Vol 25, No 2 (2019)

EDITORIAL

Editorial

Tikhilov R.M., Shubnyakov I.I., Глазков A.A.

Abstract

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Traumatology and Orthopedics of Russia. 2019;25(2):7-8
pages 7-8 views

CLINICAL STUDIES

Early Outcomes of Patient-Specific Modular Cones for Substitution of Methaphysial and Diaphysial Bone Defects in Revision Knee Arthroplasty

Cherny A.A., Kovalenko A.N., Bilyk S.S., Denisov A.O., Kazemirskiy A.V., Kulyaba T.A., Kornilov N.N.

Abstract

The aim of this study was the assessment of early outcomes of patient-specific three-dimensional titanium cones with specified porosity parameters to compensate for extensive metaphysical-diaphyseal bone defects in RTKA.

Materials and Methods. Since 2017 till 2019 30 patient-specific titanium cones (12 femoral and 18 tibial) implanted during 26 RTKAS. Clinical outcomes evaluated using KSS, WOMAC and fjS-12 scoring systems on average 10 (2–18) months after surgery. At the same time the stability of implant fixation analyzed using frontal, lateral and axial knee roentgenograms.

Results. During all procedures there were no technical difficulties in positioning and implantation of custom-made titanium cones. At the time of preparation of the publication, none of the patients had indications for further surgical intervention, as well as intra- and postoperative complications. Six months after surgery all scores improved significantly: KSS from 23 (2–42, SD 19.96) to 66.5 (62–78, SD 7.68), WOMAC from 59 (56–96, SD 28.31) to 32.25 (19–46, SD 11.76), the index FJS-12 was 29.16 points (0–68.75, SD 30.19). The average scores continued to improve up to 18 months: KSS — 97.5 (88–108, SD 9.14), WOMAC — 16.5 (9–24, SD 6.45), FJS-12 — 45.85 (25–75, SD 22.03). No radiolucent lines were noticed during this period of observation.

Conclusion. The original additive technology of designing and producing patient-specific titanium cones for compensation of extensive metaphyseal-diaphyseal bone defects in RTKA is a valid solution at least in the short term. A longer follow-up period is required to assess its medium-and long-term reliability compared to existing alternative surgical solutions.

Traumatology and Orthopedics of Russia. 2019;25(2):9-18
pages 9-18 views

Evaluation of Pain Syndrome in Patients after Total Knee Replacement

Murylev V.Y., Alekseev S.S., Elizarov P.M., Kukovenko G.A., Dering A.A., Haptagaev T.H.

Abstract

Total joint replacement is one the most effective methods for treatment of degenerative, systemic and posttraumatic diseases of the knee. However, up to 25% of patients remain dissatisfied with surgery outcomes. In the majority of cases the patients complain of pain in the operated joint. Identification of pain cause in the operated joint can turn to become a challenge for the surgeon.

Purpose of the study — to identify the causes of pain syndrome basing on examination algorithm in patients after TKR as well as to assess the diagnostic value of each particular examination method.

Materials and Methods. The authors analyzed results of comprehensive examination of 79 patients who complained of chronic knee pain after primary TKR and seeked medical help from the beginning of 2016 until December 2018. Inclusion criteria were as follows: knee prosthesis and presence of pain syndrome in the operated joint. Exclusion criteria: fistulous peri-prosthetic infection, suspected “culture-negative” infection and revisions. All patients included into the study were managed according to the standard algorithm of comprehensive examination.

Results. The most likely causes of pain were identified during the examination. Infection was observed in 39 patients (49.4%), errors in three-dimensional positioning of components was considered as a probable cause of pain in 14 patients (17.7%), aseptic loosening was reported in 13 cases (16.5%), ligamentous instability — in 6 patients (7.6%), extraarticular pain origin was observed in 5 patients (6.3%) and peri-prosthetic fractures were reported in two patients (2.5%). The authors confirmed a combination of several pain causes in 17 patients (21.5%).

Conclusion. Examination of patients with painfull knee joint prosthesis should be comprehensive due to potential combination of issues in each particular case. Integral and systematic approach to pain diagnostics in the operated joint is the “key to success” for planning further treatment tactics and for understanding the necessity and scope of revision procedure.

Traumatology and Orthopedics of Russia. 2019;25(2):19-30
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Postoperative Analgesia after Total Knee Arthroplasty: a Comparative Analysis of Current Treatment Techniques Effectiveness

Tarasov D.A., Lychagin A.V., Rukin Y.A., Kozhevnikov V.A., Yavorovskiy A.G., Strokov A.V.

Abstract

The objective of the study was to evaluate the effectiveness and safety of high-volume local infiltration and epidural analgesic techniques after primary total knee arthroplasty versus standard systemic multimodal analgesia in the context of the postoperative analgesia protocols.

Materials and Methods. A single-center randomized comparative study included 84 patients who, from august 2017 to august 2018, underwent a primary total knee arthroplasty. Depending on the method of postoperative analgesia, we randomized patients into 3 groups. Group A consisted of 32 patients who received intraoperative infiltration of periarticular tissues with 0.2% solution of ropivacaine in combination with adrenaline and subsequent bolus injection of a local anesthetic solution via a catheter inserted into the wound. Group B included patients who received epidural analgesia with a constant infusion of a 0.2% solution of ropivacaine (n = 28). In patients of group C, neither regional nor local analgesia techniques were used for postoperative analgesia (n = 24). All patients received standard systemic multimodal analgesia using nonsteroidal anti-inflammatory drugs and tramadol. The pain intensity was measured by vas when the patient was motionless, and during knee flexion (before surgery, after surgery on resolution of motor block and during the initial postoperative 24 h), side-effects were recorded.

Results. The patients of Group C, during knee flexion in the postoperative period, reported the highest pain scores (6 (5; 8) during the initial postoperative 12 h and 6 (5; 6) during the initial postoperative 24 h). Severe pain, resistant to therapy and requiring the administration of narcotic analgesics (morphine 1.0 mg), was noted in 5 (15.6%) patients in group A and in 10 (41.6%) in group C, in contrast to patients of group B, where no pain was recorded in any patient, p = 0.056, p = 0.037 and p<0.0001. Hypotension was observed only in group B in 6 (22%) patients. Intra-articular and other infectious complications among all patients were not recorded.

Conclusion. High-volume local infiltration analgesia as a modality of postoperative analgesia is not inferior in the effectiveness to the epidural analgesia, does not require strict monitoring and is accompanied by a lower incidence of side-effects and complications, which can make it the procedure of choice in multimodal analgesia schemes for total knee arthroplasty.

Traumatology and Orthopedics of Russia. 2019;25(2):31-41
pages 31-41 views

Comment to the Article „Postoperative Analgesia after Total Knee Arthroplasty: a Comparative Analysis of Current Treatment Techniques Effectiveness“

Kornilov N.N.

Abstract

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Traumatology and Orthopedics of Russia. 2019;25(2):42-43
pages 42-43 views

Mid-Term Outcomes of Primary Hip Replacement in Patients with End-Stage Chronic Renal Disease

Tsed A.N., Dulaev A.K., Mushtin N.E., Iliushchenko K.G., Shmelev A.V.

Abstract

Purpose — to evaluate mid-term outcomes of primary hip replacement in patients with end-stage chronic renal disease and to develop an algorithm for selection of surgical tactics and perioperative treatment.

Materials and Methods. The authors evaluated outcomes of primary hip replacement in 45 patients receiving renal substitution therapy and 47 patients without chronic renal disease. Patients with end-stage chronic renal disease (CRD) were divided into two groups: group I included 30 (66.6%) patients receiving chronic hemodialysis (CH) and group II included 15 (33.4%) patients after renal transplantation (RT). Group III of 47 (51.1%) patients without any signs of CRD who underwent hip arthroplasty within relevant period of time was established to evaluate the effectiveness of primary hip replacement. Blood serum Ca2+ and P5+ levels as well as levels of parathyroid hormone (PTH) and 1.25-dihydroxyvitamin D were measured to determine the rate of calcium- phosphoric metabolism disturbance. Multi-spiral CT scans of hip joint were performed to identify bone mineral density and the mean Hounsfield (Hu) value was calculated for which the data was obtained from five various points on the proximal femur and acetabulum. Beta-2 microglobulin (B2M) blood test was performed to confirm amyloid bone disease.

Results. The authors did not observe statistically significant differences for arthroplasty outcomes in patients of group II and III. Patients receiving long-term hemodialysis demonstrated significantly lower parameters of Harris score and Barthel’s index of social adaptation after hip replacement as compared to groups II and III: patients of group I demonstrated outcomes improvement at 19.55%, in group II — at 13.03%, in group III — at 10.15% as compared to preoperative status. Decrease of 1.25-dihydroxyvitamin D below 20,0 mcg results in resorption of cancellous bone in proximal femur and acetabulum along with myopathy of gluteus muscles. Sharp increase of parathyroid hormone level (over 600 pcg/ml) was accompanied by inhibition of osteoblasts proliferation and differentiation resulting in substantial impairment of mineralization.

Conclusion. According to the algorithm suggested by the authors the key parameters that need to be evaluated in preoperative period are parathyroid hormone (PTH) and 1.25-dihydroxyvitamin D. Five-fold increase of PTH (>600 pcg/ml) demands parathyroidectomy as the first stage of treatment to decrease risk of early aseptic loosening of hip prosthesis and development of periprosthetic fracture.

Traumatology and Orthopedics of Russia. 2019;25(2):44-54
pages 44-54 views

Comment to the Article „Mid-Term Outcomes of Primary Hip Replacement in Patients with End-Stage Chronic Renal Disease“

Murylev V.Y., Sorokina G.L.

Abstract

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Traumatology and Orthopedics of Russia. 2019;25(2):55-58
pages 55-58 views

Comparison of Nitinol and Titanium Nails Effectiveness for Lumbosacral Spine Fixation in Surgical Treatment of Degenerative Spine Diseases

Kolesov S.V., Kazmin A.I., Shvets V.V., Gushcha A.O., Poltorako E.N., Basankin I.V., Krivoshein A.E., Bukhtin K.M., Panteleev A.A., Sazhnev M.L., Pereverzev V.S.

Abstract

Relevance. Surgical decompression and decompression with stabilization are highly effective for treatment of spinal canal stenosis at the level of lumbar spine. However, complications developing after application of rigid fixation systems resulted in active introduction of dynamic implants into clinical practice.

Purpose of the study — to compare effectiveness of nitinol and titanium nails for lumbosacral fixation in surgical treatment of degenerative spine diseases.

Materials and methods. 220 patients who underwent surgeries in 4 hospitals were randomized into two groups, each consisting of 110 patients (1:1 ratio): a group of patients who underwent stabilization of the vertebral motor segments with rods of nitinol with the required volume of decompression at the operation level and a group of patients who underwent stabilization of the vertebral motor segments with standard rods of titanium with the required volume of decompression at the intervention level. Patients suffered clinically significant spinal canal stenosis in one or two adjacent segments: from L3 to S1. Outcomes were evaluated during three years postoperatively by VAS scale for spine and lower limbs, and by ODI and SF-36 scales.

Results. All scales demonstrated better values in both groups of patients, namely, significant decrease of pain syndrome and improvement in mental and physical health. X-ray examination of all patients during the study period demonstrated restoration of lumbar lordosis. Group of patients with dynamic nails featured less complications rate related to metal implants including adjacent segment disease.

Conclusion. Transpedicular fixation of lumbosacral spine by nitinol nails is an effective technique allowing to preserve motion along with stable fixation.

Traumatology and Orthopedics of Russia. 2019;25(2):59-70
pages 59-70 views

Foot Function Disorders in Children with Severe Spondylolisthesis of L5 Vertebra

Nikityuk I.E., Vissarionov S.V.

Abstract

Background. In children with spondylolisthesis, there are still unexplained aspects in the relationship of the degree of displacement of the L5 vertebra with the severity of the clinical picture and neurological disorders. At the same time, aspects of the mutual aggravating influence of the indicated spinal disorder on the condition of the feet have not been studied. Therefore, the problem of identifying disorder of foot function in children with spinal spondylolisthesis of the L5 vertebra is relevant.

Aim of the study — to evaluate the deviations in parameters of the transverse and longitudinal arches of feet in children suffering from severe spondylolisthesis of the L5 vertebra.

Materials and Methods. In the period from 2016 to 2018, 12 children aged 14.1 y.o. [12,7; 15,5] were examined with spondylolisthesis of the L5 vertebral body of grade III-IV, accompanied by stenosis of the spinal canal at the same level and by compression of the roots of the spinal cord. Imaging diagnostics included multispiral computed tomography (MSCT) and magnetic resonance imaging (MRI). To estimate the function of the feet, double-bearing and single-bearing plantography was used. The data for the control group included only plantographic examinations of 12 healthy children of the same age.

Results. In patients with spondylolisthesis, the mean value of the anterior t and intermediate s plantographic bearing indices were significantly lower than those of healthy children. At the same time, in tests with an increased load on the foot in patients, there was no significant increase in the mean anterior t and medial m indices, which indicates the dynamic rigidity of the transverse and medial longitudinal arches. The value of the lateral plantographic index l showed its significant pathological increase compared with the normal value at double-bearing load, which indicates the static rigidity of the lateral longitudinal arch. Correlation analysis demonstrated that, against the normal state, the bearing ability of the feet in sick children is realized through a pathological strengthening of the functional relationship between the arches of the foot at double-bearing load and a non-physiological reduction of the interaction between arches at single-bearing load.

Conclusion. In children with severe forms of vertebra spondylolisthesis, the parameters of plantographic characteristics indicate the rigidity of the arches of the feet and the distortion of their bearing pattern. It is necessary to take into account the aggravating effect of rigid feet on the state of the spine and include the examination of the bearing function of the feet in the algorithm for the comprehensive diagnosis of children with spondylolisthesis.

Traumatology and Orthopedics of Russia. 2019;25(2):71-80
pages 71-80 views

Comment to the Article „Foot Function Disorders in Children with Severe Spondylolisthesis of L5 Vertebra“

Mushkin A.Y.

Abstract

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Traumatology and Orthopedics of Russia. 2019;25(2):81-82
pages 81-82 views

Classification for Haglund’s Syndrome (Deformity)

Sereda A.P., Belyakova A.M.

Abstract

The objective of the study — to propose a classification for Haglund’s syndrome based on the differentiated treatment outcomes and to conduct a systematic review of articles on this topic.

Materials and Methods. The article based on the diagnosis and treatment of 77 patients with Haglund’s syndrome. 68 patients with Haglund’s syndrome underwent surgery (79 operations), 14 of which were endoscopic. In 9 patients conservative treatment techniques were undertaken.

Results. As a result of analyzing a variety of cases of Haglund’s syndrome, we proposed clinical and morphological classifications for Haglund’s syndrome that help to choose the optimal treatment tactics. according to its clinical form, Haglund’s deformity may be common, atypical, and “hiding”. A special clinical variation is a cosmetic form. Depending on morphological characteristics, it was proposed to distinguish upper, upper-lateral, “arc type”, total types, and atypical variations. With the upper type of deformity and, rarely, with the upper-lateral one, an endoscopic technique or minimally invasive surgical correction is preferable. For more extensive variants, the only solution should be an open procedure. The outcomes at 11.5±1.2 months after surgery showed significant improvement in patient condition as compared to the preoperative status (p<0.001). On the AOFAS, the scores were 92.2±3.1 after open procedures (86.1±3.5 and 93.2±2.2 for the different types) and 94.7±1.8 after endoscopic operations. However, we cannot speak confidently of the advantage of endoscopic surgery, since adequate resection during the endoscopic operation is possible only in limited cases of the Haglund’s deformity types (upper and upper-lateral). For the same reason, it is impossible to compare the results of minimally invasive surgery with fluoroscopic control with the results of open surgical intervention. according to AOFAS (p<0.001), conservative treatment also improved the status of patients, more specifically from 75.1±4.7 to 80.1±5.7. However these improvements were significantly less compared to surgical treatment (p<0.001). Our results of patient treatment were included in an updated systematic review of twenty-eight studies related to the results of open (681 patients in total) and endoscopic (321 patients in total) treatment of patients with Haglund’s syndrome.

Conclusion. Particular attention should be paid to the “hiding” clinical cases which do not manifest signs of tenopathy, but are detrimental to athletic performance. We consider treatment strategy based on clinical and morphological classifications as justified, when the type of operation (open, minimally invasive or endoscopic) was determined by the type of deformity and its localization.

Traumatology and Orthopedics of Russia. 2019;25(2):83-98
pages 83-98 views

Comment to the Article „Classification for Haglund’s Syndrome (Deformity)“

Berezhnoy S.Y.

Abstract

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Traumatology and Orthopedics of Russia. 2019;25(2):99-101
pages 99-101 views

Some Morphological and Functional Aspects of Chronic Osteomyelitis in Patients with Neurogenic Foot Deformities

Sudnitsyn A.S., Shchurova E.N., Varsegova T.N., Stupina T.A., Migalkin N.S.

Abstract

Relevance. Neurological disorders are one the most frequent cause for developing of chronic foot inflammation. Analysis of pathological picture of chronic osteomyelitis in patients with neurogenic foot deformities, including cases of spina bifida, is not adequately addressed.

Purpose of the study — to examine morpho-functional aspects of chronic osteomyelitis in patients with multicomponent foot deformities and with spina bifida.

Materials and Methods. The present paper is based on the study of 30 patients with multicomponent neurological foot deformities complicated by chronic osteomyelitis who had medical history of spina bifida (myelomeningocele type). Histology was used to examine resected fragments of affected bone tissue, bone sequestration and skin adjacent to osteomyelitis area. Laser doppler flowmetry was used to study capillary cutaneous blood flow on plantar foot surface. Thermal and pain sensitivity was assessed by electric sensimeter in L4, L5, S1 dermatomas on the right and on the left sides.

Results. Biopsy skin specimens harvested at osteomyelitis area demonstrated signs of parakeratosis, absence of stratum lucidum, epidermis acanthosis with 25% thickness increase (р = 0,04), 2,2 times increase of density for microvessels of the dermis (р = 0,73Е-4) and increased rate of capillary blood flow at 81,6±14,2% (р = 0,0004), fibrosis and dermis thinning at 19,1% (р = 0,03), 1,37 times increase in bulk density of perspiratory glands (р= 0,04), loss of adipose tissue and degeneration of nerve fibers in the majority of nerve stems of the dermis. Above factors were accompanied by disorders in thermal and pain sensitivity in 100% of cases and in 29% of those sensitivity was missing. Morphological picture of bone tissue in osteomyelitic area was manifested by multiple destruction cavities with pyogenic membrane, granular tissue of varying maturity, combined chronic and acute stages of the process, and by poor restorative bone formation.

Conclusion. Disorders or lack of thermal and pain sensitivity in dermatomas L4, L5, S1, of safety sense and motion control, resulting chronic load on atypical foot segments, as well as patho-histological skin alterations contribute to ulcer formation and osteomyelitis in patients with spina bifida and multicomponent foot deformities. Morphological picture of foot bony tissue at osteomyelitic site indicates typical patho-morphological signs of chronic inflammation with poor restorative bone formation.

Traumatology and Orthopedics of Russia. 2019;25(2):102-110
pages 102-110 views

Классификация синдрома (деформации) Хаглунда.

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Abstract

Статья посвящена опыту диагностики и лечения пациентов с синдромом Хаглунда. Было прооперировано 77 последовательных пациентов с синдромом Хаглунда (выполнено 79 операций), из них у 14 операция была выполнена эндоскопически. У 9 пациентов предпринималась консервативная тактика. В результате анализа многообразия встретившихся вариантов синдрома Хаглунда предложена клиническая и морфологическая классификации синдрома Хаглунда, определяющие тактику лечения. Результаты через 11,5±1,2 месяцев после операции оказались достоверно лучше предоперационного статуса (p<0.001) и составили 92,2±3,1 баллов для открытых операций (86,1±3,5 и 93,2±2,2 при разных типах) и 94,7±1,8 баллов после эндоскопических операций по шкале AOFAS. Однако делать вывод о преимуществе эндоскопической операции авторы считают невозможным, так как эндоскопическая и открытая операции применимы при разных типах деформации Хаглунда. В сравнении с группой консервативного лечения операция также оказалась более эффективной (p<0.001). Изучена частота осложнений после оперативного лечения. Выполнен систематический обзор публикаций, изучавших результаты и особенности хирургического лечения пациентов с синдромом Хаглунда.

Traumatology and Orthopedics of Russia. 2019;25(2):
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THEORETICAL AND EXPERIMENTAL STUDIES

Coatings Based on Two-Dimensionally Ordered Linear Chain Carbon for Protection of Titanium Implants from Microbial Colonization

Tapalski D.V., Nikolaev N.S., Ovsyankin A.V., Kochakov V.D., Golovina E.A., Matveenkov M.V., Sukhorukova M.V., Kozlov R.S.

Abstract

Purpose of the study – to evaluate the antibacterial activity and biological compatibility of alloy coatings based on two-dimensionally ordered linear chain carbon (TDOLCC).

Materials and Methods. Coatings based on TDOLCC were synthesized using alloying additions like nitrogen (TDOLCC+N) and silver (TDOLCC+Ag) on the surfaces of titanium plates and polystyrene plates by the ion-stimulated carbon condensation in a vacuum. The authors examined the superficial bactericidal activity of the coatings and its resistance to mechanical effects. Coated plates were evaluated in respect of rate of microbial biofilms formation by clinical isolates with multiple and extreme antibiotic resistance. Specimens were colored with crystal violet solution to visualize the biofilms. Cytotoxic effect of coatings was evaluated in respect of primary culture of fibroblasts and keratinocyte cell line HaCaT.

Results. The authors observed pronounced superficial bactericidal effect of TDOLCC+Ag coating in respect of microorganisms of several taxonomic groups independently of their resistance to antibacterial drugs. TDOLCC+Ag coating proved capable to completely prevent microbial biofilm formation by antibiotic resistant clinical isolates of S. aureus and P. aeruginosa. Silvercontaining coating demonstrated mechanical resistance and preservation of close to baseline level of superficial bactericidal activity even after lengthy abrasion treatment. TDOLCC based coatings did not cause any cytotoxic effects. Structure of monolayers formed in cavities coated by TDOLCC+N and TDOLCC+Ag was indistinguishable from the monolayers in cavities of control plates.

Traumatology and Orthopedics of Russia. 2019;25(2):111-120
pages 111-120 views

Comment to the Article „Coatings Based on Two-Dimensionally Ordered Linear Chain Carbon for Protection of Titanium Implants from Microbial Colonization“

Bozhkova S.A.

Abstract

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Traumatology and Orthopedics of Russia. 2019;25(2):121-122
pages 121-122 views

Changes in the Structure and Mechanical Properties of the Bone after Puncture Cryoablation: Experimental Study

Belyaev A.M., Prokhorov G.G., Sushnikov V.A., Artemyeva A.S., Arkhitskaya A.A., Chuglova D.A.

Abstract

Purpose of the study — to evaluate possible impact of cryoablation on a healthy bone and to identify probable causes of postoperative fractures.

Materials and Methods. The authors performed cryoablation of the femur in the experiment on 8 mature rabbits of Soviet Chinchilla (SC) breed with a follow up for up to two months. Anitrogenous cryoprobe of 1.5 mm in diameter was introduced into the femur through a perforation hole. The bone was completely frozen up to -180°С in two cycles with continuous thermometry. Pathomorfological examinations were performed after 7 and 55 days along with assessment of bone hardness. Preparation of material stipulated sawing the bone at the fracture site along the bone axis. One half-bone was used for histological examination, and another one — for measuring mechanical properties by local pressing of a diamond indenter onto the bone at certain applied force. The distance between measurement points along the bone was 250 μm. Statistical processing included variance significance analysis using t-test.

Results. The authors reported bone fractures at the site of cryodestruction in all animals in one week after the procedure. Statistical analysis of the measurements and histological examination demonstrated that freezing of the entire bone diameter up to -180°С results in its complete destruction. Strength reduction around the fracture site corresponded to the temperature distribution area in the range from -9ºС to -15ºС. However, areas of cooling below -40ºС exhibited some bone segments with normal hardness. Mosaic pattern of strength reduction is explained by microcirculation disorders. Histology confirmed thrombosis of intraosseous blood vessels in the area of cryotherapy. The first focal signs of osteomalacia emerged by the end of the first week after cryoablation. Subsequently, the bone preserved its regenerative properties, but by the end of the second month after the procedure the histogenesis was still not completed and the bone did not regain its strength.

Conclusion. The authors believe that a limited number of cases, the specific features of the angioarchitecture of animal bones and their ability to produce a heavy periosteal response do not allow to apply obtained quantitative outcomes of the present study to clinical situations. However, complete freezing of the entire bone diameter inevitably results in fracture formation.

Traumatology and Orthopedics of Russia. 2019;25(2):123-133
pages 123-133 views

RESEARCH METHODS

Magnetic Resonance Imaging of Hoffa’s Fat Pad

Stulov A.S., Tarasov A.N.

Abstract

Background. Pathological changes in the size and structure of Hoffa’s fat pad can cause pain in the anterior section of the knee joint. Therefore, they should be diagnosed. The objective of the paper is to improve the diagnostics of Hoffa’s fat pad disease on the basis of a detailed study of the clinical anatomy of the infrapatellar (Hoffa’s) fat pad and magnetic resonance imaging (MRI) findings in normal and pathological conditions.

Materials and Methods. Protocols of 86 MRI examinations of knee joints with anterior knee pain syndrome and no clearly defined traumatic history nor positive clinical tests indicating damage to the intra-articular and periarticular elements with identified structural changes in the fat pad were selected retrospectively. The control group consisted of data from 24 examinations of asymptomatic knee joints. In all cases, the pathology was confirmed during diagnostic and therapeutic arthroscopy.

Results. The MRI findings showed the normal structure of the infrapatellar fat pad, as well as pathological changes in the form of tearing, local edema, diffuse edema, synovial proliferation and fibrosis. Depending on the location and type of changes, 4 pathological syndromes were identified: “classic” Hoffa’s disease — 49 (57%) cases, infrapatellar synovial fold syndrome — 11 (13%), infrapatellar synovial fold separation syndrome — 6 (7%), and impingent syndrome of upper lateral adipose tissue — 20 (23%) cases.

Conclusions. To identify a pathology, a precise synchronization of clinical and morphological changes is required. Accurate differentiation of syndromes is possible due to knowledge of the detailed anatomical and magnetic-resonance features of the fat pad in normal and pathological conditions. This allows to diagnose the cause of pain in the anterior sections of the knee joint, specify the diagnosis, and choose the optimal plan of treatment.

Traumatology and Orthopedics of Russia. 2019;25(2):134-140
pages 134-140 views

Comment to the Article „Magnetic Resonance Imaging of Hoffa’s Fat Pad“

Bagnenko S.S.

Abstract

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Traumatology and Orthopedics of Russia. 2019;25(2):141-142
pages 141-142 views

Features of Partial Rotator Cuff Tears Diagnostics

Logvinov A.N., Ilyin D.O., Kadantsev P.M., Makarieva O.V., Burtsev M.E., Ryazantsev M.S., Magnitskaya N.E., Frolov A.V., Korolev A.V.

Abstract

Partial rotator cuff tears are the most common pathology of the shoulder joint. Diagnostic of such conditions is a challenging problem for trauma surgeon.

Purpose of the study is to analyze the diagnostic significance of manual tests and the standard MRI of the shoulder joint.

Materials and Methods. The study is a retrospective analysis of disease history data of 25 patients (15 males, 10 females) treated at the authors’ hospital during the period from 2014 to 2017. Examination was performed according to a standard protocol: assessment of shoulder range of motion, palpation, manual examination, including “full/empty can” test, a painful arc symptom and the Hawkins – Kennedy test. All patients underwent MRI of the shoulder joint. The mean age of patients was 50.8 years. Shoulder joint arthroscopic inspection was considered the gold standard for diagnostics.

Results. After data analysis, the following results were obtained: sensitivity of the “full can” test was 68%, the accuracy was 68%; “empty can” test sensitivity and accuracy were 76%, respectively. MRI sensitivity for diagnostics of supraspinatus tendon ruptures was 84% with the accuracy of 84%. The combination of the Hawkins – Kennedy test with the symptom of painful arch demonstrated accuracy and sensitivity of 64%. The study evaluated the effectiveness of MRI for diagnostic of the rupture type: sensitivity for injury from the joint surface — 80%, from the subacromial space — 70%; specificity for ruptures from the articular surface — 90% and from the subacromial space — 93%. The accuracy was 84% for both types of ruptures.

Conclusions. Combined application of manual tests and MRI of the shoulder joint allows to diagnose partial rotator cuff tears in the majority of cases.

Traumatology and Orthopedics of Russia. 2019;25(2):143-149
pages 143-149 views

Scanning Electron Microscopy of Palmar Fascia in Dupuytren’s Disease of Advanced Stage

Shchudlo N.A., Stupina T.A., Shchudlo M.M.

Abstract

Relevance. Dupuytren’s disease (palmar fascial fibromatosis) affects primarily palmar and digital fascia and results in progressive wrist deformity in many patients and often with bilateral involvement. Absence of corresponding data on the patients with severe wrist deformities along with their treatment issues is the ground for targeted research of pathomorphology of advanced disease stages.

Purpose of the study — to identify features of ultrastructure of fibromatosis nodules and bands in palmar aponeurosis of patients with Dupuytren’s disease of grade III-IV.

Materials and Methods. The authors analyzed medical histories and surgical material of 20 patients aging 42–77 years. Segments from medial portion of pretendinous cord of IV digit were cut for examination under scanning electron microscope (JSM-840, Jeol, Japan).

Results. Irrespective of disease history (from 1 to 20 years) fibrbous-fibrillar network and fine cylindrical collagen fibers prevailed in nodules of pretendinous cord which formed semicircular and circular end coils. Empty lacunae, functionally active fibroblasts and close cellular pairs were observed in nodules. Bands differed from nodules by lesser cellularity and less content of fine fibers, orientation of thick fibers mainly along one axis, straightening segments of undulated twisting and separate twisted and tightly interwoven fiber fragments.

Conclusion. In Dupuytren’s disease of grade III-IV nodules maintain the role of active contractile centers. Despite relatively small cellularity of pathologically altered tissues there is a potential for progressing, propagation and recurrence of fibromatosis.

Traumatology and Orthopedics of Russia. 2019;25(2):150-156
pages 150-156 views

REVIEW

Isolated and Multilevel Spondylolysis (Literature Review)

Skryabin E.G.

Abstract

One of the main causes of lumbar spine pain is spondylolysis. The purpose of this review is to present the current state of the problem of diagnosis and treatment isolated and multilevel spondylolysis.

Materials and Methods. The review includes 86 publications on the problem of spondylolysis for 2005–2019, obtained from electronic databases: PubMed, Cochrane Library, eLIBRARY, CYBERLENINKA.

Results. There is still the only known classification of spondylolysis by P. Niggemann et al, which includes four severity of this pathology — from mild to very severe: A, BI, BII, BIII. The classification is based on the nature of changes in the area of bone defect of the vertebral arch when the patient performs functional tests. In some cases, the pathology can be regarded as a transition between different degrees of severity of type B. The treatment of spondylolysis can be both conservative and operational. The conservative therapy consists of physical activity restriction, physiotherapy, wearing a corset, massage, and pharmacotherapy. The purpose of surgical treatment is the removal of fibrous tissue from the zone of spondylolysis and the achievement in this area the bone fusion via a bone autoplasty and(or) osteosynthesis with different metal frameworks. Reasoned arguments about the need for a combination of conservative and surgical treatment of patients with spondylolysis are also reflected in the publications. Information on multilevel spondylolysis is represented by a small number of articles. only 15 authors described clinical cases of multilevel spondylolysis in a total of 21 patients. Spondylolysis is a high risk factor for the spondylolisthesis formation. Among the various categories of patients suffering from spondylolysis and lumbar spondylolysis spondylolisthesis, pregnant women are of particular interest. Hormonal restructuring and changes in the biomechanics of the spine in women during the gestational period often leads to the appearance or intensification pain syndrome in lumbar spine complicating the pregnancy, and hence a fetus development.

Conclusion. Timely diagnosis of spondylolysis and the subsequent development of individual rehabilitation not only improves the quality of life of patients, but in some cases can prevent such a serious pathology as spondylolisthesis.

Traumatology and Orthopedics of Russia. 2019;25(2):157-165
pages 157-165 views

LETTERS TO EDITOR

Comment to the Article „Classifications of Acetabular Defects: Do They Provide an Objective Evidence for Complexity of Revision Hip Joint Arthroplasty? (Critical Literature Review and Own Cases)“

Danilyak V.V.

Abstract

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Traumatology and Orthopedics of Russia. 2019;25(2):166-169
pages 166-169 views

JUBILEE

Klara I. Shapiro. 80th Anniversary of the Birth

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Traumatology and Orthopedics of Russia. 2019;25(2):170-171
pages 170-171 views

Valentin A. Neverov. 75th Anniversary of the Birth

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Traumatology and Orthopedics of Russia. 2019;25(2):172-173
pages 172-173 views

MEMORIAL DATES

Alexander F. Krasnov. 90th Anniversary of the Birth

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Traumatology and Orthopedics of Russia. 2019;25(2):174-175
pages 174-175 views

OBITUARY

Leonid B. Reznik

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Traumatology and Orthopedics of Russia. 2019;25(2):176-177
pages 176-177 views

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