Vol 22, No 3 (2016)

CLINICAL STUDIES

COMPARISON OF DIFFERENT CORE DECOMPRESSION TECHNIQUES FOR TREATMENT OF EARLY STAGES OF OSTEONECROSIS OF THE FEMORAL HEAD

Tikhilov R.M., Shubnyakov I.I., Myasoedov A.A., Irzhansky A.A.

Abstract

Today one of the most interesting organ surgical interventions for patients with osteonecrosis of the femoral head are still different core decompression procedure. However, in the literature, we could not find any indication on what stage of the disease is different proposed techniques is the most effective.

Purpose of the study compare the results of different methods of core decompression in the early stages of the disease, before the development of hip osteoarthritis.

Materials and methods. From 2006 to 2015 we treated 84 patients (96 hips) with a diagnosis of osteonecrosis of the femoral head. The mean age of patients was 37,4±9,1 (from 18 to 71) years. Classification Association Research Circulation Osseous (ARCO) was used to determine the stage of the disease. 20 patients core decompression performed on stage II, 71 stage III and 5 in stage IV of disease. Core decompression by one tunnel 9 mm diameter was performed in 55 cases, and in 33 cases, the destruction of the core to the healthy bone has been made. Grafting of the residual cavity has been made by allogeneic bone, calcium sulfate, a combination of calcium sulfate and p3-calcium phosphate and p3-calcium phosphate. Eight joints operated by core decompression multiple tunnels of small diameter without subsequent plastic tunnels. We assessed the results on the basis of X-ray and CT scan data of the operated hip, and according to Oxford Hip Score at 3, 6 and 12 months, and then once in 1 year after surgery. In case of subsequent hip replacement was performed pathological examination area of core osteonecrosis of the femoral head.

Results. The average period of follow-up was 31,6 months (from 12 to 110 months). Preventing hip arthroplasty during this time managed in 43 cases (44.8%), 53 joints (55.2%), total hip replacement has been made in the period from 4 to 72 months (average 21.6 months) from the date of implementation of core decompression. The greater the number of good and satisfactory results have shown methods aimed at complete destruction of nonviable bone on the border of core osteonecrosis healthy bone.

Frequency of hip replacement is directly dependent on the stage of the disease.In the second stage of the disease hip replacement made in 4 cases (20%) at the third stage satisfactory performance were observed mainly in the case of small and medium sized core osteonecrosis of the femoral head (4, 18 and 16 of the joints 27, respectively). In the fourth stage of the disease arthroplasty was performed in all five cases.

Conclusions. Different techniques of core decompression are most effective before the formation of the Impressions of the loaded part of the femoral head, which corresponds to stage III ARCO classification inclusive. Efficacy techniques depends not only on the stage but also on the size and location core of osteonecrosis.

Traumatology and Orthopedics of Russia. 2016;22(3):7-21
pages 7-21 views

THE STUDY OF BLOOD FLOW DYNAMICS IN TIBIAL SUBCHONDRAL EPIPHYSEAL ZONE OF PATIENTS WITH GONARTHROSIS AFTER TUNNELIZATION AND INFUSING AUTOLOGOUS BLOOD WITH BONE MARROW ELEMENTS

Shchurova E.N., Biryukova M.I., Buravtsov P.P., Bunov V.S.

Abstract

Introduction. The knee osteoarthrosis leads to a significant reduction of working ability. as well as to disability of working-age people. Arthroplasty is dominated the main method in treatment of such patients. However, many orthopedists are more and more inclined to the surgeries which allow to preserve the knee anatomic-and-functional integrity and to delay the surgery of the knee total replacement for later periods. Subchondral tunnelization with infusing autologous blood with bone marrow elements is one of such methods. of treatment for the patients of this category.

Purpose to study the dynamics of the blood flow in the tibial epiphyseal subchondral zone after tunnelization and infusing autologous blood with bone marrow elements and its effect on the rehabilitation process of patients with gonarthrosis.

Material and methods. The work was based on the results of studying 26 patients with Degree grade 2-3 gonarthrosis. Surgical treatment included performing tunnelization of femoral and tibial condyles with infusing autologous blood containing bone marrow elements. Circulation of tibial subchondral epiphyseal zone was studied in the operation room, before surgery, after tunnelization and after infusing autologous blood. Blood flow registered using high-frequency ultrasonic Dopplerography. The patient functional condition and the pathology severity analyzed using complex index score.

Results. The significant (42-108%, р<0.05) increase in blood flow registered in tibial subchondral epiphyseal zone in patients with gonarthrosis after tunnelization of femoral and tibial condyles in 46.2% of cases, and the increased blood flow persisted after infusing autologous blood with bone marrow elements in 58% of the patients from this group. In patients with significant blood flow increase the index score rate of gait, muscle strength and mean rehabilitation criterion was reliably 23% (р<0.05), 21% (р<0.05) and 17.4% (р<0.05) more, respectively, comparing with the group of patients without the pronounced increase. The proportion of patients with the increase in the index score of gait, muscular strength, joint deformity, function, quality of life was also higher in the group of patients with blood flow rate increase.

Conclusions. The significant increase in blood flow of tibial subchondral epiphyseal zone after tunnelization and infusing autologous blood with bone marrow elements contributed to the improvement of joint function and quality of life in patients with gonarthrosis.

Traumatology and Orthopedics of Russia. 2016;22(3):22-30
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EFFECT OF LOCATION AND BONE GRAFT REMODELING ON RESULTS OF BRISTOW-LATARJET PROCEDURE

Malanin D.A., Tregubov A.S., Grunin S.V., Cherezov L.L.

Abstract

Introduction. Operation Bristow-Latarjet proved itself as one of the most effective and predictable surgical treatments. despite its widespread use, there are various complications associated with improper installation of the bone block and the violation of its remodeling.

Objective: To obtain new data on the effect of location and remodeling of bone graft block on functional outcome and stability of the shoulder joint in patients with recurrent anterior instability after the operation Bristow-latarjet.

Material and methods. The material for the study served as the analysis of results of treatment of 64 patients with posttraumatic recurrent anterior shoulder dislocation who underwent Bristow-latarjet operation. postoperatively, assessed a provision and the degree of bone remodeling unit according to computed tomography in the sagittal, axial slices, and through 3d modeling. To evaluate the functional outcome scale were used western Ontario Shoulder Index (wOSI) and Rowe scale.

Results. At the level of the articular surface (congruent or flattening) in the axial plane were 89% bone blocks, too medially or laterally arranged 9% and 2% grafts, respectively. On sagittal cT images in the middle third of the articular surface of the scapula was located 28% of the bone blocks at the bottom 60%, in the upper third of 12%. Analysis of the dependence of the results of treatment of graft positioning showed that patients with excellent and good summary on the scale WOSI and Rowe, had a correct location of the bone block in the middle and lower third of the articular process of the blade. It can be assumed that excessive lateralized or medialized bone block position in the axial plane of a more profound effect on the outcome than cranial displacement of the latter with the sagittal plane. Bony union of the graft was found by CT in 74% of cases, soft tissue 26%, the degree of resorption of the graft revealed 0-1 84% 2-3 degree in 26% of cases. In the last periods of the investigation summary measure according to the scales WOSI and Rowe after Bristow surgery was 80±5 and 450±50 points, after Latarjet surgery 80±5 and 430±60 points. (p<0,05).

Conclusion. Positioning bone graft block affected the results of operations Bristow-Latarjet. Patients with excellent and good summary on the scale WOSI and Rowe had a correct location of the bone block relative to the articular surface of the scapula. The best overall performance on scales wOSI and Rowe were observed in patients with the fusion of the bone graft and block bone resorption does not exceed 0-1 degree compared with patients having soft tissue fusion and resorption 2-3 degree.

Traumatology and Orthopedics of Russia. 2016;22(3):31-43
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CRUCIATE LIGAMENT RECONSTRUCTION

Korolev A.V., Ryazantsev M.S., Magnitskaya N.E., Afanasyev A.P., Ilyin D.O., Frolov A.V.

Abstract

Purpose: To evaluate long-term results of meniscal repair during arthroscopic ACL reconstruction.

Materials and methods: 45 patients who underwent meniscal repair during arthroscopic ACL reconstruction between 2007 and 2013 by the same surgeon were included in the study. In total, fifty meniscus were repaired (26 medial and 24 lateral). Procedures included use of one up to four Fast-Fix implants (Smith & Nephew). In five cases both medial and lateral meniscus were repaired. Cincinnati, IKDC and Lysholm scales were used for long-term outcome analysis.

Results: 19 male and 26 female patients were included in the study aging from 15 to 59 years (mean age 33,2±1,5). Median time from injury to surgical procedure was zero months (ranging zero to one). Mean time from surgery to scale analysis was 55,9±3 months (ranged 20-102). Median Cincinnati score was 97 (ranged 90-100), with excellent results in 93% of cases (43 patients) and good results in 7% (3 patients). Median IKDC score was 90,8 (ranged 86,2-95,4), with excellent outcomes in 51% of cases (23 patients), good in 33% (15 patients) and satisfactory in 16% (7 patients). Median Lysholm score was 95 (ranged 90-100), with excellent outcomes in 76% of cases (34 patients) and good in 24% (11 patients). Authors identified no statistical differences when comparing survey results in age, sex and time from trauma to surgery.

Conclusions: Results of the present study match the data from orthopedic literature that prove meniscal repair as a safe and efficient procedure with good and excellent outcomes. All-inside meniscal repair can be used irrespectively of patients' age and is efficient even in case of delayed procedures.

Traumatology and Orthopedics of Russia. 2016;22(3):44-53
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ESULTS OF MINIMALLY INVASIVE SURGICAL TREATMENT OF PATIENTS SUSCEPTIBLE TO PATHOLOGICAL FRACTURES DUE TO PROXIMAL FEMUR METASTASIS

Tikhilov R.M., Ptashnikov D.A., Grigoriev P.V., Mikailov I.M., Zasulsky P.J.

Abstract

Purpose. To study the effectiveness of minimally invasive surgical treatment of patients susceptible to pathological fractures due to proximal femur metastasis.

Materials and methods. A retrospective study was done for a group of 46 women of mean age 44.5 years (range 38 to 60 years). The histologic diagnosis of each patient was breast cancer. The overall survival of included patients was more than 18 months after intramedullary nailing and cement injection of the proximal femur. In first subgroup, 22 patients underwent intramedullary nailing and cement injection immediately after RF (radiofrequency) ablation. Second subgroup included 24 patients who underwent internal fixation of impending pathologic fractures without RF ablation. Pain relief was evaluated by visual analogue scale (VAS). Functional outcomes and life quality were assessed with MSTS and SF-36 scores.

Results. The authors obtained statistically significant differences in the scores dynamics on SF-36 scale.

Most of the patients continued comprehensive treatment as well as were receiving bisphosphonates after 18 months postoperatively. Hip function, assessed on MSTS scale, did not demonstrate statistically significant differences (83.2 for the first subgroup and 88.1 for the second). Pain syndrome in the early postoperative period was statistically lower in the first subgroup.

X-ray and CT examination of patients in the first subgroup revealed 2 cases of continued metastatic growth accompanied by cut-out syndrome, implant instability or severe pain. In the second subgroup, where prophylactic fixation was performed without radiofrequency ablation such complication was observed in 6 cases.

Conclusions. RF ablation and internal fixation of impending femoral pathologic fractures can be combined in one stage procedure. Such method proved feasibility and efficiency for treatment of osteolytic and mixed metastatic lesions of proximal femur with low incidence of implant-related complications and lower risk of revisions.

Traumatology and Orthopedics of Russia. 2016;22(3):54-64
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COMPARATIVE CHARACTERISTICS OF THE BONE MARROW FROM FEMORAL HEAD AND ILIAC BONE IN PATIENS WITH FEMORAL NECK FRACTURES

Borovkova N.V., Malygina M.A., Ponomarev I.N., Sakharova O.M.

Abstract

Increasing number of elderly patients with femoral neck fractures requires a search for an optimal treatment regimen based on a natural sustenance and regulation mechanisms of bone homeostasis.

Purpose of the study – to perform a comparative cellularity analysis of bone marrow obtained from femoral neck and iliac bone of elderly patients.

Material and methods. The experimental group included 29 patients with closed fractures of femoral neck, injured by falling on the side from a standing position. Bone marrow was obtained from femoral neck and iliac bone during procedure of screw internal fixation or hip replacement. In the control group, the authors used bone marrow harvested from the same anatomical areas of 10 cadaveric donors. Nucleated cells (NCs), hematopoietic stem cells (HSCs) and multipotent mesenchymal stem cells (MSCs) were counted in bone marrow by flow cytometry.

Results. Comparative study demonstrated that bone marrow from the hip of patients with fractures and cadaveric donors contained less concentration of NCs and HSCs than bone marrow from the ilium. However, the difference in concentration was significant only in the experimental group. At the same time, in patients with fractures the NCs concentration and absolute content of HSCs in bone marrow obtained from hip was significantly lower than those from cadaveric donors. Meanwhile, samples obtained from the iliac bone in the experimental and control groups had no significant difference. The authors also observed that concentration of HSCs and MSCs in the bone marrow from male hips was significantly lower than in females. As a result, male patients with fractures demonstrated difference in concentrations of HSCs samples from ilium and femoral neck reaching 84.6%, MSCs – 86.6%; females demonstrated differences of 68.9% and 69.2% respectively.

Discussion. The data collected allows suggesting that one of the main factor violating micro-architecture of bone and in development of osteoporosis is an alteration in the cellular composition of bone marrow. While MSCs are active in regeneration of bone tissue, increase in their concentration in the fracture zone can stimulate the healing. Thus, to improve treatment outcomes in patients with hip fractures after internal fixation with cannulated screws, it could be beneficial to use grafting of autologous bone marrow obtained from the iliac bone featured by a higher stem cells concentration.

Traumatology and Orthopedics of Russia. 2016;22(3):65-70
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FEATURES OF IMMUNE STATUS IN ADOLESCENTS WITH COXARTHROSIS

Chepeleva M.V., Teplenky M.P.

Abstract

Purpose: To Study immune status in patients with coxarthrosis consequent to treatment of congenital hip dysplasia and Perthes' disease as well as to determine additional variables indicating arthrosis progression.

Materials and methods: The authors analyzed results of preoperative immune examination of 13 male patients aged 11,4±0,7 years (10-13) with coxarthrosis of type I-II developed consequently to treatment of hip dysplasia and Perthes' disease. Based on obtained anatomical and functional outcomes the authors divided the patients into two groups. First group included 8 patients with postoperative improvement of joint function and absence of disease progression. Second group (5 patients) was featured by functional deterioration and arthrosis advancing.

Results: Patients of the second group demonstrated statistically significant elevation in certain parameters of humoral (circulating immune complex) and cellular immunity (CD3+HLA-DR (%), CD3+HLA-DR (109/l)) as well as interleukin-6.

Conclusion: Obtained results have proven that initial immune parameters (IL-6, circulating immune complex, lymphocytes with activation markers) can be used as additional variables for decision making in regard to option and advisability of reconstructive joint preserving procedures in patients with coxarthrosis consequent to treatment of hip dysplasia and Perthes' disease.

Traumatology and Orthopedics of Russia. 2016;22(3):71-78
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EVALUATION OF SAFETY AND EFFECTIVENESS OF HYLAN GF-20 IN PATIENTS WITH KNEE OSTEOARTHRITIS IN REAL LIFE PRACTICE: PRELIMINARY RESULTS

Kuropatkin G.V.

Abstract

Combined conservative treatment of osteoarthritis includes intra-articular injections of hyaluronic acid. The paper presents the interim results of a prospective observational multicenter non-comparative study conducted in accordance with routine clinical practice to assess the safety and effectiveness of Hylan GF-20 in patients with knee osteoarthritis. The primary objective of the study is to assess walking and rest pain severity by WOMAC VA3.1 scale after 26 weeks and 52 weeks compared to the baseline. To date, 42 patients completed the study (71.43% women, 28.57% men), patients mean age is 59.79 years. After intraarticular injection of Hylan GF-20 patients were examined after 3, 6 and 12 months. After 3 months a positive clinical response was observed: pain severity decreased by 51.31% (p<0,001) on WOMAC A, joint stiffness decreased by 51.02% (p<0,001) on WOMAC B, daily life difficulties decreased by 42.03% (p<0,001) on WOMAC C. The same tendency was observed in the following periods. By week 52 pain severity reduced by 53.25% (p<0,001) on WOMAC A, joint stiffness by 41.63% (p<0,001) on WOMAC B, daily life difficulties -by 47.55% (p<0.001) on WOMAC C. Level of clinical response didn't correlate with the osteoarthritis stage. Therapy resulted in improvement of life quality of patients with knee osteoarthritis by 36% (p<0,001) according to the questionnaire EQ-5D. The general patients status according to physicians improved by 33.96% (p<0,001) on VAS, and by 45.91% (p<0,001) according to patients response on VAS. By week 52 of follow-up 11,90% of patients demonstrated a decrease in required concomitant therapy of osteoarthritis. Given the chronic nature of the osteoarthritis it's the most important that the therapeutic effect of Hylan GF-20 maintains until week 52. The above results confirm the efficiency of intraar-ticular injection of hyaluronic acid in patients with knee osteoarthritis especially in early disease stage.

Traumatology and Orthopedics of Russia. 2016;22(3):79-87
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THEORETICAL AND EXPERIMENTAL STUDIES

OW FREQUENCY ULTRASOUND APPLICATION IN KNEE ARTHROSCOPY

Pedder V.V., Cherepanov D.E.

Abstract

Purpose: in vitro study of ultrasound dissection devices' impact on meniscus and knee cartilage as well as comparison of outcomes with familiar arthroscopic techniques.

Materials and methods. Meniscus and joint cartilage specimen obtained during total knee replacement were placed in a normal saline. All experiments were conducted no later than in 2 hours after obtaining and followed by histology of biopsy specimens. In the first series of experiment the authors performed meniscus dissection with ultrasound instrument «Scalpel», cold plasm ablator and surgical scalpel.

Results. The first series of experiments demonstrated disruption of fibers orientation on meniscus rim after dissection with scalpel; necrosis depth after coblation is 0,7-0,8 mm. Ultrasound dissection devices leave necrosis depth of 0,1-0,2 mm and smooth cartilage surface. The second series of experiments proved that after shaver application cartilage surface was coarse; certain necrosis sections of 16-90 nm were observed on relatively smooth cartilage surface after coblation. Application of ultrasound «Miller» device leaves smooth cartilage surface with no fibers, no signs of cartilage thinning and necrosis not exceeding 15 nm.

Conclusion. The results of experiments confirm that use of low frequency ultrasound dissection devices is advantageous as compared to mechanical and ablation cutting techniques while ensuring histologically proven atraumatic handling of biopsy specimens of meniscus and hyaline cartilage.

Traumatology and Orthopedics of Russia. 2016;22(3):88-98
pages 88-98 views

MODERN TECHNOLOGIES IN TRAUMATOLOGY AND ORTHOPEDICS

HE NEW METHOD OF MINIMALLY INVASIVE OSTEOSYTHESIS OF HUMERAL SHAFT FRACTURES WITH HELICAL PLATES

Kochish A.Y., Maiorov B.A., Belenky I.G.

Abstract

The purpose of investigation is to approve the new method of minimally invasive plate osteosynthesis in cases of diaphyseal humeral shaft fractures with helical plate.

Materials and methods. During experimental cadaveric part of the study implantation of long helical plate on humerus using minimally invasive technique on 14 fresh cadaveric shoulders was done. plate was inserted from two incisions 3-5 cm long in the upper part of the shoulder on the lateral side and in the lower part on the anterior side. Clinical part of the study included 31 patients with isolated humeral shaft fractures and humeral shaft fractures associated with fractures of proximal humerus and treated by minimally invasive fixation with helical plate.

Results. Cadaveric study included preparation and special measuring and showed that implantation of the helical plate in proposed way gives safe distances between plate and axial, radial, musculocutaneous, median nerves, main humeral vessels and tendon of the long head of the biceps.

Results of the clinical part of the study: radiological evidence of bone healing were observed on the 12 weeks in 10 from 28 cases (36%), on the 18 weeks in 18 from 25 (72%), on the 24 weeks in all 25 cases (100%). On the 24 weeks after surgery results on the DASH scale in average were 13±3,6 (from 3 to 36). Where in good results were in 17 (68%) cases, satisfactory in 8 (32%) cases. On the Constant Shoulder Score at the same time averege results were 80±4,63 (from 60 to 91). Exellent result was in 7 (28%) cases, good in 12 (48%), satisfactory in 5 (20%) cases and bad in one (4%) case with subacromial impidgement after wrong plate positioning. There were no any cases of vascular and neurological complications and nonunions.

Conclusion. Minimally invasive fixation of humeral shaft fractures with helical plates is safe and effective method of surgical treatment with good dynamic of functional rehabilitation and can be recommended for clinical use.
Traumatology and Orthopedics of Russia. 2016;22(3):99-109
pages 99-109 views

CASE REPORTS

CLINICAL CASE OF INFECTION TREATMENT AFTER ARTHROSCOPIC REPAIR OF ROTATOR CUFF

Dokolin S.Y., Artyukh V.A., Kuzmina V.I., Liventsov V.N.

Abstract

Actual principles of implant associated infection treatment require determined approach already in early symptoms stage. The paper describes a clinical case of infectious complication treatment after bone-tendon repair of supraand infraspinous muscles with anchors. Following conservative treatment with no positive dynamics the authors performed two stage surgical treatment of implant associated shoulder infection. First stage included radical debridement, removal of implants and filling the defect in left humeral head with antibacterial spacer. Following infection eradication, the second stage included arthroscopy of the left shoulder, spacer removal, grafting of defect and revision left rotator cuff repair using anchors.

The present clinical case demonstrates a lack of alertness in respect of possible postoperative infection, insufficient treatment experience of general orthopaedic surgeons and overall complexity of radical surgical procedure for treatment of such patients.

Traumatology and Orthopedics of Russia. 2016;22(3):110-116
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DIROFILARIASIS OF TENDINOUS SHEATH OF EXTENSOR POLLICIS LONGUS IMITATING DORSAL HAND GANGLION CYSTI A CASE REPORT

Sosnin D.Y., Kozyukov V.G., Kadyntsev I.V., Taskaev A.L., Shchekotova A.P., Karimova N.V., Galimova А.А.

Abstract

Early diagnostics for parasitic diseases of musculoskeletal system is rather challenging due to rare occurrence of described pathology.

The authors review a clinical case of a female patient, 49 years old, with dirofilariasis of tendinous sheath of extensor pollicis longus. The patient was admitted to hospital with a diagnosis of dorsal hand ganglion cyst. Correct diagnosis was made only after parasite extraction during surgical procedure. The authors discuss issues of differential diagnosis of such disease as well as dorsal hand ganglion. Diagnosis can be confirmed by preoperative ultrasound scans of hand soft tissues.

Traumatology and Orthopedics of Russia. 2016;22(3):117-121
pages 117-121 views

REVIEW

POSSIBILITIES OF CURRENT CELLULAR TECHNOLOGIES FOR ARTICULAR CARTILAGE REPAIR (ANALYTICAL REVIEW)

Bozhokin M.S., Bozhkova S.A., Netylko G.I.

Abstract

Despite a wide variety of surgical procedures utilized in clinical practice for treatment of articular cartilage lesions, the search for other options of articular reconstruction remains a relevant and open issue at the current stage of medicine and biotechnologies development. The recent years demonstrated a strong belief in cellular methods of hyaline cartilage repair such as implantation of autologous chondrocytes (ACI) or cultures of mesenchymal stem cells (MSC) including techniques for genetic modification of cells.

The purpose of presented review is to summarize the published scientific data on up to date results of perspective cellular technologies for articular cartilage repair that are being developed. Autologous chondrocyte transplantation originally performed by Swedish researchers in 1987 is considered the first clinically applied technique for restoration of hyaline cartilage using cellular technologies. However, the transplanted cell culture featured low proliferative capacity and inability to form a regenerate resistant to high physical activity. Another generation of methods originated at the turn of the century utilized mesenchymal stem cells instead of autologous chondrocytes. Preparation of MSCs is a less invasive procedure compared to chondrocytes harvesting and the culture is featured by a higher proliferative ability. Researchers use various biodegradable carriers (matrices) to secure cell fixation. Despite good clinical mid-term outcomes the transplanted tissue-engineering structures deteriorate with time due to cellular de-differentiation. Next generation of techniques being currently under pre-clinical studies is featured by the preliminary chondrogenic modification of transplanted cell culture. Usage of various growth factors, modified cell product and gene-activated matrices allow to gain a stable regulatory and key proteins synthesis and achieve a focused influence on regenerate's chondrogenic proliferation and in result to form a good hyaline cartilage resistant to high physical load in long term period.

Thus, development of methods for articular cartilage repair has long ago went beyond the interests of clinical physicians, and only the close interdisciplinary cooperation of clinicians and specialists for cytology, molecular genetics and, probably, virology would enable replacement of a defect with a rigorous hyaline cartilage.

Traumatology and Orthopedics of Russia. 2016;22(3):122-134
pages 122-134 views

SURGICAL TREATMENT OF STIFFNESS AND MOTION DISORDERS OF UPPER LIMB IN CHILDREN WITH SPASTIC CEREBRAL PALSY (REVIEW)

Andreev A.A., Ryzhikov D.V., Gubina E.V.

Abstract

Specific upper limb disorders accompanying spastic cerebral palsy substantially restrict self-care, writing abilities, hinder movements with external support aids and limit work capability. Spastic upper limb represents a complex multilevel abnormality progressing with age and leading to increased suffering of the patient. Little interest towards surgical correction of spastic upper limb along with insufficient awareness on surgical rehabilitation options leaves considerable number of patients without relevant treatment.

The present paper describes advances and complexities of orthopaedic correction for spastic arm in ICP, key classifications used and treatment outcomes based on scientific literature analysis.

Traumatology and Orthopedics of Russia. 2016;22(3):135-145
pages 135-145 views

SCIENTIFIC INFORMATION

COORDINATED RESOLUTION OF EXPERT’S FORUM ON THE PROBLEM OF PAIN TREATMENT IN PATIENTS WITH OSTEOARTHRITIS BEFORE AND AFTER TOTAL HIP OR KNEE REPLACEMENT

Abstract

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Traumatology and Orthopedics of Russia. 2016;22(3):146-148
pages 146-148 views

ROUND TABLE «DIAGNOSIS, TREATMENT AND PROPHYLAXIS OF PERIPROSTHETIC INFECTION»

Abstract

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Traumatology and Orthopedics of Russia. 2016;22(3):149
pages 149 views

JUBILEE

POPKOV ARNOLD V.

Abstract

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Traumatology and Orthopedics of Russia. 2016;22(3):150-151
pages 150-151 views

OBITUARIES

SAVELIEV VLADIMIR I.

Abstract

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Traumatology and Orthopedics of Russia. 2016;22(3):152
pages 152 views

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