Vol 26, No 1 (2020)

EDITORIAL

Editorial

Editorial a.

Abstract

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Traumatology and Orthopedics of Russia. 2020;26(1):7-9
pages 7-9 views

CLINICAL STUDIES

The Long-Term Results of Hip Arthroplasty in Patients with Proximal Femur Tumors

Mikailov I.M., Tikhilov R.M., Ptashnikov D.A., Denisov A.A., Grigoriev P.V.

Abstract

Relevance. The development of the modern principles of combined tumor treatment has significantly improved the survival of the patients. For these patients, the organ-preserving surgerybecomes now the mainstream tactics. For the restoration of the lower limb support ability and the hip function, the hip arthroplasty is now the most used type of surgery. Purpose of the study. The purpose of this work was to evaluate the long-term results of hip arthroplasty in the patients with extensive proximal femur defects caused by tumors and tumor-like lesions. Materials and Methods. The data on 126 patients with proximal femur tumors, undergone the surgical treatment in 2000–2013, were collected and summarized. The average age of the patients was 53.8 years (26–74), 94 women (74.6%), and 32 men (25.4%). There were 16 primary malignant bone tumors (12.7%), 10 benign aggressive (7.9%); 92 metastatic (73%), and 8 tumor-like lesions (6.4%). The average follow-up after the surgery was 72.6 months. The complications classification and analysis were performed according to the criteria of the International Society of Limb Salvage 2014 (ISOLS 2014). For the assessment of the functional result, patients were divided into 4 groups. In this context, the following indicators were taken into account: whether the acetabular component or the bipolar head were used, and the method of the soft tissues fixation to the femoral component of the endoprosthesis. Functional outcome was evaluated using the international Musculoskeletal Tumor Society (MSTS) scoring system at 3, 6, and 12 months. Results. The total number of complications, identified during the observation period from 2000 to 2018, was 26 (20.6%). The oncological complications, represented by local recurrence, were detected on average after 11.5 months. The total number of local recurrences is 6 (4.7%) which amounted to 23% in the structure of all complications. Dislocations of the endoprosthesis became the most frequent complication — 13 (10.3%) observations, 50% in the structure of all complications. Only one patient with aseptic instability of the femoral component was identified over the entire follow-up period. There were 4 (3.1%) patients with complications due to the destruction of metal constructions. All of them had an endoprosthesis stem fracture. The average period of onset of these complications was 122.5 months. Prosthetic joint infection was observed in 2 (1.6%) patients (7.2% of all complications), on the 14th and 31st days. The patient with the latter onset of infection underwent a twostaged revision arthroplasty. Functional result by the MSTS scale: 3 months — 74.8%, 6 months — 79%, 12 months 81.8%. In the patients under investigation, 5-, 10-, and 15-year survival for aggressive benign tumors and tumorlike lesions was 95%, 84%, 62%; for malignant primary tumors — 88%, 65%, 24%; for secondary bone lesions 55%, 43%, 12%, respectively. Conclusion. The use of a bipolar head made it possible to reduce the likelihood of an endoprosthesis dislocation. The fixation of the preserved muscle elements with a polymer mesh made it possible to obtain the best functional result already in the early postoperative period.
Traumatology and Orthopedics of Russia. 2020;26(1):11-20
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Comparative Assessment of Subtrochanteric Shortening Osteotomy and Paavilainen’s Proximal Osteotomy in Total Hip Arthroplasty for Crowe III–IV Dysplasia

Korytkin A.A., Gerasimov S.A., Novikova Y.S., Kovaldov K.A., Morozova E.A., Korolev S.B., El moudni Y.M.

Abstract

The purpose of the study — to compare the results of the subtrochanteric shortening osteotomy and Paavilainen proximal osteotomy in the total hip arthroplasty for Crowe III and IV dysplasia. Material and Methods. It was performed 36 hip arthroplasties in the patients with Crowe III (12) and IV (24) dysplasia. Two methods of the shortening osteotomy were used: Paavilainen osteotomy (22) and subtrochanteric osteotomy (14). The average follow-up was 42.3±22.7 months (from 6 to 88). Among the patients, there were 25 (75.8%) women and 8 (24.2%) men with the average age of 51.5±13.1 and 34.6±20.4 years, respectively. Results. The lateral acetabular deficiency required the structural repair of the femoral head in 16.7% of the cases. The average length of the osteotomized fragment was 56.8±16.3 mm, the caudal displacement of the greater trochanter apex — 47.0±15.6 mm, the limb lengthening — 30.1±10.9 mm without the statistically significant difference between the groups. The consolidation was achieved on average in 7 months. The Harris score improved on average from 37.6±10.1 points to 76.1±17.6, p<0.001 (78.1±15.3 in Paavilainen group and 72.9±20.9 in the subtrochanteric). The overall HOOS score increased from an average of 34.6±12.4 to 74.6±18.6 points, p<0.001 (78.1±15.9 in Paavilainen group and 69.1±21.7 in the subtrochanteric). The statistically significant differences between the groups after the surgery were found only in the HOOS pain section. Paavilainen group showed higher scores. Various postoperative complications occurred in 27.8% of cases, 2.4 times more often in the subtrochanteric group. The revision was required in 4 cases out of 36 (11.1%): 2 cases (9.1%) in Paavilainen group and 2 cases (14.3%) in the subtrochanteric. The survival rate of the femoral component throughout the sample was 97.2%. There was only one case of the femoral component replacement in the subtrochanteric group. Conclusion. Both the subtrochanteric shortening osteotomy and Paavilainen proximal osteotomy have good reconstructive capabilities and sufficient efficacy. We were not able to identify the clear advantages of any of the described options for shortening osteotomy, probably due to the insufficient number of observations. In our practice, we give a preference to subtrochanteric shortening osteotomy of the femur.
Traumatology and Orthopedics of Russia. 2020;26(1):21-35
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Comment to the Article “Comparative Assessment of Subtrochanteric Shortening Osteotomy and Paavilainen’s Proximal Osteotomy in Total Hip Arthroplasty for Crowe III–IV Dysplasia”

Mazurenko A.V., Shubnyakov I.I.

Abstract

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Traumatology and Orthopedics of Russia. 2020;26(1):36-39
pages 36-39 views

Risk Factors for Prosthetic Joint Infection after Primary Hip Arthroplasty

Myasoedov A.A., Toropov S.S., Berezin G.V., Karelkin V.V., Totoev Z.A., Shubnyakov I.I., Tikhilov R.M.

Abstract

Prosthetic joint infection (PJI) after primary hip arthroplasty (PHA) in most cases results in severe surgical and socio-economic problems. Along with improving the technical support of arthroplasty and antibiotic prevention schemes, a key point in reducing the rate of infectious complications is predicting of PJI in each individual patient. The purpose of the study was to reveal the key features of our patients with infectious complications after PHA in comparison with the patients with a successful outcome of arthroplasty. Materials and Methods. The outcomes of 249 cases of PHA were evaluated retrospectively. 115 of them subsequently developed PJI (main group) and 134 were without infectious complications (control group). The comparative analysis of the groups was aimed at identifying the key preoperative, intraoperative and postoperative factors for PJI, as well as combinations of the factors characteristic for our patients. Results. The risk group for the development of infectious complications included patients undergone hip surgery (p<0.001), body mass index >40 kg/m2 (p = 0.170), preoperative hemoglobin <115 g/L (p = 0.063), duration of the operation >90 min (p<0.001), intraoperative blood loss >410 ml (p<0.001), CRP >69 mg/L on day 4 th to 5 th after PHA (p<0.001), as well as a combination of 4 or more of the above factors (p<0.001). Conclusion. We believe that the correction of the management tactics of such patients taking into account the identified risk factors will reduce the incidence of PJI after PHA.
Traumatology and Orthopedics of Russia. 2020;26(1):40-47
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Surgical Treatment of 40 Patients with Pectoralis Major Ruptures: Long-Term Outcomes

Sereda A.P., Smetanin S.M.

Abstract

The aim of the study — to develop a system for evaluation of treatment outcomes important for patients with pectoralis major ruptures. The system should include the outcome criteria that meet the patients’ expectations, and should allow the long-term outcomes evaluation. Material and Methods. The paper presents the long-term results of surgical treatment of 40 consecutive patients with pectoralis major ruptures. The results were evaluated in 65.3±17.5 months after surgery. Since pectoralis major rupture occurs mainly in people going in for sports at a quite high level (37 out of 40 people in our study), a new questionnaire was created for the results evaluation. In our opinion, the new set of questions takes into account the specific expectations for such category of patients and covers the important for them areas of treatment results. The already existing scales and questionnaires have been focused on assessing joint functions in patients with upper limb pathology in daily living conditions. Among the main areas of important results we identified the following items: restoration of sports activities, recovery of strength, absence of pain and discomfort, aesthetic results. Results. All the patients reported a complete absence of strength deficiency during everyday living activities. In 33 cases out of 37 the patients continued to go in for sports: at the same level — 18, with reduced load — 6, with improved results — 9. A subjective strength assessment in the patients continued exercising was in total 8.21±0.96. The outcomes in the group “improved results” (8.8±0.78) were better than in the group “at the same level” (8.1±0.96, p = 0.046) and in the group “reduced load” (7, 5±0.54, p = 0.0023). There were no differences between “improved results” and “reduced load” groups (p = 0.157). The reasons for the dynamics of sports results, which could be caused not only by the consequences of injury, were analyzed separately. The complete symmetry of the pectoralis muscles was achieved in 10 patients (25%), including 3 bodybuilders. In other cases, there remained a some degree asymmetry. The patients could notice it or ignore. We do not exclude the latent dissatisfaction of the patients with asymmetry, even when they report that it does not matter to them. Conclusion. The surgical treatment of pectoralis major tendon rupture allows the compete restoration of daily living activities. Although to that matter, these activities are practically preserved after the conservative treatment as well. The significance of the surgical treatment is in its ability to bring some additional benefits satisfying the patient’s other priorities: return to sport, maximum recovery of strength, aesthetic results. Our questionnaire don’t have a final point gradation, but allows to reflect the patient’s expectations, results and fears.
Traumatology and Orthopedics of Russia. 2020;26(1):48-61
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Mid-Term Results of Simultaneous Reconstruction of Anterior Cruciate and Anterolateral Ligaments in Athletes

Goncharov E.N., Koval O.A., Dubrov V.E., Bezuglov E.N., Alekhin A.A., Goncharov N.G.

Abstract

Relevance. Today, there exist a large number of methods for arthroscopic reconstruction of the anterior cruciate ligament, however, the return to the competitive level among athletes remains quite low. It is believed that the functional state depends on the restoration of the rotational and anteroposterior stability of the knee. Such data facilitate the search of techniques for additional stabilization of the knee, one of which is the reconstruction of the anterolateral ligament of the knee. The goal of the study was to assess the medium-term results of combined one-stage arthroscopic reconstruction of the anterior cruciate and anterolateral ligaments of the knee in athletes and the probability of their return to the competitive level. Material and Methods. In the period from 2014 to 2015, 50 patients underwent surgery. They were divided into 2 groups. Group 1 (main) consisted of 20 patients, including 10 professional athletes, who underwent the arthroscopic reconstruction of the anterior cruciate ligament, supplemented by reconstruction of the anterolateral ligament. Group 2 (control) included 30 patients (of which 10 were the professional athletes) who underwent the arthroscopic reconstruction only of the anterior cruciate ligament. Results. Group 1. 2 years after surgical treatment, 100% of patients were able to return to the preoperative competitive levels of activity. The average Tegner Lysholm score before the operation was 72.60±6.45 points, after the operation — 97.40±1.18 points. The average value on the IKDC scale before surgery was 63.1±4.8%, after surgery — 96.3±1.8%. Group 2. Of 30 patients, 2 years after surgery, 20 patients returned to the preoperative and competitive levels (66.7%). Of the professional athletes, 5 out of 10 patients (50%) returned to the competitive level, among amateur athletes — 15 out of 20 patients (75%). The average Tegner Lysholm score before surgery was 69.6±3.5 points, after — 92.1±3.9 points. The average value on the IKDC scale before surgery was 73.4±3.2%, after — 90.3±3.7%. Conclusion. Medium-term results of the study showed that the onestage restoration of the anterior cruciate and anterolateral ligaments, compared with arthroscopic reconstruction of only the anterior cruciate ligament, increased the probability that the patients with high functional requirements and professional athletes would return to sports.
Traumatology and Orthopedics of Russia. 2020;26(1):62-71
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Comment to the Article “Mid-Term Results of Simultaneous Reconstruction of Anterior Cruciate and Anterolateral Ligaments in Athletes”

Bantser S.A.

Abstract

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Traumatology and Orthopedics of Russia. 2020;26(1):72-75
pages 72-75 views

Minimally Invasive Plate Osteosynthesis for Distal Radius Fractures: Are There Any Advantages Against Conventional Technique?

Maximov B.I.

Abstract

Purpose of the study — to illustrate the potential and to evaluate the late term results of minimally invasive plate fixation for distal radius fractures (DRF) and compare it to the treatment outcomes for patients with similar injuries where internal fixation was performed through conventional volar surgical approach. Material and Methods. 96 patients with DRF fractures were included into the study who underwent volar plate fixation by with angular stability. The main group included 42 patients (29 women and 13 men) with DMR where minimally invasive volar approach was used. Mean age of patients was 38 years (from 21 to 57 years). Control group consisted of 54 patients (33 women and 21 men) with mean age of 43 years (from 26 to 64 years) who underwent fracture stabilization via conventional volar approach. Minimal follow up after surgery and discharge was 3 months. In the late period roentgenological, functional and cosmetic outcomes were evaluated as well as patients’ satisfaction by QuickDASH-9 survey. Results. 95 patients (98.9%) demonstrated fracture consolidation in terms up to 6 weeks irrespective of surgical technique which was confirmed by X-rays during control examination. In one female patient (1.1%) consolidation following minimally invasive plating was not achieved even in one year after surgery which was considered as distal radius pseudarthrosis but featuring excellent functional outcome. Surgery time for minimally invasive fixation was 47 (41;53) minutes and for conventional surgical approach – 43 (37;46) minutes (р = 0.731). Mean time of image intensifier use during internal fixation averaged 54 (47;63) seconds during minimally invasive technique and 33 (29;37) seconds for conventional open technique (р = 0.046). Statistically significant larger flexion and extension ranges, pronation and supination angles as well as higher grip force were observed in the group of minimally invasive internal fixation in 1, 2 and 3 months after the surgery (р<0.001). Statistically lower scores for QuickDASH-9 survey were reported for the main group in 2 and 3 months postoperatively (р<0.001). Cosmetic results were better in patients after minimally invasive approach. Conclusion. Minimally invasive plating fixation of DRF is the efficient and relatively safe surgical option for such injuries. The key arguments for such approach: preservation of bone vascularization which minimally slows down fracture healing, reduced risk of infectious complications, fast functional wrist recovery already in early postoperative period as well as satisfaction of patients with cosmetic effects.
Traumatology and Orthopedics of Russia. 2020;26(1):76-84
pages 76-84 views

Pain in Anterior Knee after Locked Nailing of Diaphyseal Tibia Fractures

Pisarev V.V.

Abstract

The relevance of the study is determined by the high incidence of pain in the anterior knee after the locked nailing of the diaphyseal tibia fracture. The etiology and pathogenesis of this complication remain unclear. Most authors believe that the cause of this complication is a combination of several factors. Material and Methods. The study included 70 patients with consolidated diaphyseal tibia fractures undergone closed blocked nailing through the patellofemoral ligament. The results of the surgery were studied in the time frame of 2 to 4 years (average 36.96±12.05 months). Patients were divided into groups according to the presence or absence of pain in the anterior knee, the type of tibial fractures, the location of the nail in the proximal tibia metaphysis. The evaluation of the outcomes was carried out with the SF-36 questionnaire and the knee X-ray. The significance of differences in the samples was determined by the Pearson’s and Student’s criteria, and Fisher’s exact criterion. Results. The incidence of pain in the anterior knee was 46%. This complication led to a decrease in the patients’ quality of life to a greater extent and in most parameters than in the patient without pain, namely, physical components of health by 10% (p = 0.024), physical activity by 8.8% (p = 0.024), role-based functioning due to physical condition by 14.1% (p = 0.001). The intergroup analysis revealed that the extension of the end of the nail beyond the proximal tibial metaphysis was one of the factors that determeded the development the pain (p<0.05). There were differences in the frequency of pain in groups with different depths of immersion of the nail into the proximal metaphysis (p<0.05). The closer to the tibial plateau the proximal end of the nail was located, the more often the pain occurred in the postoperative period. In the patients with type C diaphyseal fractures, pain in the knee was much more common than in patients with type A and B fractures (p<0.05). Conclusion. The quality of life of the patients with pain in the anterior knee after locked nailing was characterized by a decrease in physical activity and role functioning in society. The main cause of the pain was the projection of the nail beyond the bone borders of the tibial metaphysis or the location of its proximal end in the subchondral area. The type of diaphyseal tibia fracture according to the AO / ASIF classification was a factor that determined the incidence of pain in the anterior knee.
Traumatology and Orthopedics of Russia. 2020;26(1):85-93
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Comment to the Article “Pain in Anterior Knee after Locked Nailing of Diaphyseal Tibia Fractures”

Chugaev D.V.

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Traumatology and Orthopedics of Russia. 2020;26(1):94-97
pages 94-97 views

The Nearest Clinical and Structural Results of Arthroscopic Reconstruction of the Upper Capsule in Patients with Cuff Tear Arthropathy after a Massive Rotator Cuff Tear

Dokolin S.Y., Kuz’mina V.I., Marchenko I.V.

Abstract

The purpose of the study was to evaluate the nearest clinical, functional and structural (according to MRI) results of arthroscopic reconstruction of the shoulder upper capsule using an acellular dermal collagen matrix and auto-tissue of the ileotibial band in the patients with shoulder arthropathy after a massive rotator cuff tear. Material and Methods. The study included 30 patients with stage I–IV shoulder arthropathy according to K. Hamada classification. All of them were undergone the arthroscopic reconstruction of the upper part of the shoulder capsule in 2017–2018. The orthopedic procedures were performed by the same surgical team using an acellular dermal collagen matrix as a biological material (group 1) and auto-tissue of the iliotibial band (group 2). Results. The proportion of the patients with good — 8 (26.7%), satisfactory — 14 (46.6%) and poor — 8 (26.7%) surgical outcomes was determined according to the ASES functional assessment scales. Transplant ruptures were recorded in one (3.3%) patient in the group with an acellular dermal collagen matrix and in two (6.6%) patients in the group with the iliotibial autograft. Conclusion. Arthroscopic reconstruction of the upper part of the shoulder capsule is a promising method for the surgical treatment of physically active working age patients with shoulder arthropathy after massive rotator cuff tear. The main goals are restoration of the shoulder vertical stability, centered position of the humeral head towards the glenoid, and improvement of the shoulder biomechanics as a whole.
Traumatology and Orthopedics of Russia. 2020;26(1):98-112
pages 98-112 views

Comment to the Article “The Nearest Clinical and Structural Results of Arthroscopic Reconstruction of the Upper Capsule in Patients with Cuff Tear Arthropathy after a Massive Rotator Cuff Tear”

Gladkov R.V.

Abstract

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Traumatology and Orthopedics of Russia. 2020;26(1):113-115
pages 113-115 views

American Shoulder and Elbow Surgeons Standardized Assessment Form: Russian Cross-Cultural Adaptation and Validation

Ilʼin D.O., Makarieva O.V., Makariev M.N., Logvinov A.N., Magnitskaya N.E., Ryazantsev M.S., Burtsev M.E., Zaripov A.R., Frolov A.V., Korolev A.V.

Abstract

American Shoulder and Elbow Surgeons Standardized Assessment Form (ASES) is one of the most widely used shoulder outcome reporting measure. However, it has not been validated in the Russian language. Purpose of this study is a cross-cultural adaptation and validation of the ASES. Materials and methods. The group of 93 patients with various shoulder pathology (39 males and 54 females) with median age of 49 years was included into the study. In the first stage the authors performed language and cultural adaptation of the ASES questionnaire to obtain a Russian version maximally matching the original. Further the authors studied the psychometric properties of the questionnaire (reliability, validity, responsiveness), the effects of maximum and minimum values (floor and ceiling effects) and estimated the coefficients of internal consistency of Cronbach’s alpha and reproducibility. 20 patients were selected to assess reproducibility by test-retest method, those patients filled out the ASES questionnaire at first appointment with an orthopedic trauma surgeon and repeatedly in 7 days; the obtained data was evaluated by an intra-class correlation coefficient (ICC). In the framework of the present research the authors assessed the validity of the obtained scale, including the correlation of the scores of the examined questionnaire with the scores by the DASH questionnaire validated in the Russian Federation to check criteria validity. Results. The study resulted in obtaining the assessment scale fully matching the original ASES version with minor linguistic and cultural features. The ASES median results was Me = 68.7 [32.6; 93.8]; no maximum and minimum scores were obtained. The Russian version of the questionnaire has good psychometric properties with internal consistency of Cronbach alpha 0.72. The overall intra-class correlation coefficient (ICC) of the ASES questionnaire was 0.95 (p<0.05). There were no statistically significant differences between the general group and the test-retest group by gender, age and type of shoulder pathology. Correlation coefficient obtained in the scope of the present research between the ASES and DASH scales was 0.9, and the GRI index was 2.8. Conclusion. Russian version of the ASES questionnaire has good psychometric properties and may be recommended to evaluate functional status of patients with shoulder joint pathology and treatment dynamics.
Traumatology and Orthopedics of Russia. 2020;26(1):116-126
pages 116-126 views

Electric Muscle Stimulation for Prevention of Venous Thromboembolism in Patients with Multiple Lower Extremity Trauma

Nikolaev K.N., Ivchenko D.R., Akimov A.V., Golubov E.A., Dvortsevoy S.N., Chevychelov S.V., Alborov Y.R., Kukushkina E.A., Smol’yaninov V.N.

Abstract

Relevance. Patients with multiple lower extremity trauma are the group of a very high risk for the development of venous thromboembolism. Therefore, they need a set of measures to prevent this complication. The risk of developing hemorrhagic complications in the I–III periods of traumatic disease prevents many physicians from prescribing anticoagulants. In addition, the application of the external fixation apparatus makes the use of mechanical blood flow acceleration (elastic bandages, compression knitwear, intermittent pneumatic compression) impossible. The purpose of the study is to evaluate the effectiveness and safety of electric muscle stimulation (EMS) for venous thromboembolism prevention in the patients with multiple trauma and the use of external fixation for the lower limb fractures. Material and Methods. The analysis of treatment results of 31 patients with multiple lower limb trauma with the use of external fixation was carried. All the patients were men with average age of 29.3±5.1 years. The patients were divided into two groups by stratified randomization. The groups were comparable by sex, age, body weight, and injury severity. The patients of main group received EMS, in control group — the authors did not use the mentioned treatment. The EMS was carried out using a Veinoplus DVT according to the scheme: 60 min morning, afternoon and evening. Vascular ultrasonography of the lower extremities was performed for all patients before EMS and then every 7 days, as well as before each surgery. All patients underwent venous thromboembolism prevention with low molecular weight heparins, followed by switching to oral anticoagulants. Results. Side effects associated with the use of the EMS, as well as hemorrhagic complications were not detected. The velocity of blood flow in the popliteal vein in the patients, received EMS, was 9.7 ± 0.7 cm/s before the session and 17.0±1.1 cm/s during the session (p<0.001). According to the vascular ultrasound, no venous thromboembolism was detected in the patients underwent the EMS. Deep vein thrombosis was diagnosed in the control group in 2 (13.3%) patients, and pulmonary embolism in 1 (6.7%). Conclusion. The use of EMS showed the absence of side effects and the development of hemorrhagic complications. The effectiveness of the EMS in the patients with external fixation was achieved due to a statistically significant (p <0.001) increase in the volumetric blood flow through the deep lower limb veins. The further study of the EMS in patients with multiple trauma, the development of optimal schemes for its use, depending on the severity of the injuries, will minimize the likelihood of developing venous thromboembolism in this category of patients.
Traumatology and Orthopedics of Russia. 2020;26(1):127-137
pages 127-137 views

THEORETICAL AND EXPERIMENTAL STUDIES

Effect of Preparations Based on Lanthanide Ions and Calcium on the Bone Density in Rats with a Femur Fracture

Akhtyamov I.F., Shakirova F.V., Korobeynikova D.A., Zhi H.H., Sadykov R.I.

Abstract

Purpose of the study — to evaluate bone density at the femur fracture site with local introduction of preparations based on etidronate lanthanide ions and calcium in the experiment. Materials and Methods. The experiment included 45 male rats divided into three comparable groups equal in quantity. The experiment in control group was performed without stimulation of bone formation, preparation based on etidronate lanthanide ions and calcium were introduced to the animals of the first group and preparation containing etidronate and calcium (without lanthanide ions) were used in the second group. Preparation was introduced twice at the site of femoral fracture in the study groups of animals. The authors performed daily clinical monitoring and measured the density of the cortical bone at the fracture site using computer tomography. Results. Earlier support on the operated limb was observed after introduction of etidronate lanthanide ions and calcium. In the respective study group after introduction of the preparation the authors reported statistically significant 20% higher cortex density at earlier terms in contrast to the control group, and 24% higher density as compared to group with introduction of etidronates and calcium (without lanthanide ions). By day 30 cortical plate density in the group with introduction of preparation based on lanthanide ions was statistically significantly higher at 37% as compared to two other groups. Conclusion. The authors observed a positive effect of studied preparations on bone regenerate formation in rats. Data of the present research allows to conclude that periosteal introduction of preparations based on etidronate lanthanide ions and calcium at the osteotomy site provides formation of a cortical plate with improved density properties, and normalization of density indicators in the present group occurred in earlier terms that in the group with preparation based on etidronates and calcium (without lanthanide ions).
Traumatology and Orthopedics of Russia. 2020;26(1):138-146
pages 138-146 views

RESEARCH METHODS

Detection of Fungi in the Palmar Aponeurosis in Patients with Dupuytren’s Contracture by Scanning Electron Microscopy

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

Abstract

The purpose of the study was to determine the capabilities of scanning electron and light microscopy in detecting fungi in surgical material from the patients with Dupuytren’s contracture. Material and Methods. The fragments of palmar aponeurosis from 27 patients with Dupuytren’s contracture were examined. Paraffin sections stained with hematoxylin-eosin and Periodic Schiff-Methenamine Silver were digitized using AxioScope.A1 microscope (Carl Zeiss Micro Imaging GmbH, Germany). For examination in JSM-840 scanning electron microscope (Jeol, Japan), the samples were dehydrated after fixation, soaked in camphene, dried, and silver sprayed in the IB-6 ionizer (Eiko, Japan). Results. In paraffin sections stained with methenamine-silver, the signs of mycotic microbiota were detected only in 2 (7.4%) of 27 patients, and with the use scanning electron microscopy — in 16 patients (59%). The morphological phenotypes and ultrastructure of intercellular contacts of yeast-like fungi were similar to Candida albicans. In all cases, the budding cells were detected. The destruction of the connective tissue of the palmar aponeurosis was observed in the form of loosening, stratification, and cavities formation (the zones of lysis). Conclusion. The scanning electron microscopy allowed to evaluate the ultrastructure of fungal cells and their interaction with surrounding tissues in the surgical material from the patients with Dupuytren’s contracture. A higher percentage of detection of fungal invasion compared to the Periodic Schiff-Methenamine staining was associated with a higher resolution and the ability of a larger area of tissue samples analysis.
Traumatology and Orthopedics of Russia. 2020;26(1):147-152
pages 147-152 views

CASE REPORTS

Treatment of the Low Extremity Severe Mechanical Injury with Uncompensated Ischemia (Case Report)

Khominets V.V., Shchukin A.V., Mikhailov S.V., Shakun D.A., Endovitskaya M.V., Zakharov M.V.

Abstract

Relevance. Discussion of the criteria for decision making “amputation vs. preservation”, when viability of the extremity is uncertain, has been continuing. The case description. The lower extremity of a serviceman was injured by a caterpillar tractor. The severity of the damage was determined by the following conditions: open segmental fracture of the femoral diaphysis, 5 cm traction-compression damage of the popliteal artery, acute thrombosis of the popliteal and tibial arteries, sciatic nerve damage, circular detachment of the thigh skin, acute hemorrhage, II degree shock, and uncompensated lower extremity ischemia throughout 24 hours. The MESS score of the injured extremity was 8 indicating that an amputation would have been considered. Nevertheless, we choose the organ preservation solution with the revascularization of the injured limb segment. A multi-stage treatment was carried out including stabilization of bone fragments, primary reconstruction of the popliteal artery to restore the arterial blood flow in the injured extremity, reperfusion injury and myoglobinuria elimination, intensive kidney protection therapy, infection management, skin defects replacement, orthopedic surgery. As a result of the treatment, the injured limb was saved. The femur fracture healed allowing the patient to walk without assistance. Conclusion. The use of the programmed surgical treatment for severe mechanical injury of the lower extremity, an individual multi disciplinary approach, assessing the severity of systemic disorders, and timely use of extracorporeal detoxification made it possible to avoid amputation, perform organ preservation surgery, and create favorable conditions for restoring the supporting function of the lower extremity.
Traumatology and Orthopedics of Russia. 2020;26(1):153-163
pages 153-163 views

Bone Cyst of Proximal Humerus after Local Betamethasone Injection (Case Report)

Kogan P.G., Kurbanov I.S., Lasunsky S.A., Chugaev D.V., Sorokin E.P., Gudz A.I., Lis'kov M.A., Krushnikov V.V.

Abstract

A potent anti-inflammatory effect and wide application of corticosteroids were the origin of their extensive use for treatment of diseases and injuries of the shoulder joint. The authors describe a clinical case of tumor-like cyst in the proximal humerus after intra-articular injection of glucocorticosteroid (GCS) in a 43 year old woman. Current medical literature reports various complications following GCS injections but the authors found no other cases of tumor-like cyst in proximal humerus associated with intra-articular GCS injection. This can be an underestimated phenomenon or a unique case. In any case, all physicians performing treatment and diagnostics medication blockades of the large joints should be aware of this occurrence. The authors assume that such complication can be prevented by clear understanding of shoulder joint anatomy and current visualization techniques such as ultrasound navigation.
Traumatology and Orthopedics of Russia. 2020;26(1):164-172
pages 164-172 views

Peculiarities of Spondylitis in the Patients Undergoing Program Hemodialysis (Case Report)

Mushkin M.A., Dulaev A.K., Tsed A.N.

Abstract

Relevance. The surgical treatment of spinal diseases and injuries in the patients on hemodialysis is one of the most complicated problems of the spine surgery, since such a surgery is associated with an increased risk of infectious complications and perioperative mortality. The case description. A 59-year-old female came to the clinic complaining back pain. Th8-9 vertebrae spondylitis complicated by an epidural and paravertebral abscess with pertinent neurological disorders and bilateral pneumonia were diagnosed. The patient had been on hemodialysis for 18 years due to the end-stage chronic kidney disease complicated by uremic osteodystrophy. The surgical debridement and stabilization of the spine were performed in one stage posterior approach using a titanium mesh implant in combination with autologous bone and posterior instrumentation. A regression of neurological disorders and the pain syndrome relief were achieved. In the late postoperative period, the instability of the posterior fixation developed twice, requiring restabilization. Within the following 3.5 years after the operation, the pain syndrome had not returned. Conclusion. The presence of equipment for hemodialysis and a multidisciplinary approach allow to achieve the positive results in the surgical treatment of inflammatory diseases of the spine in the patients with endstage chronic kidney disease.
Traumatology and Orthopedics of Russia. 2020;26(1):173-180
pages 173-180 views

REVIEW

Bone Xenografts in Trauma and Orthopaedics (Analytical Review)

Stogov M.V., Smolentsev D.V., Kireeva E.A.

Abstract

Purpose of the analytical review — to evaluate the application experience of bone xenografts in trauma and orthopaedics surgery. Methods. Data search was performed in the electronic databases of PubMed and eLIBRARY with depth of 20 years. Results. The authors identified 13 papers which described the application experience of bone xenografts in trauma surgery and orthopaedics. The highest efficiency (from 92 to 100%) was reported for cases of xenografts use to replace defects in intraarticular fractures and revision arthroplasty. Unsatisfactory outcomes were related to cases with no integration and graft rejection. The least efficiency (from 41,9 to 46,1%) was reported in reconstructive foot surgery. No effect of bone xenografts was observed for replacement of defects in cases of pseudoarthrosis. The most frequent complication was graft material infection. The summarized literature data provided the calculated share of complications following xenograft use of 7,53% (18 out of 239 cases, CI 5-95%, 4,53-11,21). Two areas were identified for improvement of technical and biological properties of bone xenografts: 1. Modification of original xeno-matrix (enhancement of purification technique, alteration of structure of chemical composition of the bone matrix); 2. Augmentation of matrix volume by additional elements (biologically active agents, stem cells). It’s noted that demand for xenografts in traumatology and orthopaedics can increase after refining and expanding the indications for clinical use. Conclusion. Bone xenografts used in the modern trauma surgery and orthopaedics to replace bone defects in revision arthroplasty as well as in certain fracture types. Such material is relatively safe and its ability to be modified allows to improve its biological properties.
Traumatology and Orthopedics of Russia. 2020;26(1):181-189
pages 181-189 views

Physical Methods of Rehabilitation for Patients with Osteoarthritis: A Scientometric Analysis of Evidence-Based Studies

Abuseva G.R., Кovlen D.V., Ponomarenko G.N., Khozyainova S.S., Adhamov B.M., Ivashchev V.V., Ishchuk V.N., Karpova T.N., Kondrina E.F., Konoplyankin I.V., Podberezkina L.A., Pronin V.D., Tolmachev S.V.

Abstract

Relevance. A rise in the life expectancy of the planet’s population, lack of exercise and growth in the number of people suffering from overweight lead to an increase in the number of patients suffering from diseases of the musculoskeletal system, including osteoarthritis. Given the absence of specific pharmacological treatment of osteoarthritis, as well as the increase in the number of patients with co-morbid pathology, it became necessary to search for the proven technologies of physical and rehabilitation medicine (PRM). The purpose of the study was to identify the most effective PRM technologies in the treatment of patients with osteoarthritis and to formulate recommendations on their use for practitioners, based on the proof obtained through the analysis of evidence-based high quality studies on the application of PRM technology. Materials and Methods. Over the past decade, there has been a significant increase in the number of studies on non-pharmacological methods of osteoarthritis treatment. The most studied of the PRM technologies with the proven effect were the following: physical exercises combined with traditional healthy gymnastics, acupuncture, peloid therapy, balneo therapy, as well as low-frequency electrotherapy, ultrasound therapy and infrared laser therapy. Conclusion. The use of PRM technologies in the treatment of patients with osteoarthritis should be based on the results of high-quality randomized controlled clinical trials which serve as the basis for the development of clinical recommendations. The process of the obtained data analysis should be conducted on the regular basis.
Traumatology and Orthopedics of Russia. 2020;26(1):190-200
pages 190-200 views

JUBILEE

Ildar F. Akhtyamov 60th Anniversary of the Birth

Editorial a.

Abstract

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Traumatology and Orthopedics of Russia. 2020;26(1):201-202
pages 201-202 views

Сердобинцев Михаил Сергеевич. К 65-летию со дня рождения

Abstract

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Traumatology and Orthopedics of Russia. 2020;26(1):203-204
pages 203-204 views

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