotomy of the tibia in order to eliminate shortening with the Ilizarov method (the distraction rate of 1 mm per day). After restoring the length of the lower leg, in order to replace the defect along the anterior surface of the tibia, a marginal “flake” was formed from a displaced fragment. At a follow-up examination, in 18 months after the injury the patient walks with full weight bearing on the injured limb without any additional means of support, continues to perform military service duties in accordance with his position.

Conclusions. The presented clinical case demonstrates that acute shortening of a limb segment with creation of artificial angular deformity is an effective method for temporary closure of a gunshot defect of soft tissues. The technique allowed closing critical soft tissue defect of the lower leg and restoring the anatomy (length) of the segment. Consequently, one was able to achieve satisfactory treatment results and restore the functions of an injured limb. Besides, acute temporary shortening technique eliminated the need to perform technically sophisticated and lengthy microsurgical reconstructions, which are associated with a flap replacement for closure of soft tissue defects in a shotgun fracture area.

Traumatology and Orthopedics of Russia. 2024;30(3):85-94
pages 85-94 views
Distraction of longitudinally split fragments using the Ilizarov method: a series of clinical cases of treating partial bone defects
Vandenbulcke F., Malagoli E., Kirienko A.
Abstract

Background. The Ilizarov method is a recognized technique for treating severe skeletal injuries, allowing for a comprehensive restoration of both bone and soft tissue components. Despite the fact that bone lengthening and transport are widely known techniques, distraction of a longitudinally split fragment is still used extremely rarely.

The aim of the study is to describe a series of clinical cases involving patients operated on using this technique.

Methods. We present a series of observations of five patients who underwent distraction of a longitudinally split fragment using the Ilizarov method between January 2006 and December 2022. Clinical information was obtained from case histories, all surgical interventions were documented. Postoperative examination was performed using radiography.

Results. A case series demonstrates the successful application of this technique for reconstruction of partial bone defects resulting from trauma or osteomyelitis. The study included five patients (4 men and 1 woman) who underwent surgery 4.8-34.0 months after trauma for a partial defect of the proximal tibia ranging from 4 to 8 cm in length. Distraction was performed in different directions along the sagittal and longitudinal axes. The time of external fixation ranged from 3.5 to 4.8 months, the external fixation index ranged from 0.49 to 1.22. The ASAMI (Association for the Study and Application of the Methods of Ilizarov) functional score at the follow-up examination was excellent in all five patients. The ASAMI bone tissue assessment showed excellent results in all patients, except for one patient with residual equinus (good result). No other complications were reported.

Conclusions. The Ilizarov method provides a minimally invasive and comprehensive approach to the elimination of partial bone defects, affecting simultaneously the skeletal and soft tissue components. Due to the longitudinal splitting during fragment transport and distraction osteogenesis, this method promotes bone and tissue regeneration and helps to avoid a volumetric bone defect and more complex segmental bone transport. Moreover, the role of transverse transport of the tibial cortex increases in the treatment of peripheral arterial diseases.

Traumatology and Orthopedics of Russia. 2024;30(3):95-104
pages 95-104 views
Lowering of the Patella — prevention and treatment of a rare complication during leg lengthening: a case report
Kirienko A., Vandenbulcke F., Malagoli E.
Abstract

Background. Changes in the level of the patella position are a well-known complication of knee replacement, reconstruction of the anterior cruciate ligament, high tibial osteotomy and consequences of injuries. However, this problem has not been disclosed in the literature in relation to distraction osteogenesis using the Ilizarov method.

The aim of the study is to describe such a rare iatrogenic complication as patella baja during limb lengthening by the Ilizarov method using a clinical case as an example.

Case description. In 2017, a 17-year-old teenager was injured in a head-on collision of cars at high speed. The patient was diagnosed with an open fracture of the left femur and fibula and tibia of the left leg. He was treated in another clinic using the Ilizarov apparatus for osteosynthesis of the femur, tibia and proximal osteotomy of the tibia to move the bone to fill the distal bone defect. At the end of the treatment, the patient had a moderate limitation of the knee flexion (180-80°). In 2018, the patient was admitted to our clinic due to osteomyelitis at the level of the consolidated fracture. A new resection of the osteomyelitis lesion and proximal osteotomy for bifocal osteogenesis were performed. During the treatment, limitation of knee flexion (180-120°) was developed and radiographic signs of low position of the patella were obtained. Given the progression of patella baja (the Caton-Deschamps index = 0.51), we were forced to return the patient to the operating room to restore the correct height of the patella.

Conclusions. The presented clinical case emphasizes the need for a more thorough assessment of the patella height after surgical treatment on the proximal tibia using the Ilizarov method. It is also noted that it is important to conduct a control MRI, which allows for a more detailed study of the initial position of the anterior tibial tubercle. In our case, early detection of complications allowed us to achieve complete recovery without any consequences.

Traumatology and Orthopedics of Russia. 2024;30(3):105-111
pages 105-111 views
Salvage of a comminuted proximal tibial polymicrobial infected non-union with antibiotic loaded bio-composite and intramedullary nailing: a case report
Stanley C., Woods R., Hassan M., McInerney N., Sheridan G.
Abstract

Background. Management of open proximal metaphyseal fractures poses a significant challenge and is fraught with complications. These injuries are severe, often accompanied by extensive soft tissue and vascular damage, leading to high risks of infection and long-term disability.

Case presentation. A 72-year-old male was severely injured in a road traffic accident. Plain X-rays and CT angiogram identified a comminuted proximal tibial fracture with transection of the popliteal artery and vein. Initial emergency treatment included fasciotomies, external fixation, and vascular primary repair. On the 12th day of admission, the patient underwent open reduction and internal fixation (ORIF) with dual plate fixation using a two incision technique. A plastic surgeon performed skin grafting, harvested from the patient’s thigh, to allow closure of his fasciotomy wounds immediately following ORIF. Four weeks post-operatively, the patient developed a wound breakdown over the lateral fasciotomy site, exposing the metal plates with a small defect developing on the medial fasciotomy wound in tandem. The patient’s course was further complicated by persistent polymicrobial infections. Over 6 months of antibiotic regimes, operative intervention was ultimately required. All of the infected metal implants were removed, the non-union sites were aggressively debrided. The tibial canal was reamed to prepare for a tibial nailing. An antibiotic loaded bio-composite was then inserted through the non-union sites into the canal followed by an intramedullary nail. A blocking screw was used to address the procurvatum deformity in the sagittal plane. The patient currently shows signs of recovery, mobilizing over short distances, weight-bearing with assistive aids and with healing wounds and early signs of callus formation on recent CT scans and plain X-rays.

Conclusions. The management of complex tibial fractures with vascular involvement demands an aggressive multidisciplinary approach and continuous adaptability in treatment plans to address the evolving challenges of such severe injuries. This case exemplifies the utility of injectable antibiotic-loaded bio-composites in a limb-salvage setting and their ability to provide high doses of local antibiotics to an infection site which, in conjunction with appropriate stable fixation and systemic antibiotics, can aid in eradicating and treating fracture-related infections.

Traumatology and Orthopedics of Russia. 2024;30(3):112-119
pages 112-119 views

Reviews

Lower extremity osseointegration — a review of the current experiences and expectations
Gross J.D., Grunfeld M., Rozbruch S., Reif T.J., Hoellwarth J.S.
Abstract

Transcutaneous osseointegration for amputees (TOFA), an alternative approach to limb-loss rehabilitation, offers an enhanced quality of life and mobility, overcoming some challenges associated with amputation. This review presents evolution, surgical techniques, patient selection principles, and outcomes associated with TOFA. Notable points include the recognition that press-fit osseointegration techniques and implants achieve the quality of life and mobility improvements with a single surgical episode. Infection remains the most common adverse event, but uncommonly requires additional surgery, and rarely requires implant removal. Press-fit osseointegration has proven suitable for rehabilitating a broad range of patients with pelvic, transfemoral, or transtibial amputation performed to manage trauma, cancer, infection, chronic pain, and deformity. This technigue is safe for patients with vascular disease, diabetes mellitus, short residual bones, and osteoporotic residual bones. This article serves as a central resource for understanding the principles and techniques of osseointegration.

Traumatology and Orthopedics of Russia. 2024;30(3):120-131
pages 120-131 views
Contemporary use of 3D printed jigs and guides for osteotomies around the knee: a systematic review
Walker J., Wang Y., Green N., Erbulut D., Alttahir M., Tetsworth K.
Abstract

Background. With improved accessibility of imaging and additive manufacturing, custom targeting guides and jigs are now widely accepted across many areas of orthopaedics. During orthopedic surgery, patient-specific guides assist in the accurate drilling and cutting of bone in conjunction with meticulous pre-operative planning. Given their increased uptake, it is important to define the lessons learned from recent clinical experience, and to document the reported benefits when using this technology intra-operatively.

The aim of this review is to evaluate the potential benefits of patient-specific guides for osteotomies about the knee, and to clarify what evidence currently exists to support their use.

Methods. A systematic review of PubMed, Embase, and Web of Science was performed for studies investigating the use of intra-operative patient-specific guides for realignment osteotomies about the knee. Randomised controlled trials, non-randomised studies, observational studies, case series, and case reports, as well as in vitro studies, were included. Screening was conducted with the Covidence software, and risk of bias was assessed with the Risk Of Bias In Non-Randomized Studies of Interventions (ROBINS-I) tool.

Results. A total of 38 studies satisfied the inclusion criteria: 21 of these included patient-specific instrumentation (PSI) for high tibial osteotomy, 6 with distal femoral osteotomy, 4 — for combined tibial/femoral rotational corrective osteotomies, 4 — in double-level osteotomies, and 6 — for intra-articular osteotomies. The main outcomes reported were accuracy of surgical correction, typically with reference to pre-operative plans, and execution accuracy based on radiographic measurements. Other common outcomes were operative time, intra-operative fluoroscopy, and operative costs. Many studies were observational in nature, with no control groups available for suitable comparison.

Conclusions. For corrective osteotomies about the knee, the literature suggests PSI has very strong potential to improve accuracy in achieving pre-operative targets. This was reported for both opening and closing wedge osteotomies of the femur, and for high tibial osteotomy. Some contradictory results have been reported for high tibial osteotomy, based on limited evidence from small studies that in many instances lacked controls for comparative analysis. Additional controlled trials are necessary to confirm the benefits of PSI for osteotomies about the knee, considering it has not yet been conclusively validated. The literature currently available indicates PSI can improve the accuracy of corrective osteotomies about the knee.

Traumatology and Orthopedics of Russia. 2024;30(3):132-147
pages 132-147 views
Detorsional guided growth — modern concepts and perspectives of clinical application: a review
Fomylina O.A., Vilensky V.A., Lesovaya A.A., Zhikharev K.O., Kornilov A.N., Malekov D.A., Kosulin A.V., Kuimova A.A.
Abstract

Background. Torsional deformities of the long bones in children are usually treated using correcting detorsional osteotomies with different types of osteosynthesis. However, this method is highly traumatic and can cause severe complications. Guided growth is the gold standard for frontal and sagittal planes deformities treatment in growing children. The technique is effective, minimally invasive, enables early weight-bearing and has lower complication rate. Recently, application of guided growth technique has been actively studied for horizontal plane deformities correction as well.

The aim of the review — based on a scientific literature analysis, to present possibilities of using guided growth technique for correcting torsional deformities of the long bones, as well as to define the ways of its improvement for further clinical application.

Methods. The search was performed in PubMed/MEDLINE, Google Scholar and eLIBRARY databases. For review, we included 8 articles (five animal experimental studies and three clinical studies), which were published from 2013 to 2023.

Results. Analyzed studies demonstrated the possibility of applying detorsional guided growth for horizontal plane deformities correction in growing children. Three main surgical techniques were suggested. Correction efficiency mainly depends on the interplate angle, proper plate positioning and longitudinal growth potential. Limitations of these studies were: a small group number; absence of preoperative CT scans in animal studies; torsional profile measurement using computed tomography was performed only in one of three clinical studies. There was also no preoperative planning of deformity correction/creation amount, so it was not possible to evaluate the accuracy of the suggested methods. The main complications were secondary deformities and limb length discrepancy.

Conclusions. Further clinical application of detorsional guided growth in children may be possible after solving the problem of secondary deformities and shortening and providing preoperative planning of the deformity correction amount.

Traumatology and Orthopedics of Russia. 2024;30(3):148-156
pages 148-156 views


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