Vol 19, No 3 (2013)

ORIGINAL ARTICLES

Retrospective analysis of effectiveness of different flaps in patients 5 with open tibia fractures

Shibaev E.Y., Vlasov A.P., Kisel D.A., Lazarev M.P., Nevedrov A.V., Tsoglin L.L., Ivanov P.A.

Abstract

In the article the results of 67 procedures of soft tissue reconstructions for the patients with open tibia fractures were analyzed. In the group, where the authors used skin rotational flaps, afterwards there were 3 (37.5%) patients with deep infection. The skin flap necrosis was diagnosed in 5 (62.5%) cases. In the group, where the authors used the reverse sural flap the deep infection occurred in 2 (28.6%) cases, but the flap necrosis developed in 3 (42.9%) cases. In the group where the authors used local muscular flaps, the deep infection occurred in 5 cases (13.2%) and the flap necrosis developed in 5 cases. In the group where we used the free muscular flap there was only 1 patient who got the deep wound infection and there were 2 patients who got necrosis. The clinical results that demonstrated the best healing and minimal complication rate of muscular flaps were confirmed high blood flow data in those flaps, measured by laser Doppler flowmetry. It means that using muscular flaps technique is most suitable for the soft tissue reconstructions in open tibia fractures. The type of the flap’s utilization is not important. Skin flap is a second line method of choice if it’s not possible to use muscular flap technique.
Traumatology and Orthopedics of Russia. 2013;19(3):5-12
pages 5-12 views

Affect of surgical approaches on functional results of total hip arthroplasty in early postoperative period

Andreyev D.V., Naumenko I.V., Goncharov M.Y., Drozdova P.V., Preobrazhenskiy P.M.

Abstract

Minimally invasive approaches implies a less soft tissue damage and, therefore, more rapid recovery of the patient in the early postoperative period. The present study is a comparison of minimally invasive and standard approaches using biomechanical analysis of standing and walking patients before and after total hip arthroplasty, as well as an analysis of clinical outcomes in the early postoperative period. Fifty patients undergoing primary total hip arthroplasty using a minimally invasive and conventional techniques were divided into three groups. The first group consisted of patients operated on using the MIS AL (modified minimally invasive approach Watson-Jones) (n = 17), the second - MDM (minimally invasive approach to the modified Mueller) (n = 16) and in the third - with the use of transgluteal conventional approach by Harding (n = 17). The estimation of biomechanical parameters in static and dynamic patients before surgery and at 8-10 days after surgery. Also assessed clinical outcome postoperative visual analogue scale (VAS) and Harris scale on day 10, 6 and 12 weeks and 1 year. When comparing the three groups of patients stabilometry best results were observed in groups of minimally invasive approaches MIS AL and MDM. When comparing the three groups significantly better (a moderate increase in the duration of the step, rolling the contralateral limb and a slight increase in the duration of the step the operated limb by increasing the duration of the roll-over) were identified in the minimally invasive group MIS AL and MDM. In assessing the scale of Harris in the early postoperative period, higher rates were observed in groups of minimally invasive approaches. A year after the operation functional results become similar in all groups.
Traumatology and Orthopedics of Russia. 2013;19(3):13-21
pages 13-21 views

Femoral tunnel formation using reference anatomical structures of the femoral intercondylar space during anterior cruciate ligament reconstruction

Malanin D.A., Suchilin I.A., Demeschenko M.V., Tscherezov L.L.

Abstract

Purpose: a clinical rationale for using reference structures of the intercondylar space to determine the femoral footprint of the ACL. Material: sixty one patients with ACL deficiency who underwent anatomic anterior cruciate ligament reconstruction using single-bundle «bone-patellar tendon-bone» autograft. Methods: radiography and radiometry, computed tomography, arthroscopy, arthrometry. Results: lateral intercondylar and lateral bifurcate ridges can be verified arthroscopically with a frequency of 94% and 48%. Orientation of the femoral tunnel formed using reference structures is more horizontal in coronal plane and has increased sagittal slope compare with traditional technique. Conclusions: The lateral intercondylar and lateral bifurcate ridges can be used as reference structures for femoral tunnel formation during anatomical anterior cruciate ligament reconstruction.
Traumatology and Orthopedics of Russia. 2013;19(3):22-28
pages 22-28 views

Analysis of the results of different types of diaphyseal tibial fractures with intraosseous and of plate osteosynthesis

Pisarev V.V., Aleinikov A.V., Vasin I.V., Oshurkov Y.A.

Abstract

Aim of this study - comparative assesment of treatment outcomes of different types of diaphyseal shin fractures in patients with bone and intraosteal lackable osteosynthesis. Material and methods. We examined 222 patients with fused diaphyseal shin fractures. In 122 patients close reduction and intraosteal lackable osteosynthesis of shin bones was performed, in 100 - open reduction and osteosynthesis of shin bones with plates LCDCP All patients were divided into subgroups according to АО/ASIF classification (fractures type А, В, С). The evaluation of the results was done in two years period after surgery with questionnaire SF36, outpatients clinic cards analysis, CITO cards study outcomes of fractures, rheovasography and X-ray examination. Results. We found that in patients with fractures types A and В these two types of osteosynthesis lead to similar results according to questionnaire SF36, comparable with control group. Bone osteosynthesis in treatment of fractures type С results in higher quality of life, comparable with control group, than intraosteal. Indicators of treatment outcomes in accordance with CITO card in bone osteosynthesis were higher than in intraosteal. In bone osteosynthesis of fractures type A the terms of temporary disability and fusion significantly lower than in intraosteal osteosynthesis of the similar fractures. Reduce of the tolerance to heavy physical stress in patients with fractures type С in intraosteal osteosynthesis determined by low blood flow in shin. Treatment of shin fractures with bone and intraosteal osteosynthesis follows by equal risks of complications.
Traumatology and Orthopedics of Russia. 2013;19(3):29-36
pages 29-36 views

First metatarsal fixed displaced distal percutaneous osteotomy in the metatarsus primus varus surgical correction

Berezhnoy S.Y.

Abstract

The purpose of the study was to expand the possibilities of metatarsus primus varus percutaneous correction through the development of surgical technique, taking into account the advantages and disadvantages of known techniques. Materials and method: by the example of 67 surgeries the results of the first metatarsal displaced distal percutaneous osteotomy fixed by the screw were reviewed. Surgical technique was described. Proposed intervention was applicable over a wide range of the first intermetatarsal angle (from 12 to 29° in this series). Immediate fool weight-bearing was authorized. An average hospital stay was 1.02 due to the painless early postoperative period. Results: desired correction of the first metatarsal has been achieved in the course of all surgical interventions. Partial or complete loss of correction in the postoperative period, that did not affect final results, was registered in three patients after interventions on four feet. The average first intermetatarsal angle after surgery was 10.6 ° (4-16). No transfer metatarsalgia, infectious or other complications were noted, as well as unsatisfactory results. Conclusions: first metatarsal fixed displaced distal percutaneous osteotomy together with previously proposed percutaneous first metatarsocuneiform joint arthrodesis technique allows percutaneous correction of any degrees of metatarsus primus varus.
Traumatology and Orthopedics of Russia. 2013;19(3):37-44
pages 37-44 views

System lipidic distress-syndrome at traumatic illness

Vlasov A.P., Trofimov V.A., Mitroshin A.N., Shevalayev G.A.

Abstract

The purpose of work was studying of a role of systemic lipid metabolism disturbances in a pathogenesis of homeostasis disorders in the early posttraumatic period at fractures of pelvic bones in experiment and clinic. Pilot and clinical studies are put in a basis of work with application of the techniques estimating structure phospholipid membranes of erythrocytes, cells of a liver, kidneys, heart, lungs, and also intensity of the processes participating in a regulation of a lipid metabolism. Results. It is established that at a pelvic trauma change of lipids structure arise not only in a blood, but also other tissues structures (a liver, kidneys, lungs, heart) that is caused by activization of phosfolipaze systems, an intensification of lipids peroxidation process. There is a systemic lipid distress syndrome. The arisen changes - one of significant in a pathogenesis of traumatic illness. At modification of lipid structure of a biomembrane the morphological and functional condition of a cell starts suffering. It is substrate of emergence of disregulation pathologies. The received scientific facts can be the base for intelligent medical actions for the purpose of the prevention of emergence of a "favorable" background of disregulation conditions by vectorial impact on one of its main pathogenetic links - a systemic lipide distress syndrome.
Traumatology and Orthopedics of Russia. 2013;19(3):45-50
pages 45-50 views

Manifestations of undifferetiated connective tissue dysplasia in children with cerebral palsy

Tupikov V.A.

Abstract

Objective - to reveal the phenotypic features of undifferentiated connective tissue dysplasia in the form of dysplastic syndrome. Material and methods. The study included 477 children (240 boys and 237 girls) with cerebral palsy (CP) aged from 1 year to 17. The control group consisted of 134 healthy children (70 boys and 64 girls) aged from 2 to 16. For verification of undifferentiated connective tissue dysplasia international phenotypic Glesby scale, Abakumova scale and Kadurina and Gorbunova scale were applied. Results. Depending on used criteria, the clinical signs of dysplastic syndrome were found in 77,3-80,9% of children with cerebral palsy compared with 14,2-15,7% in the control group. There were statistically highly significant (p <0,001) difference in the number of markers and the severity of the dysplastic syndrome in children with cerebral palsy compared with healthy children and children with double hemiplegia in comparison with other forms of cerebral palsy. It was concluded that the CP should be seen as a manifestation of systemic organ dysplasia (dysplastic syndrome). This should be considered during the examination, choosing the tactics of conservative treatment with the principle of "control ripening," The timing and methods of surgical repair of motor disorders in children with cerebral palsy.
Traumatology and Orthopedics of Russia. 2013;19(3):51-56
pages 51-56 views

THEORETICAL AND EXPERIMENTAL STUDIES

Characteristics of proximal tibial epiphysis structure and effectiveness of impression fragments fixation in tibial 57 condylar fractures (in vitro study)

Voronkevich I.A.

Abstract

The structure of cancellous bone of the proximal tibial epiphysis using CT and measurement of Leeb hardness was investigated. The author found that subchondral layer as thick as 10 - 15 mm which corresponds with the thickness of impressed fragments of tibial condylar fracture has the density and elasticity modulus up to 84,4% of lowest threshold value of the compact bone. In more deep layers from cartilage the cancellous bone progressively loose it’s density and hardness and deeper than 40 mm they reach their lowest threshold value. Higher level of plating with screwing through impression fragment can persist significantly more (p<0,05) cyclic loading (24066±2015) even without bone grafting, than the same fixators inserted lower with deeper than 20 mm screwing through the bone graft (2133±446 cyclic loading). Such application of the plate with passing screws through subchondral layer of impression fragments at the level of 5-7 mm from joint cartilage can be achieved by anatomic preoperational pre-bending of any fixator.
Traumatology and Orthopedics of Russia. 2013;19(3):57-63
pages 57-63 views

Mathematical computer modeling of biomechanical behaviour of hip endoprosthesis modified stem

Batpenov N.D., Mamonov A.M., Karpov V.N., Levochkin A.A., Baymagambetov S.A., Batpen A.N.

Abstract

The principles of mathematical modeling have been proposed in development and prognosing of biomechanical behavior of modified stem of hip prosthesis. We have made computer calculation of tensions and deformities of femoral component of metal stem and bone structures. We have defined critical disorders and wear of metal prosthesis with long groove and without groove. Mathematical calculations and the results confirm functional reliability and workability of the modified prosthesis.
Traumatology and Orthopedics of Russia. 2013;19(3):64-71
pages 64-71 views

Biomechanical consequences of anatomical reconstruction of the lateral ligaments to the ankle joint complex: an in vitro investigation

Shmidt R., Benesh S.

Abstract

The three-dimensional kinematics of both the ankle and the subtalar joints was examined after cutting and subsequent repairing the lateral ligaments using three anatomical procedures: direct repair, tendon graft and carbon-fibre implant. All procedures restored the original kinematics of the subtalar joint, except the plantar/dorsiflexion. For the talocrural joint, the tendon graft and the carbon fibre implant left a minimal laxity for the inversion/eversion and internal/external rotation movements. The direct repair procedure restored the physiologic kinematics almost completely and gave the best results, allowing to restore almost completely the physiologic kinematics. Each procedure respected the insertion points and the directions of the original ligaments. However, the different results for the direct repair and the other two anatomical procedures show that this condition alone is not sufficient to restore the kinematics of the talocrural and subtalar joints perfectly. None of the procedures caused a movement restriction. Thus, we recommend the direct repair of the ligaments as the method of choice. If the quality or the conditions of the ligaments do not allow a direct repair, we recommend to use another anatomical reconstruction.
Traumatology and Orthopedics of Russia. 2013;19(3):72-79
pages 72-79 views

The influence of roncoleukin on reparative processes of bone tissue in experimental tuberculous osteitis

Vitovskaya M.L., Zabolotnykh N.V., Vinogradova T.I., Vasilyeva S.N., Kaftyrev A.S., Ariel B.M., Kirillova E.S., Novitskaya T.A., Iskrovskiy S.V., Serdobintsev M.S.

Abstract

The effect of Roncoleukin on the recovery of the bone tissue in plastic operational defects (autobone+OsteoSet-T) on the model of experimental tuberculous osteites in 36 rabbits caused by drug resistant clinical strains of M. tuberculosis was studied. It was conducted a comparative analysis of the results of applying of Roncoleukin (12,5 mg/kg, 5 injections, one every 3 days) with anti-tuberculosis treatment in pre-and post-operative period. Efficacy was assessed in 1 and 6 months of surgical intervention on the phagocytic activity of peritoneal macrophages, X-ray study of plastics area, histological study of bone tissue sections. It was found that the most effective use of Roncoleukin appeared in the postoperative period. The analysis showed that Roncoleukin helped to accelerate the restructuring of plastic material - OsteoSet-T, reducing the prevalence of specific foci of inflammation in the bone tissue and the disappearance of alternative necrotic component; the increase of osteogenesis intensity with the new bone beams formation., as well as the activation of hematopoesis in bone marrow. The intensification of reparative processes in the bone combined with a distinct activation of phagocytosis.
Traumatology and Orthopedics of Russia. 2013;19(3):80-87
pages 80-87 views

METHODS OF EXAMINATIONS

Assessment of bone quality by the technique of multispiral computer tomography in patients with chronic osteomyelitis

Dyachkova G.V., Dyachkov K.A., Aleksandrov S.M., Larionova T.A., Klyushin N.M.

Abstract

Purpose - to study the roentgenomorphological features of the lower limb long bones in patients with chronic osteomyelitis using the technique of multi-spiral computer tomography (MSCT), and to propose the complex of parameters to assess bone quality. Material and methods. Roentgenography and computer tomography of the hips were performed in 49 patients with chronic osteomyelitis of long bones of lower extremities. The studies made using computer tomographs GE Light Speed VCT, Toshiba Aquilion-64, Somatom Smile. Results. The changes in bone structure of proximal femur were characterized by extremely marked polymorphism, and they almost didn’t repeat in the anatomical component. The cortical plate had heterogenous structure with resorption zones in the area of its transfer to the shaft. The character of roentgenomorphological changes in the shaft was individual in all the patients, but there were common manifestations as well which consisted in thickening of the cortical plate, different intensity of periosteal and endosteal layers. The cortical plate was significantly different in density, which exceeded 1700 HU in some places. When osteomyelitic process localized in the knee marked changes affected its all components, they manifested themselves in extended osteoporosis and local osteosclerosis. When osteomyelitic process localized in proximal tibia extensive resorption zones observed, the cortical plate thinned in proximal parts, its density was not more than 350 HU. Conclusion. The data demonstrated that bone quality in patients with chronic osteomyelitis had significant deviations from normal values in terms of changing both its density and architectonics. The deviations consisted in bone density decrease in the meta-epiphyseal part regardless of the process localization, in highly variable density values of the cortical plate as a result of its thickening or thinning, presence of resorption or sclerosis areas.
Traumatology and Orthopedics of Russia. 2013;19(3):88-95
pages 88-95 views

The possibilities of magnetic resonance imaging in the diagnostics of complications after metal-on-metal hip arthroplasty

Vergay A.A., Danilyak V.V., Klyuchevskiy V.V., Gil’Fanov S.I., Klyuchevskiy V.V., Molodov M.A., Shpunt I.E.

Abstract

Objective: to find adverse periprosthetic local tissue reactions after metal-on-metal hip arthroplasty with ASR XL heads. Material and methods: 119 patients with 134 ASR XL head - Corail prostheses were treated in 2007-2009. The results were studied in 94 cases (105 prostheses) - 84%. Average follow-up time consisted 62 ± 3 months. MRI was performed in 12 patients (13 hips) who had clinical nonsatisfaction. Obtained data were compared with 21 MRI (24 hips) of controlled group with good and perfect clinical results. Results. We found variations of normal periprosthetic tissue condition. Adverse reactions were identified in 10 cases. To improve the quality of pictures we developed special MRI adjustments and regimes of work. Conclusion: MRI diagnostics is indicated for the patients with metal-on-metal total hip arthroplasty in order to identify adverse local tissue reactions. The improvement of picture quality needs special adjustment of MRI equipment.
Traumatology and Orthopedics of Russia. 2013;19(3):96-102
pages 96-102 views

CASE REPORTS

Congenital malformations of hands and feet in Smith-Lemli-Opitz syndrome

Kovalenko-Klychkova N.A., Kenis V.M., Klychkova I.Y.

Abstract

Smith-Lemli-Opitz syndrome is rare genetic disorder with multiple limb malformations and neurological manifestation, caused by inborn defect of cholesterol metabolism. Congenital deformities of feet and hands are most common orthopedic symptoms in this syndrome. Description of a girl with Smith-Lemli-Opitz syndrome demonstrates specific features of this disorder and emphasize the importance of proper interpretation of orthopedic malformations for early diagnosis of genetic conditions.
Traumatology and Orthopedics of Russia. 2013;19(3):143-147
pages 143-147 views

EXPERIENCE EXCHANGE

Tactics of surgical treatment for thoracic and lumbar spinal injuries

Usikov V.D., Kuftov V.S., Ershov N.I.

Abstract

The analysis of results of surgical treatment of 154 patients with a vertebral and spinal trauma of chest and lumbar departments of a backbone aged from 16 till 75 years is carried out. All patients were operated in Bryansk city hospital N 1. The volume and sequence of surgeries, and existence were defined with the combined damages, character of an injury of a backbone and a spinal cord or absence free part bone bodies of the injured vertebra compressing a spinal cord defined different accesses on a backbone. So, surgeries at 125 (81,2 %) patients were carried out from one back access, at 23 (14,9 %) patients - to the combined back and lobbies and at 6 (3,9 %) patients - front and back access. In all cases for fixing of a spine implants “Sintez” firm (St. Petersburg) were used. Results of treatment were estimated on neurologic dynamics, restoration of an axis of a backbone, a gleam of the vertebral channel and restoration possibility of a support of a backbone. Good results of treatment are received at 87 (56,5 %), satisfactory - at 55 (35,7 %) and unsatisfactory - at 12 (7,8 %) patients.
Traumatology and Orthopedics of Russia. 2013;19(3):103-112
pages 103-112 views

Diagnostics and surgical treatment of vertebral osteoporosis

Shchedrenok V.V., Zuev I.V., Topolskova N.V., Anikeev N.V., Orlov S.V., Sebelev K.I., Chizhova M.V., Moguchaya O.V.

Abstract

The retrospective analysis of clinical and radiological diagnostics of 76 patients with vertebral osteoporosis among which women prevailed (82.9%) is carried out. The average age was 57,7 ± 5,3 years. The complex diagnostics consists of the survey x-ray,the x-ray absorptiometry, the quantitative computed tomography, spiral computed tomography and magnetic resonance imaging procedure. The quantitative computed tomography is characterized by the highest diagnostic information value (sensitivity - 99.4%, specificity - 99.5% and the accuracy - 99.3%). Surgical treatment consisted in rigid (7.9%) and dynamic (10.5%) vertebral fixation and puncture vertebroplasty (81.6%), which was consist in a dereception of underlying facet joints with introduction into it the solution consisting in equal quantities of local anesthetic and alcohol 70° (1.5-2.0 ml). The optimized technique of vertebroplasty with an additional dereception of facet joints allows to increase the level of social rehabilitation of patients by 10.2% with full regress of a pain syndrome.
Traumatology and Orthopedics of Russia. 2013;19(3):113-118
pages 113-118 views

The main approaches to the knee joint stabilization in patients with cerebral palsy

Umnov V.V.

Abstract

Objective: to improve the results of surgical correction of flexion contracture of knee joint in patients with cerebral palsy. Material and methods. 196 patients with cerebral palsy aged from 2.5 to 18 years old were examined. In 131 patients aged from 8 to 18 years old we performed lengthening of tibia flexors with posterior capsulotomy and without it, in 4 patients aged from 11 to 16 years old the contracture was corrected after preliminary reduction of muscle tone using lumbar dorsal selective rhizotomy (LDSR). Among 246 operated segments a slight contracture in 23 cases was eliminated only with lengthening of tibia flexors, in the remaining 223 cases in addition after lengthening of tibia flexors the residual contracture was corrected by the method of pre-dosed correction in plaster cast. In 16 segments if there was a severe contracture we performed a posterior capsulotomy of knee joint. Besides, we investigated the dependence of contraction degree from phase-tonic activity of tibia flexors, as well as the influence of LDSR on the possibility to correct flexion contracture in 65 knee joints of patients aged from 2.5 to 16 years old. Results. The high degree of dependence of knee flexion contracture (KFC) from tone increase of tibia muscle flexors (correlation coefficient r p<=0,01 in patients aged from 2.5 to 7 years old is 0,942, 8-16 years old - 0,712). Probably that is why in 65 investigated joints using LDSR the contracture was corrected in the younger age group in 50 %, in elder age group - in 46 % cases after reduction of muscle tone - tibia flexors by 59% and 37%. Taking into consideration the data we worked out the indications for different variants of surgical correction of KFC depending on the degree of its intensity and with account of muscle hypertonia. As a result of the appliance of differentiated approach the contracture was corrected in 91,6 cases. Conclusion. The main causes of knee flexion contracture in patients with cerebral palsy are contractures and muscle imbalance in contiguous segments, predominance of tibia flexor tone and weakness of soleus muscle. Differentiated approach allows correcting contracture in most cases.
Traumatology and Orthopedics of Russia. 2013;19(3):119-124
pages 119-124 views

Clinical variants of upper limbs deformities in children with arthrogryposis multiplex congenita

Agranovich O.E., Lakhina O.L.

Abstract

From 2004 to 2012 the authors examined and treated 207 patients with upper limb deformities due to AMC. The age of children with AMC was from 5 months till 18 years. All upper limbs deformities due to AMC were deviated into 2 groups: isolated and complex forms. The isolated forms differ from each other by the level of damage of the spinal cord. There are 4 variants of isolated form with different clinical presentations (C6-7, C5-7, C5-T1, С6). The complex form presents AMC in combination with other pathology: Erb’s palsy, cerebral palsy and congenital upper limbs anomalies. The identification variants of upper limbs deformities in patients with AMC help to choose the optimal variant of treatment and predict the results of treatment.
Traumatology and Orthopedics of Russia. 2013;19(3):125-129
pages 125-129 views

Choice of surgical treatment of pectus excavatum in children based on elasticity criteria of sternocostal complex

Khodjanov I.Y., Khakimov S.K., Kasimov K.A.

Abstract

This report presents the results of the operative correction of the pectus excavatum in 45 children aged from 5 to 15 years. In relation to the elasticity degree and age of the patients there was performed correction of the pectus excavatum by method of D. Nuss and in modification with application of a metal plate of the own construction. At normal elasticity (degree I) of the anterior sternocostal complex in 22 (48,9%) patients was executed operative intervention by method of D. Nuss, with good result in 21 (95,4%) and satisfactory in 1 (4,5%) patient. At moderate degree of elasticity (II-degree) in 13 (28,9 %) patients procedure of D. Nuss in modification of our clinic was performed. The correction of the pectus excavatum was carried out by chondrotomy of the deformed ribs and placement of the metal plate under the sternocostal complex. The good results were noted in 11 (84,6 %) patients, satisfactory - in 2 (15,4%). At the hypopastic sternocostal complex (degree III) the deformation was removed by Т-shaped or cross sternotomy with chondroresection of some ribs and then placement of the metal plate of D. Nuss under sternocostal complex. The good results were found in 7 (70 %), satisfactory - in 1 (10 %) and unsatisfactory - in 2 (20 %) patients. Thus, the long-term results of treatment depend on the elasticity of sterno-costal complex and the child’s age.
Traumatology and Orthopedics of Russia. 2013;19(3):130-135
pages 130-135 views

MODERN TECHNOLOGIES IN TRAUMATOLOGY AND ORTHOPEDICS

Dynamic control of knee axial deformities

Malyshev E.E., Pavlov D.V., Blinov S.V.

Abstract

The authors have evaluated the clinical examination of the patients with axial malalignments in the knee by the original method and device which was named varovalgometer. The measurements were conducted by tension of the cord through the spina iliaca anterior superior and the middle of the lower pole of patella. The deviation of the center of the ankle estimated by metal ruler which was positioned perpendicular to the lower leg axis on the level of the ankle joint line. The results of comparison of our method and computer navigation in 53 patients during the TKA show no statistically significant varieties but they differ by average 5° of valgus in clinical examination in comparison with mechanical axis which was identified by computer navigation. The dynamic control of axial malalignment can be used in clinical practice for estimation of the results of treatment of pathology with axial deformities in the knee; for the control of reduction and secondary displacement of the fractures around the knee; for assessment of instability; in planning of correctional osteotomies and intraoperative control of deformity correction; for estimation of Q angle in subluxation and recurrent dislocation of patella; in planning of TKA; during the growth of child it allows to assess the progression of deformity.
Traumatology and Orthopedics of Russia. 2013;19(3):136-142
pages 136-142 views

TRAUMA AND ORTHOPEDIC CARE

PSYCHOLOGICAL RESPONSE TO HOSPITALIZATION STRESS IN PATINTS IN ORTHOPEDIC-TRAUMATOLOGICAL HOSPITAL

Cherniy A.G.

Abstract

The objective - to study the psychological characteristics of response to the stress associated with hospitalization in patients with injuries admitted to the emergency or the purpose of perform routine reconstructive plastic surgery for the consequences of injuries. Material and methods. The assessment of emotional response to the hospitalization stress was performed in 60 patients with injuries and its consequences. The study was carried out using Spielberger - Hanin scale, Luscher eight-color test, the scales of Covey and Tsung. The levels of personal and reactive anxiety, and the presence of somatoform disorders were determined. Results. When emergency and planned hospital admissions for injuries and its consequences the level of personality anxiety was corresponded to parameters of the «moderate anxiety», but the definition of the level of reactive anxiety showed a statistically significant increase in the index in the study group - 44,4 ± 6,5 in comparison with 39,9 ± 4,0 (p = 0.034). There was a significant number of patients in the main group with somatic diseases (headaches, dizziness, tachycardia, extremity tremor, etc.). Conclusions. It is advisable to take into account the significant influence of psychogenic factors and psychosomatic disorders on treatment outcomes and to consider the psycho-emotional profile of patients with trauma and orthopedic diseases. If necessary, the methods of psychological correction should be applied.
Traumatology and Orthopedics of Russia. 2013;19(3):148-153
pages 148-153 views

REVIEWS

Evolution of treatment of of the proximal humerus fractures (review)

Kogan P.G., Vorontsova T.N., Shubnyakov I.I., Voronkevich I.A., Lasunskiy S.A.

Abstract

The article in generalized form acquaints with the publications devoted to the bases of proximal humeral fractures treatment. A brief digression on anatomy and biomechanics of the humeral joint allows to consider the main morphological features of it. The most commonly used classification of proximal humeral fractures concisely classify many types of damage. According to the clinical and anatomical characteristics of fractures tracked the historical aspect, the development and the current state of the most common methods of treatment. In his review collected works authors share their experience in the application of methods. It allows to further the perspective directions.
Traumatology and Orthopedics of Russia. 2013;19(3):154-161
pages 154-161 views

HISTORY OF MEDICINE

To a question about the history of surgical treatment of peripheral nerves injuries

Zolotov A.S., Pak O.I.

Abstract

The article is devoted to the history of the methods of surgical treatment of the peripheral nerve injuries. The analysis of domestic and foreign publications on this question has shown the basic surgical operations used today for nerve’s repair were developed and introduced by surgeons - innovators in second half of 19th century. These operations had unequal popularity in a different historical period. The subsequent generations of surgeons basically have improved earlier invented surgical procedures.
Traumatology and Orthopedics of Russia. 2013;19(3):162-166
pages 162-166 views

ДАННЫЕ РЕГИСТРА ЭНДОПРОТЕЗИРОВАНИЯ ТАЗОБЕДРЕННОГО СУСТАВА РНИИТО ИМ. Р.Р. ВРЕДЕНА

Data of hip arthroplasty registry of Vreden Institute for the period 2007-2012 years

Tikhilov R.M., Shubnyakov I.I., Kovalenko A.N., Cherniy A.Z., Muravyeva Y.V., Goncharov M.Y.
Traumatology and Orthopedics of Russia. 2013;19(3):167-190
pages 167-190 views

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