Vol 17, No 3 (2011)

ORIGINAL ARTICLES

THE WAYS OF BONE DEFECTS COMPENSATION IN REVISION KNEE ARTHROPLASTY

Kulyaba T.A., Kornilov N.N., Selin A.V., Razorenov V.I., Kroitoru I.I., Petukhov A.I., Kazemirsky A.V., Zasulsky P.Y., Ignatenko V.I., Saraev A.V.

Abstract

During 83 revision TKA we found out the need of bone defect compensation in 93,3% of cases. The autologic bone was used in 12 (7,5%) patients, spongeous allograft in 45 (28,1%), femoral head allograft in 10 (6,3%), structural allograft in 22 (13,8%), femoral or tibial sleeves in 17 (10,6%) and femoral or tibial augmentation blocks in 50 (31,3%). Middle-term results of revision TKA (27 months in average) were evaluated in 57 (68,7%) patients using KSS and WOMAC scores. Positive results were achieved in 48 (84,2%) patients. In 9 (10,8%) cases deep infection developed in different periods of time after surgery. Hence during revision TKA the surgeon should be ready to use different methods of bone defect compensation.

Traumatology and Orthopedics of Russia. 2011;17(3):5-12
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ORGAN PRESERVED RECONSTRUCTIVE OPERATIONS OF THE REPLACEMENT OF DEFECTS OF BONES, FORMING KNEE JOINT

Balberkin A.V., Shavyrin D.A.

Abstract

New modular endoprosthesis CITO – MATI was developed and introduced in the clinical practice on the basis of the exploration of results of reconstructive interventions on knee joint area with the usage of different Russian and foreign endoprosthesis. The aim of our work was to compare the functional results and survival of CITO – MATI and Beznoska endoprosthesis. To the moment of the study among 59 patients, who had implanted Beznoska endoprosthesis, 16 (27%) were secondly operated due to aseptic instability and the destruction of endoprosthesis components. Functional results of the Beznoska endoprosthesis application were good and excellent in 70,7%, and satisfactory in 29,3%. Among 107 patients with implanted CITO – MATI endoprosthesis 3 (2,8%) were operated because of the aseptic instability. The destruction of endoprosthesis components in the observed period of time was not revealed. Functional results of the CITO – MATI endoprosthesis application were good and excellent in 86,6% of cases, and satisfactory in 13,4%. It was revealed, that survival and functional results of the CITO – MATI endoprosthesis application are higher, than those of the Beznoska endoprothesis.

Traumatology and Orthopedics of Russia. 2011;17(3):13-18
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SHORT- AND MIDDLE-TERM RESULTS OF KNEE JOINT REPLACEMENT WITH ZIMMER NexGen CR AND LPS IMPLANTS

Slobodskoy A.B., Lezhnev A.G., Badak I.S., Voronin I.V., Dunaev A.G., Bystryakov P.A.

Abstract

The article presents the experience gained by orthopedic unit of Saratov Regional Clinical Hospital at knee joint replacement with modern implants. We analyzed use of Zimmer NexGen CR and LPC implants for initial total knee joint replacement in 285 patients. The monitoring continued for 5 years. Good and excellent results were observed in 92% of cases. Pyogenic complications were observed in 2.3% of cases. The article describes the methods of surgical intervention and post-surgical rehabilitation. We consider our experience with Zimmer NexGen LPS and CR knee-joint implants as positive and prospective for further use.

Traumatology and Orthopedics of Russia. 2011;17(3):19-33
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USE OF TECHNOLOGIES OF PLASTIC AND RECONSTRUCTIVE MICROSURGERY IN TREATMENT OF PATIENTS WITH PATHOLOGY OF ELBOW

Rodomanova L.A., Kutyanov D.I., Ryabov V.A.

Abstract

We have analyzed the results of using modern technologies of plastic and reconstructive microsurgery in treatment of 39 patients with pathology of elbow. We have stated that while using microsurgical technologies as independent and exhaustive method of treating such patients the operations have mainly mobilizing character. They aim to delete scarry contractures and recreate motion in elbow joint. The use of microsurgical technologies in a system of the specialized orthopedic treatment opens a lot of additional opportunities for the reabilitation of patients with pathology of elbow. It mainly concerns indications for performing total elbow arthroplasty and improving its results.

Traumatology and Orthopedics of Russia. 2011;17(3):24-31
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CORRECTION OF FEMUR DEFORMITIES BY ILIZAROV METHOD AND BY APPARATUS «ORTHO-SUV» BASED ON COMPUTER NAVIGATION

Solomin L.N., Schepkina E.A., Vilensky V.A., Skomoroshko P.V., Tyulyaev N.V.

Abstract

Results of correction of femur deformations by Ilizarov method and with apparatus Orto-SuV working on the basis of computer navigation are analyzed. For elimination of difficult deformations in order to avoid multiple external fixator remounting with stage-by-stage radiological control it is expedient to use apparatus Orto-SUV. In order to elimination of moderate and simple deformations (except torsion) as hexapods and traditional techniques can be a choice method. The use «Orto-SUV» apparatus allows to reduce time necessary for deformation correction and osteosynthesis term in 1,4–2,4 times (for average and severe deformations).

Traumatology and Orthopedics of Russia. 2011;17(3):32-39
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POSTURAL DISTURBANCES AND FEET DEFORMITIES IN CHILDREN WITH CEREBRAL PALSY

Kenis V.M., Ivanov S.V., Stepanova Y.A.

Abstract

The purpose of study was to estimate common postural disturbances in children with cerebral palsy in relation to feet deformities. 100 children were investigated. Age-related changes in postural patterns are described. Five stereotypical postural patterns are most common in children with cerebral palsy. Proper management of feet deformities is necessary for correction of postural disturbance. Inadequate surgical treatment, as a contrast, may be harmfull and dangerous.

Traumatology and Orthopedics of Russia. 2011;17(3):40-44
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NONSURGICAL TREATMENT OF CONGENITAL CLUBFOOT: RESULTS AND PERSPECTIVES

Klychkova I.Y., Kenis V.M., Stepanova Y.A.

Abstract

The results of 10 years of nonsurgical treatment of 350 children with idiopathic congenital clubfoot by different methods at the same hospital are compared. Biomechanically-based methods, such as Ponseti method are highly effective in treatment of idiopathic congenital clubfoot. During the 2 years follow-up good results of treatment were achieved.

Traumatology and Orthopedics of Russia. 2011;17(3):45-49
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BEARING STRUCTURE AND VERTEBRAL DEFORMATIONS IN CHILDREN OF THE FAR NORTH

Batrshin I.T.

Abstract

A total of 4350 children of indigenous and nonindigenous population of the Far North were examined by computer optical topography. They were divided into 3 groups: 500 children – the indigenous population: the Khanty, Mansi, Nenets, who live in rural areas, 450 – aborigines living in urban areas, 3400 people – the non-indigenous children (migrants). Distinctive features in the bearing form and in prevalence of vertebral deformations were revealed. The indigenous population has the expressed crosssection sizes of a trunk and good indicators of a bearing, children of migrants – a trunk with the expressed longitudinal sizes and the worst indicators of a bearing. Prevalence of a scoliosis in I group – 3,4 %, in II – 5,1 %, and in III – 9,3 %.

Traumatology and Orthopedics of Russia. 2011;17(3):50-54
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DIAGNOSTIC VALUE OF ARTHROSCOPY IN CHILDREN WITH JUVENILE IDIOPATHIC ARTHRITIS

Chikova I.A., Avramenko V.V., Krasnogorskaya O.I., Nasyrov R.A., Kalashnikova O.V., Kuznetsov I.O., Chasnyk V.G.

Abstract

29 children with monoarthiritis were included in our study. Besides routine clinical and laboratorial examination, knee arthroscopy with synovial biopsy was performed in all patients. Visual examination of synovial hyperplasia and hyperemia and microscopic examination was performed. Patients were divided into 2 groups with primary and secondary (associated with joint traumatic damage) synovitis. Patients with primary synovitis had significantly lower disease onset age, lower hemoglobin level and higher ESR and CRP and disease duration compare with secondary synovitis group. Intensive and very intensive type of synovial hyperplasia more frequently in first group, in second group more frequently mild and moderate type of synovial hyperplasia occurred. Correlation between synovial hyperplasia and hyperemia has been revealed (r=0,72, p<0,000), between hyperplasia and type of hyperplasia (r=-0,55, p<0,000), and between hyperplasia and arthritis course (r=0,42, p=0,04) was noted in primary synovitis and no any correlation in secondary synovitis. Hyperplasia stage correlated with progressive disease course (r=0,44, p<0,05) and degree with X-ray stage (r=0,48, p<0,05) in primary sinovitis. Conclusions: arthroscopy with synovial biopsy has been suggested in children with chronic monoarthritis without inflammatory activity.

Traumatology and Orthopedics of Russia. 2011;17(3):55-60
pages 55-60 views

THEORETICAL AND EXPERIMENTAL STUDIES

EXPERIMENTAL STUDY OF FIXATION HARDNESS USING DIFFERENT CONSTRUCTIONS ON MODEL OF COMMINUTED PROXIMAL ULNAR FRACTURE

Zhabin G.I., Al-Salmi A., Rumakin V.P.

Abstract

Testing of internal fixation hardness of proximal ulnar fractures (simulated) with different internal extramedullar fixators was performed (hardness for break, hardness for tension, hardness for torsion). Hardness for break and tension appeared sufficient for all internal extramedullar fixators. On the other hand, hardness for torsion was different. It increased for fracture fixed with additional screw through three fragments for all fixators and for fracture fixed with long compressive screw and plate (patent).

Traumatology and Orthopedics of Russia. 2011;17(3):61-67
pages 61-67 views

METHODS OF EXAMINATIONS

DIFFERENTIAL DIAGNOSIS OF TORTICOLLIS IN CHILDREN OF THE FIRST YEAR OF LIFE

Khodzhaeva L.Y., Khodzhaeva S.B.

Abstract

The objective of the investigation involves study of the rate of torticollis and the informative value of ultrasonic examination for differential diagnosis of torticollis in children of the first year of life. Screening of 1000 newborn infants was performed, in 115 of whom clinical signs of torticollis were revealed. The used techniques of diagnostics that included clinical examination, examination by neurologist, and the ultrasonic study made it possible to divide the torticollis patients into groups and to reveal the rate of this condition in newborn infants. It was concluded that use of the clinical, ultrasonic techniques of examination enables one to identify the form of torticollis and to prescribe adequate early therapy.

Traumatology and Orthopedics of Russia. 2011;17(3):68-72
pages 68-72 views

EXPERIENCE EXCHANGE

OPERATIVE TREATMENT OF SPINAL DEFORMITIES IN PATIENTS WITH CEREBRAL PALSY

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

Abstract

Surgical treatment of scoliosis on the background of cerebral palsy is carried out by the correction and polysegmental fixation of the spine and helps to improve balance the body, activate patient in a wheelchair, to prevent the subsequent progression of spinal deformity and rib cage, and improve self-care patients.

Traumatology and Orthopedics of Russia. 2011;17(3):73-79
pages 73-79 views

DABIGATRAN – THE NEW APPROACH FOR DEEP VENOUS TROMBOSIS PROPHYLAXIS

Minasov T.B., Minasov B.S., Zagidullin S.Z., Zagidullin N.S., Caglayan E., Gassanov N.

Abstract

The amount of total joint replacement is more than 1.5 mln world wide and requirement is increasing each year. Nevertheless one of the most dramatic complication after orthopedic manipulations are deep venous trombosis. As known, two aspects of prophylaxis are most important: duration of treatment and the doses of drags. The aim of study was to analys the influence of dabigatran for the risk of postop complications with the short time patients treatment complains. Treatment combination with dabigatran was clinically effective and the rate of adversing events was low. Thus we can conclude that treatment complains of dabigatran significantly higher then traditional injections of low molecular weight heparins.

Traumatology and Orthopedics of Russia. 2011;17(3):80-83
pages 80-83 views

VIDEOTHORACOSCOPIC SPINAL FUSION SURGERY AT THE THORACOLUMBAR SPINAL INJURIES TRANSITION

Pas’kov R.V., Sergeev K.S., Sekhniaidze D.D., Faryon A.O.

Abstract

The experience of videothoracoscopic spondylodesis in 16 patients with lesions of the thoracic and first lumbar vertebrae was presented. The authors described an original approach which consists in carrying out the anteroposterior spine fusion by performing a needle transpedicular fixation and and videothoracoscopic spondylodesis for one anesthesia.

Traumatology and Orthopedics of Russia. 2011;17(3):84-90
pages 84-90 views

MODERN TECHNOLOGIES IN TRAUMATOLOGY AND ORTHOPEDICS

ORIGINAL METHOD OF FEMORAL NECK OSTEOSYNTHESIS WITH NON-FREE AUTOPLASTY

Tikhilov R.M., Karelkin V.V., Kochish A.Y., Kornilov B.M.

Abstract

Applied topographic-anatomical studies were carried out on 12 fixed lower extremities and revealed that in the anterior portion of the middle gluteus muscle 4 cm in width the upper branches of the gluteal vessels are always held supplying the area of the iliac crest. Taking into account the received data the authors proposed a new method of femoral neck osteosynthesis with non-free autoplasty by the autograft from the iliac crest, which is moved at constant muscle-vascular supply pin and fixed with screw in the fracture. Osteosynthesis using the proposed method was performed in 24 patients and provided the union of fractures in all cases in a period of 5 to 8 months. Analysis of long-term results of treatment of 22 patients performed 3 years after the operations showed good function of injured joints and no evidence of avascular necrosis of the femoral head in 18 (83.3%) cases.

Traumatology and Orthopedics of Russia. 2011;17(3):91-96
pages 91-96 views

THE METHOD OF BONE DEFECTS PLASTY IN PATIENTS WITH FOREARM OSTEOMYELITIS BY MUSCLE FLAP FORMING FROM MUSCULUS PRONATOR QVADRATUS

Linnik S.A., Fomin N.F., Dinaev S.I., Haimin V.V., Linnik A.A.

Abstract

The authors presented new method of plasty of postoperative bone defects in patients with chronic forearm osteomyelitis using muscle flap, which is formed of musculus pronator qvadratus. This method was used in 58 patients. Good or excellent results were obtained in 60% cases, satisfactory – in 35%, unsatisfactory – in 5%. In the long-term average force of fist capture on the operated hand was 24,8±3,7 kg and on the healthy – 37,1±5,5 kg (66,7% of intact). The developed method allows to perform the bone defect plasty with a skin deficit and a significant inflammation of the surrounding soft tissues, reduces the recurrence risk and treatment time by optimizing the wound healing process.

Traumatology and Orthopedics of Russia. 2011;17(3):97-100
pages 97-100 views

TRAUMA AND ORTHOPEDIC CARE

ROAD TRAFFIC TRAUMATISM AS COMPLEX MEDIСAL-AND-SOCIAL PROBLEMS OF HEALTH’S LOSS OF THE POPULATION OF RUSSIA

Borovkov V.N., Semenova V.G., Khrupalov A.A., Sorokin G.V., Borovkov N.V.

Abstract

This study analyzes the main aspects of the formation as irreversible and reversible loss due to road traffic injuries. Analysis of the irreversible losses was based on data from official national statistics on deaths due to accidents in the years 1971-2008, as well as relevant data to WHO. The purpose of this study is to develop a methodology for assessing the avoidable health loss due to traffic injuries as a basis for determining priorities and reserves to reduce health and social consequences of accidents on the major categories of victims.

Traumatology and Orthopedics of Russia. 2011;17(3):101-108
pages 101-108 views

FEATURES OF HIP ARTHROPLASTY REGISTER IN RNIITO n.a. R.R. VREDEN

Drozdova P.V., Tikhilov R.M., Goncharov M.Y., Muravieva Y.V.

Abstract

The four-year experience of the hip arthroplasty register of RNIITO n.a. R.R.Vreden is presented. Features and lacks of the organization and the software are described. The revealed problems will be considered at perfection and creation of the new WEB-version of the register.

Traumatology and Orthopedics of Russia. 2011;17(3):109-114
pages 109-114 views

FEATURES OF MEDICAL AID FOR NEUROTRAUMA IN REGION WITH LOW POPULATION DENSITY

Moguchaya O.V., Shchedrenok V.V., Anikeev N.V., Simonova I.A.

Abstract

The system of medical aid for neurotrauma in the region with low population density in the case of the Komi Republic was studied. Neurosurgical care to the population of the republic last decade had an intense focus of development. Currently, neurosurgical service is based entirely in Syktyvkar, and is represented by three neurosurgical departments. Due to the low population density (2.3 people 1 km2), the centralization of specialized medical care and inadequate equipment of district and regional hospitals, special significance remote consultation, as well as adequate ways of evacuation with neurotrauma.

Traumatology and Orthopedics of Russia. 2011;17(3):115-118
pages 115-118 views

ДЛЯ ПРАКТИЧЕСКИХ ВРАЧЕЙ

MICROBIAL BIOFILMS OF WOUNDS: STATUS OF THE ISSUE

Afinogenova A.G., Darovskaya E.N.

Abstract

A significant amount of the data that microorganisms under natural conditions dwellings exist mainly in a kind of the difficult enough organized microbic communities which have received the name of Biofilms has by this time collected. They influence a current of chronic inflammatory diseases, and recently obtained data forms the basis to assume that Bioflms also play an essential role in disturbance of a current of processes of healing of chronic wounds. Biofilms possess high level of tolerance to antibodies, antibiotics, antiseptics, disinfectants and phagocytes. Methods of treatment of wounds with Biofilms include obligatory frequent clearing of a wound together with usage of wound coverings and antimicrobial agents for prevention of reinfection and suppression of reforming of Biofilms.

Traumatology and Orthopedics of Russia. 2011;17(3):119-125
pages 119-125 views

REVIEWS

MODERN PRINCIPLES OF DIAGNOSTICS AND ANTIBACTERIAL THERAPY OF PROSTHETIC JOINT INFECTION (REVIEW)

Bozhkova S.A.

Abstract

The hip and knee replacement was widely adopted in orthopedic surgery. It is high on the list on intervention volume, size of bleeds and to development of the general and local complications. Infectious complications are one of the basic and most expensive problems with significant socially losses after arthroplasty. Early diagnosis, selection of surgical tactics, accurate identification of the responsible microorganisms and choice of an effective antibiotic are important components of successful treatment of prosthetic joint infection. Main principles of diagnostics and rational antibacterial therapy of prosthetic infection are presented in the review.

Traumatology and Orthopedics of Russia. 2011;17(3):126-136
pages 126-136 views

DIAGNOSTICS AND TREATMENT OF SPASTIC HAND IN CHILDREN WITH INFANTILE CEREBRAL PARALYSIS: THE REVIEW PART II: CONSERVATIVE AND SURGICAL TREATMENT OF THE UPPER LIMB

Umnov V.V., Novikov V.A., Zvozil A.V.

Abstract

In article authors describe the isolated data of the foreign and domestic literature concerning a problem of conservative and surgical treatment of the upper limb extremity at patients with cerebral palsy. In the publication the features of various techniques gained the greatest distribution and actively applied now are considered. Besides, the analysis of results of treatment is carried out and problems up to the end not solved are sounded till now.

Traumatology and Orthopedics of Russia. 2011;17(3):137-145
pages 137-145 views

JUBILEE

Sergey V. Dianov

Abstract

.

Traumatology and Orthopedics of Russia. 2011;17(3):146-147
pages 146-147 views

OBITUARIES

Leonid B. Puzhitsky

Abstract

15.04.1957 – 26.06.2011

Traumatology and Orthopedics of Russia. 2011;17(3):148
pages 148 views

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