Vol 20, No 1 (2014)

Original Study Articles

Results of hip arthroplasty using Paavilainen technique in patients with congenitally dislocated hip

Tikhilov R.M., Mazurenko A.V., Shubnyakov I.I., Denisov A.O., Bliznyukov V.V., Bilyk S.S.


The purpose of the study was to analyze the medium- and long-term results of hip arthroplasty using Paavilainen technique in patients with the congenitally dislocated hip. Methods: From 2001 to 2012 180 operations were carried out were using the Paavilainen technique in 140 patients with high dislocation of the hip (Crowe IV). All patients were clinically evaluated using the Harris Hip Score (HHS), VAS and radiography. Statistical analysis was performed using the Pearson correlation coefficients, multiple regression analysis and classification trees analysis. Results: The average Harris score improved from preoperative 41.6 (40,3-43,5) to 79.3 (77,9-82,7) at final follow-up, and the difference was significant. Early complications were 9% (the most frequent were fractures of the proximal femur), later - 16.7% (pseudoarthrosis of the greater trochanter, 13.9%; disclocations-1,1%, aseptic loosening of the components - 1.7%), reoperation performed in 8.3% of cases. Such factors as age and limb length has statistically significant effect on functional outcomes. Established predictive model allows to get the best possible functional outcome in such patients with severe dysplasia. Conclusions: Total Hip arthroplasty using the Paavilainen technique is an effective method of surgical treatment in patients with the congenitally dislocated hip, but it is technically difficult operation with a high incidence of complications in comparison with standard primary total hip replacement.
Traumatology and Orthopedics of Russia. 2014;20(1):5-15
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Experimental and clinical justification of combined osteosynthesis for long bone defects (preliminary report)

Emanov A.A., Mitrofanov A.I., Borzunov D.Y., Kolchin S.N.


The motivation for researching combined technology of transosseus osteosynthesis and intramedullary nailing was need to reduce time of treatment, and improve the rehabilitation of patients with long bone defects. Defect-pseudoarthrosis with anatomical shortening of the bone was modeled in an experiment in five adult mongrel dogs. Then nailing, Ilizarov transosseous fixation and osteotomy in proximal metadiaphysis were carried out. Bone-transport was produced according to the traditional principles of academic Ilizarov. Radiological findings showed regenerate with zonal structure, bone sections of which were presented homogeneous shadows with a periosteal osteogenesis. After 30 days of distraction regenerate lost its zonal structure, and acquired a mechanical soundness. By this time also was detected consolidation of pseudarthrosis. We have experience of treatment of six patients with posttraumatic defects of the long bones, according to the described method. At the same time carried out transosseous osteosynthesis and nailing with locking in one bone fragment. The osteotomy was performed for following distraction. After necessary length of the bone was received, the opponent locking was carried out. And external fixation was removed. This technology has allowed not using Ilizarov in fixation period of the treatment.
Traumatology and Orthopedics of Russia. 2014;20(1):16-23
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Efficacy of a manual method according to the fascial distortion model in the treatment of contracted («frozen») shoulder

Fink M., Schiller J., Buhck H., Stein C.


«Frozen shoulder» is a common problem and difficult to treat. The present prospective randomised single-blind controlled trial evaluates the efficacy of the fascial distortion model according to Typaldos as a remedy for the «frozen shoulder». Material and methods. A total of 60 patients were randomised to receive either the FDM-guided treatment (FDM, n = 30) or a «conventional» manual therapy (MT, n=30). The primary endpoint for the treatment effect was the shoulder mobility, and secondary endpoints were pain (measured on a VAS), raw force and function as expressed by the Constant-Murley and DASH scores. Results. Before therapy groups were well comparable in terms of all outcome parameters. All endpoints showed a substantial and significant improvement in both treatment groups. Improvement was significantly more marked in the FDM group as compared to the MT group, and the effect occurred significantly faster. During posttreatment observation, there was no further improvement and the achieved benefit in mobility in the FDM group decreased. However, the abduction ability of 15,2±37,2° continued to be substantially better than in control patients (124.1±38.6°, p <0,01), and the ultimate improvement in abduction was 59.4° (64% more than baseline) as opposed to 25.9° (27%) in controls. Secondary outcome parameters (raw force, functional handicap, and pain) showed a significant improvement in both groups but a significantly better result in patients treated according to FDM guidelines. However, patients in this group experienced pain during the treatment more frequently (21/27 vs. 10/27, P < 0,01 ). Conclusion. «Frozen shoulder» treatment according to the FDM is an effective modality with swift onset of action and acceptable side effects that is superior to conventional manual therapy. Long-tern effects, and modes of action need to be investigated.
Traumatology and Orthopedics of Russia. 2014;20(1):24-33
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Comparative analysis of results of treatment patients with severe spinal deformities using screw and a hybrid hardware

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


Purpose: evaluation of efficacy of operative treatment with the use of screw and hybrid metal constructions in idiopathic scoliosis associated with severe spine deformities. Material and methods: The outcomes of treatment of 34 patients aged 15 to 27 years old with severe scoliosisoperated on using screw metal constructions, were reviewed. 22 patients operated on with the use of hybrid metal constructions, made a control group. The groups were compared by the following parameters: pre- and postoperative Cobb angle, deformity mobility according to traction test, total sagittal/frontal balance, CT apical vertebra rotation, operation time, intraoperative blood loss, the number of instrumented vertebrae, and correction failure at 24-hr spondylograms. Results: Group A (screw spine fixation) demonstrated better outcomes compared to group B (combined spine fixation) in the following parameters. Postoperative correction was 48% and 41%;apical vertebra rotation decreased from 78° to 55° (30%) and from 74° to 59°(21%);total sagittal/frontal balance decreased from 39/25 mmto 14/12 mm (64/52%) and from 35/26 mm to 16/15 mm (55/43%), correspondingly. These results suggest better trunk compensation and postoperative correction in a group of patients with screw fixation. Smaller values of correction failure of the main arc as well as insignificant increase of thoracic kyphosis in the postoperative period (24 months) 3.8%/4.3% in group A compared to 6.2%/7.5% in group B testify to greater reliability and stability of ‘all screw’ metal constructions. The number of fixed elements was on average one more in a group with combined fixation (13 and 14, correspondingly).
Traumatology and Orthopedics of Russia. 2014;20(1):34-43
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Complex orthopaedic management of patients with skeletal dysplasias

Baindurashvili A.G., Kenis V.M., Melchenko E.V., Grill F., Al-Kaissi A.


Skeletal dysplasias are challenging for diagnostics and treatment. We present a series of fifteen patients with different forms of skeletal dysplasias with age ranged from 6 to 17 years with variable clinical presentations managed as a part of the project of scientific cooperation between Turner Paediatric Orthopaedic Institute and Orthopaedic Hospital Vienna-Speising. The spectrum of diagnoses included multiple epiphyseal dysplasia, spondyloepiphyseal dysplasia congenita, diastrophic dysplasia, metaphyseal dysplasia, spondylometaphyseal dysplasia, Stickler syndrome, Kniest dysplasia, and anauxetic dysplasia. Complex treatment, which included axial correction and juxta-articular realignment, was performed as a single-stage, or consecutive surgery. Surgical techniques included corrective osteotomies with internal fixation, guided growth technique and external fixation devices. Best results (full axial correction, normal alignment of the joint) were achieved in 8 patients, including 2 patients with metaphyseal dysplasia, 2 patients with multiple epyphyseal dysplasia, 2 patients with spondyloepyphyseal dysplasia, patient with Stickler syndrome and patient with spondylometaphyseal dysplasia. Good results (partial correction at the present time) were seen in 4 patients (2 patients with Kniest dysplasia, 1 - with multiple epyphyseal dysplasia and 1 - with anauxetic dysplasia). Satisfactory results (non-progressive condition in previous progression) were obtained in 2 patients with diastrophic dysplasia, and poor results (progression of the deformity) - in 1 patient with diastrophic dysplasia. Positive results in most of the cases of our series make promising future for usage of complex approach for orthopedic management of children with skeletal dysplasias; advanced international cooperation is productive and helpful for diagnostics and management of rare diseases.
Traumatology and Orthopedics of Russia. 2014;20(1):44-50
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Treatment of clubfoot in young children with arthrogryposis by Ponseti method: possibilities and perspectives

Derevyanko D.V., Agranovich O.E., Buklaev D.S., Petrova E.V., Trofimova S.I.


Background. Clubfoot is the most common deformity in arthrogryposis and is characterized by a high degree of rigidity and a tendency to relapse. At present, no consensus exists on the issue of treatment of this pathology. The aim of this study was to demonstrate the possibilities of Ponseti method for the treatment of clubfoot in the younger children with arthrogryposis. Material and methods. The study was based on an analysis of treatment outcomes in 64 children (124 feet) under 3 years. 50 patients (78%) had a congenital multiple arthrogryposis, 14 children (22%) had a distal form of the disease. All the children underwent conservative treatment using Ponseti method. Results. After phased plastering by Ponseti method, the children with congenital multiple arthrogryposis aged under 1 year demonstrated correction of deformity components in 25 (48%) feet and the children from 1 to 3 years in 4 (8.7%) feet. Phased plastering in the children under 1 year with the distal form of the disease resulted in the correction in all 7 (100%) feet. In the patients with a similar form of the disease aged from 1 to 3 years, correction was achieved in 3 (23%) feet. In the cases of incomplete correction of deformity elements, when the possibilities of phased plastering were exhausted, different surgical interventions were performed. However, in neither case the surgery to remove talus was required. Conclusion. Ponseti method is most effective for the treatment of clubfoot in the children of the first year. Application of this method allows for elimination of clubfoot or significant reduction of the volume of subsequent surgery.
Traumatology and Orthopedics of Russia. 2014;20(1):51-58
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Arthroscopic anterior cruciate ligament reconstruction in adolescents. What to choose for anesthesia?

Ivanov M.D., Zabolotskiy D.V., Kulev A.G., Ulrikh G.E., Velichko K.E., Kozyrev A.S.


The purpose - to optimize the quality of perioperative management of adolescents with damage of the anterior cruciate ligament of the knee. Material and methods: Perioperative methods of anesthesia in 71 patients were estimated. Psycho-emotional status was evaluated on the basis of determining the level of reactive anxiety (Spielberg Hanin scale) and intraoperative anesthesia (unilateral spinal anesthesia or combined) has been chosen. Results: According to the results of lactate and glucose levels in the blood the efficacy of unilateral spinal anesthesia during surgery was demonstrated. Visual analog scale revealed the advantage of extended continuous iliofascial block over an isolated femoral nerve blockade for adequate analgesia for postoperative period. The advantages of the performing continuous iliofascial block under ultrasound were demonstrated.

Traumatology and Orthopedics of Russia. 2014;20(1):59-64
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Influence of kyphosis correction in thoracolumber spine on physical activity of children with infantile cerebral palsy

Umnov V.V., Nikityuk I.E., Vissarionov S.V., Vereshchakina O.A.


Objective - to determinate the influence of kyphosis correction in thoracic spine on the ability to have vertical balance of the body in patients with cerebral palsy. Material and methods. The authors have performed a comprehensive survey of 17 patients with cerebral palsy aged from 6 to 17 years with the generated non-fixed "habitual" thoracolumbar kyphosis associated with joint contractures of the lower extremities. The analysis of the radiological data was carried out to determine the dependence of severity of kyphosis on the position of the body. The state of the vertical stability of children before and after thoracolumbar orthosis with body corset were evaluated by means of computed stabilometrics. Results. Radiological findings in all children have shown a normal correlation of changes in the degree of kyphosis - its reduction if there was an exclusion of the vertical load on the spine, as well as the trunk orthosis. In this case correction of sagittal profile of the spine occurred mainly due to the lumbar area. This feature of spinal biomechanics in patients with infantile cerebral palsy unpredictably reflected on the motor activity of patients. After correction of kyphosis with corset only 29.4% of the children surveyed with stabilometrics demonstrated the improvement in the function of maintaining the vertical position of the body. In 70.6% of patients the correction of sagittal profile of the spine has led to a deterioration of the vertical balance of the body. Negative dynamics of test research in this group presupposes the exhaustion of children’s adaptive capacity, which indicates the risk of developing abnormal compensatory reactions because of corset bracing. Conclusion. The advanced integrated observation of the patients with cerebral palsy can improve the prediction of outcomes in planning of the correction of kyphosis in thoracolumbar spine.

Traumatology and Orthopedics of Russia. 2014;20(1):65-71
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Determination of optimal assemblies of software-based Ortho-SUV frame for correction of complex midfoot and hindfoot deformities

Solomin L.N., Ukhanov K.A., Mashkov V.M., Glusman M.I.


Aim: to find the optimal configuration of passive computer-assisted ORTO-SUV device for the correction of complicated midfoot and hindfoot deformities. Material and methods: The study was carried out using plastic “shin-foot”complexes, on which different versions of Orto-SUV device layout: five versions for midfoot deformities and three versions for hindfoot deformities. A model providing maximum amplitude of the movement was considered optimal. Results: Optimal layout for midfoot provides dorsiflexion of 41,1±1,7°; plantar flexion - 32,1±1,4°; supination - 53,3±1,8°; pronation - 35±1,6°; abduction - 44,2±2,1°; adduction - 43,2±1,7°. Optimal layout for the correction of hindfoot deformities provides rotation in sagittal plane upwards - 96,5±2,4°;rotation in sagittal plane downwards - 36,2±1,4°;“varusation” (angulationmedially in the frontal plane) - 31±1,3°; “valgusation” (in the frontal plane outwards) - 44,5±1,9°; movement upwards and backwards, angle of 45° to the horizontal plane - 86,4±1,2 mm; movement downwards and anteriorly, angle of 45° to the horizontal plane - 81,5±1,1 mm.
Traumatology and Orthopedics of Russia. 2014;20(1):72-79
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System coagulative and lytic distress-syndrome at the traumatic illness

Vlasov A.P., Shevalayev G.A.


Purpose - to investigate coagulation-lytic activity of different tissue structures in the early posttraumatic period after pelvic fractures. Material and methods. The study is based on experimental techniques enabling evaluation of hemocoagulation activity of skeletal muscles, liver, kidney, heart, lung, and plasma after pelvic injury (fracture). Results. Changes in coagulation-lytic system after pelvic injury were revealed to evolve not only in blood, but also in different organs (skeletal muscles, liver, kidney, lung, and heart). A systemic coagulation-lytic distress syndrome emerges. General manifestations of hemostasis failure in the early posttraumatic period are characterized by hypercoagulation and inhibition of fibrinolysis. The changes arising are significant in the pathogenesis of thromboembolic complications of traumatic disease. Conclusion. The data obtained in this study suggest a basis for reasonable medical measures aimed at the prevention of critical state of hemocoagulation system by means of target effect on one of its main pathogenetic mechanisms - an extrinsic pathway of blood coagulation.
Traumatology and Orthopedics of Russia. 2014;20(1):80-85
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Case Reports

Fibrodysplasia ossificans progressiva in children (review and clinical analysis of 5 case reports)

Kovalenko-Klychkova N.A., Klychkova I.Y., Kenis V.M., Melchenko E.V.


Ossificans progressive fibrodysplasia (OPF) presents a rare genetically caused osteopenia manifested by calcification and ossification of muscles, tendons, ligaments, fascia, and subcutaneous tissues due to aggressive fibroblasts proliferation. The disease is usually associated with congenital skeletal abnormalities: clinodactyly of the first toe, ankylosis of the first interphalangeal joints, and flexion contracture of the first finger. Surgical attempts of ossifications excision are unsuccessful and worsen the situation. 5 patients with OPF are presented. A course of the disease, clinical pattern, and surgery outcomes are disclosed. Both orthopedic manifestations such as congenital hand and foot abnormalities being a key to early clinical evaluation and secondary changes are described in detail. Also, postoperative complications are presented. Surgeonsare recommended to be on guard against this disease when planning the operations for heterotopic ossifications as well as for relating hand and foot abnormalities.

Traumatology and Orthopedics of Russia. 2014;20(1):102-109
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«Acute shortening» and functional management of a grade 3B open humeral fracture using the Ilizarov method (case report)

Fletcher M.D.


External fixation is an alternative to rigid internal fixation in the management of significant open fractures of the humerus. Acute shortening to primarily deal with soft tissue defects is well-recognised in the management of tibial fractures. A case is described whereby a grade 3B open humerus fracture with significant soft tissue injury was managed to union by acute shortening and Ilizarov stabilisation, maximising functional recovery. The use of acute shortening in humeral fractures has not previously been described.

Traumatology and Orthopedics of Russia. 2014;20(1):110-112
pages 110-112 views


Diagnostic value of radiological signs..86 of tarsal coalitions

Sapogovkiy A.V., Kenis V.M., Khusainov R.H.


Tarsal coalition - is an abnormal fusion between two or more tarsal bones which can lead to foot pain, progressive foot deformity, and frequent ankle sprains. Radiological diagnosis of tarsal coalitions on the standard plain radiographs is difficult because of indirect visualization of the fusion zone. Computed tomography is helpful for confirmation of the diagnosis. Purpose: to determine diagnostic value of indirect radiological signs of tarsal coalitions. Material and methods. The analysis of the radiographs of 25 patients with confirmed tarsal coalitions and the radiographs of 37 patients with valgus deformities of feet without tarsal coalitions. Results. The sensitivity and specificity of tarsal coalitions radiological signs were determined. Sensitivity of the "anteater nose" in our study was 92,3%, specificity - 94,31%; C-sign had sensitivity 88,89% and specificity - 77,08%; “talar beak” symptom had sensitivity 36,36 percent and specificity - 97,14%. Conclusion. Sensitivity and specificity of indirect radiological signs of tarsal coalitions determined in our study have sufficient diagnostic value, and computed tomography of the foot should be done for confirmation of diagnosis.
Traumatology and Orthopedics of Russia. 2014;20(1):86-91
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The choice of surgical approach in the treatment of two-column acetabular fractures

Grin’ A.A., Runkov A.V., Shlykov I.L.


The study aimed a comparison of treatment results in patients with two-column acetabular fractures (AO, Type C) when using different operative approaches: ilioinguinal (12), Y-type (16) and a combination of posterior-lateral and ilioinguinal approaches (3). Surgical treatment was carried out not later than 3 weeks after injury. The joint congruence was reached in all the cases. The operative time, blood loss, complications, long-term results of treatment were evaluated. The study showed the effectiveness of ilioinguinal approach in case of the simple two-column fractures. When treating patients with complex fractures of the anterior column, the authors found no significant difference in operative time and intraoperative blood loss between the cases of V-type and combined approaches. In patients with two-column fractures accompanied with posterior wall lesion the time of surgery was significantly lower when using the Y-shaped approach as against the two different approaches.

Traumatology and Orthopedics of Russia. 2014;20(1):92-97
pages 92-97 views


Method of bone plasty using template

Zolotov A.S., Pak O.I., Zolotova Y.A., Volkov A.F., Fadeev M.F.


Authors describe the proposed method of bone plasty using the template made of an aluminum foil. The detailed description of this option and some clinical cases are presented. Clinical application of the proposed method has shown its high efficiency.

Traumatology and Orthopedics of Russia. 2014;20(1):98-101
pages 98-101 views


Evolution of «the problem of soft tissues» in the field of knee arthroplasty: role and function of flap surgery

Kutyanov D.I., Rodomanova L.A.


The authors have analyzed scientific works on various aspects of the problem of knee arthroplasty connected with the pathology of periarticular soft tissues. One of the main goals was to trace the evolution of flap surgery principles in the treatment of patients with this pathology. It has been stated that today we can trace two sides in «the problem of soft tissues». The first one in the historical perspective is an operative management of complex wounds following knee arthroplasty, and this side has been studied well enough. The second one is the prophylaxis of skin necrosis and wound infection via flap surgery. This problem is still far from solving. Although in the tradition of world orthopedic surgery pedicled flap transfer and free tissue transfer in the complex cases of knee arthroplasty is not an exclusive practice, the methodology of flap surgery demands further development and scientific foundation.

Traumatology and Orthopedics of Russia. 2014;20(1):113-121
pages 113-121 views

Haglund syndrome: historical and systematic review

Sereda A.P., Kavalerskiy G.M.


Haglund syndrome is one of the leading causes of pain and functional disorders in the posterior heel. It consists of retrocalcaneal pain caused by retrocalcaneal bursitis and impindgement Achilles tendon tenopathy due to Haglund's deformity. Throughout historical rewiev and systematic rewiev of current conservative and surgical treatments for Haglund syndrome performed in the article.

Traumatology and Orthopedics of Russia. 2014;20(1):122-132
pages 122-132 views


Magdiev Dzhamalutdin A.



Traumatology and Orthopedics of Russia. 2014;20(1):133
pages 133 views

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