Vol 23, No 1 (2017)

CLINICAL STUDIES

FIRST METATARSOPHALANGEAL JOINT OSTEOARTHRITIS: PERCUTANEOUS SURGERY, CHOICE OF A SURGICAL PROCEDURE, CLINICAL AND RADIOGRAPHIC CLASSIFICATION

Berezhnoy S.Y.

Abstract

Introduction. Hallux rigidus is observed in approximately 2.5% of the adult population. Until now neither a unified classification of hallux rigidus appears to exist nor any clear principles to choose the surgical method. The variety of clinical and radiological signs explains the difficulties in establishing a comprehensive classification system and in selection of the criteria for surgical procedure. There are few published reports about hallux rigidus percutaneous surgical treatment. Existing papers are dedicated to a limited number of percutaneous techniques.

The purpose of this study was to evaluate the efficacy of percutaneous techniques for surgical treatment of the first metatarsophalangeal joint osteoarthritis; to specify factors determining the choice of procedure; to develop a grading system of the hallux rigidus severity which will help in selection of surgery.

 Materials and methods. Based on 156 surgeries (107 patients) the author demonstrated the possibilities of percutaneous techniques in the surgical treatment of hallux rigidus of different stages as well as provided a brief description of used surgical techniques.

Results. The mean age of patients was 48.8 years (ranged from 18 to 73). The mean follow-up was 7 months (ranged from 3 to 54). At the specified time the treatment outcomes of 103 patients (150 feet) were analyzed. Mean hospital stay was 0.78 days (ranged from 0 to 1). No infectious or wound-healing problems were observed. Overall, the patients were completely satisfied with the outcomes of 89 surgical treatment, qualified satisfaction was reported with patients in respect of outcomes of 57 surgeries. Four unsatisfactory outcomes were observed. The role of the relatively long first metatarsal in the development of hallux rigidus was confirmed.

 Conclusion. Percutaneous techniques provide successful treatment for all stages of hallux rigidus. The choice of a specific surgical technique may be challenging and requires consideration of a variety of clinical and radiological signs of the pathological process as well as other factors determined by a surgeon only after detailed discussion with the patient. Grading system, proposed in the study, is intended to help the surgeon in selection of individualized surgical approach. It’s recommended to use the proposed classification with the explanations to it provided in the study. 

Traumatology and Orthopedics of Russia. 2017;23(1):8-22
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ANALYSIS AND PLANNING OF HINDFOOT DEFORMITY CORRECTION IN SAGITTAL PLANE

Solomin L.N., Ukhanov К.A., Sorokin E.P., Herzenberg J.E.

Abstract

Background. The disadvantage of the known methods of analysis and planning of hindfoot deformities in the sagittal plaBackground. Long bone deformity planning is well established. However, there are not well described methods of analysis and planning of hindfoot deformities in the sagittal plane. Such planning is made even more difficult with concomitant deformation of the midfoot and/or ankle contracture or malpositioned arthrodesis. The aim of our study was to develop a universal method of analysis and planning of the calcaneus correction, based on the normally derived reference lines and angles.

Methods. We analyzed 65 standing lateral foot films in normal adults, 23-54 years old were analyzed. We drew the talus joint line (points “a” and “b” – Line 1). We drew a second line, (Line 2) the calcaneal line, which starts at the back of the calcaneal tuberosity (point “d”), drawn perpendicular to a line from top to bottom of the calcaneal tuberosity. The intersection of the calcaneal line and the talar joint line form point (c) anteriorly. We measured lines ab, ac and cd, and their ratios: ac/ab, and cd/ab.

Results. Talar joint line (Line 1) and calcaneal line (Line 2) intersect at a point (c), forming an angle 15.2° (±3.4°). The ratio ac/ab = 2.56 (± 1.1). The ratio cd/ab = 4.59 (±1.0). These ratios are constants for calculating the idealized joint lines for deformity planning. For deformity cases, draw Line 1, the talar joint line ab. Extend that line anteriorly to (c), which is a distance ab×2.56 from point (a). From (c), draw an idealized calcaneal line, Line-2, at an angle 15° to Line 1. Place (d) on this line, at a distance ab×4.59 from point (c). Next, draw the deformed calcaneal line (Line 3) and point (d1 ) where it exits the calcaneal tuberosity. Use the same technique and landmarks as for drawing the normal calcaneal line. The intersection of Lines 2 and 3 is the apex of the deformity. Rotate the piece containing Line 3 around this apex, until it is collinear with Line 2, and (d) is coincident with (d1 ).

Conclusions. We describe the normal sagittal plane relationships between the hindfoot (calcaneus – talus). This normative data is used for planning sagittal plane hindfoot deformity corrections. It can be used for hindfoot deformities analysis and correction planning. It is independent of ankle joint equinus or malpositioned ankle arthrodesis, which can be considered as separate deformities.

Traumatology and Orthopedics of Russia. 2017;23(1):23-32
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TRANSITION PREDICTORS OF X-RAY 0 STAGE FOR KNEE OSTEOARTHRITIS INTO THE 1ST STAGE (BASED ON THE COMPLEX EVALUATION OF THE KNEE JOINT BY MRI WORMS)

Makarova М.V., Valkov M.Y., Valkova L.E., Revchuk A.S., Agapitov A.V., Chernykh I.A., Parfenova A.R., Grjibovski A.M.

Abstract

Background. Osteoarthritis (OA) is the most common disease among all rheumatological diseases. Approximately 70-80% of all OA cases of are gonarthritis. Routine X-ray examination is not informative to assess non-bone structures. Magnetic resonance imaging (MRI) allows visualizing all the structural elements of a joint, such as articular soft tissue structures and subcortical parts. To achieve objective data, the researcher needs to adhere a protocol allowing to assess of all joint parts, the so-called method of evaluation of the whole body (Whole Organ Magnetic Resonance Imaging Score –WORMS). Aim. to determine predictors of OA progression for X-ray 0 stage on the basis of the knee MRI procedure byWORMS.

Methods. A cohort study. The sample consisted of patients with gonarthritis in all hospitals inArkhangelsk,Northwest Russia. The main inclusion criterion was clinically confirmed with knee OA by Altman 1991 without X-ray pathological changes. X-ray examinations of the knee joints were performed during the initial diagnosis and after one year. After the first X-ray examination patients underwent an MRI provided by machines with a magnetic field strength of 1.5 Tesla. The study included 76 patients, 22 patients were lost to follow up. Altogether, 54 (71.1%) patients completed the study. MRI evaluation of the data was carried out byWORMS protocol.

Results. The progression of X-ray 0 stage into the first stage by Kellgren-Lawrence after one year has occurred in 45 (8.3%) patients of the 54 patients. Clinically significant predictors of progression of OA of the knee based on MRI were: degeneration of the medial meniscus (OR = 5.0, 95% CI: 1.1-22.5), and synovitis (OR = 7.0, 95% CI: 1.5-33.1), degeneration of the medial meniscus and synovitis were included Regression model. Regression model revealed the most significant predictor of progression of knee OA was synovitis (OR = 5.49, 95% CI: 1.13-26.72). The sensitivity of model was 95,1% (95% CI: 85.8-94.9), specificity was 71,4% (95% CI: 33.3-94.4), positive predictive value was 5,6% (95% CI: 89.6-99.1), negative predictive value was 55,6% (95% CI: 25,9-73,4).

The findings of this study revealed the only significant MRI predictor of the transition X-ray 0 stage into the first stage was synovitis which increased the risk of the progression in 5.5 times during one year.

Traumatology and Orthopedics of Russia. 2017;23(1):33-44
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WHAT INFLUENCE ON EARLY POSTOPERATIVE PAIN INTENSITY AFTER TOTAL KNEE ARTHROPLASTY?

Saraev A.V., Lindberg M.F., Gay C., Rosseland L.A., Lerdal A., Kornilov N.N., Kulyaba T.A.

Abstract

Purpose – to describe the relationship of selected socio-demographic, clinical, and surgical factors with the severity and patterns of postoperative pain during the first three days following total knee arthroplasty.

Material and methods. The sample included 100 patients (93 women and 7 men; mean age 63.5±7.8 years) with osteoarthritis admitted for primary total knee arthroplasty. Prior to surgery, standard measures were used to assess preoperative pain and other symptoms, clinical manifestations of osteoarthritis, functional status of the knee, comorbidities, functional abilities, quality of life, and other patient characteristics. Physical, biochemical and surgical parameters of the perioperative period were also recorded. Patterns of daily changes in postoperative pain characteristics were investigated with the use of individual diaries.

 Results. All the analyzed indicators of postoperative pain progressively decreased during the three days after surgery (р<0,001), including the number of daily hours of moderate to severe pain (р<0,001). Pain levels were generally higher among women than among men (р = 0,009). Of the analyzed preoperative factors, higher levels postoperative pain were correlated with higher levels of anxiety (р = 0,029) and preoperative pain intensity (р = 0,029). Among the perioperative factors, surgery duration longer than 90 minutes was associated with higher levels of postoperative pain in activity (р = 0,012) and more hours of moderate/severe pain (р = 0,008). Characteristics of postoperative pain were unrelated to level of patient education, social or family status, employment, lifestyle, or any other clinical or laboratory variables.

Conclusion. Of the many factors previously associated with postoperative pain, only gender, anxiety and level of preoperative pain confirmed their importance in this study. Among the perioperative factors, surgery duration, which varied by the type of implant, was significantly associated with postoperative pain levels. 

Traumatology and Orthopedics of Russia. 2017;23(1):45-58
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COMBINED FEMORAL FIXATION TECNIQUE IN HAMSTRING TENDON ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: ASESSMENT OF TUNNEL WIDENING

Korolev A.V., Magnitskaya N.E., Ryazantsev M.S., Il’in D.O., Afanasyev A.P., Frolov A.V.

Abstract

Purpose – to assess the influence of combined femoral fixation technique during arthroscopic ACL reconstruction on the femoral tunnel widening at long term follow-up.

Material and methods. 99 patients with primary hamstring tendon (HT) ACL reconstruction performed in 2007-2008 were analyzed. In the study group (42 patients) on the femoral side a combined cortical suspension (Endobutton CL, Smith & Nephew) and transverse (Rigid Fix, Depuy Mitek) fixation of graft was used. In control group, isolated cortical suspension fixation (Endobutton CL, Smith & Nephew) was used. On the tibial side for graft fixation a biodegradable screw (Biointrafix, DePuy Mitek) was used in all cases. Tunnel widening was calculated in percentage against primary tunnel diameter created during the surgery. MRI data were exported to eFilm (Merge Healthcare software), measurement of femoral tunnel diameters was performed on T1 sequences in coronal and sagittal planes on three different levels.

Results. The mean age at the last follow up in the study group was 38.9±1.4, in control group – 38,6±1,08. The median time from surgery to follow up was 9 years and 4 months in the study group and 8 years 7 months in the controls. The incidence of graft failure in the study group was reported as 14.3%, while in the control group as 17,5%. The median femoral tunnel widening was larger in the control group at the joint aperture and midsection levels both in coronal and sagittal plane, although there was no statistically significant differences (p>0,05).

Conclusion. The combination of cortical suspension and transverse HT femoral graft fixation technique is likely to reduce tunnel enlargement at the long term follow-up. However further research and larger sample groups are required. 

Traumatology and Orthopedics of Russia. 2017;23(1):59-69
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SPECIFICS OF DIAPHYSEAL HUMERUS FRACTURES HEALING IN PATIENTS TREATED BY ILIZAROV EXTERNAL FIXATION

Erokhin A.N., Tarchokov V.T.

Abstract

Based on the literature data analysis a hypothesis was made that specific features of humeral diaphyseal fractures consolidation process in result of Ilizarov method treatment depend on their quantitative characteristics.

Purpose of the study – to develop quantitative characteristics of diaphyseal humerus fractures and to analyze their correlation to the terms of bone fragments healing.

Materials and methods. The authors studied X-rays of forty one patient with diaphyseal humerus fractures; age of patients ranged from 21 to 60 years (median – 37 years), there were 19 male and 22 female patients. The authors worked out the formulas using Weasis software for quantitative characteristics of diaphyseal humerus fractures: distance of the fracture site from proximal metaphysis of the humerus, extension of the fracture line and degree of bone fragments displacement. During statistical analysis of the recorded data the average standard deviation, median, minimum, maximum, 25th percentile and 75th percentile were calculated. The Shapiro-Wilk test was used to check consistency of recorded data with normal distribution of characteristics. Correlation analysis was performed by calculation of Kendall and Pearson coefficients. Statistical processing of reported data was done by means of unpaired criteria: non-parametric Wilcoxon test and parametric Student t-test. When comparing two samples a null hypothesis was rejected at the level of test significance p≤0.05. The authors utilized Microsoft Office Excel 2007 and AtteStat, version 13.1.

Results. Statistical analysis of the samples including comminuted and spiral fractures of humeral diaphysis demonstrated that the level of the fracture was within 40.9±19.9% and distributed from 11.6% to 72.4% along the diaphysis. Correlation analysis demonstrated statistically valid moderate negative relation between the level of fracture site and consolidation period (Pearson correlation coefficient r = -0.46; р = 0.0091). There is a statistically valid positive moderate relation between extension of the fracture line and consolidation period (Pearson correlation coefficient r = 0.43; р = 0.015). Statistically valid positive and weak relation was observed between the value of “post-reduction displacement” of bone fragments and consolidation period (Kendall correlation coefficient τ = 0.25; p = 0.045). Within the group of comminuted and spiral diaphyseal fractures of the humerus the authors observed a statistically valid longer consolidation period in the sample with diaphyseal fractures, located up to 48.4% away from the proximal end of the humerus as compared to the sample of fractures, located below the indicated border.

 Conclusions. Consolidation period of the diaphyseal humerus fractures demonstrated statistically valid correlation with the following characteristics of the fracture: 1) fracture location: the closer to the distal end of the humerus the shorter is consolidation term; 2) extension of the fracture site: the longer is the fracture line the longer is consolidation period; 3) post-reduction degree of bone fragments displacement: the larger is the degree of displacement the longer is consolidation period. The correlations observed during the study are true for diaphyseal humerus fractures located within 11 to 72% away from the proximal end of the humerus. 

Traumatology and Orthopedics of Russia. 2017;23(1):70-80
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SURGICAL MANAGEMENT OF BICONDYLAR TIBIA FRACTURES

Kutepov S.M., Volokitina E.A., Gilev M.V., Antoniadi Y.V.

Abstract

Purpose – to improve the tactics for surgical management of bicondylar tibia fractures to gain better outcomes.

 Materials and methods. The authors analyzed outcomes of surgical management of 69 patients within 36 months after the procedures. Two comparison groups were created to assess the effectiveness of the proposed techniques: the main group of 27 patients (39.1%) and control group of 42 patients (60.9%). In the main group the advanced and new techniques were applied (two-staged protocol of surgical correction, internal fixation with joint distraction, a combination of new L-shaped external and L-shaped internal approaches, bone grafting with b-TCP, carbon nanostructure implant and «Osteomatriks» xenograft). In the control group the conventional internal fixation was used. The difference in tibiofemoral (ΔFTA) and plateau-diaphyseal (ΔPDA) angles at various follow up stages were checked to evaluate reduction stability. P.S. Rasmussen score was used to assess the functional status and life quality of patients. Statistical methods of evaluation included parametric and non-parametric test to check confidence value of variances.

Results. In 36 months postoperatively ∆FTA >5° in the main group was observed 1.97 times less than in control group (23.1% and 45.5% respectively); ∆PDA >5° in the main group was observed 1.66 times less than in control group (30.8% and 51.5% respectively). Total number of excellent and good results the main group 36 months postoperatively according to P.S. Rasmussen score was reported as 1.81 times higher than in the control group (50% and 27.6% respectively).

 Conclusion. The paper proves the efficiency of the proposed surgical procedure for bicondylar tibia fractures management.

Traumatology and Orthopedics of Russia. 2017;23(1):80-88
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FIVE YEAR OUTCOMES OF CERAMIC-ОN-CERAMIC AND CERAMIC-ОN-POLYETHYLENE BEARINGS IN HIP JOINT REPLACEMENT

Murylev V.Y., Kavalersky G.M., Terentiev D.I., Rukin Y.A., Elizarov P.M., Muzychenkov A.V.

Abstract

In view of the increasing number of hip joint replacement volume there remains the key issue of improving prosthesis survivorship which directly depends on the friction couple.

 Material and methods. The authors have analyzed five year outcomes of two bearing types (head and insert) used in hip replacement: ceramic-on-ceramic (CoC) in 324 patients and ceramic-on-polyethylene (CoP) in 300 patients. Totally 550 patients were operated in the period starting 2010 till 2014, including 74 patients underwent bilateral hip replacement. The authors divided patients based on gender and also into three age groups: 20-40, 41-60 and 61-80 years old. The largest group comprised 156 women aged 41-60 years (28.4%). Additional grouping of patients was made based on gender, age and bearing diameter.36 mm diameter bearing was characterized of the most frequent use. Functional outcomes were assessed by Harris Hip Score. Statistical analysis was made with Statistica 10 software. Statistical significant was observed at p<0.05.

Results.28 mm diameter bearing were rarely (19.5%) applied and mainly in women which is related to need for use of smaller acetabulum components and inability to implant a larger insert.36 mm diameter bearing were used most frequently, CoC articulation of36 mm was used in men in 34% of cases and in women – in 18.12% of cases.40 mm articulations were implanted in women two times less than in men which is related to a smaller diameter of acetabulum in women. Generally, CoC bearings were implanted more often in men which can be explained by a bigger social demand as well as a higher anti-luxation stability of large diameter bearings. Dislocations of implants occurred in 5 (0.91%) patients: in 4 patients with CoP bearingand in one patient with CoC articulation. Four revision procedures (0.64%) were made due to deep periprosthetic infection: two surgeries in each group. Harris Hip Score evaluation in CoC group demonstrated excellent and good outcomes in 99.2% of cases, and in CoP group – in 97.5% of cases.

Conclusion. The authors observed no ceramic fractures or acoustic effects during 60 months follow up. It’s reasonable to increase CoC bearing diameter to achieve a better anti-luxation effect. CoC bearing selection should depend on patient’s activity and social demands but not only on the age. Based on study observations the authors forecast a higher survivorship of CoC couple within 15-20 years and expect to prove this conclusion in further studies. 

Traumatology and Orthopedics of Russia. 2017;23(1):89-97
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RESULTS OF TWO-STAGE REIMPLANTATION IN PATIENTS WITH PERIPROSTHETIC JOINT INFECTION AFTER TOTAL KNEE ARTHROPLASTY

Preobrazhensky P.M., Bozhkova S.A., Kazemirsky A.V., Goncharov M.Y.

Abstract

Treatment of chronic periprosthetic joint infection (PJI) is connected with high reinfection rate and financial costs. Two stage reimplantation with the use of dynamic and static spacers on the first stage is an effective treatment algorithm of such complication.

Purpose of the study – to evaluate the influence of a spacer type on infection eradication and intraoperative features of two-stage surgical treatment in patients with PJI after TKA.

Material and methods. From year 2007 to 2015 161 patients with PJI were treated: 80 patients with dynamic spacers and 81 – with static spacers. The mean follow up period was 65 months (95% CI: 12–91). The mean age was 62 years (95% CI: 30–84). The outcomes included analysis of infection eradication effectiveness and intraoperative features (operation time, blood loss, type of implant). We excluded 57 patients with severe bone defects (AORI 2B, 3), reinfection after the first stage and, finally, analyzed 104 patients with appropriate including criteria.

Results. Effectiveness of the first stage was 70,1%. The second stage demonstrated 90,1% effectiveness. There was statistically lower reinfection rate after the first stage in patients treated with dynamic spacer 88,1%, compared with 59.1% in patients with static spacers. The mean period between stages was 196 days. Sanation surgery with further implantation of dynamic spacer was followed by statistically (p<0,02) lower blood loss – 522.6 ml (95% CI: 150–1300), compared with static spacers – 727.8 ml (698,1 ml (95% CI; 300–1600), but the operation time was comparable (p = 0.8): 140.2 (95% CI; 75–240) и 142.9 min (95% CI: 85–210) respectively. Revision knee arthroplasty after static spacer was followed by frequent (р<0.05) use of extended surgical approach, constrained implants (p<0,05) and long operation time (p<0.02) compared with dynamic constructions.

Conclusion. Two stage reimplantation with the use of dynamic spacers provides better infection control, knee function between stages, less traumatic sanation and revision knee arthroplasty. Inability to comply recommended interval between stages, due to specifics of financing, makes the implantation of dynamic spacers in patients with PJI on the first stage more preferable.

Traumatology and Orthopedics of Russia. 2017;23(1):98-107
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INFLUENCE OF RESIDUAL VARUS DEFORMITY ON CLINICAL, FUNCTIONAL, RADIOLOGICAL AND DYNAMOMETRIC OUTCOMES OF TOTAL KNEE ARTHROPLASTY

Zinoviev M.P., Paskov R.V., Rimashevsky D.V.

Abstract

Purpose of the study – to evaluate the influence of residual varus deformity of the lower leg on clinical, functional and dynamometric outcomes of TKR.

Material and methods. In the period from September 2014 till May 2015 951 total knee replacement surgeries were performed in Ural clinical and rehabilitation center in 933 patients with initial varus deformity of lower limb. However, in 52 cases (5.5%) residual varus deformity of >3° persisted. The main group included 36 patients with mean residual varus deformity of lower leg of 3.9°±0.74° (from 3.1° to 5.6°), the control group included 34 patients with neutral mechanic axis of the lower leg. Evaluation of treatment outcomes was performed on average 14.2±1.8 months after the procedure using functional assessment of the patients according to KSS (Knee Society Score), subjective assessment of life quality (SF36), as well as evaluation of the static-dynamic function of the lower leg on diagnostic and treatment complex Biodex Systems 4 Quick Set and assessment of stability of components fixation by F.C. Ewald scale in modification of O.A. Kudinov et al.

Results. Functional assessment of the patients according to KSS (Knee Society Score) for the main group was 84.0±4.6, in control group – 82.2±4.1 points (p>0.05). Subjective assessment of life quality (SF36) in the main group was 162.6±6.4 points, in control group – 164.3±8.1 points (p>0.05). In terms of flexion and extension of lower leg there were no significant differences between two groups when assessing static and dynamic function by treatment and diagnostic complex «Biodex Systems 4 Quick Set» on average in 14.2±1.8 months after procedure: neither isometric nor isokinetic parameters in both groups demonstrated statistically significant differences (p>0.05). Based on X-rays evaluation there were no abnormalities in components fixation in both groups. There were no statistically significant differences identified in KSS and SF36 scales, dynamometry results and X-ray findings for stability of prosthesis (p>0.05).

Conclusion. The residual varus deformity in the knee of 3.9°±0.74 (from 3.1° to 5.6°) after total knee replacement in the patients with initial varus deformity of lower leg did not affect clinical, functional, X-ray and dynamometric outcomes in 14.2±1.8 months after the replacement.

Traumatology and Orthopedics of Russia. 2017;23(1):108-116
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LECTURE

ROENTGENOGRAPHY POTENTIALITIES FOR EARLY DIAGNOSIS OF HIP PATHOLOGIES

Tikhilov R.M., Shubnyakov I.I., Pliev D.G., Bogopolsky O.Y., Guatsaev M.S.

Abstract

Hip joint X-ray examination is one of the most accessible and prevalent method of roentgen diagnostics despite the emergence and development of new research options such as CT and MRT. X-ray study is the first method used for patients with hip pain. The main problem that arises in the analysis of radiographs is the incorrectly performed examination. Technically correct X-ray examination reveals the majority of changes contributing to the progression of deforming hip arthrosis, to identify changes in the early stage and to choose the best method of treatment. The article describes the basic X-ray studies and the required minimal measurements for assessing hip condition.

Traumatology and Orthopedics of Russia. 2017;23(1):117-131
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DISCUSSIONS

FEATURES OF SURGICAL TACTICS FOR PATIENTS WITH COXO-VERTEBRAL SYNDROME

Kudyashev A.L., Khominets V.V., Shapovalov V.M., Metlenko P.A., Miroevsky M.V., Rezvantsev M.V., Teremshonok A.V.

Abstract

Purpose of the study – to design the algorithm of selection for rational surgical tactics for treatment of patients with coxo-vertebral syndrome.

Material and methods. 175 patients with coxo-vertebral syndrome were included into the study who underwent total hip replacement in the period from 2009 till 2016. The authors analyzed outcomes of treatment of 134 patients at midterm follow up of 9 months (range from 8 to 10 months) after the surgery. Mean age of patients was 54,4±12,7 y.o. Patients were subdivided into a test group (94 patients) and control group (81 patients). Standard THR approaches were used in the control group by restoring anatomical center of rotation and lower leg length. The suggested algorithm of the optimal procedure selection was applied in the test group. Clinical and functional data was evaluated by Harris Hip Score and Oswestry score. Radiographic evaluation was performed based on x-rays of vertebral-pelvic complex in standing position, by functional x-rays, CT and MRI. Evaluation of differences significance between the groups was performed by MannWhitney U-test and McNemar test.

Results. Application of proposed surgical approaches allowed to increase the number of patients with good clinical and functional outcomes (test group – 82,4%, control group – 26,7%) and achieve better function of hip joint and patients’ life quality in short-term postoperative period. Excellent outcomes by Harris hip score were observed in 53,2% of patients, in control group – in 9,7%. Share of the patients complaining of lumber pain, limping and need for a walking stick after THR in the test group was less than in control group. Share of patients demonstrating pain at palpation of spinous processes, with positive test of elevated extended leg and radicular syndrome was also significantly less in test group as compared to control group.

Conclusion. Practical application of proposed algorithm for selection of a rational tactics of surgical treatment for patients with combined degenerative and distrophic pathology of the hip joint and spine allows in short-term after THR to statistically significantly improve treatment outcomes in comparison with patients that underwent conventional preoperative planning and THR.

Traumatology and Orthopedics of Russia. 2017;23(1):132-143
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COMMENTS

Tikhilov R.M., Shubnyakov I.I., Denisov A.O.

Abstract

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Traumatology and Orthopedics of Russia. 2017;23(1):144-145
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COMMENTS

Sereda A.P.

Abstract

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Traumatology and Orthopedics of Russia. 2017;23(1):145-151
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COMMENTS

Danilyak V.V.

Abstract

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Traumatology and Orthopedics of Russia. 2017;23(1):151-152
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TRAUMA AND ORTHOPEDIC CARE

EPIDEMIOLOGICAL STUDY OF LOW ENERGY FRACTURES IN REPUBLIC OF ARMENIA

Saakyan S., Zakroyeva A.G., Galstyan R., Khanamiryan T., Aroyan A., Mamikonyan N., Babalyan V., Lebedev A.K., Gladkova E.N., Lesnya O.M.

Abstract

Until present no data was available inArmeniain respect of incidence of low energy fractures that are typical of osteoporotic locations which consequently did not allow to evaluate the scope of this problem across the country.

Purpose of the study – to identify the incidence of low energy fractures in proximal femur, in distal forearm, in proximal humerus and in distal tibia across population ofArmenia aged 50 years and older.

Materials and methods. An observing population study was performed in two regions of Armenia during 2011-2013 where the frequency of selected locations in cases of moderate trauma was identified. During 2011-2012 the information was collected based on traumatology service records adding in 2013 other sources including primary level of healthcare due to observed infrequent applications for medical help in cases of trauma. Results. In 2013 the incidence of proximal femur fractures in men was reported as 136 cases per 100 000 of population aged 50 years and older, in women – 201 cases per 100 000. At the same time only 57.7% of patients with proximal femur fractures were admitted to hospital. Distal forearm fractures incidence in men and women was observed correspondingly 56/100 000 and 176/100 000 cases, proximal humerus fractures – 39/100 000 and 86/100 000 cases and distal tibia fractures – 39/100 000 and 86/100 000 cases. The predicted annual number of proximal femur fracture in Armenia amounts to 2067 cases, distal forearm fractures – 1205, proximal humerus fractures – 640.

Conclusion. Epidemiological data that was collected for the first time on low energy fractures incidence confirmed the acute osteoporosis issue inArmenia and revealed the problems in organization of medical care for the group of senior patients with injuries.

Traumatology and Orthopedics of Russia. 2017;23(1):153-162
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REVIEW

THE INFLUENCE OF COMPUTER-ASSISTED SURGERY ON CLINICAL AND RADIOGRAPHIC OUTCOMES OF PERIАRTICULAR FEMUR AND TIBIA OSTEOTOMIES IN OSTEOARTHRITIC PATIENTS (REVIEW)

Kochergin P.G., Kornilov N.N., Kulyaba T.A.

Abstract

Nowadays the clinical application of digital technologies became a growing trend at every stage of orthopedic patient treatment: from diagnostic procedures and pre-operative planning to intra-operative control of surgical manipulations and evaluation of final results later. The aim of thi sresearch was to analyze the studies dedicated to application of computer-assisted surgery (CAS) for femur and tibial osteotomies in patients with gonarthrosis. The hypothesis was that CAS improves the precision of leg alignment correction in frontal and sagittal planes that positively influencing both functional result of treatment and longevity of clinical effect. The PubMed, PubMedCentral, GoogleScholar and eLIBRARY searched for relevant studies using following key words: knee, osteoarthritis, gonarthrosis, osteotomy, CAS, navigation and its russian analogs. The majority of publications favored CAS in comparison to traditional osteotomy techniques both for leg alignment and tibial slope control. Despite generally researchers paid less attention to functional results after CASosteotomies than to precision of surgical manipulations it is possible of confirm that there is strong tendency to better knee scores after navigation while the difference is not always statistically significant. Rare publications dedicated to long term results favor CAS: 10 years survival rate is 97% that correspond to outcomes of modern total knee arthroplasty. Hence, the current literature confirms the hypothesis of our study and don’t reveal increase of complications rate associated with CAS.

Traumatology and Orthopedics of Russia. 2017;23(1):163-175
pages 163-175 views

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