Vol 20, No 3 (2014)

ORIGINAL ARTICLES

EFFICIENCY OF THE FIRST STAGE OF TWO-STAGED REVISION SURGERY IN PATIENTS WITH PERIPROSTHETIC HIP INFECTION

Lyu B., Tikhilov R.M., Shubnyakov I.I., Razorenov V.L., Denisov A.O., Bozhkova S.A., Artyukh V.A., Klitsenko O.A., Totoev Z.A.

Abstract

Objective - to evaluate the effectiveness of the first phase of a two-stage method of surgical treatment of periprosthetic infection and to identify possible factors influencing the outcomes. Material and methods. The analysis of results of treatment of 217 patients with infection operated in 2008-2012. The mean age was 56.1 years (95% CI 48.3 to 67.4). All patients underwent surgery with removal of hip endoprosthesis and installation block or articulating spacers at different times after the primary (77%) or revision (23%) arthroplasty. Results. Relapse of infection was detected in 78 cases (35.9%). In 139 (64.1%) patients remission of infection was observed, which allowed an average of 10.2 weeks (95% CI 7.87 to 14.3) perform a full-fledged replacement for a spacer prosthesis. Relapse of infection was detected in 78 (35.9%) cases. Conclusion. The main risk factors leading to a recurrence of the infection are the combination and type of microorganism, laboratory parameters, weight of the patient and the type of previous surgery.
Traumatology and Orthopedics of Russia. 2014;20(3):5-14
pages 5-14 views

IMPLANT-ASSOCIATED PATHOLOGY: AN ALGORITHM FOR IDENTIFYING PARTICLES IN HISTOPATHOLOGIC SYNOVIALIS/SLIM DIAGNOSTICS

Krenn V., Thomas P., Thomsen M., Usbeck S., Scheuber L., Boettner F., Rüther W., Hopf F., Müller S., Krukemeyer M.G., Gehrke T., Kendoff D., Tiemann A., Huber M.

Abstract

In histopathologic SLIM diagnostic (synovial-like interface membrane, SLIM) apart from diagnosing periprosthetic infection particle identification has an important role to play. The differences in particle pathogenesis and variability of materials in endoprosthetics explain the particle heterogeneity that hampers the diagnostic identification of particles. For this reason, a histopathological particle algorithm has been developed. With minimal methodical complexity this histopathological particle algorithm offers a guide to prosthesis material-particle identification. Light microscopic-morphological as well as enzyme-histochemical characteristics and polarization-optical proporties have set and particles are defined by size (microparticles, macroparticles and supra- macroparticles) and definitely characterized in accordance with a dichotomous principle. Based on these criteria, identification and validation of the particles was carried out in 120 joint endoprosthesis pathological cases. A histopathological particle score (HPS) is proposed that summarizes the most important information for the orthopedist, material scientist and histopathologist concerning particle identification in the SLIM.
Traumatology and Orthopedics of Russia. 2014;20(3):15-27
pages 15-27 views

BIORESORBABLE MATERIALS FOR BONE DEFECTS SUBSTITUTION IN PATIENTS WITH OSTEONECROSIS OF THE FEMORAL HEAD

Konev V.A., Tikhilov R.M., Shubnyakov I.I., Myasoedov A.A., Denisov A.O.

Abstract

Osteonecrosis of the femoral head is one of the serious diseases of the hip. The outcome of the disease is the development of osteoarthritis of the hip in patients of working age. Today, one of the most popular surgical procedures in the early stages of the disease remains a core decompression. The purpose of the study was to understand the efficacy and safety of core decompression and filling bone defect bioresorbable materials. Material and methods. From 2006 to 2014 in Vreden Russian Research Institute for Traumotology and Orthopedics 62 patients (79 hips) with different stages of osteonecrosis of the femoral head were treated. In all patients the classical decompression chamber of femoral head osteonecrosis was performed. In 36 patients (48 hips) the decompression was done with no additional processing the chamber, in 25 patients (31 joints) after decompression the treatment of osteonecrosis zone to the healthy bone was performed. In 56 cases the bioresorbable granular material based on calcium sulfate was used for filling the defect, in 6 cases - β-3 calcium phosphate, in 17 cases - the bioresorbable material based on the combination of calcium sulfate and 3 ß-calcium phosphate. Results. In the mean follow-up of 26.9 (6 to 62) months, the overall survival rate was 54.4%. In patients with the second stage of the disease the arthroplasty was performed only in 17.6% of cases, while in patients with the fourth stage - in 100%. In the third stage of osteonecrosis a strong correlation of survival with the necrosis volume was observed. Conclusion. The success of surgical interventions directly depended on the stage of the process, volume and fullness of osteonecrosis zone, as well as on the type of bioresorbable material and fullness of bone defect filling.
Traumatology and Orthopedics of Russia. 2014;20(3):28-38
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RECONSTRUCTION OF SOFT TISSUE OF HAND USING ISLAND AND PERFORATOR FLAPS

Mel'nikov V.S., Korshunov V.F., Romanov S.Y., Magnitskaya N.E.

Abstract

Objective: to determine the capabilities and perspectives of island and perforator flaps for soft tissue reconstruction of the hand. Material and methods. Results of treatment of 41 patients with defects of the soft tissue of the hand, treated at the in the period from 2010 to 2013 and operated using the island flaps and perforator flaps (DAP flap). Results and conclusion. In all cases the authors have received positive functional and cosmetic results, which were evaluated using a questionnaire DASH, the average score was 12.3. Digital artery perforator flaps allow close defect covering tissue any surface fingers. The use of perforator flaps allows reconstructing soft tissue defect with the skin of the same anatomical region as identical morphologically lost. The second important advantage is that the DAP flap is not included in the magisterial arteries, allows its use as a recipient for subsequent microsurgical reconstructions.
Traumatology and Orthopedics of Russia. 2014;20(3):39-43
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EFFICACY OF BILATERAL SIMULTANEOUS HALLUX VALGUS CORRECTION COMPARED TO UNILATERAL

Boychenko A.V., Solomin L.N., Parfeyev S.G., Obukhov I.E., Belokrylova M.S., Pashukova T.A.

Abstract

The aim - to compare the results of simultaneous bilateral and unilateral surgical correction of hallux valgus and to create recommendations for treatment of the patients with this pathology. Material and methods. The authorse analyzed the data of 40 patients (60 feet) who carried out an operative treatment of hallux valgus in SPb multiprofile city hospital N 2 since 2011 to 2013. Functional (AOFAS score) and X-ray results were compared between groups with bilateral and unilateral correction. Mean AOFAS score in these 2 groups after 12 months after surgery was 85,6±6,2 and 85,5±6,9 (p>0,05), mean intermetatarsal angle - 8,4±0,5° and 8,8±0,8° (p>0,05) respectively. No statistically significant difference between these two groups was found. Conclusion. A bigger surgical trauma in case of simultaneous bilateral correction neither worsens functional and x-ray results nor increases a complication rate.
Traumatology and Orthopedics of Russia. 2014;20(3):44-51
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AUTOLOGOUS PLATELET-RICH PLASMA IN THE TREATMENT OF PATIENTS WITH KNEE ARTHRITIS III STAGE

Malanin D.A., Novochadov V.V., Demkin S., Demeshenko M.V., Danilov D.I.

Abstract

The purpose of the study - to determine the effectiveness of using PRP in the treatment of patients with stage III knee arthritis. Material for the study - 81 patients , two clinical groups with unilateral ( 9 patients - 15%) or bilateral ( 51 patients - 85%) with stage III knee arthritis. The first group of patients in an amount of 40 people were treated by introducing into the knee joint of autologous platelet-rich plasma 1 every three weeks. In the comparison group of 41 patients were symptomatic treatment with non-steroidal anti-inflammatory drugs. Evaluation of the results was performed using the LEKEN scale, VAS, verbal evaluation of the effectiveness of pain at 3, 6, 9 weeks after the treatment. Results: satisfactory result has increased to 52.5 %±0.2% of patients in week 9 of the main group. Score VAS and LEKEN scale gives a clear picture to the marked reduction in pain 9 weeks to 4 observation points. Intraarticular injection of PRP in the treatment of patients with stage III can reduce the severity of pain, improve knee function and quality of life for 9 weeks during their preparation for surgical treatment. Adherence to treatment of patients with stage III receiving intraarticular PRP, close to 98%.
Traumatology and Orthopedics of Russia. 2014;20(3):52-59
pages 52-59 views

DYNAMICS OF WIDTH OF PROXIMAL FEMORAL GROWING ZONE IN PATIENTS WITH PERTHES DISEASE AFTER SURGICAL TREATMENT

Teplenky M.P., Parfenov E.M., Bunov V.S.

Abstract

Objective - to study the effect of tunnelization and apparatus hip decompression on the state of proximal femur growing plate. Material and methods. A pattern of changes in proximal femur growing plate of the affected and intact extremities was investigated in 46 children with III degree Perthes disease. The follow-up was 3 years. To unload the affected joint, an external fixator (most often, the Ilizarov apparatus) was placed on pelvic and femoral bones, which was used in a mode of non-articulating arthrodiastasis. The measurements of width of proximal femur growing zone were performed on pelvic bones rentgenograms in anteroposterior projection with internal hip rotation achieved with 1 meter focal length and their subsequent transfer to a digital format. Results. In the study group wire tunneling and apparatus fixation were shown not to result in growing plate locking, providing conditions for recovery of the shape and structure of the femoral head, which was accompanied by a slowdown in its width decrease in the affected extremity and led to the compliance of this parameter between the intact and affected extremities. No correlation was revealed between the degree of structural metaphyseal damage and the state of proximal growing zone.
Traumatology and Orthopedics of Russia. 2014;20(3):60-68
pages 60-68 views

USE OF REPEREN POLYMER MESHES IN SURGICAL TREATMENT OF PECTUS EXCAVATUM

Krupko A.V., Bogos’Yan A.B., Krupko M.S.

Abstract

In patients with the I degree of pectus excavatum a retraction of the sternocostal complex is insignificant and does not influence the functional state of visceral organs. It is the elimination of a cosmetic defect that matters for such patients above all. There are various methods of aesthetic correction, still there is no consensus on how to perform an aesthetic thoracoplasty in patients with pectus excavatum. The purpose of this study was to develop a technique of aesthetic thoracoplasty with the use of Reperen polymer and to evaluate short-term results. Material and methods. From 2011 till 2013, 10 patients underwent thoracoplasty with the use of Reperen polymer meshes. All patients were male. At the time of the surgery their average age was 18.7 years (from 15 to 26 years old). The technique consists in laying molded Reperen mesh plates on the front surface of the sternocostal complex layer by layer. From 3 to 7 layers are formed. Results. The surgeries performed were successful. In all cases the postoperative period was smooth, with no complications observed. A good result accounted for 80% of the cases, a satisfactory result was observed in 20%. We did not observe any negative results. The implants installed were not removed, no excessive contouring was observed. Conclusion. A new technique of aesthetic thoracoplasty with the use of Reperen polymer plates was developed and implemented. It was found that this type of surgery is easily tolerable by patients, gives a good aesthetic result with a low risk of complications, and is characterized by a short hospital and rehabilitation period.
Traumatology and Orthopedics of Russia. 2014;20(3):69-75
pages 69-75 views

TRANSPOSITION OF THE ACETABULUM AFTER TRIPLE PELVIC OSTEOTOMY IN THE TREATMENT OF CHILDREN WITH HIP DYSPLASIA

Kamosko M.M., Baskov V.E., Barsukov D.B., Pozdnikin I.Y., Grigoriev I.V.

Abstract

Purpose - effectiveness assessment of 500 acetabular transpositions after triple pelvic osteotomy in the treatment of children and adolescents with dysplastic hip joint pathology. Materials and methods. Using clinical, radiographic and computed tomography techniques we analyzed long-term results of surgical treatment of 470 patients with impaired stability of the hip of dysplastic genesis aged 4-19 y.o. who underwent 500 acetabular transpositions after triple pelvic osteotomy. Results and conclusions. The use of acetabular transposition after triple pelvic osteotomy in patients with dysplastic hip joint pathology in most cases allows to achieve regression of clinical manifestations and degenerative changes in patients with stage I and II of dysplastic coxarthrosis. Effectiveness largely depends on the initial state of the hip joint.
Traumatology and Orthopedics of Russia. 2014;20(3):76-85
pages 76-85 views

THEORETICAL AND EXPERIMENTAL STUDIES

MODELING OF BONE FRAGMENTS FIXATION WITH AN EXTERNAL FIXATION DEVICE FOR BILATERAL ROTATION UNSTABLE PELVIC INJURIES B TYPE ACCORDING TO AO/ASIF CLASSIFICATION

Vinogradov V.G., Lapshin V.L., Krasovsky A.Y., Angarskaya E.G.

Abstract

Objective: to determine the stability of bone fragments fixation with an external fixation device in the simulation of bilateral partly unstable pelvic injuries of B type according to AO/ASIF classification and to identify the role of different fixation elements in the stability of fixation. Material and methods: the study was performed on the finite element model of a system “an external fixation device - pelvis” developed for a software package MSCNastran. Formation of a fracture of pubic and ischial pelvic bones was accomplished by means of rupture in the finite element network and decrease of elasticity modulus in the ilio-sacral joint on both sides up to 35 mm at the site of a fracture. Loads were carried on top of the body of the first sacral vertebra with a force of 500H.The second area of application of the load was from the bottom-up on the acetabular roof with a force of 250H. In this study the effect of different elements of an external fixation device on the stiffness of bone fragments fixation was evaluated. Symmetrical elements were removed both separately and together. As a result, the stiffness of a system decreased and the displacement at the fracture site increased. Conclusion: in a model of partly stable pelvic injuries accompanied by general rotation instability in the horizontal and sagittal planes to 35 mm, an external fixation device provided high stability of bone fragments (to 3 mm) due to introduction of bone rods in the iliac wings with the obligatory introduction of the rod in the vertical branches of pubic bones and strengthening the anterior lower bar between the subsystems. What is more, installing the anterior upper bar or introduction of bone rods in the bodies of iliac bone are not necessary.

Traumatology and Orthopedics of Russia. 2014;20(3):86-92
pages 86-92 views

RESEARCH METHODS

WHAT RESULTS IN TENDON AND MUSCLE TISSUES OF THE ROTATOR CUFF FROM FULL-THICKNESS TEARS: DATA OF MRI, ARTHROSCOPY AND HISTOLOGY

Dokolin S.Y., Kuz'muna V.I., Rumakin V.P., Ovcharenko A.B.

Abstract

Full-thickness rotator cuff tears - is abundant injury which leads to the expressed pain syndrome and functional violation of the top extremity. At making decision about necessary of surgery, MRI is the important source of information about the injury The purpose: to determine the qualitative and quantitative indicators of degenerative-dystrophic changes in muscular and tendinous parts of the rotator cuff. based on a combined MRI, arthroscopic and histological diagnostics of full-thickness rupture of shoulder cuff Methods: We have examined 28 patients with full-thickness rotator cuff tears. MRI of damaged joint to all patients before an operation was performed. Thereafter an arthroscopy was performed and intraoperative biopsy of the muscular and tendinous parts of the rotator cuff, with following histological examination. Results: It was found that at small full-thickness rotator cuff tears the intensity of degenerative changes in muscular and tendinous tissue was lower, so these tears are the most promising for all kinds of treatment. At medium and big tears intensity of degenerative changes in the tissues begins to prevail over productive inflammation and it limits to the ability of conservative treatment and increases the risk of unsuccessful outcomes of arthroscopic reconstruction. Conclusions: In this regard, it is necessary to search biological decisions, which complement the stage of arthroscopic reconstruction of the rotator cuff.
Traumatology and Orthopedics of Russia. 2014;20(3):93-103
pages 93-103 views

PCR IN TRAUMATOLOGY AND ORTHOPAEDICS: METHOD DESCRIPTION AND APPLICABILITY

Polyakova E.M., Bozhkova S.A.

Abstract

Review brief presents description of polymerase chain reaction method (PCR) and its most common variants. Three PCR-based lines of research, carried out in the traumatology and orthopaedics, include identifying a causative agents of the implant-associated infection after orthopaedic surgery; detection of antibiotic resistance genes and biofilm forming genes. It was shown that PCR can be used as additional method for detection of genetic disorders, significant for traumatology and orthopaedics, and for investigation of cartilage and bone regeneration.
Traumatology and Orthopedics of Russia. 2014;20(3):104-114
pages 104-114 views

EXPERIENCE EXCHANGE

EXPERIENCE OF THE LATARJET PROCEDURE FOR RECURRENT ANTERIOR SHOULDER DISLOCATION TREATMENT

Belyak E.A., Kubashev A.A., Lazko F.L., Lomtatidze E.S., Abdulkhabirov M.A., Ptitsyn K.A., Prizov A.P.

Abstract

We have the experience of open Latarjet procedures which were perfomed to 18 patients since 2011 to 2014 in the orthopaedic department Moscow city hospital № 12, among them 14 male (77,8%) and 4 female (22,2%) with anterior shoulder instability. Mean age of the group was 24,3 years. The mean follow-up was 16±4 months (from 6 to 26 months). Mean range of motion increased after 1 year post-op: flexion 178°±2° (from 170° to 180, increased at 2.4°). There was no post-op recurrent dislocation. The patients felt no subluxation or disturbance in operated shoulder. For functional scores, WOSI pre-op was 49,8, one year post-op decreased to 30,3. DASH-score pre-op was 16,5, post-op - 5,2. The results were defined as excellent in 12 patients, good in 6 patients, we had no bad or moderate results. All patients returned to normal life and sport activity.

Traumatology and Orthopedics of Russia. 2014;20(3):115-121
pages 115-121 views

THE METHOD FOR TREATMENT OF EARLY STAGE PERTHES DISEASE (PRELIMINARY REPORT)

Akhtyamov I.F., Lobashov V.V., Anisimov O.G.

Abstract

The method of conservative treatment of Perthes disease in the early stages, before the end of the stage of fragmentation is described. The method consists in carrying out prolonged epidural analgesia by administering through an epidural catheter in a segmental innervation zone of the femoral head with local anesthetic dosage rate for 6-10 days. As a result of drug sympathectomy vasodilation and decreased tone of the vascular wall occur, that leading to improved microcirculation in the hip joint. The using this method in 7 patients showed that it allows to stop pain and restore functionality in patients immediately after the end of treatment.

Traumatology and Orthopedics of Russia. 2014;20(3):122-127
pages 122-127 views

REVIEWS

PATELLAR RESURFACING OF TOTAL KNEE ARTHROPLASTY: ANALYTICAL REVIEW

Kavalersky G.M., Sereda A.P., Lychagin A.V., Smetanin S.M.

Abstract

Patellar resurfacing is one of the unsolved problems of knee arthroplasty due to the high frequency of patella-femoral complications. In the present analytical review the authors traced the evolution of patellar resurfacing, analyzed the literature on the etiology of anterior knee pain and patellar biomechanics, discussed the indications for replacement or preservation the patella.
Traumatology and Orthopedics of Russia. 2014;20(3):128-141
pages 128-141 views

PATIENTS WITH SUSPECTED METAL IMPLANT ALLERGY: POTENTIAL CLINICAL PICTURES AND ALLERGOLOGICAL DIAGNOSTIC APPROACH (REVIEW)

Thomas P., Thomsen M., Krenn V., Summer B.

Abstract

The focus of this review are allergic complications following insertion of metallic orthopedic implants. Such potential allergic reactions encompass eczema, impaired wound and fracture healing, infection-mimicking reactions, effusions, pain and loosening. Nickel, cobalt and chromium seem to be the predominant eliciting allergens. Allergy might be considered prior to planned orthopaedic surgery or in patients with complications following arthroplasty We recommend, that differential diagnoses - in particular infection -should always be excluded in cooperation with surgery collegues. The clinical work up of a patient suspected of suffering from metal implant allergy should include a combined evaluation of medical history, clinical findings, patch testing and histology In vitro testing, namely the lymphocyte transformation test (LTT), can indicate metal sensitization, but needs careful interpretation.
Traumatology and Orthopedics of Russia. 2014;20(3):142-146
pages 142-146 views

COMPLEX REGIONAL PAIN SYNDROME

Koryachkin V.A.

Abstract

The review shows the evolution of understanding of the complex regional pain syndrome and its history. Presents modern views on the etiology and pathogenesis of the disease. Presents diagnostic and clinical aspects of this pathological condition. Describes modern methods of treatment.

Traumatology and Orthopedics of Russia. 2014;20(3):147-156
pages 147-156 views

JUBILEE

Vagram V. Agadzhanyan

Abstract

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Traumatology and Orthopedics of Russia. 2014;20(3):157-158
pages 157-158 views

Sabyrbek A. Dzhumabekov

Abstract

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Traumatology and Orthopedics of Russia. 2014;20(3):159-160
pages 159-160 views

Authors Guidelines

Abstract

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Traumatology and Orthopedics of Russia. 2014;20(3):161-162
pages 161-162 views

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