Vol 19, No 4 (2013)

Original Study Articles

Orthopedic implant-associated infection: the main etiological agents, local resistance and antimicrobial therapy recommendations

Bozhkova S.A., Tikhilov R.M., Krasnova M.V., Rukina A.N.


Surgical site infections remain a major complication of arthroplasty, spinal stabilization or other orthopedic surgeries. The pathogenesis of these complications is related to use orthopedic implants. This retrospective study investigated the microbiological etiology of implant-associated infection after orthopedic surgery over a 3-year period (2010-2012). The antibiotic resistance profiles of 1350 clinical microbial isolates were determined. The biofilm forming capacity of 394 staphylococcal strains was tested. Statistical analysis was performed using Z-criterion. From a results of the microbiological culture, Staphylococcus aureus and Staphylococcus epidermidis were isolated in 49,9% of cases, followed by: Enterococcus faecalis - 6,4%, Pseudomonas aeruginosa - 5,9%, Acinetobacter spp - 5,1% and members of the family Enterobacteriaceae - 4.1%. MRSA amounted to 23,9% and MRSE - 56,6% (p<0,05) . The percentage of strong biofilm forming strains was more among S.epidermidis strains compared to S. aureus strains (46,4 vs 37,3%; p<0,05). The strains of both Staphylococcus spp, isolated from tissue bioptates and removed orthopedic implants, possessed strong biofilm forming capacity more often than isolates from aspirates (p<0,05). The recommendations for empirical and etiotropic therapy of implant-associated infection after orthopedic surgeries were developed on the basis of data on antibiotic resistance of studied microorganisms.
Traumatology and Orthopedics of Russia. 2013;19(4):5-15
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The comparative analysis of efficiency of the early and late reconstructive microsurgical operations at patients with extensive posttraumatic defects of upper extremities

Rodomanova L.A., Kochish A.Y.


Purpose: to conduct a comparative analysis of anatomic-functional treatment outcomes in patients with posttraumatic defects of upper extremity tissues according to the time of reconstructive microsurgical operations. Material and methods. The main study group included 190 patients, who have undergone early reconstructive-plastic operations using microsurgery techniques at R.R. Vreden Russian Research Institute of Traumatology and Orthopedics from 1990 through 2009. Late reconstructive-plastic operations on the upper extremity over the same period have been performed in 206 patients, who constituted the control group. In the main group, island flaps grafting was 3.6 times more frequent, than their free transplantation. Conversely, in the control group the latter type of surgery was 1.7 times more frequent. Outcomes. The main patient group demonstrated 82.9% excellent and favorable outcomes, whereas in the control group such outcomes were achieved only in 60.7% patients, the disability rate being three times higher in the control patients. Conclusion. Early use of operations of free axial tissue complexes transplantation and island flaps grafting allows for significant increase in excellent and favorable outcomes, decrease in the complication rate and unfavorable outcomes, which correspondingly reduces the disability rate.
Traumatology and Orthopedics of Russia. 2013;19(4):16-23
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Analysis of complications after knee replacement in tumor lesions (20-year experience)

Zasulskiy P.Y., Kulyaba T.A., Ptashnikov D.A., Grigoriev P.V., Mikailov I.M.


Purpose - retrospective analysis of the causes of complications after knee replacement in tumor lesions depending on the type of implants and classification of complications by severity. Material and methods. The outcomes of operations of knee replacementin tumor lesions performed in 161 patients in the period between 1993 and 2012 were studied. All patients were divided into two groups. The first group included 68 (42.2%) patients, whom the Russian endoprostheses were implanted. The second group included 93 (57.8%) patients, who were operated using modern foreign endoprostheses. Results. 74 (45.9%) patients underwent revision surgery due to the complications in different terms after primary oncologic replacement, with 67 (90.5%) requiring a removal of the primary endoprosthesis. By severity, all complications were divided into 5 types. Infections were the most frequent complications of knee replacement resulting in revision surgery (19 cases, 25.7% of all revision operations). Conclusion. Improvement of oncological systems quality lead to the decrease in the rate of revision surgery due to mechanical reasons. However, the complication rate after knee replacement remains higher than after conventional arthroplasty.
Traumatology and Orthopedics of Russia. 2013;19(4):24-32
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Brachymetacarpia: features and surgical treatment

Zavarukhin V.I., Baindurashvili A.G., Govorov A.V.


The purpose - to study the morphofunctional changes of upper extremities in patients with brachymetacarpia. Material and methods. The results of the examination and surgical treatment by distraction osteosynthesis of six patients (10 hands, shortening of the 18-metacarpal bones) with brachymetacarpia are presented. Results. All patients noted dissatisfaction with the cosmetic state of hands and tiredness during physical activities with the hand. IV ray was shortened in 50%, V ray - in 33% of cases and III ray - in 17%. Limitation of active flexion was noted in all patients, an average flexion was 58.9 ± 7,1°. After treatment flexion increased an average on 20.5 ° (22.7%). Complications were obtained in two patients on three hands. Conclusions. Brachymetacarpia is a rare disease, the etiology of which is still unknown and requires further study. In all cases of brachymetacarpia there is a restriction of active flexion of the MCP joint of the affected ray and the indications for treatment are caused not only by a cosmetic defect, but also functional impairment. Surgical treatment of brachymetacarpia by distraction osteosynthesis gives predictably good results. Complications during the treatment of brachymetacarpia are rare and mostly related to the appearance of contractures, in order to prevent which in the postoperative period should be used preventive conservative therapy.
Traumatology and Orthopedics of Russia. 2013;19(4):33-41
pages 33-41 views


Experimental substantiation of acetabular component impaction with uncoverage in arthroplasty of patients with severe hip dysplasia

Tikhilov R.M., Shubnyakov I.I., Mazurenko A.V., Mitryaikin V.I., Sachenkov O.A., Kuzin A.K., Denisov A.O., Pliev D.G., Boyarov A.A., Kovalenko A.N.


Purpose. Estimation of critical value of acetabular component uncoverage enabling its implantation without an additional support. Methods. A comparative analysis of an original method for intraoperative measurement of uncoverage space of acetabular component based on the measurement of the depth of uncovered sector with X-ray control by the same technique was carried out. Mathematical computer modeling based on the finite element techniqueand the mechanical experiment were performed. Critical values of uncoverage enabling safe primary fixation of acetabular component were estimated in designed models. Results. High rate of coincidence of direct intraoperative and postoperative measurements by radiograms was obtained, testifying to the possibility of application of this technique of uncoverage estimation at the stage of preoperative X-ray planning in patients with different degree of dysplasia. Using the finite element technique and the mechanical experiment on pelvis models, a possibility of mounting anacetabular component with moderate uncoverage within 25% without screws and with significant uncoverage to 35% with additional two screws fixation was demonstrated.
Traumatology and Orthopedics of Russia. 2013;19(4):42-51
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Pathological changes of the anterior cruciate ligament autografts and some clinical-morphological correlations at the frontal-medial knee joint instability relapses

Grigorovskiy V.V., Strafun S.S., Bogdan S.V.


Purpose: on the basis of study of histologic changes characterizing the condition of tendinous autografts of the anterior cruciate ligament ^TACL) to establish dependencies between clinical and morphologic indicators in patients with signs of knee joint anteromedial instability relapse. Material and methods: 30 resected tendinous transplants have been used received from own patellar ligament (10 cases) and semitendinous and gracilis muscles of the femur (20 cases). After histologic study the parameters of some graduated morphologic indices that versatile characterize the basic processes condition in АТА^ tissues, frequency of their occurrence separately for femoral and tibial parts of the graft, have been determined. Results: АТАСЦ by the moment of their insufficiency with relapse of antero-medial instability, the complex of unevenly expressed pathologic changes has been observed: ischemic-necrotic, dystrophic, inflammatory, reparative-fibrosing and in rare cases metaplastic changes; their topographical combinations and quantitative expressiveness occasionally can vary. In different parts of ATACL the degree of expressiveness of certain morphologic indices of the graft condition varies and can not correspond to separate types of macroarthroscopic estimates. The correlation analysis of pairs relations for nonparametric clinical and morphologic indices separately in femoral and tibial loci has revealed that only some values of coefficient of association corresponding to an moderate range or close to it - both with positive, and negative signs, some values of the coefficient of association have appeared significant by a number of observed cases. Conclusions. The cause of small number of moderate force correlations and absence of close correlations in pairs of indicators «clinic-morphology» is supposed to be in considerable inequality, and probably in cyclic processes of reparation, dystrophy, inflammation and uncontrollable damage of an immature fibrous tissue in ATACL-regenerates, developing during adaptation of the transplant to physical activities and preparing development of its insufficiency.
Traumatology and Orthopedics of Russia. 2013;19(4):52-66
pages 52-66 views

Case Reports

Pseudarthrosis of radial shaft with dislocation of heads of radial and ulnar bones (case report)

Puseva M.E., Mikhaylov I.N., Butaev C.Z., Rudakov A.N.


The authors presented a rare clinical case - the injury of forearm complicated by the formation of the pseudarthrosis of the radial shaft in combination with old dislocation of heads the radius and ulna. The differentiated approach to the choice of surgical tactics was proposed, which consists of several consistent stages: taking free autotransplant from the crest of iliac bone, resection of pseudarthrosis of radius with replacement of the bone defect by the graft for restoration of anatomic length, conducting combined strained osteosynthesis and elimination of dislocation of a head of radial and ulnar bones by transosseous osteosynthesis. The chosen treatment strategy allowed to restore the anatomy and function of the upper extremity.
Traumatology and Orthopedics of Russia. 2013;19(4):80-84
pages 80-84 views

Surgical treatment of diastematomyelia using ct-based navigation system (case report)

Vissarionov S.V., Kokushin D.N., Snishchuk V.P.


The authors presented the clinical observation of the patient 14 years old with congenital malformation of the spinal canal associated with congenital scoliosis and multiple vertebral malformations. The main congenital malformation was diastematomyelia type I at level Th11-Th12, fixed spinal cord syndrome and flail legs. The surgery was performed in the following way: removal of the bone septum of the spinal canal and elimination of the spinal cord fixation using 3D computer navigation. Using 3D navigation allowed exactly to detect the location of the bone septum, creating conditions for reducing the extent of surgical access and minimizing the area of the approach to the same bone spicules. These factors allowed to manage in postoperative period without additional external orthotics. The observation period for patients was 1 year 7 months after surgery.
Traumatology and Orthopedics of Russia. 2013;19(4):85-91
pages 85-91 views


Treatment of unstable pelvic ring injuries with vertebropelvic transpedicular fixation

Donchenko S.V., Slinyakov L.Y., Chemyaev A.V.


In the period from 2011 to 2013 in Botkin City Hospital 17 patients with unstable injuries of pelvic ring and lumbosacral junction were operated using the method of transpedicular vertebropelvic fixation. In the preoperative period a comprehensive instrumental examination, including X-rays and CT was performed in all patients. In 11 (64.7 %) patients neurological complications were detected, of which 4 (23.5%) - cauda equina syndrome (patients with transverse fractures of the sacrum). The follow- up of patients was 1.5 years In all cases the X-ray pattern after surgical treatment was regarded as satisfactory. During the observation period the necessary to remove the fixation devices didn’t appear. The regression rate of neurological symptoms in the postoperative period depend on the severity of the initial injury and the intensity of symptoms. In the group of patients with transverse fractures of the sacrum disorders of pelvic organs remained, caused by primary severe damage in the sacral canal zone. In the other groups there was a gradual regression of motor and sensory disorders in the year after surgery. The complications in the early postoperative period: 2 (11.8 %) cases of delayed healing of surgical wounds in the sacral region (secondary healing) and one (5.9%) case of postoperative wound infection that requested the secondary surgical treatment, rehabilitation and installation of the suction-irrigation system. The method of transpedicular vertebropelvic fixation is effective in the treatment of unstable pelvic injuries if braking-down of gemipelvis is necessary and also in the combined damage of low-lumbar spine.
Traumatology and Orthopedics of Russia. 2013;19(4):67-74
pages 67-74 views


Microsurgical reconstruction of soft tissues of knee region in absence of local plastic resources in preparation for arthroplasty

Kutyanov D.I., Rodomanova L.A., Afanas’Yev A.O.


A new method of microsurgical reconstruction of soft tissues defects of a knee in the conditions of inability to form pedicled flaps of thigh and shin has been offered. Prefabricated pedicled fasciocutaneous donor flap of the thickness needed is created on the anterior and anterior-medial surface of the same thigh. The donor flap is based on the previously transplanted radial forearm fascial free flap. This method provides recreation of wholesome periarticular soft tissues, eradication of the local infection, increase of range of motion in the knee joint and possibility to fulfill in the future perspective total knee arthroplasty as well as any other surgical operations.
Traumatology and Orthopedics of Russia. 2013;19(4):75-79
pages 75-79 views


Unexplained pain after total knee arthroplasty

Parratte S., Kornilov N.N., Thienpont E., Baldini A., Tikhilov R.M., Argenson J., Kulyaba T.A.


Although total knee arthroplasty (TKA) improves function and reduces pain for the large majority of the patients, a few continue to have pain and require investigation. The causes of dysfunction and pain after total knee arthroplasty can be described as intrinsic (intra-articular) or extrinsic (extra-articular) sources of pain. For the majority of the cases, following a complete evaluation protocol, the cause of pain can be identified and a specific treatment can be applied, however occasionally there remains a group of patients with unexplained pain whose management is difficult. It was our hypothesis that revising a TKA without pre-operative diagnosis of the failure is not worth. Therefore, the aimed of this review was to: 1) analyse the results of revision TKA for unexplained pain, and 2) described the potential solutions for an alternative conservative management of the painful TKA.
Traumatology and Orthopedics of Russia. 2013;19(4):92-96
pages 92-96 views

Subluxation and dislocation of the hip in children with spina bifida (review)

Baindurashvili A.G., Ivanov S.V., Kenis V.M.


Subluxation or dislocation of the hip joint develops in 30-50% children with spina bifida during the first 2-3 years of life. These problems results from force disbalance between muscle group and other structural changes of the hip and pelvis components of the joint. The goal of treatment subluxation and dislocation of the hip joint in children with spina bifida is to make comfortable daily functions, eliminate the pain, provide the mobility and social independent. Management of subluxation and dislocation in children with spina bifida had changed in the last years because of the analysis long-term results. Indications for surgical treatment were determined more clearly, what made the results of treatment better.
Traumatology and Orthopedics of Russia. 2013;19(4):97-102
pages 97-102 views


Gennady P. Kotelnikov



Traumatology and Orthopedics of Russia. 2013;19(4):103-104
pages 103-104 views


Vladimir L. Adrianov



Traumatology and Orthopedics of Russia. 2013;19(4):105
pages 105 views

Vadim V. Aerolov



Traumatology and Orthopedics of Russia. 2013;19(4):106-107
pages 106-107 views


Согласительная конференция по проблемам перипротезной инфекции



Traumatology and Orthopedics of Russia. 2013;19(4):108-110
pages 108-110 views

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