Vol 23, No 3 (2017)

CLINICAL STUDIES

EFFECT OF BONE TUNNELS POSITIONING ON OUTCOMES OF TRANSTIBIAL ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

Bantser S.A., Trachuk A.P., Bogopol’sky O.E., Tikhilov R.M., Sushkov I.V., Murga E.A.

Abstract

Purpose of the study — to evaluate position of bone tunnels after transtibial anterior cruciate ligament reconstruction (ACLR) and to determine the relationship of outcomes on their localization.

Material and methods. 54 patients in follow up from 25 to 57 months after transtibial ACLR with hamstring tendons. In all patients was performed magnetic resonance imaging (MRI) to evaluate structure of graft. Bone tunnels localization was determined by computed tomography with three-dimensional reconstruction. Subjective score evaluation was performing by scales IKDC-2000, KOOS, Lysholm. Knee laxity was measured by anterior drawer, Lachman, pivot-shift tests and with arthrometr. Patient was separated in groups depending on the localization of the femoral tunnel for lateral intercondylar ridge (1 group — center of femoral tunnel in front of the LIR, 2 group — in zone of the LIR).

Results. Tibial tunnel position in both groups of patients was the same and localized in central or back third of the footprint. The center of femoral tunnel in 32 patients (59%) was localized in front of the LIR (1 group), in other 22 (41%) — in proximal part of LIR (2 group). Clinical results show statistically significant differences between groups in knee stability and IKDC-2000. In 1 group 78% patients have knee instability grade 1 or 2, while in 2 group similar symptoms was in 32% patients. IKDC-2000 grade A were attributed 19% patients from 1 group and 64% from 2 group, rest of them was grade B or C.

Conclusions. Transtibial anterior cruciate ligament reconstruction with hamstring tendons in most patients did not allow anatomical femoral tunnel placement. Clinical outcomes were much affected by the localization of bone tunnels.

Traumatology and Orthopedics of Russia. 2017;23(3):7-16
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SAFETY AND EFFECTIVENESS OF INTRAARTICULAR ADMINISTRATION OF ADIPOSE-DERIVED STROMAL VASCULAR FRACTION FOR TREATMENT OF KNEE ARTICULAR CARTILAGE DEGENERATIVE DAMAGE: PRELIMINARY RESULTS OF A CLINICAL TRIAL

Smyshlyaev I.A., Gilfanov S.I., Kopylov V.A., Gilmutdinov R.G., Pulin I.I., Korsakov I.N., Gilmutdinova I.R., Petrikina A.P., Eremin P.S., Kruchkova O.V., Abeltsev V.P., Zagorodniy N.V., Zorin V.L., Vasilyev V.S., Pupynin D.Y., Eremin I.I.

Abstract

The incidence of knee osteoarthritis tends to increase every year and constitutes more than 83% of overall OA morbidity. Moreover, the OA morbidity among younger patients is also increasing. However, currently available treatment methods do not provide quite satisfactory outcomes.

Purpose of the study – to evaluate safety and efficacy of intraarticular introduction of autologous adipose-derived stromal vascular fraction for treatment of knee osteoarthritis.

Material and methods. By the moment of writing the present report, 28 patients were included into the study. All patients underwent tumescent liposuction under local anesthesia. The stromal vascular fraction was isolated from lipoaspirate within 1,5 hours after harvesting and subsequently injected into the articular cavity. Follow-up period was 6 months after injections. The authors report on efficacy data of 10 patients who completed the study according to protocol and safety data of all 28 patients. Efficacy was evaluated basing on laboratory assessments and patient’s subjective assessment by validated questionnaires.

Results. Neither adverse reactions no adverse events were observed. Significant decrease of pain severity by VAS was noted in one week after injection and pain score continued decreasing during the whole follow up period. The increase of KOOS score was noted starting on the fifth week after injection. KSS part 1 score increased in 8 weeks, KSS part 2 score — in 6 months after injection. Physical health, assessed with SF-36 questionnaire significantly improved in 2 and 6 months after the procedure. There was a clear trend towards improvement of mental health.

Conclusion. Preliminary results of clinical study suggest intraarticular injection of autologous adipose-derived stromal vascular fraction to be a safe and efficient method of the treatment of knee osteoarthritis. 

Traumatology and Orthopedics of Russia. 2017;23(3):17-31
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OUTCOMES OF TRANSFORAMINAL ENDOSCOPIC DISCECTOMY FOR LUMBOSACRAL DISC HERNIATION

Volkov I.V., Karabaev I.S., Ptashnikov D.A., Konovalov N.A., Poyarkov K.A.

Abstract

Introduction. Lumbar disc herniation is a frequent pathology and surgical target. Endoscopic discectomy becomes more popular due to minimally invasive surgical technique. There is a deficit of scientific papers dedicated to analysis of potential for endoscopic discectomy depending on the specifics of spinal anatomy and degenerative changes.

The purpose of the study was to evaluate the efficacy of transforaminal endoscopic discectomy (TED) in comparison with microdiscectomy (MD) and to specify factors determining complications and failures.

Materials and methods. The authors performed randomized controlled study where main group of patients included data on prospective examination of 101 patients after TED procedure for lumbar intervertebral disc herniation. Age of patients ranged from 19 to 81 years with average of 41,4±12,6 years. Control group included data of retrospective examination of 153 patients that were operated by the same surgeon in the period from 201 till 2104 with microdiscectomy procedure. Age of patients ranged from 18 to 77 years with average of 47,8±11,3 years. Inclusion criteria were as follows: surgical procedure at the same level of the primary intervertebral herniation. Exclusion criteria were: degenerative spinal canal stenosis, spondylolisthesis, spine deformity.

Results. Clinical outcomes after TED demonstrated no difference from MD procedure. No factors of significant influence on outcomes after surgical procedure were observed. The main group was characterized by more cases of revisions and conversions of endoscopic into open procedures (13,9%) which was related to mistakes in transforaminal approach due to features of intervertebral joints and foramina anatomy resulting in impossibility to achieve adequate spinal canal decompression.

Conclusion. Transforaminal endoscopic discectomy is an effective and safe method of lumbar intervertebral herniation treatment. Complications and failures during learning curve of endoscopic procedure are associated with technique drawbacks as well as with mistakes in planning and performing the approach. Congenital alignment of lumbar spine with specific patterns of facets and foramina anatomy dictate technical difficulties with transforaminal approach. 

Traumatology and Orthopedics of Russia. 2017;23(3):32-42
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SURGICAL TREATMENT OF CHILDREN WITH CONSEQUENCES OF INFANTILE SEPTIC ARTHRITIS

Teplenky M.P., Oleinikov E.V., Bunov V.S.

Abstract

Introduction. The consequences of infantile septic arthritis are quite diverse and can manifest themselves as a damage to the growth zone, deformation and destruction of the articular components, and violation of the articular relationships. To treat this pathology, technically complex and traumatic surgical interventions are used. The purpose of this work is to analyze the medium-term results of the use of these methods in the treatment of children with septic coxitis consequences.

Material and methods. The outcomes of treatment for 37 children with consequences of septic coxitis using Ilizarov apparatus were analyzed. Average age of patients at the time of the surgery was 8.2±0.5 years (from 6 to 10 years). Follow up period was from 3 to 10 years (average 4.7 years). Functional outcomes were assessed by C.L. Colton, radiologic indices — by E. Severin score and J. Kruczynski.

Results. Patients were distributed into three groups according to anatomical features. Functional outcomes of patients in the 1st group: good (12–15 points) — 3 joints, satisfactory (9–11 points) — 5 joints, unsatisfactory (8 points) — 1 joint. X-ray findings of patients in the 1st group according to J. Kruczynski criteria: good — 5 joints, satisfactory — 4 joints; by E. Severin criteria: Ia — 1, Ib –1, IIa — 2, IIb — 3, III — 2. Functional outcomes of patients in the 2nd group: good (12–14 points) — 10 joints, satisfactory (9–11 points) — 8 joints. Distribution in the second group by J. Kruczynski criteria: good — 9, satisfactory — 9; by E. Severin criteria: IIa — 14, IIb — 4. Distribution of functional outcomes in the 3rd group in accordance with C.L. Colton criteria: good (12–15 points) — 3 joints, satisfactory (9–11 points) — 7 joints. Distribution in the third group according to J. Kruczynski criteria: good — 4, satisfactory — 6; by E. Severin criteria: IIa — 5, IIb — 4, III — 1.

Conclusion. The use of the presented transosseous external fixation technique in children with the consequences of septic coxitis provides sufficient stability of the joint without causing its decompensation and stiffness. The use of the Ilizarov fixator extends the age limits for reconstructive treatment of abnormal distal hip dislocation. 

Traumatology and Orthopedics of Russia. 2017;23(3):43-52
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ARTHROSCOPIC REPAIR OF LARGE AND MASSIVE ROTATOR CUFF TEARS: CLINICAL OUTCOMES AND POSTOPERATIVE MRI FINDINGS

Dokolin S.Y., Kuz’mina V.I., Marchenko I.V., Belykh O.A., Naida D.A.

Abstract

Purpose of the study – to identify incidence rate of recurrent rotator cuff (RC) tears, to evaluate outcomes of arthroscopic bone-tendon anchor suture, to determine the factors influencing arthroscopic treatment outcomes.

Materials and methods. Medical history data, pre-operative x-rays and MRI of shoulder joints of 305 patients (main group) who underwent arthroscopic bone-tendon anchor suture repair of large or massive RC tears during 2010-2016 were included in the study. Follow up period ranged from 1 to 6 years postoperatively with mean value of 25,6±4,5 months. Telephone survey of patients was conducted after the surgery as well as a single examination of patients with evaluation by functional scales – UCLA, ASES, CS, VAS, DN4. Preoperative standard x-rays in AP and axial views were done in all patients. Arthropathy severity was evaluated by K.Hamada classification. Comparison of patient specific data, features of RC lesions and surgical treatment was made by Kruskal-Wallis test.

Results. Good outcomes by ASES, CS and UCLA functional scales were obtained in 15 (5%) of patients, satisfactory – in 213 (69.8%), poor – in 77 (25.2%). Postoperative MRI data provided the following sub-distribution of patients: 49 (41.1%) patients with complete repair of RC tendons lesions, 38 (31.9%) patients with partial repair and 33 (27.0%) patients with recurrent tear of reconstructed tendon. Correlation analysis allowed to establish the limits for achieving good outcomes of arthroscopic bone-tendon anchor suturing for significant association with infraspinatus muscle atrophy (not exceeding 40%) and fatty infiltration of supraspinatus muscle (not exceeding 23.5%). 

Traumatology and Orthopedics of Russia. 2017;23(3):53-68
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COMPARATIVE ANALYSIS OF TREATMENT OUTCOMES IN PATIENTS WITH TYPES B AND C PYLON FRACTURES

Khominets V.V., Kudyashev A.L., Pechkurov A.L., Fedotov A.O., Naniev S.O.

Abstract

Objective — to develop and implement improved approaches to the diagnosis and tactics of surgical treatment in patients with fractures of the distal tibia metaepiphysis.

Material and methods. The study included 126 patients with fractures of distal tibia metaepiphysis of «B» and «C» types who underwent internal fixation with plates in 2005–2012. The authors analyzed surgical treatment outcomes within the period from 2.5 to 9 years (average of 5.7–2.3 years) of postoperative follow up. Average age of patients was 23.4±2.1 years. Patients were divided into the main group (64 patients) and the comparison group (62 patients). In the comparison group, traditional approaches to diagnosis and surgical treatment were used, including standard clinical examination and X-rays of the affected ankle in two views and the median access to the distal tibia metaepiphysis. In the main group, a specially elaborated algorithm for selection of optimal surgical tactics was utilized basing on the improved diagnostics program. Clinical and functional data were assessed by Foot and Ankle Outcome Score (FAOS) and SF-36 Health Survey. Roentgenological assessment was done by X-rays and CT scans. Statistical significance of the differences was evaluated by Wald-Wolfowitz and Fisher tests.

Results. Improved approaches to the tactics of surgical treatment in patients with pylon fractures of «B» and «C» types allowed to reduce the incidence of unsatisfactory anatomical and functional outcomes from 43.5% to 28.1%. The number of satisfactory and good outcomes increased by 4.7% and 10.7% respectively after application of improved therapeutic and diagnostic approaches.

Conclusion. Proposed improved approaches to verification of severe intraarticular fractures of the distal tibia metabiphysis allowed to increase the informative value of the diagnostic procedures and to avoid discrepancies between preand intraoperative assessment of fracture type by classifications of M. Mueller-AS (1989) and X. Tang, P. Tang (2012) as well as to avoid diagnostic errors in detecting the facet impression of the distal tibia metaepiphysis. 

Traumatology and Orthopedics of Russia. 2017;23(3):69-79
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CAUSES OF NON-OPTIMAL CONSERVATIVE TREATMENT OF CONGENITAL CLUBFOOT IN CHILDREN

Kenis V.M., Stepanova Y.A.

Abstract

Introduction. Ponseti method commonly accepted as the optimal approach to management of congenital clubfoot. Continuing with alternative methods should considered as malpractice. Aim: to assess causes of non-optimal treatment of congenital clubfoot in children.

Materials and methods: Assessment group included 60 patients treated earlier in other clinics with non-optimal results. Control group included 60 patients treated in our clinic by Ponseti method. We used case history analysis and parents’ interviewing.

Results. Family history of clubfoot and prenatal diagnosis positively influenced on the choice of Ponseti method. Primary consultancy of orthopedist and Internet search were main factors for choosing Ponseti method after birth. In contrast, the methods lead to non-optimal results chosen after maternity home and pediatricians.

Conclusion. Main cause of non-optimal results of congenital clubfoot treatment is the lack of information regarding current approaches among non-orthopedic physicians, which emphasizes necessity of adequate informational support.

Traumatology and Orthopedics of Russia. 2017;23(3):80-85
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THEORETICAL AND EXPERIMENTAL STUDIES

EXPERIMENTAL AND THEORETICAL VALIDATION OF DOUBLE COLUMN INTERNAL FIXATION THEORY FOR DISTAL FEMORAL FRACTURES

Belenky I.G., Sergeev G.D., Mayorov B.A., Semenov S.G., Benin A.V.

Abstract

Purpose of the study – to experimentally compare efficiency of lateral and bilateral (lateral and medial) plate fixation of distal femoral fractures and to validate the appropriateness of double column theory of distal femur anatomy for internal fixation for these fractures.

Material and methods. The authors performed a biomechanical study in two series on polyurethane models of right femur corresponding in dimensions to natural femur. After simulating a 33 C2 fracture type it was fixed by one lateral plate or two (lateral and medial) plates. After fixation the models were tested in six load ranges with maximal load from 20 to 120 kgf in cyclic mode.

Results. The authors obtained a significant difference in absolute values of fragments displacement amplitude depending on fixation method. In the first series of the experiment – one plate fixed on the lateral surface of the femur – under minimal load the displacement value was reported as0.3 mm and under maximal load —1.9 mm; in the second series of experiment – two plates fixed on the lateral and medial surfaces of the femur – displacement values were reported as0.35 mm and0.95 mm respectively.

 Conclusion. The presence or absence of medial support after internal fixation has a profound impact on ensuring stability in cases of comminuted fractures of distal femoral fractures. In this context the use of double column theory of distal femur anatomy for internal fixation can significantly improve the treatment outcomes for such patients. After trials of minimally invasive fixation method on anatomical specimen the described theory can be implemented into the clinical practice.

Traumatology and Orthopedics of Russia. 2017;23(3):86-94
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EXPERIMENTAL APPROVAL OF COMBINED FIXATION FOR FEMUR LENGTHENING

Stepanov M.A., Antonov N.I., Borzunov D.Y.

Abstract

Elimination of congenital shortening of lower limb still remains a complex and unsolved orthopaedic task which requires an improved fixation technique as well as adjusted tactics of treatment and rehabilitation procedures.

Purpose of the study — experimental approval of femur lengthening technique by external fixation with Ilizarov apparatus and internal fixation by plate.

Materials and methods. Femur lengthening was performed in 6 mongrel dogs. Average animal age was 1,5±0,3 years, average weight — 20±5 kg, femur length — 22±2 sm. External apparatus with two supports and a titanium plate of an original design were applied under general anesthesia on the right femur of animals. Lengthening was performed manually at a rate of1 mm per day in 4 stages at a distance of 10% from initial segment length. External apparatus was removed on the last day of distraction after locking the plate. X-ray examination was done on the day of surgery, in 7, 14 and 25 days from the onset of distraction as well as in 14, 30, 60 and 90 days after completion of distraction and removal of external apparatus. Three animals were taken out of experiment in 30 days of fixation, remaining three animals — in 90 days. After euthanasia the authors performed autopsy of the organic femur complex and tissues contacting the plate.

Results. The use of operated limb was not restricted during the whole distraction period. The authors observed first roentgenological signs of distraction osteogenesis on 7th day of lengthening. By the end of distraction period, at 25th day, shadows of regenerates demonstrated longitudinal striated structures in all cases. Median lucency area of 1–5 mm was located diagonally and across the regenerate or was intermittent. In 60 days of fixation X-rays demonstrated homogeneous regenerate. External fixation index was 13,9±1,5 days/sm (p≤0,05). The authors observed no cases of implants fracture or deformity during the experiment.

 Conclusion. Application of the developed plate in combination with external apparatus demonstrated high efficiency for femur lengthening in experiment study.

Traumatology and Orthopedics of Russia. 2017;23(3):95-102
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MODERN TECHNOLOGIES IN TRAUMATOLOGY AND ORTHOPEDICS

THE NEW METHOD OF LONG BONE MULTILEVEL DEFORMITIES CORRECTION USING THE ORTHOPEDIC HEXAPOD (PRELIMINARY REPORT)

Solomin L.N., Shchepkina E.A., Korchagin K.L., Sabirov F.K., Takata M., Tsuchiya H.

Abstract

For the treatment of patients with multilevel deformities when there are contraindications for an acute single step correction the external fixation should be applied including orthopedic hexapods. At the same time a separate orthopedic hexapod is used for each level of deformity. This leads to a significant bulkiness of the overall frame assembly. Calculation of deformity correction in the presence of an intermediate fragment (fragments) and practical implementation of correction represent by no means a simple task.

Purpose of the study – to perform a clinical approbation of “spring” technique for multilevel correction of long bones deformities and to evaluate the results.

Materials and methods. The authors developed an original technique for correcting multilevel deformities using a single orthopedic hexapod. During the procedure the hexapod struts are fixed only to the proximal and distal rings, and the intermediate ring (rings) is fixed to the adjacent supports using the springs – a so-called “spring” technique. The new method has been successfully tested in the treatment of 7 patients with 2 and 3-level deformities of long bones.

Results. The reported correction accuracy was 97.6%. The fixation period averaged 47 weeks (from 37 to 54 weeks). In 2 cases the authors observed soft tissues inflammation around of transosseous elements eradicated by the administration of antibiotics. In one patient with post-traumatic deformity a premature consolidation was observed at one of the levels which required re-osteotomy with further correction using two hexapods.

Conclusion. Preliminary results demonstrated that the use of simultaneous correction of deformities at several levels applying one orthopedic hexapod Ortho-SUV and springs simplifies correction calculations, provides optimal timing for deformity correction while maintaining the minimal frame dimensions.

Traumatology and Orthopedics of Russia. 2017;23(3):103-109
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3D PRINTING TECHNIQUE FOR PATIENT-SPECIFIC INSTRUMENTATION IN TOTAL KNEE ARTHROPLASTY

Karyakin N.N., Malyshev E.E., Gorbatov R.O., Rotich G.K.

Abstract

The aim of the study was to evaluate clinical and radiological outcomes of knee arthroplasty using patient specific guides produced using physical prototypes and 3D printing that are applied for positioning of resection blocks.

 Materials and methods. The authors analyzed the treatment outcomes of 4 patients during the period from 2015 to 2016 who underwent total knee arthroplasty for posttraumatic gonarthrosis of III-IV stage with the use of patient specific guides for resection blocks positioning. The mean age of patients was 59±12 years. Initially, all patients reported marked limitation of movement in the knee joint. The average flexion prior to surgery was 53.3±35.1°. According to FLFS roentgenography all patients had a varus deformity of the lower limb with an average value of 15.0±12.3°.

Results. In all cases the axis of the lower limb was normalized postoperatively. The average KOOS score for “pain” was 85.2±14.0, for “daily physical activity” — 74.5±14.8, for “symptoms and stiffness” — 69.0±11.0, for “quality of life” — 62.5±12.5 points. Average knee ROM after arthroplasty: flexion 113.3±5.787° and full extension. Such outcomes can be considered as excellent considering preoperative marked knee movement limitations in all patients.

Conclusion. Preoperative planning using the technology of producing patient specific guides and prototyping on physical tibia and femur models allowed to restore normal axis of the lower limb. The authors observed a significant improvement in joint function and a pain syndrome reduction in all patients. In authors’ opinion patient specific precision guides can be used in the following cases: inflammatory process or deformation of the femur in patient’s history; when the use of intramedullary guides is difficult and does not allow positioning of the prosthesis components with sufficient accuracy or is associated with an increased risk of a purulent-inflammatory process; ipsilateral hip joint prosthesis when it is desirable to avoid opening the medullary canal; substantial bone defects or massive osteophytes of the posterior portion of femoral condyles that impede correct rotation of the femoral component; severe movement limitations in the knee joint, when it is technically impossible to perform TKA using computer navigation and the use of a standard set of instruments poses significant technical difficulties.

Traumatology and Orthopedics of Russia. 2017;23(3):110-118
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CASE REPORTS

SURGICAL TREATMENT OF SEMINOMA METASTASIS IN CLAVICLE (CASE REPORT)

Mikailov I.M., Zasulsky P.Y., Grigoriev P.V., Dubrovskaya M.V.

Abstract

Clavicle is a very rare localization for primary tumor process as well as for metastatic lesion thereby there are few papers in medical literature dedicated to the surgical treatment of a clavicle tumor lesion. Mainly the authors report on experience on total or subtotal claviculectomy without replacement of the defect. There are singular publications on defect replacement with clavicle allograft, rib or fibula autograft or with synthetic materials. The authors report the experience of clavicle metastatic lesion treatment in a patient with testicular seminoma. The authors resected clavicle metastasis and replaced the post resection defect by a locking plate with angular stability and bone cement. The functional outcome evaluated in three months postoperatively was29 ptson MSTS score with a full range of motion in the left shoulder. Described method can be recommended for young patients with a primary tumor process or metastatic lesion of a clavicle who have high demands in respect of cosmetic and functional result.

Traumatology and Orthopedics of Russia. 2017;23(3):119-124
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RIB PENETRATION INTO THE SPINAL CANAL IN CASES OF SCOLIOSIS IN PATIENTS WITH NEUROFIBROMATOSIS TYPE-1 (case report and literature review)

Mikhaylovsky M.V., Novikov V.V., Vasyura A.S., Suzdalov V.A.

Abstract

Background. Rib penetration into the spinal canal in patients with scoliosis secondary to neurofibromatosis type-1 (NF-1) was described in a relatively small number of publications, though it’s common in clinical practice and not always diagnosed.

Materials. The authors report on an adolescent male with NF-1 left thoracic kyphoscoliosis and rib head protrusion into spinal canal with mild initial neurological deficit.

Results. A 14-year-old male patient with NF-1 and 68 degrees left thoracic scoliosis and 65 degrees kyphosis was undergoing treatment at the authors’ institution.Preoperative CT scans demonstrated protrusion of the left T11 rib head into the spinal canal on the convexity of the curve, without spinal cord compression. Surgical procedure for resection of the rib head and correction of the spinal deformity was performed which allowed to achieve good deformity correction. The authors also observed almost complete restoration of sensitive functions.

Conclusion. Rib head protrusion into the spinal canal can occur in cases of spine deformities with NF-1. If present, the imaging findings should be carefully reviewed for appearance of such lesion that may be obscured by the limitations of CT in the context of a dysplastic spinal deformity.

Traumatology and Orthopedics of Russia. 2017;23(3):125-133
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REVIEW

VREDEN RUSSIAN RESEARCH INSTITUTE OF TRAUMATOLOGY AND ORTHOPEDICS

Vorobyоv K.A., Bozhkova S.A., Tikhilov R.M., Cherny A.Z.

Abstract

Currently, the use of bone allografts for reconstructive orthopedic surgery in clinical practice around the world is becoming a common procedure. Bone allografts are the first substitute material to the autologous bone and the best alternative to any artificial substituting material. The methods used for the preservation, processing and sterilization of bone are changing and evolving with time. The main goals remain the same including exclusion of infections and creation of the material with sustained properties of the normal bone.

The present review reflects the essential methods for biological tissue processing, sterilization and preservation with the analysis of the key requirements for manufacturing of safe allogeneic osteoplastic materials with osteoinductive, osteoconductive and osteogenic properties.

Traumatology and Orthopedics of Russia. 2017;23(3):134-147
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RECONSTRUCTION OF BONE DEFECTS AFTER TUMOR RESECTION BY AUTOAND ALLOGRAFTS (review of literature)

Anastasieva E.A., Sadovoy M.A., Voropaeva V.V., Kirilova I.A.

Abstract

The problem of replacement of large bone defects resulting from segmental bone resections in patients with bone tumors is still actual in modern orthopedics. Segmental defects cause the main difficulty especially in cases of disturbance of normal biomechanics while the “gold standard” of reconstruction with bone autograft is not always possible. The reason is that the defect can be so extensive that would make it impossible to harvest necessary autobone stock. Therefore, allografts based on demineralized bone with optimal properties for osteoregeneration are used as an alternative for autograft. For certain composite materials it is possible to program the properties of future graft by changing its compound. Literature analysis revealed that the effectiveness of the allograft in combination with additional components is comparable to autograft effectiveness. Mesenchymal stem cells of both bone marrow and adipose tissue can be used as an additional component to improve osteoregeneration. It is noteworthy that the analyzed studies did not reveal the influence of stem cells on the tumor recurrence. Nevertheless, the authors support the need of further researches in this area to confirm gained results. Some authors still prefer traditional methods of bone traction despite obtaining own satisfactory results of defects reconstruction with allografts. Such opinion is based on proven effectiveness of the method, structural stability of construction during treatment period and ability to adjust the process of bone regeneration at any stage. The authors goal was to analyze publications over the recent 5 years with the results of experiments and clinical studies on the replacement of large bone defects after bone tumor resection with autoand allografts. Based on the literature analysis the authors propose a general algorithm for graft selection in replacement of large bone defects after segmental bone resections. 

Traumatology and Orthopedics of Russia. 2017;23(3):148-155
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JUBILEE

ALEKSEY G. BAINDURASHVILI

Abstract

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Traumatology and Orthopedics of Russia. 2017;23(3):156-157
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50th ANNIVERSARY OF THE DEPARTMENT OF TRAUMATOLOGY, ORTHOPEDIC AND EXTREME SURGERY AT SAMARA STATE MEDICAL UNIVERSITY

Abstract

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Traumatology and Orthopedics of Russia. 2017;23(3):158-160
pages 158-160 views

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