Vol 27, No 1 (2021)

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Background. Currently, using of osteointegrated titanium implants has become a key component for restoring lost function in various areas of clinical medicine. The actual issue remains preservation or reconstruction of bone tissue for optimal use of titanium implants in traumatology and orthopedics, as well as in maxillofacial surgery. One of the most common grafts are hydroxyapatite-based material with various inclusions, for example, an antibiotic.

The aim of the study is to characterize the regeneration of bone tissue of the jaws alveolar ridge using the hydroxyapatite-based material “Collapan-L” in clinical practice.

Material and Methods. The study of the material “Collapan-L” (Intermedapatit, Russia) using involved 30 patients with a diagnosis “chronic periodontitis of the tooth”. Patients underwent complex surgical and orthopedic treatment to restore masticatory function. At the first stage, teeth were removed with the “Collapan-L” material used to preserve the alveolus. 4 months after extraction, dental implantation was performed with simultaneous trephine biopsy from the augmentation zone for histomorphometric analysis. At the stage of implant placement and before prosthetics the stability dynamics was measured.

Results. The study involved 42 tissue samples obtained at periods from 9 to 32 weeks after removal. The morphological assessment of bone tissue from the implantation zone determined that after 4 months trabeculae from the newly formed bone, including small fragments of biomaterial, were revealed; at the same time, there were signs of biodegradation of the implanted material fragments, there was no inflammatory infiltrate. After 6 months in a significant part of cases the granules of bone material were not found, which indicates a pronounced osseointegration of the material. In its structure, the formed bone tissue differences barely noticeable from the native one, which allows us to conclude that by the time of 24 weeks, the processes of reparative osteogenesis in the alveolus are completed.

Conclusion. Histological examination and assessment of changes in the stability showed that using of bone replacement material after tooth extraction can increase the regenerative potential of bone tissue, avoid additional surgical interventions to increase the volume of bone tissue in the area of future implantation, and the formed bone tissue is close in its structure to the native one.

Background. One of the reasons for the development of the “pincer” type of femoroacetabular impingement are various reorienting pelvic osteotomies, which are widely used in the treatment of children with developmental dysplasia of the hip (DDH).

The aim of the study was to evaluate the frequency of formation of retroversion of the acetabulum after reorienting pubic-iliac, iliac-sciatic and triple pelvic osteotomies in children over 7 years old with DDH I–II degree according to Crowe.

Material and Methods. The retrospective study is based on the results of radiometry of 60 patients (69 hip joints) at an average age of 11.6±2.9 years with DDH I–II degree according to Crowe who underwent surgical treatment in 2014-2016. The patients were divided into three groups of 20 patients each. Group I underwent an iliac osteotomy. Group II underwent an ilio-sciatic osteotomy. In group III patients, the acetabulum was reoriented by triple (pubo-ilio-sciatic) pelvic osteotomy. In addition to standard radiometry of the hip joints, the following indicators were evaluated: signs of acetabular retroversion (“cross-over”, “posterior wall”, “ischial spine”), as well as the index of acetabular retroversion (ARI).

Results. The assessment of the main radiometric parameters of the spatial position and the correction value of the acetabulum was carried out at least 36 months after the surgical treatment. There were no statistically significant differences in the radiometric parameters of the spatial orientation of the acetabulum in group I and II patients (p>0.05), except for the degree of bone coverage, which was significantly higher in group II patients (p<0.05) than in group II patients, which indicated the presence of hypercorrection. In patients of group III, the values of the above-mentioned indicators varied within the physiological values. Retroversion of the acetabulum was observed in more than half of the patients in group I and in almost all patients in group II. In group III patients, acetabular retroversion was observed in only 3 patients.

Conclusion. In the vast majority of cases, a double pelvic osteotomy (pubo-iliac and ilio-sciatic) leads to the formation of hypercorrection of the acetabular fragment and its retroversion in comparison with a triple pelvic osteotomy. The pathological orientation of the acetabulum, despite the achieved stability of the hip joint, can be a morphological substrate for the development of femoro-acetabular impingement and, as a result, coxarthrosis. In the treatment of children with DDH over 7 years old the operation of choice is a triple pelvic osteotomy.

Two-stage revision arthroplasty in chronic hip periprosthetic joint infection cases is the “gold standard” treatment. First stage debridement leads to large intraoperative and drainage blood loss using standard protocols for thromboprophylaxis and drainage of the surgical wound, which is a significant disadvantage of perioperative management of such patients.

The aim of the study was to determine the effect of modified management protocol with delayed start of thromboprophylaxis and a short period of drainage on the blood loss and the effectiveness of debridement with antibiotic-impregnated spacer placement in patients with hip periprosthetic joint infection.

Materials and Methods. A single-center prospective study was conducted. 90 patients underwent endoprosthesis components removal and antibiotic-impregnated spacer placement. Patients were divided into 3 groups: start of thromboprophylaxis before surgery and 3–4 days of drainage; start of thromboprophylaxis no earlier than 12 hours after surgery and 3–4 days of drainage; start of thromboprophylaxis no earlier than 12 hours after surgery and 1 day of drainage.

Results. There was a statistically significant (p<0.05) decrease of drainage and total blood loss, and transfused blood volume in cases with the delayed start of thromboprophylaxis and a short period of drainage. The proposed protocol was safe for prevention of venous thromboembolic complications and did not affect the frequency of periprosthetic hip joint infection recurrence. The effectiveness of the first stage of treatment — 89%, the second stage — 99% in 1 year after rehabilitation according to the second international consensus on musculoskeletal infection criteria.

Conclusion. The modified protocol of perioperative management is an effective and safe as a blood-saving strategy and can be proposed for widespread use.

Background. The data available in the literature on the features of the clinical course and functional prognosis of Dupuytren`s disease in women is contradictory, there are no data on comparative pathomorphological studies of palmar fibromatosis in men and women.

The aim of the study was to identify possible differences in the clinical and pathomorphological characteristics of Dupuytren`s disease in men and women.

Materials and Methods. 228 cases of men and 39 women (6:1) who underwent fasciectomy in 2013–2019 period were analyzed. Histomorphometry of paraffin sections of the patient`s palmar fascia specimens of 24 men and 24 women was performed.

Results. Men ranged in age from 26 to 83, the median age is 3 years more in women (p<0.001), but the median age of Dupuytren`s disease debut is 2 years less in women (p<0.001). The frequency of contractures of the 3rd–4th degree was 35.9% in the group of women and 65% in the group of men (p<0.001). In the group of women the frequency of both hands involvement is 15.2% higher, I–III fingers involvement is 8.7% higher, recurrent contracture is 11.1% higher (p<0.1). Histomorphometric analysis of the patient`s palmar fascia specimens showed that women compared to men had 10.23% less adipose tissue (p<0.001), 7.87% less dense connective tissue (p<0.05), but the proportion of hyperplastic connective tissue was 20.31% higher.

Conclusion. Dupuytren`s disease is less common in women, than men. Women seek surgical treatment earlier than men. The tendency to functional limitations intensification and the risk of recurrence in women is associated with higher expression of hyperplastic changes in the fascial structures of the hand.

Background. The methods of “lengthening over the nail” (LON) and the sequential use of the external fixation and nailing in the option “lengthening and then the nail” (LATN) are characterized by ignoring non-observance of the formulated by G.A. Ilizarov is the most important condition for optimizing the osteogenesis process, namely, the preservation of medullary blood supply and osteogenic bone marrow tissue. At the same time, in clinical practice, there was no negative effect of the intramedullary nail on the formation of the regenerate. In experimental studies, the activation of periosteal bone formation during LON is noted. But the active periosteal bone formation detected in clinical practice with a sequential technique has not been confirmed by experimental studies.

The aim of the study was to compare the organotypical rebuilding of the distraction regenerate during tibial lengthening in rabbits according to Ilizarov, over the intramedullary fixator and with the sequential use of the external fixation and nailing.

Materials and Methods. The study was carried out on 54 mature rabbits of the Soviet Chinchilla breed, which were divided into 3 groups of 18 animals. In Gr-1 (control), the tibia was lengthened by 1 cm in a mini-Ilizarov apparatus at a rate of 1 mm per day for 4 sessions step. In Gr-2, the LATN technique was modeled. After the end of lengthening, an intramedullary fixator was implanted installed, the apparatus with the presence of wires only in the base supports was kept as an imitation of blocking the intramedullary fixator. In Gr-3, lengthening was performed over the intramedullary fixator; at the end of lengthening, the wires were left only in the base supports. The fixation period was is 30 days. The total duration of the experiment is 45 days. On the 10th, 15th, 20th, 30th, 45th day X-ray, CT and morphological studies were performed during the experiment.

Results. In the experimental groups, a more pronounced periosteal bone formation in the area of regenerates was noted, while in Gr-3 (LON) cortical plates were formed mainly from the periosteal component, and in Gr-2 (LATN) wide cortical plates were formed from the intermediate and periosteal areas. In this group, the maximum densitometric density values are noted. Endosteal bone formation was preserved in all groups.

Conclusion. The LON and LATN techniques, when compared with the classical Ilizarov lengthening, do not demonstrate any deficiency in the organotypical rebuilding of the bone tissue of the regenerates. All zones of bone formation are present, including endosteal, with intense periosteal bone formation. The most powerful bone structures are formed with the sequential use of the external fixation and nailing (LATN) in the form of the formation of wide cortical plates due to the intermediate and periosteal zones of the regenerate.

The aim of the study was to evaluate in vitro the effect of native and deproteinized compact and spongy allogenic bone matrices on the characteristics of adipose mesenchymal stromal cells (ASC) in combined tissue engineering.

Material and Methods. 24 samples of native and deproteinized compact and spongy bone were examined, which were exposed to mechanical treatment, modeling, followed by sterilization of the samples by ionizing radiation and bacteriological control of sterilization. Some of the samples underwent deproteinization. The characterized cultures of human ASC were used as test cultures to assess the interaction with the bone samples. The Cytation-5 fluorescent imager and Hoechst 3334 fluorochromes (BD Pharmingen™) and calcein (Calcein AM, BD Pharmingen™) were used to characterize the degree of adhesion, migration, and viability of ASC on bone matrix samples. Matrix cytotoxicity was evaluated by MTT assay on days 1 and 7 of extraction.

Results. The bone matrix samples are characterized by the absence of cytotoxicity (rank 1). ASC demonstrated good adhesion and migration on any surface of the bone matrix and preservation of cell viability during 7 days of observation. Nuclei sizes of the cells adhered to the deproteinized bone matrix of the spongy structure increased by 25–30% compared to other samples. The cells on deproteinized bone matrix had greater size (the size of the cells from nuclei 8.8 to 11.5 μm, the average size of cells nuclei from an 86.3 μm to 129,0 μm, the average perimeter of the cells nuclei from 30.7 μm to 40.7 μm) than in the native bone matrix samples.

Conclusion. The results of the study of various allogeneic bone matrices demonstrate that deep purification of the bone matrix determines the absence of cytotoxicity and the most favorable conditions for the adhesion, migration, proliferation and viability of ASC. Also makes it possible to use tissue engineering based on bone matrices of different structures. Deproteinized spongy bone matrices are best suited for this purpose.

Background. Non-unions of distal femur fractures are difficult to treat and occur in about 6% of cases. Multifactorial causes of fractures non-unions require individual treatment for each patient in accordance with the “diamond” concept. The standard protocol for patients with atrophic non-unions treatment involves bone autografts using, but there are limitations of size, shape, quality and quantity of autografts. Osteoplastic materials with osteoinductive (angiogenic) and osteoconductive activity can be used as bioresorbable implants in combination with autogenous spongy bone in the treatment of extremities long bones non-unions.

Clinical case description. A 63-year-old patient was admitted to the clinic for non-union of distal third of the femur with bone defect, fragments were fixed with a plate. The examination revealed plate fracture, screws migration (group III according to the Non-Union Scoring System). The volume of supposed bone defect was about 8.5 cm3. The surgery was performed: plate removal, debridement of the non-union zone, femur defect replacement with a bone autograft in combination with the gene-activated osteoplastic material “Histograft” in a ratio of 1:1, osteosynthesis of the femur with two plates. After 6 months. during the control computed tomography, consolidation was determined (4 points on the REBORNE scale). Pain was practically absent (NRS-2). The range of motion in the knee joint: flexion — 80o, extension — 180o. According to the Knee Society Score (KSS) — 68 points.

Conclusion. In this case report the complete fracture fusion was achieved in patient within 6 months — 4 points on the REBORNE scale. No adverse events were observed. It confirms the safety and efficacy of described method and allows to continue the clinical trials.

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Background. Currently, limb lengthening is a widespread operation used in clinical and cosmetic practice. However, in the process of implementing this technology, its main drawbacks were revealed: the duration of treatment and the slowing down of the process of osteogenesis in the elongation zone. Rapid distraction in the external fixator or with an intramedullary rod can lead to a slowdown in osteogenesis and soft tissue complications, including neuropathy and soft tissue eruption.

The aim — to develop a present its own concept of stimulating distraction osteogenesis in limb elongation, based on many years of clinical experience.

Materials and Methods. This study is based on the long-term experience of the Ilizarov Center in limb lengthening (using data from clinical and experimental studies performed in the institution: more than 200 animals and 8000 patients), as well as literature data.

Results. The introduction of the considered methods of stimulation of osteogenesis made it possible to significantly reduce the treatment time of patients and thereby reduce the number of possible complications characteristic of transosseous osteosynthesis. Systemic diseases, congenital malformation of the segment can negatively affect the quality of the new bone.

Conclusions. The use of methods of stimulation of osteogenesis allows to reduce treatment time and increase osteogenesis when limb lengthening, which allows, if necessary, to provide re-lengthening of the segment without increasing treatment time.

The aim of the study — to determine the properties of modern bioactive composite materials that have the greatest advantage for use in traumatology and orthopedics, particularly in spine surgery.

Material and Methods. We performed a comprehensive literature search using PubMed, Medline, eLIBRARY and Semantic Scholar. The keywords “implants”, “biomaterials”, “composites”, “tissue engineering”, “scaffolds”, “graphene”, “hydrogels”, “3D bioprinting” were used to identify papers examining the topic of interest. We included comparative studies published from 2010 to 2020 in our review. The following properties were evaluated in papers: biotolerance, bioactivity, osteoconductivity, osteoinductivity, osteostimulation, mechanical strength.

Results. Special attention is paid to the creation of composites. Composites are made by combining two or more materials to achieve biochemical and biomechanical properties. In composites production, a certain place is occupied by the technology of 3D bioprinting, thanks to which it is possible to develop an individual implant according to a given situation.

Conclusion. The combination of composite materials properties indicating on their bioactivity and mechanical strength, as well as the use of 3D techniques to design the geometric forms of implants, provide a high potential for use in traumatology and orthopedics, particularly in spinal surgery.

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