Vol 18, No 3 (2012)

ORIGINAL ARTICLES

THE INFLUENCE OF VARIOUS FACTORS ON BLOOD LOSS IN PATIENTS UNDERGOING TOTAL HIP REPLACEMENT

Tikhilov R.M., Serebryakov A.B., Shubnyakov I.I., Pliev D.G., Shilnikov V.A., Denisov A.O., Myasoedov A.A., Boyarov A.A.

Abstract

Objective: to assess the influence of various factors on blood loss and blood parameters in the postoperative period in patients undergoing hip replacement surgery with and without tranexamic acid. Material and methods. The operations of primary and revision hip arthroplasty were performed in 646 patients with various pathology of the hip by two surgery teams. Patients were divided into two groups: with the use the tranexamic acid - 284 and without its application - 362. We determined the amount of intraoperative blood loss, blood parameters (hemoglobin, red blood cells, platelets) before surgery and in the first, third and sixth days after the operation. Also the analysis of drainage system influence is carried out. Results. The tranexamic acid application during total hip arthroplasty allows to reduce intraoperative blood loss, to optimize the process of normalization red blood in the postoperative period. The renunciation of wound drainage decreased the total amount of blood loss on average 2.2 times and respectively, the need for blood transfusions.
Traumatology and Orthopedics of Russia. 2012;18(3):5-11
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EVALUATION OF MIDTERM FUNCTIONAL RESULTS AFTER TOTAL AND UNICOMPARTMENTAL KNEE ARTHROPLASTY WITH DIFFERENT SCORING SYSTEMS

Kornilov N.N., Kulyaba T.A., Phedorov R.E.

Abstract

Using KSS, WOMAC and IKDC score systems the authors evaluated functional results of 64 total (TKA) and unicompartmental (UKA) knee arthroplasties performed in department of knee pathology of Vreden’s Russian Research Institute Travmatology and Orthopaedics from 2001 till 2006. Before joint replacement there was no significant difference in magnitude of performance deficit between both groups. After 5-10 years (7 in average) all patients had similar pain relief but activities of daily living and level of physical performance, including high flexion, were significantly higher in UKA group than TKA. KSS and WOMAC score systems did not reflect this important difference in physical capacities of UKA and TKA patients comparing to IKDC.
Traumatology and Orthopedics of Russia. 2012;18(3):12-20
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LONG-TERM RESULTS OF CRYOSURGICAL TREATMENT OF BONE TUMOR-LIKE LESIONS

Dianov S.V., Tarasov A.N., Mochalov A.P.

Abstract

In order to optimize surgical intervention the results of surgical treatment of 324 patients with tumor-like lesions of bone were studied. Study group comprised 211 people who were executed cryosurgical intervention. In 113 patients (control group) a similar intervention was performed, but without the cryosurgical exposure. In the study group the subjective and objective assessment of outcome of treatment was significantly different (at χ2 = 9,5 p <0,01). It is explained by the variability of complications after the cryosurgical procedures. It was found that the ratio of types of surgical procedures carried out in this pathology, has changed over time. The number of intralocal and regional resections have increased while the number of segmental resections have decreased (at t = 2,7 p <0,05). The introduction bone cryosurgical procedures in clinical practice allowed to decrease the number of segmental resections from 27.6% to 4.8% and to increase the range of intralocal resections from 25.8% to 77.7%. The recurrence rate was 2.4% in the main group and 7.1% - in the comparison group.
Traumatology and Orthopedics of Russia. 2012;18(3):21-26
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MORPHOLOGICAL EVALUATION OF CONSEQUENCES OF LONG BONE OSTEOMYELITIS IN CHILDREN

Garkavenko Y.E., Krasnogorskiy I.N.

Abstract

The authors studied morphological changes in bone, cartilage and soft tissue from the zone of old inflammation and far from it in 36 children with pathological hip dislocation, in 23 - with limb shortening, in 13 - with pseudoarthrosis and long bone defects after osteomyelitis. Morphological assessment of proximal femur tissue in children, who had hematogenous osteomyelitis in early childhood, identified severe changes in cartilage and bone tissue which accompanied by muscle pathology. The state of the femoral head articular cartilage and acetabulum in patients with pathological hip dislocation is characterized by degenerative changes of varying severity (up to the formation of necrobiosis and necrosis focus), by the replacement of hyaline cartilage by tissue, formed by the type of fibrous cartilage and fibrous (scar) tissue. This picture did not have significant differences depending on the osteomyelitis prescription. Directly in the area of the former inflammatory process, as well as in the ends of pseudoarthrosis bone fragments of long bone the degenerative changes of bone tissue with the signs of resorption and low-grade osteogenic activity are marked. The morphological texture of the femur diaphysis, located far from the old inflammation, did not differ from normal. It may indicate its potency for normal bone formation. Muscle tissue in the area of old inflammation keeps the signs of unevenly expressed degeneration and atrophy. Far from this zone muscle tissue doesn’t differ from its usual structure. The described morphological changes can serve as justification for the improvement of methods of surgical treatment in children with consequences of osteomyelitis.
Traumatology and Orthopedics of Russia. 2012;18(3):27-34
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EXPERIENCE OF SURGICAL TREATMENT OF INJURIES OF MIDDLE AND LOWER CERVICAL SPINE WHILE DIVING

Ardashev I.P., Gatin V.R., Ardasheva E.I., Shpakovskiy M.S., A Grishanov A., Veretelnikova I.Y., Petrova O.I., Katkova M.A.

Abstract

Objective - to analyze the long-term results of surgical treatment of patients with injuries of middle- and lower cervical spine in diving. Materials and methods. An analysis of surgical treatment of 27 patients and assessment of the long-term results of 20 patients in a period of 6 months to 6 years were performed with analysis of clinical, neurological, radiographic data and mortality. Results. Mostly the C5 vertebra was damaged - in 17 patients (63%). Compression fractures of vertebral bodies met in 6 (22%), compression-comminuted fractures - in 16 (59%) patients, dislocations - in 5 (19%). All patients had neurological disorders. All observations noted rigid stabilization of the spine with an implant made of porous nickel-titanium, the presence of bone-metal block at the level of the damaged vertebral body Mortality in the postoperative period was 26%. In the long-term period the initial neurological symptoms were observed in 7 (30%) patients, 13 (48%) patients had marked regression of neurological symptoms. Full functional maladjustment was observed in 6 patients with no motor function below the damaged segment, originally belonging to groups A and B on the classification of H.L. Frankel. Moderate and mild degree of functional adaptation disorders were present in 5 and 4 patients respectively. In the remaining patients we did not reveal a functional maladjustment. Range of motion in the cervical spine in all patients was considered as good. Conclusions. Anterior decompressive-stabilizing surgeries on the spine with an implant made of porous nickel-titanium and metal plate CSLP allows reliably stabilization of the injured spine and the rehabilitation of this severe category of patients.
Traumatology and Orthopedics of Russia. 2012;18(3):35-40
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ANALYSIS OF INTENSITY OF PAIN SYNDROME DURING THE FIRST WALKING IN PATIENTS AFTER TOTAL JOINT REPLACEMENT JOINTS OF LOWER EXTREMITIES

Koneva E.S., Serebryakov A.B., Kamalova E.G., Shapovalenko T.V., Tarbushkin A.A., Lyadov K.V.

Abstract

The aim of the study was to assess the severity of pain in patients after total replacement of joints of the lower extremities in the exercise of walking on the day of the surgery. Walking on the day of the operation was carried out for 46 patients the comparison group included 41 patients. As a result of the study, patients carrying walking on the day of operation, assessed the severity of pain in the 3.54+1.75 on a scale of pain NRS, and patients carrying walking on the next day after surgery 5.49+1.42 points. The results indicate not only the possibility of practical implementation of the function of walking on the day of operation, but also about the possibility of its implementation at a lower level of pain at the time of its implementationon the day of surgery.
Traumatology and Orthopedics of Russia. 2012;18(3):41-44
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ASSESSMENT OF THE FUNCTIONAL STATE OF THE EXTREMITY IN PATIENTS WITH CLOSED FRACTURES OF SHIN BONES DURING THE TREATMENT BY ILIZAROV’S METHOD

Shchurov V.A., Matsukatov F.A.

Abstract

Objective - an assessment of influence an oxygen mode in tissues and rigidity of bone fragment fixation on blood supply in bone regenerate during the treatment by ILizarov's method of patients of different age with closed fractures of shin bones. Blood flow velocity in a region of closed tibia fracture was investigated using high-frequency Doppler ultrasound in the treatment of patients by Ilizarov (193 cases). The rate of blood flow in the area of fracture was increased in first weeks after injury and normalized with the increase of bone regenerate stiffness. In patients aged over 40 years in the tissues of the damaged shin a greater decrease in oxygen tension and a relatively greater increase in blood flow velocity in the zone of bone regenerate were noted.
Traumatology and Orthopedics of Russia. 2012;18(3):45-50
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ACETABULAR DEVELOPMENT AFTER SUPRAACETABULAR TUNNELIZATION IN CHILDREN WITH HIP CONGENITAL DYSPLASIA

Teplenkiy M.P., Makushin V.D., Chirkova N.G.

Abstract

Introduction. The technology of wire tunnelization of joint elements is used at RISC “RTO” for treatment of young children (10-30 months) with the hip dysplasia of various forms. Aim - to assess the effect of supraacetabular tunnelization on the formation of dysplastic acetabula. Material and methods. The results of treatment 18 children (21 joints) with the hip congenital dysplasia of II (14 joints) and III (7 joints) degree according to Tonnis have been analyzed. Gradual closed reduction of the dislocation has been performed in all the cases. Mean age at the time of reduction was 8,2±0.56 months (5-14 months). Supraacetabular tunnelization was made six months after dislocation reduction. Indications for intervention were considered in view of the x-ray parameters and signs of acetabulum showing its potential developmental delay. Results. The initial value of the acetabular index on the side of dislocation amounted to 43±0.8°. The impairment of the shape of acetabular vault and its upper-and-outer edge of moderate (9 joints) and severe (12 joints) degree has been observed in all the joints involved. The mean value of the acetabular index amounted to 22.1±0.947° (P<0.01) 3 years after the first tunnelization procedure. In the mentioned period the pathological value of AI remained for seven joints, the value conformed to the norm in 11 observations, and it was considered as a boundary state in three cases. Correct vault shape recovered in 19 joints involved, formation of roof sharp-pointed upper-and-outer edge was observed in 14 cases. The signs of moderate acetabular roof underdevelopment remained in the other observations. Conclusion. The wire tunnelization of the supraacetabular parts adjacent to acetabular cartilage in the patient group analyzed had a stimulating effect on acetabulum development, which manifested itself in the roof slope decrease, the change in acetabular contour and upper-and-outer edge shape.
Traumatology and Orthopedics of Russia. 2012;18(3):51-56
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ELECTROPHYSIOLOGICAL SUBSTANTIATION OF EFFICACY OF CONGENITAL CLUBFOOT SURGICAL TREATMENT

Klychkova I.Y., Vinokurova T.S., Guseva I.A.

Abstract

Purpose - a complex assessment of the neuromuscular apparatus in different age groups of children with congenital clubfoot before and after surgery. Material and methods. The study included 80 patients (23 girls and 57 boys) with moderate and severe congenital clubfoot between the ages of 0 to 18 years. In 46% of patients a bilateral lesion was noted, in 54% - unilateral. All patients who received surgical treatment tendon-muscle plasty by the Sturm-Zatsepin method, modified in the Turner Institute, were carried out. Long-term results of surgical treatment were investigated in terms of 1 to 5 years. Neurophysiological studies were carried out on a multi-channel computer complex "Neuro-MEP-4" (Russia). Contractive ability of the tibial, peroneal, and gastrocnemius muscles of lower leg was assessed by global electromyography (EMG) for the affected and healthy sides. In order to receive the normal age indexes of electrogenesis the identical study was conducted in 30 subjects in each age group without pathology of the lower extremities. Results. Significant abnormalities of the functional state of the neuro-muscular system in shin were revealed in patients with congenital clubfoot. The analysis of the EMG results in patients admitted for conservative treatment (group 1) showed that in unilateral disease there is a decrease of electrical activity of leg muscles on the affected side. If bilateral symmetrical lesions observed decreasing of muscle electrogenesis were noted compared with the age norm. There are quantitative and qualitative changes in electrogenesis, which are characterized by secondary changes in the muscles on the background of segmental abnormalities. After surgical intervention in patients 0-3 years the positive dynamics of the neuro-muscular functional state of the shin was achieved, which allows to recommend surgical treatment of congenital clubfoot in children in age till three years. Revealed violations of the conductivity on the peroneal nerve motor fibers in children with congenital clubfoot require constant neurological monitoring before and after surgery.
Traumatology and Orthopedics of Russia. 2012;18(3):57-66
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THEORETICAL AND EXPERIMENTAL STUDIES

USE OF THE REFERENCE ANATOMICAL STRUCTURES OF THE FEMORAL INTERCONDYLAR SPACE IN ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

Suchilin I.A., Malanin D.A., Krayushkin A.I.

Abstract

Purpose: rationale for using bony landmarks of the femoral intercondylar space for an accurate determination of ACL attachment during arthroscopic reconstruction. Material and methods: anatomic research of 57 femur bones in which were studied anterior cruciate ligament femoral footprint, lateral intercondylar ridge and lateral bifurcate ridge. Results: research has shown, that lateral intercondylar ridge was present at 52 supervision (91 %), and its average length was 15.4 ± 0.46 mm; lateral bifurcate ridge was determined in 28 (49 %), which average length was 3.95 ± 0.26 mm. Conclusions: these bone formation can be considered as the reference structure for the identification of the anterior cruciate ligament femoral insertion.
Traumatology and Orthopedics of Russia. 2012;18(3):67-72
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ENERGY METABOLISM IN SKELETAL MUSCLES IN DOGS DURING TREATMENT OF SHIN FRACTURES WITH ILIZAROV’S TECHNIGUE

Stogov M.V., Smirnov A.V.

Abstract

Aim - to study the dynamics of the recovery of energy resources in the tibialis anterior (TA) in dogs after shin fractures. Material and methods. The concentration of energy metabolism substrates, the rate of glycolysis and glycogenolysis in TA in 25 dogs during the treatment of tibial fractures by Ilizarov were studied. The values parameters in the experimental animals were compared with values in the intact (non-operated) dogs. Results. The level of glycogen and glucose decreased in TA within 14 days of fixation. On the 28th day of fixing the level of these metabolites corresponded to the level in intact animals. By the end of fixation the rate of glycogen utilization in TA of experimental animals was significantly reduced relative to intact animals, and the rate of glucose utilization was unchanged, though all glucose was almost entirely utilized by aerobic way. A month after treatment there was an increase of glycogen levels in the TA and activity of lactatedehydrogenase MM-isoenzyme. When glycogen solution added to the cell-free culture of muscle the its considerable utilization and the pyruvate accumulation were found. Conclusions. Anaerobic energy metabolism of in the TA of injured segment have prevailed before the 14-th day after the injury, the aerobic energy metabolism - after 28-days. The phenomenon of growth of anaerobic energy metabolism in TA of injured segment within three months after treatment was revealed.
Traumatology and Orthopedics of Russia. 2012;18(3):73-76
pages 73-76 views

EXPERIENCE EXCHANGE

ARTHROSCOPIC TECHNIQUE OF BONE AUTOGRAFTING OF GLENOID CAVITY DEFECTS IN PATIENTS WITH RECURRENT ANTERIOR INSTABILITY OF THE SHOULDER

Dokolin S.Y., Kislitsyn M.A., Bazarov I.S.

Abstract

Injuries of the bone anterior edge of the glenoid cavity of scapula is noted in 90% of patients with recurrent shoulder instability and it is the cause of recurrent dislocation in 67% of cases. The authors have presented a description of techniques and benefits of arthroscopic autoplasty (autografting) of scapula glenoid. A total of 10 operations were performed in 9 men and 1 woman. The average age of operated patients was 27,1±4,7 years. All patients were injured during contact sports. In the preoperative and immediate postoperative period computer tomography of damaged shoulder was performed in all patients with reconstruction in 3D images. The size of the bone defect was evaluated by 3D scans and averaged 29.7%. During the first stage free bicortical grafts with varying sizes from the wing of the ilium were harvested. Preartroscopic stage permits to avoid swelling of paraarticular structures during arthroscopy and allows to correct positioning and fixation autografts in the joint. The arthroscopic signs of defect and the technique of immersing of previously prepared free fragment through a wide 10 mm cannula and subsequent minimally invasive fixation with cannulated screws in scapula neck were described. This operation is an alternative to the transposition of coracoid process, does not require special tools and a long operating time (average 60-80 min), excludes injuries of brachial plexus branches and surgical trauma of subscapularis muscle, does not disturb the normal anatomy of the shoulder joint. There were no neurological complications, recurrences of instability in the immediate postoperative period.
Traumatology and Orthopedics of Russia. 2012;18(3):77-82
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TALONAVICULAR JOINT ARTHRODESIS AND MEDIAL DISPLACEMENT CALCANEAL OSTEOTOMY FOR TREATMENT OF PATIENTS WITH PLANOVALGUS DEFORMITY

Dubovik G.O., Zagorodniy N.V., Protsko V.G., Butaev B.G., Tamoev S.K.

Abstract

The aim of this study was to assess the results of talonavicular joint arthrodesis and medial displacement calcaneal osteotomy for surgical correction of pes planovalgus. Fourteenth patients with a pes planovalgus deformity were underwent surgery from February 2008 to December 2011. The mean age was 45,5. In 90% of cases, operations were performed on one foot, and 10% of cases at two feet. All patients were assessed before the operation with the scale of the American Orthopaedic Foot and Ankle Society (AOFAS). According to the AOFAS scale, the average improvement was 41 before the operation had reached values of 84.2 after the operation. Radiography showed an average decrease in the angle of the longitudinal arch from 12 and an average decrease in the angle of deviation between the vehicle collision and the calcaneus to 38°, increasing the height of a set of 5 mm. This combination of procedures allows greater correction and stability than either procedure performed alone, and provides a viable alternative to triple arthrodesis.
Traumatology and Orthopedics of Russia. 2012;18(3):83-88
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DOBBS’ METHOD IN TREATMENT OF CHILDREN WITH SEVERE CONGENITAL PLANOVALGUS DEFORMITY

Blandinskiy V.F., Vavilov M.A., Gromov I.V.

Abstract

The article outlines Dobbs’ method in the treatment of children having heavy vertical talus. The results of 23 clinical observations of children with congenital planovalgus deformity of 38 feet during 11 years are examined. The age of patients ranged from 1 month to 13 years. 40 operations were performed on these patients. The analysis shows that the best results were achieved in the treatment of children (17 feet), who were previously treated with Dobbs’ method, which included step-wise plastering combined with minimally invasive surgical procedures and subsequent orthopedic regime of "life in braces". With the introduction of the method the frequency of open reduction of the talus in this group of patients in our clinic has substantially declined, so Kumar et al. and Coleman et al. surgical interventions are reserved for the treatment of children, whose feet deformities were detected too late or recurred due to lack of effectiveness of the Dobbs’ method.
Traumatology and Orthopedics of Russia. 2012;18(3):89-94
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THE ERRORS, COMPLICATIONS AND MEASURES FOR ITS PREVENTION IN THE TREATMENT OF SCHOOL AGE CHILDREN WITH CONGENITAL RECURRENT CLUBFOOT BY ILIZAROV METHOD

Leonchuk S.S., Ivanov G.P., Neretin A.S., Martel I.I., Shestakov V.A.

Abstract

Objective. To analyze the errors and complications of treatment of school age children with congenital recurrent clubfoot, treated in RISC «RTO» by transosseous osteosyntesis. Material and methods. Within the period of 1999-2010 119 patients (148 feet) between the ages of 7 to 18 years with congenital recurrent clubfoot were treated by the Ilizarovs method. Patients of this group, along with holding the wires on the shin and foot, corresponding to the Ilizarov fixator assembly, received surgical procedures on soft tissue, osteotomy and stabilizing operations. Results. In the course of treatment complications were observed in 22 patients, accounted for 18.5% of the total number of patients. All complications were typical for transosseous osteosynthesis, eliminated during a course of treatment and did not affect his final result. Conclusion. Adherence to the methodical principles of transosseous osteosynthesis by Ilizarov in the surgical treatment of patients of school age with recurrent congenital clubfoot and rational management of patients in the postoperative period is the prevention of complications and contributes to achieving good results.
Traumatology and Orthopedics of Russia. 2012;18(3):95-99
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ДЛЯ ПРАКТИЧЕСКИХ ВРАЧЕЙ

LEADING ROLE OF KINEZOTHERAPY IN REHABILITATION OF PATIENTS AFTER OSTEOSYNTHESIS WITH APPLICATION OF MODERN CONSTRUCTIONS

Shimbaretskiy A.N.

Abstract

Reliable fixation of bone splinters with the latest constructions increases the role of kinezotherapy in rehabilitation of the patients with fractures at all stages of treatment. The 50-years’ experience of surgical work in the Department of Traumatology and also regular examinations of patients at the out-patient department of the Institute persuade the author that knowing the basis of kinezotherapy is necessary for operating traumatologists who are the first to give recommendations for the patients marking the main stages and methods of functional therapy. The essential particularities and details of kinezotherapy after application of modern implants are revealed in the article. It is necessary to underline that exercises being maximally easy are very important and necessity of calculation of gravitational loading for the patients with the fractures of proximal parts of extremity is essential.
Traumatology and Orthopedics of Russia. 2012;18(3):100-105
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TRAUMA AND ORTHOPEDIC CARE

FRACTURES OF VERTEBRAL BODIES IN THE STRUCTURE OF CHILDREN’S TRAUMATISM

Skryabin E.G., Smirnykh A.G.

Abstract

The aim of the study was to establish the frequency and features of uncomplicated compression fractures of vertebral bodies in children and to determine its place in the rank structure of children’s injuries. In order to achieve this goal in 2011 the medical records were studied studied: case register of emergency trauma care, hospital records, medical records, X-ray archive. The authors have found that fractures of vertebral bodies took place XVIII ranking in the structure of child’s injury, which accounted for 0.55% of traumatic injuries. Frequently the fractures of vertebral bodies occur in children aged 8-12 years. Mainly the vertebra ThVIII was injured - 11.44% of cases. Children with fractures of vertebral bodies constitute 15.66% of inpatient emergency trauma patients in a specialized children’s orthopedic trauma department
Traumatology and Orthopedics of Russia. 2012;18(3):106-110
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DISCUSSIONS

DISTRIBUTION OF MISBELIEFS ABOUT BACK PAIN AMONG MEDICAL STAFF

Cherepanov E.A., Gladkov A.V.

Abstract

The aim of this survey is the analysis of typical misbeliefs distribution about back pain among medical staff. Study design: cross-sectional discreptive study 110 medical professionals took part in this study. 48 of them were medical students (4th and 5th year of education), 62 were licensed medical doctors with ten years of experience in average. All participants were interviewed with special questionnarie containing 36 false statements about the spine and back pain. Every subject was asked to indicate whether he agrees or disagrees with each statement. The rate of incorrectly given answers was 63% in average for physicians (from 22% to 94%) and 60% in average for students (from 36% to 83%). In a small subgroup of neurosurgeons the rate of mistakes was 32% (varied from 11% to 47%). This study gives evidence of the high total level of misbeliefs about back pain among both licensed physicians and medical students. It is likely that majority of physicians do not use modern biopsychosocial model of back pain. Moreover they often act as carriers of irrational beliefs which could have negative influence on long therm effects of back pain.
Traumatology and Orthopedics of Russia. 2012;18(3):111-117
pages 111-117 views

REVIEWS

ANESTHESIA IN SURGERIES ON THE FOOT AND ANKLE (REVIEW)

Koryshkov N.A., Larionov S.V., Murashova N.A., Sobolev K.A.

Abstract

Among the various anesthetic options the combination of spinal anesthesia with the implementation of regional nerve blocks of the lower extremity and local anaesthesia of area of the wound with long-acting local anesthetics is more interesting. However the recommendations for the choice of postoperative analgesia of the foot do not exist, inspite of the pain syndrome. The prospects for wider use of regional blocks include the use of electrical stimulator in conjunction with ultrasound identification of the nerve trunks, the use of infusion pumps and catheter techniques blockades.
Traumatology and Orthopedics of Russia. 2012;18(3):118-126
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JUBILEE

Alexey G. Baindurashvili

Abstract

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Traumatology and Orthopedics of Russia. 2012;18(3):127-128
pages 127-128 views

OBITUARIES

Nikolay P. Demichev

Abstract

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Traumatology and Orthopedics of Russia. 2012;18(3):129-130
pages 129-130 views


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