Vol 24, No 4 (2018)

EDITORIAL

Editorial

Tikhilov R.M.

Abstract

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Traumatology and Orthopedics of Russia. 2018;24(4):7
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Analysis of Publications of the Russian Trauma and Orthopaedic Surgeons in Foreign Top-Rated Journals

Sereda A.P., Andrianova M.A.

Abstract

The present paper is dedicated to the publications analysis by Russian authors in top-rated foreign journals. The aim of the research to define the avant-garde status of the national trauma and orthopaedics science. The authors of the present paper analyzed the publications in the first thirty journals under the heading «Orthopaedics and sports medicine» from Scimago Journal & Country Rank rating. The search was conducted from the moment of the first issue of each journal. Total number of publications was calculated, total number of publications from each author, number of publications per institution, citations of each publication in PubMed Central и Google Scholar. The subject, chronologic characteristics and relation of the year of publication with number of citations were analyzed. 

Traumatology and Orthopedics of Russia. 2018;24(4):9-19
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CLINICAL STUDIES

Adverse Trends in the Etiology of Orthopedic Infection: Results of 6-Year Monitoring of the Structure and Resistance of Leading Pathogens

Bozhkova S.A., Kasimova A.R., Tikhilov R.M., Polyakova E.M., Rukina A.N., Shabanova V.V., Liventsov V.N.

Abstract

Osteomyelitis remains one of the most intractable diseases. The nature of the pathogen and its resistance to antibiotics significantly affect the outcome and cost of treatment.

The aim of the study: to analyze the dynamics of the spectrum and antibiotic resistance of the leading pathogens of orthopedic infection for the period 2012– 2017.

Material and methods. The structure of pathogens isolated from the focus of infection from 2774 patients with periprosthetic infection and chronic osteomyelitis was retrospectively analyzed. Antibiotic resistance of the leading pathogens that occupied more than 4% in the species structure was studied. Comparative analysis of changes in the spectrum of pathogens and antibiotic resistance was carried out for the periods 2012-2013, 2014–2015 and 2016-2017. Epidemiological analysis was performed in the program „microbiological monitoring system” Microbe-2. Statistical processing of the obtained data was carried out using the Z-criterion.

Results. From 2774 patients with orthopedic infection have been isolated 4359 strains, in the structure of which about 73.5% were occupied by S. aureus, S. epidermidis, E. faecalis, E. faecium, P. aeruginosa, Acinetobacter sp. representatives of the family Enterobacteriacea. In 27% of the cases, microorganisms of other species were identified. Microbial associations were identified in 19.4% of cases. In the structure of the leading Gram(+) pathogens, a significant decrease in the incidence of S. aureus was detected, while the share of S. epidermidis increased significantly. Among the leading Gram(-) microorganisms, a significant increase in the proportion of representatives of the fam. Enterobacteriacea was found, against the background of a decrease in the share of Acinetobacter sp. and P. aeruginosa. The level of resistance of MSSA to the studied antibiotics ranged from 0.1 to 8.8%, for MSSE the spread was from 1.9 to 16.7%. Negative dynamics of growth of resistance of non-fermenting bacteria is established. The strains of Acinetobacter sp. demonstrated greater resistance to tested antibiotics in comparison with P. aeruginosa.

Conclusion. An increase in the role of S. epidermidis and K. pneumoniae in the etiology of orthopedic infection was established. The revealed increase in the resistance of microbial pathogens to most tested and used antibiotics should be taken into account in the appointment of empirical antibiotic therapy. The extremely high frequency of resistance of gram-negative bacteria to cephalosporins and fluoroquinolones excludes the possibility of their empirical use, which requires the management of carbapenems in the starting treatment regimens. High resistance to fluoroquinolones limits the ability of oral antibiotic therapy in patients with periprosthetic infection. 

Traumatology and Orthopedics of Russia. 2018;24(4):20-31
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Correction of Foot Deformities using Triple Arthrodesis and Its Effect on Soft Tissue Blood Supply at Surgical Site in Patients with Cerebral Palsy

Leonchuk S.S., Shchurova E.N., Popkov D.A., Chibirov G.M., Bidiamshin R.R., Gatamov O.I.

Abstract

The aim of the study is to evaluate the efficiency of triple arthrodesis of foot and its effect on soft tissues blood supply at the surgical site during simultaneous correction of segment deformity in patients with cerebral palsy.

Material and Methods. The present study reflects the authors’ experience of triple arthrodesis for correction and stabilization of foot multicomponent deformities of varying severity in 75 patients (136 feet) with cerebral palsy (IIIV level by Gross Motor Function Classification System (GMFCS)) treated in the Ilizarov center in the period from April 2012 to December 2016. The average age of the patients was 16.4±4.3 years (from 11 years 8 months to 43 years 3 months). All patients included into the study had severe arthrosis of hind and midfoot. The main option of foot fixation in this group of patients was internal fixation (elastic threaded wires, compression screws) together with plaster cast immobilization for 6–8 weeks. All patients underwent average of 4.59 surgical elements during a procedure as part of simultaneous multilevel interventions. The blood supply at the surgical site was evaluated by laser and high-frequency Doppler flowmetry before and after all stages of the surgery.

Results. Long-term outcomes were evaluated at the average of 19 months after the surgery in 56 (74.7%) patients. 37 patients (66.1%) demonstrated good treatment outcomes and 19 patients (33.9%) — satisfactory outcomes. No unsatisfactory outcomes were observed. The clinical outcome of foot surgery was evaluated using the Angus-Cowell criteria. The obtained significant x-ray enhancement was maintained at the control stages of the follow up. Despite large simultaneous correction of foot deformity, there was no decrease in the parameters of microcirculatory blood supply of the skin, muscles and subcutaneous fat of the foot. The authors observed a stabilized or an increased perfusion of soft tissues.

Conclusion. Triple arthrodesis for correction of foot deformities in patients with cerebral palsy and severe arthrosis in hind and midfoot is an efficient method which allows to correct and stabilize gained position of segments. The data of physiological research testify the sparing approach of such procedure and a possibility of an earlier weight-bearing on operated limb. 

Traumatology and Orthopedics of Russia. 2018;24(4):32-43
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Surgical Treatment of Spine Deformations after Neonatal Sepsis (The Analysis of Clinical Series)

Zorin V.I., Naumov D.G., Mushkin A.Y., Evseev V.A.

Abstract

Background. Neonatal sepsis presents one of the current issues in modern pediatrics. The orthopedic outcomes of such a state and the possibility of treatment, in particular by surgical spinal reconstruction, are rarely analyzed. Objective. To analyze pathology features and treatment outcomes in infants with vertebral complications resulted from neonatal sepsis.

Material and Methods. The analysis of observation and treatment of 15 infants, who have undergone neonatal sepsis which led to vertebral lesion with subsequent gross kyphotic deformity formation, is presented.

Results. Average age of infants was 2.5 months when spinal pathology was diagnosed. In 7 of the 15 observations, a local angular kyphosis was revealed when the acute phase of disease was already passed („cured“). The thoracic vertebrae were most often affected, mainly Th 7-8 vertebral bodies. Average kyphosis was 53°. All infants were operated on during the period from 2006 to 2017. Each had two-stage spinal reconstruction including the anterior spinal fusion using a titanium mesh cage filled with bone autografts, or an autogenous bone graft only. At the second stage, the instrumental correction and fixation of the spine with a multi-support laminar structure were performed. Average age of patients at the time of surgery was 14 months. Average value of kyphosis correction was 27°. Further correction and anterior spinal fusion were achieved when performing the incorporation of a titanium mesh cage with bone autografts. The histological and bacteriological examination of the surgical material did not reveal any signs of infection or inflammation. Correction of deformity and restoration of the supporting strength of anterior vertebral column as a result of surgery were achieved in all cases. Various complications in the early and late followup period were reported in a total of 7 cases. Repeated interventions were required in two patients: in one case in the early period (dislocation of the structure supporting hook) and in one case in the long-term period (graft resorption and kyphotic deformity relapse).

Conclusion. One of the complications of neonatal sepsis is severe multilevel thoracic spondylitis, the outcome of which is the formation of severe kyphosis against the background of subtotal bone vertebral destruction. The principal possibility of radical spine reconstruction in infants with achievement of good anatomical and functional results is shown. 

Traumatology and Orthopedics of Russia. 2018;24(4):44-52
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Comparative Analysis of Pedicle Screw Placement in Children with Congenital Scoliosis: Freehand Technique (in vivo) and Guide Templates (in vitro)

Kokushin D.N., Vissarionov S.V., Baindurashvili A.G., Ovechkina A.V., Poznovich M.S.

Abstract

Objective. To evaluate accuracy between pedicle screw placement in vertebral bodies achieved in vivo with freehand techniques versus their placement in vertebrae plastic models achieved in vitro with the use of guide templates, in toddlers and preschool children with congenital kyphoscoliosis of the thoracolumbar transition and lumbar spine amid the vertebral malformation.

Material and Methods. The research is based on a retrospective analysis of the results of treatment of 10 patients with congenital kyphoscoliosis of the thoracolumbar transition and lumbar spine amid the vertebral malformation. Age – from 2 years 2 months to 6 years 8 months old (mean 3 years 8 months old), gender – 6 boys, 4 girls. Based on the postoperative multi-slice spiral computed tomography (MSCT) of the spine, the pedicle screws placement accuracy of the correcting multi-support metalwork was evaluated. These patients constituted the 1st research group (in vivo group). The 2nd research group (in vitro group) was formed from 27 vertebrae plastic models with pedicle screws inserted in them with the use of guide templates. The placement accuracy of the installed pedicle support elements was assessed based on the S.D. Gertzbein et al. scale (1990).

Results. In the 1st group, there were 52 pedicle screws placed. The screw placement accuracy according to the rate of misplacement, as follows: 53.8% in Grade 0, 25% in Grade I, 11.6% in Grade II, 9.6% in Grade III. The number of screws with the rate of misplacement in Grade 0 + Grade I was 41 (78.8%). In the 2nd group, there were 54 screws placed and slightly larger than the 1st group. The screw placement accuracy according to the rate of misplacement was 94.4% in Grade 0, 1.9% in Grade I, 3.7% in Grade II, respectively. The number of screws with the rate of misplacement in Grade 0 + Grade I was 52 (96.3%).

Conclusions. Comparative analysis showed that the number of pedicle screws successfully placed in vertebrae plastic models in children with congenital deformities of the thoracolumbar transition and lumbar spine achieved with the use of guide templates was significantly higher than the number of screws successfully placed with freehand techniques (96.3% versus 80.8%, p = 0.011). The results obtained with method of navigation templates in vitro showed high precision and accuracy of pedicle screw placement which gives the prospect for using this type of navigation in clinical practice in toddlers with congenital scoliosis. 

Traumatology and Orthopedics of Russia. 2018;24(4):53-63
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Surgical Hip Dislocation Technique in Treatment of Patients with Slipped Capital Femoral Epiphysis

Vvedenskiy P.S., Tenilin N.A., Vlasov M.V., Bogosyan A.B., Novikov A.V.

Abstract

Purpose: to evaluate the efficiency of modified Dunn procedure for treatment of severe slipped capital femoral epiphysis.

Material and Methods. The authors used the modified Duim procedure for treatment of 6 patients with SCFE aged from 10 to 13 years and displacement degree over 55°. Chronic disease form was reported in one patient, acute displacement along the chronic process was reported in 5 patients. All patients had a stable form of SCFE by Loder classification. Surgical procedure was performed within 6 to 12 months from the onset of disease.

Results. Normal anatomical relations in the hip joint were restored in all patients. During follow up from 18 until 48 months the patients did not demonstrate aseptic femoral head necrosis or chondrolysis. Adolescents did not complain on pain or hip motion limitations. Treatment outcomes assessment by Harris hip score was 97 points.

Conclusion. Based on outcomes of the modified Durm procedure the authors conclude that the method provides for complete restoration of the anatomical relations between femoral neck and epiphysis and, thus, the hip joint biomechanics. Femur dislocation allows to form an extended flap to ensure epiphysis perfusion which improves overall blood supply in the femoral head and consequently decreases the risk of aseptic necrosis and chondrolysis

 
Traumatology and Orthopedics of Russia. 2018;24(4):64-71
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Avulsion Fractures Osteosynthesis in Patients with Normal Bone Mineral Density and Osteoporosis

Reznik L.B., Guryev V.V., Turushev M.A., Negrov D.A., Il’in R.E.

Abstract

Objective: to compare the effectiveness of osteosynthesis for avulsion fractures using bioabsorbable versus titanium implants in patients differing in bone mineral density.

Material and Methods. In the experimental phase of study, two groups of bone blocks were singled out from patients' femoral heads to assess the anchoring properties of the implant in osteoporotic and healthy bone. The first group included blocks of 31 patients with osteoporosis, the second one — 27 blocks of patients without osteoporosis. In the first group, cortical bioabsorbable Poly-L-Lactic/ co-glycolic acid (PLGA) screws were implanted into 13 bone blocks, titanium screws — into 10 bone blocks, and bioabsorbable pins (PLGA) — into 8 bone blocks. In the second group, 10 titanium screws, 10 bioabsorbable screws and 7 bioabsorbable pins were implanted. The anchorage of the implant in bone was evaluated by a pull-out test. Then, depending on the anchorage used, the studied bone blocks with osteoporosis, newly obtained from the first group, were divided into three groups for the purpose of evaluating the resistance to the damaging effects of the implant. In experiment, the osteosynthesis for avulsion fracture was simulated on these bone blocks. In the first group (11 bone blocks), the transosseous osteosynthesis of the bone fragment was carried out with a titanium screw, in the second group (9 bone blocks) with a bioabsobable screw, in the third group (11 bone blocks) with a bioabsorbable pin. The results of osteosynthesis were assessed based on how often a small bone fragment was damaged by an implant and on stability of the anchored implant. In the clinical phase of study, a comparative analysis of 65 surgical interventions (38 people with osteoporosis and 27 without osteoporosis) in patients with avulsion fractures was performed. In 24 cases, bioabsorbable screws were used for osteosynthesis, AO/ASIF titanium screws were used in 31 cases, and pins were used in 10 cases.

Results. Experimental studies showed that the resistance to pull-out test of a bioabsorbable screw anchored in osteoporotic bone is 25.7% higher than a titanium screw. No statistically significant difference was found in bone without osteoporosis. Resistance to pull-out test of a bioabsorbable pin is 3% higher than a titanium screw. The model-based experiment with an avulsion fracture in osteoporotic bone using a titanium screw showed lower effectiveness of osteosynthesis: in 27.2% of cases the cortical titanium screw damaged a small bone fragment. Based on the clinical trial findings, no negative results were obtained using bioabsorbable anchorage. In 12.5% cases of osteosynthesis with a titanium screw, migration of a bone fragment was noted. The data obtained during the clinical study correlated with the experimental data. This makes the use of bioabsorbable implants advantageous.

Conclusion. For avulsion fracture osteosynthesis in patients with normal bone mineral density, it is possible to use both titanium and biodegradable fixators with equivalent strength of fragment fixation. n osteosynthesis of fractures in patients with osteoporosis it is preferable to use bioabsorbable implants

Traumatology and Orthopedics of Russia. 2018;24(4):72-80
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Midterm Treatment Outcomes of Proximal Humerus Fractures by Intramedullary Fixation

Egiazaryan K.A., Ratyev A.P., Gordienko D.I., Grigoriev A.V., Ovcharenko N.V.

Abstract

Background. Treatment tactics of proximal humerus fractures remains a matter of dispute due to multiple cases of unsatisfactory outcomes and high rate of postoperative complications.

The aim of the study to evaluate midterm outcomes of intramedullary fixation for treatment the proximal humerus fractures in comparison with plate fixation.

Material and Methods. The authors evaluated treatment outcomes of 175 patients with proximal humerus fractures who underwent surgery in the period from 2012 to 2017. Depending on the fixation method the patients were divided into two groups: the main group consisted of 107 patients who underwent intramedullary fixation by a nail of third generation; a comparison group — consisting of 68 patients who underwent fixation by a locking plate with angular stability.

Results. In one year after intramedullary nail fixation the authors observed the excellent and good outcomes on Constant scale in 83.2% of cases, satisfactory — 12.1%, unsatisfactory — 4.7%. Patients who underwent plate fixation demonstrated the following outcomes: excellent and good — 73.5%, satisfactory — 17.7%, unsatisfactory — in 8.8%. Constant score increase was equal in the main and control groups and varied depending on the fracture type.

Conclusion. Intramedullary nailing is an option for treatment of all fracture types of proximal humerus as well as for the cases of combined humeral neck and diaphysis fractures. Functional recovery parameters were higher in the main group of patients after intramedullary nailing.

Traumatology and Orthopedics of Russia. 2018;24(4):81-88
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Plastic Replacement of Palmar Defects

Rodomanova L.A., Medvedev G.A.

Abstract

Material and Methods. The authors have developed a two-step method of plastic substitution of the palmar defect, which had consisted in the preliminary preparation of the tissue complex on the own fascia of the forearm and then transposition it to the hand as island flap on the radial vascular bundle after the excision of the scar and eliminate flexion contractures of the fingers. According to the proposed method, 7 patients with vicious scars of the palmar surface of the hand and flexion contracture of the fingers were operated. Males prevailed, the mean age of patients was 39±12.4 years. In 5 cases, the cause of scar contracture of the hand was an open trauma with a tissue defect, in other cases, contact bum.

Results. Patients were examined in 3,6 and 12 months. The complication was noted in one case, which was a partial necrosis of the skin part of the flap, which required additional plasty with a split skin graft, which did not affect the final result. The flaps were stable and resistant to mechanical stress, no correction was required in any case. By 6 months protective sensibility in the hand recovered in all cases.

Conclusion. The described method of substitution of extensive deep palmar defects can be applied after correction of scar deformation and elimination of flexion contracture of fingers. Prelamination provides reliable engraftment of a full-layer or thick split skin graft taken from any area of the human body. Strong fixation of the skin graft to the fascia provides a small displacement of the skin and and the lack of excess tissue. The flap is resistant to mechanical stress and provides restoration of protective sensitivity. The damage to the donor area is insignificant, as the scar on the forearm remains hardly noticeable. The disadvantages of the proposed method include the need to perform two surgical interventions.

Traumatology and Orthopedics of Russia. 2018;24(4):89-94
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The First-Stage Treatment Аlgorithm for Deep Infected Total Hip Arthroplasty

Murylev V.Y., Kukovenko G.A., Elizarov P.M., Ivanenko L.R., Sorokina G.L., Rukin Y.A., Alekseev S.S., Germanov V.G.

Abstract

Background. Periprosthetic infection after total hip arthroplasty is a relatively common and severe complication. A two-stage revision with the temporary use of a spacer is the gold standard treatment for the deep infected total hip arthroplasty. Some authors report mechanical complications associated with spacers, which can lead to a poor functional outcome. Therefore, the aim of the study was to analyze the effectiveness of the first-stage of treatment of hip PJI with a two-stage method and to develop an spacer application algorithm in order to achieve the optimal functional result.

Material and Methods. Between 2015 and 2017, 38 patients with deep periprosthetic infection received an articulation spacer as part of a two-stage protocol in Botkin Moscow City Hospital. The mean age was 60.5 (interquartile range from 5 2 to 69) years. Five different types of spacers were us ed in the study, selected individually according to theW. Paprosky acetabular defects classification. The overall frequency of complications was evaluated.

Results. The overall periprosthetic infection treatment effectiveness was 92.1%. There was the recurrent infection in 3 patients (7.9%), in 2 (5.26%) cases microbial associations were founded. Mechanical complications occurred in 8 (21%) patients. Spacer dislocation occurred in 4 (10.4%) cases, spacer fracture in another 2 (5.2%). There were also 2 cases of protrusion into the pelvis (5.2%).

Conclusions. The first stage a two-stage revision hip arthroplasty should be carefully plarmed. To choose the appropriate spacer we proposed an algorithm based on our data to achieve a better functional result.

Traumatology and Orthopedics of Russia. 2018;24(4):95-104
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THEORETICAL AND EXPERIMENTAL STUDIES

Antibacterial Activity of Antibiotic-Impregnated Bone Cement Based Coatings Against Microorganisms with Different Antibiotic Resistance Levels

Tapalski D.V., Volotovski P.A., Kozlova A.I., Sitnik A.

Abstract

Purpose — to evaluate the presence and duration of antibiotic activity of antibiotic-impregnated bone cement based coatings samples against antibiotic-sensitive and antibiotic-resistant microorganisms.

Material and Methods. Bone cement based coatings impregnated with antibiotics (gentamycin, vancomycin, colistin, meropenem, fosfomycin) are formed on titanium (Ti) plates. A plate rinse was carried out; antibiotic concentrations in the rinsed solutions were estimated by a serial broth microdilution method. Antibacterial activity of the control and rinsed samples against the antibiotic-sensitive and multiple-antibiotic-resistant Staphylococcus aureus and Pseudomonas aeruginosa strains was estimated by a bilayer agar method.

Results. The meropenem and fosfomycin concentrations in the rinsed solutions obtained at a one-fold (16 μg/ml for both antibiotics) and two-fold treatment (2 μg/ml for meropenem and 8 μg/ml for fosfomycin) were sufficient to suppress the growth of the control strains. One-fold rinse of samples with colistin eliminated their antibacterial activity completely. The marked activity of the samples with meropenem and fosfomycin persisted against the antibiotic-sensitive P. aeruginosa ATCC 27853 strain after 2 rinse cycles; single-rinsed samples with fosfomycin also maintained the activity against the extensively antibioticresistant P. aeruginosa BP-150 strain. Vancomycin-containing samples possessed the sufficient antibacterial activity against both methicillin-sensitive (MSSA) and methicillin-resistant (MRSA) S. aureus strains; two-fold rinse of the samples eliminated their bactericidal properties.

Conclusion. Bone cement based coatings impregnated with fosfomycin and meropenem possess the most marked and long-lasting antibacterial activity, manifested mainly against the antibiotic-sensitive strains. 

Traumatology and Orthopedics of Russia. 2018;24(4):105-110
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MODERN TECHNOLOGIES IN TRAUMATOLOGY AND ORTHOPEDICS

Pubic Rami Fractures Fixation by Interlocking Intramedually Nail: First Clinical Experience

Ivanov P.A., Zadneprovsky N.N., Nevedrov A.V., Kalensky V.O.

Abstract

Background. Growing number of patients with pelvic fractures is associated with evolution of high-speed transport, high-rise construction and industrial production. The optimal surgical procedure for pubic rami fractures must ensure a stable fixation and simultaneously minimize the risk of postoperative complications. Our aim was to evaluate the efficiency of a new technique for pubic bones fixation by a titanium nail in patients with pelvic fractures.

Material and Methods. The authors present the experience on treatment of 18 patients who underwent 25 surgeries for internal fixation of pubic rami fractures by a designed solid titanium nail. Mean age of patients was 40.16±10.35 years. Proposed surgical method provides for mandatory use of image intensifier during all stages of the procedure. With patient in a supine position the authors performed internal fixation of pubic bones by a retrograde nail inserted using a navigating handle through a skin incision of1 cm in the area of symphysis. After complete insertion into the bone the nail was interlocked proximally by two3.5 mm cortex screws through an additional skin incision of1.0 cm using a navigating handle and guiding sleeves. All pelvic ring fractures were classified according to AO/OTA classification and pubic fractures by Nakatani classification. Functional outcome was evaluated by Majeed score.

Results. Bilateral fractures were diagnosed in 7 (38.8%) patients (floating pubic symphysis). 13 (72.2%) patients featured polytrauma with average ISS score of 25.1±7.8. 2 (11,1%) patients were diagnosed with open pelvic fractures, 3 (16.6%) patients had a concomitant acetabular fracture. The authors performed epicystostomy in two (11.1%) patients and laparotomy bringing out the drainages in 5 (27,8%) patients. Mean follow up was 7.8±6.2 months. Stable fixation was obtained in all patients. By the moment of the present publication x-ray healing of pubic bones was observed in 16 (64%) cases, in remaining 9 (36%) cases the follow up period was less than mean healing period (2 months). In 11 (68.8%) patients the functional outcome averaged 91±3.9 by Majeed score 6 months postoperatively, in 8 (50%) patients – 93.8±2.9 by Majeed score 12 months postoperatively and more. No complications like skin necrosis, secondary fragments displacement or infection were not observed.

Conclusion. Preliminary results demonstrated the absence of wound infection and reliable fragments fixation. This technique can be applied in patients with stomas and drainages upon the anterior abdominal wall which extends the indication range for surgical treatment of anterior pelvic ring. High fixation properties of proposed nailing create conditions for early mobilization of the patients and for conducting the exercise therapy. 

Traumatology and Orthopedics of Russia. 2018;24(4):111-120
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CASE REPORTS

Kirschner Wire Migration into SpinaL Canal after Acromioclavicular Joint Fixation (Literature Review and Clinical Case)

Gulyaev D.A., Godanyuk D.S., Kaurova T.A., Krasnoshlyk P.V., Maikov S.V.

Abstract

Fracture and migration of metal implants is a well-known issue which is especially relevant for actively loaded zones with a high amplitude of physiological movements. The authors analyzed 17 publications dedicated to Kirschner wire migration into the spinal canal after fixation of acromioclavicular joint (ACJ) injury. The present paper contains literature review and own clinical case of the authors. The authors generalize the conceptions of migration causes, surgical tactics and prevention recommendations. The key reason of fracture and migration of Kirschner wires during fixation of ACJ injury is the instability of implants, trans-articular wire insertion during fixation of reduced dislocation of acromial end of the clavicle, insufficient immobilization and untimely implants removal after removal of immobilization. Implants migration into the spinal canal is the indication for their surgical removal irrespective of clinical signs. In the majority of studied publications authors described posterior approach or lateral approach aligned with the migration direction. No grafting techniques for dura mater defects were present in the studied literature. The authors of the current paper justify a surgical procedure for removal of migrated implant using a combined posterior and lateral approach on the own clinical case. The choice of procedure algorithm results from the need for prophylaxis of secondary spinal cord lesion and liquorrhea during removal of migrated implants from spinal canal.
Traumatology and Orthopedics of Russia. 2018;24(4):121-128
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REVIEW

Regulatory Concerns about Medical Device Manufacturing Using 3D Printing: Current State of the Issue

Karyakin N.N., Shubnyakov I.I., Denisov A.O., Kachko A.V., Alyev R.V., Gorbatov R.O.

Abstract

Custom-made implants, orthotics, orthoses, models for surgical planning and education, and much more are now created using 3D printers. In this article, the authors suiiunarized information on laws and regulations in the domain of legal support for 3D printing of medical devices in Russia and abroad. 3D printing is one of the promising avenues in developing new methods of treatment, so iiiunediate establishing of clear criteria for its legal regulation is necessary. As is, there are still many gaps in the legislative framework. The issues of the quality of 3D models, material standardization and manufacturing processes using 3D printing technologies remain unresolved. When using custom-made medical devices, respecting the rights of patients and preventing the use of prohibited or restricted materials are essential. Yet, legal barriers to this irmovative direction of medicine must be avoided.
Traumatology and Orthopedics of Russia. 2018;24(4):129-136
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Retracted: Comparison Outcomes of Discover Total Disk Arthroplasty and Anterior Cervical Discectomy with Fusion in Surgical Treatment of Cervical Disk Degenerative Disease: a Meta-Analysis of Randomized Trials

Byvaltsev V.A., Stepanov I.A., Aliyev M.A., Avakov B.M., Yussupov B.R., Shepelev V.V.

Abstract

Retracted

The purpose — to compare the effectiveness of Discover cervical disk arthroplasty (CDA) and anterior cervical discectomy with fusion (ACDF) in the surgical treatment of cervical intervertebral disk (IVD) degenerative disease.

Study design — a meta-analysis of randomized clinical trials.

Material and Methods. Randomized clinical trials were conducted in the Pubmed, EMBASE, ELibrary and Cochrane Library databases published from 2008 to October 2018, which compared the results of Discover CDA and ACDF techniques in the surgical treatment of cervical IVD degenerative disease. For dichotomous variables, the relative risk and 95% confidence interval were calculated, standardized difference of mean values and their 95% confidence interval were used for continuous variables using the random effects model.

Results. This meta-analysis included 9 randomized controlled clinical trials, including the results of surgical treatment of 513 patients with degenerative disease of the cervical IVD. In the CDA group, the operation time was significantly shorter, in contrast to the group of patients who underwent ACDF (p<0.0001). The values of blood loss (p = 0.89), levels of quality of life for patients according to the Neck Disability Index (NDI) (p = 0.22), severity of pain in the cervical spine (p = 0.50) and upper limbs on a visual analogue scale (VAS) (p = 0.16), as well as the prevalence of secondary surgical procedures (p = 0.68) and adverse events (p = 0.40) between the compared groups did not have significant differences. At the same time, significantly large values of the range of motion at the operated level were noted in the CDA group (p<0.00001).

Conclusion. Discover CDA in comparison with ACDF has a significantly large values of range of motion at the operated level. At the same time, there were no statistically significant differences in the NDI scores, VAS pain scores in cervical spine and upper limbs, and the prevalence of secondary surgical procedures and adverse events between the compared groups of respondents were not identified.

Traumatology and Orthopedics of Russia. 2018;24(4):137-147
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LETTERS TO EDITOR

Анализ публикаций отечественных травматологов-ортопедов в зарубежной высокорейтинговой печати

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Abstract

Абстракт. Работа посвящена анализу публикаций соотечественников в высокорейтинговой зарубежной научной печати. Публикации анализировались в первых тридцати журналах рубрики «Orthopaedics and sports medicine» из рейтинга Scimago Journal & Country Rank. Поиск проводился с момента первого выпуска каждого журнала. Посчитано число публикаций, количество публикаций от каждого автора, число публикаций из учреждений, число цитирований каждой статьи в PubMedCentral и GoogleScholar. Проанализированы тематики публикаций, хронологические характеристики, а также связь года публикации с количеством цитирований.

Traumatology and Orthopedics of Russia. 2018;24(4):
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HISTORY OF MEDICINE

Cuneo tendinous suture - the story of one publication

Nakonechny D.G., Kiseleva A.N., Cambon-Binder A.

Abstract

In Russia and in post-Soviet countries tendon Cuneo suture is still widely known and is applied in clinical practice because of its strength and simplicity. One can find its sketch alongwith the sketches of Rozov and Kozakov sutures in most Russian handbooks on operative surgery. In foreign Uterature, however, this term is never used, and the authorship of the technique is attributed to S. Bunnell. According to the original source, the tendon suture technique suggested by S. Bunnell is different from that of B. Cuneo. Likewise, Cuneo tendon suture cannot be appUed with the use of tendon forceps, as suggested by S. Bunnell. Besides, to confirm proper use of B. Cuneo’s name in the case of the tendon suture in question, we cite an adapted translation of a certain paper by B. Cuneo and A. TaUhefer, devoted to a case study where the authors used suture of flexor tendon of little finger. We also provide historical background, concerning some interesting facts and people relevant to the topic.
Traumatology and Orthopedics of Russia. 2018;24(4):148-154
pages 148-154 views

JUBILEE

Gennadii P. Kotel'nikov

Abstract

70th Anniversary of the Birth
Traumatology and Orthopedics of Russia. 2018;24(4):155-158
pages 155-158 views

ARTICLES

Articles index published in 2018

Abstract

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Traumatology and Orthopedics of Russia. 2018;24(4):158-161
pages 158-161 views

Author’s index 2018

Abstract

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Traumatology and Orthopedics of Russia. 2018;24(4):162
pages 162 views

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