Vol 18, No 4 (2012)

MODERN TRENDS IN TRAUMATOLOGY AND ORTHOPEDICS

MODERN TRENDS IN ORTHOPEDICS: REVISION OF THE ACETABULAR AND FEMORAL COMPONENTS

Tikhilov R.M., Shubnyakov I.I., Kovalenko A.N., Tsybin A.V., Sementkovskiy A.V., Karpukhin A.S., Bashinskiy O.A.

Abstract

The revision rate of total hip arthroplasty (THA) is increasing with growth of number primary THA. The problems of revision procedures are associated with high technical demands and high incidence of poor results. Besides of medical problems the cost of revisions has impact on health care system even in developed countries. With improving of funding Russian Health Care System there is significant growth of number of total hip arthroplasties in Russia. Hence it is interesting to find out about world experience, forecasts of experts involved in the issue and current trends in revision hip arthroplasty.
Traumatology and Orthopedics of Russia. 2012;18(4):5-16
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ORIGINAL ARTICLES

CURRENT STATUS OF INTERNAL OSTEOSYNTHESIS IN TREATMENT OF PATIENTS WITH LONG-BONE FRACTURES IN MUNICIPAL MULTI-FIELD EMERGENCY HOSPITAL OF THE RUSSIAN MEGALOPOLIS

Tikhilov R.M., Belenkiy I.G., Kutyanov D.I.

Abstract

Objective: Determine the changes in the structure of methods of internal osteosynthesis in treatment of patients with long-bone fractures in municipal multi-field emergency hospital of the modern Russian megalopolis. Carry out comparative analysis of effectiveness of use of minimally invasive osteosynthesis and conventional plating of long-bone fractures. Material and methods. We have studied the results of 1249 surgical operations of internal fixation of long-bone fractures performed in one of a municipal multi-field emergency hospitals of Saint Petersburg (Russia). We have studied the statistics of 1999-2000 and 2010. Results and conclusions. Minimally invasive osteosynthesis has occupied a leading position in the structure of internal fixation of long-bone fractures within the current 10 years period. Although such operations demand precise following surgical techniques, ability to use expensive implants and equipment as well as comparatively higher and longer training of orthopedic surgeons. These circumstances seriously limit effective use of minimally invasive osteosynthesis for the current moment. But at the same time conventional plating techniques haven’t lost their importance for treatment of patients with long-bone fractures. These techniques still occupy an important part among the methods of osteosynthesis used in the Russian multi-field hospitals. It reveals the need for continuous improvement of tactics used by orthopedic surgeons as well as the technique of performing such operations.
Traumatology and Orthopedics of Russia. 2012;18(4):17-25
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TOPOGRAPHIC AND ANATOMICAL APPROACHES TO THE DEVELOPMENT OF THE PROTECTION SYSTEM OF THE POPLITEAL ARTERY DURING ARTHROSCOPIC POSTERIOR CRUCIATE LIGAMENT PLASTY

Kuznetsov I.A., Fomin N.F., Shulepov D.A.

Abstract

The purpose of this study was to determine relationships between bone elements of the knee and popliteal artery. Type of study: anatomy and clinical. Materials and methods consist of 12 cadaveric knees, 14 MRI of the knee, 59 arteriograms of lower extremity 6 of cadaveric knees were x-rayed in the axial and sagittal planes at each of 3 flexion angles (180°, 130° and 90°) to determine the distance between posterior cruciate ligament and popliteal artery. During the study was also measured lengths of bone tunnels for arthroscopy posterior cruciate ligament reconstruction. Was fined, that in 100% of cases popliteal artery was in lateroposition (form 1 to 6 mm). The maximal distance between posterior cruciate ligament and popliteal artery were noted at flexion 90°. The length of the tibial tunnel was in a range from 63 to 78 cm, femoral - from 38 to 47 mm. Methods aimed at reducing risk of popliteal artery injury are offered.
Traumatology and Orthopedics of Russia. 2012;18(4):26-32
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PLASTIC AND RECONSTRUCTIVE MICROSURGERY IN TREATMENT OF PATIENTS WITH PATHOLOGY OF LARGE JOINTS OF EXTREMITIES

Kutyanov D.I., Rodomanova L.A., Kochish A.Y.

Abstract

Objective: this study aimed to develop approaches to the use of plastic and reconstructive microsurgery in the treatment of patients with pathology of the large joints of extremities. Material and methods. We have studied the results of surgical treatment of 253 patients with injures and diseases of large joints of extremities. All the patients were treated in Russian Scientific-Research Institute of Traumatology and Orthopedics n.a. R.R.Vreden (Saint-Petersburg, Russia) within the period from 2000 to 2011. All the patients had pedicled flap transfer (65,7%) or free tissue transfer (34,3%). 105 patients (41,5%) had additionally various orthopedic operations on joints: primary or revision total arthroplasty, resections of bony tumors and total knee arthroplasty, arthrodesis and internal fixation. Results and conclusions. Microsurgical operations in patients with pathology of large joints of extremities mainly aimed 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 joint microsurgical technologies increase the opportunities for fulfilling total arthroplasty and improve its results as well as results of other orthopedic 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.
Traumatology and Orthopedics of Russia. 2012;18(4):33-42
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THE ANALYSIS OF MORPHOFUNCTIONAL CONDITION OF THE UPPER LIMB MUSCLES IN TREATMENT OF PATIENTS WITH POSTTRAUMATIC ELBOW FLEXION-AND-EXTENSION CONTRACTURES

Grebenyuk L.A., Soldatov Y.P.

Abstract

The aim of the work was to study the echography visualization-based structural features of muscles and the wrist radial flexors for surgical treatment of 56 patients with the elbow flexion-and-extension contractures. The result of surgical treatment in the main group of patients consisted in the increase of the elbow extension angle. Muscle pattern was similar to a typical, normal ultrasound image. The most characteristic feature was a significant decrease in the muscle belly thickness. The thickness of fore-arm flexor muscular layer was 29,2% decreased for the brachium injured amounting to 16.5 ± 4.7 mm (P ≤ 0.05), and that for the intact segment - to 23.3 ± 2.6 mm. In the immediate periods after treatment the signs of atrophy remained. It manifested by the significant decrease of the anterior muscle group thickness with regard to the intact segment values. The index of the echo intensity of m. biceps brachii in operated limb increased by 53.7% compared to preoperative values, reaching 22.8 ± 2.1 conv. u (P <0.05), and m. brachialis - 30 conv. u (P> 0.05). Before the treatment in patients aged 8-13 years the relative strength of the forearm muscles was reduced by 12% compared with those on the contralateral limb (P <0.05) according to t-test, and in the older age group - 20.9% (P <0.01). With increasing of movement range in the late periods after treatment were observed satisfactory contractile response of the upper limb muscles. At different stages of reconstructive and restorative treatment of patients with posttraumatic elbow contractures it is advisable to use a combination of ultrasonic imaging of muscles and hand dynamometry with the definition of the relative strength of the muscles.
Traumatology and Orthopedics of Russia. 2012;18(4):43-50
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PERCUTANEOUS MODIFICATION OF FIRST METATARSOCUNEIFORM JOINT ARTHRODESIS: A PROSPECTIVE STUDY

Berezhnoy S.Y.

Abstract

Objective: to reduce surgical approach and to ensure early weight bearing postoperatively. Material and method: by the example of 24 surgeries the results of the 1st MTCJ arthrodesis percutaneous modification, proposed by the author, were reviewed with the mean follow-up of 6 months. Surgical technique was described. 1st MTCJ hypermobility, severe metatarsus primus varus and previous surgeries failures were the indications for surgery. Immediate ambulation with one crutch and fool weight bearing since the 4-5th week postoperatively were authorized. Results: desired correction of the first metatarsal was achieved during 23 interventions. Arthrodesis had fused in 21 of 23 cases that were followed up. Two cases of non-union did not require reoperation. No infectious complications were noted.21 patients were discharged the next day after surgery due to painless early postoperative period. Conclusions: percutaneous 1st MTCJ arthrodesis is a safe and predictable procedure. Proposed surgical technique provides a reliable correction of metatarsus primus varus avoiding the main disadvantages of Lapidus procedure: extensive operative approach and postoperative period of fool non-weight bearing.
Traumatology and Orthopedics of Russia. 2012;18(4):51-58
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SURGICAL TREATMENT OF METACARPAL SYNOSTOSIS IN CHILDREN

Zaletina A.V.

Abstract

Objective: to develop the surgical treatment of patients with congenital metacarpal synostosis. Material and methods. 65 operations were performed in 58 children. with congenital metacarpal synostosis. Surgical intervention was determined by the localization of congenital metacarpal synostosis and the presence of concomitant deformities. Results. Excellent and good results were observed in 69,4% (33 hands) cases, satisfactory - in 30,6% (15 hands), unsatisfactory results were not obtained. At the same time excellent results were obtained in patients with less severe variants of metacarpal synostosis, good treatment results were observed in children with more severe associated abnormalities, as well as in cases where the correction is not performed metacarpal shortening. Overall, the results were significantly (p <0,05) better after application of advanced methods, including correction of all components of the strain. Satisfactory results were found out in patients with severe comorbidity, a total fusion of the metacarpal bones and fingers, the total PPS. Conclusions. Surgical treatment options for all congenital metacarpal synostosis should be individualized and be concluded in the performance of bone and plastic surgery to remove metacarpal synostosis and related deformities.
Traumatology and Orthopedics of Russia. 2012;18(4):59-65
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FIRST EXPERIENCE OF TRANSVERTEBRAL MICROPOLARIZATION OF THE SPINAL CORD IN THE COMPLEX TREATMENT OF UPPER LIMBS DEFORMITIES IN PATIENTS WITH ARTHROGRYPOSIS

Rozhdestvenskiy V.Y., Agranovich O.E., Soboleva J.L., Trofimova S.I.

Abstract

From 2010 till 2011 transvertebral micropolarization of the spinal cord was applied in 14 patients with arthrogryposis and upper limb deformities in the department of arthrogryposis of the Turner Scientific and Research Institute for Children's Orthopedics. Effectiveness of the method was objectively evaluated in accordance with neurophysiological study. In 4 patients improvement of upper limb motor activity as well as factors of electrogenesis of the tested muscles and peripheral nerves were noted upon the course of TVMP. The first application of transvertebral micropolarization in patients with arthrogryposis associated with damage of upper extremities showed the suitability of its use in complex treatment of this pathology and carrying out further researches in this direction.
Traumatology and Orthopedics of Russia. 2012;18(4):66-71
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MULTIMODAL ANALGESIA AFTER TOTAL HIP ARTHROPLASTY

Mukutsa I.G., Tsarenko S.V., Lyadov K.V., Koneva E.S., Voloshin A.G.

Abstract

Purpose - to assess the effect of multimodal analgesia in the early rehabilitation of patients after hip replacement. Materials and methods. A prospective single-centre randomized research, which included 32 patients. Patients of the 1st group received paracetamol, ketorolac and tramadol, the 2nd group of patients - ketorolac intravenously and the 3rd group of patients - etoricoxib and gabapentin. Patients of the 2nd and the 3rd groups underwent epidural analgesia with ropivacaine. Multimodal analgesia was carried out for 48 hours after the surgery. Assessment of pain intensity was performed by the VAS (visual analogue scale), a neuropathic pain component - on the DN4 questionnaire . Time was recorded during the first and second verticalization of patients, using the distance walkers and by fixing the distance covered with in 2 minutes. Results. The intensity of pain for more than 50 mm on VAS at movement at least once every 48 hours after the surgery was occurred among 9% of the 1st group, 22% of patients from the 2nd group and 8% of patients of the 3rd group. Number of patients with neuropathic pain component decreased from 25% to 3% (p ≤ 0.05). The first verticalization was performed 10 ± 8 hours after the surgery, the second - 21 ± 8 hours later. Two-minute walk distance was 5 ± 3 and 8 ± 4 m, respectively. It is noted more frequent adverse events in patients of the 1st group was noted compared to patients of the 2nd and the 3rd groups during first (91%, 33% and 25%, p ≤ 0.05) and the second verticalization (70%, 25% and 17%, p ≤ 0.05). Multimodal analgesia allows to proceed with the successful activation of patients after hip replacement with in the first day after the surgery. The 3rd group patients are noted with a tendency for the optimal combination of efficient and safe of analgetic therapy.
Traumatology and Orthopedics of Russia. 2012;18(4):72-75
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THE SUBSTANTIATION OF EARLY SURGICAL TREATMENT OF CONGENITAL PATELLA DISLOCATION

Tenilin N.A., Bogosyan A.B., Vvedensky P.S., Vlasov M.V.

Abstract

The present work is based on the results of congenital patella dislocation treatment in patients aged from 4 months to 18 years old (average 10,6±0,7 years). The results were estimated in the period ranged from 1 to 40 years (average 15,1±2,1 years). The new classification of congenital patella dislocations was based on the gait biomechanical parameters. The necessity of early surgical treatment of congenital patella dislocation has been proved.
Traumatology and Orthopedics of Russia. 2012;18(4):76-81
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TACTICS OF TREATMENT IN CHILDREN WITH INTRAARTICULAR FRACTURES OF THE DISTAL HUMERUS

Proshchenko Y.N., Pozdeeva N.A.

Abstract

Material and methods. The authors studied 121 patients with intra-articular fractures of the distal humerus in age from 3 to 18 years. In the study group (consisted of 81 patients) the displacement of the distal fragment retained after a single unsuccessful reduction. In these children open reduction and fixation were performed. In cases of damaged neurovascular bundle the authors carried out revision and reconstruction of damaged nerve and vascular trunks. The control group consisted of 40 children who were treated conservatively (closed reposition). Follow-up was at least 6 months after discharge. Results. Evaluation of the functional results showed improvement in 67,0% of patients in the study group and 33,0% - in the control group. In study group a good anatomic result was achieved in 73 (90%) patients, satisfactory - in 6 (7,5%) and poor - in 2 (2,5%). In the control group a good anatomical results were obtained in 7 (17,5%) patients, satisfactory - in 14 (35%), poor -in 19 (47,5%). Conclusion. Indications for surgical treatment: secondary displacement of bone fragments after a single failure or closed reduction. Elimination of fragment displacement prevents posttraumatic contractures and deformities of the upper extremity, and contribute to the full restoration of elbow joint function.
Traumatology and Orthopedics of Russia. 2012;18(4):82-86
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CASE REPORTS

SURGICAL TREATMENT OF PARALYTIC SEVERE CLUBFOOT OF SEVERE DEGREE IN ADULTS (CLINICAL PRACTICE CASE)

Mukhamadeyev A.A., Koryshkov N.A., Balayan V.D., Grazhdanov K.A.

Abstract

The short-term result of treatment of the patient with an severe clubfoot who underwent a surgical treatment is represented. Besides the patient suffered from talipes varus and short cavovarus deformity which were eliminated during the surgery. To eliminate a multicomponent talipes a technique of two-stage surgical treatment of the given severe pathology devised in SarNIITO was used. It made it possible to achieve a complete elimination of the talipes, a high-grade restoration of anatomy and functions of the ankle, and in the future it will allow to improve life quality of the particular patient.
Traumatology and Orthopedics of Russia. 2012;18(4):105-109
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EXPERIENCE EXCHANGE

REVISION SURGERY IN PATIENTS WITH SCOLIOSIS OPERATED WITH PLATE ENDOCORRECTORS

Kolesov S.V., Baklanov A.N., Shavyrin I.A., Kudryakov S.A.

Abstract

The authors presented 19 clinical observations of patients undergoing surgery at the primary idiopathic scoliosis using plate endocorrectors. The following characteristics were determined: the fixation of posterior elements of the spine there is no possibility of adequate derotation scoliotic vertebrae arc and require extensive fixation of the spine (Th2-L4), significantly reducing the functional activity of the patients. The lack of the fusion is accompanied by system micromotion, causes the instability of the upper pole of the metal construction and provokes the formation of a fistula. The presence of fibrous scar, and later - bone block, doesn’t allow to realize the lengthening effect during the patient’s growth and causes the development of Crankshaft-phenomenon, the correction of which requires a long, traumatic, multi-stage surgery.
Traumatology and Orthopedics of Russia. 2012;18(4):87-92
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RESULTS OF PRIMARY AND REVISION REVERSE SHOULDER ARTHROPLASTY

Peretyaka A.P., Maykov S.V.

Abstract

There is a report of two clinical cases of reverse shoulder joint replacement. In the first case, reverse arthroplasty performed in post-traumatic avascular necrosis of the humeral head. In the second case, the arthroplasty with reverse prosthesis was performed because of insufficiency of rotator cuff, and due to this, dislocation of unipolar shoulder. In both cases we achieved good functional outcome.
Traumatology and Orthopedics of Russia. 2012;18(4):93-98
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SUBSTANTIATION OF THE NEW METHOD OF CLOSED REDUCTION OF FRACTURE CALCANEUS

Kupitman M.E., Atmansky I.A., Chemikov M.K., Maminov D.V., Gashev A.A., Zubkov M.A., Semenov A.A.

Abstract

The authors presented the results of analysis of surgical treatment 52 patients with calcaneal fractures in the trauma department of Magnitogorsk city hospital N 3 from 2007 to 2009. On the basis of these results a new classification of calcaneal fractures was created, which determined the tactics of closed reduction. The author’s method of minimally invasive reposition in patients with calcaneal fractures n is described. The results of applying this technique in 25 patients were evaluated. According to the authors, the closed reduction technique is simple and can be applied in any trauma department in the presence of X-ray control. This technique has a very good cosmetic results and the small number of postoperative complications.
Traumatology and Orthopedics of Russia. 2012;18(4):99-104
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TRAUMA AND ORTHOPEDIC CARE

TRAUMATISM AND ORTHOPEDIC DISEASES INCIDENCE IN ADULTS OF ST. PETERSBURG IN 2008-2011 AND ACTIVITY OF TRAUMA AND ORTHOPEDIC CARE SYSTEM

Tikhilov R.M., Vorontsova T.N., Cherniy A.G., Luchaninov S.S.

Abstract

The article deals with basic findings derived from annual investigation, held by Coordination-methodic Center specialized in “orthopedics and traumatology”. The analysis of dynamics of main indices of incidence of trauma and musculoskeletal diseases in adult population was based upon official findings of federal statistic monitoring of condition and work of specialized medical service. The evaluation of structure, dynamics and work of the hospital and out-patient service was made in compare with incidence dynamics of trauma and musculoskeletal diseases. Generally Saint-Petersburg characterized with high level of traumatism of population with tendency to decreasing, big part of severe skeletal injuries of population, increasing of number of patients with chronic diseases of locomotor system, big part of yang and middle aged patients with temporary lost of possibility to work because of injuries, high level of mortality (with prevalence of men) and tendency to decreasing. Trends of processes of traumatology and orthopedic care system reflects increasing of volume of specialized trauma service for city population as in ambulatory as in hospital links, increasing of intensity of using of traumatology and orthopedic beds in city hospitals, decreasing of deaths caused of injuries in city hospitals, increasing of number of surgical interventions of locomotor system and decreasing of postoperative hospital mortality.
Traumatology and Orthopedics of Russia. 2012;18(4):110-119
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HISTORY OF MEDICINE

TREATMENT OF FRACTURES IN ANCIENT EGYPT

Bashurov Z.K.

Abstract

The most complete information about the medicine in Ancient Egypt two papyrus provided: a large medical papyrus of G. Ebers and papyrus about the surgery of E. Smith. Smith’s papyrus is of particular interest as it contains the information on the status of surgery in Ancient Egypt. Papyrus consists of descriptions of the clinical cases. To the present time, 48 cases have survived; it is arranged in order of location - from the head down to the feet. Orthopedic deformities were reflected in the figures on the walls of the pyramids and temples as well as the description of the mummies and archaeological finds.
Traumatology and Orthopedics of Russia. 2012;18(4):120-125
pages 120-125 views

REVIEWS

OSSEOINTEGRATION IN RECONSTRUCTIVE SURGERY: CONTEMPORARY STATE AND PERSPECTIVES OF FURHTHER DEVELOPMENT (REVIEW)

Shevtsov M.A., Galibin O.V., Yudintceva N.M., Blinova M.I., Pinaev G.P., Scherbina K.K., Shvedovchenko I.V., Pitkin M.

Abstract

Method of intraosseous prosthesis based on the principle of osseointegration that was introduced by Prof. Per-Ingvar Branemark is one of the most perspective approaches in contemporary reconstructive surgery This method helps to achieve increased functional activity and to improve patients quality of life in comparison to conventional treatment. In presented article the results of prosthetic treatment of amputees of different localizations, application of this technology in cranio-fascial surgery, finger joint prostheses are discussed.
Traumatology and Orthopedics of Russia. 2012;18(4):126-134
pages 126-134 views

TREATMENT OF THE LOW LIMB DEFORMITIES IN YOUNG CHILDREN WITH ARTHROGRYPOSIS (REVIEW)

Baindurashvili A.G., Derevyanko D.V., Agranovich O.E.

Abstract

The review of domestic and foreign literature on a problem of treatment of the low limb deformities in young children with arthrogryposis is revealed in the article. Questions of medical tactics and its peculiarities in one and both sided congenital hip dislocation are touched upon. Basic worldwide tends of hip surgery development and effectiveness of different methods in arthrogriposis are revealed. Views of domestic and foreign authors on a problem of knee joint contractures treatment are represented and different conservative and surgical methods according to severity of deformities are described. Results of clubfoot treatment of different authors are shown in the article. Ponseti method and its possibilities for clubfoot correction in arthrogryposis are specified. Questions of treatment of planovalgus deformities are also touched upon as well as problems of orthotic supply in accordance with type of the deformities and its combination.
Traumatology and Orthopedics of Russia. 2012;18(4):135-141
pages 135-141 views

Review of the guide for doctors authored by L.A. Rodomanov, A. Yu. Kochish "Reconstructive microsurgical operations for limb injuries." Saint Petersburg: RNIITO Vreden, 2012.

Shvedovchenko I.V.

Abstract

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Traumatology and Orthopedics of Russia. 2012;18(4):142-143
pages 142-143 views

DISCUSSIONS

COLLISIONS IN THE CLASSIFICATION OF SLAP LESIONS

Yevsyeyenko V.G., Zazirniy I.M.

Abstract

There is no agreement among experts on the classification of injury of o the long head tendon of biceps brachii in the area of its attachment to the shoulder blade. Some authors take the Snyder’s classification as basis; others describe it as a separate injury. The authors presented the review of existing classifications of the labrum shoulder injury (so-called SLAP lesions) and traumas of the tendon of the long head biceps.
Traumatology and Orthopedics of Russia. 2012;18(4):144-152
pages 144-152 views

SCIENTIFIC INFORMATION

ANNUAL THEORETICAL AND PRACTICAL CONFERENCE “VREDEN READINGS”

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Traumatology and Orthopedics of Russia. 2012;18(4):153-154
pages 153-154 views

THEORETICAL AND PRACTICAL CONFERENCE “TOPICAL ISSUES OF CHILDREN'S TRAUMATOLOGY AND ORTHOPEDICS”

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Traumatology and Orthopedics of Russia. 2012;18(4):155-156
pages 155-156 views

INDEX OF ARTICLES PUBLISHED IN 2012

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Traumatology and Orthopedics of Russia. 2012;18(4):157-159
pages 157-159 views

AUTHOR'S INDEX 2012

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Traumatology and Orthopedics of Russia. 2012;18(4):160-161
pages 160-161 views


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