Vol 27, No 3 (2021)

Background. In relation with the COVID-19 new coronavirus infection epidemic that began in Russia in the spring of 2020, a completely new group of patients appeared: patients whose coronavirus infection was combined with the proximal femur fractures. In the course of practical work, hospital doctors had to gain experience in treating these complex patients, solve new organizational and medical tasks.

The aim of the study was to evaluate the results of treatment of patients with the proximal femur fractures in combination with coronavirus infection in a «COVID» hospital at the hospital stage, 30-day and 6-month terms.

Materials and methods. The retrospective study is based on the collection and generalization of data from 64 patients with the proximal femur fractures in combination with confirmed coronavirus infection who underwent inpatient treatment from 16.03.2020 to 31.05.2021. 38 (59.4%) patients had a femoral neck fracture, 26 (40.6%) had a fracture of the trochanter region. Forty (62.5%) patients underwent surgical treatment (hip replacement was performed in 23 cases, osteosynthesis was performed in 17 cases), 24 (37.5%) patients did not undergo surgery.

Results. With conservative treatment, the hospital mortality rate was 41.6%, the 30-day mortality rate was 72.7%, and the 6 — month mortality rate was 95.5%. During surgical treatment, the hospital mortality rate was 5.0% (2 patients died). Early postoperative complications were detected in 5 (12.5%) patients. Thirty-one (77.5%) patients walked or stood with a walker on their own at the time of discharge; 7 (17.5%) patients could not be activated. The thirty-day mortality rate in the group of patients who underwent surgical treatment was 8.6%, and the 6-month mortality rate was 32.1%.

Conclusions. Surgical treatment of patients with the proximal femur fractures in combination with coronavirus infection is much more difficult than the treatment of patients without infectious pathology. However, despite number of unresolved problems, surgical treatment of such patients is possible with good results and should be actively applied.

Background. The malleoli fractures in combination with the fractures of posterior edge of the tibia are considered unstable injuries and present particular difficulties in surgical treatment.

The aim of the study was to evaluate short-term and mid-term results of osteosynthesis on account of unstable fractures of malleoli and posterior edge of the tibia using posterolateral surgical approach.

Materials and methods. The analysis of short-term and mid-term results of the treatment of 29 patients with malleoli fractures types 44-B3 and 44-C1.3, C2.3 and C3.3 (according to the AO classification) with the involvement of the Volkman`s posterior tibia fragment was performed in traumatology departments of three hospitals during the period from January 2019 to September 2020. In all 29 cases the fracture of the posterior edge of the tibia was classified as type 1 according to the classification of N. Haraguchi et al. All patients underwent osteosynthesis of the posterior edge of the tibia and the lateral malleolus via posterolateral surgical approach. Combined fracture of the medial malleolus was fixed via classical medial approach. 5 patients (17.2%) with continued instability of the distal tibiofibular syndesmosis underwent fixation with positional screw. Functional results, as well as the range of motions in the ankle joint were evaluated with the use of AOFAS and Neer scales 3, 6 and 12 months after surgery.

Results. Statistically significant improvement in functional outcomes over time was noted when evaluated on the AOFAS scale (p<0.05) and on the Neer scale (p<0.01). 12 months after the surgery these points were 83.2±13.4 and 87.8±16.8 respectively. Complications were noted in 5 patients (17.24%). Deep periimplant infection was registered just in one case, another patient had marginal necrosis of the operative wound. Three patients had clinically significant post-traumatic deforming arthritis of the ankle joint.

Conclusions. Posterolateral surgical approach has advantages when performing osteosynthesis in patients of the studied profile and enables anatomical reduction and stable fixation of fragments of the Volkman`s posterior edge of the tibia, which provides the possibility of early mobilization of the ankle joint and has positive effect on the results of treatment.

Background. Data from the national registers of arthroplasty showed that about 12% of hip and knee arthroplasty undergo revision within 10 years after the primary surgery. The leading cause of hip revisions is aseptic loosening of components, knee joint — periprosthetic infection (PPI). Some of the infectious complications, including those related to mechanical causes, remain out of sight.

The aim of the study was to identify the frequency of «unexpected» infections during revision knee and hip arthroplasty performed for aseptic complications of any etiology.

Materials and Methods. 839 cases of revision arthroplasty of knee and hip joints were analyzed, including 485 aseptic revisions in 450 patients. Clinical, X-ray, laboratory (complete blood count and comprehensive metabolic panel, coagulation panel) methods, synovial fluid analysis and microbiological examination of punctures, including intraoperative ones, were used. The ICM and EBJIS (European Bone and Joint Infections Society) consensus recommendations were used as criteria for assessing the presence of infection.

Results. The average age of patients at the time of the revision was 61.7 years. The hip joint prevailed (59.4%), knee joint — 40.6%. The growth of microorganisms in the intraoperative biomaterial was detected in 2.08% of observations: in 10 out of 287 patients after aseptic revision of the hip joints and in none of the 198 revisions of the knee joints. In 8 out of 10 cases, the causative agents were coagulase-negative staphylococci, including 6 — MRSE; in two cases, anaerobic bacteria. All revisions were carried out by a one-stage method. Patients with detected PPI underwent systemic antibacterial therapy. At the stage of catamnesis, reinfection was assumed in one of the 10 identified cases of PPI, the patient did not show up for revision. In control 63% of the group of the other (aseptic) 470 patients, PPI developed in 4 cases, two-stage revisions were carried out.

Conclusions. The frequency of infections accidentally detected during aseptic revisions of large joints was 2.08%. Three-time examination of joint punctures, including intraoperative, provides additional opportunities for the diagnosis of PPI during aseptic revision, and also allows you to choose the optimal stage of revision treatment. The experience gained makes it possible in certain cases to perform one-stage revision in the treatment of PPI.

Background. Since there is no national arthroplasty registry in the Russian Federation, the exact number of arthroplasty operations performed is unknown. Aim of the study — to evaluate the epidemiology of primary, revision hip and knee arthroplasty and periprosthetic joint infection in Russian Federation. Materials and Methods. The inquires were made to 85 subjects, 73 federal state budget institutions and 30 private hospitals. Results. Answers were received from 76 subjects of Russian Federation, 41 federal and 18 private hospitals. The studied indicators revealed to be pretty much heterogenic. The decrease of operations number from 20% to 40% in subjects of Russian Federation due to SARS-CoV-2 pandemic forced us to make no analysis for these 2020 indicators in Russian Federation generally. 147 061 primary hip and knee arthroplasties were performed in 2019 in Russian Federaion. 7 770 revison hip and knee arthroplasties were done. 6 606 cases of severe orthopaedic implant-assosiated infection were cured including 4 282 cases post hip and knee arthroplasties that constitutes 2,91 % from primary arthroplasties. Conclusions. The frequency of periprosthetic joint infection in Russian Federation correlates to the world data. High complexity for patients routing with implant-assosiated infection and strong demand for Federal Center of implant-assosiated orthopaedic infection are revealed.

Background. Restoration of the pelvic bones and acetabulum anatomy after fracture is an important criterion for functional outcome. Often, the reduction of flat pelvic bones is not an easy task. The authors proposed a method of reduction using a special support site of two or three 3.5 mm cortical screws for Matta bone forceps.

The aim of the study was to demonstrate a new way of pelvic bones fragments reduction.

Method. Three clinical situations are presented when a new method was used: 1) reduction of a pointed fragment of the acetabulum posterior column transverse fracture; 2) reduction of the acetabulum quadrilateral plate fragments with medial displacement and 3) reduction the rupture of the pelvic bones in the sacroiliac joint with the vertical displacement. Previously, a support site was created in one of the fragments from two or three not fully twisted 3.5 mm cortical screws. One of the Matta bone forceps branches was placed on the formed site, and the second on another fragment and the displacement was eliminated. Then the final osteosynthesis was performed with pelvic plates and/or cannulated screws according to the surgical plan. Before closing the wound the support site was removed.

Conclusions. The proposed method has shown its effectiveness during the reduction of the flat bones fragments, as it allows you to compress the spongy bones of the pelvis with a thin cortical layer stronger, compared with existing methods during which fragments splitting and «pulling out» anchor screws in the branches of reduction forceps can occur. The developed method of reduction demonstrated convenience and reliability.

Background. Replacement of extensive bone defects during revision knee arthroplasty (RKA) is a certain problem. The development of additive technologies allows us to produce an individual titanium augment to restore the lost bone tissue. The aim of the study is to show the possibility of replacing extensive tibia defects with an custom made augment during revision knee artroplasty. Case presentation. The patient is 66 years old. At the age of 58, due to secondary knee osteoarthritis in 2 years interval, the patient underwent total knee arthroplasty: left — in 2012, right — in 2014. Subsequently, several revision interventions were required for early periprosthetic infection of the right knee joint. From 2015 to 2018, due to the infection remission, the function of the right knee joint was satisfactory. In 2018, the patient admitted to our clinic with the periprosthetic infection relapse. Due to the previous treatment, the patient had type 3 bone defect according to the AORI classification. A two-stage revision knee arthroplasty was performed. To compensate the extensive tibial defect, the individual tibial implant was manufactured using additive technologies, and a semiconstrained endoprosthesis was implanted. There was no relapse of infection during the observation. There is deficit of active extension, there are no radiological signs of the implant instability. Conclusion. In our case, we were able to achieve satisfactory results in patient with a complex anamnesis and extensive bone defects. The use of individual implant helped to avoid arthrodesis, preserve the weight-bearing of the lower limb and articulation in the knee joint. The use of implants made using 3D technologies is a promising solution for compensating defects of types 2B and 3 according to the AORI classification.

Background. For several centuries, eponyms have been a convenient means of communication between clinicians. For some eponyms among modern surgeons, controversy over author’s priority continues. There is still no consensus on the so-called “mallet fracture”. In domestic and foreign literature, there are several author’s names for this fracture — I.F. Bush fracture, W. Busch fracture, P. Segond fracture. The aim of the study is to collect the most reliable information about the history of the eponym of avulsion of the distal phalanx of the fingers at the site of attachment of the extensor tendon, the so-called “mallet fracture”, to determine and prove the priority of the true author of the eponym. Materials and Methods. A search for information was carried out in domestic and foreign publications, manuals on traumatology and orthopedics, periodicals, Internet resources (eLIBRARY, PubMed, Scholar Google). Results. The list of likely authors of “mallet fracture” includes three surgeons: Ivan F. Busch (1771–1843, Russia), Paul Ferdinand Segond (1851–1912, France), Karl David Wilhelm Busch (1826–1881, Germany). When analyzing primary sources, it was found that for the first time “mallet fracture” was described by the French surgeon Paul Ferdinand Segond in 1880. This fact was also recognized by the German surgeon W. Busch, who a year later published an article on this damage. In the well-known “Guide to the Teaching of Surgery” by Ivan F. Bush, published in the early 19th century, information about a fracture of the distal phalanx of the finger at the site of attachment of the extensor tendon was not found. Conclusion. Taking into account the publications known to date, “mallet fracture” should be called the Segond fracture.

Background. The relevance of the talar dome osteochondral lesions problem is assosiated with the difficulties of diagnosis, the lack of unified treatment algorythm and the great number of unsatisfactory clinical and functional results. In the last decade, there has been increasing interest in this topic in the literature, which is demonstrated by a great number of publications with series of observations or clinical cases. However, attempts to create the universal algorithm for this group of patients treatment are limited by the low level of existing studies evidence, high frequency of the new data publications, as well as the impossibility of using a number of surgical methods in different countries for legislative or other reasons.

The aim is to determine the current state of the problem of the talar dome osteochondral lesions surgical treatment and to identify types of surgical interventions in patients with the studied pathology. Material and methods. 120 international articles published from 2000 to 2021, as well as 18 domestic publications for the period from 2007 to 2021 were selected for the literature analysis. The search for publications was carried out in the PubMed/MedLine and eLibrary databases.

Results. The most widespread are surgical interventions aimed at stimulation of the bone marrow, and plastic surgery using osteochondral auto - and allografts. Currently, there is no consensus on the indications for different types of surgical methods, and the previously used indications are being questioned. This determines the need to improve diagnostic and treatment concepts.

Conclusions. The studied literature cannot fully answer a number of questions related to the methods of surgical treatment of patients with symptomatic osteochondral lesions of the talar dome and indications for them. A more detailed assessment of the medium- and long-term clinical outcomes of various surgical methods and the development of algorithms for this group of patients treatment, specific for different countries, are needed.

Background. The problem of management of bone tissue defects remains one of the tasks that a surgeon faces during primary total knee arthroplasty (TKA). Since the number of TKA is increasing every year, modern scientific research aimed at solving the problem of bone defect replacement remains important. The aim of the study was to evaluate the effectiveness of various methods of bone defects management in primary TKA based on the analysis of literature. Materials and Methods. We conducted a search of articles in PubMed, eLIBRARY, Scopus from 2005 to 2020. Results. On the whole our search led to 1217 papers. Finally 19 articles that met inclusion criteria were included in this review. Each of the methods of bone defect replacement has its advantages and disadvantages. The results of the studies show that the he defect size is not a key factor for choosing the method, since with relatively identical defect parameters, different plastic options were used with a satisfactory clinical outcome. The endoprosthesis component should be fixed in at least two zones in every chosen method. In young patients with good bone quality preference in chosen methods should be given to bone grafts, which allow to preserve the bone stock. Based on the papers analysis, we have proposed the algorithm for method choosing for each clinical case. Conclusion. Each surgeon chooses a method for replacing bone defects based on their own preferences and such criteria as the equipment of the operating room, the surgical team experience, the quality of the patient’s bone and the defect size.

Correction to the article: Traumatology and Orthopedics of Russia. 2021;27(2):132-143. https://doi.org/10.21823/2311-2905-2021-27-2-132-143

This publication is the official report describing all total hip arthroplasty procedures registered in the database from 01.01.2007 to 31.12.2020. During this period, 74762 operations were performed: 67019 (89.64%) primary and 7743 (10.36%) revision. The proportion of males and females underwent primary arthroplasty was 41.1% and 59.0%, respectively. The age of patients with primary arthroplasty was 57.8 years (95% CI from 57.7 to 57.9), with revision — 59.3 years (95% CI from 59.0 to 59.6). The absolute number of primary hip arthroplasty procedures added into the database increased annually from 2007 to 2012. Since 2015, there has been a trend towards a decrease in the number of hip arthroplasty, due to the more intensive growth in the number of knee replacements performed. The number of revision hip arthroplasty operations varies from year to year with a clear tendency to increase, except 2020. The large proportion of revisions are accounted for by “early” revisions performed in the first years after primary hip arthroplasty, as well as “early” re-revisions. The main types of implants fixation on primary arthroplasty during the reporting period were cementless (50.89%) and hybrid (32.33%). In patients of older age groups, there is a significant decrease in the proportion of cementless fixation, while the proportion of hybrid, reverse hybrid and cemented structures is increasing. There are significant fluctuations in the ratio of different types of implants fixation in different years.