Vol 25, No 3 (2019)

CASE REPORTS

Total Hip Arthroplasty in Patient with Melorheostosis (Case Report)

Kuzin V.V., Egiazaryan K.A., Raksha A.P., Ratyev A.P., Kuzin A.V., Zhavoronkov E.A., Chebotarev V.V.

Abstract

Melorheostosis is a rare mesenchymal dysplasia of bone manifesting as regions of sclerosing and thickening of bone tissue. This disease may involve the adjacent soft tissues and lead to joint pain, limitation of joint motion, stiffness resulting from abnormal ossification and soft-tissue contractures due to periarticular fibrosis. The paper describes a clinical case of a patient who presented with pain and stiffness in the proximal part of the left hip which patient suffered for the last 10 years. At first the patient had intermittent pain in the lower back and left hip during and after walking. Radiographs revealed dense sclerotic and wavy cortex and hyperostosis involving the left iliac crest, the acetabulum, and the femur. CT angiography with contrast was performed for preoperative planning. During the procedure the authors performed total hip arthroplasty of the left hip with excision of fibro-ossifications in the left ilioinguinal area. Severe periarticular fibrosis of the soft tissue was observed intraoperatively and cartilage-like formation was visible around the joint. A sample of the ossification bone was resected for histologic confirmation of the diagnosis; extensive cortical sclerosis with varying thickness typical of melorheostosis was found. Early postoperative period went without complications following routine post-THR protocol. Postoperative X-rays at 6, 12, 24 months did not reveal any complications or new ossifications. Full ROM and pain-free function were achieved in the left hip and lower back of the patient. The present clinical case of total hip arthroplasty with excision of fibroossifications provided good clinical outcome for melorheostosis of the left hip.

Traumatology and Orthopedics of Russia. 2019;25(3):135-142
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Pseudoaneurysms of the Lower Extremity Vessels as a Complication of Hereditary Exostose Chondrodysplasia in Adolescents (Two Case Reports)

Zatravkina T.Y., Burov Y.A., Shanitsyn I.N., Maksyushina T.D., Titova Y.I., Sumin D.Y., Ionova T.A., Mironov I.A.

Abstract

The article describes two clinical cases of vascular complications related to hereditary exostose chondrodysplasia of the lower limbs in children. Despite early diagnostics the newgrowth was not timely removed. The anatomical localization of the exostoses in the vicinity of the main arterial trunks resulted in formation of pseudo-aneurysms due to a prolonged exposure of the vascular wall to the actively growing bone formations. After diagnostic imaging (ultrasonography and Doppler sonography, CT angiography, MR angiography of the vessels in the lower extremities) the authors performed a simultaneous resection of the femoral artery aneurysm with autovenous grafting and total resection of exostoses in both cases. Late follow up of both patients demonstrated vascular permeability at the graft site and no symptoms of stenosis were observed.

Traumatology and Orthopedics of Russia. 2019;25(3):143-152
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EDITORIAL

Editorial

Tikhilov R.M., Shubnyakov I.I., Bozhkova S.A.

Abstract

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Traumatology and Orthopedics of Russia. 2019;25(3):7-8
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CLINICAL STUDIES

Is the Any Clinical Importance for Separation Congenitally Dislocated Hip in Adults into Types C1 and C2 by Hartofilakidis?

Tikhilov R.M., Shubnyakov I.I., Denisov A.O., Pliev D.G., Shubnyakov M.I., Vahramyan A.G., Avdeev A.I.

Abstract

The main questions of the study: 1) is there any difference in anatomical features between subtypes C1 and C2 of high hip dislocation by Hartofolakidis classification; 2) are the conditions for performing the THA different and what are the surgical decisions; 3) what are the THA results in different groups? Materials and Methods. In a single center study the authors retrospectively evaluated the outcomes of 561 THAs performed in 349 patients with a high hip dislocation including 32 men (9.2%) and 317 women (90.8%) with the follow up from 12 to 188 months (average 69,4 months). In 326 cases (58.1%) the dislocation was assessed as type C1, and in 235 cases (41.9%) — as type C2. The average age of the patients at the time of surgery was 47.6 (19 to 74) years, for men — 39.1 years and 48.1 years for women. Results. Paavilainen shortening osteotomy was performed in 100% of patients with type C2 and only in 50.6% of patients with type C1, p<0.001. The cup was implanted into the true acetabulum cavity in 99.1% of cases with type C2, and for type C1 only in 69.0% of cases, p<0.001. Lateral under-coverage of the cup in patients with type C2 required supplementing by femoral head autograft only in three cases, and for type C1 — in 18 patients, p = 0.009. In the group of C2, the mean length of the osteotomized fragment of the proximal femur was 78.6 mm compared to 62.5 mm in patients with type C1. This provided a better contact area between the greater trochanter and the femur and in 92.8% of cases fixation was done by cerclage wires and two screws. In the group of patients with type C1, this option was feasible only in 60.0% of cases. Odds ratio (OR) for fixation of the greater trochanter by a special plate for primary indications in patients with type C1 were 10 367, p = 0.008. Harris Hip score improved averaged from 39.5 points to 83.6, without statistically significant differences between groups of C1 and C2. Early complications included 9 dislocations (1.6%), 8 cases of femoral nerve neuropathy (1.4%) and 3 early infections (0.5%). No cases of sciatic nerve paresis were observed. Non-union of the greater trochanter was observed with almost equal frequency in patients with C1 and C2 types, and revision fixation was needed in 27 patients (6.8%). Revision arthroplasty was performed in 22 cases (3.9%) due to 4 infections, 2 aseptic loosening of the stem, 11 aseptic loosening of the acetabular component and 5 recurrent dislocations. Conclusion. The group of patients with high hip dislocation is very heterogenic in terms of severity of anatomical changes and demands different surgical tactics. Hartofolakidis classification helps the surgeon to select the best type of the surgical procedure, minimize the mistakes and predict treatment outcomes.

Traumatology and Orthopedics of Russia. 2019;25(3):9-24
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Long-Term Results of Total Hip Arthroplasty with RM Classic Cups

Danilyak V.V., Klyuchevsky V.V., Molodov M.A., Goryunov E.V., Marchenkova K.V.

Abstract

Relevance. The RM Classic monoblock titanium-coated polyethylene cup is widely used in the total hip arthroplasty. However, so far in Russia there has been no analysis of follow-up over 10 years for a limited number of patients in a single hospital. The aim of the study was to evaluate the long-term outcomes of total hip replacement with RM Classic acetabular component. Materials and Methods. The outcomes of 328 total hip arthroplasties (289 patients operated in the period from 1997 to 2007) with RM Classic cups were evaluated in a monocentral retrospective clinical study. The average follow-up period was 14.4 years. Revision procedure due to aseptic loosening, polyethylene wear or osteolysis was considered as the end point of the study. Results. 9 revisions during the short and medium follow-up periods (up to 10 years) were associated with malpositioning of RM Classic components and errors in surgical technique. The indications for later revision THA (19 cases) were polyethylene wear and aseptic loosening. Only in one case they were combined with pelvic bone osteolysis with the formation of III a defect according to W.G. Paprosky classification. Within 15 years the Kaplan-Meier survivorship of RM Classic cup was 92.5%. There was a statistically significant difference of the survival curves in the ceramic-on-poly against metal-on-poly bearings: 94.9% and 79.4%, respectively. The average Harris Hip Score was 88.6. Conclusion. RM Classic uncemented monoblock cup has proven its high efficiency and survival in 15 years follow-up period and over.

Traumatology and Orthopedics of Russia. 2019;25(3):25-33
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Comment to the Article “Long-Term Results of Total Hip Arthroplasty with RM Classic Cups”

Myasoedov A.A.

Abstract

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Traumatology and Orthopedics of Russia. 2019;25(3):34-36
pages 34-36 views

Mid-term Outcomes of Using Custom-Made Implants for Revision Hip Arthroplasty

Kovalenko A.N., Dzhavadov A.A., Shubnyakov I.I., Bilyk S.S., Denisov A.O., Cherkasov M.A., Midaev A.I., Tikhilov R.M.

Abstract

Introduction. The matter of the replacement of acetabular defects is becoming increasingly relevant today. In their clinic the authors used custom-made implants with trabecular coating for replacement of defects in the acetabulum where and when it was necessary to ensure extended fixation of the component. Purpose — to evaluate short-term clinical and functional outcomes, osteointegration of porous coated custom-made implants, the overall survival of structural components and to identify the causes of failures and complications. Materials and Methods. During the study the authors interviewed and evaluated radiographs of 48 patients operated from October 2015 to June 2018. The patients were interviewed before and after the surgery using the Oxford hip joint scale, quality of life EQ-5D and visual analogue pain scale. Radiographs were evaluated for a period of at least 12 months for the signs of osteointegration. Results. The average OHS scores increased from 14.9 (±7) to 37.6 (±7) (p<0.01). Quality of life according to the EQ-5D index increased from 0.2 (±0.2) to 0.7 (±0.2) (p<0.01). The average value by general health scales: before operations — 49 (±17) and 73 (±18) scores after surgeries (p<0.01). The average VAS pain score decreased from 73 (±10) to 19 (±19) points (p<0.01). Osteointegration was observed in 98 percent of cases. Migration of the implant with fracture of a flange was observed in one case. Conclusions. In the short-term follow up the use of custom-made implants significantly improves hip joint function and the patients’ life quality. Custom-made implants enable primary reliable fixation in case of complex acetabular defects. High rate of osteointegration is observed for custom-made implants with porous coating within at least 12 months. Longer follow-up is needed to evaluate long-term results.

Traumatology and Orthopedics of Russia. 2019;25(3):37-46
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Patient-Specific Templates for Triple Pelvic Osteotomy in Children with Dysplastic Hip Subluxation (Preliminary Results)

Bortulev P.I., Vissarionov S.V., Baskov V.E., Barsukov D.B., Pozdnikin I.Y., Poznovich M.S.

Abstract

Purpose of the study — to evaluate the degree of correction of acetabular spatial position after triple pelvic osteotomy using patient-specific templates in children with dysplastic hip subluxation. Materials and methods. Study included 30 patients (30 hips) with dysplastic hip subluxation aging from 14 to 18 years (mean age of 16.3±1.4). All children were divided into two groups — main group consisted of 15 children (15 hips) who underwent triple pelvic osteotomy using patient-specific templates produced by 3D modeling and prototyping technology; control group consisted of 15 children (15 hips) who underwent triple pelvic osteotomy based on standard preoperative planning. X-ray and CT of hip joints was made in all patients. Results. Parameters of acetabular spatial position as well as integral parameters which define the ratio between acetabulum and femoral components and hip stability were in the range of normal variation in patients of the main group. Similar average parameters in patients of control group were below the lower margin of the physiological norm (p<0.05). Besides, the values of standard deviation of abovementioned X-ray parameters in some patients of control group demonstrated pronounced variability characterized by hyper- and hypo-correction values of spatial position of acetabular fragment. Conclusion. In contrast to standard preoperative planning the use of patient-specific templates during re-orienting triple pelvic osteotomy in children with dysplastic hip subluxation allows to level out possible errors in three-dimensional acetabulum positioning towards hyper- and hypo-correction (p<0.05) of pelvic component. This creates conditions to ensure adequate hip stability which is confirmed by key x-ray indices with values within normal reference range.

Traumatology and Orthopedics of Russia. 2019;25(3):47-56
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PRP-Therapy for Tendinopathies of Rotator Cuff and Long Head of Biceps

Malanin D.A., Norkin A.I., Tregubov A.S., Demeshchenko M.V., Cherezov L.L.

Abstract

Relevance. Owing to its controlling action on the inflammatory process, pain-relieving and reparative effects the RPR-therapy became quite demanded for treatment of certain types of tendinopathies specified by prevalence of degenerative process and poor reparative potential. Purpose of the study — to evaluate the efficiency of PRP-therapy in patients with tendinopathies of rotator cuff (RC) long head of biceps (LHB) tendons. Material and Methods. The paper presents the results of two-center prospective study for application of autologous platelet rich plasma in treatment of 122 patients: 53 men and 69 women aging 46.8±6.8 years who suffered RC tendinopathy (66%), subacromial impingement syndrome and RC tendinopathy (17%) and LHB tendinopathy (17%). Treatment outcomes were evaluated in 1, 3 and 6 months after PRP-therapy using various scales — VAS, UCLA , DASH, — and instrumental examination methods (US, MRI). Results. The authors observed statistically significant improvement in pain and functional scores in all three groups as compared to reported scores prior to PRP-therapy during 6 months follow up. During this period of evaluation, the scores of UCLA and DASH in patients with RC tendinopathy improved at 8.6 and 36.4 points, with subacromial impingement syndrome and RC tendinopathy — at 9.6 and 38.8 points, with LHB tendinopathy — at 11.5 and 44.1 point, respectively. The most notable reduction of pain syndrome by VAS was achieved in treatment of LHB tendinopathy (at 5.4 points) and RC tendinopathy (at 5.2 point). The highest average scores of satisfaction with treatment outcomes were reported in patients with RC tendinopathy (2.3) and LHB tendinopathy (2.2). MRI and ultrasound examinations after PRP-therapy demonstrated improved structure of RC and LHB tendons — decreased or eliminated swelling, areas of hypoechoic signal. Conclusion. PRP-therapy in patients with RC and LHB tendons and with subacromial impingement syndrome with RC tendinopathy significantly reduces severity of pain and improved the shoulder joint function with positive dynamics during 6 months follow up.

Traumatology and Orthopedics of Russia. 2019;25(3):57-66
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Comment to the Article “PRP-Therapy for Tendinopathies of Rotator Cuff and Long Head of Biceps”

Dokolin S.Y., Kuz’mina V.I.

Abstract

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Traumatology and Orthopedics of Russia. 2019;25(3):67-69
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The Effect of Pharmacological Thromboprophylaxis, Tourniquet and Drainage on Hemorrhagic Complications in the Early Stage after Knee Arthroplasty: Preliminary Results

Kasimova A.R., Bozhkova S.A., Tikhilov R.M., Saraev A.V., Petukhov A.I., Zhuravkov A.A., Arefyeva A.N.

Abstract

Background — venous thromboembolic complications (VTC) are potential life-threatening complications following knee arthroplasty (KA). An optimal thromboprophylaxis strategy should reduce the risk of developing VTC without increasing the risk of hemorrhagic complications. The purpose of the study is to evaluate the effect of the drugs (acetylsalicylic acid, dabigatran etexilate and rivaroxaban) for the pharmacological thromboprophylaxis and the features of the surgical procedure (use of the tourniquet and drainage) on hemorrhagic complications in early periods after knee arthroplasty. Materials and Methods. 335 patients (65 men and 270 women), without additional risk factors for the development of thromboembolic complications, were included into the study. Those patients were admitted for planned primary / revision knee arthroplasty and corresponded to inclusion / non-inclusion criteria. Patients were randomized into three clinical groups, depending on the drug used thromboprophylaxis. During the inpatient treatment period, all patients recorded the development of symptomatic VTCs and the development of hemorrhagic complications. According to the clinical indications, the number of knee joint punctures was taken into account: patella balloting, restricted flexion and a smooth joint contour. Results. Symptomatic VTCs were not observed during the study period. The volume of intraoperative blood loss did not depend on the drugs used for  thromboprophylaxis, and was determined only by the surgical technique (ρs= -0.615, p = 0.0001). The use of the tourniquet during the procedure significantly reduced intraoperative blood loss (p = 0.023). No relation between surgical technique and anemia on the 5th day (ρs = 0.11, p = 0.05), as well as between surgical technique and total blood loss (ρs = 0.12, p = 0.01) was established; weak reliable correlation between the use of the tourniquet and hidden blood loss (ρs = -0.22, p = 0.01) was reported. A negative average significant correlation was observed (ρs = -0.42, p = 0.01) for the volume of total blood loss and hemoglobin level on the 5th day after the surgery. The number of postoperative punctures was comparable in the study groups. Conclusion. Sample of present size is not sufficient to make conclusions about the equal efficacy of using acetylsalicylic acid, dabigatran and rivaroxaban for thromboprophylaxis after knee arthroplasty in patients without additional risk factors for thrombosis. Data on the significant correlation of the surgical technique with the volume of intraoperative and latent blood loss, as well as total blood loss and hemoglobin level on the 5th day after the operation allow to suggest a possible effect of the drug for thromboprophylaxis on blood loss stargin from 2nd day after the procedure. 

Traumatology and Orthopedics of Russia. 2019;25(3):70-80
pages 70-80 views

Comment on the Article “The Effect of Pharmacological Thromboprophylaxis, Tourniquet and Drainage on Hemorrhagic Complications in the Early Stage after Knee Arthroplasty: Preliminary Results”

Belov M.V.

Abstract

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Traumatology and Orthopedics of Russia. 2019;25(3):81-83
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Acute Correction of Congenital Brachymetatarsia in Adolescents and Young Adults

Keshet D., Salminen S., Eidelman M.

Abstract

Introduction. Brachymetatarsia is a relatively rare abnormal shortening of metatarsal bone with female predominance. No consensus exists about the ideal surgical treatment for this condition while the two common strategies are gradual lengthening using external fixation and acute one stage lengthening. We describe the surgical technique of acute lengthening using iliac bone graft and report our results. Materials and Methods. Twelve patients (11 females, one male) with 14 short metatarsals were treated in our hospital over a 12-year period. The mean age was 17.4 years (range 14-28 years). Treatment protocol included metatarsal osteotomy, lengthening of extensor tendon and percutaneous tenotomy of the flexor tendon at the level of affected MP joint. Autologous iliac bone graft was inserted after elongation of the metatarsal by distraction through the osteotomy site and fixed using Kirshner wire. Results. Average metatarsal shortening was 13mm (range, 11-18 mm). The metatarsal length gained was an average of 12mm (range, 11-15 mm). Uneventful bone union was achieved in all cases after six weeks. At the end of treatment, the normal cascade of the metatarsal heads (metatarsal parabola) had been restored in 11 of the 14 metatarsals treated. There were no wound complications or pin tract infections around the wire. All but one patient were satisfied with the cosmetic appearance of the foot. Conclusion. Based on our experience, acute metatarsal lengthening using an iliac autugraft is a reliable and effective treatment method for congenital brachymetatarsia in adolescents and young adults.
Level of Evidence: Level IV Case series.

Traumatology and Orthopedics of Russia. 2019;25(3):84-89
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Objective Signs of Foot Deformities in Children with Spastic Form of Cerebral Paralysis: Justification of Individual Approach to Footwear Support

Smirnova L.M., Dzhomardly E.I., Koltsov A.A.

Abstract

Relevance. Foot deformities are the most common locomotor pathology in children with infantile cerebral paralysis. At the same time many children suffering from this pathology wear standard shoes that do not take into account the individual foot anatomy. Purpose of the study — to justify the expedience of individual approach to orthopaedic support for children with infantile cerebral paralysis. Materials and methods. The authors examined 220 feet in 110 patients aging from 3 to 18 years: 62 patients with spastic form of infantile cerebral paralysis and 48 children who were examined during periodic screening at general education institutions (control group). Clinical examination methods, computerized plantography and podometry by flatbed foot scanning (ventrally, posteriorly, medially) in standing position were used in the present study. Results. Statistically significant variances (p*<0.005) were obtained for 8 indicators of foot deformity in three planes in children with infantile cerebral paralysis as compared to the norm, as well as differences between the groups of patients with varying degree of disorders in gross motor functions. The authors established pathological foot deformities in children with infantile cerebral paralysis; statistically significant variances in types and degrees of these disorders for patient groups with different levels of gross motor functions disorders; distinctiveness of foot deformities within each of the groups. Conclusion. Objectively instrumental method was used to identify the main components of foot deformities in patients with infantile cerebral paralysis with preservation and realization of walking capability: loss of height of longitudinal arches, midfoot pronation and hindfoot valgus, hallux valgus. Increased elevation of longitudinal arches (cavus foot), midfoot supination and hindfoot varus are rarer components of deformities occurring more often in patients with severer forms of the pathology. Strong variation in the spread of foot anatomy parameters observed within different groups of motor dysfunctions indicates the expediency of individual approach to footwear recommendations: standard, less or more complex orthopaedic shoes. Implementation of obtained data into the clinical practice requires additional series of biomechanical trials aimed at elaboration of criteria for recommendations and efficiency evaluation of various footwear types that take into account not only specifics of foot anatomy but also its statodynamic function as well as the level of gross motor functions of a particular patient. 

Traumatology and Orthopedics of Russia. 2019;25(3):90-99
pages 90-99 views

Outcomes of Surgical Treatment of High-Grade Spondylolisthesis (Monocenter Cohort and Literature Review)

Ryabykh S.O., Savin D.M., Filatov E.Y., Kotelnikov A.O., Sayfutdinov M.S.

Abstract

Purpose — to evaluate outcomes of surgical treatment for high-grade spondylolisthesis using bone-disc-bone osteotomy, reduction and fixation through the dorsal approach. Materials and Methods. The authors retrospectively examined a monocenter five-year cohort (IV level of evidence). The study included 10 patients aging from 7 to 22 years (Me — 12 years, M±m — 13.1±4.1 years) who underwent surgery due to high-grade spondylolysis antelisthesis in the period from 2012 to 2017. Displacement was located in L5-S1 segments and corresponded to types 4-6 by AO Spine SDSG classification in all patients. Catamnesis was followed for the period from 1 to 5 years. Surgical procedures included bone-disc-bone osteotomy, L5 reduction and dorsal instrumental multi-bearing (from 2 to 5 spinal motion segments) using reduction transpedicular screws. The following parameters were evaluated: pain syndrome prior and after surgery, sagittal balance, spondylolisthesis mobility on the functional x-rays or CYs, severity grade of anterior spondylolysis, criteria of spontaneous muscular activity and MEPs as well as structure of postoperative complications. Results. L5 displacement prior to surgery was 92.6±25.2%, after surgery — 25.4±16.6% (Z = -2.805, p = 0.005). Patients with sagittal imbalance demonstrated normalization after the surgery allowing to re-classify pathology as “balanced spondylolisthesis”: PI from 67.9±8.6 to 67.5±8.7 (Z = 0,000, p = 1,000), PT from 26.8±13.3 to 20.1±7.1 (Z = -2,090, p = 0.037), SS from 41.3±8.7 to 47.3±9.7 (Z = -1.886, p = 0.059), SA from 34.9±36.3° to 8.6±7.1° (Z = -2.803, p = 0.005). 3 cases of transient L5 radiculopathy with full regress after conservative 6 months’ treatment were reported in the early follow up period (on day 3 after procedure). Pain syndrome dynamics on VAS scale prior to and after the surgery were as follows: spine 8.1±1.0 and 0.5±0.5 (Z = -2.814, p = 0.005), lower limbs 6.8±1.5 and 0.4±0.7 (Z = -2.812, p = 0.005), respectively. Life quality indices by SRS-24 score prior to and after the surgery were 62.6±7.9 and 90.7±12.4 (Z = -2.803, p = 0.005). Mobility of spondylolisthesis was observed in 9 patients. Spondylolisthesis severity by Bridwell classification in late period scored from 1 to 3 points. Conclusion. Use of AO Spine SDSG classification along with assessment of sagittal balance as well as severity of neurological deficit and pain syndrome allow to define the severity grade of spondylolisthesis, while normalization of parameters after the surgery speaks for positive treatment outcome. Extensive release during bone-disc-bone osteotomy at L5-S1 level along with altering tilt angle of the sacrum is the key factor for mobilization and radical correction of pelvic balance in high-grade spondylolisthesis. Outcomes of surgical treatment in the analyzed cohort demonstrate significant improvement in life quality (by SRS-24 score) and reduced pain syndrome (by VAS) in patients. At the same time precise compliance to the procedure protocol and intraoperative neuro-monitoring of MEPs allow to decrease risk of complications. 

Traumatology and Orthopedics of Russia. 2019;25(3):100-111
pages 100-111 views

THEORETICAL AND EXPERIMENTAL STUDIES

Anatomical and Clinical Rationale for Posterolateral Transfibular Approach for Internal Fixation of the Posterolateral Column of the Tibial Plateau

Kochish A.Y., Kislitsyn M.A., Belen’kii I.G., Mayorov B.A., Starchik D.A.

Abstract

Purpose of the study — to provide an anatomical rationale and evaluate the clinical application of posterolateral surgical approach with osteotomy of the fibular head for internal fixation of the posterior aspect of the lateral tibial condyle. Material and Methods. Anatomical topography research was performed on 14 lower limbs of 8 fresh cadavers. In the first series of research L-shaped plate was fixed on the posterolateral surface of lateral tibial condyle from the examined approach, then preparation was performed and measuring of distances from various parts of the plates to the common peroneal nerve and anterior tibial artery. In the second series the authors prepared histological topograms by transverse sectioning of plastinated specimens from the knee joint area after implantation of L-shaped buttress plates. Prospective observation clinical study included 20 patients who underwent internal fixation with L-shaped buttress plate from the examined approach for fracture of the posterolateral column of the tibial plateau, type 41В by AO classification. KSS and Lysholm scales were used to evaluate treatment outcomes at days 7–10 and in 1, 3, 6 and 9 months postoperatively. Data of the anatomical and clinical research was compared. Results. Compliance with the technique of posterolateral transfibular surgical approach allows to avoid risk of injury to the common peroneal nerve and anterior tibial arthery which on the specimen were always located safely away from implanted plates. All 20 clinical cases demonstrated good visualization of bone fragments and articular surface of the tibial plateau which ensured reliable reduction and fixation by L-shaped buttress plate. KSS excellent and good outcome scores amounted to 50% and 45%, respectively, while satisfactory score was reported in 5% of cases; Lysholm scale demonstrated 55% of excellent outcomes, 45% of good outcomes, and 5% of satisfactory outcomes. Safety of the approach was verified: no injuries to large blood vessels or iatrogenic neuropathies were reported as well as no large hematomas or infectious complications of the surgical wound in early postoperative period. Conclusion. Results of the present study proved the feasibility and safety of the posterolateral transfibular surgical approach for internal fixation procedures in patients with intraarticular fractures of posterolateral column of the tibial plateau.

Traumatology and Orthopedics of Russia. 2019;25(3):112-123
pages 112-123 views

RESEARCH METHODS

Assessment the Accuracy of Densitometry Measurements Using DMA PP2 Phantom

Petraikin A.V., Smoliarchuk M.Y., Petryaykin F.A., Nisovtsova L.A., Artyukova Z.R., Sergunova K.A., Akhmad E.S., Semenov D.S., Vladzymyrsky A.V., Morozov S.P.

Abstract

Purpose of the study — to assess the accuracy of dual energy x-ray absorptiometry (DXA ) for measurements of mineral bone density, bone mineral content, area of selected spine zone of examination as well as impact of subcutaneous fat layer and correction of auto-segmenting of the spine on the mentioned parameters. Material and Methods. The study was performed on iDXA scanner using the designed phantom DMA PP2 of the lumber spine with inlays to simulate subcutaneous fat (SF). To ensure correct assessment of measurements (precision and accuracy) the authors performed fivefold repeated scanning. Two modifications of the phantom were used, with and without SF inlays, as well as two methods for selection of spine range for examination – automatic and correction of autosegmentation. Results. Scanning of the phantom without SF inlays demonstrated a systematic understated values of bone mineral density (BMD) and bone mineral content (BMC) along the full measured interval: mean relative error of BMD for L1-L4 interval was 10.62% with automatic segmentation and 7.43% — with  correction of autosegmentation. The least accuracy for BMD and BMC (1.53% and 0.90%, respectively) was observed during SF simulation and with correction of auto-segmentation of the spine. Analysis of variation coefficient for area of examined vertebrae, BMC and BMD demonstrated rather high precision of measurements, namely for BMD without SF in the L1-L4 interval amounted to 1.00% (auto-segmentation) and 0.56% (correction). Variation coefficient for scanning including SF inlays in the interval L1-L4 was 1.00% (auto-segmentation) and 0.68% (correction). Conclusion. The lowest level of accuracy was observed with the SFL object; in this case, the variation coefficient did not exceed 1% for all BMD interval. The mean value of the BMC accuracy also did not exceed 1% with the optimal scan parameters. The study proved the effectiveness of “RSK PK2” phantom when estimating the accuracy of BMD and BMC on iDXA scanner.

Traumatology and Orthopedics of Russia. 2019;25(3):124-134
pages 124-134 views

DISCUSSIONS

Assessment of Acetabulum Deformity During Preoperative Planning for Hip Arthroplasty

Martynenko D.V., Voloshin V.P., Sherman L.A., Shevyrev K.V., Oshkukov S.A., Stepanov E.V.

Abstract

Purpose of the study — to improve the two-dimensional planning of total hip joint arthroplasty to ensure precise positioning of the acetabular component in the deformed acetabulum. Materials and methods. Features of roentgenological anatomy of acetabulum and its coverage were studied on 1058 hip joint x-rays in the AP view in accordance with the procedure developed by the authors to define acetabular square — the site of standard positioning of a spherical femoral head in the acetabulum or of a hemispherical acetabular component. The method consisted of identifying the apex of “teardrop” figure; the most lateral points of the pelvic terminal line and roof of the acetabulum; superior part of the acetabular cavity; medial and inferior points of acetabular coverage, and building the sides of acetabular square — medial, inferior, lateral and superior boundary lines. Connection of “teardrop” apex and lateral point of the pelvic terminal line formed the medial side of acetabular square, and a perpendicular to that line drawn through the “teardrop” apex to its inferior side. The lateral side was drawn either through the intersection of the ascending diagonal line — bisector from the top of the “teardrop” figure with the contour of the acetabulum roof, or was a part of the projection of the most lateral point of the acetabular roof on the inferior side of the square. The superior side was a perpendicular connecting the intersection of the ascending diagonal and lateral bounding lines with the medial side of the acetabular square. The area of the deformed acetabular cavity located outside of the acetabular square was assessed as the acetabular defect. Results. Method of defining the acetabular square allowed to identify types of ratios between acetabular cavity and acetabular coverage in transverse (9 types) and longitudinal (7 types) direction. Combination of transverse ratio of acetabular cavity and coverage with longitudinal type allowed to define the options of acetabular deformities in two-dimensional view. The authors identified 25 types of acetabular deformities. Bone defects of acetabular walls were of the major importance among all anatomical features. Cranial defect of acetabulum was observed in 450 cases, medial wall defect — in 38 cases, defect including cranial and medial areas — in 7 cases. Conclusion. The method suggested by the authors to determine acetabular square and acetabular deformity variations allows to screen the anatomical features of the acetabulum during two-dimensional preoperative planning and to make an informed decision on the need to use other planning techniques. The type of acetabular deformity identified during preoperative planning allows to elaborate the indications for replacement of acetabular bone defects and/or resection of acetabular osteophytes.

Traumatology and Orthopedics of Russia. 2019;25(3):153-164
pages 153-164 views

RESEARCH METHODOLOGY

Study Design Guidelines

Sereda A.P., Andrianova M.A.

Abstract

Complying with certain requirements or, more precisely, following the guidelines for the design of a scientific publication helps to make it not only more comprehensible for reviewers and readers, but actually enhances the quality of work. For example, even if some aspects in design logic were fulfilled but not described, other researchers doing meta-analysis may wrongly but for a good reason downgrade such publication and exclude it from the analysis. Understanding of the guidelines for study design ensures not only the proper description of the results but the initial planning of work. The CA RE guidelines were established for reporting of clinical cases, STROBE — for reporting observational studies (cohort and case-control studies), CO NSORT — for reporting randomized studies (these guidelines are often used also for other comparative and case series studies), STARD — for reporting diagnostic studies, and PRISMA — for reporting of systematic reviews and meta-analyses. The present paper describes the key aspects of those guidelines and provides templates for graphic display of study design in form of flow charts. Evidently, we should not forget that each study is unique and there is always a place for a reasonable compromise between “requirements” and the real logic of the research in place.

Traumatology and Orthopedics of Russia. 2019;25(3):165-184
pages 165-184 views

REVIEW

Stimulation of Osteogenesis by Direct Electric Current (Review)

Ovchinnikov E.N., Stogov M.V.

Abstract

Background. Stimulation of osteogenesis in the treatment of certain orthopedic and trauma pathologies is a necessary element to ensure the best clinical outcome. The purpose of the present analytical review is to analyze the literature data in respect of evaluating the approaches and possibilities to stimulate osteogenesis using direct current. Methods. The search for literature data was performed in the open electronic databases of scientific literature PubMed and eLIBRARY under the following keywords and their combinations: “osteogenesis”, “reparative osteogenesis”, “direct electric current”, “orthopaedics”, “traumatology”, “electric current” (in Russian as well as in English language ). Results. According to some fundamental research, the stimulating effect of direct current lies is both in stimulating differentiation and proliferation of osteoblasts, and in stimulating differentiation of stem cells, mainly mesenchymal stem cells of bone marrow and adipose tissue, in the process of osteogenesis. The following stimulating technologies were developed and clinically tested to date: 1 — direct exposure of bone to the direct current; 2 — capacitive coupled stimulation; and 3 — inductive coupled (electromagnetic) stimulation. Analysis of clinical practice demonstrated that the first technology is most effective in terms of osteoreparation, but less safe than technology 2 and 3. It should be noted that there are no clear indications and modes of application for the abovementioned methods. Based on the data collected in the present analysis, technology 1 is considered by authors as the most promising. Safety of technology 1 can be enhanced by application of metal implants as electrodes in case those are planned to be used for medical reasons: wires, rods, staples, fixators, etc. Conclusion. Use of electric current to stimulate bone formation is a promising method which requires clarification in respect of indications and application modes.

Traumatology and Orthopedics of Russia. 2019;25(3):185-191
pages 185-191 views

JUBILEE

Vyacheslav V. Klyuchevskii 80th Anniversary of the Birth

Editorial a.

Abstract

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Traumatology and Orthopedics of Russia. 2019;25(3):192-193
pages 192-193 views

Vagram V. Agadzhanyan 70th Anniversary of the Birth

Editorial a.

Abstract

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Traumatology and Orthopedics of Russia. 2019;25(3):194-195
pages 194-195 views

Georgii I. Zhabin 75th Anniversary of the Birth

Editorial a.

Abstract

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Traumatology and Orthopedics of Russia. 2019;25(3):196
pages 196 views

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