Vol 18, No 1 (2012)

Analysis of the results of surgical treatment of 63 patients with knee-joint pathology who were treated in Vreden’s Scientific-research Institute of traumatology and orthopaedics (Saint-Petersburg, Russia) within the period from 2000 to 2011. All the patients had pedicled flap transfer or free tissue transfer. 53 patients (84,1%) had additionally various orthopedic operations on the knee joint: 42 patients had primary or revision total knee arthroplasty, 6 patients had resections of bony tumors and total knee arthroplasty, 4 - knee arthrodesis, 1 - open reduction and internal fixation of patella. The results of treatment were estimated according to WOMAC knee score. 4 patients had total necrosis of flap what demanded repeated reconstructive microsurgical operation. 6 patients had knee arthroplasty surgical site infection, 1 patient had recidive of osteoblastic sarcoma and he was made leg amputation. 65,7% of patients had good results according to WOMAC knee score, 28,6% patients had satisfactory results. Microsurgical operations in patients with pathology of knee-joint mainly aim to correct various pathological changes of tissues located in this particular area. In cases of scarry deformations and defects of tissues located in the area of knee-joint microsurgical technologies increase the opportunities for fulfilling total knee arthroplasty and improve its results as well as results of other orthopedical operations. At the same time microsurgical technologies may be used as preparative operations, single-step maneuvers and operations fulfilled in case of development of local infectious complications.

Experience of using modular metal blocks for knee replacement for the replacement of defects of the tibial condyles in the Russian NIITO named after R.R. Vreden is more than 9 years. Authors analyzed the results of the using of blocks that replace defect of the medial condyles tibia bone, from 2003 to 2009 years. There were three group of patients: two group - comparison group and one - control group (the first group consist of 100 patient without defect of the condyle tibia. This patients a standard knee replacement was performed; the second group consist of 28 patient with the defects of the medial condyles tibia bone. This patient was used knee replacement with the bone autoplasty defects of the medial condyles of tibia bone; the third group (control) consists of 56 patients with the defects of the medial condyles of tibia bone. This patients a knee replacement with the using of blocks that replace defect of the medial condyles tibia bone was performed. Periods of studies were from 2 years till 7 years. Scale KSS was applied for the evaluation of the results. Among the patients were women (114-66.3%), nearly one third (58-33.7%) - men, mean age - 68.4 years. Similar demographics were occurred in all groups, however, a comparative evaluation on the scale of the study and control groups in the preoperative period revealed significant differences. In the postoperative period results were similar in all groups. The applying of modular units for replacement of defects of the medial condyle of the tibia bone during knee replacement is a simple and effective method, shown with significant bone defects - more than V the area of the condyle, a depth of 10 mm, which is an alternative to bone grafting and allowing early activation of patients.

82 patients were examined with the tibia fractures. Osteosynthesis with the help of plates was executed by 40 patients, osteosynthesis with the help of hinges with blocking was executed by 42 patients. The methods of duplex scanning of vessels and reovazografic inspection were used for studying of the blood circulation in tibia. Researches were conducted on the 5th and the 10th days in 1, 2, 3 and 4 months after the operation. It was established that the surgical treatment of the tibia fractures without any difference in using various methods of the broken fragments fixation in the early postoperative period (first 10 days) leads to a decrease in the level of arterial blood flow as a result of the vessels hypotonia. The absence of postoperative immobilization and early loading lead to the more rapid restoration of the initial indices of hemodynamics. Blood flow changes are least expressed and more rapidly restored during the closed reposition osteosynthesis with the help of hinges. The reaction of the vascular system of periosteum in the process of the regeneration of the tibia tissues does not depend on the method of the surgical treatment.

Aim of the study the characteristics of changes of serum biochemical parameters in dogs with delayed maturation of the distraction regenerate after surgical lengthening the leg bones by Ilizarov. The comparative analysis of biochemical changes in blood serum of animals with delayed regenerated bone osteogenesis after surgical leg bone lengthening according to Ilizarov has been made in the work. The development of persistent and marked hypocalcemia, significant accumulation of blood serum nonoxidized degradation products during limb bone surgical lengthening according to Ilizarov have been revealed to be adverse signs evidencing of the high probability of the disorder of further formation of the regenerated bone and its subsequent maturation at the stage of fixation.

108 revisions from 721 revision surgeries were performed with using BICON-PLUS cup and SL and SLR-PLUS stems in the arthroplasty department of CITO. Average age of patients was 57.2 years (24-77). 45 patients, whose underwent acetabular revision with use of BICON-PLUS cup, had type 1(1 patient), type 2 А-В (24 patients) and type 2С-3А (20patients) acetabular defects in according to W. Paprosky. 66 patients were revised with using of SL and SLR-PLUS stems. There were type 2 in 10 patients, type 3А (34 patients), type 3В (19 patients), type 4 (3 patients) femoral defects in according to W. Paprosky classification. Indications and contra-indications to implantation BICON-PLUS cup, surgical technique features and the bone grafting method of acetabular defects are described. Follow-up period ranges from 3 months till 10 years. There are received 1.8% excellent results, 45.4% good, 47.2% satisfactory and 5.5% unsatisfactory results with Harris’s Hip Score.

The authors determined the characteristics of secondary scar deformities in children depending on its localization and specificity of the primary injury. For the period from 2008 to 2010 we examined and treated 184 children with scar deformities of varying degrees of severity and location. The examination included: clinical methods including neurological examination, as well as rentgenography, electroneuromyography, ultrasound, CT and MRI, depending on indications. In addition, depending on the localization of a deformity were performed stabilographic and biomechanical studies. Surgical and medical treatment of cicatricial deformity in children depends on the anatomical and physiological characteristics of the affected segment. In planning the reconstruction of treatment, must be taken into account the conditions of local blood circulation, which can vary greatly depending on the duration of the existence the deformity and the etiology of the primary lesion. Basic principles of prophylactic clinical examination of pediatric patients at the stages of rehabilitation:

A description of the surgical correction technology and the results of surgical treatment of 26 patients with an isolated violation of the vertebrae formation (lateral and posterolateral hemivertebra) at the lumbar spine in Russia and Kazakhstan are presented. The age of patients ranged from 1 year 6 months to 8 years 4 months. After instrumental correction of spinal deformity on the background of the lateral hemivertebrae scoliosis angle ranged from 0 to 6°. The degree of correction ranged from 94 to 100%. After extirpation of the posterolateral hemivertebrae the residual angle of scoliotic deformity ranged from 0 to 4° (average 2,5°), the degree of correction ranged from 95 to 100%, the kyphotic angle of the component from 9 to -6° (average 2,2°). Results were studied in terms from 2 to 7 years after surgery.

Expansion of vein thrombosis and embolism remains a serious problem in traumatology and orthopedics up to the present day. Maintaining the balance between the efficiency of thromboprophylaxis and the danger of post operative hemorrhage can be achieved only when the prevention medication, its dose and the duration of use have been correctly chosen. An anticoagulant of the new generation (Pradaxa), per oral direct thrombin inhibitors dabigatran etexilate to the utmost complies with the above specified requirements that are why the authors decided in favor of its use in everyday clinical practice. A primary test for open use of dabigatran in 48 patients who underwent hip or knee arthroplasty has been carried out. Taking into account the highest risk of thromboembolic complications after large joints plasty, the method of mechanical prophylaxis DVT - electro neurostimulation of shin muscles has been introduced into clinical practice. According to the results of follow-up of the patients, who received different anticoagulants, the algorithm of an anticoagulant’s choice has been developed in various kinds of clinical situations with the possibility of changing injectable preparation to per oral forms. Convenience of per oral administration and predictability of dabigatran effect made it possible to provide consistency of hospital and out-patient stages of treatment, which also contributed to the reduction of thromboembolic complications, especially at an out-patient stage.

Primary synovial chondromatosis of a shoulder is quite rare in clinical practice. The diagnostics of this pathology has to include the histological examination of intraarticular material to detect the signs of tissue malignant transformation. Currently surgical intervention of this disease involves the removal of intra-articular cartilaginous bodies and local synovectomy of the affected joint by arthroscopic or open methods. The authors describe the clinical, histologic and arthroscopic features of primary synovial chondromatosis of the shoulder in order to assess the possibility of its minimally invasive correction. The clinical example of diagnostics and treatment of patient with this pathology was presented.

There were treated 48 patients (adolescents and adults) with severe congenital clubfoot in Saratov Research Institute of Traumatology and Orthopedics. 43 patients had the age ranged from 16 to 30, 5 patients had the age over 30. 19 patients had bilateral clubfoot, 29 patients had unilateral clubfoot including 19 on right side and 10 left side. To improve treatment results and to prevent deformity recurrence we developed two-staged surgery for congenital clubfoot treatment in adults. Cartilages of talo-navicular, talo-calcanean, cuneo-talar joints are deleted and deformity is corrected with external fixator on I stage. Surgeon performs external fixator resetting, autobone grafting of these joints with compressive arthrodesis on second stage. This method results in full foot reconstruction, good functional outcome, full weight-bearing and improves patient life’s quality.

In the article recent publications dedicated to unicompartmental knee arthroplasty are analyzed. Evolution of indications and contraindications, mid- and late term results, difference in functional outcomes in comparison with total knee arthroplasty are discussed. Taking into consideration all relevant information unicompartmental knee arthroplasty may be considered as effective and reliable method of treatment of patients with knee osteoarthrosis and osteonecrosis.

The article discusses in a chronological order the terms used by different researchers during over 150 years to describe the phenomenon of osteocytic remodeling (halisteresis, oncosis with trypsis, Inseln von basophiler Substanz, zone of diffusion, intermediate resorption areas, sinus type of resorption, liquid bone, osteocytic osteolysis, osteocytes of osteoblastic type, osteocytes of osteoclastic type, resorption periosteocytaire, nid d’abeilles, calciolysis, cementolysis, osteocytic remodeling). According to the authors’ opinion a big step forward has been made in developing functional morphology of this phenomenon and defining the circle of problems, which being solved will allow further qualitative development of osteocytic remodeling concept. The time has come to systematize the known facts, and basing on its results to outline further directions of experimental-theoretical studies aimed at elaboration of methods of osteocytic remodeling and their implementation in clinical practice.

Osteochondroma is the most common tumor of the skeleton. Its frequency is more than 40% of benign and at least 20% of all human bone tumors. The objective of this study was to improve methods of diagnostics of shin bone osteochondromas with using of modern imaging techniques. There were treated 81 patients with primary tibia osteochondroma and one with a secondary chondrosarcoma during the period from 2000 to 2011 in the Clinic of Traumatology and Orthopedics of the Astrakhan Medical Academy Diagnostics was based on the data of anamnesis, physical examination, standard X-rays and computed tomography. We applied ultrasound studies of shin bones in 11 patients. The ultrasonography has allowed revealing two main forms of osteochondromas: “globular-shaped” and “hill-shaped”. The tumor goes into the third “cauliflower-shaped” form in the case of malignant transformation. The distribution of the cartilage on the osteochondroma surface is irregular and depends on the tumor shape. The indirectly malignant signs are the loss of sharpness and smoothness of the contour, hyperechoic inclusions in the cartilage cap.

Allen Bakner Kanavela's biography - the surgeon who has brought the invaluable contribution of a world scale in development of the general surgery and of hand surgery is presented.

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