Vol 23, No 4 (2017)

EDITORIAL

EDITORIAL

Tikhilov R.M.

Abstract

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Traumatology and Orthopedics of Russia. 2017;23(4):7-8
pages 7-8 views

CLINICAL STUDIES

EFFICIENCY AND SAFETY OF TOURNIQUET DURING TOTAL KNEE ARTHROPLASTY: WHEN TO PERFORM RELEASE?

Chugaev D.V., Kornilov N.N., Kogan P.G.

Abstract

Use of a pneumatic tourniquet during total knee arthroplasty is an effective option allowing reduction of the time of surgery and intraoperative blood loss. At the same time, there are a lot of researchers who advocate differing tactical approaches to the duration of the tourniquet application — the so-called “early” and “late” releases.

Purpose of the study. To assess the effectiveness and safety of various methods of tourniquet use during primary total knee arthroplasty.

Material and methods. 72 patients with end-stage knee osteoarthritis were randomly divided into two equal prospective groups: 1) keeping the tourniquet throughout the surgery, including wound closure (late release); 2) performing knee arthroplasty using the tourniquet until after implantation of the prosthesis component and implementation of hemostasis after the release of the tourniquet (early release). Such aspects as perioperative blood loss and changes in blood counts, blood transfusion volume, and severity of pain on the VAS scale, the rate of recovery of the knee joint function and number of postoperative complications were assessed during hospital stay of patients.

Results. The duration of procedures was 70±15,4 min for the Group I with tourniquet throughout surgery (late release) and 95±27,5 for the Group II with early release (p = 0,001). On the 7th day after the arthroplasty the authors observed statistically significant differences (p<0,05) in the dynamics of reducing the level of hemoglobin, red blood cells and hematocrit in patients of compared groups — in patients who underwent late release of the tourniquet, these indicators were higher. When assessing the rate of recovery of knee joint function according to the KSS -and the intensity of the pain syndrome no significant statistical differences were found in the patients of both groups.

Conclusion. Application of the tourniquet throughout the surgery to release after closure of the surgical wound does not lead to a sharp increase in the number of ischemic and thromboembolic complications, while at the same time, the application of this methodology to a large extent maintains hemoglobin indicators, red blood cells and hematocrit at a high level without a critical decrease.
Traumatology and Orthopedics of Russia. 2017;23(4):9-17
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SURGICAL TREATMENT OF CHILDREN WITH CONGENITAL LUMBAR SCOLIOSIS: COMPLETE OR PARTIAL RESECTION OF MALFORMED VERTEBRAE?

Vissarionov S.V., Kartavenko K.A., Kokushin D.N., Baindurashvili A.G., Belyanchikov S.M., Khusainov N.O., Ovechkina А.V.

Abstract

The purpose of the study – to compare the effectiveness of surgical correction of spine lumbar congenital deformity by complete or partial resection of the abnormal vertebra in children.

Material and methods. 68 children with isolated congenital malformation of the lumbar area of the spine were evaluated both clinically and instrumentally. Age of the patients was 6 months — 16 years 2 months (mean — 4 years 5 months). There were 41 female and 27 male patients. Patients were divided in two groups depending on the volume of the surgery. First group (n = 52) consisted of patients treated with complete hemivertebrae resection. Second group (n = 16) consisted of patients treated with partial resection of the malformed vertebrae.

Results. After the surgery in the 1st group scoliotic curve was 0 to 21° and kyphotic curve was from -33 to 9°. 9 years post-op scoliotic and kyphotic curves were 0 to 22° and -31 to 10° respectively. In the 2nd group scoliotic curve was 3 to 27° and kyphotic curve was from -30 to 12°. 9 years post-op scoliotic and kyphotic curves were 7 to 41° and -26 to 8° respectively. Significant differences in the amount of scoliotic curve correction were revealed between the groups: in the 1st group mean Cobb angle for the scoliotic curve after surgery was 3,3° (correction — 94%), in the 2nd group — 13,6° (correction — 80%) (p<0,05). Mean Cobb angle for the scoliotic curve in the long-term period was 5° (correction — 92%) for the 1st group wich was significantly lower (p<0,05) comparing to the 2nd group (mean Cobb angle 18,3° correction — 62%).

Conclusion. Our data showed higher efficacy of the complete resection of the hemivertebrae comparing to its partial resection in pediatric patients with isolated malformation in the lumbar spine. Complete removal of the vertebrae body, its growth plates and disks allowed to achieve radical correction of the deformity and to perform short fusion of the adjacent segments which was crucial for further normal growth and development of the child’s spine with saving the results in the long-term period. Thus complete resection of the malformed vertebrae with radical correction and short segment fusion is the most appropriate option in surgical treatment of pediatric patient of any age with isolated vertebrae malformation in the lumbar spine.

Traumatology and Orthopedics of Russia. 2017;23(4):18-28
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POTENTIAL OF ULTRASOUND-GUIDED LUMBAR FACET RADIOFREQUENCY DENERVATION

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

Abstract

The aim of the study was to evaluate the possibility of US navigation for Radiofrequency denervation (RFD) of the lumbar facets.

Material and methods. The authors performed a prospective controlled cohort study which included 50 patients with chronic pain syndrome who underwent RFD LIII-SI facets on both sides. The main group (US) included 25 patients, who underwent US guided navigation with FScontrol of the correct placement of the cannula prior to ablation. In the control group (FS) the RFD was performed only under FS control. Patients were selected after preliminary test block of medial branch with 50% pain reduction from the baseline. Patients with overweight, spinal deformity, pronounced degenerative changes, spinal stenosis and developmental anomalies were not included in the study. For the evaluation of outcomes, the numeric pain scale NRS-11 and the Oswestry index (ODI) were used, the accuracy of the cannula position was assessed and factors determining the accuracy were searched.

Results. As a result of the intervention, there was a significant decrease of NRS-11 and ODI criteria in both groups (p<0.001), a positive outcome was achieved in 18 (72%) of US patients and 16 (64%) of FS patients, p = 0.564. Of the 200 attempts to position the cannula under the ultrasound control, 169 (84.5%) were successful, in most cases (187 out of 200, 93.5%) at least 3 attempts were required to reposition the cannula. The average time for performing the procedure under the ultrasound control was 47.3±1.13 minutes. The facet angle and procedure level were defined as predictors of the cannula positioning accuracy, odds ratio 0.93 (95% CI 0.894–0.963) and 0.51 (95% CI 0.32–0.805), respectively.

Conclusion. RFD of lumbar facet under ultrasound navigation allows to achieve a relatively high accuracy of the cannula position into the zone of passage of the articular branch. The navigation capabilities are reduced at the level of LV and SI vertebrae due to structural features of the joints, namely coronary orientation of the facets with the formation of a narrow space between the transverse and upper articular process, which create difficulties for scanning. The disadvantage of ultrasound control is the lengthy procedure and the need for repeated reinsertion of the cannulae worsening the patient’s tolerance of procedure.
Traumatology and Orthopedics of Russia. 2017;23(4):29-38
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FEATURES OF THA IN PATIENTS WITH HIGH CONGENITAL HIP DISLOCATION

Kamshilov B.V., Tryapichnikov A.S., Chegurov О.К., Zhdanov A.S., Zaitseva О.P.

Abstract

There are a fair number of papers presenting the outcomes of total hip arthroplasty with shortening subtrochanteric osteotomy in neglected hip dislocation. In most of them the authors used long modular stems or Wagner stems as a femoral component. The reports describing the outcomes of such procedures with standard femoral stems are rather rare.

The purpose of this study was to evaluate short-term and medium-term outcomes of total hip arthroplasty with standard femoral stems and shortening subtrochanteric osteotomy for treatment of high hip dislocation.

Materials and methods. From 2010 to 2016 the authors performed 18 hip arthroplasties with shortening subtrochanteric osteotomy in 16 patients with high hip dislocation. All patients were clinically evaluated using Harris Hip Score and radiography prior to and after the surgery.

Results. The mean Harris Hip Score significantly improved compared to preoperative values from 39.7±1.4 to 84.7±1.6. At mean follow-up of 24±2.4 mounts the authors observed 2 case of nonunion at osteotomy site and 1 case of transient nerve palsy. Revision surgery was performed in 2 patients due to nonunion. The mean limb lengthening was 3.65±0.21 cm.

Conclusion. Our data demonstrated that total hip arthroplasty with subtrochanteric osteotomy is an effective technique for treatment of Crowe type III-IV congenital hipdislocation with high rate of successful fixation on the typical femoral stem, healing of osteotomy site and satisfactory shortand medium-term clinical outcomes. The non-modular tapered stem provides sufficient stability in distal and proximal parts of the femur. The use of standard tapered stem allows to achieve good healing rates of the osteotomy.
Traumatology and Orthopedics of Russia. 2017;23(4):39-47
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IATROGENIC HALLUX VARUS: CAUSES OF DEFORMITY AND POSSIBILITIES OF PERCUTANEOUS SURGICAL CORRECTION (RETROSPECTIVE ANALYSIS OF CASE REPORTS)

Berezhnoy S.Y.

Abstract

Introduction. Hallux varus is a relatively rare foot deformity. Commonly, hallux varus is a complication after the hallux valgus surgery and typically is the result of the first metatarsal medial eminence over resection, first and second metatarsal excessive convergence, over release of the lateral soft tissues, overtightening of the medial soft tissues and soft tissue imbalance of the first metatarsophalangeal joint.

The purpose of this study was to clarify the causes and timing of the iatrogenic hallux varus formation and to evaluate the possibility and efficiency of percutaneous techniques in its surgical treatment.

Material and methods. Thirty-one feet (31 females suffering from iatrogenic hallux varus) were examined clinically and radiologically, including 14 patients who underwent surgery. The average age of the whole group was 57 years (range, 39 to 74), the subgroup of operated patients — 60 years (range from 53 to 68). The time after primary interventions before the examination varied from 2 to 44 years. The mean follow-up after surgery was 6 months (range from 1.5 to 54).

Results. No infection or wound-healing issues were observed. Overall, the patients were completely satisfied with the outcomes of 12 surgeries and satisfied with reservation in 2 cases.

Conclusions. The visual manifestations of hallux varus are determined not only by the hallux varus angle, but also by the value of the first intermetatarsal angle. In addition to well-known factors, hallux varus formation is determined by first metatarsal bone elongation and first metatarsophalangeal joint instability. In rare cases, only one of the factors leads to the hallux varus; as a rule, we see a combination of factors with their mutual reinforcement. Despite the demonstration of usage possibility and the efficiency of percutaneous techniques in hallux varus correcting, a small number of observations in the study does not yet allow giving recommendations on the use of specific percutaneous techniques depending on the various clinical manifestations of hallux varus.
Traumatology and Orthopedics of Russia. 2017;23(4):48-57
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ARTHROSCOPIC TREATMENT OF PATIENTS WITH LATERAL HUMERAL EPICONDYLITIS (TENNIS ELBOW)

Salikhov M.R., Kuznetsov I.A., Zhabin G.I., Shulepov D.A., Zlobin O.V.

Abstract

In the past decade the clinical and anatomical studies proved that lateral humeral epicondylitis can be successfully treated arthroscopically.

Purpose of the study is to identify the optimal method of surgical treatment for patients with lateral humeral epicondylitis.

Material and methods. The authors conducted an integral study consisting of two sections: clinical and anatomical. Anatomical section included precision preparation of extensor muscles of the forearm. Clinical section was dedicated to comparative analysis of statistically valid and matched by lesion severity groups of patients who underwent open and arthroscopic procedures. All patients were divided into three groups. Patients of Group I underwent arthroscopic release of extensor carpi radialis brevis tendon (ECRB) without decorticating of the lateral humeral epicondyle. Patients of Group II underwent arthroscopic release of ECRB in combination with decortication of the lateral humeral epicondyle. Patients in Group III underwent an open release of ECRB.

Results. Patients who underwent arthroscopic release of ECRB demonstrated less pronounced pain syndrome as compared to patients after ECRB release along with decortication of epicondyle or after open release (р<0,05). VAS pain score in Group I decreased from 7 to 1 point, in Group II — from 7 to 3 points, in Group III — from 7 to 4 points. Mean time until full recovery after the surgery was 24,2±7,8 days in Group I, 39,4±5,6 days in Group II and 60,2±15,6 days in Group III (р<0,05). Functional outcomes were assessed by Mayo Elbow Performance Score (MEPS) in 9 weeks postoperatively: Group I — improvement from 60 to 79 points, Group II — from 62 to 75 points, Group III — from 60 to 75 points.

Conclusion. Drilling or removal of periosteum of the damaged epicondyle does not provide a positive effect. Decortication also has certain disadvantages like postoperative pain intensification leading to lesser range of motion in elbow and increased bleeding of the wound. Patients after simple release of ECRB demonstrated minimal postoperative pain which allows early rehabilitation and return to daily and professional activities.
Traumatology and Orthopedics of Russia. 2017;23(4):58-69
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THEORETICAL AND EXPERIMENTAL STUDIES

KNEE CARTILAGE AND SYNOVIAL MEMBRANE STRUCTURAL CHANGES DURING TIBIA DISTRACTION WITH PLATING

Stupina T.A., Stepanov M.A.

Abstract

Purpose of the study — to analyze the changes in knee articular cartilage and synovial membrane during distraction external fixation of the tibia in combination with plating.

Material and methods. Articular cartilage and synovial membrane of the knee joint were studied using histomorphometry methods in 9 mongrel dogs during distraction external fixation of the tibia combined with plating. Tibia and fibula osteotomies were performed at the border of middle and upper third, plate was fixed on tibia diaphysis. Lengthening was achieved at rate of 1 mm per day in four stages during 21–28 days. Animals were withdrawn from experiment in 30 and 90 days. After autopsy of knee joints the authors excised sections of synovial membrane from suprapatellar area, articular cartilage with underlying subchondral bone from loadable surface of femoral condyles. Thickness of articular cartilage, its area and volumetric density of chondrocytes was measured, proportion of chondrocytes within isogenic groups from the overall number of chondrocytes as well as proportion of empty lacunae. In synovial membrane the authors measured thickness of surface layer and numeric density of micro vessels. Articular cartilage of 5 intact animals was used as a control group.

Results. After 30 days of plate fixation a hyperplasia of the integument layer, mild synovitis, and hypervascularization were observed in synovial membrane. Density of micro vessels increased to 363.93±33.71 (control group — 335.05±28.88). The authors also observed subperineural and endoneural edema as well as destruction of nerve fibers in subsynovial layer. Articular cartilage retained the zonal structure. Destructive changes were manifested by fibers separation in the superficial part of surface zone and by partial loss of chondrocytes. The following parameters were reduced: cartilage thickness, area and volumetric density of chondrocytes, proportion of isogenic groups; empty lacunae exceeded the values in controls by 18.2%. After 90 days of plate fixation, thinning of the cover layer of synovial membrane was reported. The numerical density of micro vessels decreased to 325.81±36.39. In nerves of subsynovial layer the edema and vacuolization of myelin sheaths of preserved nerve fibers as well as the formation of Büngner bands in place of degenerating ones were detected. Synovitis was not observed. Fibers separation of extracellular substance in upper superficial part of the surface cartilage zone was retained. There was a tendency to increase in cartilage thickness, area and volumetric density of chondrocytes, proportion of isogenic groups; and to decrease of empty lacunae number.

Conclusion. The histological changes in the articular cartilage during distraction external fixation of the tibia in combination with plating corresponded to the initial stages of osteoarthritis of grades 1—2 according to histological classification of International Society for Study of Osteoarthritis (2006) and were accompanied by hypovascularization and denervation of synovial membrane.
Traumatology and Orthopedics of Russia. 2017;23(4):70-77
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RESEARCH METHODS

PDGF ENZYMATIC ACTIVITY IN PATIENTS WITH DELAYED FRACTURE CONSOLIDATION

Kuzmenko D.V., Lobanov G.V., Shatova O.P.

Abstract

Introduction. Techniques that use growth factors to improve bone fragment consolidation and to treat the inflammatory and degenerative diseases of the musculoskeletal system have become very popular. Many researchers are actively searching for personification of this therapy and the reasons for delayed consolidation. The purpose of the study – to identify the biomarker for delayed bone consolidation.

Materials and Methods. The study groups consisted of patients with high-energy tibia open fractures with normal (group 1) and with delayed (2nd group) consolidation of bone fragments. The enzymatic activity of platelet-derived growth factor (PDGF) in blood serum was studied after 7 days and in 1, 3 and 6 months after bone fragments reduction. Spectrophotometric technique (Specord-200) was used.

Results. In patients with normal consolidation of bone fragments, the enzymatic activity of PDGF was statistically significantly higher in comparison with the group with delayed healing. At the same time, the highest activity was reported on day 7, and by third month it was becoming lower.

Conclusion. Bone healing depends on PDGF enzymatic activity, besides significant differences on various stages of healing were observed. Further study the reasons for the PDGF enzymatic deficiency and its correction are of a great interest for reducing the timing of consolidation.

Traumatology and Orthopedics of Russia. 2017;23(4):78-82
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IMPINGEMENT-SYNDROME OF PERONEUS BREVIS TENDON AFTER CALCANEAL FRACTURES (MORPHOLOGICAL ASPECTS)

Konovalchuk N.S., Rumakin V.P., Sorokin E.P., Lasunskii S.A., Fomichev V.A.

Abstract

Background. One of the main causes of pain in patients with consequences of calcaneal fractures is the lateral impingement syndrome. This term means lateral displacement of outer calcaneal wall at the moment of fracture, narrowing of anatomical space under the lateral malleolus and compression of soft tissues in this region, including tendons of short and long peroneal muscles. This leads to chronic traumatization of tendons, alteration of their normal tracking and development of tendinitis and tenosynovitis. At this moment there are no articles in foreign or Russian literature describing how prolonged traumatization influences the internal structure of the tendons. The purpose of this study was to evaluate the morphological changes in structure of peroneus brevis tendon after different duration of compression between outer wall of calcaneus and the tip of the lateral malleolus in patients with calcaneal malunion.

Materials and methods. Fifteen patients with calcaneal malunion and lateral impingement syndrome were treated operatively between 2016 and 2017. To confirm the lateral impingement syndrome, the authors performed clinical examination and AP x-rays of ankle joint. Two peroneus brevis tendon specimens were obtained intraoperatively in each of 15 patients: one specimen from compressed and one from non-compressed area. Obtained specimens were histologically examined according to standard protocol.

Results. Microscopically all specimens showed separation of collagen bundles with loose connective tissue degeneration, increase of vascularization and inflammation. The degree of these changes differed according to the compression duration. This allowed us to analyze the dynamics of these changes.

Conclusion. The morphological changes in structure of peroneus brevis tendon during the compression between outer wall of calcaneus and the tip of the lateral malleolus correspond with dynamics of common pathologic reactions. Early stages showed signs of mechanical damage of bundles and inflammation. In prolonged impingement the intensity of inflammation decreases, but the connective tissue degeneration of the tendon continues with lipoid infiltration.
Traumatology and Orthopedics of Russia. 2017;23(4):83-91
pages 83-91 views

MODERN TECHNOLOGIES IN TRAUMATOLOGY AND ORTHOPEDICS

ALLOGENEIC BONE GRAFTING MATERIALS – UPDATE OF THE CURRENT SCIENTIFIC STATUS

Schnettler R., Franke J., Rimashevskiy D., Zagorodniy N., Batpenov N., Unger R.E., Wenisch S., Barbeck M.

Abstract

Worldwide population aging and associated with it epidemics of osteoporosis, widespread of bone and joint reconstructive surgery and first of all joint replacement lead to explosive growth of interest in bone grafting.

Although autografts are still the golden standard in bone regeneration, allogeneic bone substitutes have reached a state that allows for their application with satisfying clinical results. However, it has repeatedly been supposed that the different allogeneic materials underwent different purification processes, which modifies bone regeneration properties of these materials and also for different safety conditions. In the present publication, the treatment of the precursor tissue, the safety conditions, and the regenerative possibilities of C+TBA bone blocks based in preclinical and clinical data are described. Thus, it is described how the risks of infections and also immunological reactions becomes completely eliminated, while the special purification process allows for preservation of the native structure of the bone block. Both the in vitro studies and the clinical trials including histological follow-ups showed the optimal regeneration properties of these bone blocks. It has been shown that the allogeneic bone grafts have been integrated without causing inflammatory anomalies at the implantation site. Altogether, the allogeneic bone substitute material serves as an excellent basis for the formation of new bone. Finally, the combination of the allogeneic C+TBA bone blocks with different antibiotics is described. Interestingly, it is possible to combine the allogeneic bone substitute ether with antibiotics in the sense of prophylaxis and/or with bone marrow aspirate in order to accelerate bone remodeling.
Traumatology and Orthopedics of Russia. 2017;23(4):92-100
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CUSTOM TRIFLANGE ACETABULAR COMPONENTS IN REVISION HIP REPLACEMENT (EXPERIENCE REVIEW)

Korytkin A.A., Zakharova D.V., Novikova Y.S., Gorbatov R.O., Kovaldov K.A., El Moudni Y.M.

Abstract

Extensive defects of acetabulum especially accompanied by pelvis discontinuity at the level of acetabulum pose a serious challenge in revision hip replacement and create additional complexity in fixing the acetabular component. One of the perspective options to solve the above issue is the use of custom triflange acetabular components (CTAC) designed based on preoperative computer tomography given the specifics of bone defects of the patient. Purpose of the study — to evaluate the outcomes of CTAC use in revision hip replacement.

Materials and methods. The authors analyzed treatment outcomes of 12 patients after revision hip replacement using additive techniques of computer simulation and 3D printing CTAC. Follow up period after the surgery averaged 7±3 months (from one to ten months). 7 out of 12 patients had acetabular defects of Paprosky 3B type, 4 patients had defects of Paprosky 3A and in one patient — of Paprosky 2C.

Results. Two out of twelve patients had prosthesis dislocations that required revision hip surgery, one of those patients underwent open reduction of dislocation with wound debridement, another patient underwent replacement of articulating couple of acetabular component. Total scores under Harris Hip Score and paint VAS score prior to treatment was 28±7 and 7±1 points respectively, postoperative scores were 76±9 and 3±1 respectively.

Conclusion. The application of additive techniques for revision hip replacement in patients with extensive acetabular and pelvic defects allows to make a precise preoperative planning, to restore joint rotation center, to reconstruct bone defects and to securely fix triflange acetabular component that altogether significantly improve treatment outcomes and patients satisfaction with the surgery.
Traumatology and Orthopedics of Russia. 2017;23(4):101-111
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NEW METHOD OF ACETABULAR ORIENTATION MEASUREMENT IN THA

Dianov S.V., Domovitov S.V., Zhuzhnev A.V., Shikunov D.A., Semenov A.L.

Abstract

Relevance. The correct implantation of acetabular component in total hip arthroplasty is an important factor for obtaining good outcomes and long-term survival of the prosthesis. The anteversion angle is one of the significant indicators for the three-dimensional orientation of the cup. The purpose of the study — to develope the method of calculating the anteversion angle of the acetabular component using postoperative anteroposterior radiographs of the hip and pelvis.

The method. The authors used the projection ellipse formed by the opening of the prosthesis cup on the radiograph centered on the hip joint to calculate the desired value. The ratio sine of projectional diameter of the ellipse to its true diameter is a mathematical formula for finding the angle of anteversion. The comparison of the calculated index on anteroposterior radiographs centered on the hip joint and on the pelvis is necessary to identify the distinction between anteversion and retroversion of the acetabular component. In negative anteversion, or retroversion, the projectional diameter on the pelvic radiograph is larger than on the radiograph focused on the hip joint.

Conclusion. Measuring of anteversion angle of acetabular component on postoperative radiograph allows to gain an optimal orientation of acetabular component which decreases postoperative complications rate. X-rays of any scale can be used for measurements while the ratio but not the absolute value of measured diameters is important for the result.

Traumatology and Orthopedics of Russia. 2017;23(4):112-117
pages 112-117 views

CASE REPORTS

MASSIVE POSTTRAUMATIC HETEROTOPIC OSSIFICATION OF KNEE JOINT (CASE REPORT)

Ryazantsev M.S., Magnitskaya N., Afanasyev A.P., Ilʼin D.O., Logvinov A.N., Frolov A.V., Korolev А.V.

Abstract

Heterotopic ossification is characterized by bone tissue formation in soft tissues that possess no osteogenic properties. The authors present a clinical case of a female patient with massive heterotopic ossification in anteromedial aspect of the right knee joint with 10 years history before admission for treatment. An abrupt knee hyperextension became a trigger mechanism for the present lesion. MR tomography demonstrated af ormation pushing off the healthy tissues along the anteromedial surface of the right joint. Computer tomography visualized a massive calcination of soft tissues. During the arthroscopic procedure the authors observed a formation of a dense consistency with round borders which demonstrated minor cohesion with surrounding tissues. The formation wasremoved. Diagnosis was confirmed by histological findings. Control x-rays in 6 months after the procedure verified absence of new areas of heterotopic ossification. Removal of ossificational lowed to obtain a good clinical outcome.
Traumatology and Orthopedics of Russia. 2017;23(4):118-124
pages 118-124 views

TWO-STAGE REVISION HIP REPLACEMENT PATIENS WITH SEVERE ACETABULUM DEFECT (CASE REPORT)

Pavlov V.V., Kirilova I.A., Efimenko M.V., Bazlov V.A., Mamuladze T.Z.

Abstract

Favorable short-term results of arthroplasty are observed in 80–90% of cases, however, over the longer follow up period the percentage of positive outcomes is gradually reduced. Need for revision of the prosthesis or it’s components increases in proportion to time elapsed from the surgery. In addition, such revision is accompanied with a need to substitute the bone defect of the acetabulum. As a solution the authors propose to replace pelvic defects in two stages. During the first stage the defect was filled with bone allograft with platelet-rich fibrin (allografting with the use of PRF technology). After the allograft remodeling during the second stage the revision surgery is performed by implanting standard prostheses. The authors present a clinical case of a female patient with aseptic loosening of acetabular component of prosthesis in the right hip joint, with failed hip function of stage 2, right limb shortening of 2 cm. Treatment results confirm the efficiency and rationality of the proposed bone grafting option. The authors conclude bone allograft in combination with the PRF technology proves to be an alternative to the implantation of massive metal implants in the acetabulum while it reduces the risk of implant-associated infection, of metallosis in surrounding tissues and expands further revision options.

Traumatology and Orthopedics of Russia. 2017;23(4):125-133
pages 125-133 views

REVIEW

MODERN TRENDS IN SURGICAL TREATMENT OF PATIENTS WITH ACL RUPTURES (LITERATURE REVIEW)

Rikun O.V., Khominets V.V., Fedotov A.O.

Abstract

The authors conducted an analysis of national and foreign scientific publications dedicated to the problems in treatment of patients with ruptures of the anterior cruciate ligament of the knee joint. The results of the analysis demonstrated that such lesions still remain the key knee pathology resulting from sports injuries that significantly affect knee function and require timely reconstructive surgical correction. Based on the study the key areas of improvement in treatment for mentioned category of patients have been identified. This is the biomechanically justified single bundle anatomical ACL reconstruction which is currently widely applied in the clinical practice by using of an isometrically located autograft. Such technique represents a radically new stage in the development of treatment methods for young and middle-aged patients with high functional demands.
Traumatology and Orthopedics of Russia. 2017;23(4):134-145
pages 134-145 views

FAST-TRACK HIP AND KNEE ARTHROPLASTY (LITERATURE REVIEW)

Ageenko A.M., Sadovoy M.A., Shelyakina O.V., Ovtin M.A.

Abstract

In the present paper the authors discuss the history of fast-track formation, its development and current status. Fast-track advantages in comparison to other rehabilitation options are analyzed. The focus is placed on methods of accelerated rehabilitation after total hip and knee arthroplasty in the leading European and American clinics. Fast-track protocols of surgical centers of Denmark and Hospital for special surgery in the US are described, factors that determine time of hospital stay after total hip and knee arthroplasty are considered, predictors of hospital stay and patients satisfaction after the surgery are examined. The paper reflects the results of the comparison of frequency of thromboembolic and other complications as well as readmission rate after traditional rehabilitation and after fast-track. The paper considers fast-track in bilateral total knee replacement. The authors conclude that further research on acceleration of rehabilitation and reduction of hospital stay after total hip and knee arthroplasty needs to be focused on the optimization of pain relief, especially after discharge, blood preservation techniques, supplementation of fluids loss and strengthening of muscles. Literature analysis demonstrated that the implementation of the Protocol for accelerated recovery after joint arthroplasty in Russia is at an insufficient level. Data of foreign multicenter studies during recent years indicate a high efficacy and safety of this technique in different groups of patients.
Traumatology and Orthopedics of Russia. 2017;23(4):146-155
pages 146-155 views

JUBILEE

RASHID M. TIKHILOV 60th ANNIVERSARY OF THE BIRTH

Abstract

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Traumatology and Orthopedics of Russia. 2017;23(4):156-157
pages 156-157 views

MEMORIAL DATES

ROMAN R. VREDEN — OUTSTANDING SURGEON, SCIENTIST AND TEACHER (150TH ANNIVERSARY OF THE BIRTH)

Tikhilov R.M., Kochish A.Y.

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Traumatology and Orthopedics of Russia. 2017;23(4):158-162
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OBITUARY

ALEXANDR S. AVRUNIN. 16.12.1947 – 17.09.2017

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Traumatology and Orthopedics of Russia. 2017;23(4):163
pages 163 views

ARTICLES

INDEX OF ARTICLES PUBLISHED IN 2017

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Traumatology and Orthopedics of Russia. 2017;23(4):164-166
pages 164-166 views

AUTHOR’S INDEX 2017

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Traumatology and Orthopedics of Russia. 2017;23(4):167
pages 167 views

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