Vol 27, No 4 (2021)


Features and Results of Knee Arthroplasty after Knee Fractures Fixation

Rasulov M.S., Kulyaba T.A., Kornilov N.N., Saraev A.V., Petukhov A.I., Bantser S.A., Petlenko I.S.


The purpose of the study — to assess the results and risk of complications of primary total knee arthroplasty in patients with a history of osteosynthesis of intra-articular fractures.

Methods: Our study integrates the retrospective and prospective analysis of the results of primary total knee arthroplasty (TKA) performed in 140 patients, in period from 2015 to 2019. The retrospective part of the study included the arthroplasty results of 100 patients, prospective — 40 patients. Each of the groups was divided into 2 subgroups: with previous osteosynthesis (OS) of intra-articular fractures before arthroplasty and without history of knee surgery before arthroplasty. To assess the results of TKA, adapted to Russian-language versions of the KSS, WOMAC and FJS-12 scales were used. The X-ray of the endoprosthesis components positioning was assessed using the KRESS scale.

Results: Statistically significant differences were found between retrospective groups with OS and without it in the duration of the surgery, in the volume of intraoperative blood loss, in the higher frequency for implantation of the endoprosthesis systems with an increased degree of coupling of the components. The rate of postoperative complications was higher in retrospective group OS. Mid-term functional results did not show statistically significant differences on the KSS and WOMAC scales, patient satisfaction rates on the FJS-12 scale were worse in retrospective group OS. Prospective group of patients with a history of OS for intraarticular fractures demonstrated statistically significant increase of the knee ROM from 89° to 108°, after the TKA. The function recovery dynamics according to the KSS, WOMAC and FJS-12 was slowed down at 3 and 6 months, and according to the WOMAC and FJS-12 scales, even after 12 months post-operation.

Conclusions: The previous trauma and knee intra-articular fractures fixation leads to an earlier development of post-traumatic osteoarthritis. Functional results in the retrospective and prospective groups do not have statistically significant differences. The number of postoperative complications is greater in the retrospective groups. OS in the history statistically significantly slows down the dynamics of function recovery in the early postoperative period.

Traumatology and Orthopedics of Russia. 2021;27(4):9-20
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Mid-Term Results of Total Hip Arthroplasty for Femoral Neck Nonunions in Long-Term Hemodialysis Patients

Tsed A.N., Mushtin N.E., Dulaev A.K., Schmeljew A.V.


Background: Performing primary arthroplasty in patient with renal osteodystrophy is associated with a number of difficulties due to low bone mineral density, which complicates the fixation of the endoprosthesis components, the presence of bone defects, and functional insufficiency of the gluteal muscles.

The aim of the study — evaluation of the mid-term results of primary total hip arthroplasty using cemented femoral and acetabular implants in hemodialysis patients with nonunions of the femoral neck.

Methods: The authors conducted a study of 26 hemodialysis patients with pseudarthrosis of the femoral neck. The patients were divided into 3 groups: group I (12 patients) — classification type A of the femoral neck nonunion, group II (10 patients) — classification type B, group III (4 patients) — of type C who underwent total hip arthroplasty.

Results: The longest surgery duration was observed in patients of the III study group — 121.25±19.26 minutes. There were no statistically significant differences between the patients of the II and III study groups. The smallest rate of intraoperative blood loss was noted among patients of the 1st study group — 440.83±133.65 ml, the statistical significance of the differences was obtained both between the 1st and II, and between the I and III study groups, respectively. The smallest total number of complications after surgery was obtained in the 1st group — 4 (8.33%). Revisions were performed in 8 (30.7%) patients among all three groups. There was a significant improvement on the Oxford hip score after 12 months (mean 29.8) and 24 months (mean 33.1) in all groups compared with preoperative results (mean 12.5). Twelve 12 months after surgery, the average value of the pain severity was reduced by 72.6% and amounted to 2.01. The risk of getting any orthopedic complication in cemented total hip arthroplasty of the classification type A of the pseudarthrosis is 2.5, with type B — 3.4, with type C — 5.7.

Conclusions: The classification of femoral neck nonunions in hemodialysis patients allows to determine the tactics of surgical treatment. Cemented dual mobility cups are effective in patients with any type of femoral neck nonunions.

Traumatology and Orthopedics of Russia. 2021;27(4):21-30
pages 21-30 views

Functional and Radiographic Outcomes for Distal Radius Fractures Treated with Volar-Locked Plates and Percutaneous K-Wires: A Comparative Study

Egiazaryan K.A., Maximov B.I., Askerov A.A., Vedernikov N.N., Matvienko M.I.


Purpose — to evaluate and to compare radiological and functional outcomes of the volar locking plate fixation using pronator-sparing approach and K-wire fixation of distal radius fractures. Materials and Methods. We retrospectively analyzed 41 patients with distal radius fractures (27 female and 14 male) treated in the period from 2016 to 2020 using minimally invasive osteosynthesis via pronator-sparing approach. The mean age was 51 years (31-74 years). The control group consists of 37 patients (19 female and 18 male, mean age — 61 years (29-76 years)), who underwent minimally invasive percutaneous K-wire fixation of distal radius fractures during the same period of time. Comparative analysis of radiographic and functional outcomes in both groups of minimally invasive osteosynthesis of distal radius fractures was carried out in the period from 1 to 6 months after the surgery. Results. Primary union of distal radius fractures was confirmed in X-rays in all patients within 6 weeks after the surgery. There were no complications in patients treated by pronator-sparing volar locking plate fixation, whereas in K-wire group we had 6 patients with complications: 4 cases (11%) — superficial infection around K-wires and 2 cases (5,4%) — intraoperative damage of sensitive branch of radial nerve. There were statistically significant differences in radiographic results (volar tilt, radial inclination, and radial height) between two groups: they all were better in patients treated by pronator-sparing volar locking plate fixation during the whole follow-up period (р<0,01). Minimally invasive volar locking plate fixation via pronator-sparing approach also provided significantly better grip strength and range of wrist motion and forearm rotation in the early 6-month postoperative period, compared with percutaneous K-wire fixation (р<0,001). Conclusion. Our study demonstrates that both techniques of minimally invasive osteosynthesis of distal radius fractures are effective and relatively safe methods of surgical treatment, but volar plating via pronator-sparing approach leads to a better reconstruction of the distal radius and better functional outcomes compared to percutaneous K-wiring.

Traumatology and Orthopedics of Russia. 2021;27(4):31-41
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Classification of Proximal Tibial Fractures and Algorithm of Intramedullary Nailing: Efficacy Evaluation

Semenistyy A.A., Litvina E.A., Mironov A.N.


Background: Intramedullary nailing of proximal tibial fractures is challenging due to difficulties with fracture reduction and achievement of stable fixation. Preoperative planning based on proximal fragment length, fracture pattern and bone quality evaluation is a prerequisite for a successful operation. However, there is no classification that could adequately access these factors and guide us towards the most effective methods of fracture reduction and fixation with intramedullary nail.

The purpose of this study was to evaluate a classification of extra-articular proximal tibial fractures and algorithm for intramedullary nailing in clinical conditions.

Methods: We compared the treatment outcomes before (Group 1) and after (Group 2) the introduction of the new PFL-TN classification algorithm of intramedullary nailing of proxamal tibial fractures. The group 1 included 43 patients from 18 to 71 years old (males — 28; females — 15; average age — 44.5±2.0 years). The group 2 included 42 patients from 18 to 72 years old (males — 30; females — 12; average age — 46.1±2.0 years). The data analysis was carried out after a minimum follow-up period of 12 months. The results were analyzed by the following criteria: reduction quality assesed with reduction quality scale, number of complications, quality of life with SF-36 questionnaire and leg function with LEFS scale.

Results: The introduction of the proposed algorithm allowed to reduce the number of late complications by more than 5 times, and the number of required additional surgical interventions by more than 4 times compared to with a control group. The introduction of the proposed algorithm made it possible to improve the functional outcomes 1 year after surgery from 83.58 to 93.29% (p = 0.00002) by the LEFS scale, and the patients’ quality of life from the 77.50±1.88 to 86.71±2.03 points (p = 0.00072) and from the 81.25±1.88 to 86.84±2.26 points (p = 0.00116) by the physical and role functioning scales SF-36 questionnaire.

Conclusions: The proposed algorithm, based on the new classification, allows to optimize the surgical technique of intramedullary nailing of proximal tibial fractures.

Traumatology and Orthopedics of Russia. 2021;27(4):42-52
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Effect of Prehospital Pause on the Outcomes of Emergency Decompression and Stabilization Procedures in Patients with Tumor and Infectious Spine Diseases

Mushkin M.A., Dulaev A.K., Alikov Z.Y., Mushkin A.Y.


Purpose — to assess the relationship between duration of pathological symptoms developed due to tumor or infectious destruction of the spine, and the medium-term outcomes of urgent surgeries.

Methods: 84 patients with tumor (group 1, n = 43) and infectious (group 2, n = 41) lesions of the spine underwent decompression and stabilization procedures according to urgent indications in the period from 2016 to 2018. Neurological status (Frankel scale), pain intensity (VAS) and functional independence of patients (Karnofsky scale) were assessed before surgery, 3 months and 1 year after. Statistical relationship between outcomes and duration of the prehospital and hospital delay has been studied.

Results: 23 patients in each group had neurological deficit (53.5% and 56.1%), while the average duration of the prehospital period in those patients in both groups (Me) was 14.0 days. 11 out of 84 patients (13.1%), were hospitalized in the first 72 hours from the onset of vertebral syndrome; 6 (7.1%) of them had neurological disorders. An inverse correlation of high strength between the duration of neurological deterioration and the possibility of their improvement by 3 months after surgery was revealed in both groups (rs1 = -0.793 and rs2 = -0.828; p<0.001) and there was no relationship between outcomes and the duration of the hospital period (surgery urgency) (rs1 = -0.257; p = 0.283 and rs2 = -0.218; p = 0.330). The possibility of neurological improvement after surgery ceases to be statistically significant after 14 days from the onset of pathological symptoms (p1 = 0.083, p2 = 0.157 for both groups, respectively), while the likelihood of a decrease in pain syndrome and functional dependence on others remains independent of the duration of the prehospital period.

Conclusions: In case of tumor or infectious spine lesions, urgent decompression and stabilization procedures reduce pain and improve the functional independence regardless of the duration of the prehospital period, while extension of prehospital period of more than 2 weeks is crucial for a reliable prognosis of neurological status improvement.

Traumatology and Orthopedics of Russia. 2021;27(4):53-64
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Editorial Comment on the Article by Mushkin M.A. et al. “Effect of Prehospital Pause on the Outcomes of Emergency Decompression and Stabilization Procedures in Patients with Tumor and Infectious Spine Diseases”

Ptashnikov D.A.


The editorial comment evaluates the current state of issue of medical care at urgent states caused by pathological vertebral fractures and spinal cord compression in patients with spine destructive diseases. The rare occurrence of pathology and the deficiency of objective data determine the lack of consensus on the medical care for this category of patients. The article by M.A. Mushkin et al helps to understand how the prehospital pause affects the outcomes of emergency decompression and stabilization procedures in patients with tumor and infectious diseases of the spine, as well as to determine how much time the surgeon has at his disposal. The author of the comment believes that close cooperation of orthopedic surgeons, neurosurgeons, oncologists is necessary to solve this problem. Even despite the absence of oncologists in the staff of emergency hospitals, telemedicine allows to receive methodological support in a timely manner for making a correct decision for each patient. Interaction between clinicians, radiologists and pathologists is equally important. An important aspect is continuity in patient care. An urgently performed spinal cord decompression is only a stage of the complex treatment. Such patients should be provided with accurate routing depending on the diagnosis and the treatment early outcome.

Traumatology and Orthopedics of Russia. 2021;27(4):65-68
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Intraosseous Injection of Autologous Bone Marrow Aspirate Concentrate and Platelet-Rich Plasma for Treatment of Knee Osteoarthritis

Malanin D.A., Sikilinda V.D., Gorbatenko A.I., Demeshchenko M.V., Suchilin I.A., Kondrashenko V.V., Kostyanaya N. .


The aim of the study was to determine the effectiveness of autologous bone marrow aspirate concentrate (BMAC) and platelet-rich plasma (PRP) intraosseous injection in the treatment of patients with knee OA stages II-III.

Methods: The multicenter randomized study involved 40 patients (27 women, 13 men, average age 67.0±7.8 years, BMI 32.7±4.8, duration of disease 17.3±3.7 months) with knee OA of stages II-III according to the Kellgren-Lawrence (K-L) classification. Patients of the main (BMAC group) group (n=19) underwent a single intraosseous injection of BMAC, in the comparison group (n = 21) – a PRP injection (PRP group). The results were evaluated after 1, 3, 6, 12 months with the verbal rating scale (VRS), VAS, Leken and WOMAC scales.

Results: Comparison of the results in the groups on the VRS showed that at an earlier time (3 and 6 months), the preferences of patients were in favor of the treatment of BMAC (65% and 55% positive reviews) before PRP (55% and 45% positive reviews), whereas after 12 months the differences were insignificant. Analysis of VAS indicators in patients of both groups indicated a more pronounced decrease in the severity of pain syndrome after BMAC intraosseous injection. The analysis of the Leken scale indicators showed in favor of BMAC throughout the entire observation period, the differences were most pronounced in the first 3 months of observation. The ratio of the values of the WOMAC index in both patients groups indicated statistically significant differences that persisted in all periods of follow-up, the increase in indicators occurred to a lesser extent after the introduction of BMAC compared with PRP.

Conclusions: A single intraosseous BMAC injection has an advantage over a similar PRP injection in terms of pain, knee function and physical activity of patients at all follow-up periods. Both methods of treatment are equally safe.

Traumatology and Orthopedics of Russia. 2021;27(4):69-81
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Histological and Morphometric Changes in the Femoral Nerve During Lateral Interbody Fusion of the Lumbar Spine: Experimental Study

Varsegova T.N., Diuriagina O.V., Antonov N.I., Ryabykh S.O.


Background. Neuropathies of the lumbar plexus trunks, in particular those of the femoral nerve, are the most common complications of lateral interbody fusion of the lumbar spine. Modeling of this surgical intervention in normal animals experimentally makes it possible to assess the degree of its trauma to the nervous structures, and to understand what is the reason for the persistence or aggravation of neurological symptoms — iatrogenic injuries or the existing pathology progression. Purpose — to study histological and morphometric changes in the femoral nerve in the long-term periods after the lateral interbody fusion modeling of the canine lumbar spine. Study design — an experimental prospective continuous uncontrolled study. Materials and Methods. Discectomy via lateral approach was performed in 18 mongrel dogs (aged 2-3 years, mass 13.2-17.6 kg) at the level of L4-5 и L5-6, interbody titanium implants were mounted, the lumbar spine was stabilized with a wire device for external fixation within 30 days. Clinical and neurological evaluation was performed, as well as histological investigation of the femoral nerves from the side of surgical approach. Results. In the early postoperative period a temporary decrease in the femoral nerve function was observed, which was manifested by the disorder of the support function and muscle weakness of the pelvic limbs, decrease in the knee reflex, the foot support shift to the metatarsal pad. Later, until the end of the study (18 months), the general condition of all animals was satisfactory, there were no disorders of the limb support function and motor reflexes. After six months, in the femoral nerve there was 4-fold decrease in the proportion of large fast-conducting myelin fibers D>10 μm and 3-fold increase in that of the small ones. The mean axon diameter and myelin thickness were 62% and 53% of the norm. After 12-18 months, the dimensional characteristics of myelin fibers were restored. During the entire experiment, 4-6% of myelin fibers were reactively and destructively altered. Conclusions. The modeling of the lateral interbody fusion of the lumbar spine in normal animals experimentally demonstrated the absence of neurological symptoms after 6-18 months, which indicated low invasiveness of the surgical intervention. Nevertheless, the subclinical reactive and destructive changes in the myelin fibers of the femoral nerve revealed 6 months after the surgery indicated the need for preventive anti-neurotic therapy.

Traumatology and Orthopedics of Russia. 2021;27(4):82-92
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A New Method of Intraoperative Reposition and Holding of Bone Fragments with Ty-Raps

Ivanov P.A., Kasatskiy A.V., Zadneprovskiy N.N., Nevedrov A.V.


Background. The quality of fractures reposition in open osteosynthesis is one of the important factors determining the outcome of treatment. Often, the reposition and fixation of bone fragments is not an easy task. The authors propose a method of reposition and temporary fixation of fragments using plastic ty-raps used in electrical work. The aim of the study is to demonstrate the possibilities of new method of intraoperative reposition and fixation of bone fragments using plastic ty-raps. Materials and Methods. Ty-raps were sterilized before the surgery in the modes intended for the preparation of polymer products. After the fragments were dissected, their reposition and fixation are carried out with the help of clamps and bone clamps. At this stage, there is a need for the use of ty-raps, since the bone clamps prevent the plate from laying on the bone. To do this, 3-4 plastic ty-raps were applied to the areas of bone free from bone clamps in the area of the fragments contact. In those places where an intact periosteum and muscles are attached to the fragment, narrow transverse channels in soft tissues are formed with the instrument to wrap the bone with a ty-rap. Then the free end of the ty-rap is passed through its lock and tightened as much as possible. After tightening all the ty-raps, the bone clamps are removed. The applied ty-raps reliably keep the bone fragments from any displacement, even when the segment rotates. A bone plate is placed on the bone surface with tightened ty-raps. Then the plate fixed to the bone with screws. The plate should be placed on the bone without strong pressing, which allows you to remove the ty-raps from under the plate at any stage of osteosynthesis. The ty-raps are removed by cutting them with a scalpel or snacking with wire cutter, then the plate is fixed to the bone with the remaining screws. Conclusion. Ty-raps have many positive properties: they are affordable, cheap, do not lose their mechanical properties after sterilization, allow you to securely hold bone fragments during reposition, X-ray negative. The method has demonstrated convenience and reliability.

Traumatology and Orthopedics of Russia. 2021;27(4):93-98
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Editorial Comment on the Article by P.A. Ivanov et al. “A New Method of Intraoperative Reposition and Holding of Bone Fragments with Ty-Raps”

Sereda A.P.


In the editorial comment on the article «A New Method of Intraoperative Reposition and Holding of Bone Fragments with Ty-Raps» the advantages and disadvantages of the author’s method are discussed. The advantages include availability, low cost, convenience and reliability. At the same time, it may lead to excessive devascularization of bone fragments with the risk of delayed union or even non-union. Only a comparative study on a large number of patients can confirm or refute these concerns. The comment also contains a brief review of articles on this issue.

Traumatology and Orthopedics of Russia. 2021;27(4):99-101
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Case Reports

Spinal Hydatid Disease of Cervico-Thoracic in Pregnant Women: A Case Report and Review

Naumov D.G., Vishnevskiy A.A., Tkach S.G., Avetisyan A.O.


Background: Spinal hydatid disease is an extremely rare pathology that could leads to the serious orthopedics and neurological complications. Conservative antimicrobial therapy is not effective for spinal echinococcus. This case is unique for the next reasons: disease manifestation during pregnancy, a long period from a spine decompression to a reconstruction procedure and a technique of the surgery.

Case: A 27 year-old lady at 34 gestation weeks, previously operated on the urgent indications of paraplegia with neurogenic bladder dysfunction after 1 year and 10 months follow-up suffered vertebral column reconstruction due to recurrence of the cervico-thoracic hydatid disease, complicated by angular kyphosis. The echinococcus cyst had a closed contact with a right brachiocephalica vein, compressed the spinal canal and leads to three-column spine instability.

Conclusions: Three-column spine reconstruction with anterior corpectomy, cystectomy and fusion provide resolution of the back pain syndrome, improve neurological status and achieve local control of the infectious process in patients with echinococcosis of the spine. In the postoperative period, staged therapy with antiparasitic drugs should be prescribe.

Traumatology and Orthopedics of Russia. 2021;27(4):102-110
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Total Talar Replacement with Ceramic Implant in Combination with Tibial Component of Ankle Endoprosthesis: A Case Report

Kuznetsov V.V., Gudi S.M., Skuratova L.K., Pakhomov I.A.


Background: Surgical treatment of patients with talus posttraumatic aseptic necrosis and its consequences usually includes tibiotalocalcaneal arthrodesis with various foot joints according to additional indications. This type of surgical treatment has number of significant disadvantages: traumatic surgical technique, permanent loss of movement in functionally significant joints, high risk of non-union, high frequency of residual deformities, the need for long periods of limb immobilization. The question arises: how to overcome the existing disadvantages and improve the results of talus posttraumatic aseptic necrosis treatment? A potential solution to this problem is the total talus endoprosthetics.

Clinical case: A 64-year-old patient came to the clinic complaining of pain and deformity of the right foot and ankle area. After the examination, talus posttraumatic aseptic necrosis was diagnosed. The patient underwent ankle joint arthroplasty using total talus ceramic endoprosthesis in combination with the tibial component of the ankle joint endoprosthesis, a course of rehabilitation treatment was performed.

Results: The VAS and AOFAS scales indicators showed a significant improvement both in the pain decrease (from 75 mm before surgery to 10 mm after), and in the functional state according to AOFAS by 2.2 times (from 36 to 80 points 20 months after surgery). By the last follow-up the patient could take more than 8000 steps a day.

Conclusions^ Considering the good clinical result achieved, the ankle joint arthroplasty using total talus ceramic endoprosthesis in combination with the tibial component of the ankle joint endoprosthesis can be considered a promising method of treatment of this severe pathology.

Traumatology and Orthopedics of Russia. 2021;27(4):111-119
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Osteogenesis Hormonal Regulation: Review

Miromanov A.M., Gusev K.A.


Background. The endocrine system occupies a leading place not only in the regulation of growth and development mechanisms, but also in compensation reactions when the body is exposed to extreme factors. Coordinated hormonal regulation contributes to the correct response of the macroorganism adaptive processes, aimed at restoring and maintaining homeostasis. A cascade of endocrine changes accompanies the processes of both physiological and reparative regeneration of bone tissue at all its stages. The aim of the study was to analyze the currently known mechanisms of hormonal regulation of physiological and reparative bone tissue regeneration. Materials and Methods. The search and analysis of scientific literary sources was carried out in the electronic databases PubMed and eLIBRARY. Search depth — 10 years. Results. The review considers both fundamental aspects and new data on the main histogenetic mechanisms of osteogenesis hormonal regulation. The ways and points of interaction of the endocrine and skeletal systems are highlighted, the main functions of hormones in the participation of bone remodeling in different age periods are determined. Conclusion. In violations of physiological regulation, hormonal imbalance is assigned a key role, while under conditions of reparative osteogenesis, the role of qualitative and dynamic changes in the endocrine system has been studied insufficiently. Hormonal regulation of reparative regeneration to date has no clear assessment criteria and requires further research.

Traumatology and Orthopedics of Russia. 2021;27(4):120-130
pages 120-130 views

Genome-wide Studies of knee Osteoarthritis: Review

Novakov V.B., Novakova O.N., Churnosov M.I.


Background. Knee osteoarthritis (OA) is a multifactorial disease resulting from the interaction of many environmental, epigenetic and genetic risk factors, and the latter account for 40% to 65%. Genetic bases of the knee OA based on genome-wide association study (GWAS) are being actively studied by many scientific teams around the world. At the same time, the results obtained are often contradictory and ambiguous, as for the conducted replicative studies of knee OA. This dictates the need for additional replicative studies in various populations, including populations of Russia. The aim of the study was to analyze genome-wide studies of knee OA and to establish GWAS-significant polymorphic loci associated with OA. Materials and Methods. The search for publications was carried out in the electronic databases PubMed, PubMedCentral, eLIBRARY, in the GWAS catalog for the period from 2008 to the present by the keywords: knee osteoarthritis, GWAS studies, candidate genes. Results. Firstly, for the period from 2008 to 2021, 15 genome-wide studies of knee OA were performed (8 GWAS, 6 meta-analyzes of GWAS data, 1 study — a combination of GWAS and meta-analysis of GWAS data), as a result of which 78 polymorphic loci were found associated with the risk of developing osteoarthritis of the knee joint at p≤5×10-08. Second ly, the vast majority of these loci (62 out of 78 SNPs, 79%) showed GWAS-significant associations with OA in meta-analyzes of GWAS data and only 16 loci (21%) in GWAS studies. Third ly, almost 95% of GWAS-significant loci for knee OA (74 SNPs) were found in samples of Caucasian origin. Fourthly, 21 out of 78 GWAS-significant SNPs are associated with isolated knee OA, and 57 SNPs are associated with knee, hip and hand OA (mixed sample). Fifth, all genome-wide studies of knee OA and meta-analyzes of GWAS data were carried out abroad on samples from various foreign populations, and samples from the Russian Federation were not included in these studies. Sixth, only two GWAS-significant polymorphic loci for OA (rs143384 of the GDF5 gene for knee OA isolated localization and rs3771501 of the TGFA gene for OA of any localization) were replicated at the whole genome level of significance (p≤5×10-08) in two different studies. Conclusion. The main genome-wide studies of knee OA were reviewed and GWAS-significant polymorphisms associated with OA were identified. The obtained materials on GWAS-significant loci can be used both in the selection of polymorphisms in replicative studies of OA in various populations of Russia, and for expanding the understanding of the molecular genetic mechanisms of the disease development.

Traumatology and Orthopedics of Russia. 2021;27(4):131-144
pages 131-144 views


Scapula Dyskinesis

Pilipson Z.Y., Ilʼin D.O., Logvinov A.N., Frolov A.V., Vasiliev I.A., Bessonov D.A., Achkasov E.E., Korolev A.V.


Scapular dyskinesis is any alteration of its static position or kinematics during movements in the shoulder joint. The correct scapula orientation is associated with the tone of the muscles attached to it. The prevalence of scapular dyskinesis is high among patients with subacromial impingement syndrome, partial rotator cuff tears, shoulder joint instability and SLAP injuries. Scapular dyskinesis can be caused by a whole range of factors, including upper cross syndrome and postural adaptations predisposing to it, neurological disorders. However, instrumental diagnosis of scapular dyskinesis is difficult, which makes the use of clinical tests the main method of its detection. In this lecture, the etiology of scapular dyskinesis, classification, diagnostic tests and treatment methods are analyzed in detail. The detection of scapular dyskinesis and its type determination in patients with shoulder joint pathologies allows us to form an optimal rehabilitation therapy protocol, including techniques of myofascial release, passive and active stretching of spasmodic and training of weak muscle groups aimed at correcting postural disorders, pathology of the scapulohumeral rhythm, restoration of the glenohumeral joint normal biomechanics.

Traumatology and Orthopedics of Russia. 2021;27(4):145-154
pages 145-154 views


Instrumental Diagnosis and Preoperative Planning of Hip Arthroscopy in Femoroacetabular Impingement Syndrome: Lecture

Bogopolskiy O.E.


Femoroacetabular impingement syndrome (FAI) is essentially a mechanical conflict that occurs when the acetabulum edge of the pelvic bone interacts with femur head and neck with clinical symptoms. In a basis of this conflict, as a rule, is a single or bilateral anatomical bone defect that causes an irregular shape of the hip joint with congenital or acquired etiology. Radiography, performed in a direct projection and in 45° Dunn position with external rotation of 40°, is traditionally considered as basic tool for the radiological diagnosis of hip joint pathology. It allows to assess the anatomical and morphological structure of joint surfaces and their relationship. Detection of severe hip deformations may require computed tomography (CT). Magnetic resonance imaging (MRI) or magnetic resonance arthrography (MRA) is used to assess the condition of soft tissue structures of hip joint, its damage is often found in patients with FAI. The modern method of treating patients with FAI is hip arthroscopy, the undeniable advantage of which is low traumatic nature of the operation, low level of intraoperative complications and short postoperative rehabilitation period. For its successful implementation, it is necessary to take into account the complexity of performing hip arthroscopy, its duration, the necessity for good technical equipment and a high skill level of the operating surgeon. However, this operation has a number of limitations, which must be taken into account when selecting patients.

Traumatology and Orthopedics of Russia. 2021;27(4):155-168
pages 155-168 views


Comment to the Article by O.A. Kaplunov et al. “Hypotrophic Clavicle Pseudoarthrosis Treatment: A Case Report”

Belenkiy I.G.


In the comment on the article «Treatment of Hypotrophic Nonunion of the Clavicle: A Clinical Case», the reasons for the failure of primary and refixation of the clavicle closed fracture are analyzed in detail. A 70-year-old patient got a fracture of the middle third of the left clavicle diaphysis as a result of a fall. He underwent four surgical treatment options: plate osteosynthesis; plate osteosynthesis + bone autoplasty; plate osteosynthesis + vascularized fibular flap reconstruction; external osteosynthesis. A month after the fourth attempt of surgical treatment, fusion, improvement of the function of the right upper limb and the quality of life of the patient were achieved. Technological inaccuracy, namely, the lack of the fragments fixation stability due to the incorrectly chosen length of the plate, as well as an incomplete assessment of the anamnesis and the identified cognitive — behavioral features of the patient, are considered as possible reasons for the treatment failure. The author of the comment highlights modern approaches to the treatment of clavicle fractures, and also briefly dwells on the theory of fracture fixation in general. He pays special attention to biological and mechanical factors affecting fractures healing. The author considers the compliance with the basic principles of osteosynthesis to be the main factor in achieving good results in fracture treatment.

Traumatology and Orthopedics of Russia. 2021;27(4):169-172
pages 169-172 views


95th Anniversary of the First Russian Society of Orthopedic Surgeons

Khominets V.V., Gladkov R.V.


95 years ago, namely on October 12, 1926, through the efforts of 27 founders, including professors G.I. Turner, A.L. Polenov, R.R. Vreden and G.A. Albrecht, the first scientific society of orthopedic surgeons of Leningrad and the Leningrad region was created in our country, which continues to be an indispensable platform for the training of scientific personnel, the exchange of practical experience and research results directed by authoritative figures of domestic traumatology and orthopedics, the successors of the Leningrad school of orthopedic surgeons. The article summarizes the results of the society’s work during four periods of its activity: the first period of formation (1926–1933), the second period — work in the pre-war, war and post-war years (1934–1950), the third period — the intensive development of traumatology and orthopedics (1950–1990) and the fourth period — the modern rapid development of the specialty (since 1990). The main aim of the current activity and new areas of work are formulated.

Traumatology and Orthopedics of Russia. 2021;27(4):173-179
pages 173-179 views


Nikolay Gavrilovich Fomichev 1941-2021



Traumatology and Orthopedics of Russia. 2021;27(4):180-180
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